Risk Profiling In Vitro Fertilization Pregnancies that Develop Placenta Accreta Spectrum.

Objective:  The objective of this study is to assess whether, among a cohort of placenta accreta spectrum (PAS) patients, antenatal suspicion of PAS was less likely in in vitro fertilization (IVF) compared with non-IVF patients. In addition, we aimed to assess whether IVF patients exhibited similar risk factors for PAS compared with non-IVF patients.

Study Design:  This is an international multicenter retrospective study of patients with pathologically confirmed PAS (accreta, increta, percreta) between 1998 and 2021.

Congenital Sodium Diarrhea: Antenatal Diagnosis May Prevent Unnecessary Surgery in the Neonate.

Congenital sodium diarrhea (CSD) is a rare, life-threatening condition characterized by intractable diarrhea, hyponatremia, and metabolic acidosis. It presents similarly to other congenital disorders and, therefore, is often misdiagnosed and mistreated. We present a case of CSD that presented with dilated loops of bowel and polyhydramnios at 18 weeks and was thought to be a congenital bowel obstruction.

The Need for Presurgical Evaluation for Placenta Accreta Spectrum.

Staging or grading of placenta accreta spectrum has historically relied on histopathologic evaluation of placental and uterine specimens. This approach has limited utility, since it is retrospective in nature and does not allow for presurgical planning. Here, we argue for a paradigm shift to use of clinical and imaging characteristics to define the presurgical stage.

Surgical Techniques for the Management of Placenta Accreta Spectrum.

The surgical management of placenta accreta spectrum (PAS) is often challenging. There are a variety of techniques and management options described in the literature ranging from uterine sparing to cesarean hysterectomy. Following the inaugural meeting of the Pan-American Society for Placenta Accreta Spectrum a multidisciplinary group collaborated to describe collective recommendations for the surgical management of PAS.

The Association between Placenta Accreta Spectrum Severity and Incidence of Small for Gestational Age Neonates.

Objective: The aim of the study is to evaluate whether pathologic severity of placenta accreta spectrum (PAS) is correlated with the incidence of small for gestational age (SGA) and neonatal birthweight.

Study Design: This was a multicenter cohort study of viable, non-anomalous, singleton gestations delivered with histology-proven PAS. Data including maternal history, neonatal birthweight, and placental pathology were collected and deidentified.

Clinical Correlates of Placenta Accreta Spectrum Disorder Depending on the Presence or Absence of Placenta Previa: A Systematic Review and Meta-analysis.

Objective: To evaluate whether there are differences in risk factors and maternal outcomes of pregnancies complicated by placenta accreta spectrum depending on the presence or absence of placenta previa.

Data Sources: We performed a systematic search in Medline, EMBASE, ClinicalTrials.gov , and Web of Science from inception through April 25, 2022, without language or date restrictions.

Timing of delivery for placenta accreta spectrum: the Pan-American Society for the Placenta Accreta Spectrum experience.

Background: The Society for Maternal-Fetal Medicine recommends cesarean delivery with potential hysterectomy scheduled in the late preterm period between 34 0/7 and 35 6/7 weeks of gestation for prenatally suspected placenta accreta spectrum.

Objectives: We aimed to investigate clinical compliance with the recommended delivery timing window for placenta accreta spectrum and its impact on maternal and neonatal outcomes.

Study Design: We performed a retrospective multicenter review of data from referral centers within the Pan-American Society for Placenta Accreta Spectrum.

A double-blinded randomized controlled trial on the effects of increased intravenous hydration in nulliparas undergoing induction of labor.

Background: Rates of labor induction are increasing, raising concerns related to increased healthcare utilization costs. High-dose intravenous fluid (250 cc/h) has been previously demonstrated to shorten the time to delivery in nulliparous individuals in spontaneous labor. Whether or not this relationship exists among individuals undergoing induction of labor is unknown.

Complicated placenta accreta spectrum: identifying a high-risk cohort.

Objective: To assess differences in the perioperative complication rate between patients with placenta accreta spectrum (PAS) with and without complicating factors.

Methods: This retrospective cohort study included subjects who underwent cesarean hysterectomy with histology-proven PAS between 23 0/7 and 42 0/7 weeks gestational age (GA) from 1 July 2008 to 11 April 2017. Perioperative outcomes were compared between those with uncomplicated PAS and "complicated PAS," defined as PAS subjects who experienced ≥2 bleeding episodes, preterm premature rupture of membranes (PPROM), or premature contractions requiring tocolysis.

The Utilization of Interventional Radiologic Procedures in the Surgical Management of Placenta Accreta Syndrome.

The role of Interventional radiologic procedures for the management of suspected placenta accreta spectrum (PAS) has evolved considerably over last 3 decades. In this article, the authors describe the various techniques of vascular occlusion for the management of PAS and provide a brief review of the literature examining the pros and cons in the use of these devices.

Dextrose intravenous fluid therapy in labor reduces the length of the first stage of labor.

The aim of this systematic review with meta-analysis was to evaluate the effect on length of labor when patients receive IVF with or without dextrose. Searches were performed in electronic databases from inception of each database to May 2018. Trials comparing intrapartum IVF containing dextrose (i.

A randomized, double-blinded, controlled trial of the effects of fluid rate and/or presence of dextrose in intravenous fluids on the labor course of nulliparas.

Background: Prolonged labor has been demonstrated to increase adverse maternal and neonatal outcome. A practice that may decrease the risk of prolonged labor is the modification of fluid intake during labor.

Objective: Several studies demonstrated that increased hydration in labor as well as addition of dextrose-containing fluids may be associated with a decrease in length of labor.

Patient-prosthesis mismatch in pregnancy.

Background: Patient-prosthesis mismatch is a known and severe complication after aortic valve repair in the general population. There is a paucity of literature regarding this condition in pregnancy.

Case: We present the clinical course of a pregnant woman with severe patient-prosthesis mismatch after aortic valve replacement.

Intracranial hemorrhage in pregnancy.

A pregnant woman with a mechanical prosthetic mitral valve was anticoagulated with low-molecular-weight heparin in the first trimester followed by warfarin until 36 weeks' gestation. She was then switched to intravenous unfractionated heparin infusion to allow for regional anesthesia in anticipation of vaginal delivery. She developed severe headache on hospital day 2 that was refractory to pain medications.

Obstetric outcomes and maternal satisfaction in nulliparous women using patient-controlled epidural analgesia.

Objective: The purpose of this study was to compare obstetric outcomes and maternal satisfaction in nulliparous women in spontaneous labor who used patient-controlled epidural analgesia (PCEA) vs continuous epidural infusion (CEI).

Study Design: We conducted a double-masked trial of 270 nulliparous women who were assigned randomly to 3 groups (with a concentration 0.1% bupivacaine and 2 μg/mL fentanyl): group I, CEI-only (10 mL/h); group II, CEI + PCEA (CEI 10 mL/h plus PCEA 10 mL, at 20 minutes); group III, PCEA-only (10 mL, at 20 minutes).

Management of placenta accreta: a survey of Maternal-Fetal Medicine practitioners.

Objective: To describe the management strategies for placenta accreta used by Maternal-Fetal Medicine practitioners.

Methods: We conducted a 36-question online survey of members of the Society for Maternal-Fetal Medicine regarding management of placenta accreta, and tabulated the results.

Results: We had 508 respondents.

A randomized, double-masked trial of prophylactic indomethacin tocolysis versus placebo in women with premature rupture of membranes.

Preterm premature rupture of membranes (PPROM) complicates 3% of pregnancies and frequently results in preterm birth, often within 48 hours of membrane rupture. Our objective was to determine if subjects with PPROM between 24 and 31 (6)/ (7) weeks' gestation benefit from a 48-hour course of prophylactic indomethacin tocolysis. This was a double-masked randomized controlled trial.

A randomized, double-blinded, controlled trial comparing parenteral normal saline with and without dextrose on the course of labor in nulliparas.

Objective: The objective of the study was to compare intravenous normal saline with and without dextrose on the course of labor in nulliparae.

Study Design: In a double-blinded, controlled trial, term, nulliparae with singletons in active labor were randomized into 1 of 3 groups receiving either normal saline (NS), NS with 5% dextrose (D5NS), or NS with 10% dextrose (D10NS) at 125 mL/h. The primary outcome was total length of labor from onset of study fluid in vaginally delivered subjects.

Successful pregnancy in a patient with severe combined immunodeficiency syndrome treated with bone marrow transplantation.

Background: We present the case of a patient with a history of severe combined immunodeficiency (SCID) syndrome successfully treated with bone marrow transplantation. Her resultant Rh alloimmunization complicated her first pregnancy.

Case: The patient was diagnosed with SCID syndrome after a series of opportunistic infections.

Argon beam coagulator for treatment of hepatic rupture with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome.

Background: We present a case of hepatic rupture secondary to hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome and the novel use of the argon beam coagulator in achieving hemostasis.

Case: The patient presented at 33 5/7 weeks of gestation with elevated liver transaminases, thrombocytopenia, and ultrasonographic findings consistent with hepatic rupture. She underwent an emergent cesarean delivery followed by exploration of her abdomen by hepatobiliary surgeons.