In this double-blind, randomized clinical trial, 406 pregnant women were randomized to dydrogesterone or placebo. There were no statistically significant differences in the primary outcome (miscarriage before 20 weeks of gestation; relative risk, 0.897; 95% confidence interval, 0.548-1.467; P = 0.772), which occurred in 12.8% and 14.3% in the dydrogesterone and placebo arms, respectively. The use of dydrogesterone in women with threatened miscarriage for the prevention of early pregnancy loss in the first trimester failed to decrease the miscarriage rate or increase the live birth rate.
In this randomized clinical trial, 343 pregnant women with twin gestations were randomized to planned cesarean delivery and planned vaginal delivery groups (208 patients vs. 135 patients, respectively) between October 2013 and March 2015. The cesarean delivery rate in the planned vaginal delivery arm was 49% compared to the cesarean rate of 99% in the planned cesarean delivery arm. If all criteria for vaginal delivery are met, it would be reasonable and appropriate to offer women with diamniotic twin gestations planned vaginal delivery between 34 0/7 to 37 6/7 weeks of gestation.
In this retrospective cohort study of 243 pregnant women who had combined hemoglobin A1c (HbA1c) and a two-step oral glucose tolerance testing at less than 21 weeks of gestation, median values of HbA1c were higher in women with gestational diabetes compared to nondiabetics (5.8% compared to 5.3%; P < 0.001). The predictive probability of using HbA1c in diagnosing diabetes in early pregnancy was high compared to two-step testing (area under the curve, 0.8), with an optimal diagnostic threshold of 5.6%. Although a HbA1c level of > 6.5% is diagnostic of early gestational diabetes, a lower diagnostic threshold might be justified during pregnancy.
Teen pregnancies are at high risk of obstetrical complications with an increased rate of adverse maternal and fetal outcomes. Acute care clinicians should be familiar with, and adept at, caring for the common or emergent obstetrical complications that may occur in a pregnant teenager.
In this case control study using U.S. live birth records between 22 and 23 weeks of gestation, maternal intervention was positively associated with increasing maternal age, Medicaid use, preeclampsia, birth defects, twin gestation, multiparity, and infertility treatments while being negatively associated with non-Hispanic Black race. Positive associations for neonatal intervention included non-Hispanic Black race, preeclampsia, Medicaid use, infertility treatments, less than a high school education, increasing maternal age, and twin gestation, and negative associations included birth defects and small for gestational age pregnancies.
In this open-label, equivalence randomized trial of vaginal progestogen compared to intramuscular progestogens for preventing preterm birth in high-risk women, the difference in the risk of preterm birth at < 37 weeks of gestation between both groups was 3.1% (95% confidence interval, -7.6% to 13.8%), which was within the equivalence margin of 15% used in the study.