Pregnancy in women after coronary revascularization.

Pregnancy after coronary revascularization presents unique challenges to the management of antiplatelet therapy, anesthesia and mode of delivery. We present two cases where women of reproductive age required coronary revascularization with drug eluting stents after a myocardial infarction, and discuss key aspects of pregnancy and labor management.

Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery.

Objective: The purpose of this study was to determine the wound complication rates and patient satisfaction for subcuticular suture vs staples for skin closure at cesarean delivery.

Study Design: This was a randomized prospective trial. Subjects who underwent cesarean delivery were assigned randomly to stainless steel staples or subcuticular 4.

Tricuspid valve endocarditis during the second trimester of pregnancy.

Bacterial endocarditis in pregnancy is rare, usually resulting from preexisting cardiac lesions or intravenous drug use. We present an interesting case of tricuspid valve endocarditis in a pregnant woman and raise important points in the management of this condition during pregnancy.

Neonatal hypoglycemia in term, nondiabetic pregnancies.

Objective: To define the incidence of hypoglycemia and identify risk factors in neonates from term, singleton, nondiabetic pregnancies.

Study Design: We conducted a matched case-control study of term, singleton infants weighing more than 2500 g in nondiabetic pregnancies. Cases with hypoglycemia (glucose < 50 mg/dL) were identified by International Classification of Diseases, ninth revision, codes.

Should all pregnant diabetic women undergo a fetal echocardiography? A cost-effectiveness analysis comparing four screening strategies.

Objective: To determine if a policy of universal fetal echocardiography for all pregnant diabetic women is cost-effective as a screening tool for congenital heart defects.

Study Design: Using a decision-analysis model, we compared the cost-effectiveness of four screening strategies: (1) none--no ultrasound is performed; (2) selective fetal echocardiography after abnormal detailed anatomic survey; (3) fetal echocardiography for only high hemoglobin A1C, and (4) universal fetal echocardiography for all diabetics. The sensitivity and specificity for each strategy were derived by literature search.

Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation.

Objective: To compare rates of vaginal birth after cesarean (VBAC) failure and major complications in women attempting VBAC before and after the estimated date of delivery (EDD) METHODS: This was a 5-year retrospective cohort study in 17 university and community hospitals of women with at least 1 prior cesarean delivery. Women who attempted VBAC before the EDD were compared with those at or beyond 40 weeks of gestation. Logistic regression analyses were performed to assess the relationship between delivery beyond the EDD and VBAC failure or complication rate.

Is fetal gender associated with adverse perinatal outcome in intrauterine growth restriction (IUGR)?

Objective: The purpose of this study was to determine if there is a difference in perinatal outcome by gender among growth-restricted fetuses.

Study Design: This was a retrospective cohort study of intrauterine growth restriction (IUGR) singleton pregnancies over a 5-year period. Clinical outcomes compared by gender included preterm delivery, perinatal mortality (PNM), respiratory distress syndrome (RDS), grade 3 or 4 intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and periventricular leukomalacia (PVL).