Risk factors for massive transfusion in obstetrical hemorrhage and consideration of a whole blood program.

Background: Postpartum hemorrhage (PPH) is one of the leading causes of obstetric complications. The goal of this study was to identify risk factors for obstetric (OB) massive transfusion (MT) and determine the feasibility of developing a low-titer group O RhD-positive whole blood (LTO + WB) protocol for OB hemorrhage.

Study Design And Methods: A retrospective study of OB patients who received transfusion within 24 h.

Comparison of obstetric to institutional antibiogram as an approach to advance antimicrobial stewardship in maternal care.

Objective: To create an antibiogram derived exclusively from our obstetric population and compare the clinical isolates and susceptibilities to our institutional antibiogram.

Methods: Data collected by the University Hospital Clinical Microbiology Laboratory in SSC Soft from 01/01/2018 to 12/31/2018 was used to generate our institutional antibiogram. For comparison, we created an obstetric (OB) antibiogram using all clinical isolates collected during the same time interval from OB triage, labor & delivery, antepartum and postpartum wards.

Whole blood transfusion reduces overall component transfusion in cases of placenta accreta spectrum: a pilot program.

Objective: Placenta accreta spectrum (PAS) is a group of placental invasion pathologies associated with significant morbidity to both mother and fetus. The majority of patients with PAS will require a blood transfusion at time of delivery and subsequent cesarean hysterectomy. The optimal approach to maternal acute blood loss resuscitation is currently unknown.

Whole blood for postpartum hemorrhage: early experience at two institutions.

Background: Death from postpartum hemorrhage (PPH) remains a significant preventable problem worldwide. Cold-stored, low-titer, type-O whole blood (LTOWB) is increasingly being used for resuscitation of injured patients, but it is uncommon in PPH patients, and it is unclear what its role may be in this population.

Study Design And Methods: Brief report of the early experience of WB use for PPH in two institutions, one university hospital and one private hospital.

Prehospital Transfusion of Low-Titer O + Whole Blood for Severe Maternal Hemorrhage: A Case Report.

Beginning in 2017, multiple stakeholders within the Southwest Texas Regional Advisory Council for Trauma collaborated to incorporate cold-stored low-titer O RhD-positive whole blood (LTO + WB) into all phases of their trauma system, including the prehospital phase of care. Although the program was initially focused on trauma resuscitation, it was expanded to included non-traumatic hemorrhagic shock patients that may benefit from whole blood resuscitation. We report the case of a patient with severe maternal hemorrhage secondary to placenta accreta who received a prehospital transfusion of LTO + WB.

Prehospital low-titer cold-stored whole blood: Philosophy for ubiquitous utilization of O-positive product for emergency use in hemorrhage due to injury.

The mortality from hemorrhage in trauma patients remains high. Early balanced resuscitation improves survival. These truths, balanced with the availability of local resources and our goals for positive regional impact, were the foundation for the development of our prehospital whole blood initiative-using low-titer cold-stored O RhD-positive whole blood.

The outpatient institutional antibiogram does not accurately reflect the susceptibility of prepartum group B streptococcal isolates to erythromycin and clindamycin.

This study compared the antimicrobial susceptibilities of 100 nonduplicate group B streptococcal (GBS) isolates from screening cultures of women attending OB-GYN clinics to a similar number of outpatient infection isolates recorded on the institutional antibiogram of a university teaching hospital. The screening GBS isolates were significantly more susceptible to erythromycin (72% versus 45%) and clindamycin (77% versus 48%) than the infection isolates.

The late preterm birth rate and its association with comorbidities in a population-based study.

We sought to identify rates, associated morbidities, and preventable causes of late preterm birth (LPB) in a defined population. We conducted a retrospective cross-sectional analysis using deidentified delivery data for all who delivered in San Antonio/Bexar County, Texas between 2000 and 2008 (N  = 259,576). LPB was defined as a live birth from 34(0/7) to 36(6/7) weeks.

Neonatal intensive care unit admissions and their associations with late preterm birth and maternal risk factors in a population-based study.

Objective: To assess the association of late preterm births (LPB [34(0/7)-36(6/7)]) and maternal risk factors with Neonatal Intensive Care Unit (NICU) admissions.

Methods: A retrospective cross-sectional analysis was conducted using data of all who delivered between 2000 and 2008. Statistical analysis was done using Chi-square and multivariable logistic regression.

The use of laparoscopic surgery in pregnancy: evaluation of safety and efficacy.

Background: Laparoscopic surgery in pregnant women has become increasingly more common since the 1990s; however, the safety of laparoscopy in this population has been widely debated, particularly in emergent and urgent situations.

Methods: A retrospective chart review of all pregnant women following a nonobstetric abdominal operation at a University hospital between 1993 and 2007. Perioperative morbidity and mortality for the mother and fetus were evaluated.

Overweight and obese in gestational diabetes: the impact on pregnancy outcome.

Objective: We sought to investigate the relationship between prepregnancy weight, treatment modality (diet or insulin), level of glycemic control, and pregnancy outcome.

Study Design: We recruited women with gestational diabetes (GDM) from inner city prenatal clinics. All women were instructed in the use of an intensified management protocol using memory reflectance meters.

Gestational diabetes: the consequences of not treating.

Objective: Untreated gestational diabetes mellitus carries significant risks of perinatal morbidity at all severity levels; treatment will enhance outcome.

Study Design: A matched control of 555 gravidas, gestational diabetes mellitus diagnosed after 37 weeks, were compared with 1110 subjects treated for gestational diabetes mellitus and 1110 nondiabetic subjects matched from the same delivery year for obesity, parity, ethnicity, and gestational age at delivery. The nondiabetic subjects and those not treated for gestational diabetes mellitus were matched for prenatal visits.

The association between glucose challenge test, obesity and pregnancy outcome in 6390 non-diabetic women.

Objective: To evaluate the association between obesity, glucose challenge test (GCT) and pregnancy outcome.

Methods: A prospective cohort study of 6854 consecutive gravid patients screened for gestational diabetes (GDM) using 50-gram GCT, at 24-28 weeks' gestation was performed. A screening value 130 mg/dl was followed by 100 gr oral GTT.

Insulin and glyburide therapy: dosage, severity level of gestational diabetes, and pregnancy outcome.

Objective: We sought to investigate the association between glyburide dose, degree of severity in gestational diabetes mellitus (GDM), level of glycemic control, and pregnancy outcome in insulin- and glyburide-treated patients.

Study Design: In a secondary analysis of our previous randomized study, 404 women were analyzed. The association among glyburide dose, severity of GDM, and selected maternal and neonatal factors was evaluated.

The association between preeclampsia and the severity of gestational diabetes: the impact of glycemic control.

Objectives: We sought to determine if the rate of preeclampsia is related to the severity of gestational diabetes mellitus (GDM), and if it can be decreased by optimizing glycemic control.

Study Design: A retrospective analysis of prospectively collective data of 1813 patients with GDM was performed to determine the rate of preeclampsia. Patients were stratified after treatment was begun by level of glycemic control (well controlled was defined as mean blood glucose <95 mg/dL).

Glucose screening in Mexican-American women.

Objective: We sought to describe the predictive value for gestational diabetes mellitus (GDM) using different glucose challenge test thresholds in Mexican-American women.

Methods: A prospective population-based study of 6,857 gravid women, who were tested with a 50-g glucose challenge test at 24-28 weeks of gestation, was performed. A screening value of 130 mg/dL or greater was followed by a 3-hour, 100-g oral glucose tolerance test.

Interferon therapy in primary care.

Interferons are proteins produced by human blood cells in response to stimulation (viral infection). The natural roles of interferons are host defense and modulation of the immune system. Therapeutic uses are based on these roles.

A comparison of glyburide and insulin in women with gestational diabetes mellitus.

Background: Women with gestational diabetes mellitus are rarely treated with a sulfonylurea drug, because of concern about teratogenicity and neonatal hypoglycemia. There is little information about the efficacy of these drugs in this group of women.

Methods: We studied 404 women with singleton pregnancies and gestational diabetes that required treatment.

Group B streptococcus infection rate unchanged by gestational diabetes.

Objective: Group B streptococcal colonization in pregnancy has been associated with adverse perinatal outcomes, including intra-amniotic infection, postpartum endometritis, and neonatal sepsis. We sought to determine whether gestational diabetes increases the risk of maternal and neonatal morbidity from group B streptococcal colonization.

Methods: Gestational diabetic and nondiabetic women who underwent vaginal or anogenital culture for group B streptococcus colonization in pregnancy were followed up for pregnancy outcome.

Electronic fetal monitoring: what's reassuring?

Background: To determine which combinations of fetal heart rate pattern abnormalities are associated with normal outcome in term pregnancies.

Methods: A cohort of 2200 consecutive deliveries was examined and the fetal heart rate tracings analyzed. Singleton, term patients without chorioamnionitis or serious malformations were used to perform logistic regression analysis to select those FHR patterns associated with increased risk for Apgar<7 and cord pH<7.

Delayed appearance of pulmonary maturation markers is associated with poor glucose control in diabetic pregnancies.

Fetuses born after pregnancies complicated by diabetes display delayed pulmonary maturation as measured by the delayed appearance of biochemical indicators of pulmonary maturity (phosphatidylglycerol, lecithin/sphingomyelin ratio) and by the occurrence of hyaline membrane disease even in term gestations. We tested the hypothesis that poor maternal glycemic control is associated with delayed appearance of the biochemical markers of fetal pulmonary maturation. Consecutive diabetic pregnancies with documentation of maternal glycemic control and amniotic fluid analysis for PG were analyzed.

Induction of labor in the nineties: conquering the unfavorable cervix.

Objective: To determine the efficacy, safety, and duration of induced labor using an integrative approach (prostaglandin, amniotomy, oxytocin) and to depict these findings graphically.

Methods: Five hundred ninety-seven pregnancies requiring induction of labor between October 1993 and May 1995 were analyzed prospectively. Patients were categorized by Bishop score at entry and by parity for comparison of success of induction, maternal and fetal complications, and duration of labor.

Chemotherapeutic induction of labour. A rational approach.

Induction of labour, defined as stimulation of uterine contractions before the spontaneous onset of labour, is indicated when the condition of the mother or fetus precludes awaiting the onset of spontaneous labour. In current medical practice, induction of labour comprises 2 phases: cervical priming and induction of contractions. Although numerous agents have been used for cervical priming, the current standard of care is the use of intracervical or intravaginal prostaglandin E2.

Preeclampsia: is induction of labor more successful?

Objective: To test the hypothesis that preeclamptic women are more readily inducible than are nonpreeclamptic women, regardless of cervical condition.

Methods: One hundred eighty-three preeclamptic women and 461 nonpreeclamptic women requiring labor induction were studied prospectively. Patients were categorized by Bishop score, parity, gestational age, and method of induction.

Perinatal outcome in growth-restricted fetuses: do hypertensive and normotensive pregnancies differ?

Objective: To test the hypothesis that fetal growth restriction (FGR) associated with a maternal hypertensive disorder results in worse perinatal outcome than FGR in pregnancies without maternal hypertension.

Methods: All consecutive, singleton, nondiabetic, small for gestational age (SGA) deliveries (birth weight at or below the tenth percentile for gestational age) in a 15-year computerized data base were analyzed for pregnancy outcome. Perinatal outcome was compared after stratification by presence or absence of hypertensive disorders and by gestational age at delivery.