Maternal Pulse Pressure and the Risk of Postepidural Complications: A Randomized Controlled Trial.


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, NCT02565485.


Obstet Gynecol


Lappen JR,Myers SA,Bolen N,Mercer BM,Chien EKS




Has Abstract


2017-12-01 00:00:00














  • Using middle cerebral artery peak systolic velocity to time in utero transfusions in fetomaternal hemorrhage.

    abstract:BACKGROUND:Fetomaternal hemorrhage is a rare cause of fetal anemia and hydrops fetalis. Early and severe fetomaternal hemorrhage may benefit from in utero transfusion(s); however, hemorrhage rate is unpredictable, and reliable criteria are needed to identify recurrent anemia. CASE:Fetal hydrops due to massive fetomate...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Friszer S,Cortey A,Pierre F,Carbonne B

    更新日期:2010-05-01 00:00:00

  • Screening for human immunodeficiency virus and other sexually transmitted diseases among U.S. women with prenatal care.

    abstract:OBJECTIVE:To estimate prenatal sexually transmitted disease-human immunodeficiency virus (HIV) screening rates among insured women with prenatal care and the association of chlamydia and gonorrhea screening with Pap testing. METHODS:We estimated prenatal screening rates for syphilis, hepatitis B, HIV, chlamydia, and g...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Ross CE,Tao G,Patton M,Hoover KW

    更新日期:2015-05-01 00:00:00

  • Brenner tumor and mucinous cystadenoma of borderline malignancy in a patient with Turner's syndrome.

    abstract::A 64-year-old woman with a 45,X karyotype and Turner's syndrome and recent onset of right lower quadrant pain was found to have a mucinous cystadenoma with focal areas of borderline malignancy and a typical Brenner tumor in the right adnexa. Ovarian tumors in patients with a 45,X karyotype and Turner's syndrome are ex...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Murphy GF,Welch WR,Urcuyo R

    更新日期:1979-11-01 00:00:00

  • Prevalence of Human Papillomavirus in Self-Collected Cervicovaginal Swabs in Young Women in the United States Between 2003 and 2012.

    abstract:OBJECTIVE:To evaluate whether there was a change in prevalence of human papillomavirus (HPV) in the United States correlated with the introduction of HPV vaccines in both vaccinated and unvaccinated women. METHODS:We performed a retrospective review of prevalence data for women aged 18-29 years living in the United St...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Tarney CM,Klaric J,Beltran T,Pagan M,Han J

    更新日期:2016-12-01 00:00:00

  • A normal ultrasound does not obviate the need for amniocentesis in patients with elevated serum alpha-fetoprotein.

    abstract::Elevated levels of maternal serum alpha-fetoprotein (MSAFP) will identify a population at increased risk for specific congenital malformations, which are accurately diagnosed by amniotic fluid AFP and acetylcholinesterase. The risk for spontaneous abortion related to amniocentesis, combined with increasing confidence ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Drugan A,Zador IE,Syner FN,Sokol RJ,Sacks AJ,Evans MI

    更新日期:1988-10-01 00:00:00

  • Natural history of cervical squamous intraepithelial lesions: a meta-analysis.

    abstract:OBJECTIVE:To define the strengths and weaknesses of existing research on the natural history of cervical squamous intraepithelial lesions (SIL) and to estimate rates of progression and regression without treatment. DATA SOURCES:Studies of women whose cervical smears showed squamous atypia or worse and who were observe...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,meta分析


    authors: Melnikow J,Nuovo J,Willan AR,Chan BK,Howell LP

    更新日期:1998-10-01 00:00:00

  • Tubal pregnancy with normal hysterosalpingogram and negative serum pregnancy test.

    abstract::A patient undergoing evaluation for primary infertility with regular menses had a normal hysterosalpingogram in the follicular phase and underwent diagnostic laparoscopy the next day, with the finding of a tubal pregnancy. The patient had a negative serum pregnancy test. Although a normal hysterosalpingogram and negat...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Uribe MA,Dunn RC,Buttram VC Jr

    更新日期:1990-03-01 00:00:00

  • Placental Abruption With Delayed Fetal Compromise in Maternal Acetaminophen Toxicity.

    abstract:BACKGROUND:After maternal acetaminophen overdose, fetal fulminant liver failure, stillbirth, neonatal death, or preterm delivery may occur. CASE:A 27-year-old woman, gravida 2 para 1, presented at 28 weeks of gestation after unintentional acetaminophen overdose. Four days after ingestion, her laboratory values worsene...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Taney J,Anastasio H,Paternostro A,Berghella V,Roman A

    更新日期:2017-07-01 00:00:00

  • Maternal uterine artery Doppler flow velocimetry and the risk of stillbirth.

    abstract:OBJECTIVE:We sought to relate the risk of antepartum stillbirth to uterine artery Doppler flow velocimetry at 22-24 weeks. METHODS:Data were available from 30,519 unselected women from seven units in the UK who had uterine artery Doppler performed between 22 and 24 weeks of gestation. The risk of stillbirth (n=109) wa...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Smith GC,Yu CK,Papageorghiou AT,Cacho AM,Nicolaides KH,Fetal Medicine Foundation Second Trimester Screening Group.

    更新日期:2007-01-01 00:00:00

  • Cesarean delivery and the long-term risk of offspring obesity.

    abstract:OBJECTIVE:To examine the association between the mode of delivery and the risk of offspring obesity by age 21 years using a large community-based birth cohort study in Australia. METHODS:We followed-up a subsample of 2,625 offspring for whom we had measured physical assessments, including height and weight at 21 years...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Mamun AA,Sutharsan R,O'Callaghan M,Williams G,Najman J,McIntyre HD,Callaway L

    更新日期:2013-12-01 00:00:00

  • Relaxin in human pregnancy serum measured with an homologous radioimmunoassay.

    abstract::This study reports serum levels of relaxin in normal and special-interest pregnancies using an homologous radioimmunoassay for human relaxin. The mean levels in uncomplicated antenatal patients were lower than those reported in studies using heterologous assays, but the trend in serum levels was similar. Serum levels ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Bell RJ,Eddie LW,Lester AR,Wood EC,Johnston PD,Niall HD

    更新日期:1987-04-01 00:00:00

  • Complications and continuation of intrauterine device use among commercially insured teenagers.

    abstract:OBJECTIVE:Many U.S. health care providers remain reluctant to prescribe intrauterine devices (IUDs) to teenagers as a result of concerns about serious complications. This study examined whether 15-19-year-old IUD users were more likely to experience complications, failure, or early discontinuation than adult users aged...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Berenson AB,Tan A,Hirth JM,Wilkinson GS

    更新日期:2013-05-01 00:00:00

  • Estrogen improves psychological function in asymptomatic postmenopausal women.

    abstract::Estrogen treatment of postmenopausal women has been suggested to improve mood and psychological function. However, this remains controversial because previous studies involved heterogeneous groups, were not double blind, and included women who were also experiencing somatic symptoms that were relieved by estrogen. A r...

    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Ditkoff EC,Crary WG,Cristo M,Lobo RA

    更新日期:1991-12-01 00:00:00

  • The 4-S modification of the Roeder knot: how to tie it.

    abstract:BACKGROUND:The 4-S modification of the Roeder knot may be tied laparoscopically as a single-throw knot. TECHNIQUE:It is tied by adding a fourth wrap around the suture loop and securing the loop in place with a square knot rather than a single half-hitch. EXPERIENCE:We have used this knot in laparoscopic surgeries for...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Sharp HT,Dorsey JH

    更新日期:1997-12-01 00:00:00

  • Medical liability reform: a case study of Mississippi.

    abstract::Mississippi enacted medical negligence and other tort reform legislation that generally became effective for causes of action filed on or after January 1, 2003, and September 1, 2004. Data regarding lawsuits against physicians insured by the Medical Assurance Company of Mississippi (MACM), the largest medical liabilit...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Behrens MA

    更新日期:2011-08-01 00:00:00

  • Committee opinion no. 507: human trafficking.

    abstract::Human trafficking is a widespread problem with estimates ranging from 14,000 to 50,000 individuals trafficked into the United States annually. This hidden population involves the commercial sex industry, agriculture, factories, hotel and restaurant businesses, domestic workers, marriage brokers, and some adoption firm...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章



    更新日期:2011-09-01 00:00:00

  • Discrepancy in the interpretation of cervical histology by gynecologic pathologists.

    abstract:OBJECTIVE:To determine if subspecialty review of cervical histology improves diagnostic consensus of cervical intraepithelial neoplasia (CIN). METHODS:After routine histologic assessment within the hospital pathology department, 119 colposcopic cervical biopsies were interpreted by two subspecialty-trained gynecologic...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Parker MF,Zahn CM,Vogel KM,Olsen CH,Miyazawa K,O'Connor DM

    更新日期:2002-08-01 00:00:00

  • Look before you leap: genomic screening in obstetrics and gynecology.

    abstract::There are a number of new genetic tests and a variety of recommendations for obstetrician-gynecologists. In recent years, screening of low-risk pregnant women with noninvasive prenatal testing has been proposed as well as universal BRCA1 and BRCA2 screening of all women regardless of risk status. Both proposed genetic...

    journal_title:Obstetrics and gynecology

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    authors: Adams MC,Berg JS,Pearlman MD,Vora NL

    更新日期:2015-06-01 00:00:00

  • Vaginal drainage of posthysterectomy abscess under direct ultrasonic guidance.

    abstract::Continuous real-time ultrasound was used to assist drainage of two infected posthysterectomy vaginal cuff hematomas. This method enabled the gynecologist to determine the position either of his finger or of the instrument in the cavity at all times. This allowed him to see that any loculations within the infected hema...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: McArdle CR,Simon L,Kiejna C

    更新日期:1984-03-01 00:00:00

  • Abnormalities of lymphocyte transformations in women with intraepithelial carcinoma of the vulva.

    abstract::Cellular immunity of the delayed type in women with intraepithelial carcinoma (carcinoma is situ) of the vulva was investigated by an in vitro assay of mitogen-induced lymphocyte transformations. Test results from 9 patients were compared to those of 23 age-matched control subjects. Lymphocyte transformation responses...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Seski JC,Reinhalter ER,Silva J Jr

    更新日期:1978-09-01 00:00:00

  • Umbilical coiling index in normal and complicated pregnancies.

    abstract:OBJECTIVE:To estimate the relation between undercoiling and overcoiling of the umbilical cord and adverse pregnancy outcome. METHODS:Umbilical cords and hospital records of 885 patients were studied in a cross-sectional study design. The umbilical coiling index was determined as the number of complete coils divided by...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: de Laat MW,Franx A,Bots ML,Visser GH,Nikkels PG

    更新日期:2006-05-01 00:00:00

  • Differences in perineal lacerations in black and white primiparas.

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    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Howard D,Davies PS,DeLancey JO,Small Y

    更新日期:2000-10-01 00:00:00

  • Longitudinal analysis of a multisite clerkship.

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    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Strand DA,Vontver LA,Stenchever MA,Hadac RR,Irby DM

    更新日期:1985-11-01 00:00:00

  • A protocol of dual prophylaxis for venous thromboembolism prevention in gynecologic cancer patients.

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    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章


    authors: Einstein MH,Kushner DM,Connor JP,Bohl AA,Best TJ,Evans MD,Chappell RJ,Hartenbach EM

    更新日期:2008-11-01 00:00:00

  • Obstetrician-gynecologists as primary care physicians: the perspectives of health maintenance organization medical directors and obstetrician-gynecologists.

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    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Scroggs JA,Griffin LP,Bayerl M,Schulkin J

    更新日期:1997-08-01 00:00:00

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    abstract::Blood coagulation and fibrinolytic inhibitors and the balance between and within the two systems were investigated in 26 normal pregnant women during pregnancy and the puerperium. The concentration of the coagulation inhibitors antithrombin and protein C remained within normal levels, whereas the mean level of free pr...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Bremme K,Ostlund E,Almqvist I,Heinonen K,Blombäck M

    更新日期:1992-07-01 00:00:00

  • Single- versus three-dose cefotaxime prophylaxis for cesarean section.

    abstract::A prospective randomized study was undertaken in 100 patients undergoing cesarean section to evaluate the efficacy of cefotaxime when given as a single-dose versus the more traditional triple-dose regimen for prophylaxis. Analysis of the results demonstrated no significant differences in febrile morbidity (14 versus 2...

    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Gonik B

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  • Association of Persistent Breech Presentation With External Cephalic Version Success.

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    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Lauterbach R,Bachar G,Ben-David C,Matanes E,Ginsberg Y,Beloosesky R,Ganem N,Weiner Z,Zipori Y

    更新日期:2021-02-01 00:00:00

  • Integrated external and interstitial radiation therapy for primary carcinoma of the vagina.

    abstract::Twenty-seven patients with the diagnosis of primary carcinoma of the vagina were treated by definitive radiotherapy. Twenty-three patients received a combination of external and interstitial iridium-192 implant irradiation and four patients received only interstitial irradiation. Twenty-one patients had squamous cell ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Puthawala A,Syed AM,Nalick R,McNamara C,DiSaia PJ

    更新日期:1983-09-01 00:00:00

  • Obstacles to Studying Emerging Technologies.

    abstract::Laparoscopic radiofrequency ablation of uterine leiomyomas with a new Federal Drug Administration (FDA)-approved device, a device that delivers radiofrequency energy, is a novel procedure that aims to meet patient and physician demand for effective, minimally invasive leiomyoma treatment. However, as a new procedure, ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Waetjen LE,Parvataneni R,Varon S,Saberi NS,Jacoby VL,University of California Fibroid Network (UCFN).

    更新日期:2015-08-01 00:00:00