Labor patterns in women attempting vaginal birth after cesarean with normal neonatal outcomes.

Objective: We sought to describe labor patterns in women with a trial of labor after cesarean (TOLAC) with normal neonatal outcomes.

Study Design: In a retrospective observational study at 12 US centers (2002 through 2008), we examined time interval for each centimeter of cervical dilation and compared labor progression stratified by spontaneous or induced labor in 2892 multiparous women with TOLAC (second delivery) and 56,301 nulliparous women at 37 0/7 to 41 6/7 weeks of gestation. Analyses were performed including women with intrapartum cesarean delivery, and also limiting only to women who delivered vaginally.

Nonclinical parameters affecting primary cesarean rates in the United States.

Objective: Cesarean is the single most common operation in United States and has reached epidemic proportions in recent decades. Our objective was to study the effect of nonclinical parameters on primary cesarean rates in a large contemporary population.

Study Design: We designed a retrospective multicenter study using data obtained from electronic medical records from 19 U.

Maternal death in the emergency department from trauma.

Purpose: Trauma during pregnancy is among leading causes of non-pregnancy-related maternal death (MD). This study describes risk factors for MD from trauma during pregnancy in a large urban population.

Methods: We queried an urban Level One Trauma Center registry for the medical records of pregnant women suffering trauma from 1990 to 2007.

Duration of membrane rupture and risk of perinatal transmission of HIV-1 in the era of combination antiretroviral therapy.

Objective: The objective of the study was to determine whether the duration of membrane rupture of 4 or more hours is a significant risk factor for perinatal transmission of human immunodeficiency virus (HIV) in the era of combination antiretroviral therapy (ART).

Study Design: This was a prospective cohort study of 717 HIV-infected pregnant women-infant pairs with a delivery viral load available who received prenatal care and delivered at our institution during the interval 1996-2008.

Results: The cohort comprised 707 women receiving ART who delivered during this interval.

The association of gestational weight gain per institute of medicine guidelines and prepregnancy body mass index on outcomes of twin pregnancies.

Objective: To determine if current recommendations for weight gain in twin pregnancies according to maternal prepregnancy body mass index (PPBMI) influence perinatal outcomes.

Methods: We identified women with twins enrolled in a maternity risk screening and education program with initial screening and prenatal care initiated at <20 weeks and delivery at >23.9 weeks.

Influence of gestational age and reason for prior preterm birth on rates of recurrent preterm delivery.

Objective: We sought to compare rates of recurrent spontaneous preterm birth (SPTB) in women receiving 17-α-hydroxyprogesterone caproate (17P) with prior SPTB due to preterm labor (PTL) vs preterm premature rupture of membranes (PPROM).

Study Design: Women with singleton gestation having 1 prior SPTB enrolled at 16-24.9 weeks' gestation for weekly outpatient 17P administration were identified from a database.

Giant cell bone tumor of the thoracic spine presenting in late pregnancy.

Background: We report a case of a large giant cell tumor of the thoracic spine presenting with spinal cord compression during pregnancy.

Case: A 24-year-old woman presented at term with lower back pain, bilateral lower extremity weakness, numbness, and bowel and bladder incontinence. Magnetic resonance imaging revealed a spinal soft tissue mass compressing the spinal cord.

A comparison of obstetric maneuvers for the acute management of shoulder dystocia.

Objective: To assess the efficacy of obstetric maneuvers for resolving shoulder dystocia and the effect that these maneuvers have on neonatal injury when shoulder dystocia occurs.

Methods: Using an electronic database encompassing 206,969 deliveries, we identified all women with a vertex fetus beyond 34 0/7 weeks of gestation who incurred a shoulder dystocia during the process of delivery. Women whose fetuses had a congenital anomaly and women with an antepartum stillbirth were excluded.

Characteristics associated with severe perineal and cervical lacerations during vaginal delivery.

Objective: To characterize potentially modifiable risk factors for third- or fourth-degree perineal lacerations and cervical lacerations in a contemporary U.S. obstetric practice.

Vasopressin versus a combination of vasopressin and tourniquets: a comparison of blood loss in patients undergoing abdominal myomectomies.

Objective: To compare blood loss and need for blood transfusions in women who underwent abdominal myomectomies after receiving vasopressin or combined vasopressin and tourniquet.

Methods: A retrospective chart review was performed reviewing abdominal myomectomies that took place at our institution. Subjects were divided into three groups: no intervention, vasopressin, or combined vasopressin and tourniquet.

The effect of new antepartum weight gain guidelines and prepregnancy body mass index on the development of pregnancy-related hypertension.

We evaluated the impact of adherence to the new Institute of Medicine weight gain guidelines within each prepregnancy body mass index (PPBMI) category on the development of pregnancy-related hypertension (PRH). Patients with singleton term deliveries (≥37 weeks) with documented PPBMI and pregnancy weight gain information were identified from a database of women enrolled for outpatient nursing services. Included were women without history of cardiovascular disease, PRH, or diabetes at initiation of services (N = 7676).

The influence of maternal age on pregnancy outcome in nulliparous women with twin gestation.

We sought to determine if outcomes of nulliparous twin pregnancies differ based on maternal age. Nulliparous women with current twin pregnancies were identified from a database of women enrolled for outpatient nursing surveillance. Data were stratified into four groups by maternal age: less than 20, 20 to 34, 35 to 39, and greater than or equal to 40 years.

Contemporary patterns of spontaneous labor with normal neonatal outcomes.

Objective: To use contemporary labor data to examine the labor patterns in a large, modern obstetric population in the United States.

Methods: Data were from the Consortium on Safe Labor, a multicenter retrospective study that abstracted detailed labor and delivery information from electronic medical records in 19 hospitals across the United States. A total of 62,415 parturients were selected who had a singleton term gestation, spontaneous onset of labor, vertex presentation, vaginal delivery, and a normal perinatal outcome.

Contemporary cesarean delivery practice in the United States.

Objective: To describe contemporary cesarean delivery practice in the United States.

Study Design: Consortium on Safe Labor collected detailed labor and delivery information from 228,668 electronic medical records from 19 hospitals across the United States, 2002-2008.

Results: The overall cesarean delivery rate was 30.

Impact of prior gestational age at preterm delivery on effectiveness of 17-alpha-hydroxyprogesterone caproate in practice.

Objective: We sought to examine if 17-alpha-hydroxyprogesterone caproate (17OHPC) effectiveness is dependent on the earliest gestational age (GA) at prior spontaneous preterm birth (SPTB) when administered in the clinical setting.

Study Design: Women enrolled for outpatient services with current singleton gestation and > or =1 prior SPTB between 20-36.9 weeks were identified.

The maternal body mass index: a strong association with delivery route.

Objective: We sought to assess body mass index (BMI) effect on cesarean risk during labor.

Study Design: The Consortium on Safe Labor collected electronic data from 228,668 deliveries. Women with singletons > or = 37 weeks and known BMI at labor admission were analyzed in this cohort study.

Respiratory morbidity in late preterm births.

Context: Late preterm births (340/7-366/7 weeks) account for an increasing proportion of prematurity-associated short-term morbidities, particularly respiratory, that require specialized care and prolonged neonatal hospital stays.

Objective: To assess short-term respiratory morbidity in late preterm births compared with term births in a contemporary cohort of deliveries in the United States.

Design, Setting, And Participants: Retrospective collection of electronic data from 12 institutions (19 hospitals) across the United States on 233,844 deliveries between 2002 and 2008.

Maternal and neonatal outcomes by labor onset type and gestational age.

Objective: We sought to determine maternal and neonatal outcomes by labor onset type and gestational age.

Study Design: We used electronic medical records data from 10 US institutions in the Consortium on Safe Labor on 115,528 deliveries from 2002 through 2008. Deliveries were divided by labor onset type (spontaneous, elective induction, indicated induction, unlabored cesarean).

Excessive weight gain among obese women and pregnancy outcomes.

We evaluated pregnancy outcomes in obese women with excessive weight gain during pregnancy. A retrospective study was performed on all obese women. Outcomes included rates of preeclampsia (PEC), gestational diabetes, cesarean delivery (CD), preterm delivery, low birth weight, very low birth weight, macrosomia, 5-minute Apgar score of <7, and neonatal intensive care unit (NICU) admission and were stratified by body mass index (BMI) groups class I (BMI 30 to 35.

An examination of the clinical benefits and cost-effectiveness of tocolytic replacement following recurrent preterm labor.

We examined pregnancy outcomes in women receiving nifedipine tocolysis having recurrent preterm labor (RPTL). Singleton gestations enrolled for outpatient nursing surveillance and prescribed nifedipine tocolysis were identified (N = 4748). Women hospitalized for RPTL at <35 weeks then resuming outpatient surveillance were included (N = 1366).

Preventing adhesions in obstetric and gynecologic surgical procedures.

Adhesive disease represents a significant cause of morbidity for postoperative patients. Most surgical procedures performed by obstetrician-gynecologists are associated with pelvic adhesions that cause subsequent serious sequelae, including small bowel obstruction, infertility, chronic pelvic pain, and difficulty in postoperative treatment, including complexity during subsequent surgical procedures. The technology of adhesion prevention has significantly progressed.

Caudal dysplasia syndrome and sirenomelia: are they part of a spectrum?

Caudal dysplasia syndrome (CDS) is associated with hypoplastic lower extremities, caudal vertebrae, sacrum, neural tube, and urogenital organs. Sirenomelia is characterized by a single lower extremity, absent sacrum, urogenital anomalies, and imperforate anus. There is controversy in the medical literature about whether sirenomelia and CDS are part of the spectrum of the same malformation.

Rectal misoprostol vs 15-methyl prostaglandin F2alpha for retained placenta after second-trimester delivery.

Objective: The purpose of this study was to compare rectal misoprostol (RM) with 15-methyl prostaglandin F2alpha (PGF(2alpha)) for the management of retained placenta after second-trimester deliveries.

Study Design: A retrospective study of all second-trimester deliveries between the years 2000 and 2005 was performed. Women were divided into 2 groups, depending on whether they received RM or PGF(2alpha) after the delivery.

Antenatal factors predicting subsequent need for insulin treatment in women with gestational diabetes.

Objective: To identify characteristics indicative of subsequent requirement of insulin in patients with gestational diabetes (GDM).

Methods: Identified from a database were patients with GDM not receiving insulin or oral hypoglycemic agents at enrollment for outpatient education and surveillance. Maternal characteristics were compared between patients achieving glycemic control with diet and those requiring insulin.

Management of recurrent preterm labor in twin gestations with nifedipine tocolysis.

We examined outcomes of twin pregnancies complicated by recurrent preterm labor receiving nifedipine tocolysis. In a retrospective study design, twin pregnancies receiving outpatient preterm labor surveillance services and oral nifedipine tocolysis following a diagnosis of preterm labor were identified from a database ( N = 1421). Eligible for inclusion were patients subsequently rehospitalized with recurrent preterm labor symptoms ( N = 862).