American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Sep 2014
Balancing the risks of stillbirth and neonatal death in the early preterm small-for-gestational-age fetus.
Timing of delivery for the early preterm small-for-gestational-age (SGA) fetus remains unknown. Our aim was to estimate the risk of stillbirth in the early preterm SGA fetus compared with the risk of neonatal death. ⋯ Our findings suggest that the balance between the competing risks of stillbirth and neonatal death for the early preterm SGA fetus occurs at 32-33 weeks 6 days of gestation. These data can be useful when delivery timing remains uncertain.
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Am. J. Obstet. Gynecol. · Sep 2014
Randomized Controlled Trial Multicenter StudyDelivery timing and cesarean delivery risk in women with mild gestational diabetes mellitus.
The purpose of this study was to evaluate the relationship between gestational age (GA) and induction of labor (IOL) and the rate of cesarean delivery in women with mild gestational diabetes mellitus. ⋯ Induction of labor in women with mild gestational diabetes mellitus does not increase the rate of cesarean delivery at <40 weeks' gestation.
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Am. J. Obstet. Gynecol. · Sep 2014
Maternal and neonatal outcomes in electively induced low-risk term pregnancies.
Elective induction of labor has been discouraged over concerns regarding increased complications. We evaluated the mode of delivery and maternal and neonatal morbidities in low-risk patients whose labor was electively induced or expectantly managed at term. ⋯ Elective induction of labor at term is associated with decreased risks of cesarean delivery and other maternal and neonatal morbidities compared with expectant management regardless of parity or cervical status on admission.
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Am. J. Obstet. Gynecol. · Aug 2014
Multicenter StudyRacial disparities in outcomes of twin pregnancies: elective cesarean or trial of labor?
The objective of the study was to determine the relationships between maternal race and obstetric outcomes in twin gestations by planned mode of delivery. ⋯ Unplanned cesarean delivery rates are similar in twin pregnancies, regardless of race. Maternal and neonatal outcomes in twin gestations are similar across ethnicities, regardless of mode of delivery.
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Am. J. Obstet. Gynecol. · Jul 2014
Maternal mortality in the United States: predictability and the impact of protocols on fatal postcesarean pulmonary embolism and hypertension-related intracranial hemorrhage.
The purpose of this study was to examine the efficacy of specific protocols that have been developed in response to a previous analysis of maternal deaths in a large hospital system. We also analyzed the theoretic impact of an ideal system of maternal triage and transport on maternal deaths and the relative performance of cause of death determination from chart review compared with a review of discharge coding data. ⋯ Disease-specific protocols are beneficial in the reduction of maternal death because of hypertensive disease and postoperative pulmonary embolism. From 2-6 women die annually in the United States because of cesarean delivery itself. A reduction in deaths from postpartum hemorrhage should be the priority for maternal death prevention efforts in coming years in the United States.