RESUMEN
OBJECTIVE: Obstetrical vacuum manufacturers have long recommended a maximum of two to three pop-offs be allowed before abandoning the procedure. However, there is a paucity of evidence on the safety of vacuum-assisted vaginal delivery in relation to the number of pop-offs to support this recommendation. Our objective was to examine whether the number of pop-offs in a vacuum-assisted vaginal delivery was associated with adverse neonatal outcomes. STUDY DESIGN: This is a retrospective cohort study of women who underwent a trial of a vacuum-assisted vaginal delivery at a single tertiary care institution between October 2005 and June 2014. Maternal and fetal factors associated with the number of pop-offs were examined in bivariable analyses. Multivariable analyses were performed to determine the independent association of the number of pop-offs with adverse neonatal outcomes. RESULTS: Of the 1,730 women who met inclusion criteria, 1,293 (74.7%) had no pop-offs, 240 (13.9%) had one pop-off, 128 (7.4%) had two pop-offs, and 69 (4.0%) had three or more pop-offs. Neonatal scalp/facial lacerations, intracranial hemorrhage, seizures, central nervous system depression, and neonatal intensive care unit admission were all associated with the number of pop-offs in bivariable analyses. In multivariable analyses, compared to no pop-offs, having any vacuum pop-offs was associated with an increased odds of adverse neonatal outcomes. However, there was not a consistent dose-response relationship. CONCLUSION: While having vacuum pop-offs in a vacuum-assisted vaginal delivery was associated with an increased risk of adverse neonatal outcomes, there did not appear to be a dose-dependent association with the number of pop-offs. KEY POINTS: · There are no specific guidelines on how many pop-offs can be allowed before abandoning a vacuum-assisted vaginal delivery.. · Having any vacuum pop-offs was associated with an increased risk of adverse neonatal outcomes.. · There was no dose-dependent association between number of pop-offs and adverse neonatal outcomes..
Asunto(s)
Obstetricia , Extracción Obstétrica por Aspiración , Embarazo , Recién Nacido , Femenino , Humanos , Extracción Obstétrica por Aspiración/efectos adversos , Estudios Retrospectivos , Parto Obstétrico/métodos , Atención PrenatalRESUMEN
BACKGROUND: Continuous glucose monitoring (CGM) has transformed the care of type 1 and type 2 diabetes, and there is potential for CGM to also become influential in prediabetes identification and management. However, to date, we do not have any consensus guidelines or high-quality evidence to guide CGM goals and metrics for use in prediabetes. METHODS: We searched PubMed for all English-language articles on CGM use in nonpregnant adults with prediabetes published by November 1, 2023. We excluded any articles that included subjects with type 1 diabetes or who were known to be at risk for type 1 diabetes due to positive islet autoantibodies. RESULTS: Based on the limited data available, we suggest possible CGM metrics to be used for individuals with prediabetes. We also explore the role that glycemic variability (GV) plays in the transition from normoglycemia to prediabetes. CONCLUSIONS: Glycemic variability indices beyond the standard deviation and coefficient of variation are emerging as prominent identifiers of early dysglycemia. One GV index in particular, the mean amplitude of glycemic excursion (MAGE), may play a key future role in CGM metrics for prediabetes and is highlighted in this review.