Morbidity associated with the use of Foley balloon for cervical ripening in women with prior cesarean delivery.

Objective: We evaluated the morbidity of Foley balloon for cervical ripening in comparison to oxytocin alone in women with a prior cesarean delivery.

Study Design: A four-hospital retrospective review of all women with viable singleton pregnancies and history of a single prior cesarean delivery presenting for cervical ripening between 1994 and 2015. Exposure groups were either Foley balloon or oxytocin, at the treating physician's discretion.

Placental endothelin-converting enzyme-1 is decreased in preeclampsia.

Endothelin-converting enzyme-1(ECE-1) is a key regulatory enzyme in the processing of endothelin-1 (ET-1). We quantified and localized ECE-1 in normal and preeclamptic placentas. Normal (n=6) and preeclamptic (n=6) placentas were serially sectioned for immunofluorescence (IF).

The Impact of Fetal Anomalies on Contemporary Labor Patterns.

Objective: To compare labor patterns in pregnancies affected by fetal anomalies to low-risk singletons.

Study Design: Labor data from the Consortium on Safe Labor, a multicenter retrospective study from 19 U.S.

SMFM Consult Series #46: Evaluation and management of polyhydramnios.

Polyhydramnios, or hydramnios, is an abnormal increase in the volume of amniotic fluid. Identification of polyhydramnios should prompt a search for an underlying etiology. Although most cases of mild polyhydramnios are idiopathic, the 2 most common pathologic causes are maternal diabetes mellitus and fetal anomalies, some of which are associated with genetic syndromes.

New Insights in Peripartum Cardiomyopathy.

Significant progress in understanding the pathophysiology of peripartum cardiomyopathy, especially hormonal and genetic mechanisms, has been made. Specific criteria should be used for diagnosis, but the disease remains a diagnosis of exclusion. Both long-term and recurrent pregnancy prognoses depend on recovery of cardiac function.

Hypertension and patterns of induced labor at term.

Objective: To study patterns of induced labor at term in hypertensive women.

Study Design: We performed a retrospective cohort study using the Consortium on Safe Labor database; a multicenter study of labor and delivery practices from electronic medical records in 19 hospitals. 55,572 women were studied: 28,254 nulliparas and 27,318 multiparas, undergoing induction of labor at term without a prior cesarean with a singleton vertex live born fetus.

Antenatal Treatment with Intravenous Immunoglobulin to Prevent Gestational Alloimmune Liver Disease: Comparative Effectiveness of 14-Week versus 18-Week Initiation.

Background: Antenatal therapy with high-dose intravenous immunoglobulin (IVIG) may prevent gestational alloimmune liver disease (GALD).

Objective: The objective of this study was to determine the effectiveness of this approach in a large cohort of women at risk for poor pregnancy outcome due to GALD.

Methods: Women with a history of affected offspring were provided antenatal IVIG treatment and data were acquired prospectively from 1997 to 2015.

Do Different Modes of Labor Induction Affect the Overall Success and Risk of Trial of Labor After Cesarean Section?

OBJECTIVE: To determine whether different modes of labor induction impact the success rate and perinatal morbidity in women undergoing trial of labor after cesarean (TOLAC). STUDY DESIGN: Retrospective review of the Consortium on Safe Labor electronic database from 2002�2008; women with a prior cesarean birth, desiring TOLAC, and requiring induction of labor were included. Oxytocin and Foley bulb induction methods were compared to amniotomy alone.

Outcomes With Cerclage Alone Compared With Cerclage Plus 17α-Hydroxyprogesterone Caproate.

Objective: To examine the differences in perinatal outcomes among women with a prior preterm birth who received cerclage compared with cerclage plus 17α-hydroxyprogesterone caproate.

Methods: Women with transvaginal cerclage placement and a prior delivery between 16 and 36 weeks of gestation were identified over a 10-year period (July 2002 to May 2012) in this retrospective cohort study. Exclusion criteria were delivery at another institution, abdominal cerclage, multiple gestations, and major fetal anomalies.

Does Induction with Misoprostol Impact the Small for Gestational Age Neonate?

Objective: To compare outcomes in small for gestational age neonates induced with misoprostol to other cervical ripening agents. We hypothesized that misoprostol use will demonstrate no significant difference in outcomes compared with alternative agents.

Study Design: Small for gestational age neonates (<10th percentile for gestational age) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) sponsored Consortium on Safe Labor database were analyzed.

Placenta previa: an outcome-based cohort study in a contemporary obstetric population.

Objective: The objective of the study is to characterize the maternal and neonatal morbidities of women with placenta previa.

Study Design: This retrospective group study used the Consortium on Safe Labor electronic database, including 12 clinical centers, and 19 hospitals. Patients with placenta previa noted at the time of delivery were included.

Contemporary labor patterns and maternal age.

Objective: To evaluate labor progress and length according to maternal age.

Methods: Data were abstracted from the Consortium on Safe Labor, a multicenter retrospective study from 19 hospitals in the U.S.

Labor patterns in twin gestations.

Objective: To compare labor progression in twin vs singleton gestations.

Study Design: Retrospective review of electronic database created by Consortium on Safe Labor, reflecting labor and delivery information from 12 clinical centers 2002-2008. Women with twin gestations, cephalic presentation of presenting twin, gestational age ≥34 weeks, with ≥2 cervical examinations were included.

Eclampsia: Maternal and neonatal outcomes.

The objective of our study is to define the maternal and neonatal outcomes associated with eclampsia. This retrospective cohort study was performed using the Consortium on Safe Labor, database from 12 clinical centers, including 19 hospitals, from 2002-2008. All patients admitted with a diagnosis of eclampsia or seizure in labor and delivery or postpartum were included in the analysis.

Nonclinical parameters affecting primary cesarean rates in the United States.

Objective: Cesarean is the single most common operation in United States and has reached epidemic proportions in recent decades. Our objective was to study the effect of nonclinical parameters on primary cesarean rates in a large contemporary population.

Study Design: We designed a retrospective multicenter study using data obtained from electronic medical records from 19 U.

Gestational weight gain and obesity: is 20 pounds too much?

Objective: To compare maternal and neonatal outcomes in obese women according to weight change and obesity class.

Study Design: Cohort study from the Consortium on Safe Labor of 20,950 obese women with a singleton, term live birth from 2002-2008. Risk for adverse outcomes was calculated by multiple logistic regression analysis for weight change categories (weight loss [<0 kg], low [0-4.

What is the optimal time for delivery in women with gestational hypertension?

Objective: To assess the optimal timing of delivery for women with gestational hypertension.

Study Design: A multicenter database that contained 228,668 deliveries was used to extract data on gravidas with gestational hypertension. The week-specific rates of maternal and neonatal morbidity/mortality were calculated after induction of labor.

Ambulatory arrhythmia monitoring in pregnant patients with palpitations.

Unlabelled: OBJECTIVE To assess the frequency of rhythm disturbances (RDs) obtained following placement of a Holter monitor or an event loop recorder (ERT) in patients referred to cardiologists.

Study Design: Ninety-six gravidas were referred to the cardiology clinic for palpitations, syncope, or dizziness and had Holter monitoring or ERT after a baseline electroencephalogram. Arrhythmias were classified by severity.

Diastolic function in pregnant patients with cardiac symptoms.

Objective: Dyspnea on exertion and peripheral edema occur routinely during normal gestational stage, making early diagnosis of congestive heart failure (CHF) during pregnancy difficult. Abnormal left ventricular (LV) diastolic function may be associated with dyspnea on exertion and peripheral edema, and brain natriuretic peptide (BNP) correlates with volume overload in nonpregnant populations. We tested the hypothesis that abnormal echocardiographic diastolic parameters and elevated BNP correlate in symptomatic pregnant patients.

Obstetrical and perinatal outcomes among women with gestational hypertension, mild preeclampsia, and mild chronic hypertension.

Objective: The purpose of this study was to compare maternal and neonatal outcomes of women with gestational hypertension (GHTN), mild chronic hypertension (CHTN), and mild preeclampsia at delivery.

Study Design: A multicenter database that contained 228,668 deliveries was used to extract data on gravid women with GHTN, preeclampsia, and CHTN and on women without hypertensive disease (control group). Univariate and multivariate logistic regression analyses were performed.

Dosing and monitoring of low-molecular-weight heparin in high-risk pregnancy: single-center experience.

Study Objective: To evaluate dosing requirements and monitoring patterns of low-molecular-weight heparin (LMWH) when used in high-risk pregnancy.

Design: Retrospective, observational, cohort study.

Setting: University-affiliated medical center.

Contemporary labor patterns: the impact of maternal body mass index.

Objective: We sought to compare labor patterns by body mass index (BMI).

Study Design: A total of 118,978 gravidas with a singleton term cephalic gestation were studied. Repeated-measures analysis constructed mean labor curves by parity and BMI categories for those who reached 10 cm.

Oxytocin regimen for labor augmentation, labor progression, and perinatal outcomes.

Objective: To examine the effects and safety of high-dose (compared with low-dose) oxytocin regimen for labor augmentation on perinatal outcomes.

Methods: Data from the Consortium on Safe Labor were used. A total of 15,054 women from six hospitals were eligible for the analysis.

Assessing preventability for obstetric hemorrhage.

We sought to determine preventability for cases of obstetric hemorrhage, identify preventable factors, and compare differences between levels of hospital. We retrospectively reviewed a 1-year cohort of severe and near-miss obstetric hemorrhage in an urban perinatal network. An expert panel, using a validated preventability model, reviewed all cases.