American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Dec 2019
First stage of labor progression in women with large-for-gestational age infants.
Women with suspected large-for-gestational age fetuses have higher rates of dysfunctional labor and labor arrest diagnoses and, consequently, higher rates of cesarean deliveries. The identification of the factors that significantly affect labor progression of women with large-for-gestational age infants may better inform expected duration of labor for certain subgroups of this population. ⋯ After 3-cm cervical dilation, the time required to reach the second stage of labor is greater in women with large-for-gestational age infants compared with those with appropriate-for-gestational age infants; these differences are most pronounced in nulliparous and obese women with large-for-gestational age infants in the active phase of labor (6-10 cm). Among women with large-for-gestational age infants, labor onset and presence of diabetes mellitus or gestational diabetes mellitus have no apparent effect on the duration of the first stage of labor after 3-cm cervical dilation.
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Am. J. Obstet. Gynecol. · Dec 2019
Outcomes of secondary cytoreductive surgery for patients with platinum-sensitive recurrent ovarian cancer.
Most women with advanced epithelial ovarian cancer develop recurrent disease, despite maximal surgical cytoreduction and adjuvant platinum-based chemotherapy. In observational studies, secondary cytoreductive surgery has been associated with improved survival; however its use is controversial, because there are concerns that the improved outcomes may reflect selection bias rather than the superiority of secondary surgery. ⋯ Patients with platinum-sensitive recurrent ovarian cancer who received secondary surgery had favorable surgical characteristics and were likely to have minimal residual disease following secondary surgery. These patients had a superior median overall survival compared with patients who received chemotherapy, although unmeasured confounders may explain this observed difference.
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Am. J. Obstet. Gynecol. · Dec 2019
Obstetric Care Consensus #9: Levels of Maternal Care: (Replaces Obstetric Care Consensus Number 2, February 2015).
Maternal mortality and severe maternal morbidity, particularly among women of color, have increased in the United States. The leading medical causes of maternal mortality include cardiovascular disease, infection, and common obstetric complications such as hemorrhage and vary by timing relative to the end of pregnancy. Although specific modifications in the clinical management of some of these conditions have been instituted, more can be done to improve the system of care for high-risk women at facility and population levels. ⋯ State and regional authorities should work together with the multiple institutions within a region, and with the input from their obstetric care providers, to determine the appropriate coordinated system of care and to implement policies that promote and support a regionalized system of care. These relationships enhance the ability of women to give birth safely in their communities while providing support for circumstances when higher level resources are needed. This document is a revision of the original 2015 Levels of Maternal Care Obstetric Care Consensus, which has been revised primarily to clarify terminology and to include more recent data based on published literature and feedback from levels of maternal care implementation.
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Am. J. Obstet. Gynecol. · Nov 2019
Randomized Controlled Trial Multicenter StudyMultimodal opioid sparing postoperative pain regimen compared to the standard postoperative pain regimen in vaginal pelvic reconstructive surgery: a multicenter randomized controlled trial.
Postoperative pain control after urogynecological surgery has traditionally been opioid centered with frequent narcotic administration. Few studies have addressed optimal pain control strategies for vaginal pelvic reconstructive surgery that limit opioid use. ⋯ The ice packs, Tylenol, and Toradol multimodal pain regimen offers improved pain control the morning after surgery and 96 hours postoperatively compared with the standard regimen with no differences in patient satisfaction and quality of recovery. Ice packs, Tylenol, and Toradol can significantly limit postoperative inpatient narcotic use and eliminate outpatient narcotic use in patients undergoing vaginal pelvic reconstructive surgery.
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Am. J. Obstet. Gynecol. · Nov 2019
Randomized Controlled TrialA randomized, double-blind, placebo-controlled trial of onabotulinumtoxin A trigger point injections for myofascial pelvic pain.
Pelvic pain is estimated to effect 15% of women, and onabotulinumtoxin A is used to treat a variety of pain disorders. However, the data on the use of onabotulinumtoxin A for the treatment of women with myofascial pelvic pain are limited. ⋯ Pelvic floor onabotulinumtoxin A injections for myofascial pelvic pain were not more effective than saline injections at decreasing muscle pain on palpation. Despite this, participants who received onabotulinumtoxin A were more likely than those who received saline to report improvement, albeit not statistically significant, in their overall pelvic floor pain at 4 and 12 weeks.