Prenatally Diagnosed Vasa Previa: A Single-Institution Series of 96 Cases.

Objective: To describe outcomes for a large cohort of women with prenatally diagnosed vasa previa, determine the percentage in patients without risk factors, and compare delivery timing and indications for singletons and twins.

Methods: This was a retrospective case series of women with prenatally diagnosed vasa previa delivered at a single tertiary center over 12 years. Potential participants were identified using hospital records and perinatal databases.

Nonstress testing at ≤ 32.0 weeks' gestation: a randomized trial comparing different assessment criteria.

Objective: Comparison of time and outcomes of National Institutes of Child Health and Human Development defined fetal heart rate acceleration criteria at ≤ 32 weeks (≥ 10 beats/min, ≥ 10 seconds) compared with standard criteria (≥ 15 beats/min, ≥ 15 seconds).

Study Design: Singleton high-risk pregnancies that were referred for nonstress testing at ≤ 32 weeks' gestation were randomly assigned to 15 × 15 or 10 × 10 criteria. Data included nonstress test information, maternal data, and outcomes.

Management of thromboprophylaxis during pregnancy among specialists in maternal-fetal medicine.

Objective: To evaluate practice patterns among maternal-fetal medicine physicians with regard to thromboprophylaxis in pregnancy.

Study Design: A Web-based survey was conducted among members of the Society for Maternal-Fetal Medicine (SMFM). The Web address for the survey and unique participant identification codes were mailed out to all SMFM members.

Antithrombotic therapy and pregnancy: consensus report and recommendations for prevention and treatment of venous thromboembolism and adverse pregnancy outcomes.

Venous thromboembolism and adverse pregnancy outcomes are potential complications of pregnancy. Numerous studies have evaluated both the risk factors for and the prevention and management of these outcomes in pregnant patients. This consensus group was convened to provide concise recommendations, based on the currently available literature, regarding the use of antithrombotic therapy in pregnant patients at risk for venous thromboembolic events and adverse pregnancy outcomes.

Mid-trimester dilation and evacuation with laminaria does not increase the risk for severe subsequent pregnancy complications.

Objective: To evaluate subsequent pregnancy outcomes in women with a previous mid-trimester (12-24 weeks) pregnancy termination by dilation and evacuation (D&E) as compared to women without a previous D&E.

Method: Medical records for women who underwent a D&E between 1995 and 2003 were identified and reviewed. Women with subsequent pregnancies were compared on a 1:2 basis with women in a control group who had viable pregnancies and no previous mid-trimester DE.

The use of unfractionated heparin and low molecular weight heparins in pregnancy.

Currently unfractionated heparin (UH) and low molecular weight heparins (LMWH) are the agents of choice for anticoagulation in pregnancy. LMWH have been used safely without monitoring in nonpregnant patients; however, because of documented changes in the pharmacokinetics of these agents in pregnancy, monitoring with anti-Xa levels is necessary in pregnancy to maintain target therapeutic ranges. Patients requiring only prophylaxis during pregnancy with either UH or LMWH might benefit from occasional assessment of anti-Xa levels to confirm that target prophylactic ranges are being achieved.

Bone density changes in women who receive thromboprophylaxis in pregnancy.

Objective: The purpose of this study was to compare unfractionated heparin therapy to the low molecular weight heparin, enoxaparin sodium, and their effects on bone mineral density over the course of pregnancy.

Study Design: Pregnant patients whose condition required thromboprophylaxis were recruited in this prospective randomized controlled trial and were assigned to receive either unfractionated heparin therapy or low molecular weight heparin therapy. Bone mineral density was measured by dual energy x-ray absorptiometry at the proximal femur on enrollment and again shortly after delivery.

Cost-effectiveness of thromboprophylaxis with intermittent pneumatic compression at cesarean delivery.

Objective: To evaluate the cost-effectiveness of thromboprophylaxis at cesarean delivery with intermittent pneumatic compression.

Methods: A decision tree model using Markov analysis was developed to compare two approaches to perioperative care at the time of cesarean delivery: 1) no use of perioperative thromboprophylaxis and 2) the use of intermittent pneumatic compression for thromboprophylaxis at the time of cesarean delivery. Postcesarean deep venous thrombosis was estimated to occur in 0.

Ultrasound examination of the postpartum uterus: what is normal?

Objective: To establish normal ultrasonographic findings for the postpartum uterus after vaginal delivery, and to characterize associated bleeding patterns.

Methods: Postpartum women were scanned by transabdominal ultrasound within 48 h after normal vaginal delivery. Uterine length, uterine width, endometrial stripe thickness and endometrial contents were evaluated by a single sonographer.

Hemorrhagic complication of anticoagulation during pregnancy in a woman with lupus anticoagulant.

Background: Lupus anticoagulant is an acquired antiphospholipid antibody that can increase greatly the risk of thromboembolism during pregnancy. Because a baseline elevated activated partial thromboplastin time (PTT) is associated frequently with this antibody, monitoring anticoagulant effect with activated PTT can be unreliable.

Case: A pregnant woman with lupus anticoagulant being treated with adjusted dose heparin experienced concurrent severe thrombotic and hemorrhagic complications.

Comparison of active phase labor between triplet, twin, and singleton gestations.

Objective: To characterize the active phase of labor in triplet pregnancies and compare it with gestational age-matched twins and singletons.

Methods: Active phase rates were calculated beginning at 5 cm of dilation for women with triplet gestations longer than 24 weeks who labored and reached the second stage. Twin and singleton cohorts that also completed the first stage of labor were matched for gestational age at delivery (+/-1 week), parity, and epidural use.

Prospective evaluation of bone density in pregnant women receiving the low molecular weight heparin enoxaparin sodium.

Objective: To evaluate changes in bone density in women receiving enoxaparin sodium during pregnancy.

Methods: Bone density in the proximal femur was serially measured in 16 women receiving enoxaparin sodium (40 mg daily) during pregnancy. Baseline measurements were taken within 2 weeks of starting therapy and then at 6-8 weeks postpartum and 6 months postpartum.

Ultrafast magnetic resonance imaging of cephalopagus conjoined twins.

Background: Ultrafast magnetic resonance imaging (MRI) has been used successfully in antenatal diagnosis.

Case: We report a case of cephalopagus conjoined twins in which ultrafast MRI clarified how the twins were united, especially the neuroanatomy, and helped with antenatal counseling.

Conclusion: Ultrafast MRI can provide superior image quality to two-dimensional ultrasonography and should be considered an adjunct to ultrasound for antenatal characterization of some anomalies.

Changes in the pharmacokinetics of the low-molecular-weight heparin enoxaparin sodium during pregnancy.

Objective: We sought to evaluate the pharmacokinetics of subcutaneously administered enoxaparin sodium during and after pregnancy.

Study Design: Daily subcutaneous injections of enoxaparin sodium (40 mg) were administered to 13 pregnant women. On 3 separate occasions, once early in pregnancy (12-15 weeks), once late in pregnancy (30-33 weeks), and once in the nonpregnant state (6-8 weeks post partum), serial blood samples were collected, and plasma was analyzed for antifactor Xa activity.

Factors influencing preconception control of glycemia in diabetic women.

Background: Although periconceptional glycemic control directly impacts perinatal outcome for pregestational diabetic women, these women still frequently enter pregnancy with suboptimal control of glycemia.

Objectives: To determine how frequently diabetic women enter pregnancy with suboptimal glycemic control and to identify factors associated with not achieving optimal periconceptual control of glycemia.

Patients And Methods: Pregestational diabetic women (n = 55) who attended the Maternal Fetal Medicine Faculty Practice or the Resident Medical Complications Obstetric Clinic, Magee Women's Hospital, Pittsburgh, Pa, were administered a brief questionnaire pertaining to periconceptional education and control of glycemia.

Pregnancy after liver transplantation.

This article reviews the reported experience with pregnancy after liver transplantation and describes obstetric risks and medical issues that the maternal fetal medicine specialist has a reference for managing these pregnancies and for providing appropriate preconception counseling. Women who undergo liver transplantations have a higher risk of preeclampsia, worsening hypertension, preterm premature rupture of membranes, anemia, small for gestational age, preterm delivery, and cesarean section than the normal obstetric population. Women with preconceptional renal dysfunction appear to be at greatest risk for pregnancy complications.

Association of pregnancy complications and choice of immunosuppressant in liver transplant patients.

Background: The purpose of this study was to identify factors associated with antenatal complications for an ongoing series of pregnant women who have undergone orthotopic liver transplantation.

Methods: We reviewed Magee-Womens Hospital records from 14 pregnancies in 13 women in whom a liver had been transplanted before pregnancy. We collected and analyzed data regarding the primary liver disease, allograft status, liver function at conception and during pregnancy, immunosuppressive medications, associated medical conditions, time from transplant to conception, cytomegalovirus serostatus, and maternal and fetal outcome.

Felodipine use in pregnancy. Report of three cases.

Background: Calcium channel blockers are effective agents for the management of chronic hypertension and are being used with increasing frequency. If their safety and efficacy during pregnancy can be documented, women can be counseled to continue their antihypertensive agent during pregnancy. To our knowledge, the use of felodipine, a calcium channel blocker of the dihydropyridine group, during pregnancy has not been described.

Successful pregnancy after bilateral hypogastric artery ligation. A case report.

Background: Selective embolization of the hypogastric arteries is an effective, nonsurgical alternative for the management of obstetric and gynecologic hemorrhage. Successful pregnancy following bilateral hypogastric artery occlusion has been reported, but experience is extremely limited.

Case: We report a case of successful pregnancy in a patient previously treated with bilateral hypogastric artery embolization.

Metabolic response to meal eating and extended overnight fast in twin gestation.

Objective: Our purpose was to compare the metabolic response to normal meal eating and the vulnerability to starvation ketosis in twin versus singleton gestation.

Study Design: Data are reported on 10 twin and 10 singleton nondiabetic gestations enrolled in a 40-hour metabolic study. Singletons were age (+/- 5 years) and prepregnancy weight (+/- 10% ideal body weight) matched with twins.