American journal of perinatology
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We evaluated acute neonatal morbidities in the delivery room associated with primary cesarean performed prior to labor and in the first or second stages of labor. A retrospective cohort study was conducted on subjects undergoing term, primary cesareans at the Women's Pavilion, Miller Children's Hospital in Long Beach, California from 2000 to 2007. Acute neonatal morbidities were tabulated as a function of time during labor when cesarean was performed. ⋯ Composite neonatal morbidity was not significantly different among the stages. Acute neonatal morbidities were not affected by the presence or absence of labor. Potential long-term sequelae require further study.
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Hypertensive disorders in pregnancy constitute one of the most frequent medical complications during gestation. Unfortunately, maternal and perinatal mortality remains significant worldwide in this population. Not infrequently, patients with severe preeclampsia will need parenteral agents to achieve rapid blood pressure control to avoid end-organ damage. ⋯ Nicardipine has been used extensively in different clinical settings including neurosurgery, cardiothoracic surgery, transplant medicine, and internal medicine patients. Minimal data exist in the literature regarding the use of this medicine during pregnancy. The purpose of this article is to review the pharmacological properties of nicardipine, the available literature regarding its use during pregnancy, and potential interactions with other medicines used commonly in preeclampsia, as well as potential side effects directly affecting the peripartum period.
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Intrauterine closure of the fetal ductus arteriosus is a rare but serious condition. It can lead to congestive heart failure, fetal hydrops, and fetal death. ⋯ Postnatal therapies aimed at pulmonary hypertension or with medications that maintain the patency of the ductus arteriosus are variably successful. We present the neonatal course of a full-term neonate with severe pulmonary hypertension and intrauterine closure of the ductus arteriosus who survived to early infancy.
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Fetal tachycardia caused by the transplacental passage of thyroid stimulating immunoglobulin is well established, but very little information exists regarding the fetal heart rate appearance of this form of tachycardia. Two cases of fetal tachycardia are described in pregnancies complicated by fetal thyrotoxicosis where maternal thyroid history was unknown at the time of testing. ⋯ The tracings were essentially normal except for the baseline rate. When reviewing the differential for fetal tachycardia presenting in the antenatal period, this pattern is unique to fetal thyrotoxicosis, especially if the mother is afebrile and there is no history of medication usage that could explain this presentation.
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Comparative Study
Scheduled cesarean delivery: maternal and neonatal risks in primiparous women in a community hospital setting.
We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). ⋯ The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications.