Faculty Bibliography

There is currently no standard national approach to the management of category II fetal heart rate (FHR) patterns, yet such patterns occur in the majority of fetuses in labor. Under such circumstances, it would be difficult to demonstrate the clinical efficacy of FHR monitoring even if this technique had immense intrinsic value, since there has never been a standard hypothesis to test dealing with interpretation and management of these abnormal patterns. We present an algorithm for the management of category II FHR patterns that reflects a synthesis of available evidence and current scientific thought. Use of this algorithm represents one way for the clinician to comply with the standard of care, and may enhance our overall ability to define the benefits of intrapartum FHR monitoring.

OBJECTIVE:We assessed the association among gestational age (GA) at birth, timing of death, and risk status of the pregnancy and racial/ethnic disparities in infant mortality rate in the United States. STUDY DESIGN/METHODS:We utilized U.S. 2000 to 2004 birth cohort-linked birth and infant death data restricted to nonanomalous singleton live births. Multivariable log-binomial regression models were fit to evaluate racial/ethnic disparities in infant mortality while adjusting for potential confounders. RESULTS:Compared with whites, blacks had a higher adjusted infant mortality rate (IMR) (risk ratio [RR] 1.96, 95% confidence interval [CI] 1.91, 2.01), and Hispanics had a lower adjusted IMR (RR 0.79, 95% CI 0.76, 0.82). When categorized by GA, at 24 to 31 weeks, the adjusted early neonatal mortality (ENM) is significantly lower for black than whites, similar at 32 to 36 weeks, and at 37 weeks or more, blacks have significantly higher ENM. CONCLUSIONS:The racial/ethnic disparities in infant mortality in the United States persist and vary across GA. These disparities may largely be driven by the excess post-neonatal deaths among blacks.

Thrombocytopenia is a common complication encountered in pregnancy, and can have a wide range of prognostic implications, from completely benign to life threatening. It is important for obstetricians to be aware of the various causes of thrombocytopenia in pregnancy, and to be able to diagnose and manage these patients. This article reviews the various causes of thrombocytopenia in pregnancy, highlights clinical and laboratory features of the most common and most severe causes, and provides an overview of management for these disorders.

Obstetricians often rely on the results of randomized studies and other medical evidence to guide them in treating patients. However, not infrequently, there are problems with the manner in which we communicate medical evidence to our patients and the public. For instance, we often rely almost exclusively on relative risks without discussing absolute risks. This has the potential to cause undue anxiety, misinterpretation, unrealistic expectations, and problems with clinical decision making. This commentary encourages a more critical look at the way we interpret data and communicate medical evidence to our patients and the public.