In 1986, Vern L. Katz, Deborah J. Dotters, and William Droegemueller published “Perimortem Cesarean Delivery,” an article in which they developed the Four Minute Rule for perimortem cesarean sections. The Four Minute Rule states that if a pregnant woman’s heart stops beating, physicians should begin an operation to deliver the fetus within four minutes and aim to have the fetus delivered within five minutes of cardiac arrest. Although cardiac arrest during pregnancy is uncommon, it can happen when pregnant women experience trauma, blood clots, infection, or have preexisting heart conditions. In the article, the authors emphasize how the Four Minute Rule increased maternal and fetal survival rates and decreased cases of severe fetal brain damage. The article “Perimortem Cesarean Delivery” was the first article to present the Four Minute Rule, which has influenced international guidelines and become the standard for maternal resuscitation and fetal survival in emergency medicine, operating rooms, and many other aspects of medical practice.

In the May 1996 edition of The Annals of Surgery, John A. Morris and his collaborators published “Infant Survival After Cesarean Section for Trauma,” in which they evaluate the use of emergency cesarean sections for the treatment of pregnant trauma patients. During a cesarean section, a physician removes a fetus from a pregnant woman through an incision in her abdomen and uterus. When a pregnant woman experiences trauma, physicians can perform an emergency cesarean section to remove the fetus and administer medical treatments that would not be possible while the woman is pregnant. In their article, Morris and his colleagues examine the fetal outcomes following emergency cesarean sections to determine when the procedure should be used in a trauma setting. The authors support the use of emergency cesarean sections in trauma patients when those patients demonstrate high degrees of maternal and fetal distress. Morris and his team’s article is one of the first to focus on how trauma affects third trimester pregnancies and to develop an algorithm to help physicians treat those patients.

In 2004 Mark Landon and his colleagues in the United States published “Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery,” which compared the risks of vaginal delivery and cesarean section for delivery of a fetus after a previous cesarean delivery. During a cesarean section, a physician surgically removes a fetus from a pregnant woman through an incision in her abdomen. By the late 1900s, most clinical guidelines viewed attempting a vaginal birth after a previous cesarean delivery as a reasonable option for most women. Yet, physicians often noticed an increased risk of uterine ruptures as more patients underwent vaginal deliveries following previous cesarean sections. As such, many physicians continued to recommend cesarean deliveries for women who had a past cesarean section. Landon and his team evaluated the risks of both delivery methods and published their results in the New England Journal of Medicine in 2004. In “Maternal and Perinatal Outcomes,” the authors found that there was no significant difference between the risks of vaginal birth after cesarean and repeat cesarean sections, providing more evidence for clinical guidelines recommending vaginal births after cesarean sections.

Intrauterine devices (IUDs) have become one of the most common types of contraception in the United States. In the last decade, the American College of Obstetricians and Gynecologists, the World Health Organization, and the Food and Drug Administration (FDA) updated IUD recommendations to include placement in younger populations and nulliparous women. Research has shown that younger, nulliparous women may have smaller uterine dimensions and it is possible that larger IUDs are not suitable for those populations. This study retrospectively evaluated follow-up pelvic ultrasounds showing uterine dimensions and IUD positions of 57 women who had IUDs placed in a clinic. The largest IUD, the Paragard, showed a significantly higher rate of malpositioning than the Kyleena, Liletta, and Mirena IUDs. There is concern that the Paragard IUD, which is most commonly malpositioned, is also the IUD most dependent on position for adequate contraception. There was no correlation between uterine dimensions and IUD position at the time of analysis, however. Further data collection will continue in hopes that a larger sample size will reveal a parameter which affects IUD placement. Should further data analysis show that uterine width plays an important role in IUD position, the design for a device which can measure the width of patient's uterus (without the need for pelvic ultrasound) has been included. The concept generation for this measurement device includes laser measurements of uterine cavity width at different known lengths from the fundal wall, which output to an LED screen for recording.