Abstract:
:Approximately 0.5% of all births occur before the third trimester of pregnancy, and these very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. A recent executive summary of proceedings from a joint workshop defined periviable birth as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When delivery is anticipated near the limit of viability, families and health care teams are faced with complex and ethically challenging decisions. Multiple factors have been found to be associated with short-term and long-term outcomes of periviable births in addition to gestational age at birth. These include, but are not limited to, nonmodifiable factors (eg, fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium sulfate), and postnatal management (eg, starting or withholding and continuing or withdrawing intensive care after birth). Antepartum and intrapartum management options vary depending upon the specific circumstances but may include short-term tocolytic therapy for preterm labor to allow time for administration of antenatal steroids, antibiotics to prolong latency after preterm premature rupture of membranes or for intrapartum group B streptococci prophylaxis, and delivery, including cesarean delivery, for concern regarding fetal well-being or fetal malpresentation. Whenever possible, periviable births for which maternal or neonatal intervention is planned should occur in centers that offer expertise in maternal and neonatal care and the needed infrastructure, including intensive care units, to support such services. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline for family counseling with the goal of incorporating informed patient preferences. Its intent is to provide support and guidance regarding decisions, including declining and accepting interventions and therapies, based on individual circumstances and patient values.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
doi
10.1097/AOG.0000000000001483subject
Has Abstractpub_date
2016-06-01 00:00:00pages
e157-e169issue
6eissn
0029-7844issn
1873-233Xpii
00006250-201606000-00043journal_volume
127pub_type
共识发展会议,杂志文章abstract:BACKGROUND:Resistance to thyroid hormone manifests as high serum levels of free thyroxine and free triiodothyronine, with nonsuppressed thyroid stimulating hormone (TSH) levels. We report a case series of three patients with this condition, the changes in thyroid function tests during their pregnancies, and their obste...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3181809e3a
更新日期:2008-08-01 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::Nine reproductive-age women underwent removal of unilateral or bilateral dermoid cysts via laparoscopy. Over a follow-up period of 12-42 months, there were no immediate or long-term complications. Four patients have had repeat laparoscopy for evaluation of possible pelvic adhesion formation; one had mild periovarian a...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1989-02-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to estimate the probability of spontaneous delivery at 34 weeks or less according to cervical assessment by transvaginal scan associated with previous obstetric history. METHODS:Ultrasound transvaginal cervical length and presence of funneling were evaluated in 1,958 singleton pregn...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000154157.22500.1d
更新日期:2005-03-01 00:00:00
abstract:OBJECTIVE:To comprehensively review and critically assess the available gynecologic surgery venous thromboembolism prophylaxis literature and provide clinical practice guidelines. DATA SOURCES:MEDLINE and Cochrane databases from inception to July 2010. We included randomized controlled trials in gynecologic surgery po...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/AOG.0b013e318232a394
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVE:To evaluate whether cesarean delivery is a risk factor for emergent postpartum hysterectomy. METHODS:We performed a case-control study of patients who delivered at Women & Infants Hospital between January 1989 and February 2000. Fifty cases of emergent postpartum hysterectomy performed within 14 days of deli...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(03)00404-6
更新日期:2003-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the use of the Auto Suture Poly CS-57 disposable surgical stapler to determine if the device offers any advantages over suture closure of the uterus. METHODS:A matched case-control study design was used. Operative time, estimated blood loss, change in hematocrit, incidence of postoperative endome...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(95)00438-6
更新日期:1996-03-01 00:00:00
abstract:OBJECTIVE:To estimate the efficacy, cycle control, tolerability, and safety of a monophasic combined oral contraceptive containing nomegestrol acetate and 17β-estradiol (E2) in comparison with drospirenone and ethinyl E2. METHODS:In a randomized, open-label, comparative multicenter trial, healthy women (n=2,281; age 1...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/AOG.0b013e318250c3a0
更新日期:2012-05-01 00:00:00
abstract:OBJECTIVE:Many serum markers have been proposed to aid in the identification of an ectopic pregnancy, but few have been validated. Most studies have been limited by sample size and design. The goal of this study was to assess putative markers to identify which can be optimally combined. METHODS:We conducted a case-con...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1097/AOG.0b013e31820b3c61
更新日期:2011-03-01 00:00:00
abstract::Indium-111 attached to bleomycin is useful in the scintigraphic localization of a variety of tumors. Since it does not normally accumulate in bowel and feces, it is superior to other radiopharmaceuticals, such as gallium-67 citrate, in the demonstration of abnormalities in the abdomen and pelvis. Twenty-eight patients...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1975-09-01 00:00:00
abstract::Blood samples were obtained from 145 preovulatory and postovulatory hirsute women and the plasma was analyzed for total testosterone (T), T index, and free T concentration as well as the fraction of free T percentage and that bound by testosterone-estradiol binding globulin. Fifty-six patients were subjected to a 2-we...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1982-08-01 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:OBJECTIVE:To collect data from nine European countries for cases of obstetric hemorrhage between 2000 and 2004 in which recombinant activated factor VII (rFVIIa) was used. METHODS:The cases were identified through national surveys. Standardized case report forms included sociodemographic details, past medical and obst...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000288515.48066.99
更新日期:2007-12-01 00:00:00
abstract::Seizure disorders frequently are diagnosed and managed during adolescence; therefore, obstetrician-gynecologists who care for adolescents should be familiar with epilepsy and other seizure disorders, as well as antiepileptic drugs. Patients diagnosed with seizure disorders during childhood may have increased seizure a...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000003828
更新日期:2020-05-01 00:00:00
abstract:BACKGROUND:Pregnancy-induced hemolytic anemia is a rare maternal complication that occurs during pregnancy and resolves soon after delivery. The mechanism is unclear, and the disease is often referred to as unexplained hemolytic anemia associated with pregnancy. CASE:We report a case of life-threatening hemolytic anem...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000287292.74846.f2
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:To use a decision-analytic model to assess a comprehensive set of outcomes of prenatal genetic testing strategies among women of varying ages. METHODS:We assessed outcomes of six testing strategies incorporating diagnostic testing with chromosomal microarray, multiple marker screening, cell-free DNA screenin...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000001029
更新日期:2015-10-01 00:00:00
abstract::This month, we focus on current research in postpartum hemorrhage. Dr. Rouse discusses five recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts. ...
journal_title:Obstetrics and gynecology
pub_type: 评论,杂志文章
doi:10.1097/AOG.0b013e3182a2c357
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Vaginal evisceration can take place many years after vaginal surgery. CASE:An 87-year-old woman presented with evisceration of small bowel through the vagina, 15 years after she underwent a vaginal hysterectomy. On physical examination, her vital signs were normal. Forty centimeters of small bowel was visib...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(02)02336-0
更新日期:2003-05-01 00:00:00
abstract::Sexually transmitted infections (STIs) disproportionately affect women and create a preventable threat to their fertility. One factor that contributes to young women's high rates of STIs is reinfection from an untreated sexual partner. One way to address this problem is through expedited partner therapy, the practice ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000466366.67312.8c
更新日期:2015-06-01 00:00:00
abstract:OBJECTIVE:Epidermal growth factor is a ubiquitous mitogen that also possesses insulin-like properties. Fetal mal-growth is associated with altered epidermal growth factor levels. Maternal diabetes is frequently complicated by macrosomia, but the effect of maternal diabetes on fetal epidermal growth factor levels is not...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000110545.64874.49
更新日期:2004-02-01 00:00:00
abstract::A 68-year-old postmenopausal patient with adenoid cystic carcinoma of the cervic is described. Thirty-two other cases were collected from the literature, and a clinicopathologic analysis for the whole group is presented. The study indicates that a) adenoid cystic carcinoma usually occurs in postmenopausal patients in ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-197506000-00018
更新日期:1975-06-01 00:00:00
abstract::Uterine leiomyomas are associated with various complications during pregnancy. During a 2-year period, pregnant women with a history of leiomyomas were referred to our antenatal testing unit for ultrasound evaluation. Eighty-five patients were found to have single or multiple leiomyomas by ultrasound examination. The ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1990-01-01 00:00:00
abstract::The authors treated a 15-year-old girl with a nonfused mullerian system and absence of the cervix and vagina. Surgical reconstruction of the uterus and vagina were performed, after which menstruation first appeared. Postoperative fibrotic stenosis obliterated almost the entire vagina except for a fine uterovaginal fis...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1983-02-01 00:00:00
abstract:OBJECTIVE:To examine cigarette smoking as a risk factor for different types of epithelial ovarian cancer. METHODS:We used data from the Cancer and Steroid Hormone Study, a multicenter, population-based, case control investigation. Cases were 447 women aged 20-54 years with diagnoses of epithelial ovarian cancer. Contr...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/s0029-7844(99)00531-1
更新日期:2000-02-01 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 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 wee...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000002431
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:To identify independent risk factors for endometrial neoplasia in women with abnormal perimenopausal or postmenopausal bleeding and to use those factors to develop and test a predictive model. METHODS:We conducted a case-control study of women with abnormal perimenopausal or postmenopausal bleeding who had e...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(98)00469-4
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVE:To study the use of middle cerebral arterial Doppler findings in a group of high-risk fetuses as a predictor of adverse perinatal outcome, including subsequent neurologic handicap. METHODS:A group of very high-risk fetuses was recruited over a 2-year period for study. Weekly fetal biometries and Doppler stud...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(96)00062-2
更新日期:1996-06-01 00:00:00
abstract:OBJECTIVE:To estimate the overall reduction in ovarian cancer risk associated with the use of oral contraceptive pills (OCPs) and whether reduction in risk is affected by specifics of OCP use, such as formulation or duration of use. DATA SOURCES:We searched PubMed, Embase, the Cochrane Database of Systematic Reviews, ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,meta分析,评审
doi:10.1097/AOG.0b013e318291c235
更新日期:2013-07-01 00:00:00
abstract::The preoperative diagnosis of ectopic ovarian tissue has been reported only once in the literature. In the present case, differential ovarian and adrenal testing was used to diagnose and aberrant ovarian source of persistently elevated plasma estrogen in a patient who had undergone bilateral oophorectomy and adrenalec...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1976-02-01 00:00:00