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To determine if oxytocin dosage used for labor induction differed in obese and lean women, we analyzed records of patients who underwent term labor induction and delivered vaginally. Each of a cohort of 27 patients with a body mass index (BMI) >40 kg/m2 was matched with a patient with a BMI <28 kg/m2 for gestational age, for birth weight, and for cervical dilatation and fetal station at admission. The oxytocin dose administered during first stage labor was calculated for each patient. In addition to the matched characteristics, there was no difference between groups in parity, frequency of diabetes, epidural anesthesia use, or pharmacologic cervical ripening. Oxytocin utilization was significantly greater in obese women than in lean women. The maximum administration rate was 17.7±4.7 and 13.1±5.0 mU/min, respectively (P=0.001). Oxytocin administered per minute during the first stage of labor was greater in the obese group (11.6±4.8 vs. 8.6±4.1 mU/min; P=0.020). Neither active phase duration nor the maximum rate of dilatation differed significantly between the groups. That obese parturients required more oxytocin than lean women during the first stage of successful labor induction could not be explained by group differences in parity, birth weight, dysfunctional labor, pre-induction dilatation and station, or epidural use.

Aim: To determine whether maternal obesity is associated with dysfunctional labor patterns., Methods: In a case-control design we compared the graphic labor patterns of a group of 105 very obese subjects [body mass index (BMI) >35 kg/m(2)] with those of 113 lean controls (BMI<26 kg/m(2)). All entered spontaneous labor at term. Cases with birth weights >4 kg, diabetes mellitus, hypertension and prior cesarean delivery were excluded., Results: The obese group had a significantly higher frequency of arrest of dilatation (17.6 vs. 5.2%; P=0.005)., Conclusions: Maternal obesity is associated with active phase labor dysfunction, specifically arrest of dilatation.

The article focuses on the "30-minute rule" in obstetrics, which refers to the interval between the decision to perform a cesarean delivery and the start of the incision. Topics discussed include the case of two patients cared for by a single obstetrician; the debate surrounding the rule's medical relevance and its use in legal cases; and the potential risks and benefits of rapid delivery for both mothers and newborns.

During labor mother and fetus are evaluated at intervals to assess their well-being and determine how the labor is progressing. These assessments require skillful physical diagnosis and the ability to translate the acquired information into meaningful prognostic decision-making. We describe a coordinated approach to the assessment of labor. Graphing of serial measurements of cervical dilatation and fetal station creates "labor curves," which provide diagnostic and prognostic information. Based on these curves we recognize nine discrete labor abnormalities. Many may be related to insufficient or disordered contractile mechanisms. Several factors are strongly associated with development of labor disorders, including cephalopelvic disproportion, excess analgesia, fetal malpositions, intrauterine infection, and maternal obesity. Clinical cephalopelvimetry involves assessing pelvic traits and predicting their effects on labor. These observations must be integrated with information derived from the labor curves. Exogenous oxytocin is widely used. It has a high therapeutic index, but is easily misused. Oxytocin treatment should be restricted to situations in which its potential benefits clearly outweigh its risks. This requires there be a documented labor dysfunction or a legitimate medical reason to shorten the labor. Normal labor and delivery pose little risk to a healthy fetus; but dysfunctional labors, especially if stimulated excessively by oxytocin or terminated by complex operative vaginal delivery, have the potential for considerable harm. Conscientiously implemented, the approach to the evaluation of labor outlined in this review will result in a reasonable cesarean rate and minimize risks that may accrue from the labor and delivery process. [ABSTRACT FROM AUTHOR]

Objective: We hypothesized that predictive value of traditional Ebola virus disease (EVD) screening in West African pregnant women is low because febrile and hemorrhagic complications of pregnancy that can mimic EVD are common. Methods: Proportions of various categories of pregnancy loss from a hypothetical cohort of West African gravidas were used to construct a Kaplan-Meier curve. The incidence rate of each category was determined by multiplying its proportion by the overall incidence rate, calculated from the inverse of the area under the curve. Incidence rates of Ebola-like illnesses during pregnancy were obtained by multiplying their percentages by the incidence rates of categories of loss with which they coincide. Results: During pregnancy about 1.5% of suspected EVD cases would prove to have EVD. Most of the remaining 98.5% would have hemorrhagic and febrile complications of pregnancy. Conclusion: Current guidelines consider obstetrical interventions inappropriate in suspected EVD during pregnancy. However, because the overwhelming majority of cases suspected by screening do not have EVD and might benefit from obstetrical intervention, policy makers must consider whether the small risk to properly protected health care workers from the 1.5% with true EVD justifies withholding potentially life-saving care from the 98.5% who ultimately test negative for EVD. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The study was designed to determine the prevalence of obesity and related pregnancy complications in an inner-city prenatal clinic. STUDY DESIGN: A retrospective review was conducted of the medical records of 281 women with no chronic diseases and who delivered singleton term babies during a 1-year period. The frequencies of various pregnancy complications, including pregnancy-induced hypertension, preeclampsia, gestational diabetes, shoulder dystocia, postpartum hemorrhage, fourth degree laceration, intrauterine growth restriction, and macrosomia, were compared among groups of patients stratified by body mass index (BMI). RESULTS: Thirty-four percent of patients had a reported prepregnancy BMI of <26 kg/m[SUP2]. Fifty-two percent of patients were obese (BMI > 26 kg/m[SUP2]) when they registered for prenatal care, and 82% of patients had a BMI > 26 kg/m[SUP2] at the time of delivery. The incidence of birth weights of >4 kg was significantly higher in women with a registration BMI > 26 kg/m[SUP2](p = 0.026). Most of these macrosomic babies had mothers with a BMI > 29 kg/m[SUP2]. Patients who required cesarean delivery had significantly higher BMI than those who were delivered vaginally (p < 0.001). CONCLUSION: Obesity was more common in our inner-city population than has previously been reported and was associated with an increased risk of fetal macrosomia and operative delivery. [ABSTRACT FROM AUTHOR]

The author discusses the trend towards the acceptance of obstetrics medicine as a legitimate subspecialty of obstetrics and gynecology. He also mentioned the subjects covered within the issue including the management of end-stage renal disease during pregnancy, the pathogenesis of preeclampsia, and the obstetric challenges including breech and postpartum hemorrhage.