Challenges in the Contemporary Management of Syphilis among Pregnant Women in New Orleans, LA.

Objective: The aim of this retrospective review is to evaluate trends in the management of maternal and congenital syphilis (CS) in a tertiary care center in New Orleans, LA.

Study Design: All cases of maternal and neonatal syphilis over a five year period at Touro Infirmary, New Orleans, LA, were identified using ICD-9/10 codes. Charts were reviewed for demographic and obstetrical variables, stage of syphilis at diagnosis, lab values, and treatment regimen.

Acute feTal behavioral Response to prenatal Yoga: a single, blinded, randomized controlled trial (TRY yoga).

Background: In 2012, yoga was practiced by 20 million Americans, of whom 82% were women. A recent literature review on prenatal yoga noted a reduction in some pregnancy complications (ie, preterm birth, lumbar pain, and growth restriction) in those who practiced yoga; to date, there is no evidence on fetal response after yoga.

Objectives: We aimed to characterize the acute changes in maternal and fetal response to prenatal yoga exercises using common standardized tests to assess the well-being of the maternal-fetal unit.

Hypertensive crisis during pregnancy and postpartum period.

Hypertension affects 10% of pregnancies, many with underlying chronic hypertension, and approximately 1-2% will undergo a hypertensive crisis at some point during their lives. Hypertensive crisis includes hypertensive urgency and emergency; the American College of Obstetricians and Gynecologists describes a hypertensive emergency in pregnancy as persistent (lasting 15 min or more), acute-onset, severe hypertension, defined as systolic BP greater than 160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia. Pregnancy may be complicated by hypertensive crisis, with lower blood pressure threshold for end-organ damage than non-pregnant patients.

Neonatal brachial plexus palsy with vaginal birth after cesarean delivery: a case-control study.

Objective: The objective was to determine the rate of neonatal brachial plexus palsy (NBPP) among women with vaginal birth after cesarean delivery (VBAC) and to compare the peripartum characteristics with control subjects.

Study Design: The Maternal-Fetal Medicine Unit cesarean registry data were used to identify nonanomalous singleton pregnancies with VBAC and NBPP at gestational age of ≥37 weeks (term) and 4 control subjects (matched for gestational age and diabetes mellitus status but without brachial injury). Odds ratio (OR) and 95% confidence intervals (CIs) were calculated.

Vaginal birth after cesarean delivery: comparison of ACOG practice bulletin with other national guidelines.

Evidence-based guidelines regarding vaginal birth after cesarean from 3 countries (United States, Canada, and United Kingdom) were reviewed. The similarities in the 3 national guidelines (trial of labor after 1 previous cesarean, informed consent, delivery facility and available resources, epidural analgesia, continuous fetal monitoring, and induction and augmentation of labor) are understandable. Differences in recommendations (uterine rupture risk, success rate, intrauterine pressure catheter, and mechanical cervical ripening) are not explained.

Severe small size for gestational age and cognitive function: catch-up phenomenon possible.

Objective: We sought to compare cognitive functioning in children born with birthweight <3% vs ≥3% for gestational age (GA) between 9 months and kindergarten.

Study Design: Nonanomalous singletons from the Early Childhood Longitudinal Study-Birth Cohort were included. Associations between weight for GA and cognitive functioning were examined using a series of confounder-adjusted general linear models.

Intrapartum fetal surveillance: review of three national guidelines.

Evidence-based guidelines regarding intrapartum fetal surveillance from three countries (United States, Canada, and Australia/New Zealand) were reviewed. The similarities in the three national guidelines (purported etiology, management of periodic changes, and intermittent auscultation for low-risk women) are understandable. Differences in recommendations (role of fetal admission test, amnioinfusion for variable decelerations, scalp pH, umbilical arterial acid-base status, and education in interpretation of fetal heart tracing) are not explained.

Oligohydramnios, small for gestational age and pregnancy outcomes: an analysis using precise measures.

Background/aim: Marginal or decreased amniotic fluid volume by ultrasound estimate and fetal growth restriction have been shown to be significantly associated with perinatal mortality. The association of fetal growth restriction and precisely measured amniotic fluid volume is unknown. The purpose of this study was to determine if adverse pregnancy outcomes are more likely in pregnancies complicated by small-for-gestational-age (SGA) neonates and dye-determined oligohydramnios.

Implementation of a protocol to reduce occurrence of retained sponges after vaginal delivery.

Background: Retained sponges (gossypiboma) following vaginal delivery are an uncommon occurrence. Although significant morbidity from such an event is unlikely, there are many reported adverse effects, including symptoms of malodorous discharge, loss of confidence in providers and the medical system, and legal claims.

Objective: To report a protocol intended to reduce the occurrence of retained sponges following vaginal delivery.

Abnormal 1 hour glucose challenge test followed by a normal 3 hour glucose tolerance test: does it identify adverse pregnancy outcome?

Objective: To determine if pregnancies with an abnormal glucose challenge test (GCT) but a normal (GTT) are at increased risk for fetal macrosomia or an adverse pregnancy outcome.

Study Design: This prospective observational study matched women with an abnormal glucose challenge test and a normal GTT with the next patient with a normal GCT.

Results: Over 12 months, 107 women with abnormal GCT were matched with 107 women with normal GCT.

Association of birth weight with polymorphisms in the IGF2, H19, and IGF2R genes.

There is a substantial genetic component for birth weight variation. We tested 18 single nucleotide polymorphisms (SNPs) in the IGF2, H19, and IGF2R genes for associations with birth weight variation in 342 mother-newborn pairs (birth weight 2.1-4.

Maintenance tocolytics for preterm symptomatic placenta previa: a review.

The purpose of the review article is to determine if prolonged (≥48 hour) tocolytics with symptomatic preterm placenta previa improves perinatal outcome. OVID MEDLINE and Cochrane Databases were searched from January 1950 to January 2009. Odds ratio (OR) and 95% confidence intervals (CI) were calculated.

Does hypoglycemia following a glucose challenge test identify a high risk pregnancy?

Objective: An association between maternal hypoglycemia during pregnancy with fetal growth restriction and overall perinatal mortality has been reported. In a retrospective pilot study we found that hypoglycemia was linked with a greater number of special care/neonatal intensive care unit admissions and approached significance in the number of women who developed preeclampsia. That study was limited by its retrospective design, a narrow patient population and the inability to perform multivariate analysis because of the limitations in the data points collected.

Hepatic epithelial hemangioendothelioma in pregnancy.

Background: Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm that affects various tissues including liver, lung, gastrointestinal tract, head and neck, bone, heart and the central nervous system.

Case Report: A case of EHE is presented with lung and liver involvement during pregnancy. The patient had an uncomplicated antenatal course and delivery.

Ampicillin resistance and outcome differences in acute antepartum pyelonephritis.

Objective: To measure the incidence of ampicillin-resistant uropathogens in acute antepartum pyelonephritis and to determine if patients with resistant organisms had different clinical outcomes.

Study Design: This was a secondary analysis of a prospective cohort study of pregnant women admitted with pyelonephritis, diagnosed by standard clinical and laboratory criteria. All patients received ampicillin and gentamicin.

A randomized clinical trial comparing vaginal misoprostol versus cervical Foley plus oral misoprostol for cervical ripening and labor induction.

We compared labor induced by vaginal misoprostol versus a supracervical Foley catheter and oral misoprostol. Singleton pregnancies at > or = 24 weeks' gestation were randomized to either an initial 25-microg dose of intravaginal misoprostol, followed by 50-microg intravaginal doses at 3- to 6-hour intervals, or a supracervical Foley balloon and 100 microg of oral misoprostol at 4- to 6-hour intervals. Primary outcome was time from induction to delivery.

Valacyclovir prophylaxis to prevent recurrent herpes at delivery: a randomized clinical trial.

Objective: To measure the efficacy of valacyclovir suppression in late pregnancy to reduce the incidence of recurrent genital herpes in labor and subsequent cesarean delivery.

Methods: A total of 350 pregnant women with a history of genital herpes were assigned randomly to oral valacyclovir 500 mg twice a day or an identical placebo from 36 weeks of gestation until delivery. In labor, vulvovaginal herpes simplex virus (HSV) culture and polymerase chain reaction (PCR) specimens were collected.

Earthquakes and building design: a primer for the laboratory animal professional.

Earthquakes can occur in most regions of the United States, so it might be necessary to reinforce vulnerable animal facilities to better protect research animals during these unpredictable events. A risk analysis should include an evaluation of the seismic hazard risk at the proposed building site balanced against the estimated consequences of losses. Risk analysis can help in better justifying and recommending to building owners the costs of incorporating additional seismic reinforcements.

Acute pyelonephritis in pregnancy.

Objective: To examine the incidence of pyelonephritis and the incidence of risk factors, microbial pathogens, and obstetric complications in women with acute antepartum pyelonephritis.

Methods: For 2 years, information on pregnant women with acute pyelonephritis was collected in a longitudinal study. All women were admitted to the hospital and treated with intravenous antimicrobial agents.

Morbidity that is associated with curettage for the management of spontaneous and induced abortion in women who are infected with HIV.

Objective: The purpose of this study was to determine the morbidity that is associated with curettage for the management of abortions in women who were infected with human immunodeficiency virus compared with women who were not infected with human immunodeficiency virus.

Study Design: Women who were infected with human immunodeficiency virus (cases) and who underwent curettage for the management of scheduled and unscheduled abortions in the first half of pregnancy between January 1, 1993, and December 31, 2002, were identified. Women who were not infected with human immunodeficiency virus (control subjects) were matched 3:1 to cases for gestational age, type of abortion, and year of procedure.

Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review.

Objective: Genital herpes simplex virus (HSV) infection is one of the most common viral sexually transmitted diseases in the United States. Perinatal transmission of the virus to the fetus or neonate is a major concern in affected pregnancies. Our objective was to systematically review published data to estimate the effect of prophylactic acyclovir provided to pregnant women near term on the rate of recurrent genital herpes at delivery; the number of cesarean deliveries performed for clinical HSV recurrences or prodromal symptoms; and the prevalence of HSV virologic detection at delivery.

A comparison of the effects of epidural and meperidine analgesia during labor on fetal heart rate.

Objective: To estimate the effects of initiation of epidural analgesia on fetal heart rate (FHR) patterns compared with intravenous meperidine analgesia.

Methods: Fetal heart rate patterns in 200 nulliparous women with term pregnancies randomized to epidural analgesia with 0.25% bupivacaine were compared with those of 156 similar women given intravenous meperidine.

Using site assessment and risk analysis to plan and build disaster-resistant programs and facilities.

Research animals need protection from the catastrophic losses that can occur during disasters. The best method of protecting animals is to house them in facilities that have been reinforced using disaster-resistant construction methods. The authors explain the use of site-specific risk analysis to determine the proper building site and features.

Acute renal failure in association with severe hyperemesis gravidarum.

Background: Severe hyperemesis gravidarum is a rare but potentially devastating complication of pregnancy. Among its many potential complications are dehydration, electrolyte imbalance, malnutrition, Wernicke encephalopathy, and compromised renal function.

Case: We report the case of a 21-year-old woman at 15 weeks' gestation presenting to the emergency department with severe hyperemesis gravidarum associated with acute renal failure.