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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2004.06.055 Byline: Harish M. Sehdev, Soraya Abbasi, Patricia Robertson, Lytia Fisher, Dominic A. Marchiano, Jeffrey S. Gerdes, Jack Ludmir Abstract: The purpose of this study was to determine whether the interval between antenatal steroid exposure and delivery influences neonatal outcome in very low birth weight infants. Author Affiliation: Section of Maternal-Fetal Medicine and Newborn Pediatrics, Pennsylvania Hospital, Philadelphia, Pa, Departments of Pediatrics and Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pa Article Note: (footnote) Presented at the Twenty-Fourth Annual Meeting of the Society for Maternal-Fetal Medicine, February 2-7, 2004, New Orleans, La.

The interval between antenatal steroid exposure and delivery influences neonatal outcome in very low birth weight infants was studied. The findings indicated that in infants weighing between 500 g to 1500 g, the time interval between exposure to corticosteroids and delivery did not have any impact on neonatal outcome.

Key points * The health concerns surrounding lesbian patients differ significantly from those affecting heterosexual patients--in some ways. Encourage lesbian patients to disclose their sexual orientation to you. Be sure [...]

Women who become pregnant again shortly after having a miscarriage can be assured that their baby is no more likely to have problems than other babies. This was the conclusion of researchers who evaluated pregnancy outcomes in 64 women who had a miscarriage and got pregnant again. Some doctors believe that a woman will suffer less grief if she becomes pregnant again shortly after a miscarriage.

Many women may accept a pelvic exam performed by medical students, according to a study of 180 women. Over 80% said they would be willing to participate in training medical students to perform a pelvic exam.

There appears to be no association between water baths during labor and an increased risk of chorioamnionitis or endometritis. These conditions are infections inside the uterus. Researchers analyzed the use of water baths during labor in 110 women with chorioamnionitis or endometritis and 97 women without these infections. There was no significant link between water baths and the infections or poor fetal outcome. Many of the women said the water bath helped them to relax.

Byline: Patricia A. Robertson, Lily J. Huang, Mary S. Croughan-Minihane, Sarah J. Kilpatrick Keywords: Chorioamnionitis; endometritis; water bath; labor; infection Abstract: OBJECTIVE: Our purpose was to determine whether water baths during labor are associated with the development of chorioamnionitis or endometritis. STUDY DESIGN: One hundred ten cases of chorioamnionitis or endometritis and 97 controls were identified among singleton term gestations from the University of California at San Francisco perinatal database. Medical record review and patient interviews provided information on membrane rupture, history of bathing during labor, and relaxation and pain relief perceived by patients who experienced water bathing during labor. RESULTS: There was no statistically significant association between water baths during labor and the occurrence of chorioamnionitis or endometritis (odds ratio 0.93 [95% confidence interval 0.53 to 1.63]). CONCLUSIONS: Water baths during labor are not associated with chorioamnionitis or endometritis. (Am J Obstet Gynecol 1998;178:1215-21.) Author Affiliation: San Francisco, California Article Note: (footnote) [star] From the Departments of Obstetrics, Gynecology, and Reproductive Sciences, Family and Community Medicine, and Epidemiology and Biostatistics, University of California, San Francisco, Medical Center., [star][star] Reprints not available from the authors., a 6/6/89262

A new Women's Health Curriculum at the University of California at San Francisco appears to have been a success. In response to concerns about the medical school's teaching of women's health, faculty developed an integrated curriculum based on problem solving of case studies. Cases were taught by obstetrician-gynecologists, family practitioners, and internists. Medical students rated the course an average of 8 on a scale of 1 to 10. The students preferred that the cases be taught by obstetrician-gynecologists, but the school intends to maintain the mixture in order to provide role models for these other specialties.

The incidence of head entrapment among fetuses in the breech position may not differ whether fetuses are delivered vaginally or by cesarean section. Researchers analyzed records from 321 deliveries of breech pregnancies at 28 to 36 weeks for instances of head entrapment during delivery. Four of 52 (7.7%) infants delivered vaginally experienced head entrapment, compared to 14 of 269 (5.2%) infants delivered by cesarean section. Infants delivered vaginally had much higher birth weights and were slightly older than those delivered abdominally. Head entrapment did not cause adverse outcomes for infants in either delivery group.

Byline: Patricia A. Robertson, Clarissa M. Foran, Mary S. Croughan-Minihane, Sarah J. Kilpatrick Keywords: Breech; cesarean section; head entrapment; neonatal outcome; preterm Abstract: OBJECTIVES: We attempted to determine whether there are differences in the incidence of head entrapment and adverse neonatal outcome by mode of delivery in breech deliveries from 28 to 36 weeks of gestation. STUDY DESIGN: Computerized data and charts of 321 viable consecutive singleton breech deliveries from 28 to 36 weeks' gestation were reviewed. Statistical methods used included I.sup.2, logistic regression, and analysis of variance. RESULTS: Head entrapment occurred in 4 of 52 (7.7%) neonates delivered vaginally and 14 of 269 (5.2%) neonates delivered by cesarean section (p = 0.48). There were no statistically significant associations between head entrapment and adverse neonatal outcomes. CONCLUSIONS: There was no significant difference in the incidence of head entrapment by mode of delivery for breech infants at 28 to 36 weeks' gestation, nor was there an association with adverse neonatal outcomes after entrapment. (Am J Obstet Gynecol 1996;174:1742-9.) Author Affiliation: San Francisco, California Article Note: (footnote) [star] From the Department of Obstetrics, Gynecology and Reproductive Sciences, the Department of Family and Community Medicine, and the Department of Epidemiology and Biostatistics, University of California Medical Center at San Francisco., [star][star] Reprints not available from the authors., a 0002-9378/96 $5.00 + 0 6/6/72193

OBJECTIVES: This study details the incidence, by gestational age and birth weight, of specific neonatal morbidities in singleton neonates without major congenital anomalies. STUDY DESIGN: Data were prospectively collected on all deliveries at five tertiary centers in the United States during the years 1983 through 1986. Pregnancies were meticulously dated and the gestational ages of the neonates at delivery were confirmed by Dubowitz score. RESULTS: The incidence of respiratory distress syndrome gradually decreases with increasing gestational age until 36 weeks. A marked decrease in the incidence of necrotizing enterocolitis, patent ductus arteriosus, intraventricular hemorrhage, and sepsis occurs after 32 completed weeks. The number of days of mechanical ventilation for respiratory distress syndrome and newborn stay in the tertiary care facility also were significantly reduced after 32 weeks. CONCLUSIONS: The incidence of both respiratory distress syndrome and patent ductus arteriosus is markedly decreased by both increasing gestational age and birth weight. The incidence of grade III and IV intraventricular hemorrhage, necrotizing enterocolitis, and sepsis virtually vanishes after 34 weeks. These data relating neonatal morbidities to gestational age are important to the obstetrician in the critical decision regarding the timing of delivery and to the parents, who can benefit from a realistic prediction of the neonatal course. (AM J OBSTET GYNECOL 1992;166:1629-45.) Key words: Neonatal morbidity, gestational age, respiratory distress syndrome, intraventricular hemorrhage, sepsis

It is not uncommon for the area between a pregnant woman's anus and vagina (perineum) to tear during delivery. In some cases, the sphincter muscle surrounding the anus becomes disrupted (third and fourth degree laceration), causing incontinence of feces and gas and pain that can continue for years after the delivery. Third- and fourth-degree lacerations that include the lining of the rectum occur more often in women who are delivering for the first time or when a large fetus is being delivered vaginally. The risk factors for third- and fourth-degree lacerations for deliveries that were assisted by forceps and vacuum extraction are reported. Vacuum extraction or forceps were used in 2,832 deliveries. There were 555 third-degree tears (19.5 percent) and 296 fourth-degree tears (10.5 percent) reported. Women who had a midline episiotomy and first-time deliveries carried the highest relative risk for third- and fourth-degree lacerations (7.81 and 3.56 times, respectively). Other risk factors included arrest of labor during the second stage; fetal position with the face up and positioned high in the birth canal; maternal position flat on the back with legs straddled; the use of forceps; use of local anesthesia and Asian race. This was independent of birth weight, training of delivery attendant, age of the fetus, abnormal first-stage of labor and other factors. First-time deliveries are more prone to tears because the tissue in the perineal area is not elastic. An atypical position of the fetus may also prevent the tissue from being stretched adequately. Asian women tend to have short perineal areas, increasing the chances of tearing. Although these factors are difficult to control, other risk factors such as midline episiotomy, forceps delivery and local anesthesia can be replaced in turn by a jagged episiotomy, vacuum extraction and conduction anesthesia. Delivery in a birthing chair may also help prevent third- and fourth-degree lacerations. (Consumer Summary produced by Reliance Medical Information, Inc.)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2009.02.018 Byline: Katherine M. Gesteland (a), Debra F. Anderson (b), Lowell E. Davis (a), Patricia Robertson (a), J. Job Faber (b), Robert A. Brace (a) Keywords: bulk flow; fetal sheep; intramembranous water and solute absorption; passive diffusion; vesicular transport Abstract: To examine mechanisms that mediate increased intramembranous solute and water absorption. Author Affiliation: (a) Departments of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR (b) Heart Research Center, Oregon Health and Science University, Portland, OR Article History: Received 3 October 2008; Revised 11 December 2008; Accepted 23 February 2009 Article Note: (footnote) This study was supported in part by NIH Grants 5R01HD035890, 5R01HL045043, and P01HD034430., Reprints not available from the authors., Cite this article: Gesteland KM, Anderson DF, Davis LE, et al. Intramembranous solute and water fluxes during high intramembranous absorption rates in fetal sheep with and without lung liquid diversion. Am J Obstet Gynecol 2009;201:85.e1-6.

Background: A surrogate marker for treatment response that can be observed earlier than comparison of sequential magnetic resonance imaging (MRI) scans, which depends on relatively slow changes in tumor volume, may improve survival of brain tumor patients by providing more time for secondary therapeutic interventions. Previous studies in animals with the use of diffusion MRI revealed rapid changes in tumor water diffusion values after successful therapeutic intervention. Methods: The present study examined the sensitivity of diffusion MRI measurements in orthotopic rat brain tumors derived from implanted rat 9L glioma cells. The effectiveness of therapy for individual brain cancer patients was evaluated by measuring changes in tumor volume on neuroimaging studies conducted 6-8 weeks after the conclusion of a treatment cycle. Results: Diffusion MRI could detect water diffusion changes in orthotopic 9L gliomas after doses of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU or carmustine) that resulted in as little as 0.2 log cell kill, a measure of tumor cell death. Mean apparent diffusion coefficients in tumors were found to be correlated with and highly sensitive to changes in tumor cellularity (r = .78; two-sided P = .041). The feasibility of serial diffusion MRI in the clinical management of primary brain tumor patients was also demonstrated. Increased diffusion values could be detected in human brain tumors shortly after treatment initiation. The magnitude of the diffusion changes corresponded with clinical outcome. Conclusions: These results suggest that diffusion MRI will provide an early surrogate marker for quantification of treatment response in patients with brain tumors. [J Natl Cancer Inst 2000; 92:2029-36]

* Objective To examine the causal effects of doctor-patient relations and the severity of a medical outcome on medical patient perceptions and malpractice intentions in the event of an adverse medical outcome. * Design Randomized between-subjects experimental design. Patients were given scenarios depicting interactions between an obstetric patient and her physician throughout the patient's pregnancy, labor, and delivery. * Participants One hundred twenty-eight postpartum obstetric patients were approached for participation, of whom 104 completed the study. * Main outcome measures Patients' perceptions of physician competence and intentions to file a malpractice claim. * Results Positive physician communication behaviors increased patients' perceptions of physician competence and decreased malpractice claim intentions toward both the physician and the hospital. A more severe outcome increased only patients' intentions to sue the hospital. * Conclusion These results provide empiric evidence for a direct, causal effect of the doctor-patient relationship on medical patients' treatment perceptions and malpractice claim intentions in the event of an adverse medical outcome., In the past 30 years, medical malpractice has become 1 of the most difficult health care issues in the United States. In addition to billions of dollars in legal fees [...]