Using Middle Cerebral Artery Doppler Ultrasound to Predict Clinical Chorioamnionitis After Preterm Prelabor Rupture of Membranes.

Background: In neonates, blood flow to the brain as measured by peak systolic velocity (PSV) in the middle cerebral artery (MCA) is altered in pregnancies affected by chorioamnionitis.

Objective: We aim to determine whether PSV and other measures of flow in the MCA in the fetus are altered prior to the development of clinical chorioamnionitis following preterm prelabor rupture of membranes (PPROM).

Methods:  This was a prospective observational study.

Stage 1 Hypertension in Nulliparous Pregnant Patients and Risk of Unplanned Cesarean Delivery.

Objective: The aim of the study is to determine whether stage 1 hypertension is a risk factor for cesarean at ≥39 weeks.

Study Design: This is a retrospective cohort study of nulliparas delivering at ≥39weeks. Exposure was defined as stage 1 hypertension and compared with normotension.

Quick Sequential Organ Failure Assessment: Modifications for Identifying Maternal Morbidity and Mortality in Obstetrical Patients.

Objective: Screening tools, including the Systemic Inflammatory Response Syndrome (SIRS) criteria and Sequential Organ Failure Assessment (SOFA) criteria, have not been validated in the pregnant population. We aimed to determine if pregnancy-specific modifications to the quick SOFA (qSOFA) can improve prediction of severe maternal morbidity in pregnant women with serious infections.

Study Design: We performed a retrospective cohort study of pregnant patients with severe infections admitted to a single institution from January 1, 2011, through December 31, 2017.

Risk factors for needing postpartum antihypertensive medications with hypertensive disorders: Timing of diagnosis, presence of proteinuria, and severity of disease.

Objectives: Evaluate the association between the need for post-partum antihypertensive medications in patients with hypertensive disorders of pregnancy (HDP) and the following: timing of disease onset (antepartum vs. intrapartum), presence of proteinuria, and severity of disease.

Study Design: This was a retrospective cohort study.

Use of gestation adjusted projection method for predicting fetal head circumference.

Objectives: The aim of this study is to determine if the gestation adjusted projection (GAP) method applied to a fetal head circumference (FHC) measured on ultrasound between 32 and 36 weeks and 6 days gestation can predict birth head circumference, specifically ≥ 35 cm, which is a known risk factor for Cesarean.

Methods: This is a retrospective chart review of 60 pregnancies from January to December 2019. Eligible patients delivered a singleton term neonate and received two ultrasounds, one at 32-36 weeks and 6 days gestation (period 1) and a second within 7 days of a term birth (period 2).

Physical examination-indicated cerclage in twin pregnancy: a randomized controlled trial.

Background: Women with twin pregnancies and a dilated cervix in the second trimester are at increased risk of pregnancy loss and early preterm birth; there is currently no proven therapy to prevent preterm birth in this group of women.

Objective: This study aimed to determine whether physical examination-indicated cerclage reduces the incidence of preterm birth in women with a diagnosis of twin pregnancies and asymptomatic cervical dilation before 24 weeks of gestation.

Study Design: Multicenter, parallel group, open-label, randomized controlled trial of women with twin pregnancies and asymptomatic cervical dilation of 1 to 5 cm between 16 weeks 0/7 days of gestation and 23 weeks 6/7 days of gestation were enrolled from July 2015 to July 2019 in 8 centers.

Relationship Between Maternal Serum Bile Acid Levels and Fetal Cardiac Troponin-I Levels in Asymptomatic Pregnant Patients at Term: A Cross-sectional Observational Study.

Objective The objective of our study was to determine if a correlation exists between maternal total bile acid levels, degree of maternal pruritus, and fetal cardiac troponin-I levels in asymptomatic patients without a diagnosis of intrahepatic cholestasis of pregnancy. Study design In this cross-sectional observational study, patients were enrolled at the time of the scheduled term cesarean section. Maternal blood was drawn for fasting total bile acid levels and cord blood was collected for fetal cardiac troponin-I levels.

Predicting periviable birthweight and survival: bedside ultrasound versus anatomy scan gestational adjusted age projection.

Objective: Two methods of birthweight (BW) prediction in the periviable period: bedside ultrasound proximate to delivery versus gestation-adjusted-projection (GAP) method was compared.

Methods: Periviable births were identified over a 6-year period. The GAP method was applied to the estimated fetal weight (EFW) from anatomy scans and the gestational age at delivery to predict BW, designated EFW.

Chorionic Villus Sampling, Early Amniocentesis, and Termination of Pregnancy Without Diagnostic Testing: Comparison of Fetal Risk Following Positive Non-invasive Prenatal Testing.

Background: With the increased accuracy of non-invasive prenatal testing (NIPT) based on cell-free DNA (cfDNA) techniques, the likelihood of false-positive screening results has been reduced for high-risk populations. Following a positive screening test, a diagnostic procedure to confirm the result is strongly recommended, although some patients have terminated pregnancies because of a positive NIPT alone. Chorionic villus sampling (CVS), the diagnostic procedure of choice in the first trimester, is not available in all locations.

Effect of taurocholic acid on fetoplacental arterial pressures in a dual perfusion placental cotyledon model: a novel approach to intrahepatic cholestasis of pregnancy.

Objective: To determine if continuous infusion of taurocholic acid into the fetoplacental and intervillous circulation of a placental cotyledon affects the fetal arterial pressure response after injection of the thromboxane mimetic U44619. Taurine conjugated bile acid is one bile acid putatively mediating intrahepatic cholestasis of pregnancy (ICP).

Study Design: We selected 5 placentas from normal, unlabored patients.

Complications from Roux-en-Y gastric bypass mistaken for medical complications in gravid patients.

Background: The increased frequency of bariatric surgery has resulted in a growing number of intrapartum surgical emergencies including internal hernia, bowel obstruction, and gastric rupture.

Case: We describe the cases of three gravid women with history of laparoscopic Roux-en-Y gastric bypass surgery who experienced significant complications during subsequent pregnancy. Two patients became hemodynamically unstable and required emergent laparotomy.

Adverse pregnancy outcomes in hypertensive patients: predictive value of protein concentration versus total protein.

Objectives: To compare the predictive value of protein concentration in a twenty-four hour urine collection to the conventional total protein in a twenty-four hour urine collection for adverse pregnancy outcomes in hypertensive patients.

Study Design: Retrospective cohort study. Hypertensive patients ≥20 weeks estimated gestational age (EGA) who completed twenty-four hour urine protein collections were identified; antepartum and delivery data were examined.

The use of middle cerebral artery Doppler ultrasonography to guide delivery of a viable pregnancy complicated by metastatic gestational chroriocarinoma.

: Choriocarcinoma is a rare, aggressive subtype of gestational trophoblastic neoplasia. The diagnosis of metastatic choriocarcinoma in the setting of a viable intrauterine pregnancy is exceedingly rare and often associated with feto-maternal hemorrhage. : An otherwise healthy Gravida 1 Para 0 at 34 weeks gestational age presented with metastatic choriocarcinoma and a viable fetus.

Interaction between maternal obesity and Bishop score in predicting successful induction of labor in term, nulliparous patients.

Objective: Determine the Bishop score most predictive of induction of labor (IOL) success for different maternal weight groups.

Study Design: Retrospective cohort study. Prospectively collected database utilized to determine the optimum Bishop score within each prepregnancy body mass index (BMI) category of term, nulliparous patients undergoing IOL.

Reports to the Navy's Family Advocacy Program: impact of removal of mandatory reporting for domestic violence.

The impact of mandatory reporting laws on domestic violence reports is unclear. In 2006, the Department of Defense removed its requirement for mandatory reporting of domestic violence against adults. Our objective was to determine if there was a change in the incidence of domestic violence reports to the Navy's Family Advocacy Program after the shift from mandatory reporting to a policy allowing restricted reporting.

Nausea, vomiting, and heartburn in pregnancy: a prospective look at risk, treatment, and outcome.

Objective: To examine risk factors, treatment, and outcomes for nausea/vomiting (N/V) and heartburn during pregnancy.

Methods: We included 2731 women from a prospective cohort study of gallbladder disease in pregnancy. Subjects completed questionnaires at enrollment, early third trimester, and 4-6 weeks postpartum.

Return to military weight standards after pregnancy in active duty working women: comparison of marine corps vs. navy.

Objective: To compare the likelihood of being within weight standards before and after pregnancy between United States Marine Corps (USMC) and Navy (USN) active duty women (ADW).

Methods: ADW with singleton gestations who delivered at a USMC base were followed for 6 months to determine likelihood of returning to military weight standards. Odds ratio (OR), adjusted odds ratio (AOR) and 95% confidence intervals were calculated; p < 0.

Intramuscular 17α-hydroxyprogesterone caproate administration attenuates immunoresponsiveness of maternal peripheral blood mononuclear cells.

Objective: 17α-hydroxyprogesterone caproate (17P) may decrease risk of prematurity by suppressing maternal immunity. We hypothesized that in vivo 17P treatment attenuates immunoresponsiveness of peripheral blood mononuclear cells (PBMCs).

Study Design: Study subjects were gravidas receiving weekly prophylactic intramuscular 17P injections.

The effect of magnesium sulfate on the activity of matrix metalloproteinase-9 in fetal cord plasma and human umbilical vein endothelial cells.

Objective: Clinical evidence suggests that magnesium sulfate may reduce the risk of fetal neurologic injury in preterm delivery. Matrix metalloproteinase-9 (MMP-9) levels are elevated in preterm labor patients. There is evidence that MMP-9 may break down the blood-brain barrier in humans, causing cytokine mediated cell injury.

Persistent pulmonary hypertension of the newborn is associated with mode of delivery and not with maternal use of selective serotonin reuptake inhibitors.

We sought to determine if maternal use of selective serotonin reuptake inhibitors (SSRIs) in the second half of pregnancy is associated with persistent pulmonary hypertension of the newborn (PPHN). We performed a case-controlled study (1:6 ratio) of infants delivered at Madigan Army Medical Center with primary PPHN from 2003 through 2009. Study and control patients were compared for the following clinical factors: SSRI use after 20 weeks gestation, mode of delivery, maternal disease, body mass index, tobacco use, fetal gender, maternal age, and parity.

Continuous infusion of 17-hydroxyprogesterone caproate into either the fetoplacental or intervillous circulation of a placental cotyledon attenuates vasoconstriction of the fetoplacental arteries by thromboxane mimetic U46619.

Objective: The objective of the study was to determine whether pretreatment of fetal or maternal placental vasculature with 17-hydroxyprogesterone caproate (17-P) attenuates the vasoactive effect of the thromboxane mimetic U46619.

Study Design: Two cotyledons were obtained from each placenta studied. For the first 5 placentas, the fetal artery of 1 cotyledon from each pair was infused with 17-P.

Improved ultrasonographic estimation of birth weight in macrosomic fetuses by application of a correction factor to the gestation-adjusted projection method.

Objective: The purpose of this study was to improve estimated birth weight (EBW) determination in macrosomic fetuses (estimated fetal weight >or=4000 g) by application of a correction factor to the gestation-adjusted projection (GAP) method.

Methods: A review was performed of 411 singleton pregnancies delivered at term. On the basis of ultrasonographic examinations previously performed between 34.

Modified Zavanelli maneuver for the alleviation of shoulder dystocia.

Background: The Zavanelli maneuver has typically been instituted when conventional maneuvers have failed to alleviate shoulder dystocia. Previously reported cases involving the Zavanelli maneuver have described cephalic replacement followed by immediate cesarean delivery.

Case: We encountered a case in which, despite the McRoberts maneuver, suprapubic pressure, Wood's corkscrew manuever, and attempted extraction of the posterior fetal arm, the baby could not be delivered.