Outcome of pregnancies after pelvic artery embolization for postpartum hemorrhage: retrospective cohort study.

Objective: The effects of pelvic artery embolization (PAE) for postpartum hemorrhage (PPH) on subsequent pregnancies have been explored in small case series and one case-control study by mailed questionnaire with uncomplicated pregnancies as controls. We conducted a single-center retrospective cohort study using women with PPH without PAE for comparison.

Study Design: From a cohort of 103 women undergoing PAE for primary PPH between January 1999 and December 2012 (exposed) and 189 pregnancies with PPH not requiring PAE between January 2008 and December 2012 (unexposed), we queried the electronic medical records for readmissions to labor and delivery in subsequent years.

Fetal fibronectin for evaluation of preterm labor in the setting of cervical cerclage.

Objective: To evaluate the efficacy of fetal fibronectin (fFN) testing in cervical cerclage patients presenting with acute signs or symptoms of preterm labor.

Methods: A total of 71 fFN tests were performed in 48 women between 23 and 34 weeks' gestation who presented at two institutions at risk for imminent delivery with cerclage in situ.

Results: The sensitivity, specificity, positive predictive value, and negative predictive value for delivery within 2 weeks of fFN testing were 100, 77, 28 and 100%, respectively.

Perioperative complications of history-indicated and ultrasound-indicated cervical cerclage.

Objective: To evaluate perioperative complications of history- and ultrasound-indicated cerclage.

Methods: We performed a retrospective observational study of a cohort of patients who underwent history- (n = 198) or ultrasound-indicated (n = 89) cerclage procedures. We evaluated the rates of perioperative complications based on indication for cerclage.

Importance of timing of gestational exposure to methotrexate for its teratogenic effects when used in setting of misdiagnosis of ectopic pregnancy.

Objective: To report a case of embryopathy due to misadministration of methotrexate in the setting of suspected ectopic pregnancy that resulted in a different pattern of malformations than is typically seen with methotrexate.

Design: Case report.

Setting: Community hospital.

Variability in pathologists' detection of placental meconium uptake.

Placental meconium has been associated with poor perinatal outcomes but the reliability of the diagnosis has not been assessed. Our objective was to assess the interobserver variability in detection of placental meconium uptake. Ten pathologists from two community and four university hospitals reviewed 10 hematoxylin and eosin-stained placental slides that included cases of in utero and in vitro meconium uptake as well as negative controls.

Therapeutic cerclage may be more efficacious in women who develop cervical insufficiency after a term delivery.

Objective: Our objective was to determine whether obstetric history affects the efficacy of therapeutic cerclage.

Study Design: Data were gathered prospectively on patients receiving therapeutic cerclage, defined as midtrimester presentation with a cervical length less than 2.5 cm and prior preterm delivery or cervical dilatation with visible membranes on sterile speculum exam.

Cervical length < or = 25 mm in low-risk women: a case control study of cerclage with rest vs rest alone.

Objective: The purpose of this study was to evaluate the clinical utility of cerclage in low risk women with cervical length (CL) < or = 25 mm at transvaginal ultrasound (TVU).

Study Design: This was a retrospective cohort study of women with CL < or = 25 mm identified incidentally at TVU examinations between 16(0/7) to 24(6/7) weeks, with no history of previous preterm birth or midtrimester losses. The primary study outcome was rate of preterm delivery < 35 weeks' gestation.

Good pregnancy outcome with emergent cerclage placed in the presence of intra-amniotic microbial invasion.

Cervical insufficiency with dilation can be associated with amniotic fluid microbial invasion. Cerclage placement in the presence of infection is contraindicated because it is associated with poor fetal and maternal outcome. A 30-year-old gravida 4 para 0 with cervical insufficiency had emergent cervical suture placement at 19 weeks.

Postnatal inflammatory rat model for cerebral palsy: too different from humans.

Objective: In humans, cerebral palsy (CP) may originate from inflammation during the second and third trimesters of gestation when preoligodendrocytes (Pre-OL) are most vulnerable to an inflammatory insult. We studied a postnatal CP model to evaluate injury that would correlate with presence of Pre-OL in human pregnancy.

Study Design: On postnatal (P) days 2, 3, 4, 5 and 6, pups were treated with (lipopolysaccharide [LPS]) (n = 7; 30, 30, 60, 60, 120 microg/Kg) or saline (n = 7).

Amniotic fluid index and birth weight: is there a relationship in diabetics with poor glycemic control?

Objective: This study was undertaken to evaluate if the previously demonstrated relationship between macrosomia (> 4000 g) and polyhydramnios (> 25 cm) is linear across birth weights (BW) in diabetic patients with poor glycemic control.

Study Design: Using a prospectively collected database of patients undergoing amniocentesis for fetal lung maturity for various indications with amniotic fluid index (AFI) obtained < or = 7 days before delivery and BWs available (n = 69), we computed gestational age (GA) specific AFI and BW centiles using standard tables. BW and AFI centiles were analyzed in diabetic patients with poor glycemic control using linear regression and ANOVA, with P < .

Risk factors for cervical insufficiency after term delivery.

Objective: Cervical insufficiency can be unexpected in a woman with a previous term birth. Our objective was to determine what risk factors, if any, place women with a term delivery at risk for cervical insufficiency in a subsequent pregnancy.

Study Design: Demographic characteristics were collected for a cohort of women with at least 1 previous term birth followed by cervical insufficiency (subject group) and for uncomplicated multiparous women (control group).

Risk of third-trimester amniocentesis: a case-control study.

Risks of third-trimester amniocentesis are considered minimal; however, only case series have been reported. We performed a case-control study in which women undergoing third-trimester amniocentesis were matched with controls undergoing antenatal testing for similar indications to determine adverse outcomes associated with the procedure. Cases undergoing amniocentesis at > 32 weeks for fetal lung maturity assessment followed by antepartum testing with nonstress test and amniotic fluid index determination were matched with controls undergoing only antepartum testing based on gestational age at testing and maternal age.

Prevention of alcohol-induced learning deficits in fetal alcohol syndrome mediated through NMDA and GABA receptors.

Objective: Vasoactive intestinal peptide (VIP)-related peptides prevented the learning deficit in the offspring in a model for fetal alcohol syndrome. We evaluated whether the mechanism of the peptide protection included NR2B, NR2A, and GABAAalpha5.

Study Design: Timed, pregnant C57BL6/J mice were injected on gestational day 8 with alcohol (0.

N-methyl-D-aspartate subunit expression during mouse development altered by in utero alcohol exposure.

Objective: Alcohol-related neurodevelopmental disorders are contributors to long-term learning disabilities. By using a model for fetal alcohol syndrome, we have shown that prenatal alcohol exposure results in adult learning deficits of unknown mechanisms. In the developing hippocampus, the N-methyl-D-aspartate (NMDA) receptor subunit NR2B triggers long-term potentiation, fundamental to learning and memory; this is supplemented by the less plastic NR2A subunit in the adult.

The impact of first-trimester screening on AMA patients' uptake of invasive testing.

Objective: Prenatal testing for AMA includes invasive procedures such as CVS and amniocentesis, which have risks. We sought to determine the effects of first-trimester screening (FTS) on referrals for genetic counseling and patients' decisions to pursue invasive testing after FTS was offered in 2002.

Methods: We compared AMA patients presenting for prenatal care who underwent early genetic counseling (<13 weeks' gestation) from 2001 to those from 2003.

No phenotype associated with established lipopolysaccharide model for cerebral palsy.

Objective: Cerebral palsy (CP) is associated with childhood spasticity, seizures, and paralysis. Oligodendrocyte damage resulting in periventicular leukomalacia (PVL) in the developing brain has been implicated. Animal models of CP have used prenatal hypoxia and infection with histopathology of PVL as the end point.

Effect of epidural anaesthesia on clinician-applied force during vaginal delivery.

Objective: Epidural anesthesia (EA) is used in 80% of vaginal deliveries and is linked to neonatal and maternal trauma. Our objectives were to determine (1) whether EA affected clinician-applied force on the fetus and (2) whether this force influenced perineal trauma.

Study Design: After informed consent, multiparas with term, cephalic, singletons were delivered by 1 physician wearing a sensor-equipped glove to record force exerted on the fetal head.

Randomized trial of McRoberts versus lithotomy positioning to decrease the force that is applied to the fetus during delivery.

Objective: In an effort to reduce shoulder dystocia incidence and morbidity, some obstetricians use prophylactic maternal hip hyperflexion (McRoberts maneuver), with the hope of facilitating delivery and decreasing the traction needed for delivery. The objective of this study was to evaluate whether the delivery force is reduced with the prophylactic McRoberts maneuver in a prospective, objective manner.

Study Design: Between April 2002 and July 2003, we randomly assigned multiparous women with term, cephalic singleton gestations to delivery in the lithotomy or McRoberts position.

Role of lamellar body count for the prediction of neonatal respiratory distress syndrome in non-diabetic pregnant women.

Objective: Lamellar body count is a new and fast technique to establish the presence of fetal lung maturity. We have assessed the predictive ability of lamellar body count for neonatal respiratory distress syndrome (RDS) in a non-diabetic population.

Study Design: We accessed a cohort of amniocenteses in non-diabetic women from 1998 to 2002 (n=102).

Role of transvaginal sonographic cervical length in predicting spontaneous preterm delivery in triplet pregnancies with therapeutic cerclage.

Objective: To assess the role of transvaginal sonographic cervical length in predicting spontaneous preterm delivery at < 32 weeks in patients with both triplet pregnancy and therapeutic cerclage.

Study Design: The maternal records of all triplet pregnancies with therapeutic cerclage and sonographic cervical length before and after cerclage were reviewed (n = 17). Each of these triplet gestations was matched with 2 triplet pregnancies without cerclage based on cervical length after cerclage (+/- 0.

Effect of operative vaginal delivery on the outcome of permanent brachial plexus injury.

Objective: To evaluate whether operative vaginal delivery worsens the extent and/or degree of permanent brachial plexus injury.

Study Design: We utilized a dataset (n = 104) of vaginal deliveries resulting in permanent brachial plexus injury that ultimately underwent litigation. We excluded patients on whom neonatal injury information was incomplete (n = 5).

The role of activity-dependent neuroprotective protein in a mouse model of fetal alcohol syndrome.

Objective: Fetal alcohol syndrome (FAS) is the most common nongenetic cause of mental retardation. Peptides NAPVSIPQ (NAP) and SALLRSIPA (SAL), related to activity-dependent neuroprotective protein (ADNP), prevent alcohol-induced damage in a mouse model of FAS. Our objective was to characterize ADNP in this model to relate this protein to the mechanisms of damage and peptide neuroprotection.

Differential expression of c-fos in a mouse model of fetal alcohol syndrome.

Objective: Fetal alcohol syndrome (FAS) results in stillbirth, fetal growth restriction, and mental retardation with injury attributed to oxidative stress. Our objective was to identify signal transduction pathways expressed in a model of FAS and to quantify expression of c-fos, a gene in the stress signal pathway.

Study Design: Timed, pregnant C57Bl6/J mice were injected on E8 with saline solution or alcohol.