American journal of perinatology
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Comparative Study
Pulmonary dysfunction and therapeutic hypothermia in asphyxiated newborns: whole body versus selective head cooling.
Compared with whole body cooling (WBC), selective head cooling (SHC) of asphyxiated newborns presumably allows effective brain cooling with less systemic hypothermia and potentially fewer systemic adverse effects. It is not known if pulmonary dysfunction, one of the potential adverse systemic effects of therapeutic hypothermic neuroprotection, differs with the method of cooling. We sought to investigate if pulmonary mechanics and gas exchange during therapeutic hypothermia differ between WBC and SHC. ⋯ The incidence of PPHN was similar in both the WBC and SHC groups (17.8% versus 12.9%, P = 0.72, OR 1.5, 95% CI 0.3 to 6.1). Pulmonary dysfunction is common but not severe in asphyxiated infants during therapeutic hypothermia. Pulmonary mechanics and gas exchange do not differ with the method of achieving hypothermia.
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Comparative Study
Scheduled cesarean delivery: maternal and neonatal risks in primiparous women in a community hospital setting.
We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). ⋯ The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications.
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The aim of the study was to investigate the effect of individual room care in the neonatal intensive care unit (NICU) on the factors that influence mother-preterm infant interaction. Mothers in group I had hospitalization with their preterm infants in an individual room in the NICU. Mothers in group II were not hospitalized but had opportunity to visit their babies and spend time with them whenever they wanted. ⋯ Although the mean depression, stress, and vulnerability scores were higher in group II, there was no significant difference between the groups (P > 0.05). Postpartum depression rate was more than double in group II, but this difference was not statistically significant (P = 0.06). Individual room care in the NICU cannot prevent maternal stress, postpartum depression, and perception of vulnerability related to having a high-risk preterm infant by itself alone.
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Case Reports
Acute type A aortic dissection complicating pregnancy at 32 weeks: surgical repair after cesarean section.
A 40-year-old, gravida 2, para 1 woman presented at a gestational age of 32 + 5 weeks' with sudden onset of a sharp chest and thoracic back pain. She was admitted 1 hour before the onset of pain because of some minor postcoital vaginal blood loss. ⋯ A healthy male infant of 2105 g was delivered by emergency cesarean section followed by a Bentall procedure with composite graft replacement of the aorta, and aortic valve replacement was performed. Rapid multidisciplinary consultation, collaboration, and quick decision making led to a successful outcome for both the mother and her child.
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Randomized Controlled Trial Comparative Study
A randomized clinical trial comparing vaginal misoprostol versus cervical Foley plus oral misoprostol for cervical ripening and labor induction.
We compared labor induced by vaginal misoprostol versus a supracervical Foley catheter and oral misoprostol. Singleton pregnancies at > or = 24 weeks' gestation were randomized to either an initial 25-microg dose of intravaginal misoprostol, followed by 50-microg intravaginal doses at 3- to 6-hour intervals, or a supracervical Foley balloon and 100 microg of oral misoprostol at 4- to 6-hour intervals. Primary outcome was time from induction to delivery. ⋯ Uterine tachysystole occurred less often in the vaginal misoprostol group (21% versus 39%, P = 0.015). Compared with vaginal misoprostol, delivery within 24 hours was significantly more likely with a Foley balloon and oral misoprostol. The use of terbutaline and peripartum outcomes were similar in the two groups.