American journal of obstetrics and gynecology
-
Am. J. Obstet. Gynecol. · Mar 2020
Meta AnalysisThe impact of occupational activities during pregnancy on pregnancy outcomes: a systematic review and metaanalysis.
Data: An increasing number of studies suggest that exposure to physically demanding work during pregnancy could be associated with increased risks of adverse pregnancy outcomes, but the results remain conflicted and inconclusive. The purpose of this study was to examine the influence of occupational activities during pregnancy on maternal and fetal health outcomes. ⋯ Physically demanding work during pregnancy is associated with an increased risk of adverse pregnancy outcomes.
-
Am. J. Obstet. Gynecol. · Mar 2020
The impact of maternal prepregnancy impaired fasting glucose on preterm birth and large for gestational age: a large population-based cohort study.
The impact of maternal prepregnancy impaired fasting glucose on preterm birth and large for gestational age has been poorly understood. ⋯ Our data suggest that maternal prepregnancy impaired fasting glucose increases the risk of preterm birth, large for gestational age, and severe large for gestational age. Data also suggest that the World Health Organization cut point of impaired fasting glucose is too restrictive, and lower levels of fasting glucose also increase the risk of large for gestational age and severe for severe gestational age in the Chinese population. Further investigation is warranted to determine whether and how counseling and interventions for women with prepregnancy impaired fasting glucose could reduce the risk of preterm birth and large for gestational age.
-
Am. J. Obstet. Gynecol. · Feb 2020
Outcomes following a clinical algorithm allowing for delayed hysterectomy in the management of severe placenta accreta spectrum.
The incidence of placenta accreta spectrum is rising. Management is most commonly with cesarean hysterectomy. These deliveries often are complicated by massive hemorrhage, urinary tract injury, and admission to the intensive care unit. Up to 60% of patients require transfusion of ≥4 units of packed red blood cells. There is also a significant risk of death of up to 7%. ⋯ Delayed hysterectomy may represent a strategy for minimizing the degree of hemorrhage and need for massive blood transfusion in patients with an antenatal diagnosis of placenta percreta by allowing time for uterine blood flow to decrease and for the placenta to regress from surrounding structures.
-
Am. J. Obstet. Gynecol. · Jan 2020
Should women with gestational diabetes be screened at delivery hospitalization for type 2 diabetes?
Less than one-half of women with gestational diabetes mellitus are screened for type 2 diabetes postpartum. Other approaches to postpartum screening need to be evaluated, including the role of screening during the delivery hospitalization. ⋯ A normal oral glucose tolerance test during the delivery hospitalization appears to exclude postpartum type 2 diabetes mellitus. However, the results of the immediate postpartum oral glucose tolerance test were mixed when including impaired fasting glucose or impaired glucose tolerance. As a majority of women do not return for postpartum diabetic screening, an oral glucose tolerance test during the delivery hospitalization may be of use in certain circumstances in which postpartum follow-up is challenging and resources could be focused on women with an abnormal screening immediately after the delivery hospitalization.
-
Am. J. Obstet. Gynecol. · Jan 2020
Amniotic fluid embolism: principles of early clinical management.
Amniotic fluid embolism is an uncommon, but potentially lethal, complication of pregnancy. Because amniotic fluid embolism usually is seen with cardiac arrest, the initial immediate response should be to provide high-quality cardiopulmonary resuscitation. We describe key features of initial treatment of patients with amniotic fluid embolism. ⋯ Blood pressure support with vasopressors is preferred over fluid infusion in the setting of severe right ventricular compromise. Amniotic fluid embolism-related coagulopathy should be managed with hemostatic resuscitation with the use of a 1:1:1 ratio of packed red cells, fresh frozen plasma, and platelets (with cryoprecipitate as needed to maintain a serum fibrinogen of >150-200 mg/dL). In cases that require prolonged cardiopulmonary resuscitation or, after arrest, severe ventricular dysfunction refractory to medical management, consideration for venoarterial extracorporeal membrane oxygenation should be given.