American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Oct 2015
Comparative StudyOutcomes in twin pregnancies reduced to singleton pregnancies compared with ongoing twin pregnancies.
Multifetal pregnancy reduction has been shown to improve outcomes in triplet and higher-order multiple pregnancies. The data for fetal reduction of twin pregnancies are limited. The purpose of this study was to compare adverse pregnancy outcomes in ongoing twin pregnancies compared with twin pregnancies reduced to singletons. ⋯ Fetal reduction of twin pregnancies decreases the risk of late preterm birth and birthweight less than the 10% but not the risks of more severe complications such as early preterm birth or birthweight less than the 5%.
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Placental pathology can be useful in a variety of ways including immediate diagnosis of important conditions affecting the mother or infant, identifying conditions that are likely to recur in subsequent pregnancies, separating clinical syndromes into distinct pathological phenotypes for further investigation, and uncovering the underlying cause of unexpected adverse outcomes. Classification of placental lesions has evolved from being a purely descriptive exercise through a stage in which the major pathophysiological processes such as disorders of maternal implantation and the amniotic fluid infection syndrome were first described to a recently proposed comprehensive classification system that includes all of the major maternal and fetal vascular and infectious and idiopathic/immune inflammatory processes (Amsterdam Placental Workshop Group). Implementation of this unified system with reproducible grading and staging should help establish evidence-based recommendations for placental submission and facilitate progress in studying the pathogenesis, diagnosis, and treatment of obstetric disorders with an underlying placental etiology.
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Am. J. Obstet. Gynecol. · Oct 2015
Do laborists improve delivery outcomes for laboring women in California community hospitals?
We sought to determine the impact of the laborist staffing model on cesarean rates and maternal morbidity in California community hospitals. ⋯ We were unable to demonstrate differences in cesarean and maternal childbirth complication rates in community hospitals with and without laborists. Further efforts are needed to understand how the laborist staffing model contributes to neonatal outcomes, cost and efficiency of care, and patient and physician satisfaction.
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Am. J. Obstet. Gynecol. · Sep 2015
Blood volume determination in obese and normal-weight gravidas: the hydroxyethyl starch method.
The impact of obesity on maternal blood volume in pregnancy has not been reported. We compared the blood volumes of obese and normal-weight gravidas using a validated hydroxyethyl starch (HES) dilution technique for blood volume estimation. ⋯ Obese gravidas have similar circulating blood volume, but lower blood volume per kilogram body weight, than normal-weight gravidas near term.
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Am. J. Obstet. Gynecol. · Sep 2015
Comparative Study Clinical TrialIncreased 3-gram cefazolin dosing for cesarean delivery prophylaxis in obese women.
The purpose of this study was to determine tissue concentrations of cefazolin after the administration of a 3-g prophylactic dose for cesarean delivery in obese women (body mass index [BMI] >30 kg/m(2)) and to compare these data with data for historic control subjects who received 2-g doses. Acceptable coverage was defined as the ability to reach the minimal inhibitory concentration (MIC) of 8 μg/mL for cefazolin. ⋯ Higher adipose concentrations of cefazolin were observed after the administration of an increased prophylactic dose. This concentration-based pharmacology study supports the use of 3 g of cefazolin at the time of cesarean delivery in obese women. Normal and overweight women (BMI <30 kg/m(2)) reach adequate cefazolin concentrations with the standard 2-g dosing.