Induction of Labour at 41 Weeks Versus Expectant Management Until 42 Weeks (INDEX): Multicentre, Randomized Noninferiority Trial

(BMJ. 2019;364:I344) Because of the fact that postterm pregnancy (defined as pregnancy extended to or beyond 42 weeks gestation) has been associated with increased perinatal morbidity and mortality, induction of labor is recommended after 42 weeks gestation. Although the probability of positive outcomes for neonates born between 40 and 42 weeks gestation is overall considered good, the risk of adverse outcomes has been shown to increase gradually after 40 weeks gestation. Several studies have found that induction of labor at 41 weeks gestation and later, rather than waiting for the onset of spontaneous labor improves perinatal outcomes. However, there is much heterogeneity among these trials based on the different outcome measures, protocols, and time frames used in the various studies. This current study compared 2 management strategies: induction of labor at 41 weeks gestation or expectant management until 42 weeks gestation with subsequent induction of labor had not begun.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

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ConclusionCurrent birth weight higher than the previous newborn weight in a cesarean section for arrest of descent is associated with lower likelihood of successful vaginal birth after cesarean delivery and therefore should be taken in consideration during fetal weight estimation and the decision on the mode of delivery. This issue should be explored in future prospective large-cohort studies.
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - Category: OBGYN Source Type: research
(BMJ. 2019;364:1681) Most pregnant women want clear and accurate evidence-based information to help them make decisions about their labor and delivery experience. When confronted with a “postterm” pregnancy, which poses increased risks for women and their babies, this information is especially important. A recent Cochrane systematic review reported that induction at or beyond the due date was associated with fewer perinatal deaths, neonatal admissions to intensive care, and cesarean sections but more operative vaginal births when compared with expectant management. This editorial discussed previous studies and...
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research
This study aimed to compare neonatal and maternal outcomes in women undergoing elective induction of labor at 39 weeks gestation or beyond with the outcomes of women whose pregnancies were managed expectantly.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research
We report our experience with the care of a parturient woman diagnosed with EBS. There is little literature on pregnancy in women with this condition. Special precautions are necessary during diagnostic and therapeutic interventions to avoid bullae formation or exacerbation of existing lesions. Frictional or shearing forces are typically more damaging than compressive forces. Multidisciplinary planning was done for our patient to ensure uneventful labor and delivery. Elective induction of labor was started at 40 weeks of gestation. She eventually underwent a cesarean delivery after failed trial of labor. We present this ...
Source: Case Reports in Womens Health - Category: OBGYN Source Type: research
(BJOG. 2018;125:1558–1566.) Overweight and obesity represent a significant impact on the world’s public health, and are associated with increased risks of adverse maternal and infant outcomes during pregnancy and delivery. As maternal body mass index (BMI) increases, gestational diabetes mellitus (GDM) also increases in prevalence. GDM is associated with adverse perinatal outcomes similar to those seen in obese pregnant women, including the need for induction of labor and cesarean section, and having an infant born large for gestational age or birthweight over 4 kg. The aim of this secondary analysis fr...
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research
Conclusion:We demonstrated that propofol suppresses the expression of inflammatory substances enhanced by LPS stimulation. Furthermore, this inhibitory effect of propofol on the inflammatory substance expression is mediated by suppression of NF- κB activation.
Source: Tissue Engineering and Regenerative Medicine - Category: Biotechnology Source Type: research
​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; &AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regio...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
The objective of this population-based study was to examine the association between synthetic oxytocin use during labor and hyperactivity/inattention problems in the children.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Epidemiologic Reports Surveys Source Type: research
This study was designed to test the hypothesis that induced maternal noninfectious fever alters neonatal neural progenitor cell proliferation and enhances microglial activation in the rat dentate gyrus of the hippocampus. METHODS: Systemic vehicle or IL-6 was given 3 times to near-term pregnant rats (n = 7/group) every 90 minutes, and maternal core temperature was recorded. Neonatal brains were processed and analyzed for dentate gyrus cell proliferation (using Ki-67, n = 10/group, and glial fibrillary acidic protein, n = 6/group) and resident microglia activation (using ionized calcium-binding adaptor protein-1 [Iba-1...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Conclusions: Magnesium sulfate is an important adjuvant drug in the practice of anesthesia, with several clinical effects and a low incidence of adverse events when used at recommended doses. Introduction Magnesium is the fourth most common ion in the body, and it participates in several cellular processes, including protein synthesis, neuromuscular function and stability of nucleic acid, as well as regulating other electrolytes such as calcium and sodium. Magnesium acts as a cofactor in protein synthesis, neuromuscular function and stability and the function of nucleic acids. It is a component of adenosine 5-triph...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
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