Our objective was to estimate
and compare the risks of uterine rupture and placenta accreta in women with prior uterine surgery.
METHODS: Women with prior myomectomy or prior classical cesarean delivery were compared with women with a prior low-segment transverse cesarean delivery Ulixertinib cell line to estimate rates of both uterine rupture and placenta accreta.
RESULTS: One hundred seventy-six women with a prior myomectomy, 455 with a prior classical cesarean delivery, and 13,273 women with a prior low-segment transverse cesarean delivery were evaluated. Mean gestational age at delivery differed by group (P<.001), prior myomectomy (37.3 weeks), prior classical cesarean delivery (35.8 weeks), and low-segment transverse GM6001 cesarean delivery (38.6 weeks). The frequency of uterine rupture in the prior myomectomy group (P-MMX group) was 0% (95% confidence interval [CI] 0-1.98%). The frequency
of uterine rupture in the low-segment transverse cesarean delivery group (LTC group) (0.41%) was not statistically different from the risk in the P-MMX group (P>.99) or in the prior classical cesarean delivery group (PC group) (0.88%; P=.13). Placenta accreta occurred in 0% (95% CI 0-1.98%) of the P-MMX group compared with 0.19% in the LTC group (P>.99) and 0.88% in the PC group (P=.01 relative to the LTC group). The adjusted odds ratio for the PC group (relative to LTC group) was 3.23 (95% CI 1.11-9.39) for uterine rupture and 2.09 (95% CI 0.69-6.33) for accreta. The frequency of accreta for those with previa was 11.1% for the PC group and 13.6% for the LTC group
(P>.99).
CONCLUSION: A prior myomectomy is not QNZ manufacturer associated with higher risks of either uterine rupture or placenta accreta. The absolute risks of uterine rupture and accreta after prior myomectomy are low. (Obstet Gynecol 2012;120:1332-37) DOI: http://10.1097/AOG.0b013e318273695b”
“OBJECTIVE: To estimate whether passive descent in the second stage of labor in morbidly obese parturients is associated with reduced active pushing times and improved labor outcomes compared with immediate pushing.
METHODS: This was a retrospective cohort study of all consecutive women with a body mass index (BMI) of 40 or greater admitted for term labor that reached the second stage of labor from 2004 to 2008 at a single institution. Detailed information was collected for maternal demographics, labor progress, and neonatal outcomes. Length of active pushing, length of total second stage, and maternal and neonatal outcomes were compared between women selected to passive descent for at least 30 minutes and those who pushed immediately.
RESULTS: A total of 558 women with a BMI of 40 or greater were identified; of these, 97 underwent passive descent and 461 pushed immediately. Morbidly obese women selected for passive descent were just as likely to actively push for at least 60 minutes compared with those who pushed immediately (16.5% compared with 7.