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.
Scientists at Brigham and Women’s Hospital have published early results of an investigative blood test designed to predict which women may be at increased risk and which ones may be at lower-than-average risk for spontaneous preterm delivery. The researchers have identified circulating microparticle proteins found in blood samples taken in the first trimester of pregnancy that may provide clues about the risk of spontaneous preterm birth.
Researchers with the University of North Carolina at Chapel Hill and the Centers for Disease Control and Prevention are examining a new drug delivery system that uses dolutegravir, an established HIV drug, in a potential longacting treatment and prevention system. The system has been tested in animal models.
The authors of a multicenter study suggest that composite neonatal outcome is worse when pregnancy is interrupted in uncomplicated pregnancies at 37 to 38 weeks, even with documented fetal lung maturity, compared to pregnancies delivered at full term (39 to 40 weeks).
An individual participant data meta-analysis from Australia suggests that expectant management of patients with premature rupture of membranes between 34 and 36 weeks, compared with immediate intervention, results in comparable levels of composite neonatal adverse outcomes but in mixed maternal adverse outcomes that balance out in the final analysis.
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.
Early research is focusing on a capsule that can deliver a week’s worth of HIV drugs in a single dose. If confirmed in advanced research, such an option could allow patients to stay compliant with the dosing regimen required to fight the virus successfully.
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.