PubMed · 4492609
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S Ikeda. 1973. [Case report: forceps delivery].. https://pubmed.ncbi.nlm.nih.gov/4492609/
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It has been claimed that the expected day of delivery (EDD) determined on the basis of an ultrasound scan is more accurate than using a calendar method. The aim of this paper is to assess the evidence in support of this claim. A critical review of the methodologically best research revealed that among women with regular cycles and know first day of the last menstrual period, Naegele's rule predicted the EDD to be 3.3 days too early, on average, whereas prediction based on ultrasound scans was 2.0 days too late. The standard deviations of the two distributions were the same. After correction for the systematic biases, the two methods of prediction were thus equally precise. It is concluded that the EDD should be calculated by adding 283 days to the date of the last period rather than by adding 280 days. For women with regular cycles and known first day of the last menstrual period, ultrasound dating does not lead to a more precise prediction.
OBJECTIVE: To evaluate the usefulness of serum estradiol levels obtained on the fourth day of gonadotropin stimulation in predicting the likelihood of pregnancy during controlled ovarian hyperstimulation (COH) using luteal phase leuprolide acetate (LA). DESIGN: A 4-year retrospective analysis of day 4 estradiol levels and subsequent clinical pregnancy and delivery rates. SETTING: A university hospital tertiary referral center. PATIENT(S): Couples undergoing IVF treatment. MAIN OUTCOME MEASURE(S): Primary outcome measures included clinical pregnancy and delivery rates. Secondary outcome measures included the number of oocytes retrieved and the number of embryos available for transfer per COH cycle. RESULT(S): The clinical pregnancy and delivery rates for cycles with day 4 estradiol levels of >75 pg/mL were 42.3% (30/71) and 32.4% (23/71), respectively. These rates differed significantly from those for cycles with day 4 estradiol levels of < or = 75 pg/mL, which were only 9.1% (4/44) and 6.8% (3/44), respectively. The number of oocytes retrieved and the number of embryos available for transfer for cycles with day 4 estradiol levels of >75 pg/mL also differed significantly from those for cycles with day 4 estradiol levels of < or = 75 pg/mL (11.4 and 7.8 versus 6.8 and 4.3, respectively). CONCLUSION(S): Estradiol levels obtained on the fourth day of gonadotropin therapy are highly predictive of successful ovulation induction and pregnancy outcome in cycles using luteal phase LA.
The decision to withhold or withdraw life support in the neonatal intensive care unit (NICU) is common but is never routine. Often, moral demands make such decisions difficult and emotionally exhausting. But, what is perhaps more challenging from the moral point of view is the transition from the delivery room to the NICU. A satisfactory analysis of the moral issues of delivery room practices must include a discussion of quality of life, the best interest of the infant, the best interests of the family members, and futile treatment. Although these topics are relevant in any discussion of the moral justification of the omission, withdrawal, or use of treatment for patients, they are especially telling when entertained in the context of the transition of the fetus to a newborn. This article uses these four topics as a moral compass for certain decisions made in the delivery room.