Free access to the latest research
Welcome to the Obstetrics Resource Centre, with free access to the latest research in the field.
All content is independently selected by the Editors, Professor James O. Drife from Leeds, UK, and Professor Jim Thornton from Nottingham. The Obstetrics Resource Centre provides you with original articles, reviews, selected must-reads, lectures and a congress planner.
From the other journals
Editor's comment: Prof. Jim Thornton Good results from shoulder dystocia treated in primary midwifery care
Shoulder dystocia is one of the most feared obstetric emergencies, and fear of inadequate treatment is one reason why many women prefer to delivery in hospital. This series of 66 cases occurring under primary midwifery care, 45 at home and 19 in a birthing centre, reports good results. Two infants (3.1%) sustained a transient brachial plexus injury, but there were no long term infant sequelae.Acta Obstet Gynecol Scand 2016; 95:203–209
Editor's comment: Prof. Jim Thornton: Unclear results from UKCTOCS trial
The main results of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), involving more than 200 000 women were published in the Lancet in December. The primary analysis showed no significant difference in ovarian cancer mortality. Secondary analysis, with prevalent cases excluded, showed a nominally significant reduction in ovarian cancer mortality with multimodal screening, but no difference in overall mortality.
Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trialThe Lancet, December 2015
Selected AJOG Papers
Editor’s comment: Prof. Dan Farine: The twin study
This is a very important study as it complements the initial results of the Twins Birth Study. Both of these studies are likely to reflect a world-wide results of twins delivery as this a rigorously designed RCT looked at patients in a multitude of centers around the world. As opposed to a common belief before the study, that Caesarean delivery is the “easy way out” in twins’ birth (as in many other conditions), these were not the results of this study. Neither the short term results nor the long term ones showed benefit of an elective Caesarean delivery in term or late preterm twins where the first twin is in a vertex presentation. This may be important to the young mother who has to take care of two babies who do not need to be hampered by inconvenience and possible complications of a Caesarean delivery. There is a new keen and justified interest in the long term effect of Caesarean deliveries. There is an impressive set of data correlating Caesarean birth with increased risks of: diabetes, asthma and increased weight. It is important to mention that this association does not necessarily mean causation. In contrast, there is also an alarming data about the rising rates of adhesive placentas (accreta and percreta). These are definitely related to the scar in the uterus. Luckily, the study by Silver from the MFM network in the USA suggested that this risk is increased mainly after 3 Caesarean deliveries.
It is interesting to see that the results of this study could be interpreted in exactly the opposite way. Women who prefer a Caesarean birth for whatever reason (worries about double vaginal births, apprehension of the small risk of having both vaginal and Caesarean deliveries, need to plan delivery time etc.) may be reassured that a caesarean approach does not increase mortality or major neurological deficits. The same may apply to the obstetricians who are very uncomfortable with the delivery of the second twin. In other words this study is good for both the vaginal and CS camps.
Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy
Elizabeth V. Asztalos MD, Mary E. Hannah MD, CM, Eileen K. Hutton PhD, Andrew R. Willan PhD, Alexander C. Allen MD, CM, B. Anthony Armson MD, Amiram Gafni DSc, K.S. Joseph MD, PhD, Arne Ohlsson MD, Susan Ross PhD, J. Johanna Sanchez MIPH, Kathryn Mangoff BSc, Jon F.R. Barrett MB BCh, MD
American Journal of Obstetrics and Gynecology, In Press, Corrected Proof, Available online 29 January 2016, Available online 29 January 2016
Editor’s comment: Prof. Dan Farine: Reduced fetal movements
This is another interesting development in the saga of reduced fetal movements. The Canadian (1) and Australian NZ (2) guidelines ask women to monitor for Reduced Fetal Movements (RFM) while the British (3) and the American (4) ones make it an option and not a recommendation. These divergent approaches are interesting and maybe concerning as there is a large study from Norway (5) that showed that in a large cohort that Monitoring and managing RFM may eliminate one 1/3 of stillbirths. The current study goes beyond assessing RFM as it looked at the women that had repeated RFM. There was very limited data on repeated RFM prior to this study and most of us managed the subsequent episode similarly to the first one. In this study a subset of the patient had more than 1 episode of RFM. These women had a high incidence of placental insufficiency as well as high incidence of SGA (close to 50%) that was often not there in the first episode of the RFM. AS the authors outline this suggests that placental insufficiency as associated and possibly the cause of both RFM and growth restriction.
This study may have very important clinical implications. Women may need to be advised that repeated episodes of RFM may carry an increased risk to the baby and clinicians may consider a change in mat on the form of either increased fetal surveillance or delivery close to term.
Carolina Scala MD, Amar Bhide MD, FRCOG, Alessandra Familiari MD, Giorgio Pagani MD, Asma Khalil MD, MRCOG, Aris Papageorghiou MD, FRCOG, Basky Thilaganathan PhD, FRCOG
Am J Obstet Gynecol. 2015 Nov;213(5):678.e1-6. doi: 10.1016/j.ajog.2015.07.015. Epub 2015 Jul 20.
Editor’s comment: Prof. YvesVille: Cerebral Palsy: the changing face of an old enemy
Cerebral palsy (CP) encompasses a heterogeneous group of early-onset, non-progressive, neuromotor disorders that affect the developing fetal or infant brain. CP has become our enemy but also our curse since Little linked this condition to birth asphyxia in the mid-19th century. Freud attributed the disorder to brain injury from various causes, including prenatal events, and emphasised that extended labour was not the exclusive or even principal cause, therefore increasing our responsibility not to say our feeling of guilt. Although our practice has been hugely influenced by this threat over the last 50 years, mainly through an increase in cesarean section rates. An update on the prevalence of cerebral palsy through a systematic review and meta-analysis gauging the prevalence of CP over time has shown that it has remained depressingly and frustratingly stable over the last 10 years at around 2 per 1,000 births. (Oskoui et al, 2013) The main illustration of this catch-22 situation in developed nations is largely explained by an increase in survival of very premature and low-birthweight babies together with higher numbers of multiple births, which often result in preterm births. This has therefore led to a new generation of people affected with CP, probably because of vulnerability of the immature brain, especially in babies with intraparenchymal or intraventricular bleeds or periventricular white-matter abnormalities. The increase in such high-risk situations may contribute to mask teh factors that may contribute to decrease the prevalence of CP, such as the use of antenatal corticosteroids, cooling for term-born asphyxiated infants, and the use of magnesium sulphate...
Alastair H. MacLennan MD, FRANZCOG, Suzanna C. Thompson MBBS, FRACP, Jozef Gecz PhD
American Journal of Obstetrics and Gynecology, Volume 213, Issue 6, December 2015, Pages 779 - 788
Editor’s comment: Prof. Dan Farine: Another meta-analysis that changes dogmas in obstetrics
This is another meta-analysis that changes dogmas in obstetrics. The common wisdom has been that induction of labor increases the risk of cesarean delivery and the risk is higher if the cervix is unripe. This started changing with the post-term trial of Mary Hannah that showed that at 41 weeks there is better outcome with induction of labor. This is the third meta-analysis showing that induction of labor at term and post term does not increase the risk of CS and results in a better outcome for the baby. It has been known for long time that the rate of stillbirth starts increasing at 38 weeks on a weekly basis. This new sets of data allows for an earlier induction of labor without worrying about poor outcome and increased cesareans. The meta-anlysis by Mishanina E et al. in the CMAJ may explain why the new data is different from the old dogma as they show that oxytocin only induction does not offer these benefits (and neither do preterm inductions). This information is even more important as the number of pregnancies in older women is increasing. There is ample data now showing that risk of stillbirths at women that are 40 years and older at 39 weeks is similar to that of younger women at 41 weeks. These women can now be induced at 39 weeks without worrying about the induction per se increasing their CS rate.
Induction of labor at full term in uncomplicated singleton gestations: a systematic review and metaanalysis of randomized controlled trials
Gabriele Saccone MD, Vincenzo Berghella MD
AJOG Volume 213, Issue 5, November 2015, Pages 629–636
About the Editors
- Jim Thornton is Professor of Obstetrics and Gynaecology, at Nottingham University, and deputy director of the Nottingham Clinical Trials Unit...
- Dr Dan Farine is a Professor of Obstetrics & Gynaecology at the University of Toronto. He is cross appointed to...
- Yves Ville is a Professor of Obstetrics and Gynecology at Paris University since 1998 and is head of Obstetrics and...
- James Drife is Emeritus Professor of Obstetrics and Gynaecology at the University of Leeds, UK. He has written widely on...