David Jaspan

Trends in the rate of shoulder dystocia over two decades.

Objective. To describe the trend in the rate of shoulder dystocia over twenty-four years and identify the risk factors related to the occurrence of dystocia. Methods. Data was obtained from Maryland State regarding all vaginal deliveries that occurred during six different time periods at five-year intervals since 1979. Trends in the rate of shoulder dystocia, episiotomy, forceps and vacuum delivery were examined. Results. There were a total of 277 974 vaginal deliveries. The overall rate of shoulder dystocia was 1.29% (n = 3590). Induction of labor (adjusted OR 1.2, 1.1–1.3), presence of diabetes (gestational (OR 1.9, 1.7–2.3) or pre-gestational (OR 3.8, 2.7–5.4)), fetal macrosomia (OR 5.1, 4.1–6.3) use of episiotomy (OR 1.6, 1.5–1.8), forceps (OR 1.3, 1.0–1.8) or vacuum (OR 2.3, 2.0–3.9) at delivery were associated with a higher rate of shoulder dystocia. Trend. There was an increase in the rate of shoulder dystocia from 0.2% in 1979 to 2.11% in 2003. In addition there was a drop in the overall episiotomy rate from 73.67% to 23.94% and increase in the use of vacuum from 0.1% to 8.36%. Conclusion. The rate of shoulder dystocia has increased by 10 fold during the study period. The use of episiotomy either at spontaneous delivery or instrumental delivery does not appear to decrease the occurrence of shoulder dystocia.

Compliance with methotrexate therapy for presumed ectopic pregnancy in an inner-city population.

Fewer than 1 in 5 patients comply with the established follow-up protocol to treat presumed ectopic pregnancy medically in an urban clinic population. Institutions should consider tracking their patient compliance with follow-up to determine the efficacy of their treatment decisions.

Postpartum endometritis caused by herpes and cytomegaloviruses.

BACKGROUND: Postpartum endometritis is usually a polymicrobial infection caused by organisms that are part of the normal vaginal flora. A pathologically confirmed case of postpartum endometritis secondary to herpes and cytomegalovirus in a human immunodeficiency virus (HIV)-positive patient is reported. CASE: A 29-year-old, HIV-positive woman presented 6 days postpartum with abdominal pain and foul-smelling vaginal discharge. Pelvic ultrasonography revealed retained products of conception. Dilation and evacuation was performed, and antibiotics were started. Despite adequate antibiotics and laparoscopic drainage of a pelvic collection, fevers and pain continued. A total abdominal hysterectomy, salpingectomy, and appendectomy were performed. Pathology reported herpes and cytomegalovirus infection of the uterus. CONCLUSION: Herpes simplex virus (HSV) and cytomegalovirus need to be considered as a potential cause of postpartum endometritis. When antibiotic therapy fails, an antiviral regimen should be considered.

Scar pregnancy: a rare complication of caesarean section

In this paper, we report a rare type of ectopic pregnancy implanted in a previous caesarean scar. Scar pregnancy was diagnosed at six weeks gestation in a woman with three prior caesarean deliveries. Management with the usual dose of Methotrexate was unsuccessful. The patient continued to have pelvic pain, the beta human chorionic gonadotropin (ßhCG) increased and there was persistent foetal cardiac activity. Subsequently, dilatation and curettage was performed under ultrasound guidance without complications. We conclude that scar pregnancy presents a diagnostic and therapeutic challenge to the clinician and the optimal management strategy needs to be explored.

Centering Pregnancy Does Not Affect Rates of Breastfeeding at Postpartum Discharge [25N]

INTRODUCTION:Centering Pregnancy, a group prenatal care model, has been shown to have many benefits including increased breastfeeding rates in postpartum adolescents. We examined if our Centering Pregnancy program demonstrated increased breastfeeding rates overall.METHODS:A retrospective chart revie