Reducing pelvic floor injury by induction of labor.

Introduction And Hypothesis: We hypothesized that elective induction of labor (eIOL) at 39 weeks is protective of levator ani muscle injury (LAMI) and is associated with decreased pelvic symptoms at 6 weeks postpartum compared to expectant management of labor.

Methods: Prospective cohort pilot study of uncomplicated, primiparous women with a singleton, vertex gestation enrolled immediately post-vaginal delivery (VD). Subjects were dichotomized into two groups based on labor management: eIOL without complication defined by the ARRIVE trial versus spontaneous VD between 39 weeks and 42 weeks or no indication for IOL prior to 40 weeks.

Prevalence and Predictors of Urinary Incontinence at 1 Year Postpartum.

Objectives: Postpartum urinary incontinence estimates range from 13% to 47%. Clinical factors associated with incontinence 1 year after first delivery are varied. We assessed the prevalence of and factors associated with urinary incontinence in primiparous women at 12 months postpartum.

Fetal Weight Estimation Using Automated Fractional Limb Volume With 2-Dimensional Size Parameters: A Multicenter Study.

Objectives: To develop new fetal weight prediction models using automated fractional limb volume (FLV).

Methods: A prospective multicenter study measured fetal biometry within 4 to 7 days of delivery. Three-dimensional data acquisition included the automated FLV that was based on 50% of the humerus diaphysis (fractional arm volume [AVol]) or 50% of the femur diaphysis (fractional thigh volume [TVol]) length.

Sonographic Tips for Evaluation of Adnexal Masses in Pregnancy.

Pregnancy is frequently a women's first contact with the health care system and often her first pelvic ultrasound examination. This first sonogram can reveal previously unknown adnexal pathology. Approximately 4% of pregnant women will have an adnexal mass detected by sonography and 1% to 2% of these masses will persist.

Failed Intrauterine Pregnancy: What Is a Failed Pregnancy, What Is Not?

Pregnancy failure is defined as a lack of sonographic evidence of current or expected viability. Technologic advances in ultrasound imaging continue to redefine diagnostic criteria of pregnancy failure or success. When evaluating a pregnancy, the first step is an assessment of maternal risk factors for failure.

Neonatal Outcomes in Fetuses With a Persistent Intrahepatic Right Umbilical Vein.

Objectives: A fetal persistent intrahepatic right umbilical vein has been linked to anomalies and genetic disorders but can be a normal variant. We conducted a retrospective review to determine other sonographic findings that can stratify fetuses for further evaluation.

Methods: A total of 313 fetuses had a persistent intrahepatic right umbilical vein identified on 17- to 24-week sonography.

Ultrasonography estimates of fetal growth in fetuses affected by trisomy 21.

Objective: To construct growth curves specific for fetuses with trisomy 21 (T21) and to compare them with the reference-based standard.

Methods: A retrospective cohort study was conducted of ultrasonography examinations from women with singleton pregnancies with a confirmed diagnosis of T21 who sought care at an academic tertiary-care center in the USA between January 1, 2003, and December 31, 2013. Growth curves were constructed using linear regression and compared with the Hadlock standard.

Threshold for endometrial sampling among postmenopausal patients without vaginal bleeding.

Objective: To provide an optimum threshold for endometrial biopsy sampling among postmenopausal women without vaginal bleeding and an incidentally-found endometrial lining of above 4mm.

Methods: A cohort of postmenopausal women (aged ≥50 years) who underwent pelvic ultrasonography at a tertiary US hospital for indications other than vaginal bleeding was retrospectively evaluated. Women were included if they had an endometrial lining of above 4mm.

Sonographic biometry in the early third trimester: A comparison of parameters to predict macrosomia at birth.

Purpose: To compare the estimated fetal weight (EFW), abdominal circumference (AC), and femur length (FL), measured on sonographic (US) examinations at 28-34 weeks of gestation to determine the best predictor of macrosomia at birth.

Methods: We retrospectively evaluated 3,857 consecutive, term, singleton pregnancies. The AC, FL, and EFW were compared with birth weights (BW) of >4,000 g and >4,500 g.

Maternal adaptations in preparation for parturition predict uncomplicated spontaneous delivery outcome.

Objective: The objective of the study was to define maternal tissue adaptations in pregnancy associated with uncomplicated spontaneous vaginal delivery using anatomical and biological outcomes.

Study Design: Nulliparous gravidas were prospectively enrolled in the first trimester at 2 institutions. Demographic and delivery data were chart abstracted.

The effect of maternal body mass index on fetal growth: use of individualized growth assessment and two-level linear modeling.

Purpose: To determine the effect of maternal body mass index on fetal growth using individualized growth assessment and two-level linear modeling.

Methods: A retrospective review of biometry in the second and third trimesters from 246 normal, term singleton fetuses was performed. Four to eight biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur diaphysis length (FDL) measurements per fetus were available and used to determine second-trimester growth rates.

Longitudinal assessment of amniotic fluid volume in monoamniotic twin gestations.

Objective: The aim of this study is to describe normal amniotic fluid volume through gestation in a cohort of normal monoamniotic (MA) twins.

Method: Our ultrasound database was queried for MA twin gestations from 2004 to 2011. Monochorionic twin pregnancies mimicking MA gestations, such as twin-twin transfusion syndrome, were excluded.

Prenatally diagnosed 17q12 microdeletion syndrome with a novel association with congenital diaphragmatic hernia.

We describe the first reported case of a prenatally diagnosed and recently described 17q12 microdeletion syndrome. The fetus was noted to have a congenital diaphragmatic hernia (CDH), echogenic kidneys and cystic left lung on prenatal ultrasound. The patient underwent amniocentesis which resulted in a normal fluorescence in-situ hybridization and karyotype.

Innate immune function of the human decidual cell at the maternal-fetal interface.

The aim of the study was to investigate the innate immune function of decidual cells from term unlabored pregnancies by determining Toll-like receptor presence and function. Using immunohistochemistry, reverse transcriptase polymerase chain reaction and NF-kappaB-luciferase plasmid transfection, Toll-like receptor presence and function was determined. Decidual cells express Toll-like receptors 1, 2, 4 and 6 which respond to lipopolysaccharide and peptidoglycan stimulation producing Interleukin-8.

Preterm premature rupture of membranes: diagnosis, evaluation and management strategies.

Preterm premature rupture of the membranes (PPROM) is responsible for one-third of all preterm births and affects 120,000 pregnancies in the United States each year. Effective treatment relies on accurate diagnosis and is gestational age dependent. The diagnosis of PPROM is made by a combination of clinical suspicion, patient history and some simple tests.

An evidence-based approach to the evaluation and treatment of premature rupture of membranes: Part II.

Unlabelled: Preterm premature rupture of membranes (PPROM) occurs in 3% of pregnancies and is responsible for one third of all preterm births. In part I of this series, the definition, pathophysiology, and diagnosis of PPROM was reviewed. In this part, treatment is discussed.

An evidence-based approach to the evaluation and treatment of premature rupture of membranes: Part I.

Unlabelled: Preterm premature rupture of membranes (PPROM) occurs in 3% of pregnancies and is responsible for one third of all preterm births. PPROM will affect 120,000 women in the United States each year. It is associated with significant maternal, fetal, and neonatal morbidity and mortality resulting from infection, umbilical cord compression, abruptio placentae, and prematurity.

Vulvar cancer.

Vulvar cancer was reported in 3,200 women in 1998, resulting in 800 deaths. Recent evidence suggests that vulvar cancer comprises two separate diseases. The first type may develop from vulvar intraepithelial neoplasia caused by human papillomavirus infection and is increasing in prevalence among young women.