American journal of obstetrics and gynecology
-
Am. J. Obstet. Gynecol. · Oct 2015
ReviewUsing ultrasound in the clinical management of placental implantation abnormalities.
Placental implantation abnormalities, including placenta previa, placenta accreta, vasa previa, and velamentous cord insertion, can have catastrophic consequences for both mother and fetus, especially as pregnancy progresses to term. In these situations, current recommendations for management usually call for an indicated preterm delivery even in asymptomatic patients. However, the recommended gestational age(s) for delivery in asymptomatic patients are empirically determined without consideration of the recent literature regarding the usefulness of specific ultrasound findings to help individualize management. The purpose of this article is to propose literature-supported guidelines to the current opinion-based management of asymptomatic patients with placental implantation abnormalities based on relevant and specific ultrasound findings such as cervical length, distance between the internal cervical os and placenta, and placental edge thickness.
-
Am. J. Obstet. Gynecol. · Oct 2015
Congenital diaphragmatic hernia: does gestational age at diagnosis matter when evaluating morbidity and mortality?
The objective of the investigation was to study the relationship between gestational age at diagnosis and mortality and morbidity in fetuses with an isolated congenital diaphragmatic hernia. ⋯ Gestational age at diagnosis is an independent predictor of postnatal prognosis for children presenting an isolated congenital diaphragmatic hernia and should be taken into account when estimating postnatal morbidity and mortality.
-
Am. J. Obstet. Gynecol. · Oct 2015
Serious maternal complications after early preterm delivery (24-33 weeks' gestation).
We sought to describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route, and type of cesarean incision. ⋯ The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection, and intensive care unit admission for early preterm births requiring cesarean delivery.
-
Am. J. Obstet. Gynecol. · Oct 2015
Do laborists improve delivery outcomes for laboring women in California community hospitals?
We sought to determine the impact of the laborist staffing model on cesarean rates and maternal morbidity in California community hospitals. ⋯ We were unable to demonstrate differences in cesarean and maternal childbirth complication rates in community hospitals with and without laborists. Further efforts are needed to understand how the laborist staffing model contributes to neonatal outcomes, cost and efficiency of care, and patient and physician satisfaction.
-
Am. J. Obstet. Gynecol. · Oct 2015
Postpartum contraceptive use among women with a recent preterm birth.
The objective of the study was to evaluate the associations between postpartum contraception and having a recent preterm birth. ⋯ During contraceptive counseling with women who had recent preterm births, providers should address an optimal pregnancy interval and consider that women with recent extreme preterm birth, particularly those whose infants died, may not use contraception because they want to get pregnant.