Complicated Monochorionic-Diamniotic Twins in a Pregnant Woman with COVID-19 in the Second Trimester.

Objective: A majority of studies evaluating the risk of vertical transmission and adverse outcomes in pregnancies with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are mostly based on third-trimester infections. There is limited data available on pregnancy sequelae of maternal infection in the first or second trimester.

Study Design: We present a patient with monochorionic-diamniotic twins that develops coronavirus disease 2019 infection at 15 weeks of gestation.

Transcervical Foley Balloon Plus Vaginal Misoprostol versus Vaginal Misoprostol Alone for Cervical Ripening in Nulliparous Obese Women: A Multicenter, Randomized, Comparative-Effectiveness Trial.

Objective: Nulliparous obese women are at increased risk of labor induction and cesarean delivery (CD). We sought to determine whether the combination of a transvaginal Foley balloon plus misoprostol prostaglandin E1 (PGE1) is superior to misoprostol alone in reducing the risk for CD.

Study Design: We undertook a multicenter, open-label, comparative-effectiveness randomized clinical trial of nulliparous obese women with unfavorable cervix (Bishop's score ≤ 6) undergoing labor induction from January 2016 to June 2018 at three tertiary centers.

Transverse versus vertical skin incision for planned cesarean hysterectomy: does it matter?

Background: To investigate differences in perioperative outcomes by type of skin incision, transverse versus vertical, for planned cesarean hysterectomy for placenta accreta spectrum (PAS).

Methods: A retrospective cohort study of all women who underwent a planned cesarean hysterectomy for abnormal placentation at a single academic medical center over 5 years. The Student's t-test was used for continuous variables and Fisher's exact test compared categorical variables.

Balloon Uterine Tamponade Device After Peripartum Hysterectomy for Morbidly Adherent Placenta.

Background: Perioperative hemorrhage is a common complication of peripartum hysterectomy for morbidly adherent placenta. We present an application of a balloon uterine tamponade device in the setting of a cesarean delivery and subsequent supracervical hysterectomy for abnormal placentation.

Case: A 33-year-old gravid woman, 6 para 3022, at 33 2/7 weeks of gestation was admitted in preterm labor, with placenta previa and suspected morbidly adherent placenta, for a planned cesarean delivery and hysterectomy.

The impact of cerclage in twin pregnancies on preterm birth rate before 32 weeks.

Purpose: To evaluate whether cerclage in twins reduces the rate of spontaneous preterm birth <32 weeks when compared to expectant management.

Methods: This is a retrospective cohort study of twin pregnancies with the following indications for cerclage from two institutions: history of prior preterm birth, ultrasound-identified short cervix ≤2.5 cm, and cervical dilation ≥1.

Fetal Heart Size: A Comparison Between the Point-to-Point Trace and Automated Ellipse Methods Between 20 and 40 Weeks' Gestation.

Objectives: To evaluate whether the global area and circumference of the heart varies between two measurement techniques: the point-to-point trace and the electronic ellipse methods.

Methods: The epicardial border of the 4-chamber view was measured in 200 fetuses between 20 and 40 weeks' gestation, from which the area and circumference using the point-to-point trace and electronic ellipse were measured. Analysis of variance, correlation, and regression analysis using fractional polynomials and 7 independent variables (head circumference, biparietal diameter, abdominal circumference, femur length, estimated fetal weight, mean ultrasound gestational age, and last menstrual period gestational age) were performed.

Rare Dysuria: Prostatic Abscess due to Disseminated Coccidioidomycosis.

We present a case of disseminated coccidioidomycosis with formation of a prostatic abscess in a 28-year-old diabetic male. Though rare, Coccidiodes prostatitis should be included in the differential for patients who have spent time in endemic areas and present with prostatitis or other genitourinary tract symptoms, especially in the setting of immunocompromise. The small number of Coccidiodes prostatitis cases described in the literature previously are reviewed, along with a wider discussion of coccidioidomycosis.

Psychiatric factors do not affect recurrence risk of hyperemesis gravidarum.

Aim: The aim of this study is to determine whether psychiatric symptoms affect recurrence risk of hyperemesis gravidarum (HG).

Methods: The study sample included 108 women with HG treated with i.v.

Antihistamines and other prognostic factors for adverse outcome in hyperemesis gravidarum.

Objective: The purpose of this study is to determine the frequency of adverse perinatal outcome in women with hyperemesis gravidarum and identify prognostic factors.

Study Design: This is a case-control study in which outcomes of first pregnancies were compared between 254 women with hyperemesis gravidarum treated with intravenous fluids and 308 controls. Prognostic factors were identified by comparing the clinical profile of patients with hyperemesis gravidarum with a normal and an adverse pregnancy outcome.

Solitary diverticular type V bile duct cyst.

Bile duct cysts are a rare form of biliary disease characterized by single or multiple dilations anywhere along the biliary tree. Todani Type V bile duct cysts are intrahepatic and typically involve multiple fusiform dilations. We present the case of a neonate with an unusual prenatally identified solitary diverticular type V bile duct cyst that was evaluated, monitored, and subsequently resected with right lobectomy at the age of 6 months.

Reduction of surgical site infections in low transverse cesarean section at a university hospital.

Background: We implemented evidence-based interventions to reduce risk of surgical site infection (SSI) following low transverse cesarean section (LTCS).

Methods: An observational study was conducted to determine LTCS SSI rates and the impact of infection control interventions at an academic teaching hospital during the period October 2005 to December 2008, including the use of 2% chlorhexidine gluconate (CHG) for surgical skin preparation before LTCS and no-rinse CHG cloths for preoperative skin cleansing. We compared overall and risk strata specific SSI rates and standardized incidence ratios during 4 study periods and estimated cost savings.

Myomectomy at time of cesarean delivery: a retrospective cohort study.

BACKGROUND: Myomectomy at time of cesarean delivery is traditionally discouraged because of the risk of hemorrhage. A retrospective cohort study was performed to determine whether myomectomy at time of cesarean delivery leads to an increased incidence of intrapartum and short-term postpartum complications. METHODS: A computer search of medical records from May 1991 to April 2001 identified a total of 111 women who underwent myomectomy at time of cesarean delivery and 257 women with documented fibroids during the index pregnancy who underwent cesarean delivery alone.

Obstructive fetal hydronephrosis managed by amnioinfusions and bladder aspirations.

Background: Fetuses diagnosed with posterior urethral valve syndrome risk development of significant pulmonary and renal complications. Historically, medical options included expectant management, percutaneous shunting, fetal surgery, and pregnancy termination.

Case: A 34-year-old primigravida presented at 26.

Ratio of choroid plexus circumference to ventricular circumference in the diagnosis of fetal hydrocephalus.

Objective: To establish normative measures of the biologic growth of fetal choroid plexus circumference (CPC) and ventricular circumference (VC) in normal pregnant women.

Study Design: We studied 185 women with uncomplicated pregnancies ranging in gestational age from 14 to 26 weeks and undergoing ultrasound examination for genetic amniocentesis. CPC and VC were measured with a transverse scan of the fetal head to establish normative values.

Genetic amniocentesis following multifetal pregnancy reduction to twins: assessing the risk.

Fifty-three patients who elected to reduce their pregnancies to a twin gestation in our centre are known to have subsequently undergone genetic amniocentesis. Five of these patients lost entire pregnancy following the genetic amniocentesis procedure. This is equivalent to a 9.

Risk assessment of amniocentesis between 11 and 15 weeks: comparison to later amniocentesis controls.

We studied 693 consecutive early amniocenteses (prior to 15 weeks) and found a spontaneous abortion rate to 28 weeks' gestation of 1.5 per cent. A control group of women having standard amniocentesis (15-20 weeks) experienced a 0.

Prenatal diagnosis of Sjögren-Larsson syndrome using enzymatic methods.

Sjögren-Larsson syndrome (SLS) is an autosomal recessive disorder characterized by the presence of congenital ichthyosis, mental retardation, and spasticity. The primary biochemical defect in SLS has recently been identified to be a deficiency of fatty aldehyde dehydrogenase (FALDH), which is a component of fatty alcohol:NAD+ oxidoreductase (FAO). We monitored four pregnancies at risk for SLS by measuring FAO and FALDH in cultured amniocytes or cultured chorionic villus cells.

Sjögren-Larsson syndrome: technique and timing of prenatal diagnosis.

Background: Sjögren-Larsson syndrome is an autosomal recessive disease with sequelae including ichthyosis, mental retardation, and spasticity. Although fetal skin biopsy has permitted prenatal diagnosis of Sjögren-Larsson syndrome in the late second trimester, it is accompanied by substantial risks, including fetal loss, premature labor, and detection at a gestational age close to the legal limit for pregnancy termination in most states. A new technique involving biochemical assay of cultured amniocytes for reduced levels of fatty alcohol:oxidized nicotinamide-adenine dinucleotide (NAD+)-oxidoreductase may allow earlier and less invasive detection of Sjögren-Larsson syndrome.

Fetal neutrophils and eosinophils express normal levels of L-selectin.

L-selectin is a leukocyte adhesion molecule important in the initial stages of the interaction of neutrophils with endothelium during neutrophil emigration from the bloodstream. Neutrophils and eosinophils from newborn infants express significantly less L-selectin than do neutrophils and eosinophils from adults. It is not known whether L-selectin expression on fetal granulocytes is similarly decreased.

Detection of complex gangliosides in human amniotic fluid.

Gangliosides are possibly very potent immunosuppressive molecules. Here we show that human amniotic fluid contains high concentrations of a number of previously unnoted, structurally complex and highly polar gangliosides. These unusual molecules are present early in pregnancy (first trimester), increase in concentration with gestational age, and reach maximum levels (0.

A report of 131 cases of multifetal pregnancy reduction.

Objective: To evaluate multifetal pregnancy reduction as a treatment for patients seeking to reduce the risks of multiple gestation.

Methods: One hundred thirty-one women had transabdominal multifetal pregnancy reduction performed by a single practitioner; 103 have delivered.

Results: Multifetal pregnancy reduction was associated with a 7% pregnancy loss rate and no losses within the first 4 weeks after the procedure.

Prenatal diagnosis of glucose-6-phosphate-dehydrogenase deficiency.

Prior to the development of the DNA-based technology reliable prenatal diagnosis of G6PD deficiency was not possible. We show that, using PCR amplification and restriction endonuclease digestion, prenatal diagnosis is possible. We have now been able to determine that the male fetus of a mother heterozygous for G6PD Mediterranean had inherited the maternal X chromosome with the normal G6PD gene.