Green Journal v117 no6 June '11

Editorial: Makena. TUrns out that neonatal outcomes aren't different with progesterone injections for women at risk for preterm birth. Suggestion is to offer either injections or vaginal suppositories, that they are about equally effective. Vaginal suppositories, in either gel or capsule form, are much cheaper.

Shoulder Dystocia study, Hoffman et al: Level III evidence. Of 132K births, 1.5% had SD. 5% of those had an injury. Delivery of the posterior shoulder seems like the way to go after McRoberts with suprapubic. Fewer injuries. Also, the more maneuvers you have to do, the higher the risk of injury. (Women whose babies were injured tended to be young, black, and nullips. Babies who were injured weighed 92g more on average.) Midwifery management led to fewer injuries, resident management led to the most injuries. Vacuum babies were more likely to have SD than SVD babies. Gaskin maneuver was used 22 times, with 1 injury.

Early term births, Reddy et al: Early-term babies do more poorly than later-term babies. Surprise, surprise.

Risk of c/s by BMI among nullips, Fyfe et al: Level II evidence. Higher in 1st stage only, not 2nd stage.

Change in BMI and GD in 2nd pg, Ehrlich et al: Level II evidence. Increase in BMI between pg increases risk of GDM

Comparing IUGR mesurements, Tuuli et al: Level II evidence. second tri is better than 1st and 1st-to-2nd-lag for SGA prediction.

Echogenic bowel on U/S, Goetzinger et al: Level II evidence. Echogenic bowel is associated with IUGR and IUFD risk. Retrospective cohort study, from 1990-2008, n=260 with echogenic bowel, 0.4% of the population. Of those 260, 13 were downs, 1 trisomy 18, 2 trisomy 13, 1 chromosomal mosaicism, 5 CMV infection, 6 cystic fibrosis, 1 cystic fibrosis and chromosomal mosaicism. 579 IUFDs (0.9%), and 12% IUGR. Echogenic bowel were 8.6 times more likely to have IUFD. RR 1.6 of having IUGR. Increased risk of IUGR and IUFD remains even if all follow-up testing is normal, 1.9 OR for IUGR and 6.2 OR for IUFD.

Who in the US uses long-term birth control, Kavanaugh et al: Level III evidence. Compared 2002 data to 2006-08 data. Use increased from 2.4% to 5.6%. Women born outside the US and those who started sex early are more likely to use implants and IUDs. Women who've had a baby or two and Hispanic women also use them more than others.

Changes in abortion rates, Jones & Kavanaugh: Abortion rate declined from 2000 to 2008. Rate increased for poor women. Women who are cohabiting, ages 20-24, and black, are more likely to have abortions.

your next teeth

Your next set of teeth came in all at once, six of them, just after nine months.

Now you're 10.5 months, and your first molar broke through this week. You do so well with your teething, but we can tell it hurts.

Love
Mama