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Low risk obstetrics

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https://www.readbyqxmd.com/read/28343177/gaps-in-obstetric-care-processes-we-can-only-improve-what-is-being-measured
#1
Charlotte Millde Luthander, Hans Järnbert Pettersson, Ulf Högberg, Sophie Berglund, Charlotta Grunewald
A multifaceted intervention at all six obstetric units in the Stockholm Health Region was performed in 2008-2011 in order to increase safety for the newborn infants. Case-controlled criterion-based reviews of care processes during labor and delivery have been used to assess factors associated with suboptimal care during labor and delivery. Categories of increased risk of adverse outcome during labor and delivery were defined. Cases with low Apgar scores and healthy controls were scrutinized and compared to data from a study with an identical design performed before the intervention...
March 27, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28331637/mode-of-delivery-in-drug-dependent-pregnant-women-a-case-control-study
#2
Ana Raquel Neves, Fabiane Neves, Isabel Santos Silva, Maria do Céu Almeida, Pitorra Monteiro
Objective. To determine the contribution of drug use during pregnancy to the route of delivery. Methods. A case-control study was conducted at a hospital in Coimbra, Portugal, between 2001 and 2014. Drug-dependent pregnant women (n = 236) were compared with a control group of low risk women (n = 228) in terms of maternal characteristics, obstetric history, pregnancy complications, and labor details. Factors that influenced the mode of delivery were determined. Statistical analysis was performed with SPSS v...
2017: Journal of Pregnancy
https://www.readbyqxmd.com/read/28321847/antenatal-corticosteroids-for-accelerating-fetal-lung-maturation-for-women-at-risk-of-preterm-birth
#3
REVIEW
Devender Roberts, Julie Brown, Nancy Medley, Stuart R Dalziel
BACKGROUND: Respiratory morbidity including respiratory distress syndrome (RDS) is a serious complication of preterm birth and the primary cause of early neonatal mortality and disability. While researching the effects of the steroid dexamethasone on premature parturition in fetal sheep in 1969, Liggins found that there was some inflation of the lungs of lambs born at gestations at which the lungs would be expected to be airless. Liggins and Howie published the first randomised controlled trial in humans in 1972 and many others followed...
March 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28320352/a-comparison-of-intrapartum-interventions-and-adverse-outcomes-by-parity-in-planned-freestanding-midwifery-unit-and-alongside-midwifery-unit-births-secondary-analysis-of-low-risk-births-in-the-birthplace-in-england-cohort
#4
Jennifer Hollowell, Yangmei Li, Kathryn Bunch, Peter Brocklehurst
BACKGROUND: For low risk women, there is good evidence that planned birth in a midwifery unit is associated with a reduced risk of maternal interventions compared with planned birth in an obstetric unit. Findings from the Birthplace cohort study have been interpreted by some as suggesting a reduced risk of interventions in planned births in freestanding midwifery units (FMUs) compared with planned births in alongside midwifery units (AMUs). However, possible differences have not been robustly investigated using individual-level Birthplace data...
March 21, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28319949/the-impact-of-kidney-development-on-the-life-course-a-consensus-document-for-action
#5
(no author information available yet)
Hypertension and chronic kidney disease (CKD) have a significant impact on global morbidity and mortality. The Low Birth Weight and Nephron Number Working Group has prepared a consensus document aimed to address the relatively neglected issue for the developmental programming of hypertension and CKD. It emerged from a workshop held on April 2, 2016, including eminent internationally recognized experts in the field of obstetrics, neonatology, and nephrology. Through multidisciplinary engagement, the goal of the workshop was to highlight the association between fetal and childhood development and an increased risk of adult diseases, focusing on hypertension and CKD, and to suggest possible practical solutions for the future...
March 21, 2017: Nephron
https://www.readbyqxmd.com/read/28318119/rural-hospital-employment-of-physicians-and-use-of-cesareans-and-nonindicated-labor-induction
#6
Shailendra Prasad, Peiyin Hung, Carrie Henning-Smith, Michelle Casey, Katy Kozhimannil
OBJECTIVE: Workforce issues constrain obstetric care services in rural US hospitals, and one strategy hospitals use is to employ physicians to provide obstetric care. However, little is known about the relationship between hospital employment of maternity care physicians and use of obstetric care procedures in rural hospitals. We examined the association between obstetric physician employment and use of cesareans and nonindicated labor induction. STUDY DESIGN: We conducted a cross-sectional analysis of a telephone survey of all 306 rural hospitals providing obstetric care in 9 states from November 2013 to March 2014 and linked the survey data (N = 263, 86% response rate) to all-payer childbirth data on maternity care utilization from 2013 Statewide Inpatient Database (SID) hospital discharge data...
March 20, 2017: Journal of Rural Health
https://www.readbyqxmd.com/read/28315018/influence-of-pelvic-volume-on-surgical-outcome-after-low-anterior-resection-for-rectal-cancer
#7
G Zur Hausen, J Gröne, D Kaufmann, S M Niehues, K Aschenbrenner, A Stroux, B Hamm, M E Kreis, Johannes C Lauscher
BACKGROUND: Low anterior resection (LAR) for rectal cancer is a potentially challenging operation due to limited space in the pelvis. CT pelvimetry allows to quantify pelvic space, so that its relationship with outcome after LAR may be assessed. Studies investigating this, however, yielded conflicting results. We hypothesized that a small pelvis is associated with a higher rate of incomplete mesorectal excision, anastomotic leakages, and increased rate of urinary dysfunction in patients operated for rectal cancer...
March 18, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/28303822/human-papillomavirus-and-chlamydia-trachomatis-infection-in-gyneco-obstetric-outpatients-from-a-mexican-hospital
#8
Laura Conde-Ferráez, Jorge Ramiro Carrillo Martíez, Guadalupe Ayora-Talavera, María Del Refugio González Losa
CONTEXT: Human papillomavirus (HPV) and Chlamydia trachomatis are the most frequent sexually transmitted infections, usually asymptomatic. Persistent infection with high-risk HPV types and other cofactors such as the concomitant infection with C. trachomatis can represent a higher risk to develop cervical lesions; therefore, screening with sensitive methods could aid to identify women at risk. AIMS: The aim is to determine the prevalence and concurrence of both infections, detected with in-house molecular methods, and to identify the risk factors associated to the infections in Mexican women...
January 2017: Indian Journal of Medical Microbiology
https://www.readbyqxmd.com/read/28297186/the-new-obstetrical-dilemma-stunting-obesity-and-the-risk-of-obstructed-labour
#9
Jonathan C K Wells
The "obstetrical dilemma" refers to the tight fit between maternal pelvic dimensions and neonatal size at delivery. Most interest traditionally focused on its generic significance for humans, for example our neonatal altriciality and our complex and lengthy birth process. Across contemporary populations, however, the obstetrical dilemma manifests substantial variability, illustrated by differences in the incidence of cephalo-pelvic disproportion, obstructed labour and cesarean section. Beyond accounting for 12% of maternal mortality worldwide, obstructed labour also imposes a huge burden of maternal morbidity, in particular through debilitating birth injuries...
April 2017: Anatomical Record: Advances in Integrative Anatomy and Evolutionary Biology
https://www.readbyqxmd.com/read/28286050/the-role-of-maternal-age-in-twin-pregnancy-outcomes
#10
Amelia S McLennan, Cynthia Gyamfi-Bannerman, Cande V Ananth, Jason D Wright, Zainab Siddiq, Mary E D'Alton, Alexander M Friedman
BACKGROUND: There is limited data on how maternal age is related to twin pregnancy outcomes. OBJECTIVE: To assess the relationship between maternal age and risk for preterm birth, fetal death, and neonatal death in the setting of twin pregnancy. STUDY DESIGN: This population-based study of US birth, fetal death, and period linked birth-infant death files from 2007-2013 evaluated neonatal outcomes for twin pregnancies. Maternal age was categorized as 15 to 17, 18 to 24, 25 to 29, 30 to 34, 35 to 39, and ≥40 years of age...
March 9, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28286001/understanding-high-utilization-of-unscheduled-care-in-pregnant-women-of-low-socioeconomic-status
#11
Pooja K Mehta, Tamala Carter, Cjloe Vinoya, Shreya Kangovi, Sindhu K Srinivas
BACKGROUND: Pregnant high utilizers of unscheduled care may be at particular risk for poor perinatal outcomes, but the drivers of this association have not been explored from the patient perspective. PURPOSE: We sought to understand maternal preference for unscheduled hospital-based obstetric care to inform interventions and improve value of publicly funded care during pregnancy. METHODS: We conducted a comparative qualitative analysis of in-depth semistructured interviews...
March 9, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/28284877/midwifery-continuity-of-carer-in-an-area-of-high-socio-economic-disadvantage-in-london-a-retrospective-analysis-of-albany-midwifery-practice-outcomes-using-routine-data-1997-2009
#12
Caroline Se Homer, Nicky Leap, Nadine Edwards, Jane Sandall
OBJECTIVE: in 1997, The Albany Midwifery Practice was established within King's College Hospital NHS Trust in a South East London area of high social disadvantage. The Albany midwives provided continuity of care to around 216 women per year, including those with obstetric, medical or social risk factors. In 2009, the Albany Midwifery Practice was closed in response to concerns about safety, amidst much publicity and controversy. The aim of this evaluation was to examine trends and outcomes for all mothers and babies who received care from the practice from 1997-2009...
February 27, 2017: Midwifery
https://www.readbyqxmd.com/read/28283263/impact-of-oocyte-donation-on%C3%A2-perinatal-outcome-in-twin-pregnancies
#13
Lucie Guilbaud, Pietro Santulli, Eva Studer, Vanessa Gayet, François Goffinet, Camille Le Ray
OBJECTIVE: To compare perinatal outcomes of twin pregnancies after oocyte donation (OD), in vitro fertilization (IVF) with autologous oocyte (AO), and non-IVF conception. DESIGN: Five-year retrospective cohort study. SETTING: Tertiary university medical center. PATIENT(S): All patients with twin pregnancies who gave birth after 24 weeks of gestation. The outcomes of 102 OD twin pregnancies were compared with those of 201 AO and 369 non-IVF twin pregnancies...
March 7, 2017: Fertility and Sterility
https://www.readbyqxmd.com/read/28279637/a-qualitative-exploration-of-how-midwives-and-obstetricians-perception-of-risk-affects-care-practices-for-low-risk-women-and-normal-birth
#14
Sandra Healy, Eileen Humphreys, Catriona Kennedy
BACKGROUND: Maternity care is facing increasing intervention and iatrogenic morbidity rates. This can be attributed, in part, to higher-risk maternity populations, but also to a risk culture in which birth is increasingly seen as abnormal. Technology and intervention are used to prevent perceived implication in adverse outcomes and litigation. QUESTION: Does midwives' and obstetricians' perception of risk affect care practices for normal birth and low-risk women in labour, taking into account different settings? METHODS: The research methods are developed within a qualitative framework...
March 6, 2017: Women and Birth: Journal of the Australian College of Midwives
https://www.readbyqxmd.com/read/28278227/do-children-born-to-teenage-parents-have-lower-adult-intelligence-a-prospective-birth-cohort-study
#15
Mohsina Khatun, Abdullah Al Mamun, James Scott, Gail M William, Alexandra Clavarino, Jake M Najman
Teenage motherhood has been associated with a wide variety of negative offspring outcomes including poorer cognitive development. In the context of limitations of previous research, this paper assesses the contemporary relevance of this finding. In this study we investigate the long-term cognitive status (IQ) among 21 year adult offspring born to teenage parents using the Mater University Study of Pregnancy- a prospective birth cohort study, which recruited all pregnant mothers attending a large obstetrical hospital in Brisbane, Australia, from 1981 to 1983...
2017: PloS One
https://www.readbyqxmd.com/read/28277398/testing-the-effectiveness-of-therapeutic-showering-in-labor
#16
Mary Ann Stark
Therapeutic showering is a holistic nursing intervention that is often available and supports physiologic labor. The purpose of this study was to compare the effectiveness of therapeutic showering with usual care during active labor. Research questions were as follows: Are there significant differences between women who showered 30 minutes during active labor and those who received usual labor care in anxiety, tension, relaxation, pain, discomfort, and coping? Is there a difference in use of obstetric interventions between groups? A convenience sample of healthy low-risk women in active labor was recruited (N = 32)...
March 8, 2017: Journal of Perinatal & Neonatal Nursing
https://www.readbyqxmd.com/read/28277383/the-use-of-vasopressors-during-spinal-anaesthesia-for-caesarean-section
#17
Warwick D Ngan Kee
PURPOSE OF REVIEW: Hypotension remains one of the most researched subjects in obstetric anaesthesia. The purpose of this study is to review the most recent published articles on the use of vasopressors during spinal anaesthesia for caesarean section. RECENT FINDINGS: Despite continued research indicating advantages of phenylephrine over ephedrine, practitioners in some countries continue to favour ephedrine. Recent research has continued to compare the two drugs with some work emerging on high-risk patients...
March 8, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28268196/prenatal-ultrasound-diagnosis-and-outcome-of-placenta-previa-accreta-after-caesarean-delivery-a-systematic-review-and-meta-analysis
#18
REVIEW
Eric Jauniaux, Amar Bhide
BACKGROUND: Women with a history of previous caesarean delivery, presenting with a placenta previa have become the largest group with the highest risk for placenta previa accreta. OBJECTIVE: To evaluate the accuracy of ultrasound imaging in the prenatal diagnosis of placenta accreta and the impact of the depth of villous invasion on management in women presenting with placenta previa or low-lying placenta and with one or more prior caesarean deliveries. STUDY DESIGN: Data sources: We searched PubMed, Google Scholar, clinicalTrials...
March 4, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28268060/irresponsible-and-responsible-resource-management-in-obstetrics
#19
REVIEW
Birgit Arabin
Low budgets constrain and high budgets stimulate choices. In high-income countries, this economic reality may lead to overuse of healthcare services and pose unnecessary risks for mothers and infants. Options for improvement can be created at different levels of healthcare systems. Pregnancy provides an effective opportunity to profile maternal risks and represents a vulnerable but potentially modifiable period from prenatal life to adulthood. In response to system-inherent false incentives, professional responsibility requires obstetricians to strive to improve the future health of families and their offspring despite disincentives for doing so...
January 25, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28264638/to-ignore-or-not-to-ignore-placental-calcifications-on-prenatal-ultrasound-a-systematic-review-and-meta-analysis
#20
Fadi G Mirza, Labib M Ghulmiyyah, Hani Tamim, Maha Makki, Dima Jeha, Anwar Nassar
OBJECTIVE: The human placenta is known to calcify with advancing gestational age, and, in fact, the presence of significant calcifications is one of the components of grade III placenta, typical of late gestation. As such, the presence of significant placental calcifications often prompts obstetric providers to expedite delivery. This practice has been attributed, in part, to the presumed association between grade III placenta and adverse pregnancy outcomes. Such approach, however, can be the source of major anxiety and may lead to unnecessary induction of labor, with its associated predisposition to cesarean delivery as well as a myriad of maternal and neonatal morbidities...
March 6, 2017: Journal of Maternal-fetal & Neonatal Medicine
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