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  1. Book: Clinical obstetrics

    Reece, E. Albert / Leguizamón, Gustavo / Macones, George A. / Wiznitzer, Arnon

    the fetus & mother

    2021  

    Title variant Clinical obstetrics
    Author's details editors Albert Reece, Gustavo Leguizamón, George Maconees, Arnon Wiznitzer
    Keywords Obstetrics
    Subject code 618.2
    Language English
    Size xxx, 649 Seiten, Illustrationen, 26 cm
    Edition Fourth edition
    Publisher Wolters Kluwer
    Publishing place Philadelphia
    Publishing country United States
    Document type Book
    Note Zugang zur Online-Ausgabe über Code ; Includes bibliographical references and index
    HBZ-ID HT021071587
    ISBN 978-1-975141-46-2 ; 9781975141486 ; 1-975141-46-6 ; 1975141482
    Database Catalogue ZB MED Medicine, Health

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    In stock of ZB MED Cologne/Königswinter

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    2021 A 1229 available for loan (reading room) Lesesaal EG
    Zugang zur Online-Ausgabe über Code aus lizenzrechtlichen Gründen nicht verfügbar

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  2. Book: Fetal assessment

    Odibo, Anthony O. / Macones, George A.

    (Clinics in perinatology ; 38,1)

    2011  

    Author's details guest ed. Anthony O. Odibo ; George A. Macones
    Series title Clinics in perinatology ; 38,1
    Collection
    Language English
    Size XIV, 178 S. : Ill., graph. Darst.
    Publisher Saunders an imprint of Elsevier
    Publishing place Philadelphia, PA
    Publishing country United States
    Document type Book
    HBZ-ID HT016778436
    ISBN 978-1-4557-0484-2 ; 1-4557-0484-9
    Database Catalogue ZB MED Medicine, Health

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  3. Article ; Online: Optimizing the length of the second stage and management of pushing.

    Cahill, Alison G / Macones, George A

    American journal of obstetrics and gynecology

    2023  Volume 230, Issue 3S, Page(s) S876–S878

    Abstract: Although the optimal length of the second stage of labor to minimize maternal and neonatal morbidities and optimize spontaneous vaginal delivery is not known, available evidence suggests that increasing length of the second stage is associated with ... ...

    Abstract Although the optimal length of the second stage of labor to minimize maternal and neonatal morbidities and optimize spontaneous vaginal delivery is not known, available evidence suggests that increasing length of the second stage is associated with increasing maternal and neonatal morbidity. Thus, evidence-based strategies to safely shorten the second stage, such as initiating pushing when complete dilation is reached among those with neuraxial anesthesia, is prudent. Many aspects of optimal management of the second stage of labor require future study to continue to guide clinical second-stage management.
    MeSH term(s) Pregnancy ; Female ; Infant, Newborn ; Humans ; Labor Stage, Second ; Time Factors ; Delivery, Obstetric ; Anesthesia ; Anesthesiology
    Language English
    Publishing date 2023-07-26
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2022.07.017
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Elective Induction of Labor Following Prior Cesarean Delivery.

    Saucedo, Alexander M / Macones, George A / Cahill, Alison G / Harper, Lorie M

    American journal of perinatology

    2024  

    Abstract: Objective:  Following the release of A Randomized Trial of Induction versus Expectant Management (ARRIVE) trial, the induction of labor at 39 weeks has increased in the United States. The risk of uterine rupture and optimal timing of elective induction ... ...

    Abstract Objective:  Following the release of A Randomized Trial of Induction versus Expectant Management (ARRIVE) trial, the induction of labor at 39 weeks has increased in the United States. The risk of uterine rupture and optimal timing of elective induction in those patients with a prior cesarean delivery is not well-described, and they were not included in the original trial. We aimed to determine the risk of uterine rupture in those patients undergoing elective induction of labor with prior cesarean delivery.
    Study design:  This was a retrospective cohort of participants with prior cesarean delivery from 1996 to 2000. Participants were included if they had two or more prior cesareans. Participants were excluded if they had a history of an unknown prior incision, a classical incision, gestational age <39 weeks, any diabetes, chronic hypertension, twin gestation, collagen or vascular disease, or HIV. Those undergoing expectant management were compared with those undergoing elective induction with no medical or obstetrical indications for delivery. Analysis was performed at three gestational age groups: 39 weeks, 40 weeks, and 41 weeks. The primary outcomes were uterine rupture, rates of successful vaginal delivery, and a composite major morbidity risk. Multivariable logistic regression was performed.
    Results:  At 39 weeks, 618 (10.3%) elective inductions were compared with 5,365 (89.7%) undergoing expectant management; uterine rupture occurred more frequently (13 patients [2.1%] vs. 49 patients [0.9%]; adjusted odds ratio [aOR], 2.5; 95% confidence interval, 1.3-4.6) with fewer successful vaginal birth after cesarean [VBAC; 66.8 vs. 75%; aOR, 0.6; 95% confidence interval, 0.5-0.7]. The risk of uterine rupture was similar between groups at 40 weeks (5 patients [0.8%] vs. 21 patients [1.2%];
    Conclusion:  Patients undergoing elective induction of labor with a prior cesarean scar had an increased risk of uterine rupture when compared with expectant management at 39 weeks, with fewer successful VBAC.
    Key points: · TOLAC elective induction at 39 weeks has an increased risk of uterine rupture.. · TOLAC elective induction at 39 weeks has a less successful chance of vaginal delivery.. · Awaiting spontaneous labor in this cohort does not increase the risk of uterine rupture..
    Language English
    Publishing date 2024-05-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605671-4
    ISSN 1098-8785 ; 0735-1631
    ISSN (online) 1098-8785
    ISSN 0735-1631
    DOI 10.1055/a-2310-9817
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: A National Leader in Women's Reproductive Health.

    Macones, George A

    Missouri medicine

    2018  Volume 114, Issue 3, Page(s) 155

    Language English
    Publishing date 2018-09-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 427362-x
    ISSN 0026-6620
    ISSN 0026-6620
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Reply.

    Macones, George A

    American journal of obstetrics and gynecology

    2018  Volume 218, Issue 1, Page(s) 145

    Language English
    Publishing date 2018-01-02
    Publishing country United States
    Document type Letter
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2017.10.039
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Optimal misoprostol dosing among patients with a body mass index greater than 30: a randomized controlled trial.

    Saucedo, Alexander M / Alvarez, Miriam / Macones, George A / Cahill, Alison G / Harper, Lorie M

    American journal of obstetrics and gynecology

    2024  Volume 230, Issue 5, Page(s) 565.e1–565.e16

    Abstract: Background: Patients with obesity experience an increased duration of labor with an increased risk for perinatal morbidity. When compared with parturients without obesity, they also experience fewer uterine contractions after administration of ... ...

    Abstract Background: Patients with obesity experience an increased duration of labor with an increased risk for perinatal morbidity. When compared with parturients without obesity, they also experience fewer uterine contractions after administration of misoprostol. It is unclear if the same dose of misoprostol should be used for induction of labor in patients with obesity compared to non-obese patients. Therefore, we sought to investigate if a higher dose of misoprostol for patients with obesity is more effective.
    Objective: This study aimed to determine if 50 μg compared with 25 μg of vaginal misoprostol reduced the time from induction start to delivery among patients with obesity.
    Study design: We performed a double-blinded, pragmatic randomized controlled trial, between June 1, 2022, and July 17, 2023. Patients with a body mass index ≥30 kg/m
    Results: Of the 180 patients randomized, 88 were assigned to the 25 μg group and 92 were assigned to the 50 μg group. Of those, 96.1% of patients received the designated intervention. The baseline characteristics were similar between groups. No difference was found in the primary outcome of time to delivery (21.6 hours vs 18.6 hours; d=.28; 95% confidence interval, -0.02 to 0.57). In a planned subgroup analysis, multiparous patients delivered faster in the 50 μg group (15.2 hours vs 12.0 hours; d=.51; 95% confidence interval, 0.04-0.97). The risk for tachysystole associated with fetal heart tracing changes was rare overall (2.2%) and not significantly different between groups. No differences in maternal or neonatal adverse effects were observed.
    Conclusion: Patients with obesity who underwent cervical ripening with 50 μg of vaginal misoprostol experienced a similar time to delivery when compared with those who received 25 μg of misoprostol. However, multiparous patients had a significantly reduced time to delivery when 50 μg was used. A higher dose of misoprostol may be a promising intervention for reducing time in labor, which warrants further study.
    MeSH term(s) Adult ; Female ; Humans ; Pregnancy ; Administration, Intravaginal ; Body Mass Index ; Dose-Response Relationship, Drug ; Double-Blind Method ; Labor, Induced/methods ; Misoprostol/administration & dosage ; Obesity ; Oxytocics/administration & dosage ; Time Factors
    Language English
    Publishing date 2024-02-15
    Publishing country United States
    Document type Journal Article ; Pragmatic Clinical Trial
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2024.02.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Patient Safety in Obstetrics: More Evidence, Less Emotion.

    Macones, George A

    Obstetrics and gynecology

    2017  Volume 130, Issue 2, Page(s) 257–259

    MeSH term(s) Emotions ; Female ; Gynecology ; Humans ; Obstetrics ; Patient Safety ; Pregnancy
    Language English
    Publishing date 2017-05-03
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 207330-4
    ISSN 1873-233X ; 0029-7844
    ISSN (online) 1873-233X
    ISSN 0029-7844
    DOI 10.1097/AOG.0000000000002169
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Reply.

    Macones, George A

    American journal of obstetrics and gynecology

    2017  Volume 217, Issue 1, Page(s) 95

    Language English
    Publishing date 2017-07
    Publishing country United States
    Document type Letter
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2017.03.023
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Elective Induction of Labor Following Prior Cesarean Delivery

    Saucedo, Alexander M. / Macones, George A. / Cahill, Alison G. / Harper, Lorie M.

    American Journal of Perinatology

    2024  

    Abstract: Objective: Following the release of A Randomized Trial of Induction versus Expectant Management (ARRIVE) trial, the induction of labor at 39 weeks has increased in the United States. The risk of uterine rupture and optimal timing of elective induction ... ...

    Abstract Objective: Following the release of A Randomized Trial of Induction versus Expectant Management (ARRIVE) trial, the induction of labor at 39 weeks has increased in the United States. The risk of uterine rupture and optimal timing of elective induction in those patients with a prior cesarean delivery is not well-described, and they were not included in the original trial. We aimed to determine the risk of uterine rupture in those patients undergoing elective induction of labor with prior cesarean delivery.
    Study Design: This was a retrospective cohort of participants with prior cesarean delivery from 1996 to 2000. Participants were included if they had two or more prior cesareans. Participants were excluded if they had a history of an unknown prior incision, a classical incision, gestational age <39 weeks, any diabetes, chronic hypertension, twin gestation, collagen or vascular disease, or HIV. Those undergoing expectant management were compared with those undergoing elective induction with no medical or obstetrical indications for delivery. Analysis was performed at three gestational age groups: 39 weeks, 40 weeks, and 41 weeks. The primary outcomes were uterine rupture, rates of successful vaginal delivery, and a composite major morbidity risk. Multivariable logistic regression was performed.
    Results: At 39 weeks, 618 (10.3%) elective inductions were compared with 5,365 (89.7%) undergoing expectant management; uterine rupture occurred more frequently (13 patients [2.1%] vs. 49 patients [0.9%]; adjusted odds ratio [aOR], 2.5; 95% confidence interval, 1.3–4.6) with fewer successful vaginal birth after cesarean [VBAC; 66.8 vs. 75%; aOR, 0.6; 95% confidence interval, 0.5–0.7]. The risk of uterine rupture was similar between groups at 40 weeks (5 patients [0.8%] vs. 21 patients [1.2%]; p  = 0.387) and 41 weeks (7 patients [1.4%] vs. 2 patients (0.8%); p  = 0.448).
    Conclusion: Patients undergoing elective induction of labor with a prior cesarean scar had an increased risk of uterine rupture when compared with expectant management at 39 weeks, with fewer successful VBAC.
    Key Points: TOLAC elective induction at 39 weeks has an increased risk of uterine rupture. TOLAC elective induction at 39 weeks has a less successful chance of vaginal delivery. Awaiting spontaneous labor in this cohort does not increase the risk of uterine rupture.
    Keywords elective induction ; prior cesarean ; trial of labor ; TOLAC ; vaginal birth after cesarean ; VBAC ; uterine rupture
    Language English
    Publishing date 2024-04-22
    Publisher Thieme Medical Publishers, Inc.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 605671-4
    ISSN 1098-8785 ; 0735-1631
    ISSN (online) 1098-8785
    ISSN 0735-1631
    DOI 10.1055/a-2310-9817
    Database Thieme publisher's database

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