Prophylactic uterine artery embolization in first-trimester cervical pregnancy termination with placenta accreta: A case report.

The current standard treatment for placenta accreta is a hysterectomy, which carries a significant risk of hemorrhage. Although prophylactic uterine artery embolization (UAE) is established as an effective means of minimizing perioperative bleeding, there are few reports of its use early in pregnancy with invasive placenta. A 45-year-old woman, gravida 6, para 1, at 11 weeks of gestation presented with heavy, painless uterine bleeding and was diagnosed with a spontaneous abortion complicated by cervical pregnancy and placenta accreta.

The glitz and glamour randomized trial: the effect of fingernail polish on post-caesarean surgical site infection.

Current surgical scrub guidelines suggest that fingernail polish should not be worn by healthcare providers despite collective evidence not demonstrating a relationship between fingernail polish and surgical-site infection (SSI). The purpose of this study was to determine the effect of surgical staff wearing nail polish on the incidence of SSI after caesarean delivery. In this calendar block-randomised clinical trial, surgical staff were assigned to wear nail polish or to have unpainted nails for alternating two-week periods.

Maternal anthropometric measurements and correlation to maternal and fetal outcomes in late pregnancy.

Background: Body mass index does not distinguish between lean and fat body mass; therefore, its utility defining body composition is limited in pregnancy. Anthropometric measurements may better represent variation in body composition among women who are overweight or obese. We sought to examine body fat composition using maternal anthropometric measurements in late pregnancy and correlate with mode of delivery.

Fetal and maternal inflammatory response in the setting of maternal intrapartum fever with and without clinical and histologic chorioamnionitis.

Background: Both infectious and noninfectious causes of maternal fever have been linked to adverse neonatal outcomes including low Apg0ar scores, respiratory distress, hypotonia, and neonatal seizures. Even in the absence of infection, the occurrence of intrapartum fever is a strong risk factor for poor long-term neonatal developmental outcomes, including encephalopathy, cerebral palsy, and neonatal death.

Objective: The primary objective of this study was to compare intrapartum and postpartum maternal and fetal umbilical cord serum levels of cytokines RANTES, interferon-ɣ, interleukin-1β, interleukin-2, interleukin-4, interleukin-6, interleukin-8, interleukin-10, interleukin-13, and tumor necrosis factor-α among nonfebrile patients, febrile patients without clinical chorioamnionitis, and febrile patient with clinical chorioamnionitis.

The vertical dimension of obesity: adverse pregnancy outcomes in the short obese versus tall obese parturient.

The objective of this study was to examine the effect of maternal height on adverse perinatal outcomes in obese parturients. This retrospective study was conducted from January 2015 to December 2015. Patients with BMI ≥ 35.

Randomized control trial of intravenous acetaminophen for reduction of intrapartum maternal fever.

Background: Intravenous acetaminophen reaches a higher mean peak plasma concentration than oral acetaminophen in a shorter period of time. The favorable pharmacokinetics of intravenous acetaminophen may be beneficial for treating intrapartum maternal fever.

Objective: The primary objective was to compare intravenous and oral acetaminophen in time to defervescence (temperature <38°C).

Opioid-free multimodal analgesia pathway to decrease opioid utilization after cesarean delivery.

Aim: To evaluate an opioid-free multimodal analgesic pathway (MAP) to decrease opioid utilization after cesarean delivery (CD) compared to historic data of our institution prior to using MAP for pain management (pre-MAP).

Methods: The MAP was implemented in three phases from September 2018 to August 2019. Patients received 1000 mg intravenous (IV) acetaminophen with 30 mg IV ketorolac at 0 (arrival time at recovery room), 6, 12 and 18 h of postoperative course.

Post-cesarean delivery outpatient opioid consumption and perception of pain control following implementation of a restrictive opioid prescription protocol.

Background: Cesarean delivery is the most common laparotomy performed in the United States and can be the first exposure to opioids for many women. Unnecessary consumption of opioids may lead to long-term addiction and further perpetuate this national health crisis.

Objectives: The primary objective of the study was to assess whether a quality improvement initiative by means of a restrictive opioid prescription policy decreases opioid consumption and maintains patient satisfaction after cesarean delivery.

Autoimmune progesterone dermatitis following vaginal progesterone exposure in pregnancy.

In the non-pregnant state, exogenous as well as endogenous fluctuations of progesterone have been demonstrated to cause a rare delayed hypersensitivity reaction known as autoimmune progesterone dermatitis. We describe the case of a 20-year-old woman in her second pregnancy who presented to our delivery unit at 31 weeks and 3 days gestation for a cutaneous breakout with pruritic pustules, blisters, and crusts across her chest back and extremities 23 days after the initiation of vaginal progesterone. After suspension of the vaginal progesterone, the patient's cutaneous lesions resolved.

Vaginal cleansing with chlorhexidine gluconate or povidone-iodine prior to cesarean delivery: a randomized comparator-controlled trial.

Background: Several randomized controlled trials have demonstrated that preoperative abdominal skin preparation with chlorhexidine gluconate is superior to povidone-iodine for the prevention of surgical site infections. Despite these results, povidone-iodine is still the most commonly used agent for vaginal preparation, even though it may not be ideal.

Objectives: The objectives of the study were as follows: (1) to determine whether vaginal cleansing with a 4% chlorhexidine gluconate solution results in fewer wound infections as compared with povidone-iodine when used for vaginal antisepsis prior to cesarean delivery and (2) to compare rates of patient reported side-effects associated with vaginal application of 4% chlorhexidine gluconate solution and 10% povidone-iodine.

An Original Suprapannicular Incision Technique for Cesarean Delivery in the Morbidly Obese Parturient.

Background: Obese patients are at an increased risk of cesarean delivery and its associated wound complications. We present an alternative incision technique for obese parturients that avoids making a Pfannenstiel incision under the panniculus while still providing access to the lower uterine segment.

Technique: For our technique, an assistant uses Allis clamps to exert caudal traction on the patient's panniculus and a transverse skin incision is made under the umbilicus, 3 cm below the line joining the anterosuperior iliac crests.

Double Balloon Cervical Ripening Catheter for Control of Massive Hemorrhage in a Cervical Ectopic Pregnancy.

Cervical pregnancy can be complicated by perfuse vaginal bleeding. Mechanical compression directed at tamponing the cervical vessels can control hemostasis. There are several types of balloon catheters that have been described for cervical compression.

Risk Factors for Intrapartum Fever in Term Gestations and Associated Maternal and Neonatal Sequelae.

Aim: To determine factors associated with intrapartum fever and to examine associated maternal and neonatal outcomes.

Methods: Retrospective study of patients between 360/7 and 420/7 gestational weeks who entered spontaneous or induced active labor and developed temperature ≥38°C; a similar group that did not develop fever were controls. Univariate and multivariate analyses were performed with p < 0.

Clinical significance of a false positive glucose challenge test in patients with a high body mass index.

Objective: To determine if there is an increased maternal or neonatal morbidity in overweight and obese patients with a false positive glucose challenge test (GCT).

Methods: Patients with a body mass index (BMI) ≥25.0 at registration were included in this prospective 36-month study.

Determination of antepartum and intrapartum risk factors associated with neonatal intensive care unit admission.

Objective: To determine antepartum and intrapartum factors that are associated with admission to neonatal intensive care unit (NICU) among infants delivered between 36.0 and 42.0 weeks at our institution.

Management of Membranous Glomerulonephritis in Pregnancy: A Multidisciplinary Challenge.

We present a case of 28-year-old female, who had a past obstetrical history complicated by uncontrolled blood pressure, early onset preeclampsia, and a fetal demise at 29 weeks. Her blood pressure normalized after each pregnancy, and no diagnosis of renal disease was ever established. In her most recent pregnancy, she remained normotensive and initially presented with normal blood urea nitrogen and creatinine levels.

Increased breath markers of oxidative stress in normal pregnancy and in preeclampsia.

Objectives: The purpose of this study was to compare the intensity of oxidative stress in normal pregnancy, preeclampsia, and nonpregnant women using a breath test.

Study Design: We studied primiparous women in third trimester pregnancy (38 uncomplicated, 26 with preeclampsia) and 60 nonpregnant control subjects. Volatile organic compounds (VOCs) in alveolar breath were analyzed by gas chromatography/mass spectroscopy to construct the breath methylated alkane contour (BMAC), a 3-dimensional display of abundance of C4-C20 alkanes and monomethylated alkanes.