American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Dec 2004
Randomized Controlled Trial Comparative Study Clinical TrialIntrapartum management of nonreassuring fetal heart rate patterns: a randomized controlled trial of fetal pulse oximetry.
We tested if fetal pulse oximetry in addition to electronic fetal monitoring (CTG) and scalp blood sampling improves the accuracy of fetal assessment and allows safe reduction of operative deliveries (-50%) and scalp blood sampling (-50%) performed because of nonreassuring fetal status. Study design A randomized controlled trial was conducted in 146 patients with term pregnancies in active labor and abnormal fetal heart rate patterns: 73 had electronic fetal heart rate monitoring (CTG) and fetal scalp blood sampling (control group), 73 had CTG, fetal scalp blood sampling, and continuous fetal pulse oximetry (study group). ⋯ There was a safe reduction in operative deliveries (-50%) and scalp blood sampling (-50%) performed because of nonreassuring fetal status. The increase in cesarean sections because of dystocia in the study group was a well-documented arrest of labor, but it did not change the total number of operative deliveries in this group.
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Am. J. Obstet. Gynecol. · Dec 2004
Randomized Controlled Trial Comparative Study Clinical TrialMisoprostol versus methylergometrine: pharmacokinetics in human milk.
The purpose of this study to compare breast milk pharmacokinetics between misoprostol 200 mug and methylergometrine 250 mug after single oral dosing in women who require postpartum uterotonic therapy. ⋯ Misoprostol warrants further investigation as an alternative to postpartum methylergometrine because it enters and leaves breast milk at twice the rate, with one third of the milk/plasma ratio, which significantly lowers infant exposure and facilitates a timed dosing regimen.
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Am. J. Obstet. Gynecol. · Dec 2004
Multicenter Study Comparative StudyColposcopy quality control by remote review of digitized colposcopic images.
This study was undertaken to estimate the accuracy of colposcopy quality control review of subjects' digitized colposcopic images during the atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion triage study (ALTS). ⋯ Colposcopy quality control by review of digitized colposcopic images in clinical trials warrants further evaluation if the accuracy can be improved.
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Am. J. Obstet. Gynecol. · Dec 2004
Comparative StudyUmbilical cord pH and base excess values in relation to adverse outcome events for infants delivering at term.
This study was undertaken to determine the relationship of umbilical cord pH and base excess (BE) values to adverse neonatal outcomes for a large tertiary hospital population delivering at term. Study design The perinatal/neonatal database of St. Joseph's Health Care, London, Canada, was used to obtain the umbilical cord pH and BE values, incidence of adverse neonatal outcomes, and patient demographics for all term (>/=37 weeks' gestation), singleton, liveborn infants with no major anomalies delivering between November 1995 and March 2002 (n=20,456). Statistical analyses included chi(2) analysis, logistic regression models to develop odds ratios and creation of receiver operating characteristic (ROC) curves with area under curve (AUC) calculations. ⋯ There is a progression of risk in term infants for Apgar less than 7 at 5 minutes, NICU admission, and need for assisted ventilation with worsening acidosis at birth, which begins with cord blood values close to mean values indicating a higher threshold for associated acidemia with these outcomes than is seen for more severe neonatal outcomes.