Amniotic fluid proteomic signatures of cervical insufficiency and their association with length of latency.

Problem: Cervical insufficiency is a precursor of preterm birth. Treatment with emergency cervical cerclage is contraindicated in the presence of intra-amniotic infection. Detecting infection with Gram stain and culture of amniotic fluid lacks sensitivity.

[Le diabète pendant la grossesse].

Objectif: La présente Directive passe en revue les données probantes liées au diagnostic et à la prise en charge obstétricale du diabète durant la grossesse.

Issues: Les issues évaluées étaient les issues maternelles à court et à long terme, dont la prééclampsie, la césarienne, le diabète éventuel et d'autres complications cardiovasculaires et les issues fœtales, dont les anomalies congénitales, la mortinaissance, la macrosomie, le traumatisme de la naissance, l'hypoglycémie et les effets à long terme. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans PubMed et The Cochrane Library au moyen d'un vocabulaire contrôlé (termes MeSH « diabète » et « grossesse ») appropriés.

Diabetes in Pregnancy.

Objective: This guideline reviews the evidence relating to the diagnosis and obstetrical management of diabetes in pregnancy.

Outcomes: The outcomes evaluated were short- and long-term maternal outcomes, including preeclampsia, Caesarean section, future diabetes, and other cardiovascular complications, and fetal outcomes, including congenital anomalies, stillbirth, macrosomia, birth trauma, hypoglycemia, and long-term effects.

Evidence: Published literature was retrieved through searches of PubMed and the Cochrane Library using appropriate controlled vocabulary (MeSH terms "diabetes" and "pregnancy").

Perinatal Outcome in 1515 Cases of Prolonged Second Stage of Labour in Nulliparous Women.

Objective: To examine perinatal outcomes among nulliparous women with a second stage of labour lasting more than three hours.

Methods: We conducted a retrospective review of all nulliparous women over a 14-year period who had a term, live, singleton, cephalic fetus ≥ 2500 g and who had a second stage of labour lasting at least three hours. Outcome measures included five-minute Apgar score < 7, cord arterial pH < 7.

Obstetrical and neonatal outcomes in obese parturients.

Objective: Obstetrical risk is increased with maternal obesity. This prospective study was designed to simultaneously evaluate the outcomes in obese parturients and their newborns.

Methods: Patients with a body mass index (BMI) > or =35 were prospectively identified and compared to an equal number of normal weight parturients.

Does routine induction of labour at 41 weeks really reduce the rate of caesarean section compared with expectant management?

Objective: It is contended that routine induction of labour at 41 completed weeks of gestation reduces, or at least does not increase, a woman's chance of Caesarean section (CS), compared with expectant management. We wanted to know if this was true in our own hospital.

Methods: We performed a retrospective review of 1367 nulliparous women who had reached 41+0 weeks undelivered with a live, singleton, fetus with a cephalic presentation.

How often do perinatal events at full term cause cerebral palsy?

Objective: To determine the contribution of perinatal events to cerebral palsy in children born at full term.

Methods: The delivery records of a cohort of babies born at full term in one tertiary care hospital over an 11-year period were reviewed. The obstetric history and neonatal chart of each baby admitted to the Neonatal Intensive Care Unit was then examined.

A modified technique to deliver the posterior arm in severe shoulder dystocia.

Background: Posterior arm delivery resolves almost all cases of severe shoulder dystocia. However, if the posterior arm is extended or lies under the fetus's body, the usually described technique for its delivery may not be practicable.

Case: A young, multiparous woman with type II diabetes had a low-midcavity vacuum delivery.