American journal of obstetrics and gynecology
-
Am. J. Obstet. Gynecol. · Feb 2015
Outcomes of expectantly managed pregnancies with multiple gestations and preterm premature rupture of membranes prior to 26 weeks.
The objective of the study was to determine the obstetric and neonatal outcomes of expectantly managed multifetal pregnancies complicated by early preterm premature rupture of membranes (PPROM) prior to 26 weeks. ⋯ Overall, neonatal survival to hospital discharge was 43%, but only 17% survived without significant neonatal morbidity. These data provide a basis for counseling and management of women with multifetal gestation complicated by very early PPROM.
-
Am. J. Obstet. Gynecol. · Feb 2015
The impact of adoption of the international association of diabetes in pregnancy study group criteria for the screening and diagnosis of gestational diabetes.
The objective of the study was to compare the International Association of Diabetes in Pregnancy Study Group (IADPSG) and the Canadian Diabetes Association (CDA) criteria for the diagnosis of gestational diabetes mellitus (GDM). ⋯ The use of the IADPSG criteria instead of the CDA criteria would result in a considerable increase in the rate of GDM, but this also appears to identify additional women at similar risk of adverse pregnancy outcome. Further studies are needed to determine whether this observation persists after controlling for confounders such as body mass index as well as whether treatment in these cases would improve perinatal outcome.
-
Am. J. Obstet. Gynecol. · Feb 2015
Is universal cervical length screening indicated in women with prior term birth?
To determine whether universal transvaginal ultrasound (TVU) cervical length (CL) screening is indicated in women with prior term births. ⋯ Women with prior term birth have a trend toward a lower incidence of CL ≤20 mm, compared with nulliparous women. Further studies are needed to determine whether women with prior term births should be included or excluded from TVU CL screening.
-
Am. J. Obstet. Gynecol. · Feb 2015
Randomized Controlled Trial Comparative StudyRandomized controlled double-blind trial of transversus abdominis plane block versus trocar site infiltration in gynecologic laparoscopy.
The objective of the study was to determine whether transversus abdominis plane (TAP) block reduces postoperative pain when compared with trocar site infiltration of bupivacaine in gynecological laparoscopy. ⋯ As part of this multimodal analgesic regimen, neither block method provided a significant clinical benefit compared with trocar site bupivacaine infiltration.
-
Am. J. Obstet. Gynecol. · Feb 2015
Review Practice GuidelineSociety for maternal-fetal medicine (SMFM) clinical guideline #7: nonimmune hydrops fetalis.
Nonimmune hydrops is the presence of ≥2 abnormal fetal fluid collections in the absence of red cell alloimmunization. The most common etiologies include cardiovascular, chromosomal, and hematologic abnormalities, followed by structural fetal anomalies, complications of monochorionic twinning, infection, and placental abnormalities. We sought to provide evidence-based guidelines for the evaluation and management of nonimmune hydrops fetalis. ⋯ Evaluation of hydrops begins with an antibody screen (indirect Coombs test) to determine if it is nonimmune, detailed sonography of the fetus(es) and placenta, including echocardiography and assessment for fetal arrhythmia, and middle cerebral artery Doppler evaluation for anemia, as well as fetal karyotype and/or chromosomal microarray analysis, regardless of whether a structural fetal anomaly is identified. Recommended treatment depends on the underlying etiology and gestational age; preterm delivery is recommended only for obstetric indications including development of mirror syndrome. Candidates for corticosteroids and antepartum surveillance include those with an idiopathic etiology, an etiology amenable to prenatal or postnatal treatment, and those in whom intervention is planned if fetal deterioration occurs. Such pregnancies should be delivered at a facility with the capability to stabilize and treat critically ill newborns. The prognosis depends on etiology, response to therapy if treatable, and the gestational age at detection and delivery. Aneuploidy confers a poor prognosis, and even in the absence of aneuploidy, neonatal survival is often <50%. Mirror syndrome is a form of severe preeclampsia that may develop in association with fetal hydrops and in most cases necessitates delivery.