Time trends in pregnancy-related outcomes among women with type 1 diabetes mellitus, 2004-2017.

Objective: To examine time trends in US pregnant women with type 1 diabetes mellitus for maternal characteristics and pregnancy outcomes.

Study Design: We abstracted clinical data from the medical records of 700 pregnant women from 2004 to 2017. For each time period, means and percentages were calculated.

Continuous Glucose Monitoring, Glycemic Variability, and Excessive Fetal Growth in Pregnancies Complicated by Type 1 Diabetes.

Background: To examine trimester-specific associations among glycemic variability, fetal growth, and birthweight in pregnancies with type 1 diabetes mellitus (Type 1 DM).

Methods: In this retrospective cohort study of 41 pregnant women with Type 1 DM, we used continuous glucose monitoring (CGM) data to calculate glycemic variability (coefficient of variation of glucose) over a 7-day interval in each trimester. Clinical data, including fetal biometry, birthweight, and perinatal complications, were extracted from medical records.

The association of circulating angiogenic factors and HbA1c with the risk of preeclampsia in women with preexisting diabetes.

Objective: To assess whether glycemic control, soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF) were associated with the development of preeclampsia (PE) or gestational hypertension (GHTN) in women with preexisting diabetes.

Methods: Maternal circulating angiogenic factors (sFlt1 and PlGF) measured on automated platform were studied at four time points during pregnancy in women with diabetes (N = 159) and reported as multiples of the median (MOM) of sFlt1/PlGF ratio (median, 25th-75th percentile) noted in non-diabetic non-hypertensive control pregnant population (N = 139). Diagnosis of PE or GHTN was determined by review of de-identified clinical data.

Angiogenic factors and pregnant woman with new onset seizures.

Background: In patients with new onset seizures during pregnancy, it can be challenging to differentiate between eclampsia and other etiologies. Soluble fms-like tyrosine kinase (sFlt1) is an antiangiogenic protein that is elevated in preeclampsia and eclampsia.

Case: A multiparous woman presented at 22 weeks gestation with seizures.

Spinal cord stimulation and the pregnant patient-specific considerations for management: A case series and review of the literature.

Objectives: The use of spinal cord stimulation (SCS) is a form of neuromodulation used to treat chronic pain in those patients who are refractory to conventional medical management. Not uncommonly, SCS can dramatically improve a patient's quality of life, and those who are in the childbearing years may go on to become pregnant. The purpose of this case series is to describe: 1) implantation considerations in women of childbearing age; 2) use of rechargeable systems; 3) the obstetric and anesthetic concerns in patients with spinal cord stimulators; 4) risks of using SCS in the peripartum period.

Effects of a low-glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial.

Background: The optimal diet for pregnancy that is complicated by excessive weight is unknown.

Objective: We aimed to examine the effects of a low-glycemic load (low-GL) diet in overweight and obese pregnant women.

Design: We randomly assigned 46 overweight or obese pregnant women to receive a low-GL or a low-fat diet.

Rupture of the posterior cul-de-sac during spontaneous labor.

Background: Women with genital anomalies are at increased risk of labor dysfunction. Rupture of the posterior cul-de-sac causing an intraabdominal delivery is a rare complication of labor that may be related to a congenitally atretic vagina.

Case: A nulliparous woman at 28 weeks of gestation with a known short vagina presented with preterm labor; her cervix could not be palpated or visualized.

Optical properties of human amniotic fluid: implications for videofetoscopic surgery.

Objective: Videofetoscopy typically demands the substitution of oft-turbid amniotic fluid with clear crystalloid. This maneuver can be cumbersome and may lead to complications. We sought to determine the optical properties of the amniotic fluid, as a pre-requisite for optimizing video image processing during videofetoscopy and eventually avoid amniotic fluid replacement.

Light-scattering spectroscopy differentiates fetal from adult nucleated red blood cells: may lead to noninvasive prenatal diagnosis.

Present techniques for prenatal diagnosis are invasive and present significant risks of fetal loss. Noninvasive prenatal diagnosis utilizing fetal nucleated red blood cells (fNRBC) circulating in maternal peripheral blood has received attention, since it poses no risk to the fetus. However, because of the failure to find broadly applicable identifiers that can differentiate fetal from adult NRBC, reliable detection of viable fNRBC in amounts sufficient for clinical use remains a challenge.

Incisional hernia with bowel incarceration and obstruction at 34 weeks gestational age.

Background: Hernias commonly coexist with pregnancy; however, an incarcerated hernia with bowel obstruction is rare at advanced gestation and requires urgent intervention.

Case: A multiparous woman with a known large incisional hernia presented at 33 weeks and 5 days gestational age with acute-onset, upper abdominal pain and nausea. The patient was diagnosed with small bowel obstruction secondary to an incarcerated hernia.

Pancreatic adenocarcinoma in the pregnant patient: a case report and literature review.

Pancreatic cancer is the fifth most common cause of cancer-related death in the USA. However, the antepartum diagnosis of pancreatic adenocarcinoma in the pregnant patient is exceedingly rare, with only six cases previously reported in the literature. Optimizing both maternal and fetal health outcomes is particularly challenging when surgical procedures are necessary for staging and/or therapeutic purposes--as these interventions often pose significant risks to both the mother and the developing fetus.

Risk of cesarean wound complications in diabetic gestations.

Objective: This study was undertaken to examine the association between pregestational diabetes mellitus (DM) and wound complications after cesarean delivery (CD).

Study Design: This was a retrospective, observational cohort study in patients with type 1 and 2 DM compared with non-DM controls undergoing CD. Wound complications were defined as wound infection, wound separation greater than 1 cm, and wound dehiscence.