Reducing hemodynamic compromise with placental removal at 10 versus 15 minutes: a randomized clinical trial.

Objective: To determine if hemodynamic compromise can be reduced with manual placental removal at 10 compared with 15 minutes.

Study Design: Singleton pregnancies admitted for delivery with no contraindication to a vaginal delivery were randomized to a 10-minute group (placentas manually removed if not spontaneously delivered by 10 minutes) versus a 15-minute group. The primary outcome, hemodynamic compromise, was defined as: blood loss exceeding 1000 mL and/or circulatory instability (inability to maintain blood pressure/pulse secondary to acute blood loss) and/or drop in hematocrit of ≥10 percentage points.

Does the International Classification of Disease (ICD-9) code accurately identify neonates who clinically have hypoxic-ischemic encephalopathy?

Background/aims: Hypoxic-ischemic encephalopathy (HIE) refers to neonatal neurological signs and symptoms of hypoxia and/or ischemia. Our aim was to determine the accuracy of ICD-9 codes to identify newborns with HIE confirmed by umbilical cord blood analysis.

Methods: ICD-9 codes in the newborn chart for birth trauma, birth asphyxia, intrauterine hypoxia, and fetal distress were used to identify newborns with suspected HIE by neonatal personnel.

Cervical dysplasia in pregnancy: a multi-institutional evaluation.

Objective: This study was undertaken to identify the prognostic indicators associated with postpartum regression of cervical dysplasia diagnosed in pregnancy.

Study Design: A retrospective cohort study of pregnant women referred for colposcopy from 2004-2007 at four academic centers.

Results: One thousand seventy-nine patients were identified.

American College of Obstetricians and Gynecologists Practice Bulletins: original versus revised.

We compared the types (A, B, or C) of recommendations and levels (I, II, III, or others) of references in the original versus revised practice bulletins (PBs). American College of Obstetricians and Gynecologists (ACOG) compendiums and Web site were used to obtain the PBs. Chi-square test for trend or Wilcoxon matched-pairs tests were used.

Physician attire in the military setting: does it make a difference to our patients?

Objective: To examine patient preference regarding physician attire and whether perception of medical competence was influenced by the physician's clothing style.

Methods: New patients presenting to the OB/GYN clinic at the Naval Medical Center Portsmouth were asked to complete a survey regarding patient preference for physcian attire and any effect on their comfort or confidence in the physician.

Results: Surveys were collected over a 2-month period.

Prediction of small for gestational age newborns using ultrasound estimated and actual amniotic fluid volume: published data revisited.

Background: Intrauterine growth restriction (IUGR) is a complex problem in modern obstetrics. The presence of oligohydramnios is reported as an important diagnostic and prognostic factor in the management of a pregnancy complicated by IUGR.

Aim: To determine the predictive accuracy of sonographic and actual amniotic fluid volume (AFV) to identify small for gestational age (SGA; birthweight < 10%).

Resolution of infant shoulder dystocia with maternal spontaneous symphyseal separation: a case report.

Background: Shoulder dystocia is the unpredictable and unpreventable nightmare of the obstetrician. We report a case of spontaneous pubic symphyseal separation, the first reported case to result in the resolution of shoulder dystocia.

Case: A 39-year-old woman, gravida 4, para 3, was admitted with ruptured membranes in labor at term.

Obstetric characteristics for a prolonged third stage of labor and risk for postpartum hemorrhage.

Aim: To determine the obstetric characteristics associated with a prolonged third stage of labor and risk factors for a postpartum hemorrhage (PPH) in women undergoing vaginal delivery.

Method: Secondary analysis of a prospective randomized investigation comparing placental removal at 20 versus 30 min to prevent PPH.

Results: Between 1 March 2004 and 1 March 2005, 1,607 women were recruited.

A comparison of 3 criteria of oligohydramnios in identifying peripartum complications: a secondary analysis.

Objective: The objective of the study was to ascertain the diagnostic accuracy of 3 criteria of oligohydramnios in identifying 4 peripartum complications.

Study Design: The 3 definitions of oligohydramnios were amniotic fluid index (AFI) 5.0 cm or less and AFI <5% for gestational age (GA) using nomograms by Moore and Cayle or Magann et al.

Timing of placental delivery to prevent post-partum haemorrhage: lessons learned from an abandoned randomised clinical trial.

It has been recognised that, if the length of the third stage of labour exceeds 30 min, then there is an increased risk of a post-partum haemorrhage. Recent information has suggested that 18 min is the optimal time for removal of the undelivered placenta to prevent a post-partum haemorrhage. A randomised trial comparing 20 vs.

Ludwig's angina in pregnancy.

Ludwig's angina is an infectious process involving the submental, sublingual, and submandibular spaces that can rapidly progress to hemodynamic instability and airway loss. Treatment involves antibiotics, incision, drainage and the placement of extraoral drains. This is the first reported recent case of Ludwig's angina in a pregnant patient.

Antepartum bleeding of unknown origin in the second half of pregnancy: a review.

Unlabelled: The objective of this study was to determine the prevalence, adverse pregnancy complications, and optimal management of pregnancies complicated by bleeding in the second half of pregnancy of an unknown origin (ABUO). A MEDLINE search from 1966 through November 2004 using the search terms "antepartum hemorrhage" or "hemorrhage" or "uterine hemorrhage" and "pregnancy complications" and "cardiovascular complications" and "second trimester pregnancy" or "third trimester pregnancy" was undertaken. The inclusion criteria focused on bleeding not resulting from placenta previa or abruption or to any known cause.