Pregnancy after age 50: defining risks for mother and child.

Assisted reproductive technology using donor-egg in vitro fertilization (D-IVF) has enabled women 50 years and above to successfully achieve pregnancy. We examine the safety profile of these pregnancies through a large, single-center case series and retrospective cohort analysis in which all participants were carefully screened medically prior to conception. Consecutive women aged ≥ 50 years (n = 101) who achieved a viable pregnancy via D-IVF were identified and their perinatal outcomes were recorded.

Thyroperoxidase and thyroglobulin antibodies in early pregnancy and preterm delivery.

Objective: To further evaluate the relationship between thyroid antibodies and preterm births.

Methods: This is a prospective study of pregnancy outcome and demographic data combined with retrospective measurement of thyroperoxidase and thyroglobulin antibodies. Sera were obtained at 11-13 and 15-18 weeks of gestation from 10,062 women with singleton viable pregnancies (a subset from the First- and Second-Trimester Risk of Aneuploidy [FaSTER] trial).

The association of elective cessation of tocolysis and preterm birth in singleton gestations.

We evaluated outcomes following tocolysis discontinuation in singleton pregnancies between 33.0 and 36.9 weeks' gestation.

Management of epilepsy and pregnancy: an obstetrical perspective.

Women with epilepsy who take antiseizure medicines have successful and unremarkable pregnancies the majority of the time. Achieving seizure freedom is important for successful pregnancies, and it is also highly predictive of seizure freedom during pregnancy. From data derived from the general population, vitamin supplementation is important to prevent birth defects, and women with epilepsy of child-bearing potential should be encouraged to take folic acid supplements daily.

The association between vasa previa, multiple gestations, and assisted reproductive technology.

Patients with multiple gestations, low-lying placentas, velamentous cord insertions, and history of assisted conception should be evaluated carefully for a vasa previa. Serial surveillance for signs of preterm labor and elective cesarean delivery at 34 to 35 weeks after corticosteroids for fetal lung maturity is a reasonable management strategy for vasa previa in multiple gestations.

First-trimester screening with nasal bone in twins.

Objective: The purpose of this study was to evaluate the Down syndrome detection rate at a 5% screen positive rate in first-trimester screening for twins.

Study Design: This was a retrospective study from August 2005 to July 2007 of twins who underwent first-trimester screening with nuchal translucency, nasal bone, pregnancy-associated plasma protein-A, and free beta-hCG. Risks were calculated on the basis of the Fetal Medicine Foundation twin algorithm.

Maternal thyroid hypofunction and pregnancy outcome.

Objective: To estimate whether maternal thyroid hypofunction is associated with complications.

Methods: A total of 10,990 patients had first- and second-trimester serum assayed for thyroid-stimulating hormone (TSH), free thyroxine (freeT4), and antithyroglobulin and antithyroid peroxidase antibodies. Thyroid hypofunction was defined as 1) subclinical hypothyroidism: TSH levels above the 97.

First- and second-trimester thyroid hormone reference data in pregnant women: a FaSTER (First- and Second-Trimester Evaluation of Risk for aneuploidy) Research Consortium study.

Objective: The purpose of this study was to calculate first and second trimester reference ranges and within-woman correlations for TSH, free T4, and thyroid antibodies.

Study Design: TSH, free T4, and thyroid antibodies were measured in paired sera from 9562 women in the FaSTER trial of Down syndrome screening.

Results: The median first trimester TSH (1.

Variability in thyroid-stimulating hormone suppression by human chorionic [corrected] gonadotropin during early pregnancy.

Objective: The objective of the study was to further explore relationships between human chorionic gonadotropin (hCG), TSH, and free T4 in pregnant women at 11 through 18 wk gestation.

Study Design: The design of the study was to analyze hCG in comparison with TSH and free T4, in paired first- and second-trimester sera from 9562 women in the First and Second Trimester Evaluation of Risk for Fetal Aneuploidy trial study.

Results: hCG is strongly correlated with body mass index, smoking, and gravidity.

Growth abnormalities and multiple gestations.

Growth abnormalities which include intrauterine growth restriction and weight discordance between twins are common in pregnancies complicated by multiple gestations and may be associated with poor perinatal outcomes. Knowledge of chorionicity is paramount when managing a multiple pregnancy. Monochorionic twins are at greater risk than dichorionic twins for growth issues, which may result in long-term complications including adverse neurological sequelae for the offspring.

Sequential first- and second-trimester TSH, free thyroxine, and thyroid antibody measurements in women with known hypothyroidism: a FaSTER trial study.

Objective: The purpose of this study was to examine how closely hypothyroidism management in the general pregnancy population satisfies recently issued guidelines and to determine whether improvements are indicated.

Study Design: This was an observational study in which women at 5 recruitment centers in the first- and second-trimester evaluation of risk for aneuploidy trial allowed the use of sequentially obtained first- and second-trimester sera for additional research. Three hundred eighty-nine women had hypothyroidism by self-report.

The use of 17 alpha-hydroxyprogesterone caproate (17p) in women with cervical cerclage.

Our objective was to compare the incidence of recurrent spontaneous preterm delivery (SPTD) in patients with cervical cerclage treated with weekly 17 alpha-hydroxyprogesterone caproate (17P) injections versus daily outpatient nursing surveillance (ONS) without 17P. Included in this retrospective cohort study were singleton gestations with cerclage placed at the discretion of the provider due to prior SPTD, delivering between January 1, 2004 and May 1, 2006. The study group (n = 232) consisted of women receiving once-weekly nursing visit and 17P injection.

Thrombophilia and the obstetric patient.

Objective: To examine how practicing obstetricians evaluate and manage thrombophilias in selected clinical situations.

Methods: A questionnaire investigating knowledge and practice patterns pertaining to thrombophilia was mailed to 300 randomly selected American College of Obstetricians and Gynecologists Fellows and Junior Fellows in February 2005.

Results: Approximately 50% (151) of questionnaires were returned.

Increased incidence of gestational diabetes in women receiving prophylactic 17alpha-hydroxyprogesterone caproate for prevention of recurrent preterm delivery.

Objective: Progesterone has a known diabetogenic effect. We sought to determine whether the incidence of gestational diabetes mellitus (GDM) is altered in women receiving weekly 17alpha-hydroxyprogesterone caproate (17P) prophylaxis for the prevention of recurrent preterm birth.

Research Design And Methods: Singleton gestations in women having a history of preterm delivery were identified from a database containing prospectively collected information from women receiving outpatient nursing services related to a high-risk pregnancy.

The impact of multiple gestations on late preterm (near-term) births.

Multiple pregnancies currently account for 3% of all births in the United States but are disproportionately responsible for larger rates of prematurity and significant neonatal morbidity. The mean birth age for most multi-fetal pregnancies occurs during the late preterm period when both spontaneous preterm labor and iatrogenic premature birth because of obstetrical or maternal complications are common. Multiples pose numerous unique challenges, emphasizing the significant impact of plurality on late preterm births.

Antenatal sonographic prediction of twin chorionicity.

Objective: We sought to determine the accuracy of antenatal diagnosis of twin chorionicity at a single tertiary care center and assess the consequences of incorrect diagnoses.

Study Design: Twins with chorionicity diagnosed by ultrasound < or = 24 weeks' gestation were retrospectively reviewed. Chorionicity was assigned by sonographic findings including placental location(s), the lambda and T-signs, and/or fetal gender(s).

Multiple gestations and late preterm (near-term) deliveries.

Multiple gestations present unique challenges to the modern obstetrician. Many twin and high-order multiple pregnancies are delivered between 34 and 37 weeks' gestation either secondary to preterm labor or obstetrical complications necessitating intervention. Recognizing the increasing prevalence of multiple gestations and the impact of late preterm deliveries in modern practice, this review analyzes the impact of multiple pregnancies on perinatal outcomes, reviews the strategies to prevent preterm labor, and summarizes potential indications for late preterm delivery.

Additional benefits of first trimester screening.

The goal of first trimester screening for aneuploidy is to provide patients their risk assessment for fetal Down syndrome. Nonetheless, it has been noted that combined screening offers physicians and patients other important pregnancy information. For example, first trimester ultrasound results in accurate pregnancy dating and enables the early diagnosis of multiple gestations during the period when amnionicity and chorionicity is best discerned.

First trimester screening for Down syndrome in multiple pregnancy.

The incidence of twins, triplets, and high-order multiples has increased substantially in the last two decades secondary to fertility treatments and to delayed childbearing. Prenatal diagnosis in these patients is challenging. Options for screening tests are limited.

Education and quality review for nuchal translucency ultrasound.

First trimester nuchal translucency ultrasound has evolved from an ultrasound measurement used only in a research setting to a screening tool which is being offered to the general obstetric population. Studies of nuchal translucency suggest great variation in Down syndrome detection rates which may be secondary to significant differences in sonographic training and nuchal translucency image quality. Inaccurate screening has the potential to adversely impact patients.

Postterm pregnancy: practice patterns of contemporary obstetricians and gynecologists.

The purpose of this study was to determine the management of postterm pregnancy by contemporary practicing obstetricians. A questionnaire investigating practice patterns pertaining to postterm pregnancy was mailed to 1000 randomly selected American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in March 2004. The response rate was 52.

Screening for Down syndrome: practice patterns and knowledge of obstetricians and gynecologists.

Objective: To assess obstetricians' practice patterns and knowledge regarding screening for Down syndrome.

Methods: A questionnaire was mailed to 1,105 American College of Obstetricians and Gynecologists Fellows and Junior Fellows in 2004.

Results: Sixty percent of questionnaires were returned.

Prenatal diagnosis and multiple pregnancy.

The incidence of twins, triplets, and high-order multiples has increased dramatically in the last two decades secondary to greater reliance on fertility treatments and to delayed childbearing. Offspring of a multiple gestation are at increased risk for both chromosomal and structural abnormalities. Prenatal diagnosis in these patients is challenging.

Prophylactic ephedrine and combined spinal epidural: maternal blood pressure and fetal heart rate patterns.

Objective: Labor analgesia with the combined spinal epidural approach has been associated with maternal hypotension and fetal heart rate (FHR) changes. The purpose of this study was to estimate whether prophylactic intramuscular ephedrine before combined spinal epidural prevents these complications.

Methods: In a prospective double blind trial, 100 healthy patients with term singletons received intramuscular ephedrine 25 mg or placebo by random allocation before combined spinal epidural.