American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Mar 2019
Clinical TrialDevelopment of a standardized, reproducible screening examination for assessment of pelvic floor myofascial pain.
Pelvic floor myofascial pain is common, but physical examination methods to assess pelvic floor muscles are defined poorly. We hypothesized that a simple, transvaginal pelvic floor examination could be developed that would be highly reproducible among providers and would adequately screen for the presence of pelvic floor myofascial pain. ⋯ Our newly developed, standardized, reproducible examination incorporates assessment of internal and external points to screen for pelvic floor myofascial pain. The examination is straightforward and reproducible and allows for easy use in clinical practice.
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Am. J. Obstet. Gynecol. · Mar 2019
Safety of robotic-assisted gynecologic surgery and early hospital discharge in elderly patients.
A minimally invasive surgical approach has proven to decrease peri- and postoperative complications and shorten duration of hospital stay; however, there are limited data evaluating the safety of robotic-assisted surgery and early hospital discharge in the elderly population. Because age is a well-known, independent risk factor for perioperative morbidity and gynecologists treat many elderly patients, this is an important area of study. ⋯ Despite having more preoperative risk factors and more surgically complex procedures, elderly patients undergoing robotic-assisted gynecologic surgery had similar postoperative complication rates, and almost half of elderly patients were safely discharged the day of surgery. Our data suggest that robotic-assisted gynecologic surgery and early hospital discharge are safe in elderly patients.
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Am. J. Obstet. Gynecol. · Feb 2019
The impact of extending the second stage of labor to prevent primary cesarean delivery on maternal and neonatal outcomes.
A low rate of primary cesarean delivery is expected to reduce some of the major complications that are associated with a repeat cesarean delivery, such as uterine rupture, adhesive placental disorders, hysterectomy, and even maternal death. Since 2014, and in alignment with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, we changed our approach to labor dystocia, defined as abnormal progression of labor, by allowing a longer duration of the second stage of labor. ⋯ The new policy of labor management successfully decreased primary cesarean deliveries, with a small rise in instrumental deliveries. However, it also increased the other immediate maternal and neonatal complications. A higher rate of lower umbilical artery cord pH was the most significant finding; however, the early neurological outcome did not change. It is possible that the ongoing adjustment to the new labor protocol will avoid, in the future, maternal and neonatal complications. The long-term maternal and neonatal consequences of our new approach will be evaluated in future studies.
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Am. J. Obstet. Gynecol. · Feb 2019
Observational StudyA simple model to predict the complicated operative vaginal deliveries using vacuum or forceps.
Complicated operative vaginal deliveries are associated with high neonatal morbidity and maternal trauma, especially if the procedure is unsuccessful and a cesarean delivery is needed. The decision to perform an operative vaginal delivery has traditionally been based on a subjective assessment by digital vaginal examination combined with the clinical expertise of the obstetrician. Currently there is no method for objectively quantifying the likelihood of successful delivery. Intrapartum ultrasound has been introduced in clinical practice to help predict the progression and final method of delivery. ⋯ The combination of the angle of progression and the head circumference can predict 87% of complicated operative vaginal deliveries and can be performed in the delivery room.
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Am. J. Obstet. Gynecol. · Feb 2019
Two-stage screening for preterm preeclampsia at 11-13 weeks' gestation.
Screening for preeclampsia at 11-13 weeks' gestation by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor (triple test) can predict about 90% of preeclampsia, with delivery at <32 weeks (early-preeclampsia), and 75% of preeclampsia with delivery at <37 weeks (preterm preeclampsia), at a screen-positive rate of 10%. In pregnancies identified as being at high risk for preeclampsia by such screening, administration of aspirin (150 mg/d from 11 to 14 weeks' gestation to 36 weeks) reduces the rate of early preeclampsia by about 90% and preterm preeclampsia by about 60%. Recording of maternal history and blood pressure are part of routine prenatal care, but measurement of uterine artery pulsatility index and placental growth factor require additional costs. ⋯ Two-stage screening and biomarker testing for only part of the population will have financial benefits over conducting the test for the entire population.