Quality improvement efforts directed at optimal umbilical cord management in delivery room.

Delayed or deferred cord clamping (DCC) and umbilical cord milking (UCM) benefit all infants by optimizing fetal-neonatal transition and placental transfusion. Even though DCC is recommended by almost all maternal and neonatal organizations, it has not been universally implemented. There is considerable variation in umbilical cord management practices across institutions.

Cord management strategies in multifetal gestational births.

Multifetal gestations are associated with high risks of neonatal mortality and morbidities primarily due to prematurity. Delayed cord clamping and cord milking facilitate the postnatal transition and improve outcomes. Limited evidence shows that delayed cord clamping for 30-60 s and cord milking are feasible without causing harm and potentially beneficial in uncomplicated multifetal deliveries.

Impacts of embracing 39-week elective induction across an entire labor and delivery unit.

Background: Induction of labor among low-risk, 39-week nulliparas increased significantly in the United States following publication of the outcomes of A Randomized Trial of Induction Versus Expectant Management trial. However, the rates of labor induction and outcomes in non-nulliparous patients and the wider impacts on the labor unit have not been reported widely.

Objective: This study aimed to compare the induction of labor rates and outcomes before and after liberal implementation of 39-week elective induction at a single center.

Limitations of Gravimetric Quantitative Blood Loss during Cesarean Delivery.

 This study examined the accuracy, sources of error, and limitations of gravimetric quantification of blood loss (QBL) during cesarean delivery.  Blood loss determined by assays of the hemoglobin content on surgical sponges and in suction canisters was compared with QBL in 50 parturients.  QBL was moderately correlated to the actual blood loss (  = 0.

Nonmydriatic Photographic Screening for Diabetic Retinopathy in Pregnant Patients with Pre-Existing Diabetes in a Safety Net Population: 1 Year Results from the Diabetic Retinopathy in Pregnant Patients Study.

Pregnant patients with pre-existing diabetes mellitus (DM) are at increased risk for development or progression of existing diabetic retinopathy (DR). A quality improvement project was initiated to improve DR screening during pregnancy at a safety net hospital. This article highlights the utility and generalizability of our telemedicine-based screening model.

Accuracy of Blood Loss Measurement during Cesarean Delivery.

 This study aims to compare the accuracy of visual, quantitative gravimetric, and colorimetric methods used to determine blood loss during cesarean delivery procedures employing a hemoglobin extraction assay as the reference standard.  In 50 patients having cesarean deliveries blood loss determined by assays of hemoglobin content on surgical sponges and in suction canisters was compared with obstetricians' visual estimates, a quantitative gravimetric method, and the blood loss determined by a novel colorimetric system. Agreement between the reference assay and other measures was evaluated by the Bland-Altman method.

Nonpneumatic antishock garment combined with bakri balloon as a nonoperative "uterine sandwich" for temporization of massive postpartum hemorrhage from disseminated intravascular coagulation.

Disseminated intravascular coagulation (DIC) is an uncommon but potentially catastrophic complication of postpartum hemorrhage. We describe two cases of massive postpartum hemorrhage complicated by DIC that were successfully temporized with combined use of the Bakri balloon and nonpneumatic antishock garment (NASG) during massive transfusion. In the first case, a healthy, term gravida underwent emergent cesarean for fetal bradycardia during labor induction.

A new model for providing cell-free DNA and risk assessment for chromosome abnormalities in a public hospital setting.

Objective: Cell-free DNA (cfDNA) offers highly accurate noninvasive screening for Down syndrome. Incorporating it into routine care is complicated. We present our experience implementing a novel program for cfDNA screening, emphasizing patient education, genetic counseling, and resource management.

Altered placental development in undernourished rats: role of maternal glucocorticoids.

Maternal undernutrition (MUN) during pregnancy may lead to fetal intrauterine growth restriction (IUGR), which itself predisposes to adult risk of obesity, hypertension, and diabetes. IUGR may stem from insufficient maternal nutrient supply or reduced placental nutrient transfer. In addition, a critical role for maternal stress-induced glucocorticoids (GCs) has been suggested to contribute to both IUGR and the ensuing risk of adult metabolic syndrome.

Paradoxical increase in maternal plasma leptin levels in food-restricted gestation: contribution by placental and adipose tissue.

Maternal food restriction (FR) during pregnancy results in decreased body weight with increased plasma leptin. To address this paradox, we investigated the effects of FR during pregnancy on growth and leptin levels in maternal, placental, and fetal sites. From embryonic day E10, control pregnant rats received ad libitum (AdLib) food, whereas study rats were 50% FR.

Clinician bias in fundal height measurement.

Objective: To establish whether the degree of clinician bias in fundal height measurement is affected by patient body mass index (BMI) or provider experience.

Methods: Singleton, ultrasound-dated pregnancies between 24 weeks and 40 weeks underwent fundal height measurements (n=103) by two providers, each using one blank and one marked measuring tape. Outcomes were the differences between the blank and marked measurements (bias) and between fundal height and gestational age for blank and marked tapes.