Abstract:
OBJECTIVE:To assess the morbidity associated with continuing the second-stage duration of labor, weighing the probability of spontaneous vaginal birth without morbidity compared with birth with serious maternal or neonatal complications. METHODS:In a retrospective cohort, we analyzed singleton, vertex births at 36 weeks of gestation or greater without prior cesarean delivery (n=43,810 nulliparous and 59,605 multiparous women). We calculated rates of spontaneous vaginal birth and composite serious maternal or neonatal complications. Results were stratified by parity (nulliparous or multiparous) and epidural status (yes or no). Competing risks models were created for 1) spontaneous vaginal birth with no morbidity, 2) birth with maternal or neonatal morbidity, and 3) no spontaneous vaginal birth and no morbidity, and our main interest was in comparing number 1 against number 2. RESULTS:Rates of spontaneous vaginal birth without morbidity were slightly higher after the first half hour (greater than 0.5-1.0 hours) for nulliparous women, after which rates decreased with increasing second-stage duration. For multiparous women, rates of spontaneous vaginal birth without morbidity decreased with increasing second-stage duration. For illustration, for a nulliparous woman with an epidural at 3.0 hours of the second stage of labor who extended by another 1.0 hour, her likelihood of delivering by spontaneous vaginal birth was 31.4% compared with her likelihood of birth with any serious complication in the subsequent hour, which was 7.6%. The percentage of cesarean deliveries for nonreassuring fetal heart rate tracing were higher for women without compared with women with an epidural. CONCLUSION:Rates of spontaneous vaginal birth without serious morbidity steadily decreased for increasing second-stage duration except for the first half hour for nulliparous women. We did not observe an inflection point at a particular hour mark for either spontaneous vaginal delivery without morbidity or births with morbidity. Our findings will assist in decision-making for extending second-stage duration.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
Grantz KL,Sundaram R,Ma L,Hinkle S,Berghella V,Hoffman MK,Reddy UMdoi
10.1097/AOG.0000000000002431subject
Has Abstractpub_date
2018-02-01 00:00:00pages
345-353issue
2eissn
0029-7844issn
1873-233Xpii
00006250-201802000-00020journal_volume
131pub_type
杂志文章abstract::The purpose of this study was to investigate the potential relationship between the salivary electrical resistance, as measured by the Cue Fertility Monitor, and the time of ovulation. Twenty-seven cycles in 18 volunteers were analyzed. A slight correlation could be demonstrated between the day of salivary electrical ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVE:To determine the relationships among the pregnancy outcomes of growth-retarded fetuses, Doppler flow velocimetry of the fetomaternal circulation, and pathologic changes in the placenta. METHODS:Forty-seven fetuses confirmed to be growth-retarded by ultrasonographic biometry were monitored during pregnancy in...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVE:To evaluate the potential savings in cost of care derived from performing vaginal hysterectomies instead of abdominal hysterectomies in selected women with fibroid uteri equivalent in size to a 14-18 week gestation. METHODS:Women 35-46 years of age undergoing hysterectomy for fibroid uteri were selected to a...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(94)00402-Y
更新日期:1995-03-01 00:00:00
abstract::The recent United States Food and Drug Administration approval of a commercial kit containing the Yuzpe regimen for emergency contraception is a welcome event. Unlike emergency contraceptive pills sold in other countries, however, the United States product has a pregnancy test bundled with the pills. The test could id...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(99)80049-0
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND:Uterine torsion is defined as the rotation of more than 45 degrees around the long axis of the uterus. An uncommon but potentially fatal event, uterine torsion is rarely diagnosed until the time of surgery. With magnetic resonance imaging (MRI), however, an accurate diagnosis of uterine torsion may now be ma...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(94)00283-j
更新日期:1995-05-01 00:00:00
abstract:OBJECTIVE:To generate estimates of the association between markers of ovarian aging and natural fertility in a community sample at risk for ovarian aging. METHODS:Women aged 30-44 years with no history of infertility who had been trying to conceive for less than 3 months provided early-follicular phase serum and urine...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3182116bc8
更新日期:2011-04-01 00:00:00
abstract::The purpose of this investigation was to assess computed tomographic (CT) pelvimetry in the evaluation of breech presentation for trial of labor. Thirty-two patients with singleton term breech deliveries formed the study group. Seventeen of the 32 (53.1%) patients fulfilled the criteria for attempted vaginal delivery....
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1986-10-01 00:00:00
abstract:BACKGROUND:Doppler measurement of the fetal middle cerebral artery peak systolic velocity is a valuable tool in detecting the presence of fetal anemia in Rh-sensitized pregnancies. We present a case in which discordant left and right middle cerebral artery Dopplers complicated clinical management. CASE:An RhD-alloimmu...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000263463.09931.40
更新日期:2007-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness and safety of the vaginal application of misoprostol for induction of labor at term, with the interval duration from labor induction to vaginal birth as the primary outcome measure. METHODS:Two hundred twenty-two women with indications for induction of labor at term were randomi...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0029-7844(96)00220-7
更新日期:1996-10-01 00:00:00
abstract::Conjoined twins occur with a frequency of 1/50,000--1/100,000 deliveries. The cephalothoracopagus variety is particularly rare. This paper presents a case report of cephalothoracopagus (Janiceps) twinning, with a detailed pathologic analysis, as well as an historical review and discussion of diagnostic modalities. ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1979-09-01 00:00:00
abstract:OBJECTIVE:To assess the associations between specific pregnancy complications and posttraumatic stress disorder based on neurobiologic and behavioral characteristics, using Michigan Medicaid claims data from 1994-1996. METHODS:Two thousand, two hundred nineteen female recipients of Michigan Medicaid who were of childb...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(00)01097-8
更新日期:2001-01-01 00:00:00
abstract:OBJECTIVE:To describe a second-stage partogram based on a system of scoring the descent and position of the fetal head and to use this system for studying progress in the second stage of labor and predicting mode of delivery and obstetric outcome. METHODS:A prospective observational study of 1413 women at term with a ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(00)00981-9
更新日期:2000-11-01 00:00:00
abstract:OBJECTIVE:To determine the utilization rate of second-trimester genetic sonogram and its role in influencing the decision for amniocentesis in women at increased risk for fetal trisomy 21. METHODS:From November 1, 1993, to December 31, 1996, a second-trimester genetic sonogram or only genetic amniocentesis (as a first...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/S0029-7844(97)00227-5
更新日期:1997-08-01 00:00:00
abstract:OBJECTIVE:To determine the frequency of intrauterine rubella infection in Taiwan. METHODS:One hundred three pregnant women with evidence of rubella infection were enrolled. Congenital rubella infection was diagnosed by testing specific immunoglobulin (Ig) M in fetal cord serum obtained from funipuncture or amniotic fl...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1994-09-01 00:00:00
abstract::Patient choices and plans may sometimes carry increased risk or include alternatives that individual physicians feel uncomfortable supporting or recommending. We consider in this commentary how the ethical principles of respect for autonomy and nonmaleficence can be balanced using, among other examples, the choice by ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3182167413
更新日期:2011-05-01 00:00:00
abstract::Fourteen women with amenorrhea-galactorrhea were treated with bromo-ergocryptine. Serum prolactin hPRL, hLH, hFSH, estradiol 17-beta (E2), and progesterone values were determined before and during treatment. No consistent pretreatment hormonal pattern was found. During treatment hPRL levels fell in 13 of 14 patients, ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1976-07-01 00:00:00
abstract:OBJECTIVE:To compare maternal and neonatal outcomes using two different testing strategies for gestational diabetes mellitus (GDM) diagnosis: the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) and Carpenter-Coustan approaches. Specifically, we wanted to compare the rates of cesarean deliv...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000002195
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVE:Intrauterine contraception is used by many women worldwide, however, it is rarely used in the United States. Although available at no cost from the state family planning program for low-income women in California, only 1.3% of female patients obtain intrauterine contraceptives annually. This study assessed kn...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e318173fd83
更新日期:2008-06-01 00:00:00
abstract::Use of a scalp electrode facilitates and adds precision to electronic fetal monitoring. We report an instance of neonatal osteomyelitis due to infection of the electrode insertion site. Electrode-associated soft and bony tissue infections are most commonly mediated by cervicovaginal microflora and appear clinically an...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1989-03-01 00:00:00
abstract:OBJECTIVE:To estimate whether the use of specific types of assisted reproductive technology (ART) is associated with an increased risk of placenta-mediated pregnancy complications, which include preeclampsia, stillbirth, small for gestational age at birth, and placental abruption. METHODS:A population-based retrospect...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3181b76bd1
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:Pellagra is a rare clinical syndrome caused by niacin deficiency, and although most commonly nutritional in origin, may be secondary to carcinoid syndrome. CASE:A premenopausal nulliparous woman with metastatic carcinoid tumor developed isolated vulvovaginal manifestations characterized by well-demarcated s...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e318191bb51
更新日期:2009-02-01 00:00:00
abstract:OBJECTIVE:To estimate the rates of early neonatal and maternal complications in a consecutive series of successful Kielland's rotational forceps deliveries. METHODS:This was a retrospective cohort study of consecutive cases of successful rotational forceps deliveries performed in singleton pregnancies at 36 weeks of g...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e31828b72cb
更新日期:2013-05-01 00:00:00
abstract:OBJECTIVE:To investigate the relationship between erythropoietin concentration in umbilical venous blood and clinical signs of fetal hypoxia. METHODS:We measured erythropoietin concentrations in umbilical venous blood from 200 consecutively born neonates using an enzyme-linked immunosorbent assay (ELISA) with two mono...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:
更新日期:1993-04-01 00:00:00
abstract::Most large series of neonatal ovarian cysts are limited to those diagnosed in the newborn period. Eight cases of fetal ovarian cysts diagnosed prenatally by ultrasound have been reported, only one of which was aspirated in utero. Reported is the youngest fetus to undergo in utero aspiration of an ovarian cyst to reduc...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1986-09-01 00:00:00
abstract::The relationship of three different fetal ponderal indexes was studied in 116 normal pregnancies between 20 and 41 weeks. All three fetal ponderal indexes were found to be independent of gestational age. Throughout normal gestation, the femur length to abdominal circumference ratio X 100 was found to be 22.3 +/- 2.4 (...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1985-06-01 00:00:00
abstract::Recent studies suggest that fetal biometry may allow recognition of pregnancies at risk for Down syndrome. Second-trimester biparietal diameter (BPD)/femur length and observed-to-expected femur length ratios were examined in 48 chromosomally abnormal fetuses and compared with those of a control population composed of ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1989-11-01 00:00:00
abstract::Although pneumonia complicating pregnancy remains an unusual occurrence, it can have serious consequences for both the mother and fetus. Although Streptococcus pneumoniae remains the most common bacterial pathogen, recent epidemics have emphasized the importance of considering Legionella pneumophila as the etiologic a...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-198603001-00003
更新日期:1986-03-01 00:00:00
abstract::The influence of prostaglandins as well as adrenoceptor agonists and antagonists on contractile activity of isolated cervical smooth muscle from term pregnant women was studied. Prostaglandin E2 had an inhibitory effect at extremely low concentrations. Inhibition also was induced by prostaglandin F2 alpha, prostagland...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1986-04-01 00:00:00
abstract:OBJECTIVE:We sought to investigate the prevalence and risk factors for vaginal yeast colonization over a 1-year period. METHODS:We conducted a longitudinal cohort study of 1,248 asymptomatic young women by collecting demographic and behavioral data at baseline, 4, 8, and 12 months. RESULTS:Seventy percent of women we...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000140687.51048.73
更新日期:2004-11-01 00:00:00
abstract::Vaginal hysterectomy fulfills the evidence-based requirements as the preferred route of hysterectomy for benign gynecologic disease. Despite proven safety and effectiveness, the vaginal approach for hysterectomy has been and remains underused in surgical practice. Factors associated with underuse of vaginal hysterecto...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000000398
更新日期:2014-09-01 00:00:00