These investigators found that the routine use of acetaminophen alone rather than a combination acetaminophen-opioid significantly reduced overall and daily opioid use. In addition, there was no worse effect on overall pain score or length of stay.
Throught the years, clinicians' understanding of the conduct of labor has undergone periodic re-evaluation. In the 1950s, cesarean delivery was a major operation. Today, the procedures are shorter, accompanied by less surgical fanfare, and associated with fewer days in the hospital. Nevertheless, as the only other option to vaginal delivery, the operation, performed in 35% of cases for failure to progress, still should be considered “major” considering its potential for maternal complications.
The authors of this two-center study found that magnetic resonance is not superior to ultrasound in diagnostic accuracy for placenta accreta spectrum disorders, and its usefulness is tempered particularly by a tendency to falsely upgrade the stage of severity.
In this retrospective cohort study, almost 20% of women who desired bilateral complete salpingectomy for permanent contraception at the time of cesarean delivery could not undergo the procedure because of adhesions or engorged vasculature.
SYNOPSIS: The major factors leading to increased odds of cesarean delivery in all infertile women, but particularly in those who conceive following in vitro fertilization, are advanced maternal age and previous uterine surgery.
A collection of articles and letters to the editors suggests that postpartum ultrasound evaluation of uterine wall thickness is of little value in predicting uterine wall complications in subsequent pregnancies, that two-layer closure of the uterus during cesarean delivery probably is better than single-layer closure, and that staple closure of the skin in patients with three or more previous cesarean deliveries is associated with more wound complications than suture closure.
A recent meta-analysis of randomized, clinical trials has shown that discontinuing oxytocin infusion once active labor has been attained in inductions and augmentations of labor will result in a reduction of cesarean delivery and tachysystole, but an increase in the length of labor.
This cross-sectional survey of 720 women found that 85% filled an opioid prescription after cesarean delivery, and the median number of tablets dispensed was 40. The median number of tablets consumed was only 20 tablets and the number dispensed did not correlate with patient satisfaction, pain control, or the need for a refill.
A recent randomized clinical trial has shown that using a more liberal threshold for second stage labors in nulliparous patients with and without epidural can result in a major decrease in the need for cesarean sections.