Cracking the code: interpreting content and phrases used in maternal-fetal medicine fellowship letters of recommendation.

Background: Letters of recommendation for Maternal-Fetal Medicine(MFM) fellowship are a critical part of the applicant selection process. However, data regarding best practices for how to write LOR for MFM is limited. Similarly, within letters of recommendation, differences in the "code" or meaning of summative words/phrases used at the end of letters of recommendation are seen between surgery, pediatrics, and medicine.

Mpox (Monkeypox) Infection During Pregnancy.

Background: An mpox (formerly "monkeypox") outbreak began in 2022, leading to infection in special populations, including pregnant individuals.

Case: We present a case of an individual who presented with a labial ulcer and subsequent papular rash at 31 weeks of gestation. She was diagnosed with mpox infection and was treated with tecovirimat.

Society for Maternal-Fetal Medicine Consult Series #65: Transabdominal cerclage.

Cerclage is the mainstay of treatment for cervical insufficiency. Although transabdominal cerclage may have advantages over transvaginal cerclage, it is associated with increased morbidity and the need for cesarean delivery. In this Consult, we review the current literature on the benefits and risks of transabdominal cerclage and provide recommendations based on the available evidence.

Best Practices for Writing Letters of Recommendation for Maternal-Fetal Medicine Fellowship: An Empty Scoping Review.

Objectives: Though letters of recommendation (LOR) for Maternal-Fetal Medicine (MFM) fellowship are a critical part of application process, little is known regarding best practices for writing them. This scoping review sought to identify published data outlining best practices in writing MFM fellowship LOR.

Study Design: Scoping review conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and JBI guidelines.

Vaginal cleansing before unscheduled cesarean delivery to reduce infection: a randomized clinical trial.

Background: Cesarean delivery is the most performed major surgery among women, and surgical-site infections following a cesarean delivery are a significant source of postoperative morbidity. It is unclear if vaginal cleansing before a cesarean delivery decreases post-cesarean delivery infectious morbidity.

Objective: This study aimed to evaluate if preoperative vaginal cleansing with povidone-iodine among women undergoing a cesarean delivery after labor decreases postoperative infectious morbidity.

Multisystem inflammatory syndrome in children (MIS-C) in pregnancy can mimic new-onset pre-eclampsia: A case report.

Introduction: Pregnant women affected by coronavirus disease 2019 (COVID-19) are at increased risk of severe disease, admission to an intensive care unit, and adverse pregnancy outcomes. In contrast, children typically experience a mild form of COVID-19. Nonetheless, there is a risk of multisystem inflammatory syndrome in children (MIS-C) following a SARS-CoV-2 infection.

Maternal Oxygen Supplementation Compared With Room Air for Intrauterine Resuscitation: A Systematic Review and Meta-analysis.

Importance: Supplemental oxygen is commonly administered to pregnant women at the time of delivery to prevent fetal hypoxia and acidemia. There is mixed evidence on the utility of this practice.

Objective: To compare the association of peripartum maternal oxygen administration with room air on umbilical artery (UA) gas measures and neonatal outcomes.

Driving Factors of Preterm Birth Risk in Adolescents.

 We examined rates of spontaneous and indicated preterm births (S-PTB and I-PTB, respectively) and clinical risk factors for PTB in adolescents.  This is a population-based, retrospective cohort using 2012 U.S.

Therapeutic hypothermia and cardiac intervention after cardiac arrest in pregnancy with underlying maternal arrhythmia: A case report.

There are few case reports of utilization of therapeutic hypothermia during pregnancy, and most report successful maternal and fetal outcomes. There is no available evidence that supports withholding therapeutic hypothermia in these patients. There are no long-term data on neonatal outcomes.

Predictive Value of Midtrimester Universal Cervical Length Screening Based on Parity.

Objectives: To evaluate the effect of parity on performance characteristics of midtrimester cervical length (CL) in predicting spontaneous preterm birth (sPTB) before 37 weeks.

Methods: This was a retrospective cohort study of 13,508 women with no history of sPTB undergoing universal transvaginal CL screening at 17 to 23 weeks' gestation from 2011 to 2016. Patients who declined screening or with unknown delivery outcomes were excluded.

Effect of Oxygen vs Room Air on Intrauterine Fetal Resuscitation: A Randomized Noninferiority Clinical Trial.

Importance: Two-thirds of women in labor receive supplemental oxygen to reverse perceived fetal hypoxemia and prevent acidemia. Oxygen is routinely administered for category II fetal heart tracings, a class of fetal tracing used to designate intermediate risk for acidemia. This liberal use of oxygen may not be beneficial, particularly because neonatal hyperoxygenation is harmful.

Clinical implications of umbilical artery Doppler changes after betamethasone administration.

Betamethasone (BMZ) is commonly administered to patients with fetal growth restriction (FGR) and abnormal umbilical artery Doppler (UAD) velocimetry due to the increased risk of preterm delivery; however, the clinical impact of UAD changes after BMZ exposure is unknown. To test the hypothesis that lack of UAD improvement after BMZ administration is associated with shorter latency and greater neonatal morbidity in patients with FGR. This was a retrospective cohort study of pregnancies complicated by FGR and abnormal UAD between 24 and 33 weeks gestation.

Resolution of a Low-Lying Placenta and Placenta Previa Diagnosed at the Midtrimester Anatomy Scan.

Objectives: To identify the incidence and resolution rates of a low-lying placenta or placenta previa and to assess the optimal time to perform follow-up ultrasonography (US) to assess for resolution.

Methods: We conducted a retrospective cohort study of women with a diagnosis of a low-lying placenta or placenta previa at routine anatomic screening. Follow-up US examinations were reviewed to estimate the proportion of women who had resolution.

SMFM Special Report: Putting the "M" back in MFM: Reducing racial and ethnic disparities in maternal morbidity and mortality: A call to action.

Racial and ethnic disparities in maternal morbidity and mortality rates are an important public health problem in the United States. Because racial and ethnic minorities are expected to comprise more than one-half of the US population by 2050, this issue needs to be addressed urgently. Research suggests that the drivers of health disparities occur at 3 levels: patient, provider, and system.

Umbilical Cord Oxygen Content and Neonatal Morbidity at Term.

Objective:  The objective of this study was to investigate the relationship between umbilical cord partial pressure of oxygen (pO) at delivery and neonatal morbidity.

Study Design:  This is a secondary analysis of a prospective cohort study of term deliveries with universal cord gas collection between 2010 and 2014. The primary composite outcome of neonatal morbidity included neonatal death, meconium aspiration syndrome, intubation, mechanical ventilation, hypoxic-ischemic encephalopathy, and hypothermia treatment.

Early Second-Trimester Fetal Growth Restriction and Adverse Perinatal Outcomes.

Objective: To estimate the risk of adverse perinatal outcomes among women with isolated fetal growth restriction from 17 to 22 weeks of gestation.

Methods: This was a retrospective cohort study of all singleton, nonanomalous pregnancies undergoing ultrasonography to assess fetal anatomy between 17 and 22 weeks of gestation at a single center from 2010 to 2014. After excluding patients with fetal structural malformations, chromosomal abnormalities, or identified infectious etiologies, we compared perinatal outcomes between pregnancies with and without fetal growth restriction, defined as estimated fetal weight less than the 10th percentile for gestational age.

Evidence-Based Bundles and Cesarean Delivery Surgical Site Infections: A Systematic Review and Meta-analysis.

Objective: To estimate the association of implementation of evidence-based bundles with surgical site infection rates after cesarean delivery.

Data Sources: We searched MEDLINE through PubMed, EMBASE, Scopus, the Cochrane Database of Systematic Reviews, Google Scholar, and ClinicalTrials.gov.

Impact of evidence-based interventions on wound complications after cesarean delivery.

Background: A number of evidence-based interventions have been proposed to reduce post-cesarean delivery wound complications. Examples of such interventions include appropriate timing of preoperative antibiotics, appropriate choice of skin antisepsis, closure of the subcutaneous layer if subcutaneous depth is ≥2 cm, and subcuticular skin closure with suture rather than staples. However, the collective impact of these measures is unclear.

Intrauterine Hyperoxemia and Risk of Neonatal Morbidity.

Objective: To test the hypothesis that intrauterine hyperoxemia is associated with an increased risk of neonatal morbidity.

Methods: This was a secondary analysis of a prospective study of singleton, nonanomalous deliveries at or beyond 37 weeks of gestation at an institution with a universal umbilical cord gas policy from 2010 to 2014. The primary outcome was a composite of neonatal morbidity including neonatal death, meconium aspiration syndrome, intubation, mechanical ventilation, hypoxic-ischemic encephalopathy, and hypothermic therapy.

Group Prenatal Care Compared With Traditional Prenatal Care: A Systematic Review and Meta-analysis.

Objective: To estimate the effect of group prenatal care on perinatal outcomes compared with traditional prenatal care.

Data Sources: We searched MEDLINE through PubMed, EMBASE, Scopus, Cumulative Index of Nursing and Allied Health literature, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov.