2-hour recommendation, and evidence would suggest that as many as 60% of women with a 2-hour pause in labor will go on to deliver vaginally (Obstet Gynecol. 2001;98:550Y554).Finally, the data regarding the standards for length of labor in the second stage are antiquated and based on a time when operative vaginal deliveries were performed in the majority if not a large minority of women, and the use of epidural analgesia was rare. Furthermore, there have been recent studies that suggest that the complications from a prolonged second stage of labor arise from obstetric intervention as much as from the length of the second stage itself. This led to recommendations to lengthen the current guidelines for the second stage all by 1 hour. The current standards have been for 1 hour for multiparous women without an epidural, 2 hours for multiparous women with an epidural, 2 hours for nulliparous women without an epidural, and 3 hours for women with an epidural. Thus, the new recommendations are for 2, 3, 3, and 4 hours, respectively. I think these Table 5 recommendations are the crux of this document and am curious to see if all of these changes will be adopted and how long such adoption will take. As each of these aspects of care is responsible for tens and hundreds of thousands of cesarean deliveries, the impact could be enormous. However, I think the most important component of these changes is that they are done in a thoughtful, patient-centric fashion. With the widespread use of VBAC that was encouraged and then declined, certainly 1 factor in the abandonment of VBAC was the initial lack of attention on patient safety. Although I do not think any of these management changes will have such a dramatic impact as a uterine rupture, I also would not want to see broad adoption of guidelines supplants clinical acumen. However, as many of these represent a more thoughtful approach to labor and delivery, hopefully they will encourage a greater focus on clinical skills beyond the simple use of the scalpel, and we can demonstrate a second reduction in cesarean deliveries over the coming decade.VABC) ABSTRACT Delayed pushing in the second stage of labor may facilitate delivery and avoid potential adverse outcomes. This retrospective cohort study was designed to assess the effectiveness of delayed pushing, estimate its effect on delivery mode, assess its relationship with maternal and neonatal well-being, and estimate its effect on the duration of second stage of labor.The study included consecutive women admitted at term who reached the second stage of labor; those who delayed pushing were compared with those who pushed immediately. Data on maternal demographics and outcomes and neonatal outcomes were obtained from medical records. Delayed pushing, used at the practitioner's discretion, was defined as initiation of pushing 60 minutes or greater after complete dilatation. Baseline characteristics were compared between the 2 groups using W 2 analysis and the Student t and Mann-Whitney U tests. Mode of delivery and rates of maternal...

Background Intrauterine devices (IUDs) are highly effective methods of contraception, but use continues to lag behind less effective methods such as oral contraceptive pills and condoms. Women who are aware of the actual effectiveness of various contraceptive methods are more likely to choose the IUD. Conversely, women who are misinformed about the safety of IUDs may be less like to use this method. Individuals increasingly use the Internet for health information. Information about IUDs obtained through the Internet may influence attitudes about IUD use among patients. Objective Our objective was to evaluate the quality of information about intrauterine devices (IUDs) among websites providing contraceptive information to the public. Study Design We developed a 56-item structured questionnaire to evaluate the quality of information about IUDs available through the Internet. We then conducted an online search to identify websites containing information about contraception and IUDs using common search engines. The search was performed in August 2013 and websites were reviewed in October 2015 to ensure no substantial changes. Results Our search identified over 2000 websites, of which 108 were eligible for review; 105 (97.2%) of these sites contained information about IUDs. Eighty-six percent of sites provided at least one mechanism of the IUD. Most websites accurately reported advantages of the IUD including that it is long-acting (91%), highly effective (82%), and reversible (68%). However, only 30% of sites explicitly indicated that IUDs are safe. Fifty percent of sites (n=53) contained inaccurate information about the IUD such as an increased risk of pelvic inflammatory disease beyond the insertion month (27%) or that women in non-monogamous relationships (30%) and nulliparous women (20%) are not appropriate candidates. Forty-four percent of websites stated that a mechanism of IUDs is prevention of implantation of a fertilized egg. Only 3% of websites incorrectly stated that IUDs are an abortifacient. More than a quarter of sites listed an inaccurate contraindication to the IUD such as nulliparity, history of pelvic inflammatory disease, or history of an ectopic pregnancy. Conclusions The quality of information about IUDs available on the Internet is variable. Accurate information was mixed with inaccurate or outdated information that could perpetuate myths about IUDs. Clinicians need knowledge about accurate,, evidence-based Internet resources to provide to women given the inconsistent quality of information available through online sources.

Numerous breast cancer risk assessment tools that allow users to input personal risk information and obtain a personalized breast cancer risk estimate are available on the Internet. The goal of these tools is to increase screening awareness and identify modifiable health behaviors; however, the utility of this risk information is limited by the readability of the material. We undertook this study to assess the overall readability of breast cancer risk assessment tools and accompanying information, as well as to identify areas of suggested improvement. We searched for breast cancer risk assessment tools, using five search terms, on three search engines. All searches were performed on June 12, 2014. Sites that met inclusion criteria were then assessed for readability using the suitability assessment of materials (SAM) and the SMOG readability formula (July 1, 2014–January 31, 2015). The primary outcomes are the frequency distribution of overall SAM readability category (superior, adequate, or not suitable) and mean SMOG reading grade level. The search returned 42 sites were eligible for assessment, only 9 (21.4 %) of which achieved an overall SAM superior rating, and 27 (64.3 %) were deemed adequate. The average SMOG reading grade level was grade 12.1 (SD 1.6, range 9–15). The readability of breast cancer risk assessment tools and the sites that host them is an important barrier to risk communication. This study demonstrates that most breast cancer risk assessment tools are not accessible to individuals with limited health literacy skills. More importantly, this study identifies potential areas of improvement and has the potential to heighten a physician’s awareness of the Internet resources a patient might navigate in their quest for breast cancer risk information.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-015-3601-2) contains supplementary material, which is available to authorized users.