Preterm preeclampsia as an independent risk factor for thromboembolism in a large national cohort.

Background: Preterm preeclampsia, a product of vascular dysfunction, is associated with prolonged hospital admission and proteinuria, significant risk factors for thromboembolism in pregnancy. The risk of thromboembolism in preterm preeclampsia warrants further investigation.

Objective: To determine the relationship between preterm preeclampsia and thromboembolic risk.

Relationship between risk factor profile and prescription of low-dose aspirin for preeclampsia prevention.

Objective: The purpose of this study was to assess obstetrician-gynecologist utilization of low-dose aspirin for women at increased risk for hypertensive disorders of pregnancy using guidelines developed by the American College of Obstetricians and Gynecologists and supported by the United States Preventive Services Task Force. Further, the study evaluated prescribing practices in relation to specific risk factor profiles to identify which women are at highest risk of not receiving recommended therapy.

Methods: This was a retrospective cohort study reviewed and approved by the local Institutional Review Board.

Prediction and Prevention of Preterm Birth: A Prospective, Randomized Intervention Trial.

Objective: The study aimed to determine if a program of mid-trimester serum proteomics screening of women at low risk for spontaneous preterm birth (sPTB) and the use of a PTB risk-reduction protocol in those whose results indicated an increased risk of sPTB would reduce the likelihood of sPTB and its sequelae.

Study Design: Prospective comparison of birth outcomes in singleton pregnancies with mid-trimester cervical length ≥2.5 cm and at otherwise low risk for sPTB randomized to undergo or not undergo mid-trimester serum proteomics screening for increased risk of sPTB (NCT03530332).

Interpretation of Fetal Heart Rate Monitoring in the Clinical Context.

Use of intrapartum fetal heart rate (FHR) monitoring has had limited success in preventing hypoxic injury to neonates. One of the most common limitations of FHR interpretation is the failure to consider chronic and acute clinical factors that may increase the risk of evolving acidemia. This manuscript reviews common clinical factors that may affect the FHR and should be considered when determining the need for early intervention based on changes in the FHR.

Moms in medicine: Job satisfaction among physician-mothers in obstetrics and gynecology.

Background: Physician satisfaction is linked to positive patient outcomes. Mothers form an increasing fraction of the obstetrics and gynecology (ob/gyn) workforce.

Objective: Define factors that affect physician satisfaction among ob/gyn physicians who are also mothers.

Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus.

Objective: We sought to report obstetric and neonatal characteristics and outcomes following primary uterine rupture in a large contemporary obstetric cohort and to compare outcomes between those with primary uterine rupture vs those with uterine rupture of a scarred uterus.

Study Design: This was a retrospective case-control study. Cases were defined as women with uterine rupture of an unscarred uterus.

Cervical length screening: a randomized trial assessing the impact on visit length and patient attitudes.

Objectives: The purpose of this study was to quantify the time required for transvaginal cervical length measurements during a second-trimester anatomy scan and to evaluate patient attitudes regarding cervical length assessment.

Methods: Consenting women were randomly assigned to one of the following: (1) standard arm-cervix visualized, no prespecified cervical length measurement; (2) sequential arm-3 transabdominal cervical length measurements obtained, transvaginal sonography performed if images were inadequate or if any measurement was 3 cm or less; and (3) screening transvaginal sonography arm-3 transvaginal cervical length measurements obtained. Times were recorded for the entire examination and cervical length evaluation.

Outcomes of expectantly managed pregnancies with multiple gestations and preterm premature rupture of membranes prior to 26 weeks.

Objective: The objective of the study was to determine the obstetric and neonatal outcomes of expectantly managed multifetal pregnancies complicated by early preterm premature rupture of membranes (PPROM) prior to 26 weeks.

Study Design: This was a retrospective cohort of all multifetal pregnancies complicated by documented PPROM occurring before 26 0/7 weeks and managed expectantly by a single maternal-fetal medicine practice between July 4, 2002, and Sept. 1, 2013.

Simple, validated vaginal birth after cesarean delivery prediction model for use at the time of admission.

Objective: To create a simple tool for predicting the likelihood of successful trial of labor after cesarean delivery (TOLAC) during the pregnancy after a primary cesarean delivery using variables available at the time of admission.

Methods: Data for all deliveries at 14 regional hospitals over an 8-year period were reviewed. Women with one cesarean delivery and one subsequent delivery were included.

Tachysystole in term labor: incidence, risk factors, outcomes, and effect on fetal heart tracings.

Objective: Recent recommendations called for obstetricians to abandon the terms of "hyperstimulation" and "hypercontractility" in favor of the more rigidly defined term, "tachysystole" (TS). The aim of the current study is to describe incidence of and risk factors for TS, describe fetal heart rate (FHR) changes associated with TS, and investigate maternal and neonatal outcomes associated with TS.

Study Design: For this retrospective cohort study, we reviewed and analyzed the intrapartum FHR and tocometric characteristics of all patients with a singleton, nonanomalous fetus in term labor in a single hospital system over a 28-month period.

How do good candidates for trial of labor after cesarean (TOLAC) who undergo elective repeat cesarean differ from those who choose TOLAC?

Objective: Our aim was to compare good candidates for trial of labor after cesarean (TOLAC) who underwent repeat cesarean to those who chose TOLAC.

Study Design: Data for all deliveries at 14 regional hospitals over an 8-year period were reviewed. Women with a primary cesarean and 1 subsequent delivery in the dataset were included.

Uterine rupture associated with VBAC.

Uterine rupture during attempted vaginal birth after cesarean is a rare, but serious complication and can result in death or long-term disability. Several factors can increase the risk of uterine rupture during vaginal birth after cesarean and adequate counseling is necessary. Current literature suggests that timely diagnosis and delivery of the fetus is necessary for optimal outcome.

Maternal obesity and contraction strength in the first stage of labor.

Objective: The purpose of this study was to determine whether maternal obesity is associated with cesarean delivery and decreased contraction strength in the first stage of labor.

Study Design: We studied a retrospective cohort of women who delivered within a single healthcare system from 2007-2009; we included 5410 women with an intrauterine pressure catheter during the last 2 hours of the first stage of labor and who either had a vaginal delivery or cesarean delivery for dystocia. Logistic regression was used to determine how body mass index was associated with cesarean delivery or mean Montevideo units of ≥200.

Uterine rupture with attempted vaginal birth after cesarean delivery: decision-to-delivery time and neonatal outcome.

Objective: To estimate the time from the diagnosis of uterine rupture to delivery that would prevent adverse neonatal sequelae.

Methods: Cases of uterine rupture from January 1, 2000, to December 31, 2009, were identified in nine hospitals in the Intermountain Health Care system and at the University of Utah. Maternal demographics, labor characteristics, and neonatal outcomes were obtained.

Frequency of fetal heart rate categories and short-term neonatal outcome.

Objective: To estimate the time spent in each fetal heart rate category during labor and during the last 2 hours before delivery in term singleton pregnancy and to estimate the relationship between the time spent in each category and short-term neonatal outcomes.

Methods: This study reviewed fetal heart rate data and newborn outcomes of women in term labor in 10 hospitals over 28 months. Fetal heart rate characteristics were assessed by labor and delivery nurses, and categories were assigned by computer using definitions from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Estimating recurrence of spontaneous preterm delivery.

Objective: To identify factors associated with spontaneous preterm birth and to estimate the risk of its recurrence for the second through fourth births among women in Utah who had a first and any subsequent birth between 1989 and 2001, using a retrospective cohort study design.

Methods: Utah state birth records were reviewed to identify women with a first live birth and at least one subsequent live birth from 1989 to 2001. Recurrence risks for spontaneous preterm birth were calculated for first through fourth births.

The use of prenatal ultrasound for the detection of fetal aneuploidy.

Ultrasound is a noninvasive tool for early evaluation of the fetus and intrauterine environment. Its limitations include the lack of standardization of evaluation that patients receive, as well as varying sonologist's experience and equipment. Further, many fetuses with aneuploidy will not demonstrate significant sonographic findings, making detection limited.

Hyperemesis in pregnancy: an evaluation of treatment strategies with maternal and neonatal outcomes.

Objective: The objective of the study was to evaluate the use of interventions such as a peripherally inserted central catheters (PICC) line or nasogastric (NG)/nasoduodenal (ND) tube with the use of medications alone in the management of pregnancies with hyperemesis.

Study Design: Subjects were identified with confirmed intrauterine pregnancy, admitted with hyperemesis gravidarum (HEG) between 1998 and 2004. Medical records were then abstracted for information with regard to therapy.

Preeclampsia and subsequent risk of cancer in Utah.

Objective: The purpose of this study was to determine if preeclampsia is associated with a reduced risk of cancer later in life.

Study Design: We performed a cohort study where women with preeclampsia over the interval 1947 to 1999 were identified from the Utah Population Database. Preeclamptics (n = 17,432) were matched 1:3 with nonpreeclamptics (n = 52,296) on maternal age and birth year.

Factors associated with nonanomalous stillbirths: the Utah Stillbirth Database 1992-2002.

Objective: This study was undertaken to characterize risk factors associated with nonanomalous stillborn (SB) infants and to ascribe the probability of fetal survival by gestational age among high-risk pregnancies.

Study Design: We compiled a database of all SB infants and an equivalent number of controls using information obtained from Utah Birth and Fetal Death Certificates during the years 1992 through 2002. Adjusted and unadjusted odds ratios for risk factors associated with SB were generated.