Reliability and validity of last menstrual period for gestational age estimation in a low-to-middle-income setting.

AIM: Gestational age estimation by ultrasonography is the gold standard for dating pregnancies. However, the availability of prenatal ultrasonography in low-to-middle-income countries is limited. This study aimed to assess the reliability and validity of last menstrual period (LMP) as a gestational age dating method among women in Johannesburg, South Africa. METHODS: A total of 741 pregnant women were enrolled into a longitudinal study (June 2013 to July 2016). Gestational age was determined by LMP and ultrasonography. Differences in ultrasound-based and LMP-based gestational age estimates were assessed according to the American College of Obstetrics and Gynecologists' guidelines and women were classified as having discrepant results or not. Multiple statistical analyses determined the level of agreement between the two methods and validity of LMP estimates. RESULTS: Compared to ultrasound, dating by LMP assessed gestational age as 0.2 days longer. Women with discrepant results were of significantly lower weight and household socioeconomic status than those without discrepancies. While there was a substantial agreement (k = 0.64; 95% confidence interval, CI: 0.54, 0.71, P < 0.001) between the two methods, LMP only had a 29.0% (95% CI: 14.2, 48.0) sensitivity in identifying late-term neonates and a 33.3% (95% CI: 4.33, 77.7) sensitivity in identifying post-term neonates. CONCLUSION: In the absence of ultrasound, LMP is a reliable alternative for gestational age dating during early pregnancy. However, it is not sensitive in identifying late- and post-term pregnancies and should not be relied upon to make clinical decisions regarding elective cesarean section or induction of labor for supposed prolonged pregnancies.The authors wish to acknowledge their colleagues in the Department of Obstetrics and Gynaecology and the Fetal Medicine Unit at CHBAH as well as the research team at DPHRU and the study participants

Characteristics of fetal heart rate tracings prior to uterine rupture

Objective: To identify the fetal heart rate patterns that occurred in a 2‐h period of time preceding uterine rupture. Methods: The fetal monitor strips and the medical records of patients with a confirmed diagnosis of uterine rupture were reviewed. These patients delivered at the University of Michigan Hospital from January 1, 1985 to December 31, 1999 and were ≥28 weeks gestational age. Asymptomatic uterine scar dehiscences were excluded. The weeks of gestation, the number of cesarean sections, the surgical findings, and the maternal complications were obtained from the review of the maternal records. The fetal monitor strips for the 2 h preceding the uterine rupture were analyzed, and the fetal heart rate patterns were classified. Results: During the study period, there were 11 patients identified with uterine rupture. Seven of the 11 (64%) had operative or post‐operative complications. There were no maternal deaths. Review of the eight fetal heart rate tracings available revealed 7/8 (87.5%) with recurrent late decelerations and 4/8 (50%) with terminal bradycardia. All four of the patients with fetal bradycardia were preceded by recurrent late decelerations (100%). Conclusions: The most common fetal heart rate abnormalities that occurred prior to uterine rupture were recurrent late decelerations and bradycardia. The appearance of recurrent late decelerations may be an early sign of impending uterine rupture.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135337/1/ijgo235.pd

Practice advisory: interim guidance for care of obstetric patients during a zika virus outbreak

Zika during pregnancy has been associated with birth defects, specifically significant microcephaly. Transmission of Zika to the fetus has been documented in all trimesters; Zika virus RNA has been detected in fetal tissue from early missed abortions, amniotic fluid, term neonates and the placenta. However, much is not yet known about Zika virus in pregnancy. Uncertainties include the incidence of Zika virus infection among pregnant women in areas of Zika virus transmission, the rate of vertical transmission and the rate with which infected fetuses manifest complications such as microcephaly or demise. The absence of this important information makes management and decision making in the setting of potential Zika virus exposure (i.e. travel to endemic areas) or maternal infection, difficult. Currently, there is no vaccine or treatment for this infection

Exercise Beliefs During Pregnancy in a Predominantly Low-Income, Urban Minority Population

In 2002, and reaffirmed in 2009, The American College of Obstetricians and Gynecologists recommended that healthy pregnant women exercise for at least thirty minutes most days of the week. Exercise during a healthy pregnancy is safe and has many maternal and fetal benefits. Identified benefits include management of weight gain, improvement in mood, and preparation for labor. Previous research has evaluated women’s beliefs and practices of exercise in pregnancy, but it has focused on affluent, ethnic majority populations. This survey study was performed to assess beliefs about exercise in pregnancy in a predominantly low-income, urban minority population.https://jdc.jefferson.edu/cwicposters/1031/thumbnail.jp

American College of Obstetricians and Gynecologists practice bulletins: An overview

Objective The purpose of this study was to review the American College of Obstetricians and Gynecologists practices bulletins to quantify the type of recommendations and references and determining whether there are any differences between obstetric and gynecologic bulletins. Study design All practice bulletins published from June 1998 to December 2004 were reviewed. Odds ratios and 95% confidence intervals were calculated. Results The 55 practice bulletins contained 438 recommendations of which 29% are level A, 33% level B, and 38% level C. The 55 bulletins cite 3953 references of which 17% are level I, 46% level II, 34% level III, and 3% others. Level A recommendations were significantly more likely among the 23 gynecologic than 32 obstetric bulletins (37% versus 23%, odds ratios 1.95, 95% confidence intervals 1.28, 2.96). The study types referenced in obstetric and gynecologic bulletins were similar (P \u3e .05 for comparison of levels I, II, and III and meta-analysis references). Conclusion Only 29% of the American College of Obstetricians and Gynecologists recommendations are level A, based on good and consistent scientific evidence

SMC Alumni Bulletin 06-1970

Features the article American College* Qualifies Fuller As Ob-Gyn Fellow . Doctor Forest Laverne Fuller, of the South Bay Ob-Gyn Medical Group, Chula Vista, Calif., will be installed as a Fellow of the American College of Obstetricians and Gynecologists at its Annual Meeting, April 12-18, in New York City.https://knowledge.e.southern.edu/alumni_newsletter/1051/thumbnail.jp

Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2019

cdc:51363Recommended by the Advisory Committee on Immunization Practices (www.cdc.gov/vaccines/acip) and approved by the Centers for Disease Control and Prevention (www.cdc.gov), American Academy of Pediatrics (www.aap.org), American Academy of Family Physicians (www.aafp.org), and American College of Obstetricians and Gynecologists (www.acog.org).0-18yrs-child-combined-schedule.pdf2019SupersededACIPPrevention and ControlInfectious Disease