Obstetrics and gynecology
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Obstetrics and gynecology · May 2010
Evaluating risk-adjusted cesarean delivery rate as a measure of obstetric quality.
To validate the risk-adjusted cesarean delivery rate as a measure of obstetric quality through its association with maternal and neonatal outcomes for all pregnancies (model 1) and in primiparous patients with singleton pregnancies (model 2). ⋯ Lower-than-expected risk-adjusted cesarean delivery rates in all patients or when restricted to a more homogeneous group of primiparous patients with term singleton pregnancies are associated with higher-than-expected adverse maternal or neonatal outcomes. Higher-than-expected risk-adjusted cesarean delivery rates do not result in improved outcomes.
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Obstetrics and gynecology · May 2010
First-trimester vaginal bleeding and complications later in pregnancy.
To evaluate the association of first-trimester bleeding without miscarriage and complications later in the first pregnancy as well as in the next pregnancy. ⋯ Women with first-trimester bleeding in the first pregnancy have an increased risk of complications later in the first pregnancy and of recurrence of first-trimester bleeding and other complications in the second pregnancy.
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To estimate the incidence of amniotic-fluid embolism and to describe risk factors, management, and outcomes. ⋯ High-quality supportive care can result in good maternal outcomes after amniotic-fluid embolism. Clinicians should consider both the risks and benefits of induction and cesarean delivery because more restricted use may result in a decrease in the number of women suffering a potentially fatal amniotic-fluid embolism. The observed increased risk of fatality in ethnic-minority women may be associated with differences in underlying medical conditions or access to care, and clinicians should that ensure appropriate services are provided to minimize this risk.
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Obstetrics and gynecology · May 2010
Factors associated with cesarean delivery in nulliparous women with type 1 diabetes.
To identify factors associated with cesarean delivery in nulliparous women with type 1 diabetes mellitus. ⋯ The rate of cesarean delivery in nulliparous women with type 1 diabetes mellitus is very high. Prepregnancy body weight, gestational weight gain, and accuracy of the prediction of fetal macrosomia are potentially modifiable risk factors for cesarean delivery.