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The article discusses the impact and controversies surrounding the 2014 Guidelines for the management of labor issued by American College of Obstetricians and Gynecologists, highlighting unresolved issues regarding dysfunctional labor and rising cesarean section rates. Despite calls for revision, the new Guidelines fail to address concerns, offering unbalanced assessments and contradictory recommendations, raising questions about their evidence-based nature.

Objective The objective of this study was to compare performance of a maternal surface electrode patch with ultrasound- and tocodynamometer-based monitoring to detect fetal heart rate and uterine contractility in late preterm labors. Study Design Thirty women between 34 0/7 and 36 6/7 weeks' gestation were monitored simultaneously with a Doppler/tocodynamometer system and a wireless fetal–maternal abdominal surface electrode system. Fetal and maternal heart rate and uterine contraction data from both systems were compared. Reliability was measured by the success rate and percent agreement. Deming regression and Bland–Altman analysis estimated the concordance between the systems. Uterine contractions were assessed by visual interpretation of monitor tracings. Results The success rate for the surface electrode system was 89.5% (95% confidence interval [CI], 85.7–93.3), and for ultrasound it was 88.4% (95% CI, 84.9–91.9; p = 0.73), with a percent agreement of 88.1% (95% CI, 84.2–92.8). Results were uninfluenced by the patients' body mass. The mean Deming slope was 1 and the y-intercept was −3.0 beats per minute (bpm). Bland–Altman plots also showed a close relationship between the methods, with limits of agreement less than 10 bpm. The percent agreement for maternal heart rate was 98.2% (95% CI, 97.4–98.8), and for uterine contraction detection it was 89.5% (95% CI, 85.5–93.4). Conclusion Fetal heart rate and uterine contraction monitoring at 34 0/7 to 36 6/7 weeks using abdominal surface electrodes was not inferior to Doppler ultrasound/tocodynamometry for fetal–maternal assessment. Registration clinicaltrials.gov/February 20, 2017/identifier NCT03057275. Key Points Monitoring the preterm fetal heart rate with surface electrodes is feasible. Preterm contractions can be monitored with surface electrodes. The technique was noninferior to standard external monitors. [ABSTRACT FROM AUTHOR]

Cesarean birth has increased substantially in many parts of the world over recent decades and concerns have been raised about the propriety of this change in obstetric practice. Sometimes, a cesarean is necessary to preserve fetal and maternal health. But in balancing the risks of surgical intervention the implicit assumption has been that cesarean birth is an equivalent alternative to vaginal birth from the standpoint of the immediate and long-term health of the fetus and neonate. Increasingly, we realize this is not necessarily so. Delivery mode per se may influence short-term and abiding problems with homeostasis in offspring, quite independent of the indications for the delivery and other potentially confounding factors. The probability of developing various disorders, including respiratory compromise, obesity, immune dysfunction, and neurobehavioral disorders has been shown in some studies to be higher among individuals born by cesarean. Moreover, many of these adverse effects are not confined to the neonatal period and may develop over many years. Although the associations between delivery mode and long-term health are persuasive, their pathogenesis and causality remain uncertain. Full exploration and a clear understanding of these relationships is of great importance to the health of offspring. [ABSTRACT FROM AUTHOR]

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.

Objective: We compared the association between cord arterial catecholamine levels and fetal oxygenation in newborns of mothers with diabetes mellitus to those of nondiabetic pregnancies.Methods: Cord blood obtained at delivery in 25 term appropriate-for-gestational age newborns of women with diabetes and 27 nondiabetic controls were assayed for norepinephrine, epinephrine, insulin, glucose, and blood gases.Results: There was no statistical difference in parity, birth weight, gestational age, delivery mode, use of epidural analgesia, or frequency of low 1-min Apgar scores between the groups. The pO2 and frequency of cord arterial pH < 7.20 were also similar. Diabetic pregnancies had somewhat higher fetal glucose and substantially higher insulin levels than controls. Regression analysis using cord arterial pH to reflect oxygenation revealed significant inverse relationships between cord artery pH and ln norepinephrine (Prob > F = .001) and ln epinephrine (Prob > F = .019) in controls. In newborns of women with diabetes, however, neither relationship was significant.Conclusion: The expected surge in catecholamines associated with diminished oxygenation was attenuated in fetuses of diabetic mothers. This suggests the possibility that fetal exposure to hyperglycemia or other metabolic derangements in pregnant diabetics might compromise the fetal ability to adapt to changes in oxygenation, and might thereby contribute to the risk of fetal death. [ABSTRACT FROM AUTHOR]