Abstract:
OBJECTIVE:To test the hypothesis that increasing the intravenous fluid bolus volume at the time of epidural placement in women with narrow pulse pressure would reduce postepidural fetal heart rate (FHR) abnormalities, hypotension, and resuscitative obstetric interventions. METHODS:We performed a single-center randomized controlled trial. Eligible participants were normotensive with a nonanomalous singleton gestation at or after 35 weeks and with a narrow pulse pressure (less than 45 mm Hg) on admission. Enrolled patients remained eligible for randomization at epidural request if they were within 6 hours of admission and the FHR remained category 1. Patients were allocated to a 500-mL (institutional standard) or 1,500-mL intravenous fluid bolus at epidural placement. A reference group with admission pulse pressure 50 mm Hg or greater was also evaluated. The primary outcome was a category 2 or 3 FHR pattern within 60 minutes after the epidural test dose. Evaluated secondary outcomes included maternal hypotension and composite resuscitative interventions to correct FHR abnormalities or hypotension. We calculated that 276 women (138/group) would provide 80% power to detect a relative 50% reduction in the occurrence of the primary outcome from 27% in the 500-mL group to 13.5% in the 1,500-mL group (two-sided α=0.05). RESULTS:From October 2015 to November 2016, 276 women were allocated to receive a 500-mL (n=139) or 1,500-mL (n=137) fluid bolus. One hundred thirty-eight women were evaluated in the reference group. Demographic, obstetric, and labor characteristics were similar between groups. The 1,500-mL group had significantly fewer postepidural FHR abnormalities (38.0% compared with 51.8%, relative risk 0.73, 95% CI 0.56-0.96, P=.02). Maternal systolic hypotension (10.2% compared with 34.5%, relative risk 0.30, 95% CI 0.17-0.51, P<.001) and composite postepidural interventions (18.3% compared with 44.2%, relative risk 0.42, 95% CI 0.28-0.62, P<.001) were also less frequent in the 1,500-mL group. Fetal heart rate abnormalities remained significantly less frequent in the reference group than among women with a narrow pulse pressure on admission for delivery. CONCLUSION:A 1,500-mL intravenous fluid bolus in women with a narrow pulse pressure decreases the risk of postepidural FHR abnormalities (number needed to treat=7), results in less frequent postepidural hypotension, and reduces the need for resuscitative interventions. Admission pulse pressure may be used to individualize intrapartum fluid management at the time of initiation of neuraxial labor analgesia. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov, NCT02565485.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
Lappen JR,Myers SA,Bolen N,Mercer BM,Chien EKSdoi
10.1097/AOG.0000000000002326subject
Has Abstractpub_date
2017-12-01 00:00:00pages
1366-1376issue
6eissn
0029-7844issn
1873-233Xpii
00006250-201712000-00025journal_volume
130pub_type
杂志文章,随机对照试验abstract:OBJECTIVE:To describe the technique and complications of vaginal repair of advanced pelvic organ prolapse using intravenous sedation, pudendal nerve block, and local anesthesia. METHODS:A retrospective review of the gynecologic surgical records of 20 patients was performed. Patient demographics, surgical procedure, su...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(95)00331-k
更新日期:1995-12-01 00:00:00
abstract:OBJECTIVE:To prospectively validate the Sepsis in Obstetrics Score, a pregnancy-specific sepsis scoring system, to identify risk for intensive care unit (ICU) admission for sepsis in pregnancy. METHODS:This is a prospective validation study of the Sepsis in Obstetrics Score. The primary outcome was admission to the IC...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000002260
更新日期:2017-10-01 00:00:00
abstract:OBJECTIVE:To evaluate absorption of estradiol (E2) and compare two low doses of 17 beta-E2 (25 microgram and 10 microgram) in postmenopausal women with atrophic vaginitis. METHODS:In a double-masked, randomized, parallel-group study, 58 postmenopausal women were treated with 25 microgram or 10 microgram of 17 beta-E2 ...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0029-7844(01)01385-0
更新日期:2002-04-01 00:00:00
abstract:OBJECTIVE:To estimate the association between obstetric forceps volume and severe perineal lacerations or adverse neonatal outcomes. METHODS:This is a retrospective cohort of forceps deliveries performed at a tertiary care hospital. Obstetricians were grouped by quartile of forceps volume over the study time period. S...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000000096
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:To describe the natural history and outcomes of a large cohort of expectantly managed angular pregnancies diagnosed in the first trimester by specific ultrasound criteria. METHODS:We conducted a prospective case series of women with prenatally diagnosed angular pregnancy at a single academic tertiary care ce...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000003595
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:To calculate pooled risk estimates for combinations of cytology result, human papillomavirus (HPV) 16/18 genotype and colposcopy impression to provide a basis for risk-stratified colposcopy and biopsy practice. DATA SOURCE:A PubMed search was conducted on June 1, 2016, and a ClinicalTrials.gov search was con...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,meta分析
doi:10.1097/AOG.0000000000002812
更新日期:2018-09-01 00:00:00
abstract::Sixty-six of 390 patients studied at LAC/USC Women's Hospital between 1970 and 1973 had positive oxytocin challenge tests (OCT). Twenty-four percent of patients who were allowed direct monitored labor after a positive OCT showed no late deceleration and must be assumed to have had false-positive tests. Patients with p...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1976-01-01 00:00:00
abstract::Women who present with pain and bleeding in the first trimester are at risk for ectopic pregnancy, a life-threatening condition. Conditions that predispose a woman to ectopic pregnancy are damaged fallopian tubes from prior tubal surgery or previous pelvic infection, smoking, and conception using assisted reproduction...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/01.AOG.0000198632.15229.be
更新日期:2006-02-01 00:00:00
abstract:OBJECTIVES:To estimate the prevalence of urinary tract injury and the relative risk of litigation from an injury for benign gynecologic surgery in Canada and to analyze a subset of cases of litigation, determining independent risk factors that predicted medical and legal outcomes. METHODS:The prevalence of urinary tra...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000144127.78481.8c
更新日期:2005-01-01 00:00:00
abstract::Twenty-three patients with premature uterine contractions occurring between the 27th and 35th weeks of pregnancy were treated in a prospective and randomized study with intravenous ritodrine in a 0.1 wt/vol% solution of isotonic saline (N = 12) or isotonic glucose (N = 11). The aim of the study was to record the effec...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1981-09-01 00:00:00
abstract::Sixty-four cases of stage I vulvar squamous cell carcinoma were analyzed histologically to define a patient subset at minimum risk for recurrence or nodal metastases. Three patterns of invasion were predefined: carcinoma in situ with early stromal invasion (33%), pushing (8%), and infiltrative (59%). Infiltrative patt...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1987-11-01 00:00:00
abstract:OBJECTIVE:To compare the accuracy of D&C and office Z-sampler endometrial biopsy in predicting hysterectomy tumor grade in women with endometrial cancer. METHODS:Between September 1987 and July 1994, 183 women with endometrial cancer had D&C or office Z-sampler endometrial biopsy before hysterectomy. RESULTS:One hund...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(95)00105-Z
更新日期:1995-07-01 00:00:00
abstract::Umbilical cord blood gases were measured as objective parameters of neonatal outcome in patients delivered by Silastic vacuum extractor and were compared with those values from patients delivered spontaneously, by forceps, or by sequential use of vacuum and forceps. The results demonstrated no clinically significant d...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1988-01-01 00:00:00
abstract::Patient care emergencies may occur at any time in any setting, particularly the inpatient setting. It is important that obstetrician-gynecologists prepare themselves by assessing potential emergencies, establishing early warning systems, designating specialized first responders, conducting emergency drills, and debrie...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,实务指引
doi:10.1097/01.AOG.0000444442.04111.c6
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVE:To estimate the prevalence of depressive symptoms among women of reproductive age attending family planning clinics across southeast Texas in addition to demographic and reproductive characteristics associated with these symptoms. METHODS:A retrospective, self-reported, paper-and-pencil survey designed to as...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.obstetgynecol.2003.08.012
更新日期:2003-12-01 00:00:00
abstract::Ultrasonography plays an integral part in the prenatal diagnosis of neural tube defects. However, experienced sonographers with careful evaluation are successful in accurately diagnosing spina bifida only 80-90% of the time. This study was conducted to evaluate the accuracy and reliability of certain cranial ultrasoun...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1990-07-01 00:00:00
abstract:OBJECTIVE:To identify risk factors for fever in labor. METHODS:A retrospective case-control study was conducted. Maternal sublingual temperature was measured every 2-4 hours during labor in 3109 of 3860 consecutive term parturients presenting from September 1992 through December 1993. Women who had fever (at least one...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(95)00254-O
更新日期:1995-11-01 00:00:00
abstract:OBJECTIVE:To assess outcomes and costs associated with around-the-clock point-of-care intrapartum group B streptococcus (GBS) polymerase chain reaction (PCR) screening. METHODS:Intrapartum PCR screening was implemented in 2010. Intrapartum PCR was compared with antenatal culture screening in an uncontrolled, single in...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1097/AOG.0000000000003057
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVE:To assess the association of education, performance feedback, and the Hawthorne effect with a reduction in the episiotomy rate in a large academic institution. METHODS:We describe a prospective observational study of a project conducted between March 2012 and February 2017 to assist clinicians in meeting the...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000002060
更新日期:2017-07-01 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 determine if bacteria are capable of producing phosphatidylglycerol in amniotic fluid (AF) and the number of colony forming units (CFU) of bacteria necessary to produce this result. METHODS:Eleven species of bacteria and one species of yeast, common to the female genital tract and implicated in chorioamni...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(95)00032-m
更新日期:1995-05-01 00:00:00
abstract:OBJECTIVE:To assess pregnancy outcomes at 40, 41, and 42 weeks' gestation when labor induction is done routinely at 42 but not 41 weeks. METHODS:We reviewed all singleton pregnancies delivered at 40 or more weeks' gestation between 1988 and 1998 at Parkland Memorial Hospital, Dallas, Texas. We excluded women with hype...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(00)00862-0
更新日期:2000-08-01 00:00:00
abstract::A thorough inspection of the pelvis for adhesions was made at the time of laparoscopic tubal sterilization in 2131 patients. Contraceptive use was then compared in women with adhesions (cases) and those without adhesions (controls). Current or previous intrauterine device (IUD) use was not associated with a statistica...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1988-02-01 00:00:00
abstract:OBJECTIVE:To obtain estimates of the effects of amniotomy on the risk of cesarean delivery and on other indicators of maternal and neonatal morbidity (Apgar score less than 7 at 5 minutes, admission to neonatal intensive care unit [NICU]). DATA SOURCES:Published studies were identified through manual and computerized ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,meta分析
doi:
更新日期:1996-05-01 00:00:00
abstract::We compared the TDx Fetal Lung Maturity test and the fluorescence polarization method using 1-palmitoyl-2(6-[(7-nitro-2,1,3-benzoxadiazol-4- yl)amino]caproyl)phosphatidylcholine (NBD-phosphatidylcholine). Using 76 paired human amniotic fluid samples, the fluorescence polarization values of the two methods were found t...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1992-12-01 00:00:00
abstract:OBJECTIVE:To investigate neonatal morbidity and maternal complication rates with delivery body mass index (BMI) 60 or greater. METHODS:This retrospective, multicenter cohort study included singleton pregnancies between 23 and 42 weeks of gestation from January 2005 to April 2016. Women with BMI 60 or greater were comp...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1097/AOG.0000000000002316
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:To evaluate whether there is an increased risk of cesarean delivery in women who delay childbearing into their later reproductive years, using a well-defined cohort and controlling for difference in baseline susceptibility such as complications of pregnancy and labor. METHODS:The current study included all w...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1993-02-01 00:00:00
abstract::The histologic diagnoses of premalignant and malignant lesions of the cervix obtained by examining the colposcopically directed biopsy material from 643 patients were compared with those of the surgical material subsequently obtained. The procedures during which samples were acquired included hysterectomy (370), cervi...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1981-08-01 00:00:00
abstract::This month we focus on current research in recurrent pregnancy loss. Dr. Ros discusses four recent publications, which are concluded with a "bottom-line" that is the take-home message. A complete reference for each can be found on on this page along with direct links to abstracts. ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000003337
更新日期:2019-07-01 00:00:00
abstract::The pre- and postoperative endocrine profile in a patient with an ovarian sex cord tumor with annular tubules resembles a granulosa cell tumor despite morphologic features of a Sertoli-Leydig cell tumor. Gonadotropin and prolactin levels were compatible with estrogen-progesterone synergy on hypothalamic pituitary func...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1986-09-01 00:00:00