Fetal acidemia is a common final pathway to fetal death, and in many cases, to fetal central nervous system injury. However, certain fetal pathophysiological processes are associated with significant category II or category III fetal heart rate changes before the development of or in the absence of fetal acidemia. The most frequent of these processes include fetal infection and/or inflammation,…

Epidural-related maternal fever affects 15% to 25% of patients who receive a labor epidural. Two meta-analyses demonstrated that epidural-related maternal fever is a clinical phenomenon, which is unlikely to be caused by selection bias. All commonly used neuraxial techniques, local anesthetics with or without opioids, and maintenance regimens are associated with epidural-related maternal fever,…

On April 5, 2023, the US Food and Drug Administration (FDA) withdrew approval of 17-alpha hydroxyprogesterone caproate (17-OHPC), effective immediately, due to lack of evidence that it reduces the risk of recurrent spontaneous preterm birth (PTB). This decision withdraws approval for all formulations of 17-OHPC (both intramuscular and subcutaneous) and applies to both brand name (Makena) and…

Fertility-sparing treatment in patients with cervical cancer should, in principle, follow identical algorithms to that in patients without future reproductive plans. In recent years, a trend toward nonradical procedures, such as conization or simple trachelectomy, has become apparent in medical literature, because of their associations with better pregnancy outcomes. However, the published…

There is no doubt that parturition can produce fetal and neonatal adversity, but the frequency with which this occurs is uncertain, particularly in modern healthcare settings. Moreover, there is a paucity of recent studies in this area. Substantial challenges impede epidemiologic study of the effect of parturition on offspring. Randomized trials would be ethically fraught. Therefore, large…

To reduce cesarean delivery rates in nulliparous women, guidelines for diagnosing nonprogressive labor have been developed by the National Institute of Child Health and Human Development, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. These are mainly based on data from the Consortium for Safe Labor study. The guidelines have not been tested…