American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Oct 2016
Review Meta AnalysisFetal fibronectin testing for prevention of preterm birth in singleton pregnancies with threatened preterm labor: a systematic review and metaanalysis of randomized controlled trials.
Fetal fibronectin is an extracellular matrix glycoprotein that is produced by amniocytes and cytotrophoblasts and has been shown to predict spontaneous preterm birth. ⋯ Fetal fibronectin testing in singleton gestations with threatened preterm labor is not associated with the prevention of preterm birth or improvement in perinatal outcome but is associated with higher costs.
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Am. J. Obstet. Gynecol. · Oct 2016
ReviewAntenatal corticosteroids beyond 34 weeks gestation: What do we do now?
The practice of antenatal corticosteroid administration in pregnancies of 24-34 weeks of gestation that are at risk of preterm delivery was adopted over 20 years after the first randomized clinical trial in humans. It is biologically plausible that antenatal corticosteroid in pregnancies beyond 34 weeks of gestation would reduce rates of respiratory morbidity and neonatal intensive care admission. Mostly guided by the results of a large multicenter randomized trial of antenatal corticosteroid in late preterm infants, the Antenatal Late Preterm Steroids Trial, the American Congress of Obstetricians and Gynecologists has released a practice advisory that the "administration of betamethasone may be considered in women with a singleton pregnancy between 34 0/7 and 36 6/7 weeks of gestation at imminent risk of preterm birth within 7 days." However, many unanswered questions about the risks and benefits of antenatal corticosteroids in this population remain and should be considered with the adoption of this treatment recommendation. ⋯ Some of these consequences may include treatment with multiple steroid courses or "treatment creep" in women at 34 to <37 weeks of gestation who do not meet the inclusion/exclusion criteria of the Antenatal Late Preterm Steroids Trial, particularly when a high percentage of women do not receive antenatal corticosteroid within 7 days of delivery. Finally, we believe that caution should be exercised before wide-scale universal adoption of antenatal corticosteroid for pregnancies that are at risk of preterm birth at 34 to <37 weeks of gestation, when it is unclear whether there are long-term effects. For a more balanced rationale for the decision to use antenatal corticosteroid treatment in pregnancies at >34 weeks of gestation, we urge for ongoing research into the risks and benefits of antenatal corticosteroid use in preterm infants overall, for better prediction of preterm birth so that antenatal corticosteroid can be administered within the ideal time frame, and for long-term neurodevelopmental follow-up of the participants in the large randomized Antenatal Late Preterm Steroids Trial.
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Am. J. Obstet. Gynecol. · Oct 2016
Implementation of universal screening for depression during pregnancy: feasibility and impact on obstetric care.
Given the growing policy and public health interest in the identification and treatment of depression in pregnancy, an understanding of the feasibility, challenges, and implications for resource utilization of the implementation of a universal screening program is crucial. ⋯ This study demonstrates the feasibility of universal depression screening during both the antepartum and postpartum periods with the use of the Edinburgh Postnatal Depression Scale as an initial screen followed by mental health referral for further diagnostic evaluation and treatment. The population of women who screened positive and who accepted additional services differed at the 2 time points, which reinforces the utility of screening during both the antepartum and postpartum periods. Although universal screening for depression is feasible, further study of the barriers to mental health evaluation and treatment and the impact of treatment on obstetric outcomes are needed.
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Am. J. Obstet. Gynecol. · Oct 2016
Randomized Controlled Trial Comparative StudyComparison of suture materials for subcuticular skin closure at cesarean delivery.
Subcuticular skin closure with suture after cesarean has been shown to result in lower rates of wound complications than with staple closure. However, the optimal choice of suture material for subcuticular skin closure is unclear. Vicryl (a braided multifilament synthetic suture; Ethicon, Somerville, NJ) and Monocryl (a monofilament synthetic suture; Ethicon) are the commonly used suture materials for subcuticular closure of transverse skin incisions after cesarean in the United States. Whereas in vitro and animal studies suggest multifilament suture materials may be associated with a higher risk of wound infection than monofilament sutures, clinical data on their relative effectiveness are limited. ⋯ Subcuticular skin closure with 4-0 Vicryl is associated with comparable rates of surgical site infection and other wound complications as 4-0 Monocryl. While this is an observational study with the potential for selection bias and residual confounding, our results suggest physician preference is acceptable for choice of subcuticular suture material at cesarean.