Category: Obstetrics

Placental transfusion in newborns needing resuscitation

A narrative review summarizes the current evidence on three different methods of placental transfusion in preterm and term infants who need resuscitation – delayed cord clamping, milking of the uncut umbilical cord, and milking of the cut umbilical cord. The…

Zika virus guideline

Updated guidelines from the CDC recommend Zika virus testing for infants born to mothers who have laboratory features of  exposure to Zika virus and to infants who have clinical features of infection (microcephaly, intracranial calcifications, eye anomalies and other neurologic…

Antenatal betamethasone for late preterm delivery

A multicenter randomized trial of singleton pregnancies at 34 – 36 week gestation compared placebo versus betamethasone (two doses, 24 hours apart). There were around 1400 infants in each group. In the betamethasone group fewer infants developed respiratory problems than…

Racial disparity in previable birth

A population-based retrospective cohort study of over a million live births in Ohio from 2006 to 2012 found that 0.25% of births occurred between 16 – 22 weeks (previable births). Compared to white mothers, black mothers had a three to…

Zinc deficiency in neonates and their mothers

Maternal zinc supplementation is associated with a decreased frequency of infections in infants in the first six months of life, and in low-income women it may reduce the risk of preterm birth. Neonates who are preterm, small for gestational age…

Morphine vs clonidine for neonatal abstinence syndrome

A small randomized trial compared the use of morphine versus clonidine for the treatment of neonatal abstinence syndrome. Compared to infants randomized to morphine (n = 15), infants treated with clonidine (n =16) had a shorter duration of treatment (median of…

Antenatal magnesium sulfate and school-age outcomes

ACTOMgSO4 was a randomized multicenter trial from Australia and New Zealand, comparing magnesium sulfate with placebo given to pregnant women expected to deliver before 30 weeks gestation. Early-childhood outcomes of this trial showed a reduction in cerebral palsy with magnesium…

The unborn smoker

A large retrospective population-based cohort study from Canada compared pregnancy outcomes in pregnant women who smoked to those who did not. Active smokers had a significantly higher rate of preterm delivery (almost double) and intrauterine fetal demise (almost five times).…

Benefits of umbilical cord milking

A systematic review and meta-analysis of seven randomized trials of umbilical cord milking compared to control conditions found the following benefits in preterm infants less than 33 weeks gestation – a higher hemoglobin and hematocrit, reduction in oxygen requirement at…

Educational intervention to extend breastfeeding

A randomized trial of over five hundred black and Latina mothers studied the effects of a post-delivery culturally-tailored educational intervention on the duration of breast feeding. The intervention group mothers received an in-hospital educational session with a social worker, educational…

Maternal antidepressant therapy and PPHN

A systematic review examined the association between maternal therapy with antidepressants and neonatal persistent pulmonary hypertension (PPHN). Seven studies were included. Quantitative analysis was possible only for studies using selective serotonin uptake inhibitors. Exposure to SSRIs late in pregnancy was…

Periviable birth: Workshop summary

The findings of a Joint Workshop held by leading organizations in obstetric and pediatric/neonatal care were recently published in multiple journals and contains summaries and recommendations about obstetric and neonatal management. Highlights of this report: The term perviable birth was…

Umbilical cord milking versus immediate cord clamping

A randomized trial of infants born at less than 32 weeks gestation compared the effects of umbilical cord milking versus immediate cord clamping. Thirty infants were assigned to each arm. Infants who underwent umbilical cord milking had a higher serum hemoglobin,…

Defining term pregnancy

The American College of Obstetricians and Gynecologists has just issued a committee opinion on the definition of term pregnancy. The five-week period between 37 – 42 weeks is now classified into: 1. Early term 2. Full term 3. Late term…

Cord milking prior to umbilical cord clamping vs immediate clamping

A single-center randomized trial compared the effects of immediate umbilical cord clamping after birth with clamping after active cord milking in infants 24 – 28 weeks gestation. In the latter group, around 20 cms of the cord was actively milked…

US childbirths costliest in the world

The costs for medical care during pregnancy and delivery in the US are higher than any other country in the world. They have been increasing over the years. The biggest category of hospital payouts for private insurers and Medicaid is…

Which formula you use for ultrasound estimation of fetal gestation matters

In a Swedish study three different formulae were applied to mid-trimester ultrasound measurements of fetal biparietal diameter and femur length in order to calculate gestational age in infants less than 27 weeks gestation. These estimates were compared to gestation determined…

Outcome of fetal echogenic bowel

A retrospective review from a single center was performed of all fetal ultrasounds that showed a fetal echogenic bowel. If the finding was an isolated one (around 40% of cases) then the outcome was uneventful. If it was associated with…