American journal of obstetrics & gynecology MFM
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Am J Obstet Gynecol MFM · Jan 2021
Randomized Controlled TrialCesarean wound closure in body mass index 40 or greater comparing suture to staples: a randomized clinical trial.
Cesarean delivery is the most common major surgical procedure performed in the United States. Women with class III obesity have an increased risk of cesarean delivery and have wound complication rates higher than healthy body mass index counterparts. Available evidence regarding optimal wound closure is lacking specific to the population of women with class III obesity despite a known increased rate of wound complications. ⋯ Surgical staples or subcuticular suture for skin closure at the time of cesarean delivery in women with a body mass index of ≥40 kg/m2 resulted in similar composite wound complication rates; however, lower cesarean wound infection rates were noted among wounds closed with staples.
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Am J Obstet Gynecol MFM · Jan 2021
Randomized Controlled Trial Multicenter StudyEffect of gabapentin on hyperemesis gravidarum: a double-blind, randomized controlled trial.
Hyperemesis gravidarum is a disabling disease of nausea, vomiting, and undernutrition in early pregnancy for which there are no effective outpatient therapies. Poor weight gain in hyperemesis gravidarum is associated with several adverse fetal outcomes including preterm delivery, low birthweight, small for gestational age, low 5-minute Apgar scores, and neurodevelopmental delay. Gabapentin is most commonly used clinically for treating neuropathic pain but also substantially reduces chemotherapy-induced and postoperative nausea and vomiting. Pregnancy registry data have shown maternal first-trimester gabapentin monotherapy to be associated with a 1.2% rate of major congenital malformations among 659 infants, which compares favorably with the 1.6% to 2.2% major congenital malformation rate in the general population. Open-label gabapentin treatment in hyperemesis gravidarum was associated with reduced nausea and vomiting and improved oral nutrition. ⋯ In this small trial, gabapentin was more effective than standard-of-care therapy for reducing nausea and vomiting and increasing oral nutrition and global satisfaction in outpatients with hyperemesis gravidarum. These data build on previous findings in other patient populations supporting gabapentin as a novel antinausea and antiemetic therapy and support further research on gabapentin for this challenging complication of pregnancy.
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Am J Obstet Gynecol MFM · Jan 2021
Randomized Controlled TrialLidocaine patches for postcesarean pain control in obese women: a pilot randomized controlled trial.
Obesity increases the risk of opioid-related morbidity. Lidocaine patches have been shown to reduce postoperative pain after noncesarean surgeries. ⋯ This pilot suggests that 5% lidocaine patches applied superior and lateral to the cesarean incision are not effective at reducing the average total dose of morphine milligram equivalents administered in the first 24 hours after cesarean delivery among women with obesity, and they did not seem to improve median pain scores. An appropriately powered randomized trial would not be expected to demonstrate reduction in opioid use or pain.
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Am J Obstet Gynecol MFM · Jan 2021
Randomized Controlled TrialEnhanced discharge counseling to reduce outpatient opioid use after cesarean delivery: a randomized clinical trial.
Strategies to curb overprescribing have focused primarily on the prescriber as the point of intervention. Less is known about how to empower patients to use fewer opioids and decrease the quantity of leftover opioids. Previous studies in nonobstetrical populations suggest that patient counseling about appropriate opioid use improves disposal of unused opioids and overall knowledge about opioid use. Less is known about whether counseling reduces opioid use after hospital discharge. ⋯ Enhanced discharge opioid counseling doubled the frequency of participants reporting proper opioid disposal and improved overall knowledge about the risks associated with opioids. This intervention did not decrease opioid use in a population of women with low overall opioid use. These findings highlight possible methods to intervene on the short-term (misuse and diversion) and long-term (persistent opioid use) consequences of overprescribing.
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Am J Obstet Gynecol MFM · Jan 2021
A bibliometric analysis of obstetrics and gynecology articles with highest relative citation ratios, 1980 to 2019.
The Relative Citation Ratio is a novel bibliometric tool that quantifies the impact of research articles. The objectives of this study were to identify the 100 obstetrics and gynecology articles with the highest relative citation ratios, evaluate how characteristics of these articles changed over time, and compare characteristics of these articles with top-cited obstetrics and gynecology articles. ⋯ The Relative Citation Ratio is a novel bibliometric tool that does not rely on absolute citation rates and provides unique insight into the dissemination of knowledge in obstetrics and gynecology. Nearly half of the influential obstetrics and gynecology articles identified with this metric would not have been recognized as citation classics by conventional bibliometric analysis.