When closing the skin incision for a cesarean delivery, the options include surgical clips (staples) and sutures. In women undergoing their first or second cesarean delivery, most data suggest that using suture is associated with fewer wound complications, specifically infection and separation (the wound reopening). However, most studies do not include women undergoing their third
Labor and Delivery of Twin Pregnancies
Twin pregnancies represent 3% of all births in the United States. Currently, approximately 75% of all twin pregnancies are delivered via cesarean. However, recent studies suggest that this high rate may not be necessary and that vaginal delivery of twins can be achieved safely for the mother and her twins. At MFM Associates, we care
Twin Pregnancy in Women 45 Years or Older
With advances in assisted reproductive technology including In-vitro fertilization (IVF) and egg donation, women are now able to conceive well into their 40’s and 50’s. However, uncertainty exists regarding the safety of these pregnancies for women and their newborns. Additionally, twin pregnancy is a common result of IVF, and all twin pregnancies are higher-risk pregnancies.
Pregnancy Outcomes in Patients With Prior Uterine Rupture or Dehiscence
Women with a history of uterine rupture in labor or women with a uterine “window” (extreme thinning of the lower uterine portion) are often told that they should not conceive again because the risks are too great. In this study, we reported excellent outcomes in a cohort of women with prior uterine rupture or uterine
Rescue Corticosteroids in Twin Pregnancies and Short-Term Neonatal Outcomes
Singleton babies born prematurely, particularly those born prior to 34 weeks, have improved outcomes if their mothers received antenatal corticosteroids (AQCS) prior to delivery. Recent studies suggest that a second (“rescue”) course of ACS further improve outcomes. Twin pregnancies have a far higher risk of preterm birth, but there are less data examining the effect
Type of Congenital Uterine Anomaly and Adverse Pregnancy Outcomes
A uterine anomaly (also called mullerian anomaly) refers to a uterus that does not have normal shape (pear-shaped0. There are several subtypes of uterine anomalies and each can have a different impact pregnancy for women with these uterine abnormalities. In this study, we report pregnancy complication rates in a large cohort of women with uterine
The Independent Associations of a Short Cervix, Positive Fetal Fibronextin, Amniotic Fluid Sludge, and Cervical Funneling with Spontaneous Preterm Birth in Twin Pregnancies
In twin pregnancies, a short cervical length on ultrasound, as well as a positive fetal fibronectin test, are both associated with an increased risk of preterm birth. In this study, we found that the presence of amniotic fluid sludge (particulate matter seen on ultrasound just above the cervix) also increased the risk of preterm birth.
Antenatal Surveillance in Twin Pregnancies Using the Biophysical Profile
Twin pregnancies are at increased for stillbirth and warrant close surveillance, particularly towards the end of pregnancy. In singleton pregnancies, it has been shown that a Biophysical profile (BPP), which is an ultrasound assessment of fetal well-being, is superior to a NonStress Test (NST), which involves 20-40 minutes of fetal heart rate monitoring. In this
Preterm Birth or Small for Gestational Age in a Singleton Pregnancy and Risk of Recurrence in a Subsequent Twin Pregnancy
Prior preterm birth and SGA in a singleton pregnancy increase the risk of the same condition in a subsequent twin pregnancy. We postulate that the extrinsic mechanism responsible for the pathophysiology of adverse outcomes in twin pregnancies overlaps with that in singleton pregnancies.
What is New in Medical Student and Resident Education?
Published in the July issue of Obstetrics and Gynecology, Dr. Fox discusses four recent publications, which are concluded with a “bottom line” meant to be the take-home message. Recent publications include: “National Cluster-Randomized Trial of Duty Hour Flexibility in Surgical Training,” “Preparedness of Obstetrics and Gynecology Residents for Fellowship Training,” “Structured Teaching of Early Pregnancy
