American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Dec 2019
First stage of labor progression in women with large-for-gestational age infants.
Women with suspected large-for-gestational age fetuses have higher rates of dysfunctional labor and labor arrest diagnoses and, consequently, higher rates of cesarean deliveries. The identification of the factors that significantly affect labor progression of women with large-for-gestational age infants may better inform expected duration of labor for certain subgroups of this population. ⋯ After 3-cm cervical dilation, the time required to reach the second stage of labor is greater in women with large-for-gestational age infants compared with those with appropriate-for-gestational age infants; these differences are most pronounced in nulliparous and obese women with large-for-gestational age infants in the active phase of labor (6-10 cm). Among women with large-for-gestational age infants, labor onset and presence of diabetes mellitus or gestational diabetes mellitus have no apparent effect on the duration of the first stage of labor after 3-cm cervical dilation.
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Am. J. Obstet. Gynecol. · Dec 2019
Randomized Controlled Trial Comparative StudyRandomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring.
Standard prenatal care, consisting of 12-14 visits per pregnancy, is expensive and resource intensive, with limited evidence supporting the structure, rhythm, or components of care. Some studies suggest a reduced-frequency prenatal care model is as safe as the standard model of care for low-risk pregnant women, but evidence is limited. We developed and evaluated an innovative, technology-enhanced, reduced prenatal visit model (OB Nest). ⋯ OB Nest is an innovative, acceptable, and effective reduced-frequency prenatal care model. Compared to routine prenatal care, OB Nest resulted in higher patient satisfaction and lower prenatal stress, while reducing the number of appointments with clinicians and maintaining care standards for pregnant women. This program is a step toward evidence-driven prenatal care that improves patient satisfaction.
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Am. J. Obstet. Gynecol. · Dec 2019
Outcomes of secondary cytoreductive surgery for patients with platinum-sensitive recurrent ovarian cancer.
Most women with advanced epithelial ovarian cancer develop recurrent disease, despite maximal surgical cytoreduction and adjuvant platinum-based chemotherapy. In observational studies, secondary cytoreductive surgery has been associated with improved survival; however its use is controversial, because there are concerns that the improved outcomes may reflect selection bias rather than the superiority of secondary surgery. ⋯ Patients with platinum-sensitive recurrent ovarian cancer who received secondary surgery had favorable surgical characteristics and were likely to have minimal residual disease following secondary surgery. These patients had a superior median overall survival compared with patients who received chemotherapy, although unmeasured confounders may explain this observed difference.
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Am. J. Obstet. Gynecol. · Dec 2019
Obstetric Care Consensus #9: Levels of Maternal Care: (Replaces Obstetric Care Consensus Number 2, February 2015).
Maternal mortality and severe maternal morbidity, particularly among women of color, have increased in the United States. The leading medical causes of maternal mortality include cardiovascular disease, infection, and common obstetric complications such as hemorrhage and vary by timing relative to the end of pregnancy. Although specific modifications in the clinical management of some of these conditions have been instituted, more can be done to improve the system of care for high-risk women at facility and population levels. ⋯ State and regional authorities should work together with the multiple institutions within a region, and with the input from their obstetric care providers, to determine the appropriate coordinated system of care and to implement policies that promote and support a regionalized system of care. These relationships enhance the ability of women to give birth safely in their communities while providing support for circumstances when higher level resources are needed. This document is a revision of the original 2015 Levels of Maternal Care Obstetric Care Consensus, which has been revised primarily to clarify terminology and to include more recent data based on published literature and feedback from levels of maternal care implementation.
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Am. J. Obstet. Gynecol. · Dec 2019
Prospective evaluation of screening performance of first-trimester prediction models for preterm preeclampsia in an Asian population.
The administration of aspirin <16 weeks gestation to women who are at high risk for preeclampsia has been shown to reduce the rate of preterm preeclampsia by 65%. The traditional approach to identify such women who are at risk is based on risk factors from maternal characteristics, obstetrics, and medical history as recommended by the American College of Obstetricians and Gynecologists and the National Institute for Health and Care Excellence. An alternative approach to screening for preeclampsia has been developed by the Fetal Medicine Foundation. This approach allows the estimation of patient-specific risks of preeclampsia that requires delivery before a specified gestational age with the use of Bayes theorem-based model. ⋯ Based on a large number of women, this study has demonstrated that the Fetal Medicine Foundation Bayes theorem-based model is effective in the prediction of preterm preeclampsia in an Asian population and that this method of screening is superior to the approach recommended by American College of Obstetricians and Gynecologists and the National Institute for Health and Care Excellence. We have also shown that the Fetal Medicine Foundation prediction model can be implemented as part of routine prenatal care through the use of the existing infrastructure of routine prenatal care.