Clinical Outcomes of Pregnant and Postpartum Extracorporeal Membrane Oxygenation Patients.

Background: The use of extracorporeal membrane oxygenation (ECMO) as a rescue therapy for cardiopulmonary failure is expanding in critical care medicine. In this case series, we describe the clinical outcomes of 21 consecutive pregnant or postpartum patients that required venovenous (VV) or venoarterial (VA) ECMO. Our objective was to characterize maternal and fetal survival in peripartum ECMO and better understand ECMO-related complications that occur in this unique patient population.

Five-year trends in maternal cardiac arrest in Maryland: 2013-2017.

Background: The United States (US) maternal mortality rate (MMR) continues to increase. Until recently, the MMR in Maryland (MD) was consistently higher than the national average. Maternal cardiac arrest (MCA) is a rare condition, but can lead to devastating consequences.

Venovenous Extracorporeal Membrane Oxygenation to Prolong Pregnancy: A Case Report.

We report a gravida in fulminant acute respiratory distress syndrome, mechanically ventilated at 27 weeks estimated gestational age, who further deteriorated into severe combined hypercarbic, hypoxemic respiratory failure. At 30 weeks estimated gestational age, she was placed on venovenous extracorporeal membrane oxygenation (ECMO) because of refractory respiratory failure. Her physical status improved without fetal deterioration.

Platelets in preeclamptic pregnancies fail to exhibit the decrease in mitochondrial oxygen consumption rate seen in normal pregnancies.

Cellular oxygen consumption and lactate production rates have been measured in both placental and myometrial cells to study obstetrics-related disease states such as preeclampsia. Platelet metabolic alterations indicate systemic bioenergetic changes that can be useful as disease biomarkers. We tested the hypothesis that platelet mitochondria display functional alterations in preeclampsia.

Liver lacerations as a complication of CPR during pregnancy.

Aim: Cardiac arrest in peripartum patients is a rare but devastating event; reported rates in the literature range from 0.019% to 0.0085%.

The Relationship between Rostral Retraction of the Pannus and Outcomes at Cesarean Section.

Objective Maternal obesity presents several challenges at cesarean section. In an effort to routinely employ a transverse suprapubic skin incision, we often retract the pannus in a rostral direction using adhesive tape placed after induction of anesthesia and before surgical preparation of the skin. We sought to understand the association between taping and neonatal cord blood gases, Apgar scores, and time from skin incision to delivery of the neonate.

Anesthetic Implications of an Obstetric Patient with Blue Rubber Bleb Nevus Syndrome.

Blue rubber bleb nevus syndrome, a syndrome of multifocal venous malformations, has been reported rarely during pregnancy. This syndrome has been associated with airway lesions in some patients and neuraxial abnormalities in other patients. We report the anesthetic and obstetric management of a patient with an extensive distribution of both airway and neuraxial lesions.

Predictors of fetal growth in maternal HIV disease.

We sought to determine predictors of fetal growth restriction in maternal HIV disease. Pregnant HIV-positive women on antiretroviral therapy were monitored with serial viral load and CD4 counts. Individualized growth potential (GP) percentile was calculated for birth weight (BW).

The effect of computer-mediated administration on self-disclosure of problems on the addiction severity index.

Objectives: People tend to disclose more personal information when communication is mediated through the use of a computer. This study was conducted to examine the impact of this phenomenon on the way respondents answer questions during computer-mediated, self-administration of the Addiction Severity Index (ASI) called the Addiction Severity Index-Multimedia Version((R)) (ASI-MV((R))).

Methods: A sample of 142 clients in substance abuse treatment was administered the ASI via an interviewer and the computerized ASI-MV((R)), three to five days apart in a counterbalanced order.

Decreased placental oxygenation capacity in pre-eclampsia: clinical application of a novel index of placental function preformed at the time of delivery.

Objective: We have previously described placental oxygenation capacity as an index of placental function. The aim of this study was to utilize this test to evaluate placental gas exchange capacity in pre-eclampsia and fetal growth restriction (FGR).

Study Design: Two nested case-control studies were conducted between: (i) pre-eclamptic appropriate-for-gestational-age fetus (AGA) and non-pre-eclamptic AGA; and (ii) pre-eclamptic FGR and non-pre-eclamptic FGR based on gestational age match.

Analysis of disease in the obstetric intensive care unit at a university referral center: a 24-month review of prospective data.

Objective: To determine the current spectrum of disease in an obstetric population resulting in admission to the intensive care unit (ICU) at a tertiary care hospital.

Study Design: Analysis of data from obstetric patients admitted for critical care management at the University of Maryland Medical Center over a 24-month period.

Results: Critical care admission was required for 34 (1.

Umbilical arterial-venous blood gas difference: a novel expression of placental respiratory function.

We applied the concept of umbilical arterial and venous (A-V) blood gas difference in evaluating placental respiratory function to establish normative values for these relationships. Umbilical A-V cord blood gas samples were obtained in standardized fashion in uncomplicated singleton pregnancies. A-V pO (2) and A-V pCO (2) differences were related to obstetric factors, placental weight, and gestational age.

Protease inhibitor therapy and fetal growth potential in HIV-positive women.

Our objective was to test if protease inhibitors (PIs) increase the incidence of fetal growth restriction (FGR). Human immunodeficiency (HIV)-seropositive women were studied. At birth the neonatal weight percentile was assigned by predicted growth potential (GP), accounting for race, parity, weight, height, gestational age, birthweight, and gender (Gardosi, 1992).

Gravid hysterectomy: a decade of experience at an academic referral center.

Objective: To evaluate the incidence of gravid hysterectomy (GH) and to examine the indications as well as risk factors and complications associated with the procedure at an academic perinatal referral center.

Study Design: Retrospective chart review of all patients who underwent GH from 1991 to 2001. Demographics, obstetric history, delivery information, complications and outcome were analyzed.

Simulated laparoscopic operating room crisis: An approach to enhance the surgical team performance.

Objective: Diminishing human error and improving patient outcomes is the goal of task training and simulation experience. The fundamentals of laparoscopic surgery (FLS) is a validated tool to assess technical laparoscopic skills. We hypothesize that performance in a crisis depends on technical skills and team performance.

Rupture of the uterine scar during term labour: contractility or biochemistry?

Objective: Vaginal birth after a prior low transverse caesarean section (VBAC) is advocated as a safe and effective method to reduce the total caesarean section rate. However, the risk of uterine rupture has dampened the enthusiasm of practising clinicians for VBAC. Uterine rupture occurs more frequently in women receiving prostaglandins in preparation for the induction of labour.

Intrauterine pressure during the second stage of labor in obese women.

Objective: The perception that obese women have longer labors and a higher frequency of operative delivery because they are "poor pushers" persists despite the absence of objective study. We tested the hypothesis that obese women generate inadequate intrauterine pressure during the second stage of labor.

Methods: Intrauterine pressure was prospectively measured in 71 women during the second stage of labor.

Uterine contractility in women whose fetus is delivered in the occipitoposterior position.

Objective: Most fetuses in the occipitoposterior position rotate spontaneously after striking the pelvic floor. The increased prevalence of prolonged labor, operative delivery, and oxytocin augmentation in women with an occipitoposterior fetal position seems consistent with decreased uterine contractility. We sought to test the hypothesis that women with a persistent occipitoposterior fetal position have inadequate intrauterine pressure.

Myometrial thickness during human labor and immediately post partum.

Objective: Morphologic studies suggest dramatic, asymmetric uterine growth during pregnancy that is caused by muscle cell hypertrophy. This growth is most marked at the fundus. Our objective was to evaluate sonographically the in vivo changes in myometrial thickness during active labor, second-stage labor, and after delivery.

Effects of sublingual nitroglycerin on human uterine contractility during the active phase of labor.

Nitroglycerin is administered intravenously in acute obstetric emergencies to relax the uterus. However, complications (eg, hypotension, acute uterine bleeding) are frequent, which prompted a search for alternative routes of administration. We hypothesized that the sublingual administration of nitroglycerin would reduce uterine tone and contractility with few complications.

The effect of fundal pressure manoeuvre on intrauterine pressure in the second stage of labour.

Objective: To investigate the relationship between intrauterine pressure and the application of a standardised fundal pressure manoeuvre, and to determine the maternal, fetal and labour characteristics that modulate the relationship.

Design: Prospective measurement of intrauterine pressure during the second stage of labour.

Setting: North American university hospital.

Pushing in labor: performance and not endurance.

Objective: It is believed that delivery is faster if women are instructed to voluntarily bear down in synchrony with their uterine contractions. Confronted by the large variance in the duration of the second stage of labor, many clinicians attribute a "fast" or a "short" expulsion time solely to the patient's willingness to cooperate or to the strength of epidural anesthesia if it is a factor. Yet, knowledge of pushing performance and the factors affecting it remain limited.