American journal of obstetrics and gynecology
-
Am. J. Obstet. Gynecol. · Jul 2003
Ten-minute umbilical cord occlusion markedly reduces cerebral blood flow and heat production in fetal sheep.
The study was undertaken to determine to what extent a 10-minute total umbilical cord occlusion affects autoregulation of cerebral blood flow and cerebral heat production in the fetus. ⋯ Ten-minute total umbilical cord occlusion results in major reductions in cerebral blood flow and heat production. Autoregulation of cerebral blood flow was lost within 4 minutes of occlusion, probably as a result of hypoxia, combined with hypotension. The fact that the reduction in cerebral heat production preceded and exceeded the reduction in blood flow may suggest active down-regulation of cerebral metabolism, the mechanism of which is unclear at present.
-
Am. J. Obstet. Gynecol. · Jul 2003
Graves' disease in pregnancy: prospective evaluation of a selective invasive treatment protocol.
Graves' disease in pregnancy carries a risk of fetal thyrotoxicosis from the transplacental transfer of thyroid-stimulating antibodies or fetal hypothyroidism from transplacental transfer of antithyroid drugs and thyroid-blocking antibodies. ⋯ In women with Graves' disease, umbilical blood sampling in selected cases may improve the control of fetal thyroid function.
-
We sought to identify risk factors for anal sphincter injury during vaginal delivery. ⋯ Our results are consistent with recent reports that identify forceps delivery and nulliparity as risk factors for recognized anal sphincter injury at the time of vaginal delivery. Further investigation should focus on the determination of whether the association of injury to instrumentation is causal or, in fact, modifiable. Because of the established association between sphincteric muscular damage and anal incontinence, patients should be counseled about the risk of anal sphincter injury when operative vaginal delivery is contemplated. Such patients should be followed closely in the postpartum setting to assess for the development of potential anorectal complaints.
-
Am. J. Obstet. Gynecol. · Jul 2003
Randomized Controlled Trial Multicenter Study Clinical TrialExternal cephalic version beginning at 34 weeks' gestation versus 37 weeks' gestation: a randomized multicenter trial.
In about 3% to 4% of all pregnancies at term, the fetal presentation will be noncephalic. External cephalic version (ECV) at term has been shown to decrease the rate of noncephalic presentation at birth and to decrease the rate of cesarean section associated with breech presentation. However, success rates for ECV are low. We did a randomized trial to compare a policy of beginning ECV early, at between 34 and 36 weeks' gestation, and beginning ECV at 37 to 38 weeks' gestation. ⋯ Early ECV performed at 34 to 36 weeks compared with 37 to 38 weeks may reduce the risk of noncephalic presentation at delivery. A large pragmatic trial of early ECV is now required to assess this approach further in terms of cesarean section rates and neonatal outcomes before changes in clinical practice.