American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialPlymouth randomized trial of cardiotocogram only versus ST waveform plus cardiotocogram for intrapartum monitoring in 2400 cases.
The physiology of changes in the ST waveform of the fetal electrocardiogram has been elucidated in extensive animal and human observational studies. A combination of heart rate and ST waveform analysis might improve the predictive value of intrapartum monitoring. Our purpose was to compare operative intervention and neonatal outcome in labors monitored by the conventional cardiotocogram with those monitored by ST waveform plus the cardiotocogram. ⋯ ST waveform analysis discriminates cardiotocogram changes in labor, and the protocol for interpretation is safe. Further randomized studies are warranted.
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Am. J. Obstet. Gynecol. · Oct 1993
Comparative StudyFactors contributing to the increased cesarean birth rate in older parturient women.
Our purpose was to determine factors contributing to the increased use of cesarean section in patients > or = 35 years old. ⋯ We could not identify any controllable physician factors affecting the rate of cesarean section in patients > or = 35 years old. The increased oxytocin requirements and the incidence of dystocia with birth weight > or = 3600 gm suggest that maternal and fetal characteristics contribute to the increased frequency of cesarean section in older parturients.
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Am. J. Obstet. Gynecol. · Oct 1993
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial.
Our purpose was to determine the effect of epidural analgesia on nulliparous labor and delivery. ⋯ In a randomized, controlled, prospective trial epidural analgesia resulted in a significant prolongation in the first and second stages of labor and a significant increase in the frequency of cesarean delivery, primarily related to dystocia.
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Am. J. Obstet. Gynecol. · Oct 1993
The presence of cervical and vaginal fetal fibronectin predicts preterm delivery in an inner-city obstetric population.
It has previously been shown that fibronectin bearing a specific oncofetal domain is present at the chorionic-decidual interface and that its release into cervical and vaginal secretions accurately predicts preterm delivery in patients with uterine contractions. This study examines whether serial assessment of cervical and vaginal fetal fibronectin allows for the prediction of preterm delivery in symptom-free patients derived from an inner-city, general obstetric population. ⋯ Among patients undergoing monthly cervical and vaginal sampling between 24 and 36 weeks' gestation, the presence of fetal fibronectin is a sensitive and specific predictor of preterm delivery.
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Am. J. Obstet. Gynecol. · Oct 1993
Comparative StudyMaternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome)
Our purpose was to describe the incidence and effects of serious obstetric complications on maternal outcome in pregnancies complicated by HELLP syndrome. ⋯ HELLP syndrome is associated with serious maternal morbidity, especially when it arises in the postpartum period.