Genetic risk factors associated with gestational diabetes in a multi-ethnic population.

Aims: Genome-wide association studies have shown an increased risk of type-2-diabetes (T2DM) in patients who carry single nucleotide polymorphisms in several genes. We investigated whether the same gene loci confer a risk for gestational diabetes mellitus (GDM) in women from Hawaii, and in particular, Pacific Islander and Filipino populations.

Methods: Blood was collected from 291 women with GDM and 734 matched non-diabetic controls (Pacific Islanders: 71 GDM, 197 non-diabetic controls; Filipinos: 162 GDM, 395 controls; Japanese: 58 GDM, 142 controls).

Complications of operative vaginal delivery and provider volume and experience.

Objective: To evaluate associations between operative vaginal delivery complications and provider experience (operative vaginal delivery volume and time since residency).

Methods: We included all operative vaginal deliveries between 2008 and 2014 at a tertiary care teaching hospital, stratified into forceps-assisted and vacuum-assisted deliveries. Complications included severe perineal lacerations (3rd and 4th degree) and neonatal injuries (subgaleal/subdural/cerebral hemorrhage, facial nerve injury, and scalp injury), which were identified by International Classification Diagnosis-9 codes.

Associations Between Maternal Obesity and Race, with Obstetric Anal Sphincter Injury: A Retrospective Cohort Study.

This retrospective cohort study examined associations between maternal body mass index (BMI), race, and obstetric anal sphincter injury (OASI) (3rd/4th degree perineal lacerations). Obstetric anal sphincter injury may lead to significant maternal morbidity, and a more thorough understanding of risk factors for this complication may guide providers in patient counseling and procedures such as episiotomy or operative vaginal delivery. Vaginal deliveries performed at Kapi'olani Medical Center for Women and Children from 2008-2015 were included.

Successful quintuplet pregnancy of monochorionic male quadruplets and single female after double embryo transfer: case report and review of the literature.

Objective: To report a rare case of quintuplets with monochorionic male quadruplets and a single female after two-blastocyst transfer.

Design: Case report.

Setting: University teaching hospital.

B-type natriuretic peptide and echocardiography reflect volume changes during pregnancy.

Objective: To evaluate B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac structure and function in normal women through pregnancy and the postpartum.

Methods: In this prospective observational study, we obtained serial transthoracic echocardiograms, BNP, and NT-proBNP at seven intervals from 6 weeks' gestation through 12 months postpartum. Women with hypertension or cardiac disease were excluded.

Restricted episiotomy use and maternal and neonatal injuries: a retrospective cohort study.

Purpose: There is relatively little information on episiotomies in the context of restricted episiotomy use. This study sought to examine maternal and neonatal injuries with restricted episiotomy use.

Methods: We performed a retrospective database analysis of vaginal deliveries at a tertiary care maternity hospital from June 2010 to June 2015.

Managing Diabetes in Pregnancy Using Cell Phone/Internet Technology.

In Brief For pregnant women with diabetes, using cell phone/Internet technology to track and report self-monitoring of blood glucose results improves compliance and satisfaction compared to using the more traditional methods of log books, telephone calls, and voicemail messages.

Can we really diagnose diabetes during pregnancy?

Objective: To identify the accuracy of diagnosing postpartum diabetes and glucose intolerance using antepartum glycosylated hemoglobin (HbA1c) and fasting glucose values.

Study Design: A retrospective Hawaiian cohort of women with gestational diabetes during 2004-2011 were evaluated. Antepartum HbA1c and postpartum 75-g glucose tolerance tests were obtained.

Hemodynamic effects of nifedipine tocolysis.

Aim: To describe the effects of nifedipine tocolysis on blood pressure and heart rate in non-hypertensive women.

Methods: This was a retrospective study from 2001 to 2011 to compare blood pressures and heart rates among non-hypertensive women on nifedipine tocolysis up to 8 h after nifedipine initiation. Measurements at 20-60 and 61-120 min were compared to assess the differential effects of dosing on hemodynamics and reflected the effects of the initial and complete loading doses, respectively.

Assessment of vascular endothelial growth factor, basic fibroblast growth factor, and transforming growth factor levels in amniotic fluid.

Objective: To measure amniotic fluid levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor (TGF)-beta2 and to characterize their levels with respect to advancing gestational age and pregnancy-related complications.

Study Design: Amniotic fluid was collected from a total of 37 patients, 2 of whom had twin pregnancies. Twenty-seven specimens were collected in the second trimester and 10 specimens were collected in the third trimester.

Moyamoya disease in pregnancy: a case series and review of management options.

Background: Pregnancy has a potentially deleterious affect on moyamoya disease (MMD), a cerebrovascular condition characterized by spontaneous occlusion of the distal internal carotid arteries resulting in the neoangiogenesis of fragile collateral blood vessels. The disease renders patients susceptible to both hemorrhagic and ischemic stroke.

Methods: A 16-year (1995-2010) chart review was performed at the Kapi'olani Medical Center for Women and Children and the Queen's Medical Center, the two largest birthing centers in Hawai'i.

Obstetric anal sphincter injury repair workshop for residents.

Objective: Obstetric anal sphincter injury (ASI) is associated with significant morbidity We conducted an ASI workshop for 20 obstetrics and gynecology residents and assessed its impact. Our goal was to determine and enhance residents' knowledge using a multimedia presentation, hands-on simulator and tests. We comment on trends regarding residents' knowledge bases and their retention of the material.

Management of group B Streptococcus in pregnant women with penicillin allergy.

Objective: To determine whether group B Streptococcus (GBS)-colonized pregnant women who report a history of penicillin allergy can safely undergo diagnostic evaluation to rule out or confirm the potential for an IgE-mediated (allergic) reaction to penicillin.

Study Design: Over 18 months, all pregnant women with GBS-positive vaginal/rectal cultures and a history of penicillin allergy were referred to the Department of Allergy and Immunology for a history and possible skin testing. Patients who had experienced anaphylaxis were advised to continue avoiding penicillin and were not skin tested.

Total antioxidant capacity and reactive oxygen species in amniotic fluid.

Objective: To identify the presence and/or absence of reactive oxygen species and total antioxidant capacity in amniotic fluid and to determine changes in the levels of reactive oxygen species and total antioxidant capacity with advancing gestational age of pregnancy and fetal or neonatal weights.

Methods: Amniotic fluid was collected from a total of 26 nonsmoking patients. Nine specimens were collected in the third trimester of pregnancy, and 17 specimens were collected in the second trimester.