Length of the second stage of labor and preterm delivery risk in the subsequent pregnancy.

Background: Cervical injury is regarded as an important risk factor for preterm delivery. A prolonged second stage of labor may increase the risk of cervical injury that, in turn, may be associated with increased risk of spontaneous preterm delivery in the subsequent pregnancy.

Objective: We sought to evaluate whether the duration of the second stage of labor in a term primiparous singleton delivery is associated with an increased risk of singleton spontaneous preterm delivery (<37 weeks) in the second pregnancy.

Treatment of a Pregnant Patient in a Persistent Vegetative State.

Background: Brain injury leading to a persistent vegetative state during pregnancy involves difficult medical and ethical decisions.

Case: A 21-year-old multigravid woman entered a persistent vegetative state at 20 1/7 weeks of gestation after cardiac arrest with postanoxic brain injury from a suspected drug overdose. The clinical disciplines responsible for her case formed a collaborative care plan involving ventilator, nutrition, and medication support of the mother and regular fetal monitoring and ultrasound testing.

Invasive placental disease: the impact of a multi-disciplinary team approach to management.

Purpose: To determine the impact of a structured multi-disciplinary management strategy on clinical outcomes in women with invasive placental disease (IPD).

Materials And Methods: This was a retrospective cohort study of consecutive women having peripartum hysterectomies with IPD over seven years. For the most recent three years, a structured multidisciplinary team (MDT) reviewed each suspected case, created a management plan, and implemented that plan.

Use of intracervical balloons and chorioamnionitis in term premature rupture of membranes.

Objective: To determine whether ripening and induction in patients with term premature rupture of membranes (PROM) via intracervical balloon placement (ICB) increases the risk of chorioamnionitis when compared to women with term PROM ripened and induced with other methods.

Study Design: A retrospective cohort study of term singleton gestations undergoing ripening and induction after PROM between July 2009 and June 2012 was conducted. Exposure of interest was ICB placement.

Clinical evaluation during postpartum hemorrhage.

Obstetric hemorrhage remains the most important cause of maternal mortality worldwide, accounting for 30% of all direct maternal deaths. As the method of management depends on multiple concurrent and sequential evaluations of the patient's status, it is helpful to have an evaluation strategy prepared for when a postpartum hemorrhage is encountered to facilitate interventions. This review describes an etiology-based approach to the clinical evaluation of postpartum hemorrhage and a suggested systems process that allows both a timely and appropriate evaluation of the hemorrhaging mother.

Postpartum hemorrhage.

Postpartum hemorrhage (PPH) is the leading cause of death related to pregnancy worldwide. Most deaths resulting from PPH are preventable. Physicians, nurses, midwives, and other birth attendants should be aware of the risk factors for PPH and be trained adequately in the preventive measures and management strategies for this pregnancy complication.

Changes in prepregnancy body mass index between the first and second pregnancies and risk of large-for-gestational-age birth.

Objective: The objective of our study was to determine whether changes in prepregnancy body mass index (BMI) between the first 2 pregnancies is associated with increased risk for large-for-gestational-age (LGA) birth in the second pregnancy.

Study Design: A population-based, retrospective cohort analysis was performed using the Missouri 1989-1997 longitudinally linked data. Women with the first 2 consecutive singleton live births (n = 146,227) were analyzed.

Balloon-assisted occlusion of the internal iliac arteries in patients with placenta accreta/percreta.

Background: Placenta accreta/percreta is a leading cause of third trimester hemorrhage and postpartum maternal death. The current treatment for third trimester hemorrhage due to placenta accreta/percreta is cesarean hysterectomy, which may be complicated by large volume blood loss.

Purpose: To determine what role, if any, prophylactic temporary balloon occlusion and transcatheter embolization of the anterior division of the internal iliac arteries plays in the management of patients with placenta accreta/percreta.

A clinicohistopathologic comparison between HELLP syndrome and severe preeclampsia.

Objective: To determine whether differences in the clinical entities of HELLP syndrome and severe preeclampsia are associated with different placental lesions.

Study Design: This was a case control study of singleton pregnancies with HELLP syndrome or severe preeclampsia. Archived pathology slides were retrieved and reviewed.

Obstetric admissions to the intensive care unit: outcomes and severity of illness.

Objective: To determine whether mortality prediction based on a current model of outcome prediction is accurate in obstetric patients.

Methods: Consecutive obstetric admissions to a medical intensive care unit from 1991 to 1998 were reviewed to determine whether mortality prediction is feasible in obstetric patients based on a widely used model. The Simplified Acute Physiologic Score (SAPS II) was used to predict the probability of hospital mortality.

The impact of prenatal care on preterm births among twin gestations in the United States, 1989-2000.

Objective: The purpose of this study was to determine the association between prenatal care and preterm births among twin gestations in the presence and absence of high-risk pregnancy conditions.

Study Design: Twin birth data in the United States were used to determine the association between preterm birth and prenatal care with the use of logistic regression.

Results: Of the 779,387 twin births, 54.

Fetal deaths in the United States. Influence of high-risk conditions and implications for management.

Objective: To estimate the effect of specific maternal-fetal high-risk conditions on the risk and timing of fetal death.

Methods: This study examined 10,614,679 non-anomalous singleton pregnancies delivering at or beyond 24 weeks' gestation, derived from the U.S.

The impact of prenatal care on postneonatal deaths in the presence and absence of antenatal high-risk conditions.

Objective: This study was undertaken to determine the association, if any, between prenatal care and postneonatal death in the presence and absence of high-risk pregnancy conditions.

Study Design: Data were derived from the national linked birth/infant death data set for the years 1995 to 1997 provided by the National Center for Health Statistics. Analyses were restricted to singleton live births that occurred after 23 completed weeks of gestation.

The impact of prenatal care in the United States on preterm births in the presence and absence of antenatal high-risk conditions.

Objective: This study was undertaken to determine the association between prenatal care in the United States and preterm birth rate in the presence, as well as absence, of high-risk pregnancy conditions for African American and white women.

Study Design: Data were derived from the natality data set for the years 1995 to 1998 provided by the National Center for Health Statistics. Analyses were restricted to singleton live births that occurred at >/=20 weeks' gestation.

Down syndrome risk estimation after normal genetic sonography.

Objective: The objective of this study was to determine whether there are any indication-specific variations in risk reduction for fetal Down syndrome after a normal genetic sonogram.

Study Design: A second-trimester genetic sonogram was offered to all pregnant women who were at increased risk for fetal Down syndrome (>/=1:274) because of either advanced maternal age (>/=35 years), an abnormal triple screen, or both. Outcome information included the results of genetic amniocentesis (if performed), the results of pediatric assessment, and follow-up after birth.

Atrial fibrillation in pregnancy associated with oral terbutaline.

Background: Terbutaline has direct effects on the cardiac conduction system, but when used to treat preterm labor it is rarely associated with clinically significant cardiac arrhythmias. Commonly used drug references did not list atrial fibrillation as a complication of terbutaline, and our literature search found only one case of atrial fibrillation that occurred with parenteral administration.

Case: A 30-year-old gravida 1 carrying a twin gestation at 35 weeks was taking 2.

Second-trimester genetic sonography in patients with advanced maternal age and normal triple screen.

Objective: To estimate the value of second-trimester genetic sonography in detecting fetal Down syndrome in patients with advanced maternal age (at least 35 years) and normal triple screen.

Methods: Since July 1999, a prospective collection and recording of all individual triple screen risks for fetal Down syndrome was initiated for all patients with advanced maternal age presenting in our ultrasound unit for second-trimester genetic sonography. Genetic sonography evaluated the presence or absence of multiple aneuploidy markers.

The impact of prenatal care on neonatal deaths in the presence and absence of antenatal high-risk conditions.

Objective: The purpose of this study was to determine the association between prenatal care in the United States and the neonatal death rate in the presence and absence of antenatal high-risk conditions.

Study Design: Data were derived from the national perinatal mortality data sets for the years 1995 through 1997, which were provided by the National Center for Health Statistics. Analyses were restricted to singleton live births that occurred after 23 completed weeks of gestation.

Prenatal care and black-white fetal death disparity in the United States: heterogeneity by high-risk conditions.

Objective: To determine the impact of prenatal care in the United States on the fetal death rate in the presence and absence of obstetric and medical high-risk conditions, and to explore the role of these high risk conditions in contributing to the black-white disparity.

Methods: This is a population-based, retrospective cohort study using the national perinatal mortality data for 1995-1997 assembled by the National Center for Health Statistics. Fetal death rate (per 1000 births) and adjusted relative risks were derived from multivariable logistic regression models.