Obstetrical and neonatal outcomes in patients with surgically repaired heart disease.

Background: Congenital and acquired heart disease complicate 1% to 4% of pregnancies in the United States. Beyond the risks of the underlying maternal congenital heart disease, cardiac surgery and its sequelae, such as surgical scarring resulting in higher rates of arrhythmias and implanted valves altering anticoagulation status, have potential implications that could affect gestation and delivery.

Objective: This study aimed to investigate whether history of maternal cardiac surgery is associated with adverse obstetrical or neonatal outcomes compared with patients without a history of cardiac disease or surgery, considered "healthy controls.

Evaluation of Early Screening for Diabetes Mellitus in Pregnancy with Hemoglobin A1c.

Early diabetes screening is recommended for high-risk pregnant women risk via a 1-hour glucose challenge test (1-hour GCT). Hemoglobin A1c (HbA1c) can be obtained with initial obstetric laboratories. We sought to examine the relationship between HbA1c and 1-hour GCT for early diabetes screening in pregnancy.

Precision Medicine-A Demand Signal for Genomics Education.

Pressed by the accumulating knowledge in genomics and the proven success of the translation of cancer genomics to clinical practice in oncology, the Obama administration unveiled a $215 million commitment for the Precision Medicine Initiative (PMI) in 2016, a pioneering research effort to improve health and treat disease using a new model of patient-powered research. The objectives of the initiative include more effective treatments for cancer and other diseases, creation of a voluntary national research cohort, adherence to privacy protections for maintaining data sharing and use, modernization of the regulatory framework, and forging public-private partnerships to facilitate these objectives. Specifically, the DoD Military Health System joined other agencies to execute a comprehensive effort for PMI.

Incidence of Hypertensive Disorders of Pregnancy in Women with COVID-19.

Objective: The study aimed to examine the incidence of hypertensive disorders of pregnancy in women diagnosed with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2, also known as COVID-19).

Study Design: This was a retrospective cohort study of all women who delivered at MedStar Washington Hospital Center in Washington, DC from April 8, 2020 to July 31, 2020. Starting April 8, 2020, universal testing for COVID-19 infection was initiated for all women admitted to labor and delivery.

Review of maternal COVID-19 infection: considerations for the pediatric ophthalmologist.

With the increasing number of COVID-19 cases in the United States, more data is being reported on transmission, symptomatology, clinical course, and treatment of the virus. Research has focused on the trends and unique characteristics in at-risk populations, including pregnant women. This report summarizes the current data on considerations in pregnancy and postpartum period for mother and neonate to elucidate potential transmission risks for pediatric ophthalmologists.

Characterizing placental stiffness using ultrasound shear-wave elastography in healthy and preeclamptic pregnancies.

Purpose: To measure the stiffness of the placenta in healthy and preeclamptic patients in the second and third trimesters of pregnancy using ultrasound shear-wave elastography (SWE). We also aimed to evaluate the effect of age, gestational age, gravidity, parity and body mass index (BMI) on placental stiffness and a possible correlation of stiffness with perinatal outcomes.

Methods: In a case-control study, we recruited a total of 47 singleton pregnancies in the second and third trimesters of which 24 were healthy and 23 were diagnosed with preeclampsia.

Neonatal and maternal outcomes of pregnancies with a fetal diagnosis of congenital heart disease using a standardized delivery room management protocol.

Objective: We sought to determine if fetuses with prenatally diagnosed congenital heart disease (CHD) were more likely to undergo cesarean delivery in the setting of a non-reassuring fetal heart rate tracing (NRFHT) and to determine if those fetuses were more likely to have a fetal acidosis.

Study Design: A retrospective cohort study of neonates prenatally diagnosed with CHD from August 2010 to July 2016. The control group consisted of gestational age matched controls without CHD.

Ovulation Suppression to Prevent Hemoperitoneum and Surgical Menopause in Anticoagulated Women.

Premenopausal women taking anticoagulation therapy are at risk of developing hemorrhagic ovarian cysts. This paper presents 3 cases of acute hemoperitoneum, with resultant surgical menopause, secondary to cystic hemorrhage in premenopausal women with repaired congenital heart disease (CHD). Adults with CHD taking long-term anticoagulation should be considered candidates for ovulation suppression with hormone-based contraception.

Effect of Implementing Quantitative Blood Loss Assessment at the Time of Delivery.

Objective: To evaluate the ability of estimated blood loss (EBL) and quantitative blood loss (qBL) to predict need for blood transfusion in women with postpartum hemorrhage (PPH).

Study Design: This is a retrospective chart review that identified women with PPH (>1,000 mL for vaginal or cesarean delivery) between September 2014 and August 2015, reported by EBL ( = 92), and October 2015 and September 2016, reported by qBL ( = 374). The primary metric was the area under the receiver-operating characteristic curve for blood transfusion.

Reducing Cesarean Delivery Surgical Site Infections: A Resident-Driven Quality Initiative.

Objective: To examine the association of a resident-driven quality initiative with cesarean delivery surgical site infections.

Methods: This was a quasi-experimental, preintervention and postintervention study of women undergoing cesarean delivery at 23 weeks of gestation or greater between January 2015 and June 2018 at a single tertiary care center. We implemented a resident-driven, evidence-based surgical bundle, excluding women who underwent emergency cesarean or had chorioamnionitis.

Pregnancies complicated by maternal osteogenesis imperfecta type III: a case report and review of literature.

The restrictive lung disease can be exacerbated by growing fundus in women with osteogenesis imperfecta type III. Regional anesthesia can be performed in these women. Mode of delivery for women with osteogenesis imperfecta type III is generally cesarean delivery.

Implementation of universal rapid human immunodeficiency virus screening on labor and delivery.

Background: A case of mother to child transmission (MTCT) of HIV at a medical center in Washington, DC, resulted in the implementation of universal opt-out rapid testing of patients admitted for delivery. This article evaluates the policy's efficacy and implementation.

Methods: We evaluated the implementation using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Third trimester ultrasound for fetal macrosomia: optimal timing and institutional specific accuracy.

Purpose: To determine the performance of third trimester ultrasound in women with suspected fetal macrosomia.

Materials And Methods: We performed a retrospective cohort study of fetal ultrasounds from January 2004 to December 2014 with estimated fetal weight (EFW) between 4000 and 5000 g. We determined accuracy of birth weight prediction for ultrasound performed at less than and greater than 38 weeks, accounting for diabetic status and time between ultrasound and delivery.

Neonatal outcomes in fetuses with cardiac anomalies and the impact of delivery route.

Background: Congenital fetal cardiac anomalies compromise the most common group of fetal structural anomalies. Several previous reports analyzed all types of fetal cardiac anomalies together without individualized neonatal morbidity outcomes based on cardiac defect. Mode of delivery in cases of fetal cardiac anomalies varies greatly as optimal mode of delivery in these complex cases is unknown.

Bioengineering Strategies to Treat Female Infertility.

Bioengineering strategies have demonstrated enormous potential to treat female infertility as a result of chemotherapy, uterine injuries, fallopian tube occlusion, massive intrauterine adhesions, congenital uterine malformations, and hysterectomy. These strategies can be classified into two broad categories as follows: (i) Transplantation of fresh or cryopreserved organs into the host and (ii) tissue engineering approaches that utilize a combination of cells, growth factors, and biomaterials that leverages the body's inherent ability to regenerate/repair reproductive organs. While whole organ transplant has demonstrated success, the source of the organ and the immunogenic effects of allografts remain challenging.

Glycemic control, compliance, and satisfaction for diabetic gravidas in centering group care.

Purpose: To determine if diabetic gravidas enrolled in Centering® group care have improved glycemic control compared to those attending standard prenatal care. To compare compliance and patient satisfaction between the groups.

Materials And Methods: We conducted a prospective cohort study of diabetics enrolled in centering group care from October 2013 to December 2015.

Analysis: OB/GYN-Genetics.

Ovarian salvage from a patient with brain death is not available and will not preserve viable ova for future reproduction. Previous interest in assisted reproductive technology is only the first step in this process, which requires careful assessment of maternal risks and potential for recurrent genetic disease.

A case of recurrent hyperreactio luteinalis in three spontaneous pregnancies.

Hyperreactio luteinalis is a rare condition in pregnancy characterized by enlarged ovaries with multiple theca luteal cysts, and recurrence of disease has seldom been documented in the literature. This is a case report of a woman who developed recurrent hyperreactio luteinalis with three spontaneous pregnancies. Endocrine evaluation was performed and revealed hyperandrogenism.

Catecholaminergic Ventricular Tachycardia, Pregnancy and Teenager: Are They Compatible?

Arrhythmias in pregnancy are becoming more common given more available and effective medical, ablation and device treatment options. Several changes associated with pregnancy, increased blood volume, cardiac output, and heart rate secondary to an increased sympathetic state, facilitate more frequent occurrences of arrhythmias throughout the pregnancy and during labor and delivery. We present a case of successful pregnancy in a teenage female with a previous diagnosis of CPVT, followed by a review of the literature.

Deleterious BRCA1/2 mutations in an urban population of Black women.

Information on the prevalence of deleterious BRCA1 and BRCA2 (BRCA1/2) mutations in clinic-based populations of Black women is limited. In order to address this gap, we performed a retrospective study to determine the prevalence of deleterious BRCA1/2 mutations, predictors of having a mutation, and acceptance of risk-reducing surgeries in Black women. In an urban unselected clinic-based population, we evaluated 211 self-identified Black women who underwent genetic counseling for hereditary breast-ovarian cancer syndrome.

Use of cell-free DNA in the investigation of intrauterine fetal demise and miscarriage.

Objective: To estimate whether cell-free DNA is present in nonviable pregnancies and thus can be used in diagnostic evaluation in this setting.

Methods: We conducted a prospective cohort study of 50 participants at MedStar Washington Hospital Center, Washington, DC, between June 2013 and January 2014. Included were women with pregnancies complicated by missed abortion or fetal demise.

Understanding the Limitations of Circulating Cell Free Fetal DNA: An Example of Two Unique Cases.

Circulating cell free fetal DNA (cffDNA) is an effective screening modality for fetal aneuploidy. We report two cases of false positive results. The first case involves a female, with self-reported Down syndrome.

Multidisciplinary management of pregnancy in complex congenital heart disease: a model for coordination of care.

With advancements in medical care, many women with complex congenital heart disease (CHD) are now living into adulthood and childbearing years. The strains of pregnancy and parturition can be dangerous in such patients, and careful interdisciplinary plans must be made to optimize maternal and fetal health through this process. Several large studies have been published regarding risk prediction and medical management of pregnancy in complex CHD, though few case studies detailing clinical care plans have been published.