Pulmonary embolism management in the critical care setting.

The American Heart Association (AHA) categorizes pulmonary embolism (PE) into three main categories based on the presence or absence of hemodynamic changes and evidence of right ventricular dysfunction. The AHA characterizes massive PE as occurring in the setting of persistent hypotension, profound bradycardia, or pulselessness; submassive PE as occurring with evidence of right ventricular dysfunction or myocardial necrosis in the absence of hemodynamic changes; and low-risk PE as occurring in the absence of markers of massive and submassive PE. This chapter provides an overview of how to identify and manage patients with submassive and massive pulmonary embolism.

Cervical Length as a Predictor of Preterm Delivery in an Unselected Cohort of Women with Twin Pregnancies.

Objective: To determine the risk of spontaneous preterm delivery (SPTD) associated with transvaginal cervical length (TVCL) in an unselected cohort.

Study Design: This is a retrospective study of serial TVCLs in unselected twin gestations. Receiver operator curves for SPTD were constructed from TVCLs at 18, 20, 22, and 24 weeks.

Management of severe hypertension in pregnancy.

While hemorrhage is the leading cause of maternal death in most of the world, hypertensive disorders of pregnancy are the leading cause of maternal mortality in the United States. The opportunity to improve outcomes lies in timely and appropriate response to severe hypertension. The purpose of this article is to review the diagnostic criteria for severe hypertension, choice of antihypertensive agents, and recommended algorithms for evaluation and management of acute changes in clinical status.

Rate of sonographic cervical shortening and biologic pathways of spontaneous preterm birth.

Objective: The objective of the study was to estimate the relationship between midtrimester cervical length (CL) and maternal serum markers of systemic inflammation, activation of the maternal-fetal hypothalamic-pituitary axis, and alterations in thrombosis-hemostasis.

Study Design: This is a secondary analysis of a prospective cohort study designed to predict preterm birth in the general obstetric population. Women had serial CL ultrasounds and assessment of maternal serum corticotrophin-releasing hormone, C-reactive protein, and thrombin-antithrombin III complexes between 20 and 33 weeks' gestation and were followed up until delivery.

Rate of sonographic cervical shortening and the risk of spontaneous preterm birth.

Objective: We hypothesized that change in cervical length (CL) on serial ultrasounds is associated with spontaneous preterm birth (SPTB) <36 weeks for women with a short cervix (CL <25 mm).

Study Design: This was a secondary analysis of a multicenter prospective observational study designed to study predictors of preterm birth. Women from the general obstetric population had serial CL ultrasounds between 20-33 weeks' gestation and were followed up until delivery.

Obstetricians seldom provide postpartum diabetes screening for women with gestational diabetes.

Objective: We aimed to determine whether obstetrician-gynecologists provided postpartum type 2 diabetes mellitus screening for women with a history of gestational diabetes.

Study Design: We identified women diagnosed with gestational diabetes, and then assessed whether obstetrician-gynecologists provided postpartum diabetes mellitus screening by ordering American Diabetes Association-recommended glucose tests or by referring women to primary care physicians for such testing.

Results: Of 2617 gravid women with a 1-hour glucose challenge test, 90 had gestational diabetes and postpartum follow-up.