Journal of perinatal medicine
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There is a consistent view in the literature that research on pregnant woman with psychoses is ethically questionable or impermissible. This paper provides a critical appraisal of these views by asking whether pharmacologic research on pregnant women with psychosis for maternal, fetal, and newborn benefit is ethically permissible. We examine separately the documented clinical benefits and risks to the pregnant patient, the fetal patient, and the neonatal and pediatric patient. ⋯ Having shown that such research is permissible, we then ask what ethical considerations should guide study design. We show that Phase I studies are appropriate and can meet the requirements of the Common Rule, which are more specific than international guidance. As a matter of professionally responsible obstetric practice, pregnant women with psychoses should be included, and not be neglected, in research for both maternal and fetal benefit.
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Comparative Study Observational Study
Measurement of novel biomarkers of neuronal injury and cerebral oxygenation after routine vaginal delivery versus cesarean section in term infants.
It remains unclear if mode of delivery can have any impact on the neonatal brain. Our aim was to determine in term newborns any differences based on mode of delivery in either neuronal injury biomarkers, phosphorylated axonal neurofilament heavy chain (pNF-H) and ubiquitin C-terminal hydrolase (UCHL1), or brain oxygenation values, regional cerebral tissue oxygen saturation (CrSO2) and cerebral fractional tissue oxygen extraction (CFOE). ⋯ We found no difference in neuronal injury markers between term neonates born vaginally compared to those born by cesarean section. From a neurologic standpoint, this supports current obstetric practice guidelines that emphasize vaginal birth as the preferred delivery method whenever possible.
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To evaluate the risk of developing pulmonary edema in women exposed to nifedipine, magnesium sulfate (MgSO4), or both in a preterm setting. ⋯ MgSO4 treatment is strongly associated with the development of pulmonary edema when used either as a tocolytic agent or for seizure prophylaxis. In light of the availability of safer alternatives, MgSO4 should be used for tocolysis only in cases whereby the benefits clearly outweigh the risks.
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To determine the factors affecting neonatal prognosis in preterm premature rupture of membranes (PPROM). ⋯ Expectant management within 14 days after PPROM is associated with poor neonatal outcomes. Decisions regarding an expectant strategy should be made carefully. An immediate, planned delivery after steroid administration should be considered to improve neonatal prognosis in patients who have PPROM after 26 weeks' gestation.
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Factor XI deficiency is predominantly found in the Ashkenazi Jewish population with a prevalence of 9%, but also seen in other ethnicities. Little information is available on obstetric anesthesia management in women with Factor XI deficiency. Therefore, we undertook a study to evaluate obstetric, anesthetic and perinatal outcomes in parturients with Factor XI deficiency. ⋯ This study is the first step in building a national database for anesthetic cases and outcomes of parturients with Factor XI deficiency. Further efforts must be made to provide safe analgesia for these women.