External cephalic version for a malpresenting first twin before labor: a prospective case series.

Background: In twin pregnancies where the presenting twin is not cephalic, cesarean delivery is the standard of care. External cephalic version (ECV) has been used for malpresenting singleton pregnancies with low risk of complications. ECV in twin pregnancies is poorly studied.

Influence of weight gain on risk for cesarean delivery in obese pregnant women by class of obesity: pregnancy risk assessment monitoring system (PRAMS).

Background: Currently, all obese women in the United States (US) are recommend to gain the same amount of weight during pregnancy, regardless of class of obesity. Limited literature has looked at the risk of cesarean, and possible mitigation of this risk, by specific class of obesity.

Objective: To determine the influence of weight gain on the odds of cesarean delivery for obese women (as determined by pre-pregnancy body mass index [BMI]), by class of obesity.

The association of skin incision placement during cesarean delivery with wound complications in obese women: a systematic review and meta-analysis.

Objective: To determine the risk of wound complications by skin incision type in obese women undergoing cesarean delivery. Electronic databases (MEDLINE, Scopus, and Ovid) were searched from their inception through August 2018. We included all randomized controlled trials and cohort studies reporting the placement of skin incision during cesarean section in obese women, defined as those with BMI ≥30 kg/m.

Operative Vaginal Birth of a Critically Endangered Gorilla With Forceps Assistance.

Background: An obstetrician on standby assessed an 18-year-old primiparous captive gorilla with a term singleton fetus with a protracted labor course.

Case: After it was determined that an arrest of descent had occurred, a viable, 2,280 g male neonate was delivered through an operative vaginal birth with forceps assistance without major complications.

Conclusion: Given the numerous anatomic and biochemical similarities of humans and other great apes, it is possible that the high maternal mortality and stillbirth rates of gorillas could be reduced by using the same principles of obstetric management in a multidisciplinary fashion.

External cephalic version of the non-cephalic presenting twin: a systematic review.

Objective: Decreasing the primary cesarean delivery rate and associated maternal and fetal complications is a priority for obstetric care providers. External cephalic version (ECV) is a procedure recommended for women with singleton pregnancies where the fetus is malpresenting to avoid vaginal breech delivery, which is inherently riskier than cesarean delivery. However, little is known about this procedure in the context of twin gestations.

Intraoperative Fetal Monitoring for Nonobstetric Surgery.

Necessary nonobstetric surgical procedures should not be withheld from pregnant women for fear of risks to the women and their pregnancies; however, careful preoperative planning should be undertaken to mitigate risks that may be present. Fetal monitoring recommendations will be dependent on the woman's preferences, gestational age of the pregnancy, and situational-specific risks (including anticipated risk of cardiovascular instability). Some fetal heart rate changes (lower baseline, less variability) can be anticipated, depending on anesthetic agents utilized during the procedure, and should not routinely prompt delivery.

Intraoperative fetal heart monitoring for non-obstetric surgery: A systematic review.

Limited data are available on fetal monitoring during non-obstetric surgery in pregnancy. We performed a systematic review to evaluate the incidence of emergent cesarean delivery performed for non-reassuring fetal heart rate patterns during non-obstetric surgery. Electronic databases were searched from their inception until October 2018 without limit for language.

Universal cervical length screening with a cervicometer to prevent preterm birth <34 weeks: a decision and economic analysis.

Preterm birth is a leading cause of neonatal morbidity and mortality worldwide; evidence-based strategies to decrease preterm birth are desperately needed. The purpose of this study was to estimate which of three strategies for screening for shortened cervix in asymptomatic low-risk women is the most cost-effective in terms of prevention of preterm birth and associated morbidity. A decision analysis model was developed from available published evidence comparing three strategies in screening asymptomatic low-risk women for shortened cervix: (1) cervicometer with subsequent referral for transvaginal ultrasound, (2) transvaginal ultrasound screening, and (3) no screening.

Transvaginal ultrasound training for the obstetrics and gynecology resident: A multisite randomized controlled trial of educational DVD.

Purpose: Residents in obstetrics and gynecology are deemed to be proficient in transvaginal ultrasound (TVUS) upon graduation, although TVUS education in residency is not standardized. The objective of this study is to assess for improvement in TVUS knowledge among residents after viewing an educational DVD.

Methods: This is a multisite prospective randomized controlled trial using an educational DVD ("Gynecology: Beginners Only"), compared to routine education.

Long-acting reversible contraception in adolescents in Sub-Saharan Africa: evidence from demographic and health surveys.

Objective: To explore (1) long-acting reversible contraception (LARC) use and (2) future contraceptive preferences in Sub-Saharan African adolescents as undesired pregnancies in Sub-Saharan African adolescents are associated with significant maternal/neonatal morbidity.

Methods: Nationally-representative Demographic and Health Surveys (USAID) obtained informed consent and interviewed 45,054 adolescents, including 19,561 (43.4% of total) sexually active adolescents (aged 15-19) from 18 least developed Sub-Saharan African nations regarding contraception (years 2005-2011, response rate 89.

The Recurrence Risk of Fetomaternal Hemorrhage.

Massive fetomaternal hemorrhage (FMH) can cause devastating pregnancy outcomes. Perinatal prognosis may be improved by intrauterine transfusion, but the appropriate management for these pregnancies remains unclear. To determine the recurrence risk of FMH after intrauterine transfusion, we performed a systematic review of all case reports/series of patients with proven FMH treated with intrauterine transfusion and who had subsequent follow-up of at least 72 h until delivery.

External cephalic version in premature rupture of membranes: a systematic review.

Background: External cephalic version (ECV) increases the likelihood of a vaginal delivery in patients with breech presentation. Our objective was to determine the rate of cephalic vaginal delivery in women undergoing ECV after PROM.

Methods: We performed a systematic review of all case reports, case series and clinical trials of patients undergoing an ECV after PROM ≥ 24 weeks.

Vitamin D and conjugated equine estrogen: the association with coronary artery atherosclerosis in cynomolgus monkeys.

Objective: To analyze vitamin D3 plasma concentrations among monkeys randomized to oral conjugated equine estrogen (CEE) versus control and the association with coronary artery atherosclerosis (CAA).

Methods: Surgically postmenopausal monkeys (N = 50) were fed an atherogenic diet containing a woman's equivalent of 1000 IU/day of vitamin D3. The monkeys were randomized at baseline to receive CEE (equivalent of 0.

Contraceptive use in adolescents in Sub-Saharan Africa: evidence from Demographic and Health Surveys.

Objective: Failure to use contraceptives contributes to an unacceptably high rate of undesired pregnancy in Sub-Saharan adolescents with associated maternal and neonatal mortality/morbidity. Evidence-based research is needed to understand contraceptive usage in Sub-Saharan adolescents and to enable appropriate allocation of donor resources.

Design: Nationally-representative USAID (U.

Prenatal care associated with reduction of neonatal mortality in Sub-Saharan Africa: evidence from Demographic and Health Surveys.

Objective: To determine whether prenatal care by a skilled provider (physician, nurse or midwife) and specific prenatal interventions were associated with decreased neonatal mortality.

Design: Mothers' reports in nationally representative surveys (conducted 2003-2009) about their most recent delivery were analyzed. Setting.