American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Oct 2013
Randomized Controlled Trial Comparative StudyExtraperitoneal versus transperitoneal cesarean section: a prospective randomized comparison of surgical morbidity.
We sought to test the hypothesis that an extraperitoneal cesarean section (ECS) technique reduces postoperative pain without increasing intraoperative and postoperative complications. ⋯ An extraperitoneal approach to cesarean section appears to reduce postoperative pain, usage of analgesics, and intraoperative nausea without an increase in significant complications.
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Am. J. Obstet. Gynecol. · Oct 2013
Implementing an obstetric triage acuity scale: interrater reliability and patient flow analysis.
A 5-category Obstetric Triage Acuity Scale (OTAS) was developed with a comprehensive set of obstetrical determinants. The objectives of this study were as follows: (1) to test the interrater reliability of OTAS and (2) to determine the distribution of patient acuity and flow by OTAS level. To test the interrater reliability, 110 triage charts were used to generate vignettes and the consistency of the OTAS level assigned by 8 triage nurses was measured. ⋯ The percentage of patients admitted to the antenatal or birthing unit decreased from 80% (OTAS 1) to 12% (OTAS 5). OTAS provides a reliable assessment of acuity and its implementation has allowed for triaging of obstetric patients based on acuity, and a more in-depth assessment of the patient flow. By standardizing assessment, OTAS allows for opportunities to improve performance and make comparisons of patient care and flow across organizations.
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Am. J. Obstet. Gynecol. · Oct 2013
The risk of stillbirth and infant death by each additional week of expectant management stratified by maternal age.
The objective of the study was to examine fetal/infant mortality by gestational age at term stratified by maternal age. ⋯ Risk varies by maternal age, and delivery at 39 weeks minimizes fetal/infant mortality for both groups, although the magnitude of the risk reduction is greater in older women.
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Am. J. Obstet. Gynecol. · Oct 2013
Meta Analysis Comparative StudyLaparoendoscopic single-site versus conventional laparoscopic gynecologic surgery: a metaanalysis of randomized controlled trials.
To assess the current evidence regarding the efficiency, safety, and potential advantages of laparoendoscopic single-site surgery (LESS) for treating gynecologic diseases. ⋯ This metaanalysis provides evidence that LESS is comparable in the efficacy and safety, but does not offer potential advantage such as better cosmesis and lesser pain compared with CL for treating gynecologic diseases.
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Am. J. Obstet. Gynecol. · Oct 2013
ReviewEvidence-based surgery for cesarean delivery: an updated systematic review.
The objective of our systematic review was to provide updated evidence-based guidance for surgical decisions during cesarean delivery (CD). We performed an English-language MEDLINE, PubMed, and COCHRANE search with the terms, cesarean section, cesarean delivery, cesarean, pregnancy, and randomized trials, plus each technical aspect of CD. Randomized control trials (RCTs) involving any aspect of CD technique from Jan. 1, 2005, to Sept. 1, 2012, were evaluated to update a previous systematic review. ⋯ Recommendations with high levels of certainty as defined by the US Preventive Services Task Force favor pre-skin incision prophylactic antibiotics, cephalad-caudad blunt uterine extension, spontaneous placental removal, surgeon preference on uterine exteriorization, single-layer uterine closure when future fertility is undesired, and suture closure of the subcutaneous tissue when thickness is 2 cm or greater and do not favor manual cervical dilation, subcutaneous drains, or supplemental oxygen for the reduction of morbidity from infection. The technical aspect of CD with high-quality, evidence-based recommendations should be adopted. Although 73 RCTs over the past 8 years is encouraging, additional well-designed, adequately powered trials on the specific technical aspects of CD are warranted.