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[Obstetrics].

Véronique Othenin-Girard1, Noémie Bouchet1, Riccardo E Pfister2

  • 1Service d'obstétrique, Département de gynécologie et obstétrique, HUG, 1211 Genève 14.

Revue Medicale Suisse
|January 17, 2018
PubMed
Summary

New guidelines address preterm delivery lung maturation, with short-term benefits but potential long-term risks. Research also explores ultrasound for safe vaginal birth after cesarean and aspirin

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Neonatology

Background:

  • Recent guidelines address lung maturation for preterm deliveries after 37 weeks gestation.
  • Concerns persist regarding the high number needed to treat and potential neurological effects.
  • Established practices for vaginal birth after cesarean and uterine closure are being re-evaluated.

Purpose of the Study:

  • To review current evidence on interventions for preterm delivery and maternal-fetal medicine.
  • To evaluate the benefits and risks of antenatal corticosteroids for lung maturation.
  • To discuss advancements in achieving vaginal birth after cesarean and surgical techniques.

Main Methods:

  • Systematic review of recent studies and guidelines.

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  • Analysis of data on short-term benefits and long-term risks of interventions.
  • Evaluation of ultrasound techniques for assessing uterine scar integrity.
  • Review of surgical methods for uterine closure during cesarean delivery.
  • Discussion of aspirin's role in pre-eclampsia prevention.
  • Main Results:

    • Antenatal corticosteroids show short-term benefits for lung maturation but require a high number of cases to prevent complications, with potential neurological risks.
    • Ultrasound measurement of the lower uterine segment is beneficial for assessing risk during attempted vaginal birth after cesarean.
    • Optimal uterine closure techniques during cesarean delivery are under investigation.
    • Aspirin remains a key consideration for pre-eclampsia risk reduction.

    Conclusions:

    • Careful consideration of benefits versus risks is needed for lung maturation interventions in late preterm infants.
    • Ultrasound assessment and refined surgical techniques can improve safety for vaginal birth after cesarean.
    • Aspirin continues to be a valuable tool in managing pre-eclampsia risk.