Cervicovaginal microbiome in twin vs singleton gestations.

Background: The vaginal microbiome diversity profile varies by race and ethnicity and changes considerably from the nonpregnant state to the pregnant state, specifically with a shift to Lactobacillus predominance in singleton gestations. There is a paucity of data that evaluate the cervicovaginal microbiome in women with twin gestations as a distinct population from those with singleton gestations.

Objective: We sought to characterize the cervicovaginal microbiome diversity profiles among twin gestations in the second trimester of pregnancy.

Fetal overgrowth in pregnancies complicated by diabetes: validation of a predictive index in an external cohort.

Purpose: To assess validity of a fetal overgrowth index in an external cohort of women with diabetes in pregnancy METHODS: We performed a retrospective analysis of data derived from women with singleton gestations complicated by diabetes who delivered January 2015-June 2018. The following index variables were used to calculate risk of fetal overgrowth as defined by a customized birthweight ≥ 90th centile: age, history of fetal overgrowth in a prior pregnancy, gestational weight gain, fetal abdominal circumference measurement and fasting glucose between 24 and 30 weeks.

Results: In our validation cohort, 21% of 477 pregnancies were complicated by fetal overgrowth.

Standard External Doppler Fetal Heart Tracings versus External Fetal Electrocardiogram in Very Preterm Gestation: A Pilot Study.

 Very preterm babies can be difficult to monitor using standard external Doppler fetal heart tracings (eFHR). External fetal electrocardiogram (fECG) is a potential alternative.  This was a prospective observational pilot study of hospitalized patients at 24 to 28 weeks' gestation.

Tension compared to no tension on a Foley transcervical catheter for cervical ripening: a randomized controlled trial.

Background: Cervical ripening of an unfavorable cervix can be achieved by placement of a transcervical catheter. Advantages of this method include both lower cost and lower risk of tachysystole than other methods. Despite widespread use with varying degrees of applied tension, an unanswered question is whether there is an advantage to placing the transcervical catheter to tension compared with placement without tension.

Orthopedic Injury in Pregnancy.

There are many reasons why a woman's pregnancy can put her at risk for orthopedic pain and injury. Given the high percentage of pregnant patients experiencing some degree of musculoskeletal pain, it is surprising that this is not an area of wider study. This chapter takes an evidence based approach to help the reader understand the implications of the numerous anatomic and physiologic changes associated with the gravid state, and how they act to promote both discomfort and injury.

The Effect of Clinical Chorioamnionitis on Cesarean Delivery in the United States.

Objective: To examine the association of clinical chorioamnionitis on cesarean delivery in a national sample of hospital discharges.

Data Source: Hospital discharge data from the 1998-2010 Nationwide Inpatient Sample.

Study Design: We performed a cross-sectional study and general linear modeling was used to determine the association of clinical chorioamnionitis on risk of cesarean delivery.

A barrier retractor to reduce surgical site infections and wound disruptions in obese patients undergoing cesarean delivery: a randomized controlled trial.

Background: Surgical site infections (SSIs) are an important cause of morbidity following cesarean delivery, particularly in obese patients. Methods to reduce SSIs after cesarean delivery would have an important impact in obese obstetric patients.

Objective: The purpose of this study was to determine whether the Alexis O cesarean delivery retractor, a barrier self-retaining retractor, reduces SSIs and wound disruptions in obese patients undergoing cesarean delivery.

A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy.

Objective: Women commonly experience low back pain during pregnancy. We examined whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to reduce pain, impairment, and disability in the antepartum period.

Study Design: A prospective, randomized trial of 169 women was conducted.

Childhood lead poisoning prevention through prenatal housing inspection and remediation in St. Louis, MO.

Objective: We assessed the screening and remediation of home lead hazards prenatally in a high-risk population, hypothesizing that average blood-lead level and the number of poisonings would drop by 25%.

Study Design: One hundred fifty-two women underwent prenatal home inspections by certified lead inspectors. The hazards that were identified were remediated.

Clinical and laboratory trends in fetal lung maturity testing.

Background: The surfactant/albumin ratio is a popular fetal lung maturity (FLM) test that will be unavailable in the near future. We conducted surveys of obstetricians and clinical laboratorians to assess FLM testing trends from the perspectives of both disciplines and to identify how both communities might adapt to the loss of the surfactant/albumin ratio.

Methods: 2067 physicians were surveyed about their familiarity with and clinical utility of various FLM tests.

Comparison of costs of surgical site infection and endometritis after cesarean delivery using claims and medical record data.

We used administrative and clinical data from a case-control study to calculate the costs of surgical site infection and endometritis after cesarean delivery. Attributable costs determined by multivariate generalized least-squares regression models with the 2 data sets were similar, suggesting that administrative data can be used to calculate infection costs.

Attributable costs of surgical site infection and endometritis after low transverse cesarean delivery.

Background: Accurate data on costs attributable to hospital-acquired infections are needed to determine their economic impact and the cost-benefit of potential preventive strategies.

Objective: To determine the attributable costs of surgical site infection (SSI) and endometritis (EMM) after cesarean section by means of 2 different methods.

Design: Retrospective cohort.

Risk factors for endometritis after low transverse cesarean delivery.

Objective: To determine independent risk factors for endometritis after low transverse cesarean delivery.

Study Design: We performed a retrospective case-control study during the period from July 1999 through June 2001 in a large tertiary care academic hospital. Endometritis was defined as fever beginning more than 24 hours or continuing for at least 24 hours after delivery plus fundal tenderness in the absence of other causes for fever.

Risk factors for surgical site infection after low transverse cesarean section.

Background: Independent risk factors for surgical site infection (SSI) after cesarean section have not been well documented, despite the large number of cesarean sections performed and the relatively common occurrence of SSI.

Objective: To determine independent risk factors for SSI after low transverse cesarean section.

Design: Retrospective case-control study.

A short interpregnancy interval is a risk factor for preterm birth and its recurrence.

Objective: We tested the hypothesis that short interpregnancy intervals (IPIs) increase the risk for preterm birth (PTB), recurrence of PTB, and delivery at early extremes of gestational age.

Study Design: Using the Missouri Department of Health's birth certificate database, we performed a population-based cohort study of 156,330 women who had 2 births from 1989-1997. The association between IPI and subsequent pregnancy outcome was assessed.

A prospective randomized safety trial of celecoxib for treatment of preterm labor.

Objective: We compared the safety of celecoxib, a selective cyclo-oxygenase-2 inhibitor, with the safety of the nonselective cyclo-oxygenase inhibitor indomethacin, when it was administered for treatment of preterm labor.

Study Design: In a randomized, double-blind, placebo-controlled trial, 24 pregnant women in preterm labor at 24 to 34 weeks of gestation received either indomethacin or celecoxib for 48 hours. Clinical assessment, fetal sonography, and Doppler blood flow studies of the fetal ductus arteriosus were performed daily.