American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Oct 2016
Review Meta AnalysisFetal fibronectin testing for prevention of preterm birth in singleton pregnancies with threatened preterm labor: a systematic review and metaanalysis of randomized controlled trials.
Fetal fibronectin is an extracellular matrix glycoprotein that is produced by amniocytes and cytotrophoblasts and has been shown to predict spontaneous preterm birth. ⋯ Fetal fibronectin testing in singleton gestations with threatened preterm labor is not associated with the prevention of preterm birth or improvement in perinatal outcome but is associated with higher costs.
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Am. J. Obstet. Gynecol. · Oct 2016
Randomized Controlled Trial Multicenter StudyLateral asymmetric decubitus position for the rotation of occipito-posterior positions: multicenter randomized controlled trial EVADELA.
Fetal occiput posterior positions are associated with poorer maternal outcomes than occiput anterior positions. Although methods that include instrumental and manual rotation can be used at the end of labor to promote the rotation of the fetal head, various maternal postures may also be performed from the beginning of labor in occiput posterior position. Such postures might facilitate flexion of the fetal head and favor its rotation into an occiput anterior position. ⋯ Lateral asymmetric decubitus position on the side opposite that of the fetal spine did not facilitate rotation of fetal head. Nevertheless, other maternal positions may be effective in promoting fetal head rotation. Further research is needed; posturing during labor, nonetheless, should remain a woman's active choice.
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Am. J. Obstet. Gynecol. · Oct 2016
Implementation of universal screening for depression during pregnancy: feasibility and impact on obstetric care.
Given the growing policy and public health interest in the identification and treatment of depression in pregnancy, an understanding of the feasibility, challenges, and implications for resource utilization of the implementation of a universal screening program is crucial. ⋯ This study demonstrates the feasibility of universal depression screening during both the antepartum and postpartum periods with the use of the Edinburgh Postnatal Depression Scale as an initial screen followed by mental health referral for further diagnostic evaluation and treatment. The population of women who screened positive and who accepted additional services differed at the 2 time points, which reinforces the utility of screening during both the antepartum and postpartum periods. Although universal screening for depression is feasible, further study of the barriers to mental health evaluation and treatment and the impact of treatment on obstetric outcomes are needed.
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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.