Journal of perinatal medicine
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Case Reports
The exit procedure (ex-utero intrapartum treatment): management of giant fetal cervical teratoma.
The prognosis of giant cervical teratomas is determined by the severity of the associated airway obstruction. Ex-utero intrapartum treatment (EXIT) is a technique to establish a patent airway before completion of birth, while the infant remains on placental support. We present two cases of newborns with cervical teratomas treated with the EXIT procedure. In the first, this technique allowed a tracheotomy to be performed, and in the second, correction of tracheal displacement and subsequent nasotracheal intubation was achieved.
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Randomized Controlled Trial
Induction of labor with oral misoprostol for premature rupture of membranes at term in women with unfavorable cervix: a randomized, double-blind, placebo-controlled trial.
To evaluate the efficacy and safety of oral misoprostol for labor induction in women with term premature rupture of membranes (PROM) and an unfavorable cervix. ⋯ Oral misoprostol given to women with unfavorable cervix soon after term PROM significantly reduces the induction-to-delivery time and the need for oxytocin and antibiotics.
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Randomized Controlled Trial Multicenter Study
Atosiban versus usual care for the management of preterm labor.
To compare the efficacy of atosiban with usual management of threatened preterm labor. ⋯ These findings support the use of atosiban to delay preterm birth and are consistent with previously conducted, randomized, controlled trials. Atosiban was associated with fewer maternal and fetal adverse events compared with other tocolytics, and presented no safety concerns for either the mother or the unborn baby.
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In order to determine the risk factors and outcomes of ventilator-associated pneumonia (VAP) in the neonatal intensive care unit (NICU), a retrospective cohort study was conducted on 259 patients who were ventilated >48 h. Clinical characteristics and risk factors were compared and non-conditional logistic regression analysis was performed to determine independent predictors for VAP. There were 52 episodes of VAP (20.1%). ⋯ VAP occurred at significant rates among mechanically ventilated NICU patients and is associated with care procedures. The risk factors of neonatal VAP were re-intubation, duration of mechanical ventilation, treatment with opiates and endotracheal suctioning. Additional studies are necessary to develop interventions to prevent neonatal VAP.
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Treatment of cervical intraepithelial neoplasia (CIN) greatly reduces the risk of cervical cancer. Treatment involves ablation or excision of the transformation zone of the cervix, most commonly using an electrosurgical excision technique known as LLETZ. However, the peak incidence of CIN occurs in young women, so if excision of a portion of the cervix has an adverse effect on pregnancy outcome, this might have a significant impact. This review discusses the methodology and findings of the published literature on the association between cervical treatment and preterm birth, and the clinical implications of these findings.