Abstract:
OBJECTIVE:We sought to determine the interventions utilized by maternal-fetal medicine specialists in the prediction and prevention of preterm labor in higher-order multiple (HOM) gestations. STUDY DESIGN:Online questionnaires and email surveys were sent to all the maternal-fetal medicine specialists in Canada (n=122). Questionnaire items included interventions physicians routinely recommended for HOM gestations including: (1) bed rest; (2) cervical length measurement on transvaginal ultrasound; (3) corticosteroids use; (4) cerclage; and (5) tocolytic therapy. RESULTS:Response rate was 66% (81/122), with 68% of respondents in practice for >10 years. Of physicians, 91% did not routinely recommend bed rest (95% confidence interval [CI], 84.7-97.2). In all, 82% (95% CI, 73.63-90.4%) recommended routine cervical length assessment with 32.3% (95% CI, 20.7-43.2) and 37.1% (95% CI, 25.3-48.6) of this group suggesting assessment at 16-18 and 19-21 weeks, respectively. Frequency of assessment varied from biweekly (53.3%; 95% CI, 40.9-65.0), to monthly (23.3%; 95% CI, 12.8-33.1), to a single measurement repeated only if abnormal (12.5%; 95% CI, 4.5-20.8). In all, 28% (95% CI, 18.2-37.8) recommended routine administration of corticosteroids for lung maturation. Timing of administration varied, with 24% initiating steroids between 24-26 weeks, 59% between 27-28 weeks, and 17% after 28 weeks. None reported routine cerclage placement. However, 71% (95% CI, 61.1-80.8) would perform cerclage based on history or ultrasound. Of respondents, 81% (95% CI, 72.4-89.5) would consider using tocolytic agents for threatened preterm labor including calcium channel blockers (94%), nonsteroidal antiinflammatory drugs (5%), and nitroglycerin transdermal patch (24%). CONCLUSION:The variable practice guidelines and paucity of data for management of HOM pregnancy places the onus on individual practitioners to develop their own management schemes. This results in heterogeneous management, which is based on conflicting international guidelines, studies, expert opinion, or past experience.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Baker E,Hunter T,Okun N,Farine Ddoi
10.1016/j.ajog.2014.12.031subject
Has Abstractpub_date
2015-05-01 00:00:00pages
671.e1-7issue
5eissn
0002-9378issn
1097-6868pii
S0002-9378(14)02490-9journal_volume
212pub_type
杂志文章abstract::The kinetics of maternal-fetal interferon and a chemical interferon inducer were studied in Swiss-Webster white mice at 8, 15, and 19 days of gestation. Crude interferon was administered by maternal tail vein injection to one group. There was no transfer of interferon to the fetus despite high maternal levels. A chemi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(85)80189-7
更新日期:1985-05-01 00:00:00
abstract:OBJECTIVE:Iron supplementation in pregnancy seems beneficial for neonatal/maternal outcomes, but it was associated with diabetes and hypertension in the general population. STUDY DESIGN:We investigated the association between iron supplementation during midpregnancy and metabolic/hypertensive abnormalities in 500 cons...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2009.04.049
更新日期:2009-08-01 00:00:00
abstract::The cellular localization of angiotensin II immunoreactivity and the presence of angiotensin II binding in rat ovaries were studied. Angiotensin II immunohistochemical staining was demonstrated throughout the corpora lutea of gonadotropin-stimulated immature rats and pseudopregnant adult rats, as well as in some strom...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(88)80122-4
更新日期:1988-08-01 00:00:00
abstract:OBJECTIVE:We evaluated whether women with vulvar vestibulitis syndrome (VVS) could be subdivided on the basis of genotyping the polymorphic mannose-binding lectin (MBL) gene. STUDY DESIGN:DNA from 123 women with VVS was tested for a single nucleotide polymorphism at codon 54 of the MBL gene. Blood samples from 86 of t...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2007.05.037
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate factors that are associated with significant birth weight discordancy. STUDY DESIGN:As a part of an ongoing collaborative study of twins, maternal and fetal data were obtained from the medical records of twin gestations at eight medical centers. The study population ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/s0002-9378(03)00658-6
更新日期:2003-09-01 00:00:00
abstract:BACKGROUND:Oxytocin is a potent uterotonic agent that is widely used for induction and augmentation of labor. Oxytocin has a narrow therapeutic index and the optimal dosing for any individual woman varies widely. OBJECTIVE:The objective of this study was to determine whether genetic variation in the oxytocin receptor ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2017.05.023
更新日期:2017-09-01 00:00:00
abstract::Abnormal uterine bleeding is often the presenting complaint in women with underlying coagulopathies. A clear understanding of the pathophysiology of common bleeding disorders will help the practicing obstetrician/gynecologist in the diagnosis and treatment of these conditions. The normal hemostatic process can be divi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/s0002-9378(96)80083-4
更新日期:1996-09-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine the effects of raloxifene on endothelial function in healthy, postmenopausal women. STUDY DESIGN:This was a randomized, double-blind, placebo-controlled crossover trial. Subjects (n = 19; mean age, 61 years) underwent endothelial function testing at baseline and aft...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1067/mob.2003.28
更新日期:2003-02-01 00:00:00
abstract:OBJECTIVE:We sought to provide evidence-based guidelines regarding the diagnosis and management of amniotic fluid embolism. STUDY DESIGN:A systematic literature review was performed using MEDLINE, PubMed, EMBASE, and the Cochrane Library. The search was restricted to English-language articles published from 1966 throu...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,实务指引
doi:10.1016/j.ajog.2016.03.012
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:The physiopathology of preeclampsia is still unclear, but an imbalance between reactive oxygen species (ROS) and antioxidants, also called oxidative stress, appears to be an important contributing factor. The ROS promote lipid oxidation and are known to induce stress proteins, such as hemeoxygenase 1 (HO-1) a...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2008.12.031
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate which factors affect the occurrence of neonatal ultrasonographic evidence of severe cerebral lesions in the presence of intrauterine infection. STUDY DESIGN:From a cohort of 567 singleton neonates who were born between 24.0 and 31.6 weeks of gestation, we identified ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2008.06.059
更新日期:2008-10-01 00:00:00
abstract:OBJECTIVE:We sought to describe placental findings in asphyxiated term newborns meeting therapeutic hypothermia criteria and to assess whether histopathologic correlation exists between these placental lesions and the severity of later brain injury. STUDY DESIGN:We conducted a prospective cohort study of the placentas...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2010.08.024
更新日期:2010-12-01 00:00:00
abstract::Epidural analgesia in labor is generally accepted as safe and effective and therefore has become increasingly popular. However, little is known regarding the effect of epidural analgesia on the incidence of cesarean section for dystocia in nulliparous women. During the first 6 months of 1987 we studied 711 consecutive...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90377-3
更新日期:1989-09-01 00:00:00
abstract::A program of office menstrual aspiration was initiated in our institution in 1972. Since that time 1,443 patients have been admitted into the study. These patients were evaluated by age, marital status, gravidity, repeat pregnancy terminations, complications, and detailed tissue analysis as well as contraception utili...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(79)90888-3
更新日期:1979-05-15 00:00:00
abstract::With the establishment of a normal range of values for the growth of the ultrasound fetal femur length, a new approach for the study of growth-retarded fetuses is suggested. Ultrasound femur length was measured on a group of "high-risk" pregnancies, and its ability to differentiate the symmetrically small from the asy...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(82)90390-8
更新日期:1982-09-01 00:00:00
abstract::Androgen resistance is thought to vary phenotypically from a normal female to an infertile male. Previous evaluation of infertile males has been limited to androgen receptor-binding affinity. The androgen receptor gene has been isolated, cloned, and studied extensively in patients with complete androgen insensitivity ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90052-s
更新日期:1991-12-01 00:00:00
abstract:OBJECTIVE:We sought to compare bony pelvis dimensions at the level of pelvic support in women with and without pelvic organ prolapse (POP). STUDY DESIGN:Pelvic floor dimensions of 42 white women with POP > 1 cm beyond the hymen were compared with 42 age- and parity-matched women with normal support. Bony landmarks rel...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2008.10.040
更新日期:2009-03-01 00:00:00
abstract::Obstetric uterine rupture has previously been reported after the laparoscopic removal of deep intramural myomas, but never has it been reported to follow the removal of superficial myomas. A 39-year-old primigravid woman with a history of a superficial subserous laparoscopic myomectomy was seen for acute abdominal sym...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(97)70110-8
更新日期:1997-12-01 00:00:00
abstract::A case of nonimmune hydrops fetalis in association with angioosteohypertrophy (Klippel-Trenaunay) syndrome is reported for the first time. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90443-7
更新日期:1988-11-01 00:00:00
abstract:OBJECTIVE:Thrombotic vascular disease may predispose patients to the development of preeclampsia. The purpose of this study was to determine whether maternal or fetal genotype frequencies of the inherited thrombophilic gene mutations (factor V Leiden, methylenetetrahydrofolate, and prothrombin) are altered in severe pr...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.114691
更新日期:2001-07-01 00:00:00
abstract::In an evaluation of the limulus lysate assay (LLA) as a method for detecting gonococcal endotoxin in cervical exudates diluted 1:800, positive LLA results were obtained from 17 of 18 patients (94%) with culture-proved gonococcal cervicitis, and negative results were obtained from 22 of 22 patients (100%) with culture-...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(80)90702-4
更新日期:1980-07-01 00:00:00
abstract::The purpose of this review was to estimate the impact of timing of seasonal influenza vaccination during pregnancy on health and economic outcomes. Cost-effectiveness analysis with a dynamic model of the US population of pregnant women and infants who were <6 months incorporated seasonal variation in influenza inciden...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2011.04.009
更新日期:2011-06-01 00:00:00
abstract::An isolated heart preparation was used to study the effects of terbutaline sulfate (Brethine) on fetal cardiac function. Pregnant guinea pigs received daily subcutaneous injections of terbutaline for 10 day, whereas a control group received placebo injections. Fetal guinea pig hearts were evaluated for cariodynamic an...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90346-3
更新日期:1989-09-01 00:00:00
abstract:OBJECTIVE:We studied the role of multidrug resistance proteins in regulating transplacental transmission of corticosteroids and protease inhibitors. STUDY DESIGN:We performed quantitative polymerase chain reaction and FACS analyses to study MDR1 (encodes P-glycoprotein) and MRP-1 expression in extravillous (HTR-8/SVne...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2007.02.019
更新日期:2007-05-01 00:00:00
abstract::The concentrations of certain steroids in arterial and ovarian venous blood were measured in 42 postmenopausal women undergoing hysterectomy for uterine disease. A concentration gradient across the ovary was found for testosterone in 21 women, for androstenedione in 16, for estradiol in 15, for estrone in 8, and for d...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(80)90287-2
更新日期:1980-11-01 00:00:00
abstract:OBJECTIVE:This study investigates the occurrence of miscarriages over the reproductive life span of women in a population-based study. STUDY DESIGN:A questionnaire was sent in 1994 to a random sample of 3000 Finnish women aged 18 to 44 years (73% response rate). Age-adjusted percentages of women having had miscarriage...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(99)70568-5
更新日期:1999-08-01 00:00:00
abstract:OBJECTIVE:The electrophysiologic properties of gap junctions between human myometrial smooth muscle cells were studied. STUDY DESIGN:Double whole-cell patch clamp recordings were made on pairs of cells from primary cultures of myometrial cells from women undergoing cesarean section. Macroscopic gap junction currents w...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(98)70443-0
更新日期:1998-03-01 00:00:00
abstract:OBJECTIVE:This study was undertaken to develop, implement, and evaluate a program designed to improve residents' teaching skills. STUDY DESIGN:A training program to improve the teaching skills of obstetrics and gynecology residents was developed and implemented. All residents completed a survey of their teaching skill...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/s0002-9378(03)00879-2
更新日期:2003-09-01 00:00:00
abstract::Prostaglandin E2 is a powerful oxytocic agent that reliably initiates labor, even in the presence of an unripe cervix. The low incidence of fetomaternal complication contributes to its universal use. We report a rare case of uterine rupture after intracervical application of prostaglandin E2 gel. Thus far no prostagla...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90094-8
更新日期:1991-08-01 00:00:00
abstract::Large ovarian cysts are conventionally treated by laparotomy. We describe a technique of transabdominal drainage under ultrasonographic control followed by laparoscopic excision of an ovarian cyst that was 24 x 10 x 20 cm. This approach has the benefits of minimal-access surgery and is suitable for unilocular benign c...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(96)70060-1
更新日期:1996-11-01 00:00:00