American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Oct 2004
Perinatal intervention and neonatal outcomes near the limit of viability.
The purpose of this study was to evaluate trends in the level of obstetric and neonatal intervention near the limit of viability and perinatal morbidity and mortality rates over time. ⋯ Obstetric intervention and aggressive neonatal resuscitation have increased for pregnancies delivered between 23 and 26 weeks of gestation over the past decade. Although survival has increased over time and with advancing gestational age at delivery, short-term morbidity in survivors is similar, regardless of gestational age in this cohort. A brief delay in delivery of those pregnancies who are at risk for delivery between 23 and 26 weeks of gestation may improve survival, although short-term morbidity in survivors will not be affected substantially.
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Am. J. Obstet. Gynecol. · Sep 2004
Comparative StudyDiagnosis of pulmonary embolism: a cost-effectiveness analysis.
Pulmonary embolism is a major cause of maternal death. The work up for suspected pulmonary embolism is complex, with many potential diagnostic options. We performed a cost analysis to evaluate which of several diagnostic strategies was the most cost-effective with the least number of deaths from pulmonary embolism. ⋯ Suspected pulmonary embolism remains a diagnostic quandary. Our analysis indicated that spiral computed tomography offers the most cost-effective method for diagnosing this potentially fatal condition.
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Am. J. Obstet. Gynecol. · Sep 2004
The continuing effectiveness of active management of first labor, despite a doubling in overall nulliparous cesarean delivery.
The purpose of this study was to determine the continuing effectiveness of active management of labor, a protocol that involves early detection and correction of dystocia with oxytocin in spontaneous cephalic nulliparous labor, by analysis of the contribution of this cohort to a doubled overall nulliparous cesarean delivery rate. ⋯ Active management of spontaneous first labors remains an effective protocol for the promotion of vaginal delivery with low peripartum mortality rates; factors other than dystocia in spontaneous labor account for the progressive increase in the nulliparous cesarean delivery rate.
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Am. J. Obstet. Gynecol. · Sep 2004
ST segment analysis of the fetal electrocardiogram plus electronic fetal heart rate monitoring in labor and its relationship to umbilical cord arterial blood gases.
This study was undertaken to determine the ability of intrapartum electronic fetal heart rate monitoring (EFM) plus fetal electrocardiogram (ECG) ST segment automated ANalysis (STAN, Neoventa Medical, Goteborg, Sweden) monitoring to predict metabolic acidemia (defined as an umbilical cord artery pH < 7.15 and base deficit > or = 12 mmol/L) at birth. ⋯ The STAN clinical guidelines have a poor positive predictive value and a sensitivity of less than 50% for metabolic acidemia at birth.
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Am. J. Obstet. Gynecol. · Aug 2004
Racial and ethnic disparities in the provision of epidural analgesia to Georgia Medicaid beneficiaries during labor and delivery.
The purpose of this study was to measure racial and ethnic differences in the proportion of Medicaid patients who receive epidural analgesia during labor and delivery. ⋯ The study subjects all had identical Medicaid insurance and met the same low-income Medicaid eligibility criteria, yet race/ethnicity was still a significant predictor of epidural analgesia after we had controlled for age, rural-urban residence, and availability of anesthesiologists. Further studies are needed to assess perceived benefits, risks, costs, and obstacles to epidural analgesia that are perceived by patients, physicians, nurses, and midwives.