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ACOG PRACTICE BULLETIN NUMBER 106, JULY 2009
Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles
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Intrapartum_Fetal_Heart_Rate_Monitoring_Nomenclature__Interpretation__and_General_Management_Princip
In the most recent year for which data are available, approximately 3.4 million
fetuses (85% of approximately 4 million live births) in the United States were
assessed with electronic fetal monitoring (EFM), making it the most common
obstetric procedure (1). Despite its widespread use, there is controversy about
the efficacy of EFM, interobserver and intraobserver variability, nomenclature,
systems for interpretation, and management algorithms. Moreover, there is evidence
that the use of EFM increases the rate of cesarean deliveries and operative
vaginal deliveries. The purpose of this document is to review nomenclature
for fetal heart rate assessment, review the data on the efficacy of EFM, delineate
the strengths and shortcomings of EFM, and describe a system for EFM
classification.
Wednesday, September 2, 2009
MEDICAL EBOOK DOWNLOAD, ACOG PRACTICE BULLETIN NUMBER 106, JULY 2009, Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles
MEDICAL EBOOK DOWNLOAD, American Journal of Obstetrics & Gynecology AUGUST 2009, The future of intrapartum care: navigating the perfect storm—an obstetrician’s odyssey
MEDICAL EBOOK DOWNLOAD
American Journal of Obstetrics & Gynecology AUGUST 2009
The future of intrapartum care: navigating the perfect storm—an obstetrician’s odyssey
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The_future_of_intrapartum_care_navigating_the_perfect_storm___an_obstetrician___s_odyssey.pdf
American Journal of Obstetrics & Gynecology AUGUST 2009
The future of intrapartum care: navigating the perfect storm—an obstetrician’s odyssey
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The_future_of_intrapartum_care_navigating_the_perfect_storm___an_obstetrician___s_odyssey.pdf
MEDICAL EBOOK DOWNLOAD, American Journal of Obstetrics & Gynecology AUGUST 2009, Safety of late second-trimester pregnancy termination by laminaria dilatation and evacuation in patients with previous multiple cesarean sections
MEDICAL EBOOK DOWNLOAD
American Journal of Obstetrics & Gynecology AUGUST 2009
Safety of late second-trimester pregnancy termination by laminaria dilatation and evacuation in patients with previous multiple cesarean sections
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Safety_of_late_second-trimester_pregnancy_termination_by_laminaria_dilatation_and_evacuation_in_pati
OBJECTIVE: To assess whether there is an increased perioperative risk
in termination of late second-trimester pregnancy after multiple cesarean
sections by laminaria dilatation and evacuation.
STUDY DESIGN: During the period between January 2002 and June
2008, 636 consecutive patients underwent late second-trimester
(17-24 weeks) pregnancy terminations by dilatation and evacuation.
Patients were divided into 3 subgroups: those with no previous
cesarean section (n = 545), those with 1 previous cesarean
section (n = 59), and those with several previous cesarean sections
(n = 32).
RESULTS: There were no significant differences in major perioperative
complications, such as anesthetic complications, need for blood transfusion,
and cervical lacerations comparing the 3 subgroups. Importantly,
there were neither cases of uterine perforation nor retained products
of conception in the 3 subgroups.
CONCLUSION: Late second-trimester pregnancy termination after multiple
cesarean sections by laminaria dilatation and evacuation is probably
not associated with an increased perioperative risk. Larger studies
are needed to empower this study.
Key words: cesarean section, dilatation and evacuation, late
abortion, scarred uterus
American Journal of Obstetrics & Gynecology AUGUST 2009
Safety of late second-trimester pregnancy termination by laminaria dilatation and evacuation in patients with previous multiple cesarean sections
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Safety_of_late_second-trimester_pregnancy_termination_by_laminaria_dilatation_and_evacuation_in_pati
OBJECTIVE: To assess whether there is an increased perioperative risk
in termination of late second-trimester pregnancy after multiple cesarean
sections by laminaria dilatation and evacuation.
STUDY DESIGN: During the period between January 2002 and June
2008, 636 consecutive patients underwent late second-trimester
(17-24 weeks) pregnancy terminations by dilatation and evacuation.
Patients were divided into 3 subgroups: those with no previous
cesarean section (n = 545), those with 1 previous cesarean
section (n = 59), and those with several previous cesarean sections
(n = 32).
RESULTS: There were no significant differences in major perioperative
complications, such as anesthetic complications, need for blood transfusion,
and cervical lacerations comparing the 3 subgroups. Importantly,
there were neither cases of uterine perforation nor retained products
of conception in the 3 subgroups.
CONCLUSION: Late second-trimester pregnancy termination after multiple
cesarean sections by laminaria dilatation and evacuation is probably
not associated with an increased perioperative risk. Larger studies
are needed to empower this study.
Key words: cesarean section, dilatation and evacuation, late
abortion, scarred uterus
MEDICAL EBOOK DOWNLOAD, American Journal of Obstetrics & Gynecology AUGUST 2009, Discontinuation of antihypertensive drug use during the first trimester of pregnancy and the risk of preeclampsia and eclampsia among women with chronic hypertension
MEDICAL EBOOK DOWNLOAD
American Journal of Obstetrics & Gynecology AUGUST 2009
Discontinuation of antihypertensive drug use during the first trimester of pregnancy and the risk of preeclampsia and eclampsia among women with chronic hypertension
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Discontinuation_of_antihypertensive_drug_use_during_the_first_trimester_of_pregnancy_and_the_risk_of
OBJECTIVE: The goal of this study was to investigate the association
between the discontinuation of antihypertensive medication use during
the first trimester of pregnancy and the risk of preeclampsia and
eclampsia.
STUDY DESIGN: We conducted a nested case-control approach
within a cohort that was reconstructed from the linkage of 3 databases.
To be included in the study, women had to match the following
criteria: (1) between 15-45 years old on the first day of
gestation, (2) covered by Québec’s Drug Insurance Plan for at least
12 months before and during pregnancy, (3) exposed to an antihypertensive
drug on the first day of gestation, and (4) have had a delivery. Multivariate conditional logistic regression models were used to estimate the risk.
RESULTS: Adjusting for confounders, the odds ratio was 0.66; 95%
confidence interval, 0.27-1.56.
CONCLUSION: Our finding does not support the presence of a statistically
significant association between antihypertensive discontinuation
during the first trimester of pregnancy and the risk of
preeclampsia and eclampsia.
Key words: antihypertensive drug discontinuation, chronic
hypertension, eclampsia, preeclampsia, pregnancy
American Journal of Obstetrics & Gynecology AUGUST 2009
Discontinuation of antihypertensive drug use during the first trimester of pregnancy and the risk of preeclampsia and eclampsia among women with chronic hypertension
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Discontinuation_of_antihypertensive_drug_use_during_the_first_trimester_of_pregnancy_and_the_risk_of
OBJECTIVE: The goal of this study was to investigate the association
between the discontinuation of antihypertensive medication use during
the first trimester of pregnancy and the risk of preeclampsia and
eclampsia.
STUDY DESIGN: We conducted a nested case-control approach
within a cohort that was reconstructed from the linkage of 3 databases.
To be included in the study, women had to match the following
criteria: (1) between 15-45 years old on the first day of
gestation, (2) covered by Québec’s Drug Insurance Plan for at least
12 months before and during pregnancy, (3) exposed to an antihypertensive
drug on the first day of gestation, and (4) have had a delivery. Multivariate conditional logistic regression models were used to estimate the risk.
RESULTS: Adjusting for confounders, the odds ratio was 0.66; 95%
confidence interval, 0.27-1.56.
CONCLUSION: Our finding does not support the presence of a statistically
significant association between antihypertensive discontinuation
during the first trimester of pregnancy and the risk of
preeclampsia and eclampsia.
Key words: antihypertensive drug discontinuation, chronic
hypertension, eclampsia, preeclampsia, pregnancy
MEDICAL EBOOK DOWNLOAD, American Journal of Obstetrics & Gynecology AUGUST 2009, Uterine artery Doppler flow studies in obstetric practice
MEDICAL EBOOK DOWNLOAD
American Journal of Obstetrics & Gynecology AUGUST 2009
Uterine artery Doppler flow studies in obstetric practice
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Uterine_artery_Doppler_flow_studies_in_obstetric_practice.pdf
The advent of sonography has changed the practice of obstetrics by providing a window
to the womb through which the anatomic structure of the fetus can be evaluated. The
addition of Doppler flow studies of maternal and fetal vessels has provided a tool where
the physiology of the maternal-fetal unit can be assessed. This information can provide
the physician and the patient with vital information for a subsequent approach to the
pregnancy. The use of fetal Doppler blood flow studies has become common in the
evaluation and management of pregnancies complicated by conditions such as suspected
fetal growth restriction and red blood cell isoimmunization to guide intrauterine therapy
and delivery. The most commonly assessed Doppler flow studies of the fetus are the
umbilical artery and middle cerebral artery (MCA). Doppler flow studies of the MCA are
used in the assessment of the fetus at risk for anemia and growth-restricted fetus. Doppler
flow studies of the umbilical artery can reflect abnormalities in “down-stream” or the fetal
side of placental resistance, and the assessment of the maternal vasculature evaluates
“up-stream” blood flow or the maternal side of placental resistance. The purpose of this
review is to describe the clinical utility of uterine artery Doppler flow studies in the
prediction of adverse pregnancy outcomes in low and high risk populations.
Key words: Doppler, fetal growth restriction, middle cerebral artery, pregnancy
American Journal of Obstetrics & Gynecology AUGUST 2009
Uterine artery Doppler flow studies in obstetric practice
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Uterine_artery_Doppler_flow_studies_in_obstetric_practice.pdf
The advent of sonography has changed the practice of obstetrics by providing a window
to the womb through which the anatomic structure of the fetus can be evaluated. The
addition of Doppler flow studies of maternal and fetal vessels has provided a tool where
the physiology of the maternal-fetal unit can be assessed. This information can provide
the physician and the patient with vital information for a subsequent approach to the
pregnancy. The use of fetal Doppler blood flow studies has become common in the
evaluation and management of pregnancies complicated by conditions such as suspected
fetal growth restriction and red blood cell isoimmunization to guide intrauterine therapy
and delivery. The most commonly assessed Doppler flow studies of the fetus are the
umbilical artery and middle cerebral artery (MCA). Doppler flow studies of the MCA are
used in the assessment of the fetus at risk for anemia and growth-restricted fetus. Doppler
flow studies of the umbilical artery can reflect abnormalities in “down-stream” or the fetal
side of placental resistance, and the assessment of the maternal vasculature evaluates
“up-stream” blood flow or the maternal side of placental resistance. The purpose of this
review is to describe the clinical utility of uterine artery Doppler flow studies in the
prediction of adverse pregnancy outcomes in low and high risk populations.
Key words: Doppler, fetal growth restriction, middle cerebral artery, pregnancy
MEDICAL EBOOK DOWNLOAD, American Journal of Obstetrics & Gynecology AUGUST 2009, Emergency contraceptive use as a marker of future risky sex, pregnancy, and sexually transmitted infection
American Journal of Obstetrics & Gynecology AUGUST 2009,
Emergency contraceptive use as a marker of future risky sex, pregnancy, and sexually transmitted infection
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Emergency_contraceptive_use_as_a_marker_of_future_risky_sex__pregnancy__and_sexually_transmitted_inf
OBJECTIVE: The objective of the study was to examine whether emergency
contraceptive use predicts future sex at risk for pregnancy, pregnancy,
or sexually transmitted infection among young women.
STUDY DESIGN: A secondary analysis of control group participants
(n:718) from a recent trial of advanced provision of emergency
contraception was conducted.
RESULTS: We found no association between use of emergency contraception
and either pregnancy or infection. Recent use predicted decreased
occurrence of subsequent sex at risk for pregnancy among
women with a history of sexually transmitted infection (relative risk
[RR], 0.39; 95% confidence interval [CI], 0.15-0.97), whereas ever
having used predicted increased occurrence among women who either
were highly effective method users (RR, 1.45; 95% CI, 1.05-2.01) or
had no history of sexually transmitted infection (RR, 1.31; 95% CI,
1.04-1.65).
CONCLUSION: Information about prior emergency contraceptive use
was not a useful predictor of subsequent pregnancy, infection, or sex at
risk for pregnancy among these young women.
Key words: adolescent, postcoital contraception, pregnancy,
reproductive health care, sexually transmitted infections
Cite this article as: Sander PM, Raymond EG, Weaver MA. Emergency contraceptive use as a marker of future risky sex, pregnancy, and sexually transmitted
infection. Am J Obstet Gynecol 2009;201:146.e1-6.
Emergency contraceptive use as a marker of future risky sex, pregnancy, and sexually transmitted infection
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Emergency_contraceptive_use_as_a_marker_of_future_risky_sex__pregnancy__and_sexually_transmitted_inf
OBJECTIVE: The objective of the study was to examine whether emergency
contraceptive use predicts future sex at risk for pregnancy, pregnancy,
or sexually transmitted infection among young women.
STUDY DESIGN: A secondary analysis of control group participants
(n:718) from a recent trial of advanced provision of emergency
contraception was conducted.
RESULTS: We found no association between use of emergency contraception
and either pregnancy or infection. Recent use predicted decreased
occurrence of subsequent sex at risk for pregnancy among
women with a history of sexually transmitted infection (relative risk
[RR], 0.39; 95% confidence interval [CI], 0.15-0.97), whereas ever
having used predicted increased occurrence among women who either
were highly effective method users (RR, 1.45; 95% CI, 1.05-2.01) or
had no history of sexually transmitted infection (RR, 1.31; 95% CI,
1.04-1.65).
CONCLUSION: Information about prior emergency contraceptive use
was not a useful predictor of subsequent pregnancy, infection, or sex at
risk for pregnancy among these young women.
Key words: adolescent, postcoital contraception, pregnancy,
reproductive health care, sexually transmitted infections
Cite this article as: Sander PM, Raymond EG, Weaver MA. Emergency contraceptive use as a marker of future risky sex, pregnancy, and sexually transmitted
infection. Am J Obstet Gynecol 2009;201:146.e1-6.
MEDICAL EBOOK DOWNLOAD,American Journal of Obstetrics Gynecology First-trimester maternal serum screening and the risk for fetal distress during labor
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First-trimester_maternal_serum_screening_and_the_risk_for_fetal_distress_during_labor.pdf
Title: First-trimester maternal serum screening and the risk for fetal distress during labor
Source: American Journal of Obstetrics & Gynecology. 201(2):166e1-166e6, August 2009.
Abstract
Abstract
OBJECTIVE: The purpose of this study was to assess whether low pregnancy-associated plasma protein-A (PAPP-A) levels in the first trimester are related to the risk of emergency cesarean section delivery (CS) for fetal distress during labor and fetal intrapartum acidemia.
STUDY DESIGN: We prospectively studied patients who requested first-trimester biochemical screening for Down syndrome.
RESULTS: Among the 1037 women who were enrolled, 152 women (14.7%) had a low first-trimester PAPP-A value, and 855 women (85.3%) had a normal first-trimester PAPP-A value. Excluding elective CS, 19 of 117 women (16.2%) with low PAPP-A values vs 59 of 749 women (7.9%) with normal PAPP-A values underwent CS for concerning fetal status during labor (P = .003; odds ratio, 2.27; 95% confidence interval, 1.30-3.97). This difference remained significant after correction for possible confounders (hypertension, preterm delivery, small for gestational age, labor induction). Among these 78 women, umbilical artery pH was significantly lower in fetuses from mothers with low vs normal PAPP-A values (pH = 7.19 [range, 6.95-7.39] vs pH = 7.26 [range, 7.02-7.39]; P = .022).
CONCLUSION: Low PAPP-A levels at first-trimester screening are associated independently with higher rates of emergency CS for nonreassuring fetal status during labor and lower pH.
(C) Mosby-Year Book Inc. 2009. All Rights Reserved.
STUDY DESIGN: We prospectively studied patients who requested first-trimester biochemical screening for Down syndrome.
RESULTS: Among the 1037 women who were enrolled, 152 women (14.7%) had a low first-trimester PAPP-A value, and 855 women (85.3%) had a normal first-trimester PAPP-A value. Excluding elective CS, 19 of 117 women (16.2%) with low PAPP-A values vs 59 of 749 women (7.9%) with normal PAPP-A values underwent CS for concerning fetal status during labor (P = .003; odds ratio, 2.27; 95% confidence interval, 1.30-3.97). This difference remained significant after correction for possible confounders (hypertension, preterm delivery, small for gestational age, labor induction). Among these 78 women, umbilical artery pH was significantly lower in fetuses from mothers with low vs normal PAPP-A values (pH = 7.19 [range, 6.95-7.39] vs pH = 7.26 [range, 7.02-7.39]; P = .022).
CONCLUSION: Low PAPP-A levels at first-trimester screening are associated independently with higher rates of emergency CS for nonreassuring fetal status during labor and lower pH.
(C) Mosby-Year Book Inc. 2009. All Rights Reserved.
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