Preterm birth occurs in 1 of 8 pregnancies and may result in significant morbidity and mortality. 17- alpha hydroxyprogesterone caproate (17- OHP caproate) has been found to be efficacious in reducing the risk of subs...Preterm birth occurs in 1 of 8 pregnancies and may result in significant morbidity and mortality. 17- alpha hydroxyprogesterone caproate (17- OHP caproate) has been found to be efficacious in reducing the risk of subsequent preterm delivery in women who have had a previous spontaneous preterm birth (sPTB). This analysis was undertaken to evaluate if 17- OHP caproate therapy works preferentially depending on the gestational age at previous spontaneous delivery. We hypothesized that treatment with 17- OHP caproate is more effective in prolonging pregnancy depending on the gestational age of the earliest previous preterm birth (20- 27.9, 28- 33.9 vs 34- 36.9 weeks). Study design: This was a secondary analysis of 459 women with a previous sPTB enrolled in a randomized controlled trial evaluating 17- OHP caproate versus placebo. Effectiveness of 17- OHP caproate for pregnancy prolongation was evaluated based on gestational age at earliest previous delivery according to clinically relevant groupings (20- 27.9, 28- 33.9, and 34- 36.9 weeks). Statistical analysis included the chi-square, Fisher exact, and Kruskal-Wallis tests, logistic regression, and survival analysis using proportional hazards. Results: Gestational age at earliest previous delivery was similar between women treated with 17- OHP caproate or placebo (P = .1). Women with earliest delivery at 20 to 27.9 weeks and at 28 to 33.9 weeks delivered at significantly more advanced gestational age if treated with 17- OHP caproate than with placebo (median 37.3 vs 35.4 weeks, P = .046 and 38.0 vs 36.7 weeks, P = .004, respectively) and were less likely to deliver < 37 weeks (42% vs 63% , P = .026 and 34% vs 56% , P = .005, respectively). Those with earliest delivery at 34 to 36.9 weeks were not significantly different between 17- OHP caproate or control. Conclusion: 17- OHP caproate therapy given to prevent recurrent PTB is associated with a prolongation of pregnancy overall, and especially for women with a previous spontaneous PTB at < 34 weeks.展开更多
Objective: To quantify anesthesia-related complications associated with cesarean delivery in a well-described, prospectively ascertained cohort from multiple university-based hospitals in the United States and to eval...Objective: To quantify anesthesia-related complications associated with cesarean delivery in a well-described, prospectively ascertained cohort from multiple university-based hospitals in the United States and to evaluate whether certain factors would identify women at increased risk for a failed regional anesthetic. Methods: A prospective observational study was conducted of women (n = 37,142) with singleton gestations undergoing cesarean delivery in the centers forming the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Detailed information was collected regarding choice of anesthesia and procedure-related complications, including failed regional anesthetic and maternal death. Potential risk factors for a failed regional anesthetic were analyzed. Results: Of the women studied, 34,615 (93% ) received a regional anesthetic. Few (3.0% ) regional procedures failed, and related maternal morbidity was rare. Increased maternal size, higher preoperative risk, rapid decision-to-incision interval, and placement later in labor were all significantly related to an increased risk of a failed regional procedure. Of the general anesthetics, 38% were administered when the decision-to-incision interval was less than 15 minutes. Women deemed at the greatest preoperative risk (American Society of Anesthesiologists score ≥ 4) were approximately 7-fold more likely to receive a general anesthetic (odds ratio 6.9, 95% confidence interval 5.83-8.07). There was one maternal death, due to a failed intubation, in which the anesthetic procedure was directly implicated. Conclusion: Regional techniques have become the preferred method of anesthesia for cesarean delivery. Procedure-related complications are rare and attest to the safety of modern obstetric anesthesia for cesarean delivery in the United States.展开更多
文摘Preterm birth occurs in 1 of 8 pregnancies and may result in significant morbidity and mortality. 17- alpha hydroxyprogesterone caproate (17- OHP caproate) has been found to be efficacious in reducing the risk of subsequent preterm delivery in women who have had a previous spontaneous preterm birth (sPTB). This analysis was undertaken to evaluate if 17- OHP caproate therapy works preferentially depending on the gestational age at previous spontaneous delivery. We hypothesized that treatment with 17- OHP caproate is more effective in prolonging pregnancy depending on the gestational age of the earliest previous preterm birth (20- 27.9, 28- 33.9 vs 34- 36.9 weeks). Study design: This was a secondary analysis of 459 women with a previous sPTB enrolled in a randomized controlled trial evaluating 17- OHP caproate versus placebo. Effectiveness of 17- OHP caproate for pregnancy prolongation was evaluated based on gestational age at earliest previous delivery according to clinically relevant groupings (20- 27.9, 28- 33.9, and 34- 36.9 weeks). Statistical analysis included the chi-square, Fisher exact, and Kruskal-Wallis tests, logistic regression, and survival analysis using proportional hazards. Results: Gestational age at earliest previous delivery was similar between women treated with 17- OHP caproate or placebo (P = .1). Women with earliest delivery at 20 to 27.9 weeks and at 28 to 33.9 weeks delivered at significantly more advanced gestational age if treated with 17- OHP caproate than with placebo (median 37.3 vs 35.4 weeks, P = .046 and 38.0 vs 36.7 weeks, P = .004, respectively) and were less likely to deliver < 37 weeks (42% vs 63% , P = .026 and 34% vs 56% , P = .005, respectively). Those with earliest delivery at 34 to 36.9 weeks were not significantly different between 17- OHP caproate or control. Conclusion: 17- OHP caproate therapy given to prevent recurrent PTB is associated with a prolongation of pregnancy overall, and especially for women with a previous spontaneous PTB at < 34 weeks.
文摘Objective: To quantify anesthesia-related complications associated with cesarean delivery in a well-described, prospectively ascertained cohort from multiple university-based hospitals in the United States and to evaluate whether certain factors would identify women at increased risk for a failed regional anesthetic. Methods: A prospective observational study was conducted of women (n = 37,142) with singleton gestations undergoing cesarean delivery in the centers forming the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Detailed information was collected regarding choice of anesthesia and procedure-related complications, including failed regional anesthetic and maternal death. Potential risk factors for a failed regional anesthetic were analyzed. Results: Of the women studied, 34,615 (93% ) received a regional anesthetic. Few (3.0% ) regional procedures failed, and related maternal morbidity was rare. Increased maternal size, higher preoperative risk, rapid decision-to-incision interval, and placement later in labor were all significantly related to an increased risk of a failed regional procedure. Of the general anesthetics, 38% were administered when the decision-to-incision interval was less than 15 minutes. Women deemed at the greatest preoperative risk (American Society of Anesthesiologists score ≥ 4) were approximately 7-fold more likely to receive a general anesthetic (odds ratio 6.9, 95% confidence interval 5.83-8.07). There was one maternal death, due to a failed intubation, in which the anesthetic procedure was directly implicated. Conclusion: Regional techniques have become the preferred method of anesthesia for cesarean delivery. Procedure-related complications are rare and attest to the safety of modern obstetric anesthesia for cesarean delivery in the United States.
