Topical negative pressure wound therapy to prevent wound complications following caesarean delivery in high-risk obstetric patients: A randomised controlled trial.

BACKGROUND AND AIMS: We investigated whether the use of a prophylactic negative pressure wound therapy (NPWT) system in women undergoing caesarean would decrease wound complications in a high-risk population. MATERIALS AND METHODS: A randomised controlled trial was performed. Women with risk factors for wound complications undergoing caesarean delivery were randomised to a standard dressing or NPWT placed over their caesarean wound. We standardised the closure of the subcutaneous fat and skin layers, both with Vicryl. Patients were followed for wound complications for up to 6 weeks after their caesareans. The incidence of wound complications was the primary outcome. The single-use NPWT system, PICO, was provided by Smith and Nephew for use in this trial. The trial was registered on clinicaltrials.gov, # NCT03082664. RESULTS: We report here on 154 women randomised to either a standard dressing or to the NPWT. Wound complication rates were equivalent between groups, with 19.4 and 19.7% (P = 0.43) of women with follow-up information available experiencing wound complications. CONCLUSION: We found no difference in wound complications in women with risk factors treated with a prophylactic NPWT system or standard wound dressing at the time of caesarean birth.

Cell-Free DNA as an Addition to Ultrasound for Screening of a Complete Hydatidiform Mole and Coexisting Normal Fetus Pregnancy: A Case Report.

Background Complete hydatidiform mole and coexisting normal fetus pregnancies (CHMCF) are rare and can be life-threatening to the mother. Definitive diagnosis can be made with chorionic villus sampling or amniocentesis. However invasive procedures carry a risk of bleeding. We present the case of a twin molar pregnancy where a cell-free DNA screening test was utilized to evaluate for CHMCF pregnancy. Case A patient presented at 15-week gestational age with suspected CHMCF pregnancy. Ultrasound revealed a normal-appearing pregnancy abutting a multicystic lesion concerning for a complete mole. Cell-free DNA was obtained and was suggestive of complete paternal uniparental disomy. Pathological evaluation of the products of conception confirmed the diagnosis of CHMCF. Conclusion In atypical cases, cell-free DNA may be useful in evaluation of molar pregnancy.

A Novel Treatment for Massive Hemorrhage after Maternal Trauma in Pregnancy.

Background Trauma in pregnancy can lead to life-threatening hemorrhage. Conventional treatments of hemorrhage include medical and surgical management. However, if these measures fail uterine compression is an option to control bleeding. We present a case where this management was employed. Case A patient presented at 36 weeks of gestation with multiple injuries after a motor vehicle collision and experienced disseminated intravascular coagulation (DIC). The use of a Bakri balloon in combination with external compression with Coban, a sterile self-adherent bandage, after delivery temporized her bleeding and allowed her to become stable for further management. Conclusion When other measures fail and a hysterectomy is considered unsafe, the combination of internal and external uterine compression is an option.

Misoprostol in Addition to a Double-Balloon Catheter for Induction: A Double-Blind Randomized Controlled Trial.

OBJECTIVE: This article aims to evaluate whether the use of a double-balloon catheter with oral misoprostol results in a lower rate of cesarean and shorter times to delivery than the use of the double-balloon catheter with oral placebo. STUDY DESIGN: In a double-blind randomized controlled trial, a double-balloon catheter was used for induction of labor with two doses of either 50 µg of misoprostol or placebo. Outcomes included cesarean rate, time to vaginal delivery, change in Bishop's score, and oxytocin usage. RESULTS: A total of 343 women were screened and 199 randomized: 99 to the misoprostol arm and 100 to the placebo arm. Cesarean delivery rate was not different between the groups (misoprostol: 13.1% vs. placebo: 17.0%, p = 0.45). Time to vaginal delivery was significantly shorter (mean: 14.6 ± 6.9 vs. 20.8 ± 13.8 hours, p < 0.0001), change in Bishop's score was significantly greater (median: 5 vs. 4 points, p = 0.005), and use of oxytocin was significantly less frequent (86.9 vs. 98.0% patients, p = 0.01) in the misoprostol group. CONCLUSION: The use of a double-balloon catheter with oral misoprostol for induction did not reduce the cesarean delivery rate, but did result in shorter labors, a greater increase in Bishop's score, and a lower need for oxytocin use.

Does Maternal Body Mass Index Have an Effect on the Accuracy of Ultrasound-Derived Estimated Birth Weight?: A Retrospective Study.

OBJECTIVES: The purpose of this study was to investigate the relationship between the maternal body mass index (BMI) and the accuracy of ultrasound-derived birth weight. METHODS: A retrospective chart review was performed on women who had an ultrasound examination between 36 and 43 weeks' gestation and had complete delivery data available through electronic medical records. The ultrasound-derived fetal weight was adjusted by 30 g per day of gestation that elapsed between the ultrasound examination and delivery to arrive at the predicted birth weight. RESULTS: A total of 403 pregnant women met inclusion criteria. Age ranged from 13-44 years (mean ± SD, 28.38 ± 5.97 years). The mean BMI was 32.62 ± 8.59 kg/m2 . Most of the women did not have diabetes (n = 300 [74.0%]). The sample was primarily white (n = 165 [40.9%]) and Hispanic (n = 147 [36.5%]). The predicted weight of neonates at delivery (3677.07 ± 540.51 g) was higher than the actual birth weight (3335.92 ± 585.46 g). Based on regression analyses, as the BMI increased, so did the predicted weight (P < .01) and weight at delivery (P < .01). The accuracy of the estimated ultrasound-derived birth weight was not predicted by the maternal BMI (P = .22). Maternal race and diabetes status were not associated with the accuracy of ultrasound in predicting birth weight. CONCLUSIONS: Both predicted and actual birth weight increased as the BMI increased. However, the BMI did not affect the accuracy of the estimated ultrasound-derived birth weight. Maternal race and diabetes status did not influence the accuracy of the ultrasound-derived predicted birth weight.