Background: Triploidy is commonly associated with the development of early-onset preeclampsia. While previable preeclampsia is often a contraindication to prolonging pregnancy, there may be rare circumstances in which an alternative approach may be offered.
Case: A nulliparous patient with a dichorionic twin gestation, recently diagnosed triploidy in one twin, and history of chronic hypertension presented at 18 weeks of gestation with signs and symptoms suggestive of preeclampsia.
Background: Recent reports have described a rare but severe complication of coronavirus disease 2019 (COVID-19) in nonpregnant adults that is associated with extrapulmonary organ dysfunction and appears to be secondary to a hyperinflammatory state.
Case: A multiparous woman at 28 weeks of gestation, diagnosed with COVID-19 4 weeks prior, was admitted with chest pain. Evaluation indicated myocarditis and marked elevations of inflammatory markers consistent with multisystem inflammatory syndrome in adults.
Maternal cardiac disease is a major cause of non-obstetric morbidity and accounts for 10-25% of maternal mortality. Valvular heart disease may result from congenital abnormalities or acquired lesions, some of which may involve more than one valve. Maternal and fetal risks in pregnant patients with valve disease vary according to the type and severity of the valve lesion along with resulting abnormalities of functional capacity, left ventricular function, and pulmonary artery pressure.
View Article and Find Full Text PDFObjective: Our survey aimed to identify knowledge and application of guidelines in the United States by assessing practicing obstetricians and gynecologists (OBGYN) use of thromboprophylaxis, preferred methods and whether their type of practice influenced their choices.
Study Design: A cross-sectional survey of fellows of the American College of Obstetricians and Gynecologists (ACOG) was performed. A 21-item paper and electronic questionnaire was sent to each participant.
Objective: Pilot studies have suggested the amount of cell-free fetal DNA (cffDNA) in the maternal serum is increased in pregnancies complicated by placenta accreta. Our objective was to determine if levels of cffDNA can predict invasive placentation.
Methods: We enrolled women with antenatally suspected placenta accreta compared with gestational age-matched cases of placenta previa and women with prior cesarean deliveries (CDs) and normal placentation.
J Matern Fetal Neonatal Med
November 2013
Objective: We surveyed obstetricians to determine their knowledge, patterns of care and treatment preferences for women with placenta accreta.
Methods: A 27-item survey was mailed to fellows of the American College of Obstetricians and Gynecologists. The survey included demographics, questions regarding knowledge and items to examine practice patterns.
Although maternal death remains rare in the United States, the rate has not decreased for 3 decades. The rate of severe maternal morbidity, a more prevalent problem, is also rising. Rise in maternal age, in rates of obesity, and in cesarean deliveries as well as more pregnant women with chronic medical conditions all contribute to maternal mortality and morbidity in the United States.
View Article and Find Full Text PDFObstet Gynecol Clin North Am
March 2012
Though the preterm birth rate in the United States has finally begun to decline, preterm birth remains a critical public health problem. The administration of antenatal corticosteroids to improve outcomes after preterm birth is one of the most important interventions in obstetrics. This article summarizes the evidence for antenatal corticosteroid efficacy and safety that has accumulated since Graham Liggins and Ross Howie first introduced this therapy.
View Article and Find Full Text PDFHistory has always been a series of pendulum swings, and there is perhaps no better example in obstetrics than that of vaginal birth after cesarean. Vaginal birth after cesarean (VBAC) rates rose steadily in the early 1990s. However, VBAC rates have declined dramatically over recent years, while the cesarean delivery rate has continued to rise unabated.
View Article and Find Full Text PDFObjective: We examined predictors of massive blood loss for women with placenta accreta who had undergone hysterectomy.
Study Design: A retrospective review of women who underwent peripartum hysterectomy for pathologically confirmed placenta accreta was performed. Characteristics that are associated with massive blood loss (≥ 5000 mL) and large-volume transfusion (≥ 10 units packed red cells) were examined.
Objective: To examine factors that influence the morbidity and mortality of peripartum hysterectomy and analyze the effect of hospital volume on maternal mortality.
Methods: We examined women who underwent peripartum hysterectomy at the time of cesarean delivery in a quality and resource utilization database. Procedure-associated intraoperative, perioperative, and postoperative medical complications, length of stay, intensive care unit use, and maternal mortality were analyzed.
Objective: To perform a population-based analysis to examine the morbidity and mortality of peripartum hysterectomy in comparison with nonobstetric hysterectomy.
Methods: Data from the Nationwide Inpatient Sample were used to compare peripartum and nonobstetric hysterectomy in women younger than 50 years of age. Intraoperative, perioperative, and postoperative medical complications were examined.
Abnormal placentation poses a diagnostic and treatment challenge for all providers caring for pregnant women. As one of the leading causes of postpartum hemorrhage, abnormal placentation involves the attachment of placental villi directly to the myometrium with potentially deeper invasion into the uterine wall or surrounding organs. Surgical procedures that disrupt the integrity of uterus, including cesarean section, dilatation and curettage, and myomectomy, have been implicated as key risk factors for placenta accreta.
View Article and Find Full Text PDFAm J Obstet Gynecol
April 2009
In 1972, Drs Liggins and Howie published a landmark article demonstrating that antenatal corticosteroids significantly reduced the frequency of respiratory distress syndrome and neonatal mortality. A single course of antenatal corticosteroids has become standard of care for pregnant women at risk for preterm birth. Recent studies have suggested weekly courses of antenatal corticosteroids result in improvement in the acute neonatal condition but have not supported long-term benefit.
View Article and Find Full Text PDFPostpartum hemorrhage is an obstetric emergency that represents a major cause of maternal morbidity and mortality. With the recent rise in the cesarean delivery rate, prompt recognition and proper management at the time of cesarean delivery are becoming increasingly important for providers of obstetrics. Preparedness for hemorrhage can be achieved by recognition of prior risk factors and implementation of specific hemorrhage protocols.
View Article and Find Full Text PDFThere have been great strides in transplant medicine over the past few decades, and hundreds of pregnancies have now been reported in liver transplant recipients. Information on pregnancy in transplant patients has been collected through case reports, retrospective center-specific studies, and voluntary registries. Overall, favorable pregnancy outcomes have been reported for these patients.
View Article and Find Full Text PDFRecent additions to the literature provide evidence supporting the use of repeat courses of antenatal steroids. Both human and animal studies offer evidence that repeat courses of corticosteroids improve neonatal pulmonary outcomes, especially for the infants delivered at earlier gestational ages. Although there is also evidence to suggest altered neuronal maturation and intrauterine growth restriction in animals treated with repeat steroids, randomized controlled studies in humans have shown that birth weight reduction was only seen in those infants treated with 4 or more courses of corticosteroids.
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