Management of Diabetic Ketoacidosis in Pregnancy.

Diabetic ketoacidosis (DKA) is a rare, but potentially life-threatening complication of diabetes. Certain physiological changes during pregnancy predispose pregnant individuals to developing DKA. Early recognition and aggressive treatment are essential to avoid maternal and fetal morbidity and mortality.

Clinical Stratification of Pregnant COVID-19 Patients based on Severity: A Single Academic Center Experience.

Objective: This study aimed to describe baseline characteristics of a cohort of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and determine if these correlate with disease severity and perinatal outcomes.

Study Design: This was a retrospective cohort trial conducted at the University of Texas Medical Branch Galveston, Texas. All pregnant women presented to our medical center, who were screened and tested positive for SARS-CoV-2 virus, were included.

Reference intervals for hemoglobin and hematocrit in a low-risk pregnancy cohort: implications of racial differences.

As anemia in pregnancy is associated with adverse perinatal outcomes, we sought to define the mean and the fifth percentile of Hb and Ht using a contemporary multiethnic large cohort of low-risk pregnancies, and assess potential racial differences. We conducted a retrospective cohort study on women who delivered between 1 January 2008 and 31 December 2013 in Reggio Emilia County, Italy. Linear mixed effects models were used to describe changes in mean Hb and Ht, while quantile regression with matrix-design bootstrap defined changes in the fifth percentile of Hb and Ht, controlling for race, maternal age, smoking, and pregnancy number.

Conservative Management and Planned Surgery for Periviable Advanced Extrauterine Abdominal Pregnancy with Favorable Outcome: Report of Two Cases.

Advanced abdominal pregnancy is an extremely rare condition that poses diagnostic and management challenges. A high index of suspicion and careful assessment of the patient's symptoms, supplemented with obstetric ultrasound, and magnetic resonance imaging, are crucial for timely diagnosis and management to prevent life-threatening complications. The presence of periviable fetuses in advanced abdominal pregnancies increases the challenge to achieve a balance between maternal and fetal benefits and risks.

Perinatal Outcomes after Short versus Prolonged Indomethacin for Tocolysis in Women with Preterm Labor.

Objective Indomethacin tocolysis is generally limited to 48 hours. Indomethacin has been administered for longer durations to prolong gestation in extreme prematurity. Our aim is to compare perinatal outcomes after a prolonged course, > 48 hours versus ≤  48 hours in preterm labor.

Twin pregnancies discordant for single umbilical artery.

Objective: To evaluate the perinatal outcomes in twin pregnancies discordant for single umbilical artery (SUA).

Study Design: This was a retrospective cohort study. Our database was searched for all cases of twin gestation and SUA from 1997-2009.

Increased Apoptosis in Chorionic Trophoblasts of Human Fetal Membranes with Labor at Term.

Objective: To determine the association of apoptosis in the layers of human fetal membranes with labor at term.

Study Design: Human fetal membranes were collected from elective cesarean sections (n = 8) and spontaneous vaginal deliveries (n = 8) at term. The extent of apoptosis within the layers of fetal membranes was determined using terminal deoxynucleotidyl transferase deoxy-UTP-nick end labeling (TUNEL) immunohistochemical assay and western blots.

Disseminated Intravascular Coagulation, Hemoperitoneum, and Reversible Ischemic Neurological Deficit Complicating Anaphylaxis to Prophylactic Antibiotics during Cesarean Delivery: A Case Report and Review of Literature.

Routine use of prophylactic antibiotics reduces the risk of postcesarean fever and infections by over 50% in both nonelective and elective (scheduled) procedures. Although anaphylaxis to prophylactic antibiotics is rare, potentially fatal complications might occur. Herein, we present a case where disseminated intravascular coagulation and reversible ischemic neurological deficit complicated anaphylactic reactions to prophylactic antibiotics administered during cesarean delivery.

Elevated expression of catechol-O-methyltransferase is associated with labor and increased prostaglandin E(2) production by human fetal membranes.

Objective: The purpose of this study was to evaluate the expression and function of catechol-O-methyltransferase in human fetal membranes at term.

Study Design: Fetal membranes obtained from women between 38-42 weeks of gestation, after (1) vaginal delivery with spontaneous labor and (2) prelabor elective cesarean section (no labor), were assayed for catechol-O-methyltransferase expression using quantitative real-time polymerase chain reaction analysis, immunohistochemistry, and Western blot analysis. Prostaglandin E(2) secretion from amnion and choriodecidua explants treated with or without catechol-O-methyltransferase inhibitor was assayed by enzyme-linked immunosorbent analysis.

Systemic lupus erythematosus presenting with leukocytoclastic vasculitis and seizure during pregnancy.

Systemic lupus erythematosus (SLE) is a rare multisystem disease with a wide array of presentation and is a diagnostic challenge during pregnancy. A 20-year-old gravida 1 at 39 weeks' gestation was referred to our hospital for elevated blood pressure, headache, and history of seizure. She was admitted with the impression of severe preeclampsia.

Treatment with an inhibitor of catechol-O-methyltransferase activity reduces preterm birth and impedes cervical resistance to stretch in pregnant rats.

Catechol-O-methyltransferase (COMT) enzyme catalyzes the methylation of the 2- or 4-hydroxyestrogens to 2- or 4-methoxyestrogens. Both the hydroxyestrogens and methoxyestrogens have been shown to block or enhance the effects of estrogen respectively. Our objective was to investigate the potential role of COMT in parturition and cervical ripening using a rat model.

Fetal origin of adverse pregnancy outcome: the water disinfectant by-product chloroacetonitrile induces oxidative stress and apoptosis in mouse fetal brain.

Epidemiological studies indicate a relationship between water disinfectant by-products (DBP) and adverse pregnancy outcomes (APO) including neural tube defects. These studies suggest that fetal brain may be vulnerable to DBP during early stages of development. Therefore, we examined several molecular markers commonly known to indicate chemical-induced neurotoxicity during fetal brain development following prenatal exposure to the DBP; chloroacetonitrile (CAN).

Effect of gestational age and position on peak expiratory flow rate: a longitudinal study.

Objective: We sought to study the effects of gestational age and maternal position on peak expiratory flow rates.

Methods: Peak expiratory flow rates were measured in the standing, sitting, and supine positions in 38 healthy pregnant women at 4-week intervals starting at less than 10 weeks until delivery and again at 6 weeks postpartum. The highest reading of 3 consecutive peak expiratory flow rate measurements for each encounter and position was used in the analysis.

The 30-minute decision-to-incision interval for emergency cesarean delivery: fact or fiction?

The objective of this study was to evaluate the effect of the current guideline of 30-minute decision-to-incision interval (D-I) in emergent cesarean delivery (ECD) on neonatal and maternal outcomes. A retrospective chart review was conducted of pregnant women who underwent ECDs between January 1999 and December 2001. The overall median D-I was 20 minutes (range, 5 to 57 minutes).

Prenatal diagnosis of a fetus with unbalanced translocation (4;13)(p16;q32) with overlapping features of Patau and Wolf-Hirschhorn syndromes.

Wolf-Hirschhorn syndrome (WHS) and Patau syndrome are two of the most severe conditions resulting from chromosome abnormalities. WHS is caused by a deletion of 4p16, while Patau syndrome is caused by trisomy for some or all regions of chromosome 13. Though the etiologies of these syndromes differ, they share several features including pre- and postnatal growth retardation, microcephaly, cleft lip and palate, and cardiac anomalies.

Localization of the Fas-Fas ligand system in human fetal membranes.

Objective: To determine if fetal membranes might be one of the sources of Fas and Fas ligand in amniotic fluid.

Study Design: Human fetal membranes from elective cesarean section (n = 6) were fixed in paraformaldehyde. Rolls of paraffinembedded fetal membranes were cut into 5-micron sections.

Amniotic fluid matrix metalloproteinase-9 and interleukin-6 in predicting intra-amniotic infection.

Objective: To assess the potential role of amniotic fluid (AF) matrix metalloproteinase-9 and interleukin-6 in predicting intra-amniotic infection.

Methods: Eighty-four women with singleton gestations with preterm contraction, preterm labor, preterm premature rupture of membranes, or clinical suspicion of intra-amniotic infection were studied. Amniotic fluid was obtained by transabdominal amniocentesis before starting any treatment.