American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Jun 2014
Racial/ethnic disparities in contraceptive use: variation by age and women's reproductive experiences.
Disparities in unintended pregnancy in the United States are related, in part, to black and Hispanic women being overall less likely to use effective contraceptive methods. However, the fact that these same groups are more likely to use female sterilization, a highly effective method, suggests there may be variability in disparities in contraceptive use across a woman's life course. We sought to assess the relationship between race/ethnicity and contraceptive use in a nationally representative sample and to approximate a life course perspective by examining effect modification on these disparities by women's age, parity, and history of unintended pregnancy. ⋯ Interventions designed to address disparities in unintended pregnancy should focus on improving contraceptive use among younger women.
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Am. J. Obstet. Gynecol. · Jun 2014
Multicenter StudyPreventability of severe acute maternal morbidity.
We sought to assess potential preventability of severe acute maternal morbidity (SAMM) cases admitted to intensive-care units (ICUs) or high-dependency units (HDUs). ⋯ The majority of SAMM cases were potentially preventable or required improvement in care. Themes around substandard care related to delay in diagnosis and treatment for postpartum hemorrhage and septicemia. These findings can inform clinical educational programs and policies to improve maternal outcomes. This study has now been expanded to a national New Zealand audit of all SAMM cases admitted to an ICU/HDU.
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Am. J. Obstet. Gynecol. · Jun 2014
Case ReportsSomething to Reed about: fibroids, cutaneous leiomyomas, and renal cell carcinoma.
A 48 year-old woman with a history of fibroids presents with asymptomatic skin lesions. Biopsy reveals cutaneous leiomyomas and subsequent genetic evaluation confirms the diagnosis of hereditary leiomyomatosis and renal cell cancer. In this report, we review the typical presentation of the syndrome as well as recommendations for surveillance.
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Am. J. Obstet. Gynecol. · May 2014
Obesity and the risk of stillbirth: a population-based cohort study.
Obesity is a known risk factor for stillbirth. However, this relationship has not been characterized fully. We attempted to further examine this relationship with a focus on delivery near and at term. ⋯ There is a pronounced increase in the risk of stillbirth with increasing BMI; the association is strongest at early- and late-term gestation periods. Extreme maternal obesity is a significant risk factor for stillbirth.
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We sought to examine the relationship between maternal markers of inflammation and labor performance. ⋯ Proinflammatory activation is important in labor initiation. However, once active labor is established, excess inflammation can be detrimental to efficient labor progress. These data may explain, in part, the known associations among clinical chorioamnionitis, cesarean delivery, and postpartum hemorrhage.