American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Sep 2006
Multicenter StudyAre the Agency for Healthcare Research and Quality obstetric trauma indicators valid measures of hospital safety?
The objective of the study was to examine whether the United States Agency for Health Care Research and Quality obstetric patient safety indicators are significantly affected by patient-specific and hospital-level characteristics not related to the safety environment. ⋯ The risk of obstetric trauma is significantly influenced by both patient and hospital characteristics and is not a good indicator of patient safety.
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Am. J. Obstet. Gynecol. · Sep 2006
Operative vaginal delivery and midline episiotomy: a bad combination for the perineum.
The purpose of this study was to determine the impact of operative vaginal delivery (forceps or vacuum) and midline episiotomy on the risk of severe perineal trauma. ⋯ The use of operative vaginal delivery, particularly in combination with midline episiotomy, was associated with a significant increase in the risk of anal sphincter trauma in both primigravid and multigravid women. Given the reported substantial long-term adverse consequences for anal function, this combination of operative modalities should be avoided if possible.
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Am. J. Obstet. Gynecol. · Sep 2006
Comparative StudyInduction of labor and cesarean delivery by gestational age.
Studies of cesarean delivery (CD) rates among women undergoing induction of labor (IOL) often compare such women to women experiencing spontaneous labor at similar gestational ages. We sought to examine the association between IOL at various gestational ages and CD, accounting for the effect of increased gestational age among the comparison group who were managed expectantly. ⋯ Our findings suggest that IOL may not increase a woman's risk of CD when compared to expectant management. While this question has been addressed prospectively at 41 weeks gestation, it requires further examination at earlier gestations and among various subgroups.
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The purpose of this study was to assess the influence of maternal age on obstetric indices of uterine efficiency in spontaneous nulliparous labor managed according to a standardized protocol in order to determine whether increasing maternal age is more commonly associated with dystocia. ⋯ In a context of uniform labor management, all 4 indices of dystocia examined were increased progressively with maternal age, although oxytocin augmentation proved a generally effective intervention in all age categories. These findings have implications for the analysis of intervention rates by health care providers, particularly in developed countries where the proportion of older nulliparas is increasing.