bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obstetrical Providers’ Preferred Mode of Delivery and Attitude Toward Nonmedically Indicated Caesarean Sections: A Cross-Sectional Study
Authors: Rivo J.C. , Amyx M. , Pingray V. , Casale R.A. , Fiorillo A.E. , Krupitzki H.B. , Malamud J.D. , Mendilaharzu M. , Medina M.L. , Del Pino A.B. , Ribola L. , Schvartzman J.A. , Tartalo G.M. , Trasmonte M. , Varela S. , Althabe F. , Belizán J.M. 
Published: May 2019

(BJOG. 2018;125:1294–1302)
There has been an international rise in cesarean section (CS) rates, sometimes attributed to an increase in nonmedically indicated CS, including CS on maternal request (CSMR). Some evidence has suggested that women prefer vaginal delivery, however, and provider’s attitudes may have a greater effect on this trend. This study used a sample of Argentine obstetrical providers and described their preferred modes of delivery and attitudes towards CS in the absence of medical indication and CSMR.
Intramuscular Versus Intravenous Oxytocin to Prevent Postpartum Hemorrhage at Vaginal Delivery: Randomized Controlled Trial
Authors: Adnan N. , Conlan-Trant R. , McCormick C. , Boland F. , Murphy D.J. 
Published: May 2019

(BMJ. 2018;362:k3546)
Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and has been increasing over the last 15 years in many developed countries. While uterotonic drugs such as oxytocin have been established as useful tools in preventing PPH, the best administration method remains unclear. When given intramuscularly, a uterotonic effect will be obtained in 3 to 7 minutes, with the effect lasting 30 to 60 minutes. Intravenous oxytocin has an effect almost immediately and the plateau concentration is reached at 30 minutes. However, intravenous administration has been associated with hypotension and tachycardia. At these investigators’ medical center, the practice of administering oxytocin 10 international units (IU) intravenously after delivery was changed in 2010 to intramuscular oxytocin, following Royal College of Obstetricians and Gynaecologists guidelines. This randomized, controlled trial, the Labour Oxytocin Route (LabOR) was prompted by concerns from midwives and obstetricians at the study center regarding a perceived rise in PPH after this change in practice was adopted. The LabOR trial aimed to determine whether intravenous oxytocin 10 IU was more effective than intramuscular oxytocin 10 IU at preventing PPH after vaginal delivery.
Is there a Benefit to Continue Magnesium Sulphate Postpartum in Women Receiving Magnesium Sulfate Before Delivery? A Randomized Controlled Study
Authors: Vigil-DeGracia P. , Ludmir J. , Ng J. , Reyes-Tejada O. , Nova C. , Beltré A. , Yuen-Chon V. , Collantes J. , Turcios E. , Lewis R. , Cabrera S. 
Published: May 2019

(BJOG. 2018;125:1304–1311)
Magnesium sulfate is proven to prevent eclampsia in women with preeclampsia. Previous studies have not clearly established whether or not the use of magnesium sulfate in the postpartum period contributed to reducing postpartum eclampsia. This study investigated if patients who received a loading dose plus maintenance infusion for 8 or more hours before delivery required an additional maintenance infusion of magnesium sulfate for 24 hours postpartum.
Safety of Eliminating Postpartum Magnesium Sulphate: Intriguing but Not Yet Proven
Authors: Scott J.R. 
Published: May 2019

(BJOG. 2018;125(10):1312)
The development of eclampsia in women with preeclampsia significantly increases maternal morbidity and mortality. While the prophylactic use of magnesium sulfate has been used to prevent eclampsia in patients with preeclampsia, there is a lack of consensus regarding the optimum dosage, timing and administration schedule. In the United States, a magnesium sulfate infusion is commonly administered through labor and for 12 to 24 hours postpartum, after an initial 4 to 6 g loading dose.
Effect of Individual Dietetic Intervention on Gestational Weight Gain and Associated Complications in Obese Pregnant Women
Authors: Robertson N. , Ladlow B. 
Published: May 2019

(Aust N Z J Obstet Gynaecol. 2018;58:274–277)
Obesity in pregnancy is increasingly prevalent and associated with many complications. Dietetic intervention may be useful in optimizing gestational weight gain (GWG) in obese pregnant women and improving maternal and fetal outcomes. A GWG target of 5 to 9 kg is recommended for obese women by the Institute of Medicine (IOM), but lower GWG may be safe for individuals in obesity classes 2 and 3 if guided by a clinician. This study aimed to review the effect of individual nutritional counseling by a dietitian on GWG and obstetric outcomes.
Neonatal Outcomes of Elective Early-term Births After Demonstrated Fetal Lung Maturity
Authors: Tita A.T.N. , Jablonski K.A. , Bailit J.L. , Grobman W.A. , Wapner R.J. , Reddy U.M. , Varner M.W. , Thorp J.M. , Leveno K.J. , Caritis S.N. , Iams J.D. , Saade G. , Sorokin Y. , Rouse D.J. , Blackwell S.C. , Tolosa J.E. 
Published: May 2019

(Am J Obstet Gynecol. 2018;219:296.e1–296.e8)
Positive fetal lung maturity testing is associated with a decrease in the risk of respiratory neonatal morbidity in preterm and early-term neonates, compared with neonates who do not undergo testing. However, several studies suggest that respiratory outcomes, among others, are worse even after fetal lung maturity has been demonstrated in early-term neonates, compared with full-term neonates. This has led to a decline in fetal lung maturity testing. This study aimed to estimate the frequency and risks of adverse neonatal outcomes with early-term birth after positive fetal lung maturity testing compared with full-term birth in the absence of indications for early delivery.
Use of Nonsteroidal Antiinflammatory Drugs During Pregnancy and the Risk of Miscarriage
Authors: Li D.K. , Ferber J.R. , Odouli R. , Quesenberry C. 
Published: May 2019

(Am J Obstet Gynecol. 2018;219:275.e1–275.e8)
While nonsteroidal antiinflammatory drugs (NSAIDs) are commonly used among pregnant women, there is concern that exposure to NSAIDs during early pregnancy may have an adverse impact on implantation and increase the risk of miscarriage. For successful embryonic implantation, a sufficient amount of prostaglandin is required, but NSAIDs inhibit the biosynthesis of prostaglandin. Previous studies have yielded conflicting results. This study aimed to determine whether the use of NSAIDs during pregnancy is associated with the risk of miscarriage by using a natural indication-control cohort of pregnant women using acetaminophen rather than NSAIDs.
Opioid Detoxification in Pregnancy: Systematic Review and Meta-Analysis of Perinatal Outcomes
Authors: Wang M.J. , Kuper S.G. , Sims B. , Paddock C.S. , Dantzler J. , Muir S. , Harper L.M. 
Published: May 2019

(Am J Perinatol. 2018. Doi:10.1055/s-0038-1670680)
Opioid replacement therapy (ORT) is the recommended treatment for opioid use disorder during pregnancy, as it is associated with more positive maternal and neonatal outcomes and reduction in risky behavior. However, as ORT uses methadone or buprenorphine, neonatal abstinence syndrome (NAS) remains an issue, and the long-term neurodevelopmental impact of ORT exposure during pregnancy and NAS on neonates is unclear. The authors of the present study thereby reviewed the literature to determine neonatal effects of prenatal opioid maintenance therapy versus detoxification in opioid-dependent women and assessed the efficacy and safety of available treatment options.
Role of Epigenetic Mechanisms in Transmitting the Effects of Neonatal Sevoflurane Exposure to the Next Generation of Male, but not Female, Rats
Authors: Ju L.S. , Yang J.J. , Morey T.E. , Gravenstein N. , Seubert C.N. , Resnick J.L. , Zhang J.Q. , Martynyuk A.E. 
Published: May 2019

(Br J Anaesth. 2018;121:406–416)
Neonatal anesthesia-induced abnormalities and their mechanisms are poorly understood, even in exposed animals. Some studies have shown that rats, especially male rats, develop behavioral deficiencies and exacerbated hypothalamic-pituitary adrenal responses to stress when exposed as neonates to anesthetic. Furthermore, recent studies suggest that these deleterious effects could be carried into the next generation via epigenetic mechanisms (noncoding RNAs, DNA methylation). There is a pressing need for further research, in order to establish safety guidelines for anesthesia in children, The authors of the present study exposed neonatal rats to sevoflurane and evaluated their progeny for inherited behavioral and molecular alterations.
Risk Factors for Cesarean Delivery and Adverse Neonatal Outcome in Twin Pregnancies Attempting Vaginal Delivery
Authors: Schachter-Safrai N. , Karavani G. , Haj-Yahya R. , Shlomai N.O. , Porat S. 
Published: May 2019

(Acta Obstet Gynecol Scand. 2018;97:845–851)
Concerns regarding the safety of vaginal delivery for twins has persisted due to some patients’ and obstetricians’ perception that it may lead to increased morbidity and mortality for the second twin. The Twin Birth Study, though, demonstrated the safety of planned vaginal delivery as neither maternal risk or neonatal morbidity and mortality was decreased with planned cesarean delivery. Because of these study results, the American College of Obstetricians and Gynecologists and the Society of Maternal-Fetal Medicine have recommended that women with twin gestations where the first twin is in the cephalic presentation be counseled to plan a vaginal delivery. However, that study did not assess risk factors that could lead to an unplanned cesarean delivery and also did not report on outcomes for those pregnancies that did require an unplanned cesarean delivery. The goal of this study was to identify risk factors for both cesarean delivery and delivery-related neonatal morbidity and mortality among women who were attempting vaginal delivery of twins.
Intravenous Remifentanil Patient-controlled Analgesia Versus Intramuscular Pethidine for Pain Relief in Labour (RESPITE): An Open-label, Multicenter, Randomized Controlled Trial
Authors: Wilson M.J.A. , MacArthur C. , Hewitt C.A. , Handley K. , Gao F. , Beeson L. , Daniels J. 
Published: May 2019

(Lancet. 2018;392:662–672)
While pethidine (meperidine) is widely used for pain relief during labor, there are unfavorable side effects, such as nausea/vomiting, maternal sedation, and possible neonatal depression. In addition, more than a third of women receiving pethidine ultimately request epidural labor analgesia. Remifentanil is a potential alternative to pethidine for labor pain relief. Its rapid onset and short duration of action provide some benefits although its short duration requires administration via intravenous (IV) patient controlled analgesia (PCA). It is not commonly used in maternity units in the United Kingdom, however, as previous trials evaluating remifentanil versus pethidine yielded low-quality evidence. Stronger evidence was required to evaluate the efficacy and safety of remifentanil as compared with pethidine for labor pain management. The RESPITE trial primary outcome compared IV remifentanil PCA with intramuscular pethidine looking at the need to convert to epidural analgesia with secondary outcomes evaluating visual analog scale (VAS) pain scores, mode of delivery and adverse maternal or neonatal outcomes.
The Effect of Spinal Hyperbaric Bupivacaine-Fentanyl or Hyperbaric Bupivacaine on Uterine Tone and Fetal Heart Rate in Laboring Women: A Randomized Controlled Study
Authors: Kuberan A. , Jain K. , Bagga R. , Makkar J.K. 
Published: May 2019

(Anaesthesia. 2018;73:832–838)
Combined spinal-epidural (CSE) analgesia is a rapid and effective analgesic technique during labor, with minimal motor impairment and high maternal satisfaction. Despite these advantages, high incidences of fetal heart rate (FHR) abnormalities and uterine hyperactivity have been reported with its use. This study assessed the difference between spinal bupivacaine-fentanyl or bupivacaine on baseline uterine tone and FHR abnormalities; the hypothesis was that the use of fentanyl would be associated with higher uterine tone.
Management of Anesthesia and Delivery in Women With Chiari I Malformations
Authors: Waters J.F.R. , OʼNeal M.A. , Pilato M. , Waters S. , Larkin J.C. , Waters J.H. 
Published: May 2019

(Obstet Gynecol. 2018;132:1180–1184)
A type I Chiari malformation, which is the most common type of Chiari malformation (0.6% prevalence), is defined as descent of the cerebellar tonsils below the foramen magnum by >5 mm. While most patients with this congenital malformation are asymptomatic, 30% can experience symptoms, ranging from headaches exacerbated by cough to more severe effects, such as confusion, deconjugate gaze, and papilledema as a result of increased intracranial pressure. Subsequently, there are concerns that pregnant women with Chiari I malformations may experience tonsillar herniation and neurological deterioration during vaginal delivery. In this case series, the authors assessed whether vaginal delivery or neuraxial anesthesia increased the risk of neurological deterioration in women with uncorrected Chiari I malformation.
Randomized Double-blind Comparison of Bolus Phenylephrine or Ephedrine for Treatment of Hypotension in Women With Preeclampsia Undergoing Caesarean Section
Authors: Mohta M. , Duggal S. , Chilkoti G.T. 
Published: May 2019

(Anaesthesia. 2018;73:839–846)
Preeclampsia is a common complication of pregnancy. In the past, anesthesiologists had sometimes avoided the use of spinal anesthesia in parturients with preeclampsis due to concerns about spinal-induced hypotension leading to inadequate uteroplacental perfusion. However, more recent studies have shown spinal anesthesia to be a safe technique in preeclamptic women as the hypotension associated with it is less severe than that experienced by normotensive parturients and is easily treated. However, effective treatment of postspinal hypotension remains an important component of anesthetic management. While phenylephrine has become the vasopressor of choice for treatment of hypotension in healthy women undergoing cesarean section due to the lower risk of fetal acidosis, the preferred vasopressor for preeclamptic women remains unclear. This randomized, double blind study was performed to compare the effects of phenylephrine versus ephedrine for the treatment of spinal-induced hypotension in preeclamptic women undergoing cesarean section.
Hypnotic Agents for Induction of General Anesthesia in Caesarean Section Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Houthoff Khemlani K. , Weibel S. , Kranke P. , Schreiber J.U. 
Published: May 2019

(J Clin Anesth. 2018;48:73–80)
Thiopentone is a well-known general anesthesia induction agent for cesarean section (CS). Alternative agents include benzodiazepines, ketamine, and propofol. However, all these agents are lipid soluble and have rapid maternal-fetal equilibration. There is no reliable evidence available to support the use of any one of these specific drugs as a dedicated hypnotic agent in the setting of general anesthesia in CS patients. Therefore, to identify an “evidence-supported” practice, the authors of the present study conducted a meta-analysis as per PRISMA guidelines to compare the efficacy and safety profiles of benzodiazepines, ketamine, and propofol to that of thiopentone.
A Randomized Trial Comparing Surgeon-administered Intraoperative Transversus Abdominis Plane Block With Anesthesiologist-administered Transcutaneous Block
Authors: Narasimhulu D.M. , Scharfman L. , Minkoff H. , George B. , Homel P. , Tyagaraj K. 
Published: May 2019

(Int J Obstet Anesth. 2018;35:26–32)
Traditionally, transversus abdominis plane (TAP) blocks are performed percutaneously by anesthesiologists using ultrasound guidance to prevent damage to intra-abdominal structures or injection into the incorrect plane. However, ultrasound-guided blocks pose potential problems, particularly in obese patients or patients with poor muscular tone, where visualization may be difficult. There have been reports of puncturing intraperitoneal structures during the performance of these blocks. In addition, ultrasound-guided blocks may be time consuming. An alternative to this method is surgeon-administered intraoperative TAP blocks, which eliminate the risk of intraperitoneal injury since they are performed under direct visualization. This study aimed to compare surgical TAP blocks with conventional TAP blocks in patients undergoing cesarean delivery.
Preoperative Caesarean Delivery Intravenous Acetaminophen Treatment for Postoperative Pain Control: A Randomized Double-blinded Placebo Control Trial
Authors: Towers C.V. , Shelton S. , van Nes J. , Gregory E. , Liske E. , Smalley A. , Mobley E. , Faircloth B. , Fortner K.B. 
Published: May 2019

(Am J Obstet Gynecol. 2018;218:353.e1–353.e4)
Acetaminophen is thought to inhibit central pain receptor sites, which may lead to an overall reduction in perception of pain. Thus, it is possible that the use of preoperative intravenous (IV) acetaminophen could decrease the use of opioids after cesarean delivery. In the present study, the authors evaluated the effects of a preoperative IV dose of acetaminophen on maternal opioid use after cesarean delivery, postdelivery length of stay, pain scores on postoperative days 1 and 2, and acetaminophen levels in cord blood.
The promise and perils of ‘Big Data’: focus on spondyloarthritis
Authors: Curtis Jeffrey R. 
Published: May 2019

Purpose of review
This review will describe the available large-scale data sources to study spondyloarthritis (SpA), enumerate approaches to identify SpA and its disease-related manifestations and outcomes, and will outline existing and future methods to collect novel data types [e.g. patient-reported outcomes (PRO), passive data from wearables and biosensors].

Recent findings
In addition to traditional clinic visit-based SpA registries, newer data sources, such as health plan claims data, single and multispecialty electronic health record (EHR) based registries, patient registries and linkages between data sources, have catalyzed the breadth and depth of SpA research. Health activity tracker devices and PRO collected via PROMIS instruments have been shown to have good validity when assessed in SpA patients as compared to legacy disease-specific instruments. In certain cases, machine learning outperforms traditional methods to identify SpA and its associated manifestations in EHR and claims data, and may predict disease flare.

Summary
Although caution remains in the application of newer data sources and methods including the important need for replication, the availability of new data sources, health tracker devices and analytic methods holds great promise to catalyze SpA research.
Supine Test: A New Test for Detecting Lacrimal Gland Prolapse Before Upper Blepharoplasty
Authors: Kashkouli Mohsen Bahmani , Tabrizi Amir , Ghazizadeh Mahya , Khademi Behzad , Karimi Nasser 
Published: May 2019

Purpose:
To introduce a new (Supine) test and assess the values of lateral eyelid bulging for diagnosis of lacrimal gland (LG) prolapse before upper blepharoplasty.

Methods:
In a prospective case series (2011–2017), lateral eyelid bulging and Supine Test were recorded, preoperatively. Lacrimal gland prolapse was graded as mild (<4 mm), moderate (4–7 mm), and severe (>7 mm). A few spots of cautery on LG capsule was performed in patients with bilateral mild and suture repositioning in unilateral or bilateral moderate and severe LG prolapse. Patients with asymmetric LG prolapse were treated based on more severe grade, bilaterally.

Results:
Included were 1,207 patients. Frequency of positive Supine Test (11.8%, 142/1,207) increased from almost 10% in patients less than 41 years of age to 15% in more than 60 years of age. Their mean age was significantly older, and 53.2% showed asymmetric LG prolapse. Septum was just opened in patients with positive Supine Test, and all had LG prolapse of ≥3 mm (mean: 5.6 mm, range: 3–14 mm). Mild LG prolapse, moderate LG prolapse, and severe LG prolapse were observed in 22.5%, 62.6%, and 14.7% of the patients, respectively. Mean follow-up time was 22 months (12–60 months). Recurrence was observed in 1 patient (bilateral) after suture repositioning. Lateral eyelid bulging had a high negative (96.2%) and low positive (30.6%) predictive value when compared with the Supine Test.

Conclusions:
Positive Supine Test means LG prolapse of ≥3 mm (100% positive predictive value). Negative lateral eyelid bulging was highly predictive of no LG prolapse.
Intent of health care providers to adopt a clinical decision support tool in the management of minor pediatric head injuries
Authors: Zarchi Tova B. 
Published: May 2019

ABSTRACT

Background:
Radiographic neuroimaging in minor pediatric head injuries contains risks of radiation-induced malignancy. The Pediatric Emergency Care Applied Research Network (PECARN) head injury protocol identifies head-injured children who are at very low risk of clinically important traumatic brain injuries and can safely not receive a head computed tomography (CT) scan.

Local problem:
The identified urgent care facility had no facility-wide protocol to manage head injuries.

Methods:
The purpose of the evidence-based practice project was to educate health care providers on the risks of indiscriminate head CT prescription and the utility of the PECARN head injury protocol in the management of minor pediatric head injuries.

Interventions:
A knowledge assessment was conducted using pre- and posttests and the likelihood to adopt the PECARN head injury protocol in clinical practice was evaluated using the Evidence-Based Practice Attitude Scale. Additionally, rates of head CT scans ordered that were inappropriate according to the PECARN head injury protocol were calculated postproject and compared with preproject rates.

Results:
Data analysis was performed using descriptive statistics. Findings included increase in provider knowledge on the use of the PECARN head injury protocol and high likelihood of intent to adopt the PECARN head injury protocol in clinical practice. In addition, rates of head CT prescription postproject were lower than preproject rates, and 82.61% of CT scans ordered postproject were appropriate according to the PECARN head injury protocol.

Conclusions:
Using the PECARN head injury protocol was associated with consistency of care, reduced unnecessary health care resource utilization, and health care costs.
Contemporary management of frontal sinus fractures
Authors: Dedhia Raj D. , Morisada Megan V. , Tollefson Travis T. , Strong E. Bradley 
Published: May 2019

Purpose of review
Frontal sinus fracture management is evolving. This article will highlight recent literature and provide an evidence-based algorithm in the contemporary management of frontal sinus fractures.

Recent findings
The role of transnasal endoscopic treatment of frontal sinus fractures has expanded to include fracture reduction and posterior table reconstruction. Evidence continues to support the safety of nonoperative management in select frontal sinus outflow tract fractures.

Summary
The management of frontal sinus fractures with frontal sinus outflow tract injury continues to evolve with a trend toward observation and minimally invasive approaches. Restoration of the frontal sinus outflow tracts with transnasal endoscopic techniques is being used increasingly in the acute and delayed setting. For severe fractures, the role of conservative treatment paradigms requires further research.