Optimizing Cefazolin Prophylaxis in Obstetrical Patients with Reported Beta-Lactam Allergy Undergoing Cesarean Delivery.

Objectives: Evaluate the impact of an allergy history-guided algorithm for optimizing perioperative cefazolin use in patients with reported beta-lactam allergy undergoing cesarean delivery.

Methods: The Allergy Clarification for Cefazolin Evidence-based Prescribing Tool (ACCEPT) was developed through consensus by allergists, anesthesiologists, and infectious diseases specialists, and implemented over a 2-month period (December 1, 2018, to January 31, 2019). A segmented regression on monthly cefazolin use was conducted during the baseline (January 1 to November 30, 2018) and intervention (February 1 to December 31, 2019) periods to evaluate the impact of ACCEPT on the monthly use of perioperative cefazolin in patients with reported beta-lactam allergy undergoing cesarean delivery.

Mild neonatal morbidity in twins by planned mode of delivery: a secondary analysis of the Twin Birth Study.

Background: The Twin Birth Study showed no differences in major severe adverse neonatal outcomes between those with planned vaginal delivery and those with planned cesarean delivery.

Objective: This was a secondary analysis of the Twin Birth Study in which mild neonatal morbidities, not previously reported, were compared between parturients with planned cesarean deliveries and those with planned vaginal delivery in twin births.

Study Design: This was a secondary analysis of the Twin Birth Study.

Improving Intrapartum Group B Streptococcus Prophylaxis in Patients with a Reported Penicillin or Cephalosporin Allergy: A Quality Improvement Project.

Objective: To evaluate the impact of a standardized allergy-guided approach to Group B Streptococcus (GBS) prophylaxis in pregnant women with reported penicillin or cephalosporin allergy.

Methods: This interrupted time-series analysis included obstetric patients requiring GBS prophylaxis who reported penicillin or cephalosporin allergies. Patients were divided into baseline (April 1, 2019 to July 21, 2020) and intervention (July 22, 2020 to July 31, 2021) groups.

Analytical Performance and Quality Indicators of Fully Automated Immunoassays for sFlt-1 and PlGF.

Background: The ratio of the antiangiogenic factor, soluble fms-like tyrosine kinase 1 (sFlt-1), to the proangiogenic factor, placental growth factor (PlGF), is associated with increased risk of preeclampsia. Here, we describe an analytical evaluation of the Elecsys sFlt-1 and PlGF assays at the first North American site in which they were clinically implemented.

Methods: The analytical evaluation included short- and long-term imprecision, method comparison, accuracy, linearity, sample stability, limit of quantification verification, and measurement uncertainty.

Timing of antenatal corticosteroids in relation to clinical indication.

Purpose: This study aimed at determining the proportion of women who receive antenatal corticosteroids (ACS) within the optimal time window before birth based on the indication for ACS, and to explore in more detail indications that are associated with suboptimal timing.

Methods: A retrospective cohort study of all women who received ACS in a single tertiary center between 2014 and 2017. The primary outcome was an ACS-to-birth interval ≤ 7 days.

Antenatal corticosteroids and neurodevelopmental outcomes in late preterm births.

Objectives: Antenatal corticosteroids (ACS) decrease neonatal mortality and morbidity among preterm neonates, yet there has been concern regarding their long-term safety. We hypothesised that potential long-term adverse effects of ACS may be observed among infants born during the late preterm period (LPT, 34-36 weeks of gestation), when the benefits of ACS are subtle.

Design: Population-based, retrospective cohort.

Gestational diabetes and fetal growth in twin compared with singleton pregnancies.

Background: Gestational diabetes mellitus is associated with accelerated fetal growth in singleton pregnancies but may affect twin pregnancies differently because of the slower growth of twin fetuses during the third trimester of pregnancy and their greater predisposition to fetal growth restriction.

Objective: This study aimed to evaluate the association of gestational diabetes mellitus with longitudinal fetal growth in twin pregnancies and to compare this association with that observed in singleton pregnancies.

Study Design: This was a retrospective cohort study of all women with a singleton or twin pregnancy who were followed up at a single tertiary referral center between January 2011 and April 2020.

Pathologic Basis for the Definition of Discordant Growth in Dichorionic Twins.

Objective: The aim of the current study was to identify the optimal cutoff that should define discordance in dichorionic twin gestations through correlation with abnormal placental pathology as a specific measure of fetal growth restriction of the smaller twin.

Methods: We performed a retrospective cohort study of all women with dichorionic twin pregnancies who gave birth in a single center between 2002 and 2015. We investigated the association between the level of growth discordance and maternal vascular malperfusion (MVM) pathology in the placenta of the smaller twin, with and without adjustment for whether the smaller twin is small for gestational age (SGA).

Comparison of sonographic fetal weight estimation formulas in patients with preterm premature rupture of membranes.

Background: Estimation of fetal weight (EFW) by ultrasound is useful in clinical decision-making. Numerous formulas for EFW have been published but have not been validated in pregnancies complicated by preterm premature rupture of membranes (PPROM). The purpose of this study is to compare the accuracy of EFW formulas in patients with PPROM, and to further evaluate the performance of the most commonly used formula - Hadlock IV.

Patterns of discordant growth and adverse neonatal outcomes in twins.

Background: Intertwin size discordance is an independent risk factor for adverse neonatal outcomes in twin pregnancies. However, size discordance at a given point in gestation fails to take into consideration information, such as the timing of onset and the rate of progression of discordance, that may be of prognostic value.

Objective: In this study, we aimed to identify distinct patterns of discordant fetal growth in twin pregnancies and to determine whether these patterns are predictive of adverse pregnancy outcomes.

Delivery of monochorionic twins: lessons learned from the Twin Birth Study.

Background: The current literature regarding the recommended mode of delivery of monochorionic-diamniotic twins is limited to small numbers, retrospective studies, and comparisons of outcomes of monochorionic-diamniotic twin pregnancies with those of dichorionic-diamniotic twin pregnancies instead of outcomes of trial of labor vs elective cesarean delivery of monochorionic-diamniotic twins.

Objective: This study aimed to compare perinatal and maternal outcomes of planned cesarean delivery and planned vaginal delivery of monochorionic-diamniotic twins using the Twin Birth Study data.

Study Design: This study is a secondary analysis of the Twin Birth Study.

Removal vs. retention of cervical cerclage in pregnancies complicated by preterm premature rupture of membranes: a retrospective study.

Purpose: To compare pregnancy outcomes in women with pPROM and a cervical cerclage in whom the cerclage was removed within 24 h and those in whom the cerclage was retained in situ.

Methods: A two-center retrospective cohort study of women with a singleton gestation with pPROM at < 34 weeks of gestation in the presence of cervical cerclage (January 1, 2012-July 30, 2016). Maternal and perinatal outcomes were compared between women in whom cerclage was removed within 24 h from pPROM and those in whom cerclage was retained until the onset of delivery.

The predictive value of sonographic placental markers for adverse pregnancy outcome in women with chronic kidney disease.

Objective: To determine the rate of sonographic placental markers and their predictive value for preeclampsia and fetal growth restriction in women with chronic kidney disease (CKD).

Study Design: A retrospective cohort study of women with CKD followed at a tertiary referral center between 2016 and 2019 (n = 86). All women underwent 2nd trimester sonographic placental examinations that included assessment of placental morphology, umbilical cord, and uterine artery Doppler.

Comparing Foley Catheter to Prostaglandins for Cervical Ripening in Multiparous Women.

Objective: This study sought to test the hypothesis that among multiparous women requiring cervical ripening, mechanical ripening with a Foley catheter is more effective than prostaglandin preparations.

Methods: This was a retrospective analysis of multiparous women with a singleton gestation who required cervical ripening in a single tertiary center from 2014 to 2019. Women who underwent cervical ripening with a Foley catheter (Foley group) were compared with women who underwent cervical ripening using a controlled-release dinoprostone vaginal insert (PGE-CR group) or dinoprostone vaginal gel (PGE-gel group).

Examining Cesarean Section Rates in Canada Using the Modified Robson Classification.

Objective: Canada's cesarean delivery (CD) rate continues to increase. The Society of Obstetricians and Gynaecologists of Canada advocates the use of the modified Robson classification for comparisons. This study describes national and provincial CD rates according to this classification system.

Neurodevelopmental disorders among term infants exposed to antenatal corticosteroids during pregnancy: a population-based study.

Objective: An increasing proportion of fetuses are exposed to antenatal corticosteroids (ACS). Despite their immediate beneficial effects, the long-term safety of ACS has been an ongoing source of concern. In the current study, we assessed the likelihood of neurodevelopmental problems among term infants exposed to ACS earlier in pregnancy compared with non-exposed term infants.

The worst of both worlds-combined deliveries in twin gestations: a subanalysis of the Twin Birth Study, a randomized, controlled, prospective study.

Objective: The reported incidence of combined twin delivery (vaginal delivery of twin A followed by cesarean delivery for twin B) ranges between 5% and 10%. These estimates are based mostly on small studies or retrospective data. We aimed to evaluate to incidence and risk factors for and outcomes of combined twin deliveries, using a subanalysis of the Twin Birth Study, a randomized, controlled, prospective study.

Respiratory morbidity in late preterm twin infants.

Purpose: Antenatal corticosteroids have been shown to decrease neonatal respiratory morbidity in singleton pregnancies when given during the late-preterm period (34-36 weeks). Whether these findings also apply to late-preterm twins, who account for approximately one-third of infants born at 34-35 weeks, is currently unclear. The answer to this question depends, in part, on whether the risk of respiratory morbidity among late-preterm twin infants is similar to that observed in late-preterm singletons.

Association between hypertensive disorders and fetal growth restriction in twin compared with singleton gestations.

Background: Hypertensive disorders of pregnancy (including preeclampsia or gestational hypertension) are associated with fetal growth restriction in singleton pregnancies, an association that may be attributed to abnormal placentation as the shared etiology between these conditions. Given that the pathogenesis of these conditions in twin pregnancies may involve mechanisms other than abnormal placentation, it is unclear whether a similar association between hypertensive disorders of pregnancy and fetal growth restriction is present in twins. Data on the relationship between hypertensive disorders of pregnancy and fetal growth restriction in twins are limited and conflicting.

Defining early vs late fetal growth restriction by placental pathology.

Introduction: Although early and late fetal growth restriction have been suggested to be distinct entities, the optimal gestational age cut-off that differentiates the two conditions is currently unclear and has been arbitrarily set in previous studies between 32 and 37 weeks. We aimed to use placental pathology findings to determine that optimal gestational age cut-off between early and late fetal growth restriction.

Material And Methods: A retrospective cohort study of all women with singleton gestation who gave birth to a neonate diagnosed as small-for-gestational age (small-for-gestational age, defined as birthweight <10th percentile for gestational age) at a tertiary referral center between January 2001 and December 2015, and for whom placental pathology was available.

The role of placental malperfusion in the pathogenesis of preeclampsia in dichorionic twin and singleton pregnancies.

Introduction: In singletons, the pathogenesis of hypertensive disorders of pregnancy (HDP) is attributed to abnormal placentation, characterized by maternal vascular malperfusion (MVM) lesions. Whether MVM plays a similar role in twin pregnancies is unclear. The purpose of the study was to compared placental pathology findings between dichorionic-twin and singleton pregnancies complicated by HDP.

Placental abnormalities differ between small for gestational age fetuses in dichorionic twin and singleton pregnancies.

Objective: Twin fetuses grow slower during the third trimester compared with singletons. However, the extent to which the relative smallness of twins is the result of placenta-mediated factors similar to those associated with fetal growth restriction in singletons remains unclear. Our aim was to address this question by comparing placental findings between small for gestational age (SGA) twins and SGA singletons.