Lauren J Green, Rebecca Pullon, Lucy H Mackillop, Stephen Gerry, Jacqueline Birks, Dario Salvi, Shaun Davidson, Lise Loerup, Lionel Tarassenko, Jude Mossop, Clare Edwards, Rupert Gauntlett, Kate Harding, Lucy C Chappell, Marian Knight, Peter J Watkinson
OBJECTIVE: To estimate normal ranges for postpartum maternal vital signs. METHODS: We conducted a multicenter prospective longitudinal cohort study in the United Kingdom. We recruited women before 20 weeks of gestation without significant comorbidities and with accurately dated singleton pregnancies. Women recorded their own blood pressure, heart rate, oxygen saturation and temperature daily for 2 weeks postpartum. Trained midwives measured participants' vital signs including respiratory rate around postpartum days 1, 7, and 14...
January 7, 2021: Obstetrics and Gynecology
Holly B Ende, M James Lozada, David H Chestnut, Sarah S Osmundson, Rachel L Walden, Matthew S Shotwell, Jeanette R Bauchat
OBJECTIVE: To identify and quantify risk factors for atonic postpartum hemorrhage. DATA SOURCES: PubMed, CINAHL, EMBASE, Web of Science, and and databases were searched for English language studies with no restrictions on date or location. Studies included randomized trials, prospective or retrospective cohort studies, and case-control studies of pregnant patients who developed atonic postpartum hemorrhage and reported at least one risk factor...
January 7, 2021: Obstetrics and Gynecology
Henry Tal Lesser, Sarah M Capelouto, Aleeza Abbasi, Dwight J Rouse
No abstract text is available yet for this article.
January 7, 2021: Obstetrics and Gynecology
Stephen Wood, Selphee Tang
OBJECTIVE: To examine the relative contribution of changes in patient demographics and physician management to changes in the cesarean delivery rate in labor among nulliparous women. METHODS: We conducted a retrospective cohort study of 485,451 births to nulliparous women who experienced labor at or beyond 35 weeks of gestation in Alberta, Canada, from 1992 to 2018. The data were from a province-wide perinatal database. The primary outcome was cesarean delivery...
January 7, 2021: Obstetrics and Gynecology
U Vivian Ukah, Natalie Dayan, Brian J Potter, Aimina Ayoub, Nathalie Auger
OBJECTIVE: To examine long-term risks of mortality after a pregnancy complicated by severe maternal morbidity. METHODS: We analyzed a longitudinal cohort of 1,229,306 women who delivered in the province of Quebec, Canada from 1989 through 2016. Severe maternal morbidity included conditions such as cerebrovascular accidents, acute renal failure, severe preeclampsia, and other life-threatening complications. The outcome was in-hospital mortality after the last pregnancy, categorized as postpartum (42 days or fewer after delivery) and long-term (43 days to 29 years after delivery)...
January 7, 2021: Obstetrics and Gynecology
Courtney Martin, James Pappas, Kim Johns, Heather Figueroa, Kevin Balli, Ruofan Yao
OBJECTIVE: To evaluate whether implementation of a semiautonomous treatment algorithm was associated with improved compliance with American College of Obstetricians and Gynecologists guidelines for rapid administration of antihypertensive therapy in the setting of sustained severe hypertension. METHODS: This was a single-center retrospective cohort study of admitted pregnant and postpartum patients treated for severe hypertension between January 2017 and March 2020...
January 7, 2021: Obstetrics and Gynecology
Alan T N Tita, Lindsay Doherty, William A Grobman, Uma M Reddy, Robert M Silver, Gail Mallett, Madeline Murguia Rice, Yasser Y El-Sayed, Ronald J Wapner, Dwight J Rouse, George R Saade, John M Thorp, Suneet P Chauhan, Maged M Costantine, Edward K Chien, Brian M Casey, Sindhu K Srinivas, Geeta K Swamy, Hyagriv N Simhan, George A Macones
OBJECTIVE: To compare risks of maternal and perinatal outcomes by completed week of gestation from 39 weeks in low-risk nulliparous patients undergoing expectant management. METHODS: We conducted a secondary analysis of a multicenter randomized trial of elective induction of labor at 39 weeks of gestation compared with expectant management in low-risk nulliparous patients. Participants with nonanomalous neonates, who were randomized to and underwent expectant management and attained 39 0/7 weeks of gestation, were included...
January 7, 2021: Obstetrics and Gynecology
Courtney N Knill, R Scott Crandall, Derek T Jurus
BACKGROUND: Placenta accreta spectrum is most commonly diagnosed antenatally or at the time of delivery, but it may also present in the postpartum period. CASE: A 29-year-old primigravid patient without risk factors for placenta accreta spectrum had an uncomplicated vaginal birth with normal blood loss and delivery of an intact-appearing placenta. Five days postpartum, she was not lactating and uterine imaging to evaluate for retained products of conception was suspicious for placenta accreta spectrum...
January 7, 2021: Obstetrics and Gynecology
Mario M Leitao, Qin C Zhou, Maria B Schiavone, Renee A Cowan, Evan S Smith, Alexia Iasonos, Mitchell Veith, Michael Rafizadeh, Katherine Curran, Bhavani Ramesh, Kaity Chang, Dennis S Chi, Yukio Sonoda, Amy K Brown, Jonathan A Cosin, Nadeem R Abu-Rustum, Martin A Martino, Jennifer J Mueller, Kara Long Roche, Elizabeth L Jewell, Vance Broach, Nicholas C Lambrou, John P Diaz, Oliver Zivanovic
OBJECTIVE: To estimate the effectiveness of prophylactic negative pressure wound therapy in patients undergoing laparotomy for gynecologic surgery. METHODS: We conducted a randomized controlled trial. Eligible, consenting patients, regardless of body mass index (BMI), who were undergoing laparotomy for presumed gynecologic malignancy were randomly allocated to standard gauze or negative pressure wound therapy. Patients with BMIs of 40 or greater and benign disease also were eligible...
January 7, 2021: Obstetrics and Gynecology
Mei-Yi Wu, Ping-Jen Hu, Chung-Shun Wong, Tzu-Ting Chen, Jui-Yuan Hsueh, Yuh-Feng Lin, Yu-Kang Tu
OBJECTIVE: To assess the association between hypertensive disorders of pregnancy and adverse events after pregnancy, including chronic kidney disease and major adverse cardiovascular events (cerebrovascular accident, coronary artery disease, or death). METHODS: A nationwide, population-based cohort study was conducted analyzing women with hypertensive disorders of pregnancy identified from Taiwan National Health Insurance Research Database from 2004 to 2015. Hypertensive disorders of pregnancy were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes...
January 7, 2021: Obstetrics and Gynecology
John T Soper
This review summarizes the current evaluation and management of gestational trophoblastic disease, including evacuation of hydatidiform moles, surveillance after evacuation of hydatidiform mole and the diagnosis and management of gestational trophoblastic neoplasia. Most women with gestational trophoblastic disease can be successfully managed with preservation of reproductive function. It is important to manage molar pregnancies properly to minimize acute complications and to identify gestational trophoblastic neoplasia promptly...
January 7, 2021: Obstetrics and Gynecology
Christine Dehlendorf, Aletha Y Akers, Sonya Borrero, Lisa S Callegari, Denicia Cadena, Anu Manchikanti Gomez, Jamie Hart, Laura Jimenez, Miriam Kuppermann, Barbara Levy, Michael C Lu, Kiko Malin, Monica Simpson, Sarah Verbiest, Miriam Yeung, Joia Crear-Perry
Over the past decade, increasing attention has been paid to intervening in individuals' health in the "preconception" period as an approach to optimizing pregnancy outcomes. Increasing attention to the structural and social determinants of health and to the need to prioritize reproductive autonomy has underscored the need to evolve the preconception health framework to center race equity and to engage with the historical and social context in which reproduction and reproductive health care occur. In this commentary, we describe the results of a meeting with a multidisciplinary group of maternal and child health experts, reproductive health researchers and practitioners, and Reproductive Justice leaders to define a new approach for clinical and public health systems to engage with the health of nonpregnant people...
January 7, 2021: Obstetrics and Gynecology
Danielle Symons Downs, Abigail M Pauley, Krista S Leonard, Mohamed Satti, Nicole Cumbo, Isabella Teti, Mark Stephens, Tammy Corr, Robert Roeser, Timothy Deimling, Richard S Legro, Jaimey M Pauli, A Dhanya Mackeen, Lisa Bailey-Davis
OBJECTIVE: To examine obstetric physicians' beliefs about using professional or regulatory guidelines, opioid risk-screening tools, and preferences for recommending nonanalgesic therapies for postpartum pain management. METHODS: A qualitative study design was used to conduct semi-structured interviews with obstetric and maternal-fetal medicine physicians (N=38) from two large academic health care institutions in central Pennsylvania. An interview guide was used to direct the discussion about each physicians' beliefs in response to questions about pain management after childbirth...
January 7, 2021: Obstetrics and Gynecology
Runzhi Wang, Kristen Lee, Charlotte A Gaydos, Jean R Anderson, Jean Keller, Jenell S Coleman
No abstract text is available yet for this article.
January 7, 2021: Obstetrics and Gynecology
Alexis Griffin, Dallas Reed
No abstract text is available yet for this article.
January 7, 2021: Obstetrics and Gynecology
Liza Johannesson, Giuliano Testa, J Michael Putman, Gregory J McKenna, E Colin Koon, Jackie R York, Johanna Bayer, Lilly Zhang, Zachary S Rubeo, Robert T Gunby, Anthony R Gregg
OBJECTIVE: To describe aggregated pregnancy outcomes after uterus transplantation from a single, experienced center. METHODS: This prospective study reports on live births among 20 women who received a uterus transplant from 2016 to 2019 at Baylor University Medical Center at Dallas. These live births occurred between November 2017 and September 2020. The main measures were live birth, maternal complications, and fetal and newborn outcomes. RESULTS: There were six graft failures (four surgical complications and two with poor perfusion postoperatively)...
January 7, 2021: Obstetrics and Gynecology
Madeline Y Sutton, Ngozi F Anachebe, Regina Lee, Heather Skanes
Racial and ethnic disparities in women's health have existed for decades, despite efforts to strengthen women's reproductive health access and utilization. Recent guidance by the American College of Obstetricians and Gynecologists (ACOG) underscores the often unacknowledged and unmeasured role of racial bias and systemic racial injustice in reproductive health disparities and highlights a renewed commitment to eliminating them. Reaching health equity requires an understanding of current racial-ethnic gaps in reproductive health and a concerted effort to develop and implement strategies to close gaps...
January 7, 2021: Obstetrics and Gynecology
Gianna Wilkie, Thomas D Shipp, Sarah E Little, Ayotunde Fadayomi, Daniela A Carusi
No abstract text is available yet for this article.
January 7, 2021: Obstetrics and Gynecology
Alisse Hauspurg
No abstract text is available yet for this article.
January 7, 2021: Obstetrics and Gynecology
Marco Papa, Lucia Mauri, Camilla Sandrini, Nicola Persico, Anna Maria Colli
BACKGROUND: Sustained fetal supraventricular tachycardia is a potentially life-threatening disorder and is usually treated by administering antiarrhythmia drugs to the mother, which can require at least 48-72 hours to achieve normal sinus rhythm. In neonates with supraventricular tachycardia, first-line treatment is stimulation of the vagus nerve to elicit the diving reflex, commonly by application of a cold pack to the face, with a high, albeit sometimes temporary, success rate. CASE: We describe a case of fetal supraventricular tachycardia at term treated successfully by eliciting the diving reflex with an ice pack to the maternal abdomen over the lower uterine segment...
January 7, 2021: Obstetrics and Gynecology
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