Recommendations from major society guidelines for post-caesarean thromboprophylaxis differ greatly.

Objective To determine how well antenatal corticosteroids (ACS) were timed, based on the indication for administration for women delivering preterm.Design Retrospective cohort study.Setting Tertiary medical centre.Population Six hundred and thirty women who had singleton preterm births between 24 and 34 weeks' gestational age.Methods Charts from 2006 to 2011 were reviewed for indications for ACS administration, which included premature rupture of membranes, threatened preterm labour, risk factors for spontaneous preterm birth such as short ultrasound cervical length, positive fetal fibronectin, and hypertensive disorders of pregnancy. Charts were reviewed for timing of ACS administration in relation to delivery.Main outcome measures The primary outcome was optimal timing, defined as administration of ACS ≥24 hours to ≤7 days prior to delivery.Results Of 630 women who delivered preterm, 589 (93%) received ACS prior to delivery. ACS timing was optimal in 40% (238 of 589) of cases. Women with hypertensive disorders were most likely to have steroids optimally timed (62%). Asymptomatic women at increased risk for preterm delivery were less likely to receive optimally timed ACS (12%). The majority of women who received steroids >2 weeks prior to delivery (57%) received a second course.Conclusion A majority of women who delivered preterm did not receive optimally timed ACS. Diagnostic tools that identified women at risk for preterm birth were not able to identify patients for appropriate steroid timing. Given the range of clinical scenarios in which patients are at increased risk for preterm delivery, further research is needed to assist clinicians in optimising steroid administration.

Forceps and vacuum delivery decreased significantly in the USA from 2005 to 2013.

(Am J Obstet Gynecol. 2018;219:185.e1–185.e10) Postpartum hemorrhage is a leading contributor to maternal mortality. How race is associated with adverse outcomes in the setting of postpartum hemorrhage is not well characterized. Given that severe morbidity and mortality outcomes in the setting of postpartum hemorrhage may account for an important part of overall maternal disparities, the objective of this study was to determine whether race was associated with an increased risk for mortality and severe morbidity in the setting of obstetrical complications.

Objective To determine whether prolonged latency after preterm prelabour rupture of membranes (PPROM) is associated with an increased risk for adverse neurodevelopmental outcomes.Design This is a secondary analysis of the randomised controlled trial of magnesium sulphate for the prevention of cerebral palsy. Setting Multicentre trial.Population A total of 1305 women with PPROM were analysed, 1056 of whom had an interval of <3 weeks between diagnosis and delivery and 249 of whom had an interval of ≥3 weeks between diagnosis and delivery.Methods We evaluated whether the time interval between diagnosis of PPROM and delivery was associated with an increased risk for adverse neurodevelopmental outcomes. Latency was analysed as a continuous variable and categorised by weeks of latency.Main outcome measures The primary outcome was motor and mental Bayley scores of <70 at 2 years of age. Secondary outcomes included motor and mental Bayley scores <85 and mean Bayley scores. Logistic regression was used to control for confounding factors.Results In the univariate analysis, motor and mental Bayley scores of <70 were similar in the <3 weeks (16.8 and 14.4%) and ≥3 weeks (15.3 and 14.1%) groups. In the regression analysis adjusting for confounding factors, PPROM for ≥3 weeks was an independent risk factor for motor (adjusted odds ratio (aOR) 2.12; 95% confidence interval, 95% CI 1.29-3.49) and mental (aOR 1.83, 95% CI 1.13-3.00) Bayley scores of <70. Neonatal sepsis, gestational age at delivery, maternal education, and race were significantly associated with neurodevelopmental outcomes.Conclusions Whereas delivery at later gestational age is associated with improved prognosis for many outcomes, prolonged exposure to an intrauterine environment of PPROM is an independent risk factor for adverse neurodevelopmental outcomes.