摘要:

OBJECTIVETo assess the effect of antenatal and postnatal corticosteroids on head circumference growth and weight gain from birth to discharge.METHODSWe conducted a retrospective analysis of non-anomalous newborns admitted to the neonatal intensive care unit from 23 to 34 6/7 weeks of gestation. Independent variables included maternal age, race, nulliparity, poor prenatal care, multiple gestation, obstetric complications, alcohol, tocolytic drugs, smoking, illicit drugs, gestational age at birth, presentation, method of delivery, 5-minute Apgar score < 7, surfactant use, severe intracranial hemorrhage, and length of stay.RESULTSAntenatal and postnatal corticosteroids were given in 62% and 14% of the newborns, respectively, and 10% of newborns received both. The mean (±SD) weight gain and head circumference growth in the nursery was 440 ± 582 g (n= 14,217) and 2.54 ± 3.42 cm (n= 12,808), respectively. After multivariable analysis, use of antenatal corticosteroids did not affect weight gain (3.6 ± 4.6 g) and head circumference growth (0.05 ± 0.04 cm) compared with no exposure to perinatal corticosteroids, but postnatal corticosteroids were associated with significant reductions in weight gain and head circumference growth (−120 ± 12.2 g and −0.53 ± 0.11 cm, respectively).CONCLUSIONSAntenatal corticosteroid therapy did not affect weight gain or head circumference growth in the nursery, even when used in conjunction with postnatal corticosteroid therapy.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVEWe evaluated the effect of the Newborns' and Mothers' Health Protection Act on clinical and cost outcomes.METHODSWe conducted an observational study of 18,023 healthy, mother-infant dyads before (n= 8670) and after (n= 9353) implementation of the Newborns' and Mothers' Health Protection Act legislation. Logistic regression was used to calculate adjusted odds ratios (ORs) for the following outcome measures: length of stay at least 48 hours, satisfaction with maternal length of stay, 7- and 30-day hospital readmission utilization, and 7- and 30-day emergency room utilization. Analysis of covariance was used to evaluate adjusted mean hospitalization costs per delivery.RESULTSMothers in the postlegislation period were more likely to have hospital stays at least 48 hours (OR 3.99; 95% confidence interval [CI] 3.57, 4.44) and rate their length of stay as “about right” (OR 5.54; 95% CI 4.76, 6.46) compared with mothers in the prelegislation period. Neonates in the postlegislation period were more likely to have hospital stays of at least 48 hours (OR 3.96; 95% CI 3.54, 4.43) and less likely to be rehospitalized within 7 days after hospitalization (OR 0.61; 95% CI 0.40, 0.95) compared with neonates in the prelegislation period. Adjusted mean hospitalization costs increased $116 per delivery in the postlegislation period.CONCLUSIONSAfter implementation of the Newborns' and Mothers' Health Protection Act legislation, maternal and newborn length of stay and maternal satisfaction with length of stay increased substantially, and hospitalization costs increased significantly. The strongest clinical benefit was observed among neonates who were at a lower risk for hospitalization within 1 week of discharge. With the exception of 30-day emergency room utilization, there was insufficient statistical power to test for differences among other maternal clinical outcomes.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Recently, the Food and Drug Administration (FDA) approved thalidomide for the treatment of the painful symptoms of erythema nodosum leprosum. This most recent FDA decision is a marked reversal to its previous rejection of this drug in the 1960s. The initial rejection by the FDA in the 1960s spared countless American children as thalidomide was shown to cause birth defects and miscarriages worldwide. The FDA's reputation as one of the finest consumer safety authorities was strengthened because of this decision. The recent approval of thalidomide by the FDA, with accompanying strict guidelines and monitoring procedures, has not only brought forth potential benefits, but also created new potential problems.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo assess the performance of stimulation tests for the prediction of intrapartum fetal acidemia.DATA SOURCESWe conducted a MEDLINE (Internet Grateful Med) literature review from 1966 to 2000 using the terms “fetal scalp pH,” “fetal scalp stimulation,” and “fetal acoustic stimulation.”STUDY SELECTIONArticles were included if sensitivity, specificity, and predictive values for intrapartum fetal acidemia could be calculated. Reactivity was a fetal heart rate (FHR) acceleration of 15 beats per minute for 15 seconds. Likelihood ratio and 95% confidence intervals (CIs) for four different fetal provocations were calculated using the Cochrane collaboration 2000 Review Manager 4.1. This permitted an estimate of the degree of confidence surrounding the point estimate of the likelihood ratio for the presence or absence of acidemia given a positive or negative test. The likelihood ratio is a stable predictive property of any test because it combines information from both sensitivity and specificity, is independent of prevalence, and avoids the limitations of traditional predictive values.TABULATION, INTEGRATION, AND RESULTSEleven of 512 articles met criteria for inclusion and included four stimulation tests — fetal scalp puncture, Allis clamp scalp stimulation, vibroacoustic stimulation, and digital scalp stimulation. Pooled likelihood ratio and 95% CIs were similar among the four different stimulation tests. Each test was very useful at predicting both the lack of and the presence of fetal acidemia. Likelihood ratio and 95% CIs for the prediction of fetal acidemia given a positive test were: scalp puncture 8.54 (CI 1.28, 56.96), Allis clamp 10.4 (CI 1.47, 73.61), vibroacoustic stimulation 5.06 (CI 2.69, 9.50), and digital 15.68 (CI 3.22, 76.24). For a negative test, these were: scalp puncture 0.12 (CI 0.02, 0.78), Allis clamp 0.10 (CI 0.01, 0.68), vibroacoustic stimulation 0.20 (CI 0.11, 0.37), and digital 0.06 (CI 0.01, 0.31).CONCLUSIONIntrapartum stimulation tests appear to be useful to rule out fetal acidemia in the setting of a nonreassuring FHR pattern. Our data reveal the degree of confidence around the estimate of the likelihood ratio of a stimulation test. The very low negative likelihood ratios warrant the use of these tests when a nonreassuring intrapartum FHR pattern appears. Because these tests are less than perfect, caution is advised; careful continued monitoring with repeat testing during the course of labor should be performed as long as suspicious FHR patterns persist. Fetal scalp pH should be determined whenever possible after a positive stimulation test (lack of acceleration).

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo explore the effects of interventions given to improve pregnancy outcome in women with antiphospholipid antibodies.DATA SOURCESCochrane Controlled Trials Register, Cochrane Collaboration Pregnancy and Childbirth Group's Specialized Register of Controlled Trials, EMBASE, and MEDLINE were searched in December 1999.STUDY SELECTIONRandomized or quasi-randomized controlled trials of therapy for pregnancy loss associated with antiphospholipid antibodies were identified.TABULATION, INTEGRATION, AND RESULTSTrial selection, data extraction, and quality assessment were performed by two authors independently. Quantitative analysis of summary data was performed using the fixed- and random-effects models with heterogeneity assessments. Pregnancy loss and adverse neonatal outcomes were the main outcome measures. Ten trials (n= 627) fulfilled the inclusion criteria (of which four lacked adequate allocation concealment). Three trials of aspirin alone showed no significant reduction in pregnancy loss (relative risk [RR] 1.05, 95% confidence interval [CI] 0.66, 1.68). Heparin combined with aspirin (two trials, 140 patients) significantly reduced pregnancy loss compared with aspirin alone (RR 0.46, 95% CI 0.29, 0.71). Prednisone and aspirin resulted in a significant increase in prematurity (RR 4.83, 95% CI 2.85, 8.21) but no significant reduction in pregnancy loss (RR 0.85, 95% CI 0.53, 1.36).CONCLUSIONCombination therapy with aspirin and heparin may reduce pregnancy loss in women with antiphospholipid antibodies by 54%. Further large, randomized controlled trials with adequate allocation concealment are necessary to exclude significant adverse effects.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo systematically review published randomized controlled trials (RCTs) to compare the safety and efficacy of 25 μg versus 50 μg of intravaginal misoprostol for cervical ripening and labor induction.DATA SOURCESWe supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify RCTs of misoprostol for cervical ripening and labor induction, which compared repeated doses of 25 μg and 50 μg.STUDY SELECTIONWe evaluated, abstracted data, and assessed the quality of RCTs to compare the safety and efficacy of 25 μg versus 50 μg of intravaginal misoprostol for cervical ripening and labor induction.TABULATION, INTEGRATION, AND RESULTSFive RCTs met inclusion criteria for meta-analysis. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for each outcome (random- and fixed-effects models). In addition, we aggregated the results of two separate studies, permitting an indirect comparison of the two doses being analyzed. In the meta-analysis, tachysystole and hyperstimulation syndrome appear to occur less frequently among women who received 25 μg of misoprostol than with 50 μg. However, neonatal outcomes appear to be comparable with the two doses. Regarding efficacy, use of the 50-μg dose was associated with a shorter interval to vaginal delivery, greater proportion of deliveries within 24 hours, and less frequent need for oxytocin augmentation. The indirect comparison of two studies yielded similar results.CONCLUSIONPublished data indicate that intravaginal misoprostol at doses of 50 μg for cervical ripening and labor induction is more efficacious but it is unclear whether it is as safe as the 25-μg dose.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The development of gynecology as a specialty, although primarily American in origin, was influenced in large degree by Robert Lawson Tait, a brilliant Scottish/English surgeon who practiced in the late 19th century. Tait, a self-proclaimed gynecologist, is perhaps most widely known as the first to perform salpingectomy to treat ruptured tubal pregnancy. He was also the first to record removal of an ovary for relief of pelvic pain and to induce menopause, perform salpingectomy for the treatment of tubal disease, and develop the technique of transverse transperineal repair of low rectovaginal fistulas. His scrupulous cleanliness was undoubtedly the forerunner of our modern aseptic methods. Tait's bold, innovative surgical techniques led to a significant decrease in surgical mortality, and his prescient, aggressive approach was at the forefront of changes in the practice of obstetrics, which resulted in a marked decrease in maternal morbidity and mortality. This master teacher, whose contributions inspired the next great generation of abdominal and pelvic surgeons, deserves greater recognition within our specialty.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID