Management of a Parturient with Diastrophic Dysplasia.

A 27-year-old primigravida patient with diastrophic dysplasia (DTD) presented to our obstetrics clinic at 8 weeks' gestational age. Diastrophic dysplasia is a rare, autosomal-recessive abnormality that presents multiple challenges to perinatal anesthetic management, including difficult airway management and relative contraindications to neuraxial anesthesia. The patient underwent elective cesarean delivery at 35 weeks' gestational age under general anesthesia.

First-trimester cystic hygroma: relationship of nuchal translucency thickness and outcomes.

Objective: To estimate the relationship between nuchal translucency thickness and abnormal karyotype, major congenital anomaly, perinatal loss, and composite abnormal outcome in fetuses with first-trimester nuchal cystic hygroma.

Methods: We performed a retrospective cohort study of first-trimester fetuses with ultrasound-diagnosed nuchal cystic hygroma collected over a 10-year period.

Results: There were 944 first-trimester fetuses with nuchal cystic hygroma.

Diagnosis and management of thyroid disease in pregnancy.

Thyroid disease is common, affecting 1% to 2% of pregnant women. Pregnancy may modify the course of thyroid disease, and pregnancy outcomes can depend on optimal management of thyroid disorders. Consequently, obstetric providers must be familiar with thyroid physiology and management of thyroid diseases in pregnancy.

Group prenatal care: an analysis of cost.

Introduction: Group prenatal care may have benefits over traditional care; however, the economic performance of this model is largely unexplored. We sought to understand the finances of group prenatal care at a small, rural, critical access hospital.

Methods: Volume, cost, and revenue estimates were obtained and an economic model was created.

Screening and diagnosis of gestational diabetes mellitus.

Screening, diagnosis, and treatment of gestational diabetes mellitus (GDM) are common practice, despite controversy regarding benefits. A review of the literature from 1950 to 2006 revealed 3 randomized controlled trials evaluated the treatment of GDM but 2 of these studies lacked power to detect a difference in outcomes. The single trial with sufficient power showed a 67% lower rate of serious perinatal complication (a composite of shoulder dystocia, nerve injury, fracture, and death) and a 53% lower rate of macrosomia with treatment of GDM.

Rates of postpartum glucose testing after gestational diabetes mellitus.

Objective: To estimate rates of postpartum glucose tolerance testing in women diagnosed with gestational diabetes mellitus (GDM) and to assess factors associated with testing.

Methods: This was a retrospective cohort study of 344 women with GDM who received prenatal care in a maternal diabetes clinic during 2001-2004. Rates of postpartum glucose testing were estimated from hospital, clinic, and laboratory records.