Do Obese Women Receive the Necessary Interventions to Achieve Vaginal Birth after Cesarean?

Objective We aimed to determine if obese women undergoing trial of labor after cesarean (TOLAC) were more likely to undergo repeat cesarean for arrest disorders prior to active labor, and whether this was due to decreased use of standard interventions to achieve vaginal birth. Study Design This was a secondary analysis of a prospective registry. Women undergoing TOLAC with one prior cesarean and a singleton, term gestation who had a repeat cesarean for an arrest disorder were included.

Delivery of the Obese Gravida.

Obesity in pregnancy confers morbidity to both the mother and neonate. Obese women are at increased risk of cesarean delivery, operative vaginal delivery, and failed trial of labor after cesarean delivery. In addition to impacting the mode of delivery, obesity is associated with hemorrhage, infection, and thromboembolic complications in the peripartum period.

Effect of obesity on neonatal outcomes in pregnancies with preterm premature rupture of membranes.

Background: Maternal obesity is associated with increased systemic inflammation and an increased risk of preterm premature rupture of membranes. There is an established association between an inflammatory intrauterine environment and adverse neonatal outcomes that is independent of gestational age and mediated by the fetal inflammatory response. It is unknown whether the maternal systemic inflammation that is present in obese women influences the intrauterine environment and predisposes the fetus to adverse neonatal outcomes after preterm premature rupture of membranes.

Validation of a vaginal birth after cesarean delivery prediction model in women with two prior cesarean deliveries.

Objective: To evaluate whether an existing vaginal birth after cesarean delivery (VBAC) prediction model validated for women with one prior cesarean delivery also accurately predicts the likelihood of VBAC in women with two prior cesarean deliveries.

Methods: We performed a secondary analysis of all women attempting trial of labor after cesarean delivery (TOLAC) with a term singleton pregnancy and two prior cesarean deliveries in the Maternal-Fetal Medicine Units Network (MFMU) Cesarean Registry. Probability of VBAC was calculated for each participant using the MFMU VBAC prediction model.

Reiterative template switching: the effect of single-strand homopolymeric DNA on non-template-directed nucleotide addition by DNA polymerase.

Template switching occurs when DNA polymerase juxtaposes two discontinuous DNA molecules with 3'-terminally complementary ends generated through non-template-directed nucleotide addition. We examined whether juxtaposition of homopolymeric single-stranded oligonucleotides affects non-templated addition. We hypothesized that if DNA polymerase first juxtaposed the two substrates, then the non-template-directed nucleotide addition of any deoxynucleotide would decrease in the presence of its non-complementary template.