@article {3620, title = {Intrapartum fetal heart rate monitoring interpretation in labour: a critical appraisal.}, journal = {Minerva Ginecol}, volume = {67}, year = {2015}, month = {2015 Feb}, pages = {65-79}, abstract = {

Electronic fetal monitoring (EFM) has been introduced in the obstetrics practice as a test to identify the first signs of fetal deterioration, allowing a prompt intervention to reduce neonatal morbidity and mortality. However, results from clinical trials fail to demonstrate a clear benefit with the use of EFM. No decrease in the incidence of cerebral palsy due to intrapartum asphyxia has been achieved and a significant increase in the rate of operative deliveries and in medico-legal litigations has been observed instead. Despite the lack of evidence supporting its safety and effectiveness, this method is routinely used in the clinical practice and periodical updated guidelines to standardize the method of interpretation and proper actions are proposed. However, limitations still exist and the unavoidable consequences are the increasing rate of caesarean delivery, partly due to a defensive attitude in medical choices, and medico-legal litigations for presumed inappropriate evaluation in case of perinatal adverse event. While Obstetrics Societies are trying to "fight" the rise in caesarean section rates, intrapartum EFM tracings are taken in the court proceedings as one of the main evidences in case of adverse event. The aim of this review is to discuss the limitations of guidelines dealing with intrapartum EFM and the pathophysiological basis to assess the suspicious tracings which represent the most observed and critical issue of EFM interpretation.

}, issn = {1827-1650}, author = {Maso, G and Piccoli, M and De Seta, F and Parolin, S and Banco, R and Camacho Mattos, L and Bogatti, P and Alberico, S} } @article {1616, title = {Gestational diabetes and fetal growth acceleration: induction of labour versus expectant management.}, journal = {Minerva Ginecol}, volume = {62}, year = {2010}, month = {2010 Dec}, pages = {533-9}, abstract = {

AIM: The aim of the study was to compare elective induction of labour at 38 weeks versus expectant management in A1 and A2 gestational diabetes (GDM) pregnancies with fetal growth acceleration. Primary outcome of the study was C-section (CS) rate, while secondary outcomes were macrosomia incidence and adverse perinatal outcomes.

METHODS: A retrospective cohort study was carried out. Data were collected between 1996 and 2006 and evaluated through patients{\textquoteright} records analysis. Differences between the two study groups were investigated using non-parametric tests for continuous variables and χ2 test for categorical ones.

RESULTS: There was no significant difference between induction and expectant management in terms of caesarean section rate. A trend favoring women in the induction group in terms of incidence of macrosomia and neonatal outcomes was identified, but results were not statistically significant.

CONCLUSION: Labour induction at 38 weeks in GDM patients with fetal growth acceleration does not seem to determine an increased incidence of C-section in comparison to expectant management, particularly in case of maternal obesity.

}, keywords = {Adult, Body Mass Index, Cesarean Section, Diabetes, Gestational, Elective Surgical Procedures, Female, Fetal Development, Fetal Macrosomia, Gestational Age, Humans, Incidence, Infant, Newborn, Italy, Labor, Induced, Medical Records, Obesity, Pregnancy, Pregnancy Outcome, Retrospective Studies, Risk Factors, Statistics, Nonparametric, Watchful Waiting}, issn = {0026-4784}, author = {Alberico, S and Businelli, C and Wiesenfeld, U and Erenbourg, A and Maso, G and Piccoli, M and Ronfani, L} }