Systemic Lupus Erythematosus: Perinatal Outcomes in Patients Treated With and Without Hydroxychloroquine.

Systemic lupus erythematosus (SLE) is an autoimmune disease commonly encountered during pregnancy. The use of hydroxychloroquine (HCQ) for SLE treatment in pregnancy has been supported by a few small studies performed in populations dissimilar from populations in the United States. Our objective was to compare maternal and neonatal outcomes in pregnant patients with SLE treated with and without HCQ at a tertiary care center in the United States.

Antibiotic Timing in Previable Prelabor Rupture of Membranes Less Than 24 Weeks of Gestation.

Objective: This study aimed to compare neonatal and maternal outcomes between immediate and delayed prophylactic antibiotic administration after previable prelabor premature rupture of membranes (PROM) less than 24 weeks of gestation.

Study Design: Retrospective cohort study of singleton pregnancies with PROM between 16 and 23 weeks of gestational age conducted at a single tertiary care referral center between June 2011 and December 2015. Patients with multiple gestations, fetal anomalies, those who elected augmentation, or with a contradiction to expectant management, such as suspected intra-amniotic infection or stillbirth, were excluded from the study.

Racial disparities in peripartum cardiomyopathy: eighteen years of observations.

Background: Black women have greater than a three-fold risk of pregnancy-associated death compared to White women; cardiomyopathy is a leading cause of maternal mortality.

Objectives: This study examined racial disparities in health outcomes among women with peripartum cardiomyopathy.

Study Design: Retrospective cohort of women with peripartum cardiomyopathy per the National Heart, Lung, and Blood Institute definition from January 2000 to November 2017 from a single referral center.

Management of reproductive health after cardiac transplantation.

Pregnancy after cardiac transplantation poses immense challenges. Maternal risks include hypertensive disorders of pregnancy, rejection, and failure of the cardiac allograft that may lead to death. Fetal risks include potential teratogenic effects of immunosuppression and prematurity.

Preterm premature rupture of membranes (PPROM): outcomes of delivery at 32(°/7)-33(6/7) weeks after confirmed fetal lung maturity (FLM) versus expectant management until 34(°/7) weeks.

Objective: Our objective was to compare maternal and neonatal outcomes in patients with preterm premature rupture of membranes (PPROM) delivered prior to 34(°/7) weeks upon confirmation of fetal lung maturity (FLM) to those managed expectantly until 34(°/7) weeks.

Methods: We performed a retrospective cohort study of non-anomalous singleton gestations with PPROM occurring after 24 weeks delivered between 32(°/7) and 34(°/7) weeks from 2004 to 2012. Patients delivered upon documented FLM (+FLM)--defined as the presence of phosphatidylglycerol (PG) at 32(°/7)-33(6/7) weeks if amniotic fluid was obtainable vaginally--were compared with patients delivered without documented FLM between 32(°/7) and 34(°/7) weeks (expectant).

Relationship between interpregnancy interval and cervical length in high-risk women.

Objective: Our objective was to evaluate the relationship between the interpregnancy interval (IPI) and next-pregnancy mid-trimester cervical length (CL) in women at high risk for recurrent spontaneous preterm birth (SPTB).

Methods: Retrospective review identified high-risk women, defined as a prior SPTB <36 weeks, who began scheduled serial transvaginal sonographic CL screening at 16-18 weeks gestation between December 2008 and November 2010. All CL assessment ended by 22(6/7) weeks, and weekly 17-α hydroxyprogesterone caproate, 250 mg IM, was recommended to all patients.

Low-dose aspirin, smoking status, and the risk of spontaneous preterm birth.

Objective: We evaluated the relationship between aspirin supplementation and perinatal outcomes for potential effect modification by smoking status.

Study Design: A secondary analysis of two multicenter trials for which prophylactic aspirin supplementation was given to either low- or high-risk women for prevention of preeclampsia (PE). We examined the effect of aspirin by smoking status using the Breslow-Day test.

Cervical pessary use and preterm birth.

Preterm birth remains a considerable public health concern and priority. Little headway has been made in the prevention of preterm birth despite considerable research in this area. New ideas and treatments are desperately needed.

Is midtrimester vitamin D status associated with spontaneous preterm birth and preeclampsia?

Objective: The objective of this study is to evaluate whether midtrimester maternal vitamin D is associated with preeclampsia < 37 weeks or spontaneous preterm birth (SPTB) < 35 weeks.

Study Design: Nested case-control comprising two case subsets: (1) 100 women with preeclampsia < 37 weeks and (2) 100 women with SPB < 35 weeks. Controls consisted of 200 women delivered between 39 and 40 weeks.

Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery.

Objective: We sought to identify risk factors for uterine atony or hemorrhage.

Study Design: We conducted a secondary analysis of a 3-arm double-blind randomized trial of different dose regimens of oxytocin to prevent uterine atony after vaginal delivery. The primary outcome was uterine atony or hemorrhage requiring treatment.

Selective uptake of influenza vaccine and pregnancy outcomes.

Objective: To describe the characteristics of pregnant women who accept the influenza vaccine and evaluate the relationship between vaccination and adverse pregnancy outcomes.

Methods: Retrospective cohort study of women receiving prenatal care during the 2009-2011 influenza seasons. Vaccination status was ascertained through our perinatal record system and clinic vaccination logs.

Early term births: considerations in management.

The frequency of early term birth varies depending on patient, provider, and system characteristics. Early term deliveries are associated with suboptimal neonatal outcomes without evidence of maternal benefit. Some early term births are either unavoidable or absolutely indicated for maternal and/or fetal benefit in the setting of medical or obstetric risks.

Antibiotic prophylaxis for cesarean delivery: survey of maternal-fetal medicine physicians in the U.S.

Objective: To describe practices concerning antibiotic prophylaxis for cesarean delivery among maternal-fetal medicine (MFM) physicians in the United States.

Methods: A 10-item self-administered survey about their routine use of antibiotics for cesarean delivery was mailed once only to a random sample of 1000 US-based fellows of the Society of Maternal-Fetal Medicine in November 2009.

Results: There were a total of 250 respondents from 40 US states between 10/09 and 4/2010, corresponding to a response rate of 25%.

Use of ethnic-specific medians for Hispanic patients reduces ethnic disparities in multiple marker screening.

Objective: To estimate whether midtrimester maternal serum analyte concentrations differ between Caucasian and Hispanic women and whether using ethnic-specific medians affects quad screen performance.

Method: Caucasian and Hispanic patients with singletons who underwent maternal serum screening in our laboratory were identified. Alfa-fetoprotein (AFP), estriol, human chorionic gonadotrophin (hCG), and inhibin-A medians were derived separately for Caucasians, Hispanics, and for the composite group.

Discussion: 'Infant death among Ohio residents' by Donovan et al.

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research.

Synthetic graft use in vaginal prolapse surgery: objective and subjective outcomes.

Introduction And Hypothesis: This study reports 1-year outcomes in women who underwent transvaginal pelvic organ prolapse (POP) surgery with Prolift transvaginal mesh.

Methods: Pre- and postoperative objective vaginal Pelvic Organ Prolapse Quantification (POP-Q) and subjective symptom and impact assessments (Pelvic Floor Distress Inventory (PFDI)-20 and Pelvic Floor Impact Questionnaire (PFIQ)-7, respectively) were performed. Postoperative vaginal tenderness, stricture, and patient satisfaction were also obtained.

The management of cervical intraepithelial neoplasia during pregnancy: is colposcopy necessary?

Objective: The 2006 American Society for Colposcopy and Cervical Pathology Consensus guidelines state that it is acceptable to defer colposcopy until 6 weeks postpartum in pregnant patients with atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesion (LSIL) cytology. Therefore, we sought to determine the incidence of cervical intraepithelial neoplasia (CIN) 2,3 in pregnant patients referred to a university colposcopy clinic.

Materials And Methods: A retrospective study identified all pregnant women with abnormal cytology referred to the University of Alabama at Birmingham colposcopy clinic between May 2005 and September 2007.

Discussion: 'Physician gender, specialty, and hysterectomy utilization' by Gretz et al.

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Gretz H, Bradley WH, Zakashansky K, et al. Effect of physician gender and specialty on utilization of hysterectomy in New York, 2001-2005.