Pub Date : 2021-01-01DOI: 10.1093/MED/9780190947088.003.0025
R. Molina, Neel T Shah
This article provides a summary of a landmark study describing racial and ethnic disparities in maternal morbidity and obstetric care practices. The article describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The article briefly reviews other relevant studies and information, and discusses implications. The article concludes with a relevant clinical case highlighting unconscious bias and how it affects the care providers deliver to their patients. Racial disparities are rampant in medicine, this article highlights the role of race in maternal outcomes.
{"title":"Racial and Ethnic Disparities in Maternal Morbidity and Obstetric Care","authors":"R. Molina, Neel T Shah","doi":"10.1093/MED/9780190947088.003.0025","DOIUrl":"https://doi.org/10.1093/MED/9780190947088.003.0025","url":null,"abstract":"This article provides a summary of a landmark study describing racial and ethnic disparities in maternal morbidity and obstetric care practices. The article describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The article briefly reviews other relevant studies and information, and discusses implications. The article concludes with a relevant clinical case highlighting unconscious bias and how it affects the care providers deliver to their patients. Racial disparities are rampant in medicine, this article highlights the role of race in maternal outcomes.","PeriodicalId":114053,"journal":{"name":"50 Studies Every Obstetrician-Gynecologist Should Know","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126846774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1093/MED/9780190947088.003.0009
Zachary Colvin, A. Palatnik
This article reviews the study “Fetal Fibronectin in Cervical and Vaginal Secretions as a Predictor of Preterm Delivery,” published in The New England Journal of Medicine in 1991 by Lockwood et al. The study examined the use of fetal fibronectin found in cervicovaginal secretions as a marker for preterm delivery in symptomatic women presenting with preterm contractions or with preterm premature rupture of membranes. The chapter reviews the findings of this study as well as the place of fetal fibronectin testing in current obstetrical practice based on subsequent studies.
{"title":"Fetal Fibronectin in Cervical and Vaginal Secretions as a Predictor of Preterm Delivery","authors":"Zachary Colvin, A. Palatnik","doi":"10.1093/MED/9780190947088.003.0009","DOIUrl":"https://doi.org/10.1093/MED/9780190947088.003.0009","url":null,"abstract":"This article reviews the study “Fetal Fibronectin in Cervical and Vaginal Secretions as a Predictor of Preterm Delivery,” published in The New England Journal of Medicine in 1991 by Lockwood et al. The study examined the use of fetal fibronectin found in cervicovaginal secretions as a marker for preterm delivery in symptomatic women presenting with preterm contractions or with preterm premature rupture of membranes. The chapter reviews the findings of this study as well as the place of fetal fibronectin testing in current obstetrical practice based on subsequent studies.","PeriodicalId":114053,"journal":{"name":"50 Studies Every Obstetrician-Gynecologist Should Know","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127879521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1093/MED/9780190947088.003.0018
K. Fox
This article provides a summary of a landmark study on labor, in a large, multicenter modern cohort of women with singleton, vertex gestations. Emanuel Friedman published his original labor curve showing the expected progression of normal labor in 1955, and that for multiparous patients in 1956.2,3 He plotted the individual labor progression of 500 nulliparous laboring women from a single center to calculate the average progression of labor. In his cohort, 70% of whom were between 20 and 30 years old, many were Caucasian, and 55% of women were delivered via forceps. Dr. Friedman classically identified the second stage of labor starting at 4cm dilatation. Since the mid-20th century, many practice patterns have changed, and today’s population of women delivering in the United States is diverse and, on average, older and heavier than in 1955; therefore, use of the traditional labor curve has been questioned. The investigators in this study performed a secondary analysis of data from a multicenter cohort of 26,838 patients with singleton gestation, spontaneous labor, and normal outcomes. Using a sophisticated statistical approach Zhang et al. produced a modern labor curve.
{"title":"The Natural History of the Normal First Stage of Labor","authors":"K. Fox","doi":"10.1093/MED/9780190947088.003.0018","DOIUrl":"https://doi.org/10.1093/MED/9780190947088.003.0018","url":null,"abstract":"This article provides a summary of a landmark study on labor, in a large, multicenter modern cohort of women with singleton, vertex gestations. Emanuel Friedman published his original labor curve showing the expected progression of normal labor in 1955, and that for multiparous patients in 1956.2,3 He plotted the individual labor progression of 500 nulliparous laboring women from a single center to calculate the average progression of labor. In his cohort, 70% of whom were between 20 and 30 years old, many were Caucasian, and 55% of women were delivered via forceps. Dr. Friedman classically identified the second stage of labor starting at 4cm dilatation. Since the mid-20th century, many practice patterns have changed, and today’s population of women delivering in the United States is diverse and, on average, older and heavier than in 1955; therefore, use of the traditional labor curve has been questioned. The investigators in this study performed a secondary analysis of data from a multicenter cohort of 26,838 patients with singleton gestation, spontaneous labor, and normal outcomes. Using a sophisticated statistical approach Zhang et al. produced a modern labor curve.","PeriodicalId":114053,"journal":{"name":"50 Studies Every Obstetrician-Gynecologist Should Know","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117214692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1093/MED/9780190947088.003.0004
Alexandra A. Belcher-Obejero-Paz, A. Lee-Parritz
The ACHOIS Trial describes the treatment of gestational diabetes mellitus on pregnancy outcomes. Women between 16 and 30 weeks gestation who had a response between normal and diabetic on a glucose-tolerance test were randomized to either usual care or to an intervention that included dietary advice, glucose-monitoring and insulin therapy. The trial found that treating gestational diabetes is associated with improved maternal and fetal outcomes, including decrease is macrosomia, birth trauma, shoulder dystocia, and preeclampsia.
{"title":"Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes","authors":"Alexandra A. Belcher-Obejero-Paz, A. Lee-Parritz","doi":"10.1093/MED/9780190947088.003.0004","DOIUrl":"https://doi.org/10.1093/MED/9780190947088.003.0004","url":null,"abstract":"The ACHOIS Trial describes the treatment of gestational diabetes mellitus on pregnancy outcomes. Women between 16 and 30 weeks gestation who had a response between normal and diabetic on a glucose-tolerance test were randomized to either usual care or to an intervention that included dietary advice, glucose-monitoring and insulin therapy. The trial found that treating gestational diabetes is associated with improved maternal and fetal outcomes, including decrease is macrosomia, birth trauma, shoulder dystocia, and preeclampsia.","PeriodicalId":114053,"journal":{"name":"50 Studies Every Obstetrician-Gynecologist Should Know","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127074234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1093/MED/9780190947088.003.0033
C. Chandler, A. Olawaiye
This article provides a summary of a landmark study regarding the diagnosis of endometrial cancer. How accurate is endometrial sampling in women with endometrial carcinoma and hyperplasia? The article describes a meta-analysis in which the results of 39 studies using a variety of different endometrial sampling devices are compared by their sensitivity and specificity for diagnosis endometrial carcinoma and atypical hyperplasia of the endometrium. The article briefly reviews criticisms and limitations of the included studies, discusses implications, and concludes with a relevant clinical case.
{"title":"The Accuracy of Endometrial Sampling in the Diagnosis of Patients With Endometrial Carcinoma and Hyperplasia","authors":"C. Chandler, A. Olawaiye","doi":"10.1093/MED/9780190947088.003.0033","DOIUrl":"https://doi.org/10.1093/MED/9780190947088.003.0033","url":null,"abstract":"This article provides a summary of a landmark study regarding the diagnosis of endometrial cancer. How accurate is endometrial sampling in women with endometrial carcinoma and hyperplasia? The article describes a meta-analysis in which the results of 39 studies using a variety of different endometrial sampling devices are compared by their sensitivity and specificity for diagnosis endometrial carcinoma and atypical hyperplasia of the endometrium. The article briefly reviews criticisms and limitations of the included studies, discusses implications, and concludes with a relevant clinical case.","PeriodicalId":114053,"journal":{"name":"50 Studies Every Obstetrician-Gynecologist Should Know","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133683366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1093/MED/9780190947088.003.0046
C. Sacha, J. Petrozza
Understanding the risks of adverse outcomes such as birth defects after the use of assisted reproductive technology (ART) is crucial for both OB/GYN physicians and patients suffering from infertility. In a South Australian population cohort study of 308,974 spontaneous and assisted pregnancies between 1986 and 2002 in women over age 20, assisted conceptions were associated with an increased risk of birth defects, including cerebral palsy, compared to spontaneous conceptions in fertile women (adjusted odds ratio 1.28, 95% confidence interval 1.16–1.41). However, when examining in vitro fertilization and intracytoplasmic sperm injection (ICSI) pregnancies, only ICSI with fresh transfer remained associated with an increased risk of birth defects compared to spontaneous conceptions in fertile women in adjusted models. These findings suggest that while patients should be counseled regarding the potential increased risk of birth defects with ART procedures such as ICSI, more research is needed regarding the impact of infertility itself and specific ART interventions on neonatal outcomes.
{"title":"Reproductive Technologies and the Risk of Birth Defects","authors":"C. Sacha, J. Petrozza","doi":"10.1093/MED/9780190947088.003.0046","DOIUrl":"https://doi.org/10.1093/MED/9780190947088.003.0046","url":null,"abstract":"Understanding the risks of adverse outcomes such as birth defects after the use of assisted reproductive technology (ART) is crucial for both OB/GYN physicians and patients suffering from infertility. In a South Australian population cohort study of 308,974 spontaneous and assisted pregnancies between 1986 and 2002 in women over age 20, assisted conceptions were associated with an increased risk of birth defects, including cerebral palsy, compared to spontaneous conceptions in fertile women (adjusted odds ratio 1.28, 95% confidence interval 1.16–1.41). However, when examining in vitro fertilization and intracytoplasmic sperm injection (ICSI) pregnancies, only ICSI with fresh transfer remained associated with an increased risk of birth defects compared to spontaneous conceptions in fertile women in adjusted models. These findings suggest that while patients should be counseled regarding the potential increased risk of birth defects with ART procedures such as ICSI, more research is needed regarding the impact of infertility itself and specific ART interventions on neonatal outcomes.","PeriodicalId":114053,"journal":{"name":"50 Studies Every Obstetrician-Gynecologist Should Know","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125437939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1093/MED/9780190947088.003.0021
A. Battarbee, N. Vora
In a prospective, multicenter blinded study at 35 international centers, the Noninvasive Examination of Trisomy (NEXT) study evaluated the performance of cell-free DNA screening for fetal trisomy compared to standard first trimester screening with nuchal translucency and serum analytes in a routine prenatal population. Among the 15,841 women who had standard screening and cell-free DNA analysis with neonatal outcome data, there were 68 chromosomal abnormalities (1 in 236). Of these, 38 were Trisomy 21 (1 in 417). Cell-free DNA analysis had a higher area under the curve (AUC) for trisomy 21, compared to standard screening (0.999 vs. 0.958, p = 0.001). Cell-free DNA analysis also had greater sensitivity, specificity, and positive predictive value compared to standard screening for trisomy 21, 18, and 13. While cell-free DNA analysis cannot detect all chromosome abnormalities, it performed better than standard screening for detection of trisomies 21, 18, and 13 in a routine population including low- and high-risk women.
{"title":"Cell-Free DNA Screening for Fetal Aneuploidy","authors":"A. Battarbee, N. Vora","doi":"10.1093/MED/9780190947088.003.0021","DOIUrl":"https://doi.org/10.1093/MED/9780190947088.003.0021","url":null,"abstract":"In a prospective, multicenter blinded study at 35 international centers, the Noninvasive Examination of Trisomy (NEXT) study evaluated the performance of cell-free DNA screening for fetal trisomy compared to standard first trimester screening with nuchal translucency and serum analytes in a routine prenatal population. Among the 15,841 women who had standard screening and cell-free DNA analysis with neonatal outcome data, there were 68 chromosomal abnormalities (1 in 236). Of these, 38 were Trisomy 21 (1 in 417). Cell-free DNA analysis had a higher area under the curve (AUC) for trisomy 21, compared to standard screening (0.999 vs. 0.958, p = 0.001). Cell-free DNA analysis also had greater sensitivity, specificity, and positive predictive value compared to standard screening for trisomy 21, 18, and 13. While cell-free DNA analysis cannot detect all chromosome abnormalities, it performed better than standard screening for detection of trisomies 21, 18, and 13 in a routine population including low- and high-risk women.","PeriodicalId":114053,"journal":{"name":"50 Studies Every Obstetrician-Gynecologist Should Know","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126771201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1097/00132582-200703000-00028
Matthew K. Janssen, S. Ralston
The article provides a review of a landmark study characterizing the risk of repeat cesarean deliveries. This multicenter prospective cohort study of over 30,000 cesarean deliveries demonstrates that risks of cesarean delivery increase sequentially, even in the absence of placenta accreta. The most dramatic increase is noted in the high rates of accreta with placenta previa and multiple cesarean deliveries, greater than 40% with 3 of more cesarean deliveries. This review highlights the key findings, methodology, and impact of this landmark study. It discusses other studies that continue to verify these results as well as contextualize them in the management of placenta accreta with developing centers of excellence. Finally, the article provides a sample clinical case scenario that applies the findings of this study.
{"title":"Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries","authors":"Matthew K. Janssen, S. Ralston","doi":"10.1097/00132582-200703000-00028","DOIUrl":"https://doi.org/10.1097/00132582-200703000-00028","url":null,"abstract":"The article provides a review of a landmark study characterizing the risk of repeat cesarean deliveries. This multicenter prospective cohort study of over 30,000 cesarean deliveries demonstrates that risks of cesarean delivery increase sequentially, even in the absence of placenta accreta. The most dramatic increase is noted in the high rates of accreta with placenta previa and multiple cesarean deliveries, greater than 40% with 3 of more cesarean deliveries. This review highlights the key findings, methodology, and impact of this landmark study. It discusses other studies that continue to verify these results as well as contextualize them in the management of placenta accreta with developing centers of excellence. Finally, the article provides a sample clinical case scenario that applies the findings of this study.","PeriodicalId":114053,"journal":{"name":"50 Studies Every Obstetrician-Gynecologist Should Know","volume":"256 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126049879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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