Jeanine Carbone

Staples compared with subcuticular suture for skin closure after cesarean delivery: a systematic review and meta-analysis.

OBJECTIVE: To estimate whether staples or subcuticular suture closure is associated with a higher risk of wound complications when used for transverse skin incisions after cesarean delivery. DATA SOURCES: A systematic review and meta-analysis were performed through electronic database searches (MEDLINE, Cochrane, and Trial Registries). METHODS OF STUDY SELECTION: We searched electronic databases from 1966 to September 2010 for randomized controlled trials (RCTs) and prospective cohort studies comparing staples to subcuticular sutures after cesarean delivery. The primary outcome was occurrence of a wound complication (infection or separation). Secondary outcomes were components of the composite outcome, operating time, postoperative pain, cosmesis, and patient satisfaction. Heterogeneity was assessed using the &khgr;2 test for heterogeneity, and I2 test. Pooled odds ratios (ORs) were calculated using a fixed-effects model. We assessed publication bias using funnel plots and Egger test. RESULTS: Six studies met inclusion criteria: five RCTs and one prospective cohort study. Staple closure (n=803) was associated with a twofold higher risk of wound infection or separation compared with subcuticular suture closure (n=684) (13.4% versus 6.6%, pooled OR 2.06, 95% confidence interval [CI] 1.43–2.98). The number needed to harm associated with staple closure was 16. The increased risk persisted when analysis was limited to the RCTs (OR 2.43, 95% CI 1.47–4.02). There was no evidence of significant statistical heterogeneity among studies (&khgr;2=0.74, P=.327, I2=13.7%) or publication bias (Egger test, t=−0.86, P=.439). Staple closure was associated with shorter duration of surgery, whereas the two techniques appeared equivalent overall with regard to pain, cosmesis, and patient satisfaction. CONCLUSION: Staple closure is faster to perform but associated with a higher risk of wound complications.

Revisiting the risk for aneuploidy in fetuses with isolated pyelectasis

Previous studies are contradictory with regard to the association of isolated pyelectasis and aneuploidy. Our objective was to test the hypothesis that isolated pyelectasis is associated with aneuploidy and calculate likelihood ratios using a large ultrasound database.

Combination of foley bulb and vaginal misoprostol compared with vaginal misoprostol alone for cervical ripening and labor induction: a randomized controlled trial.

OBJECTIVE:To test the hypothesis that use of the Foley bulb plus vaginal misoprostol will result in shorter induction-to-delivery time compared with vaginal misoprostol alone.METHODS:We randomized 123 women undergoing induction of labor with singleton pregnancies at 24 weeks of gestation or greater

Efficiency of first‐trimester growth restriction and low pregnancy‐associated plasma protein‐A in predicting small for gestational age at delivery

To evaluate the efficiency of first‐trimester fetal growth restriction (FGR), low pregnancy‐associated plasma protein A (PAPP‐A), and their combination for predicting small for gestational age (SGA) at delivery.

Prenatal Screening for Thrombophilias: Indications and Controversies

A thrombophilia is defined as a disorder of hemostasis that predisposes a person to a thrombotic event. Data suggest that at least 50% of cases of venous thromboembolism in pregnant women are associated with an inherited or acquired thrombophilia, which can lead to an increased risk of maternal thromboembolism and adverse pregnancy outcomes such as recurrent pregnancy loss, intrauterine fetal demise, preterm preeclampsia, and intrauterine growth restriction. Inherited and acquired thrombophilias have different indications for testing. This article examines screening procedures for thrombophilias in the setting of adverse pregnancy outcomes.

Discussion: ‘Scheduling the first prenatal visit’ by Nettleman et al

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Nettleman MD, Brewer J, Stafford M. Scheduling the first prenatal visit: office-based delays. Am J Obstet Gynecol 2010;203:207.e1-3.