Reassessing the Duration of the Second Stage of Labor in Relation to Maternal and Neonatal Morbidity.

OBJECTIVE: To assess the morbidity associated with continuing the second-stage duration of labor, weighing the probability of spontaneous vaginal birth without morbidity compared with birth with serious maternal or neonatal complications. METHODS: In a retrospective cohort, we analyzed singleton, vertex births at 36 weeks of gestation or greater without prior cesarean delivery (n=43,810 nulliparous and 59,605 multiparous women). We calculated rates of spontaneous vaginal birth and composite serious maternal or neonatal complications. Results were stratified by parity (nulliparous or multiparous) and epidural status (yes or no). Competing risks models were created for 1) spontaneous vaginal birth with no morbidity, 2) birth with maternal or neonatal morbidity, and 3) no spontaneous vaginal birth and no morbidity, and our main interest was in comparing number 1 against number 2. RESULTS: Rates of spontaneous vaginal birth without morbidity were slightly higher after the first half hour (greater than 0.5-1.0 hours) for nulliparous women, after which rates decreased with increasing second-stage duration. For multiparous women, rates of spontaneous vaginal birth without morbidity decreased with increasing second-stage duration. For illustration, for a nulliparous woman with an epidural at 3.0 hours of the second stage of labor who extended by another 1.0 hour, her likelihood of delivering by spontaneous vaginal birth was 31.4% compared with her likelihood of birth with any serious complication in the subsequent hour, which was 7.6%. The percentage of cesarean deliveries for nonreassuring fetal heart rate tracing were higher for women without compared with women with an epidural. CONCLUSION: Rates of spontaneous vaginal birth without serious morbidity steadily decreased for increasing second-stage duration except for the first half hour for nulliparous women. We did not observe an inflection point at a particular hour mark for either spontaneous vaginal delivery without morbidity or births with morbidity. Our findings will assist in decision-making for extending second-stage duration

Antimicrobial Agent Dosing in Infants

AbstractPurposeThe goal of this article was to review infant physiology and its effects on the pharmacokinetic properties of antimicrobial agents.MethodsA review of the drug development process was performed. A literature search was conducted on the pharmacokinetics of various antimicrobial agents in infants.FindingsThe pharmacokinetic properties of antimicrobial agents in infants are most often affected by the renal maturation of premature infants. Hepatic metabolism and volume of distribution play a common role as well.ImplicationsThe dosing and dosing intervals of various medications were reviewed and compared with details of adult dosing. It is vital to continue to gather pharmacokinetic data in infants to ensure adequate safety and dosing of medications

Periodic Coupled-Cluster Green's Function for Photoemission Spectra of Realistic Solids

We present an efficient implementation of coupled-cluster Green's function (CCGF) method for simulating photoemission spectra of periodic systems. We formulate the periodic CCGF approach with Brillouin zone sampling in Gaussian basis at the coupled-cluster singles and doubles (CCSD) level. To enable CCGF calculations of realistic solids, we propose an active-space self-energy correction scheme by combining CCGF with cheaper many-body perturbation theory (GW) and implement the model order reduction (MOR) frequency interpolation technique. We find that the active-space self-energy correction and MOR techniques significantly reduce the computational cost of CCGF while maintaining the high accuracy. We apply the developed CCGF approaches to compute spectral properties and band structure of silicon (Si) and zinc oxide (ZnO) crystals using triple-$\zeta$ Gaussian basis and medium-size k-point sampling, and find good agreement with experimental measurements.Comment: 7 pages, 4 figures, 1 tabl

Diagnostic potential of chromogenic substrates for rapid detection of bacterial enzymatic activity in health and disease associated periodontal plaques

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65525/1/j.1600-0765.1984.tb01327.x.pd

Association of in utero magnesium exposure and spontaneous intestinal perforations in extremely low birth weight infants

Determine whether antenatal exposure to magnesium is associated with spontaneous intestinal perforation in extremely low birth weight infants (≤1000 g)

An opportunistic study evaluating pharmacokinetics of sildenafil for the treatment of pulmonary hypertension in infants

To assess sildenafil and N-desmethyl sildenafil (DMS) exposure in infants receiving sildenafil for the treatment of pulmonary hypertension (PH)

Center Variation in the Delivery of Indicated Late Preterm Births

Evidence for optimal timing of delivery for some pregnancy complications at late preterm gestation is limited. The purpose of this study was to identify center variation of indicated late preterm births

Benzoyl-arginine naphthylamide (BANA) hydrolysis by Treponema denticola and/or Bacteroides gingivalis in periodontal plaques

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73624/1/j.1399-302X.1990.tb00425.x.pd

Sildenafil and retinopathy of prematurity risk in very low birth weight infants

To examine the effect of sildenafil therapy on development of severe retinopathy of prematurity (ROP) requiring surgical intervention in premature infants