Management of Nephrolithiasis in Pregnancy: Multi-Disciplinary Guidelines From an Academic Medical Center.

The management of nephrolithiasis during pregnancy can be stressful for urologists due to concerns for investigations and treatments that may pose risk of fetal harm, and unfamiliarity with optimal management of these complex patients. In response, we created multi-disciplinary evidence-based guidelines to standardize the care for obstetric patients presenting with flank pain and suspicion for nephrolithiasis. A multi-disciplinary team involving Urology, Obstetric Anesthesiology, Obstetrics and Gynecology, Diagnostic Radiology, and Interventional Radiology from a single academic medical center was assembled.

Use of Electronic Medical Records to Estimate Changes in Pregnancy and Birth Rates During the COVID-19 Pandemic.

Importance: The influence of the COVID-19 pandemic on fertility rates has been suggested in the lay press and anticipated based on documented decreases in fertility and pregnancy rates during previous major societal and economic shifts. Anticipatory planning for birth rates is important for health care systems and government agencies to accurately estimate size of economy and model working and/or aging populations.

Objective: To use projection modeling based on electronic health care records in a large US university medical center to estimate changes in pregnancy and birth rates prior to and after the COVID-19 pandemic societal lockdowns.

Evaluation of a proximity card authentication system for health care settings.

Background: Multiple users access computer workstations in busy clinical settings, requiring many logins throughout the day as users switch from one computer to another. This can lead to workflow inefficiencies as well as security concerns resulting from users sharing login sessions to save time. Proximity cards and readers have the potential to improve efficiency and security by allowing users to access clinical workstations simply by bringing the card near the reader, without the need for manual entry of a username and password.

Cerclage retention versus removal following preterm premature rupture of membranes and association with amniotic fluid markers.

Objective: To evaluate whether amniotic fluid markers can aid the decision of whether to retain or remove a cervical cerclage after preterm premature rupture of membranes (PPROM).

Methods: A retrospective cohort study included pregnancies involving PPROM after diagnostic amniocentesis and cerclage placement. Cerclage was retained for more than 12 hours after PPROM in the study group (n=18); the comparison group comprised women who underwent immediate cerclage removal after PPROM (n=22).

Exploring dissociation and oxytocin as pathways between trauma exposure and trauma-related hyperemesis gravidarum: a test-of-concept pilot.

Posttraumatic stress disorder (PTSD) is associated with gastrointestinal and genitourinary comorbidities. These map onto the somatization disorder symptoms in the Diagnostic and Statistical Manual of Mental Disorders ( American Psychiatric Association, 1994 ) and the dissociative (conversion) disorders symptoms in the International Classification of Diseases taxonomy ( World Health Organization, 2007 ). Hyperemesis gravidarum (HG) is one of these symptoms and a gastrointestinal comorbidity of PTSD occurring in pregnancy.

Does cerclage improve neonatal outcomes in a molar pregnancy and a coexistent fetus? A case report.

Background: Complete hydatiform mole and coexistent viable fetus is very rare. The use of a cervical cerclage for cervical indications in the presence of this condition has never been reported. Although the diagnosis was made postnatal, the objective is to present a case with good neonatal outcome.

Use of a pressure guidewire in fetal cardiac intervention for critical aortic stenosis.

Fetal cardiac intervention for critical aortic stenosis (AS) with evolving hypoplastic left heart syndrome is performed in an attempt to maintain a biventricular circulation postnatally. The procedure has been hindered by technical challenges and poor candidate selection. We report here the novel use of a pressure guidewire during aortic valvuloplasty in a fetus at 21 weeks' gestation with critical AS and evolving hypoplastic left heart syndrome.

Seasonal influenza A (H1N1) infection in early pregnancy and second trimester fetal demise.

A second trimester fetal demise followed influenza-like illness in early pregnancy. Influenza A virus (H1N1) was identified in maternal and fetal tissue, confirming transplacental passage. These findings suggested a causal relationship between early exposure and fetal demise.

Critical care in obstetrics: pregnancy-specific conditions.

This chapter summarizes the clinical presentation, pathophysiology, evaluation and management of six commonly encountered complications unique to pregnancy that require critical care management: obstetric haemorrhage; pre-eclampsia/HELLP (haemolysis-elevated liver enzymes-low platelets) syndrome; acute fatty liver of pregnancy; peripartum cardiomyopathy; amniotic fluid embolism; and trauma.

Service use data analysis of pre-pregnancy psychiatric and somatic diagnoses in women with hyperemesis gravidarum.

Introduction: The purpose of this study was to redress weaknesses in past studies of a psychogenic etiology for hyperemesis gravidarum (HG) by (1) estimating from a known population what proportion of HG cases also have psychiatric diagnoses, (2) determining if psychiatric disorder preceded HG, and (3) re-considering whether non-pregnancy somatic conditions also precede HG.

Methods: We analyzed insurance data for all 11,016 members who gave birth to singletons in 2000-2004, 208 of whom had HG.

Results: Prevalence of HG was 1.

Why and how a Department of Obstetrics and Gynecology stopped doing routine newborn male circumcision.

In 2004, the Department of Obstetrics and Gynecology at the University of Michigan decided to stop offering routine circumcision for specialty and disciplinary, logistic, and educational reasons. The Pediatric Hospitalist Service assumed responsibility for the procedures and the educational process with resultant patient and staff satisfaction, educational, logistical and economic benefits.

The Hispanic paradox in twin pregnancies.

The objective of this study was to compare length of gestation, fetal growth, and birthweight by race/ethnicity and pregravid weight groups in twin pregnancies. Three thousand and thirty-six twin pregnancies of 28 weeks or more gestation were divided by race/ethnicity (White, Black and Hispanic), and pregravid body mass index (BMI) groups (less than 25.0 vs.

Midupper arm circumference (MUAC) changes in late pregnancy predict fetal growth in twins.

The objective of the study was to test the hypothesis that changes in arm anthropometry can be used to determine the risk of faltering growth in twin gestations. Serial data on midupper arm circumference (MUAC) and maternal weight gain were collected from a sample of 156 mothers. Changes in MUAC were monitored from 20 to 34 weeks.

The cost of twin pregnancy: maternal and neonatal factors.

Objective: The purpose of this study was to evaluate factors affecting birth charges in twin pregnancies.

Study Design: Clinical and financial data were obtained on 1486 twin pregnancies delivered between 1995 to 2002 at medical centers in Maryland, Florida, Michigan, and South Carolina. Maternal and neonatal length of stay (LOS) and charges were modeled by gestational age and other risk factors using a general linear model.

Relative analgesic potencies of levobupivacaine and ropivacaine for epidural analgesia in labor.

Background: The minimum local analgesic concentration has been defined as the median effective local analgesic concentration (EC50) in a 20-ml volume for epidural analgesia in the first stage of labor. The aim of this study was to assess the relative analgesic potencies of epidural levobupivacaine and ropivacaine by determination of their respective minimum local analgesic concentrations.

Methods: Parturients at 7 cm of cervical dilation or less who requested epidural analgesia were allocated to one of two groups in this double-blind, randomized, prospective study.

Specialized prenatal care and maternal and infant outcomes in twin pregnancy.

Objective: This study was undertaken to evaluate the effect of a prenatal nutrition and education program on twin pregnancy, neonatal, and early childhood outcomes.

Study Design: This prospective intervention study of women who participated in a specialized program (Program Pregnancies) versus nonparticipants included twice-monthly visits, dietary prescription of 3000 to 4000 kcal per day, multimineral supplementation, and patient education.

Results: Program Pregnancies were associated with improved pregnancy outcomes (preeclampsia, adjusted odds ratio [AOR] 0.

The association between maternal factors and perinatal outcomes in triplet pregnancies.

Objective: The purpose of this study was to evaluate the associations between maternal factors and outcomes in triplet pregnancies.

Study Design: This was a historic cohort study of 194 triplet pregnancies of >or=24 weeks of gestation that were delivered from 1983 through 2001 from five medical centers.

Results: In analyses that were limited to pregnancies with all live-born triplets (178 pregnancies), women with a previous good outcome (>2500 g + >37 weeks of gestation) had longer gestations (+7.

Effect of epidural epinephrine on the minimum local analgesic concentration of epidural bupivacaine in labor.

Background: The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration in a 20-ml volume for epidural analgesia in the first stage of labor. The aim of this study was to determine the local anesthetic-sparing efficacy of epidural epinephrine by its effect on the MLAC of bupivacaine.

Methods: In this double-blind, randomized, prospective study, 70 parturients who were at 7 cm or less cervical dilation and who requested epidural analgesia were allocated to one of two groups.