Seminars in perinatology
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We sought to quantify the added risk of thromboembolism in the obese parturient, evaluate risk factors for thromboembolism in the obese parturient, and provide suggestions as to when and in what form thromboembolism prophylaxis should be considered. Although recent guidelines from national colleges and advisory groups have attempted to guide the clinician in thromboprophylaxis in the obese parturient, the lack of adequate prospective series and trials has lead to some contrary recommendations. ⋯ Despite a paucity of gold standard evidence, the prevalence of obesity and its associated risk of venous thromboembolism warrants careful consideration for the use of thromboprophylaxis in the obese pregnant population. This is especially important in the presence of additional thromboembolism risk factors.
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The current obesity epidemic appears to contribute significantly to adverse fetal outcomes, and in this work we compile up-to-date evidence for the link between maternal obesity and risk of stillbirth. The review revealed a preponderance of evidence showing that the risk of stillbirth is increased among obese mothers with amplified risk estimates as the severity of obesity increases. ⋯ The literature has predominantly reported a strong association between maternal prepregnancy obesity and stillbirth. The considerable magnitude of association, consistency of positive results for the association between maternal obesity and stillbirth, the establishment of temporality between maternal obesity and stillbirth, the incremental elevation in risk with ascending BMI values, as well as the improvement in fetal survival with decrease in interpregnancy BMI among obese mothers strongly provide sufficient evidence that the relationship between maternal obesity and stillbirth may be causal.
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The epidemic of obesity continues to grow undaunted, promising to affect the lives of more women of childbearing age. The challenges facing those charged with obstetrical care of the obese may require variation in care from forethought and planning, to consultation or referral for care at specialized centers. ⋯ Awareness of prolonged labor curves and the risk of shoulder dystocia must also be part of the management of labor. The data regarding many interventions attempted on behalf of these at risk gravidas are rudimentary but may allow for modifications in care that will positively impact outcomes for mother and child.
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Seminars in perinatology · Oct 2011
ReviewSpontaneous late preterm births: what can be done to improve outcomes?
Despite the increase in indicated late preterm births, spontaneous preterm labor and preterm premature rupture of the fetal membranes are the most common antecedent diagnoses leading to births between 34-0/7 and 36-6/7 weeks of gestation. Regional and institutional variation in the rates of late spontaneous preterm birth suggests that there may be opportunities to reduce the number of these births. This article summarizes the factors contributing to late spontaneous preterm birth and offers suggestions to improve care for these mothers and infants.