American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Oct 2016
Randomized Controlled Trial Multicenter StudyOmission of fetal sampling in treatment of subsequent pregnancies in fetal-neonatal alloimmune thrombocytopenia.
Fetal-neonatal alloimmune thrombocytopenia affects approximately 1 of 1000 live births, most of which are not severely thrombocytopenic. Despite effective treatment with intravenous gammaglobulin and/or prednisone, antenatal management of a subsequent affected pregnancy is complicated by the risks associated with fetal blood sampling. Furthermore, there are no biomarker(s) of high risk other than the occurrence of intracranial hemorrhage in a previous sibling. Management of these high-risk pregnancies requires intensive treatment initiated at 12 weeks of gestation. ⋯ The 2 recommended protocols of intensive initial treatment followed by empiric escalation of therapy at 32 weeks of gestation are reasonably safe, effective in increasing fetal platelet counts, and allow omission of fetal blood sampling by increasing the fetal platelet count in almost all cases.
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Am. J. Obstet. Gynecol. · Oct 2016
Quantitative fetal fibronectin and cervical length to predict preterm birth in asymptomatic women with previous cervical surgery.
Quantitative fetal fibronectin testing has demonstrated accuracy for prediction of spontaneous preterm birth in asymptomatic women with a history of preterm birth. Predictive accuracy in women with previous cervical surgery (a potentially different risk mechanism) is not known. ⋯ Prediction of spontaneous preterm birth using cervicovaginal fluid quantitative fetal fibronectin in asymptomatic women with cervical surgery is valid, and has comparative accuracy to that in women with a history of spontaneous preterm birth.
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Am. J. Obstet. Gynecol. · Oct 2016
Childhood abuse and suicidal ideation in a cohort of pregnant Peruvian women.
Childhood abuse is a major global and public health problem associated with a myriad of adverse outcomes across the life course. Suicide is one of the leading causes of mortality during the perinatal period. However, few studies have assessed the relationship between experiences of childhood abuse and suicidal ideation in pregnancy. ⋯ Maternal history of childhood abuse was associated with increased odds of antepartum suicidal ideation. It is important for clinicians to be aware of the potential increased risk of suicidal behaviors among pregnant women with a history of childhood physical and sexual abuse.
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Am. J. Obstet. Gynecol. · Oct 2016
Maternal and neonatal outcomes of attempted vaginal compared with planned cesarean delivery in triplet gestations.
The prevailing obstetric practice of planned cesarean delivery for triplet gestations is largely empiric and data on the optimal route of delivery are limited. ⋯ In a multicenter US cohort, attempted vaginal delivery of triplets is associated with higher risks of maternal transfusion and neonatal mechanical ventilation. Composite severe neonatal morbidity may be higher with attempted vaginal delivery although studies with greater power are required. The low probability of successful vaginal delivery raises questions regarding the utility of attempted vaginal delivery in triplet gestations. Our data support planned prelabor cesarean delivery as the preferred mode of delivery for triplet gestations.
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Am. J. Obstet. Gynecol. · Oct 2016
Review Meta AnalysisSafety of ovarian preservation in women with stage I and II cervical adenocarcinoma: a retrospective study and meta-analysis.
The safety of ovarian preservation remains uncertain in women with cervical adenocarcinoma and significant risk factors for ovarian metastases vary among different studies. ⋯ Ovarian preservation has no effect on prognosis in women with early-stage cervical adenocarcinoma. Risk factors for ovarian metastases were stage IIB, deep cervical stromal invasion, lymph node metastasis, corpus uteri invasion, and parametrial invasion. In women with early-stage cervical adenocarcinoma without these risk factors, ovarian conservation can be considered.