Postoperative care of symphysiotomy performed for severe shoulder dystocia with fetal demise.

BACKGROUND: Shoulder dystocia is an obstetric emergency which occurs in 0.2-3% of all births ACOG Committee on Practice Bulletins-Obstetrics and The American College of Obstetrician and Gynecologists (2002) . Symphysiotomy is a treatment option reserved primarily for developing countries where mortality rates of Cesarean delivery are 1-2% Monjok et al. (2013) . CASE: A G3P2002 with a history of two prior vaginal deliveries had a term delivery complicated by a severe shoulder dystocia. She underwent emergent symphysiotomy at an outside institution, with delivery of a dead macrosomic infant. She was transferred to our tertiary care center for further care. CONCLUSION: Symphysiotomy is rarely performed in the United States. We submit our postoperative management to add to the literature of this rarely performed obstetric intervention. PRÉCIS: Symphysiotomy for severe shoulder dystocia is rarely utilized in the United States. We describe a case of symphysiotomy done for severe shoulder dystocia at an outside institution, and the patient's subsequent care at our institution.

Risk factors for a prolonged length of stay in women hospitalized for preeclampsia in Texas.

OBJECTIVES: To identify correlates of a prolonged length of stay (PLOS) in women hospitalized for preeclampsia/eclampsia in Texas, USA. METHODS: Statewide hospital data were obtained, and the records of women who were discharged in 2004 and/or 2005 with a principal discharge diagnosis of preeclampsia or eclampsia were extracted using ICD-9-CM codes. PLOS was defined as a stay greater than 5 days. Odds ratios (OR) for PLOS were calculated. Generalized estimating equations were used to account for a small group of women who were hospitalized multiple times during the study period for preeclampsia. A total of 21,203 records were analyzed. RESULTS: The crude incidence of PLOS was 17.5%. Advancing maternal age was positively associated with PLOS: for every 10-year increase, there was a 20% increase in the odds of PLOS (adjusted OR = 1.20,95% confidence interval (CI): 1.13, 1.28). The strongest risk factor for PLOS was the presence of renal disease: adjusted OR 5.81 (95% CI: 3.97, 8.50). Protective factors included Medicaid beneficiary status, and being admitted from the emergency department. CONCLUSIONS: The strongest correlate of PLOS in a large cohort of women hospitalized for preeclampsia was the presence of renal disease.

Bleeding patterns with monophasic and triphasic low-dose ethinyl estradiol combined oral contraceptives.

BACKGROUND: This retrospective analysis evaluated the association of age and weight with cycle control in women using either of two formulations of low-estrogen-dose oral contraceptives. STUDY DESIGN: Data for this secondary analysis were derived from a randomized multicenter trial assessing the efficacy and safety of norgestimate (NGM) 180/215/250 mcg/ethinyl estradiol (EE) 25 mcg (n=1506) and norethindrone acetate 1 mg/EE 20 mcg (n=1057). In this retrospective analysis, the incidence of breakthrough bleeding/spotting (BTB/S) was evaluated in women stratified by age (18-24, 25-34 and >34 years) and weight (155 lb). RESULTS: A lower percentage of women experienced BTB/S with NGM/EE during most cycles, regardless of age or weight, compared with norethindrone acetate/EE. At Cycle 6, the incidences of BTB/S for NGM/EE versus norethindrone acetate/EE were as follows: 18-24 years, 10.9% versus 29.7% (p<.0001); 25-34 years, 10.9% versus 18.6% (p<.001); >34 years, 8.1% versus 19.1% (p<.005); 155 lb, 10.0% versus 18.3% (p<.01). CONCLUSION: NGM/EE provided better cycle control as defined by BTB/S compared with norethindrone acetate/EE, regardless of subject age or weight for six cycles.