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: Inverse correlation between rates of operative vaginal delivery and Caesarean

    A large Italian registry study has shown, perhaps unsurprisingly, a significant inverse correlation between rates of overall Caesarean birth and operative vaginal delivery rates.  The authors note the rising rate of second stage Caesareans, which are often very morbid for both mother and baby, and advocate a careful change in obstetric culture to encourage vaginal instrumental delivery in delayed second stage of labour. 

    Cesarean delivery rates and obstetric culture - an Italian register-based study

    Plevani et al.

    Acta Obstet Gynecol Scand. 2016 Nov 21. doi: 10.1111/aogs.13063.
  • Editor's comment: Prof. Jim Thornton: Induction and Autism; reassurance from Sweden
    Some previous research had suggested an association between labour induction and autism disorders. However in this large study from Sweden, comparison with siblings whose births were discordant with respect to induction, thus accounting for shared environmental and genetic factors, induction was not associated with autism in the child (HR, 0.99; 95% CI, 0.88-1.1).
    Oberg AS et al. Association of Labor Induction With Offspring Risk of Autism Spectrum Disorders. JAMA Pediatr. 2016 Sep

    Association of Labor Induction With Offspring Risk of Autism Spectrum Disorders.

    6;170(9):e160965. doi: 10.1001/jamapediatrics.2016.0965. Epub 2016 Sep 6.

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Selected AJOG Papers

Editor’s comment: Prof. Dan Farine: Towards normal birth – but at what cost by Hans Peter Dietz and Stuart Campbell
(Editor's comment relates to the AJOG article below)

I read with interest the clinical opinion paper “Towards normal birth – but at what cost” by Hans Peter Dietz and Stuart Campbell that was published in the October edition of the American Journal of Ob/Gyn. The article is interesting for a variety of different reasons; the authors seem to be passionate about the topic. They provide well thought and well researched references to support their arguments; most practicing obstetricians can relate to the fact that often patients are biased towards CD (both ways) and that proper education and informed consent are very time consuming and in certain setting are very difficult to provide.

Editor’s comment: Prof. Yves Ville: The street light effect of Down syndrome screening in pregnancy. Time to broaden risk assessment in early pregnancy.
(Editor's comment relates to the AJOG articles below)

Our present prenatal screening and diagnostic approach remains directed predominantly at identifying Down syndrome. However there are far more prevalent and serious conditions that have become amenable to prenatal screening and diagnosis.

Editor’s comment: Prof. Dan Farine: Exercise in Pregnancy the Norwegian outlook
(Editor's comment relates to the AJOG article below)

The issue of exercise in pregnancy has been studied extensively in the last 30 years with some researchers such as James Clapp the 3rd and Raoul Artal devoting a large portion of their careers to this issue.  The data generated by them and others showed generally that exercise in pregnancy had a variety of positive effects on associated diseases (diabetes hypertension etc.) and specific pregnancy outcomes. Concerns that extensive physical activity would lead to poor outcomes were shown to be non-true in studies such as James Clapp’s who found that Olympians had better outcomes than sedentary pregnant women.

Editor’s comment: Prof. Dan Farine: CMV in pregnancy what is new?
(Editor's comment relates to the AJOG article below)

This study provides more details on the diagnosis and probably more importantly the prognosis of CMV.  The paper starts with a statement that the CMV infection occurs in 0.7% of all births. Although this is probably the best current estimate it is important to note that in North America there is no routine screening for CMV. This in turn alters the presentation of the disease as few patients are screened for CMV (and these are obviously at a higher risk) and even fewer are tested for CMV. Many series are therefore skewed by the entry point of severe ultrasound findings. The question of the need for routine screening for CMV was obviously not addressed in this French study and still remains open. 

Editor’s comment: Prof. Yves Ville: Non-invasive whole fetal genome sequencing : Putting the cart before the horse ?
(Editor's comment relates to the AJOG article below)

The development of next-generation sequencing (NGS) technologies (ie, new high-throughput and massively parallel DNA sequencing technologies) has substantially reduced both the cost and the time required to sequence an entire human genome.  Its application to the human fetus has become a reality that is close to clinical implementation. (Lefkowitz R. et al) It is therefore both critical and urgent to be prepared for a shift in paradigm in prenatal screening and diagnosis.

Editor’s comment: Prof. Dan Farine: Disclosure of possible conflicts and other pitfalls waiting those who publish
(Editor's comment relates to the AJOG article below)

In this interesting paper the major finding is that 68% of physicians submitting a paper to the Society of Gynecological Surgery (SGS) did not properly disclose their full relationship to industry. Interestingly, the way that the under-reporting was found was based on earlier disclosure of these physicians of such a relationship.

Publishing is a way to achieve recognition as an expert and academic promotion. Publications are the major way to disseminate new information and improve medical practice. Individuals may feel pressure to publish for these reasons. The editors and readers want to see the best information published and they want to be sure that biases are optimally eliminated or at least disclosed...

Editor’s comment: Prof. Dan Farine: Acidemia with Normal pH:
(Editor's comment relates to the AJOG article below)

This interesting study looks retrospectively at the rare occurrence of acidemia and/or low base access in babies with normal Apgar scores. The “common sense approach” has been to assume that the test is erroneous as the baby was doing well and ignore it. In Medico-Legal conferences the rationale for pushing for universal cord pH testing has been that it may identify the group of interest for asphyxia (low pH and Apgar scores). According to this approach it was even more interesting to identify the neonates with a normal pH and base excess. These babies may have been exposed to a hostile intra-uterine environment based on history and/or abnormal fetal heart rates and possibly to less than optimal care. However, since they were not acidotic they would not go on to develop cerebral palsy based on the McLennan dogma that was adopted by the major obstetrical societies (FIGO, ACOG, UK guidelines Australian-NZ ones etc.)...

Editor’s comment: Prof. Yves Ville: To know the chance, a chance to know.
(Editor’s comment relates to the 3 AJOG articles below…)

Advanced screening for fetal aneuploidies using fetal DNA in maternal blood represents a major technical breakthrough that is still struggling to find a pragmatic place within the screening algorithms in most countries, after 4 years of clinical use. The wide and sometimes wild dissemination of the test stresses the critical need for the prescribers of the test to understand the difficulties of its interpretation.

Editor’s comment: Prof. Yves Ville: An unsuspected enemy is doubly dangerous (L. Frank Baum)
(Editor’s comment relates to the 3 AJOG articles below: Aubry et al, Khalifeh et al & Saade et al)
Over a third of infant deaths arise from complications related to preterm births, making prematurity the most frequent cause of infant mortality. Health complications are also a lifelong burden of survivors including mental retardation, cerebral palsy, learning and behavioral problems, respiratory problems, vision and hearing loss, but also diabetes, high blood pressure, and heart disease. This inventory has become a classic lament of perinatologists facing the implacable consequences of prematurity.

Trends in prematurity have been either on the rise (1990-2006) or flattening (2006-2013) with medically indicated « late » prematurity as the main adjustment variable. However around 1/25 pregnancies still face unexpected delivery before 33 weeks’ and roughly half of them are primigravidas without anticipated risk factors...

Editor’s comment: Prof. Yves Ville: Is the due date becoming overdue ?
(Editor’s comment relates to the 3 AJOG articles below: Gibson et al, Melamed et al & Masoudian et al)

In vitro fertilization using egg donation (ED) is being used increasingly for women requiring assisted reproduction techniques (ART) with a delivery rate per transfer of around 40%. Initially designed to overcome infertility in young women with hypergonadotropic hypogonadism, this technique is now also increasingly used to achieve pregnancy in older women.

Multiple studies have documented that ED pregnancies are associated with a higher incidence of pregnancy-induced hypertension and placental dysfunction, including small for gestational age, and preterm delivery. However, multiple gestations, advanced age, and underlying polycystic ovary syndrome are constant confounding factors for all studies examining the association between assisted reproductive techniques (ARTs) and hypertensive disorders in pregnancy...

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