Journal of perinatal medicine
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The aim of this study was to assess the risk of subsequent delivery complications after extremely preterm deliveries by initial (index) pregnancy mode of delivery (MOD): cesarean (CD) versus vaginal (VD). ⋯ MOD at extreme prematurity did not impact subsequent maternal hemorrhage or overall morbidity. However, CD was associated with substantial uterine rupture risk despite evidence of practice to avoid labor (lower birth weight and earlier delivery) in the subsequent pregnancy.
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Randomized Controlled Trial
The impact of route of anesthesia on maternal and fetal ischemia modified albumin levels at cesarean section: a prospective randomized study.
Ischemia modified albumin has been shown to increase in ischemic situations, and has also been shown to increase in fetal cord blood in deliveries by cesarean section. The aim of this study is to reveal whether anesthesia has an impact on maternal and fetal cord ischemia modified albumin levels. ⋯ Fetal cord ischemia modified albumin levels were higher in the general anesthesia group, therefore, it is proposed that regional anesthesia should be the preferred route of anesthesia for an elective cesarean section, at least until the impact of high fetal cord IMA levels are manifested.
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To reduce the incidence of hypothermia (admission temperatures <36°C) in extremely low birth weight (ELBW) neonates using a multi-intervention quality improvement (QI) initiative. ⋯ A concerted QI approach improved admission temperature in ELBW neonates, with more neonates in the euthermic range, without increasing the risk for hyperthermia. Such an approach could be associated with improved outcomes in this population.
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The obesity epidemic is a problem of global importance with a profound impact on maternal-fetal health. Currently, 1 in 5 women, worldwide, are obese at time of conception. ⋯ Surgery has the exciting potential to treat obesity in women of reproductive age and to prevent obesity-related reproductive complications. Pregnancy after bariatric surgery appears to be safe and is effective in reducing complications such as gestational diabetes mellitus, gestational hypertensive disorders and fetal macrosomia, but may result in an increase in neonates born small-for-gestational-age.
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Placenta accreta is an increasingly prevalent and potentially dangerous complication of pregnancy. Although most studies on the subject have addressed the risk factors for the development of this condition, evidence on maternal and neonatal outcomes for these pregnancies is scarce. The objective of the present study is to compile current evidence with regard to risk factors as well as adverse outcomes associated with placenta accreta. ⋯ Although there is a significant shortage of studies on the subject, it appears that placenta accreta is associated with adverse maternal and neonatal outcomes, some of which may be life threatening. Prenatal diagnosis and adequate planning, particularly in high-risk populations, may be indicated for the reduction of these adverse outcomes.