Complications of central venous catheters during pregnancy and postpartum: a case series.

Objective: The objective of the study was to determine the incidence of central venous catheter-related complications during pregnancy and postpartum.

Study Design: This was a retrospective case series of patients admitted for obstetric care and who had a central venous catheter placed between Jan. 1, 2000, and July 10, 2006.

Association of obesity with pulmonary and nonpulmonary complications of pregnancy in asthmatic women.

Objective: To evaluate whether maternal obesity is associated with pulmonary and nonpulmonary pregnancy complications in asthmatic women.

Methods: This is a secondary analysis of the prospective cohort Asthma During Pregnancy Study. Asthma patients were classified as having either mild or moderate to severe disease at the beginning of the study.

The Maternal-Fetal Medicine Units cesarean registry: chorioamnionitis at term and its duration-relationship to outcomes.

Objective: The purpose of this study was to evaluate the relationship between chorioamnionitis and its duration to adverse maternal, fetal, and neonatal outcomes.

Study Design: This was a 13-university center, prospective observational study. All women at term carrying a singleton gestation who underwent primary cesarean from January 1, 1999 to December 31, 2000 were eligible.

The relationship of asthma medication use to perinatal outcomes.

Background: Maternal asthma has been reported to increase the risk of preeclampsia, preterm deliveries, and lower-birth-weight infants, but the mechanisms of this effect are not defined.

Objective: We sought to evaluate the relationship between the use of contemporary asthma medications and adverse perinatal outcomes.

Methods: Asthmatic patients were recruited from the 16 centers of the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network from December 1994 through February 2000.

Randomized trial of inhaled beclomethasone dipropionate versus theophylline for moderate asthma during pregnancy.

Objective: This study was undertaken to compare the efficacy of inhaled beclomethasone dipropionate to oral theophylline for the prevention of asthma exacerbation(s) requiring medical intervention.

Study Design: A prospective, double-blind, double placebo-controlled randomized clinical trial of pregnant women with moderate asthma was performed.

Results: There was no significant difference (P=.

Asthma during pregnancy.

Objective: To determine neonatal and maternal outcomes stratified by asthma severity during pregnancy by using the 1993 National Asthma Education Program Working Group on Asthma and Pregnancy definitions of asthma severity. The primary hypothesis was that moderate or severe asthmatics would have an increased incidence of delivery at <32 weeks of gestation compared with nonasthmatic controls.

Methods: This was a multicenter, prospective, observational cohort study conducted over 4 years at 16 university hospital centers.

Asthma morbidity during pregnancy can be predicted by severity classification.

Background: The 1993 National Asthma Education Program Working Group on Asthma and Pregnancy defined asthma severity as mild, moderate, or severe on the basis of symptoms and spirometry, but no studies have evaluated the relationship between this classification system and subsequent asthma morbidity during pregnancy.

Objective: The objective of this study was to evaluate the relationship between asthma severity classification during pregnancy and gestational asthma exacerbations.

Methods: Asthma severity was defined according to the 1993 classification, adjusted to include medication requirements, in a volunteer sample of 1739 pregnant asthmatic patients who were less than 26 weeks' gestation.

Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT.

Purpose: To calculate mean fetal radiation dose from helical chest computed tomography (CT) by using maternal-fetal geometries obtained from healthy pregnant women and to compare the calculated CT doses with the fetal doses reported with scintigraphy.

Materials And Methods: Maternal-fetal geometries were determined in 23 pregnant women with varying body mass index and fetal gestational age. Monte Carlo techniques were used to estimate the dose that would be received by each fetus from CT scanning performed with the following parameters: 120 kVp; 100 mA; scanning time, 1 second per section; collimation, 2.

Hypertension.

This article reviews some of the salient points in the management of hypertension as recommended by the "Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure." New developments since publication of this 1997 report are also discussed.

Lack of association of severe preeclampsia with maternal and fetal mutant alleles for tumor necrosis factor alpha and lymphotoxin alpha genes and plasma tumor necrosis factor alpha levels.

Objective: The purpose of this study was to determine whether the increased frequency of mutant alleles of the gene for tumor necrosis factor alpha and elevated maternal and fetal plasma levels of tumor necrosis factor alpha were associated with severe preeclampsia.

Study Design: We performed a prospective cross-sectional study involving 112 patients with severe preeclampsia matched for gestational age with 106 normotensive pregnant women. Deoxyribonucleic acid for restriction fragment length polymorphism analysis was extracted from maternal and fetal blood.

Management of acute severe hypertension and encephalopathy.

We still do not have an ideal drug to treat acute severe hypertension in pregnancy. Hydralazine and labetalol are the safest agents, but they are inadequate to control blood pressure in some women. Both hypertensive encephalopathy and eclampsia now appear to be forms of an acute process known as reversible posterior leukoencephalopathy syndrome.

Peripartum cardiomyopathy: a longitudinal echocardiographic study.

Objective: Our purpose was to determine echocardiographic trends after initial diagnosis of peripartum cardiomyopathy.

Study Design: Nine women diagnosed with peripartum cardiomyopathy were prospectively recruited for a longitudinal echocardiographic study. Severe myocardial dysfunction was defined as left ventricular end-diastolic dimension > or = 60 mm + fractional shortening < or = 21%, and mild dysfunction was defined as left ventricular end-diastolic dimension < 60 mm + fractional shortening 22% to 24%.

Septic shock in pregnancy.

Objective: To evaluate the etiology, management, and maternal and perinatal outcome in patients with septic shock during pregnancy.

Methods: In 18 patients with septic shock during pregnancy, the criteria for the diagnosis were sepsis-induced hypotension unresponsive to adequate fluid resuscitation and requirement for vasopressors.

Results: Causes of shock were pyelonephritis (n = 6), chorioamnionitis (n = 3), postpartum endometritis (n = 2), toxic shock (n = 2), and one each of septic abortion, ruptured appendix, ruptured ovarian abscess, necrotizing fasciitis, and bacterial endocarditis.

Biventricular assist device as a bridge to cardiac transplantation in the treatment of peripartum cardiomyopathy.

Peripartum cardiomyopathy is an unexpected complication of the puerperium with a high mortality rate. Appropriate therapy requires accurate identification of this disease, which is frequently difficult in a patient who has been previously healthy. Medical therapy using alteration of intravascular volume (to optimize ventricular preload), the addition of inotropic agents (to correct ventricular function), and intra-aortic balloon counterpulsation (to improve afterload reduction) is the first line of therapy.

Peripartum cardiomyopathy: an ominous diagnosis.

Objective: Our purpose was to review and characterize the initial presentation, etiology, and prognosis of peripartum cardiomyopathy.

Study Design: Cases of peripartum cardiomyopathy confirmed by echocardiography were prospectively collected between 1986 and 1994.

Results: A total of 28 patients without an antecedent history of heart disease were diagnosed with peripartum cardiomyopathy.

Sacroiliitis associated with pyelonephritis in pregnancy.

Background: Sacroiliitis is a rare infection and an unusual cause of back pain during pregnancy. Because pregnancy and infections commonly associated with pregnancy are risk factors, this diagnosis should be considered in the gravida with sacroiliac pain.

Case: A 17-year-old woman at 24 weeks' gestation, with a history of illicit drug use, presented to a local emergency room with back and buttock pain.

Sudden chest pain and cardiac emergencies in the obstetric patient.

The differential diagnosis and work-up of a patient with chest pain during pregnancy is presented in this article. This is followed by discussions of cardiac emergencies including hypertensive crisis, pulmonary edema, arrhythmias, cardiopulmonary resuscitation, myocardial infarction, and aortic dissection.

A longitudinal study of cardiac output in normal human pregnancy.

Objective: Our purpose was to investigate the maternal hemodynamic and cardiac structural changes that occur during pregnancy.

Study Design: Eighteen women underwent serial echocardiography beginning at 8 to 11 weeks' gestation, then at monthly intervals throughout pregnancy and at 6 and 12 weeks post partum. Cardiac output was measured by pulsed- and continuous-wave Doppler at the aortic valve.

Pulmonary edema associated with pregnancy: echocardiographic insights and implications for treatment.

Objective: To evaluate the role of echocardiography in determining the cause of pulmonary edema in pregnancy and the impact this information has on management.

Methods: We studied prospectively 45 pregnant or recently postpartum women admitted to an obstetric intensive care unit with pulmonary edema during a 6-year period. Between 1 and 4 days after the onset of pulmonary edema, two-dimensional and M-mode echocardiography was performed, as was continuous, pulsed, and color Doppler echocardiography.