Abstract:
BACKGROUND:Surgical site infections (SSIs) are an important cause of morbidity following cesarean delivery, particularly in obese patients. Methods to reduce SSIs after cesarean delivery would have an important impact in obese obstetric patients. OBJECTIVE:The purpose of this study was to determine whether the Alexis O cesarean delivery retractor, a barrier self-retaining retractor, reduces SSIs and wound disruptions in obese patients undergoing cesarean delivery. STUDY DESIGN:This was a randomized controlled trial of obese women (body mass index ≥ 30 kg/m(2)) undergoing nonemergent cesarean delivery. Patients were randomized to the treatment group (using the Alexis O cesarean delivery retractor) or to the control group (using conventional handheld retractors). The primary outcome was SSI or wound disruption during the 30 day postoperative period. Secondary outcomes included operative time, estimated blood loss, change in hemoglobin, antiemetic use, length of postoperative hospital stay, hospital readmission, and other postoperative complications. RESULTS:A total of 301 patients were enrolled in the study. One hundred forty-four patients were randomized to the treatment group and 157 to the control group. Baseline characteristics and indications for cesarean delivery were similar between the 2 groups. Median body mass index was 40.1 kg/m(2). There were no significant differences between the treatment and the control group in the primary outcome of SSI or wound disruption rates at the 30 day assessment (20.6% vs 17.6%, P = .62), during the postoperative inpatient hospitalization or at the 1-2 week postoperative visit. There were also no differences in the primary outcome when adjusting for obesity class or thickness of the subcuticular layer. Patients in the treatment group had lower rates of uterine exteriorization (54.3% vs 87.3%, P < .001), but there were no differences in all other outcomes. CONCLUSION:Use of the Alexis retractor in cesarean delivery deliveries did not decrease SSI or wound disruption rates in an obese population. Its use as a retractor should be left to the discretion of the surgeon and clinical circumstances.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Scolari Childress KM,Gavard JA,Ward DG,Berger K,Gross GAdoi
10.1016/j.ajog.2015.09.096subject
Has Abstractpub_date
2016-02-01 00:00:00pages
285.e1-285.e10issue
2eissn
0002-9378issn
1097-6868pii
S0002-9378(15)01210-7journal_volume
214pub_type
杂志文章,随机对照试验abstract::To determine the usefulness of the assays of maternal serum alpha-fetoprotein, human placental lactogen, and pregnancy-specific beta 1-glycoprotein in prenatal diagnosis of fetal alcohol syndrome, these proteins were followed in 35 problem drinkers (greater than 100 gm of ethanol weekly) and in 14 abstinent women thro...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90286-3
更新日期:1986-09-01 00:00:00
abstract::There are conflicting data in the literature concerning the effects of oral contraceptives on platelet aggregation. We studied 26 healthy women who used oral contraceptives for at least three months. The control group consisted of 25 healthy women of childbearing age, who were receiving no medications. No differences ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(78)90897-9
更新日期:1978-10-01 00:00:00
abstract:OBJECTIVE:Our purpose was to review the findings of a Gynecologic Endoscopic Review Committee established to monitor and review operative endoscopic procedures performed by the staff at a large private hospital, Swedish Hospital Medical Center, in Seattle. STUDY DESIGN:Hospital charts of patients undergoing the endosc...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1994-06-01 00:00:00
abstract::Gonadotropins are released in a pulsatile fashion at a frequency of between 1 and 2 hours in the follicular phase of the menstrual cycle. Human menopausal gonadotropins are usually administered intramuscularly. We evaluated the gonadal response to intravenous human menopausal gonadotropins administered in a pulsatile ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(84)90736-1
更新日期:1984-03-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to analyze the obstetric and neonatal impact of an opioid detoxification program during pregnancy, as well as to examine variables associated with successful opioid detoxification. STUDY DESIGN:This is a retrospective cohort study of women electing inpatient detoxification and s...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2013.05.026
更新日期:2013-09-01 00:00:00
abstract::Forty-six infants exposed to indomethacin in utero for treatment for preterm labor were compared with infants from two control groups. In one control group the next consecutive patient treated with a tocolytic agent was used, and the other control group was formed by picking the next consecutive patient matched by ges...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(86)80012-6
更新日期:1986-10-01 00:00:00
abstract::A clinical study was designed to test whether sustained administration of progesterone to nursing mothers could prolong lactation and delay the postpartum recovery of fertility. The hormone was administered by subdermal implantation of six pellets that each contained 100 mg of progesterone. This treatment was administ...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:
更新日期:1982-09-15 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::We have studied the effects of magnesium sulfate (MgSO4) administration in chronically instrumented normotensive and hypertensive pregnant sheep. Animals of 90 to 144 days' gestation were divided in two groups; those with normotensive arterial pressure and those in which renovascular hypertension had been produced. Ou...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(77)90255-1
更新日期:1977-04-01 00:00:00
abstract::Amniotic fluid samples from 12 pregnant baboons at 173 to 176 days of gestation were studied. Five fetuses were growth retarded and seven were normally developed. Mean amniotic fluid volumes and composition (osmolality, protein concentration, delta optical density at 450 nm, and amniotic fluid/maternal plasma creatini...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90114-6
更新日期:1986-07-01 00:00:00
abstract:OBJECTIVE:We sought to determine the impact of geographic location on advanced-stage ovarian cancer mortality in relation to adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines and hospital case volume. STUDY DESIGN:This was a retrospective observational cohort study of patients diagnosed wi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2015.01.045
更新日期:2015-07-01 00:00:00
abstract::Since previous data suggested hyperresponsiveness to human menopausal gonadotropin by women with low body weight, the daily dose was reduced to 1.5 ampules in patients undergoing in vitro fertilization weighing less than 55 kg. This allowed the extension of treatment to a minimum of 6 days. These changes were associat...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90778-8
更新日期:1988-01-01 00:00:00
abstract::The responses to genital tract infection vary among different women to a far greater extent than has previously been appreciated. All women are not genetically identical and have not been exposed to identical environments; therefore it is naive to expect that a particular microorganism will elicit the identical respon...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1067/mob.2000.104258
更新日期:2000-07-01 00:00:00
abstract::Two studies were performed to assess the effect of fat feeding on glucose tolerance before, during, and after gestation of BHE rats. In the first study 5% or 22% fat diets were fed from 3 weeks before mating until after gestation. In the second study, these diets were fed from weaning until 400 days of age. Glucose to...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90272-x
更新日期:1989-07-01 00:00:00
abstract::In a large randomized, controlled study of fetal heart rate monitoring with either continuous electronic fetal heart monitoring or auscultation at specified intervals, only one pattern of deviation in the fetal heart rate correlated significantly with neonatal neurologic examinations at 0 to 48 hours and 72 hours to 1...
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:10.1016/0002-9378(91)90700-2
更新日期:1991-05-01 00:00:00
abstract:OBJECTIVES:Review publications that significantly impacted on the knowledge of bacterial vaginosis. STUDY DESIGN:Assessment of information on the epidemiology, bacteriology, and pathology of bacterial vaginosis. RESULTS:Bacterial vaginosis has a complex microbiology. Further information is required on the epidemiolog...
journal_title:American journal of obstetrics and gynecology
pub_type: 历史文章,杂志文章,评审
doi:10.1016/0002-9378(93)90337-i
更新日期:1993-08-01 00:00:00
abstract::To clarify whether there is a variation of dopamine effect throughout the normal menstrual cycle, 24 studies were performed during the follicular, periovulatory, and luteal phase in seven ovulatory women. The subjects were studied for 24 hours after receiving two different dopamine agonists, 2.5 mg of bromocriptine in...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90672-1
更新日期:1986-02-01 00:00:00
abstract:BACKGROUND:The combination of the qualitative fetal fibronectin test and cervical length measurement has a high negative predictive value for preterm birth within 7 days; however, positive prediction is poor. A new bedside quantitative fetal fibronectin test showed potential additional value over the conventional quali...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2016.08.012
更新日期:2016-12-01 00:00:00
abstract::Chromosomal microarray analysis is a high-resolution, whole-genome technique used to identify chromosomal abnormalities, including those detected by conventional cytogenetic techniques, as well as small submicroscopic deletions and duplications referred to as copy number variants. Because chromosomal microarray analys...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2016.07.016
更新日期:2016-10-01 00:00:00
abstract::Intrapartum fetal scalp blood pH studies remain controversial in obstetrics. Electronic fetal monitoring, by contrast, has achieved nearly uniform acceptance. Controlled comparative studies from one institution are unlikely to provide adequate numbers. Intrapartum fetal monitoring is used consistently at our instituti...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(84)90233-3
更新日期:1984-06-01 00:00:00
abstract::The amniotic fluid index and the nonstress test are commonly used in the expectant management of preterm premature rupture of membranes. This study was designed to investigate the interrelationship of the nonstress test and the amniotic fluid index during the preterm rupture of membranes latency period. Fifty patients...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90477-9
更新日期:1991-10-01 00:00:00
abstract::Male hormonal contraception, based on the suppression of both gonadotropins, follicle-stimulating hormone and luteinizing hormone, resulting in marked decrease in sperm production, is designed for couples in stable relationships where the male partner desires to assume family planning responsibilities using reversible...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2004.01.057
更新日期:2004-04-01 00:00:00
abstract::Of 468 diagnosis-related groups identified by the federal government for Medicaid reimbursement, 15 are related to obstetric hospital care. Each diagnosis-related group is considered a distinct group in which cases are homogeneous with respect to resource consumption. Because the diagnosis-related group system is base...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(87)90052-4
更新日期:1987-03-01 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:OBJECTIVE:We sought to evaluate the efficacy of maternal posturing during labor on the prevention of persistent occiput posterior (OP) position. STUDY DESIGN:We conducted a randomized trial including 220 patients in labor with a single fetus in documented OP position. Main outcome was the proportion of anterior rotati...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ajog.2012.10.882
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVE:We sought to determine if genetic polymorphisms in the aryl hydrocarbon receptor signaling pathway are associated with menopausal hot flashes via hormone levels. STUDY DESIGN:Women (n = 639) aged 45-54 years completed a study survey and provided blood for genetic and hormone analyses. The associations were a...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2012.05.019
更新日期:2012-09-01 00:00:00
abstract:OBJECTIVE:Our purpose was to examine the importance of fungal cultures in evaluating patients with symptoms of chronic vaginitis by assessing the relative contribution of various yeast species and by comparing infections caused by Candida albicans with those caused by other species. STUDY DESIGN:A prospective observat...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(95)90347-x
更新日期:1995-09-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to investigate the use of vaginal progesterone for the prevention of preterm delivery in twin pregnancies. STUDY DESIGN:We conducted a prospective, randomized, double-blind, placebo-controlled trial that involved 390 naturally conceived twin pregnancies among mothers with no his...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ajog.2015.02.021
更新日期:2015-07-01 00:00:00
abstract::The current goal of evidence-based medicine, prospective therapeutic interventions in large numbers of patients, may not always reach an accurate conclusion. Individual variations in genetic characteristics need to be acknowledged and taken into account in the analysis. Some women with recurrent vulvo-vaginal candiosi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2006.03.098
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:We wanted to test whether the recently described method of using the transferrin receptor system for fluorescence-activated cell-sorter enrichment of nucleated red blood cells can be used for prenatal diagnosis from maternal blood. STUDY DESIGN:Instead of the laborious, expensive fluorescence-activated cell-...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(92)91603-8
更新日期:1992-05-01 00:00:00