Publications (2)9.46 Total impact
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Article: Number of cervical examinations and risk of intrapartum maternal fever.
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ABSTRACT: To estimate the association between number of cervical examinations and risk of maternal fever during term labor and delivery. Within a 4-year retrospective cohort study of all consecutive term (37 weeks of gestation or more) singleton deliveries reaching the second stage of labor, we identified women who developed an intrapartum fever and compared them with women who remained afebrile through 6 hours postpartum. Primary exposure was number of digital cervical examinations. Extensive data were collected from the medical record, including obstetric and medical history, cervical examinations and timing, admitting diagnoses, and outcomes. Time-to-event analyses were used to account for length of labor. Cox proportional hazard models were developed adjusting for potentially confounding factors. Of 2,395 women who were afebrile at admission, 174 (7.2%) developed an intrapartum fever. Women were examined one to 14 times. There was no significant association between increasing number of examinations and risk of fever. Even for the 505 women who had more than seven examinations during labor, there was no statistically significant increased risk of fever (hazard ratio 0.9, 95% confidence interval 0.4-2.0) compared with those with one to three examinations. Subanalyses by labor type and examinations after rupture of membranes also showed no significant association between number of cervical examinations and risk of intrapartum fever. During term labor management, maternal fever risk is not significantly increased by the number of cervical examinations. II.Obstetrics and Gynecology 06/2012; 119(6):1096-101. · 4.73 Impact Factor -
Article: Effect of magnesium sulfate on fetal heart rate patterns in the second stage of labor.
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ABSTRACT: To estimate the effect of maternal exposure to magnesium sulfate on fetal heart rate characteristics during active labor. Within a 4-year retrospective cohort study of consecutive term deliveries reaching the second stage of labor, we compared women exposed to magnesium for severe preeclampsia to all women not exposed. Primary outcome was the electronic fetal monitoring tracing in the 30 minutes preceding delivery. Secondary outcomes were fetal acidemia and nursery disposition. Attributable risk estimates and multivariable logistic regression were used to estimate the association between magnesium exposure and fetal heart rate characteristics. Unadjusted risk estimates for the association between fetal heart rate characteristics and neonatal outcomes were generated stratified by group. Of 5,387 women, 248 (4.6%) were exposed to magnesium. Magnesium exposure was associated with lower fetal heart rate baseline (136.9 ± 12.3 beats per minute compared with 139.0 ± 13.5 beats per minute; P=.02), increased risk of baseline less than 120 beats per minute (adjusted odds ratio [OR] 1.76, 95% confidence interval [CI] 1.21-2.56), and increased risk of absent or minimal variability (adjusted OR 2.41, 95% CI 1.78-3.27). More than 20% increased frequency of ever absent or minimal variability was attributable to magnesium (attributable risk 0.21, 95% CI 0.15-0.27). There were no significant differences in presence or number of accelerations or decelerations; however, magnesium was associated with fewer prolonged decelerations (adjusted OR 0.64, 95% CI 0.49-0.84). After excluding women with adverse neonatal outcomes, these associations remained. Maternal exposure to magnesium is associated with lower fetal heart rate baseline within the accepted normal range, decreased variability, and fewer prolonged decelerations without evidence of adverse effect on neonatal outcome. II.Obstetrics and Gynecology 06/2012; 119(6):1129-36. · 4.73 Impact Factor
