Expectant management of retained products of conception following abortion: A retrospective cohort study

2021 ◽  
Author(s):  
Yoshimitsu Wada ◽  
Hironori Takahashi ◽  
Hirotada Suzuki ◽  
Mai Ohashi ◽  
Manabu Ogoyama ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Expectant Management ◽  
Retained Products Of Conception ◽  
Products Of Conception ◽  
Retained Products

scholarly journals Retrospective cohort study comparing current third stage management to expedient squatting third stage management

2021 ◽  
Author(s):  
Judy Cohain ◽  
Rina E. Buxbaum
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Expectant Management ◽  
Positive Outcome ◽  
Low Risk ◽  
Active Management ◽  
Stage Management ◽  
The Third ◽  
Third Stage

Abstract Objective: To compare current the third stage management to expedient squatting at 3 minutes postpartum. Design, Setting, Sample and Methods: A retrospective cohort study of 1,098 planned, attended low risk vaginal births in Israel using Judy’s 3,4,5 minute third stage protocol compared to 2,691 attended low risk vaginal births in British Columbia using various forms of active or expectant management of the third stage of labor. Main Outcome measures: PPH>1000, PPH>500 and manual removal of placenta Results: Among similar groups of low risk births, active management, or expectant management resulted in 4.1% PPH over 1000 cc, whereas Judy’s 3,4,5 minute protocol resulted in 0% PPH over 500 cc. Conclusion: Evidence supports less postpartum bleeding and postpartum hemorrhage when women deliver the placenta in squatting 3 minutes after birth. The risks are minimal and the data suggests the likelihood of a very positive outcome, making it recommended for practitioners in all settings to try it.

scholarly journals Comparison of Four Methods of Treating Ectopic Pregnancy: A Retrospective Cohort Study

2018 ◽  
Vol 78 (01) ◽  
pp. 70-77 ◽  
Author(s):  
Zeynep Inal ◽  
Hasan Inal
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cardiac Activity ◽  
Expectant Management ◽  
Sociodemographic Characteristics ◽  
Additional Dose ◽  
Group 4 ◽  
Fetal Cardiac Activity ◽  
Β Hcg

Abstract Objective To compare the results of expectant management, single and multidose methotrexate (MTX) and surgical management of ectopic pregnancy (EP). Materials and Methods In this retrospective cohort study, the original files of 233 patients who were treated for EP between May 2009 and December 2016 were analyzed. The patients were assigned to the following groups based on the applied treatment methods: Group 1, expectant management (n = 24), Group 2, single-dose MTX (n = 144), Group 3, multiple-dose MTX (n = 25), and Group 4, surgical intervention (n = 40). The following parameters were recorded and assessed: sociodemographic characteristics, pelvic ultrasonography findings (gestational sac, ectopic mass appearance, positive fetal cardiac activity), serum beta-human chorionic gonadotropin (β-hCG) levels on Day 0, Day 4, and Day 7, and surgical procedures in women that underwent surgical interventions. Results The sociodemographic characteristics were similar in all four groups. The percentage of ectopic mass and positive fetal cardiac activity was greater and the diameter of the mass was larger in Group 4 than in the other groups. The β-hCG values on Day 0, Day 4, and Day 7 were statistically different between the groups (p < 0.001). The cutoff value for the β-hCG change for EP resolution was 18% between Day 0 and Day 4 (AUC = 0.726, p < 0.001) and 15% between Day 4 and Day 7 (AUC = 0.874, p < 0.001). The probability of the requirement for an additional dose of MTX was 0.78 (95% CI 0.71 – 0.87; p < 0.001) times lower in patients who had a > 18% decrease in β-hCG levels from Day 0 to Day 4 in comparison to those who had a decrease < 18% from Day 0 to Day 4. The probability of the requirement for an additional dose of MTX was 1.64 (95% CI 1.25 – 2.16; p < 0.001) times greater in patients whose reduction in β-hCG levels from Day 4 to Day 7 was < 15% in comparison to those who had > 15% reduction from Day 4 to Day 7. Conclusions Additional dose requirements for patients with EP may be predicted early in the changes in β-hCG levels between Day 0 and Day 4. Further prospective studies are required to elucidate this issue.

Outpatient Expectant Management of Term Prelabor Rupture of Membranes: A Retrospective Cohort Study

2019 ◽  
Author(s):  
Kelly M. Chacón ◽  
Allison S. Bryant Mantha ◽  
Mark A. Clapp
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Expectant Management ◽  
Outpatient Management ◽  
Maternal And Neonatal Outcomes ◽  
Secondary Outcomes ◽  
Prelabor Rupture Of Membranes ◽  
Linear Regressions

Abstract Objective To examine outcomes among women with prelabor rupture of membranes (PROM) who declined induction and chose outpatient expectant management compared with those admitted for induction. Study Design This is a retrospective cohort study of term women with singleton, vertex-presenting fetuses who presented with PROM between July 2016 and June 2017 and were eligible for outpatient expectant management (n = 166). The primary outcomes were time from PROM to delivery and time from admission to delivery. Maternal and neonatal outcomes were also compared between groups. Multivariable linear regressions were used to assess time differences between groups, adjusting for known maternal and pregnancy characteristics. Results Compared with admitted patients, women managed expectantly at home had significantly longer PROM to delivery intervals (median 29.2 vs. 17 hours, p < 0.001), but were more likely to deliver within 24 hours of admission (95.1 vs. 82.9%, p = 0.004). In the adjusted analysis, PROM to delivery was 7 hours longer (95% confidence interval [CI]: 3.9–10.0) and admission to delivery was 5.3 hours shorter (95% CI: 2.8–7.7) in the outpatient expectant management cohort. There were no differences in secondary outcomes. Conclusion Outpatient management of term PROM is associated with longer PROM to delivery intervals, but shorter admission to delivery intervals.

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