Hypertension in pregnancy and adverse outcomes among low-risk nulliparous women expectantly managed at or after 39 weeks: a secondary analysis of a randomised controlled trial.

Objective: To evaluate whether hypertensive disorders of pregnancy (HDP) among low-risk nulliparous women expectantly managed at or after 39 weeks of gestation are associated with adverse outcomes.

Design: Secondary analysis of a randomised trial.

Setting: Multicentre, USA.

Neonatal Birthweight, Infant Feeding, and Childhood Metabolic Markers.

Objective: Antenatal and early neonatal nutritional environment may influence later metabolic health. Infants of mothers with gestational diabetes mellitus (GDM) have higher risk for childhood obesity and metabolic syndrome (MetS). Leptin and adiponectin are known biomarkers for MetS and may guide interventions to reduce later obesity.

Racial and Ethnic Inequities in Cesarean Birth and Maternal Morbidity in a Low-Risk, Nulliparous Cohort.

Objective: To evaluate race and ethnicity differences in cesarean birth and maternal morbidity in low-risk nulliparous people at term.

Methods: We conducted a secondary analysis of a randomized trial of expectant management compared with induction of labor in low-risk nulliparous people at term. The primary outcome was cesarean birth.

Machine Learning Estimation of Low-Density Lipoprotein Cholesterol in Women With and Without HIV.

Introduction: Low-density lipoprotein cholesterol (LDL-C) is typically estimated from total cholesterol, high-density lipoprotein cholesterol, and triglycerides. The Friedewald, Martin-Hopkins, and National Institutes of Health equations are widely used but may estimate LDL-C inaccurately in certain patient populations, such as those with HIV. We sought to investigate the utility of machine learning for LDL-C estimation in a large cohort of women with and without HIV.

Fetal Tachycardia in the Setting of Maternal Intrapartum Fever and Perinatal Morbidity.

Objective: The fetal consequences of intrapartum fetal tachycardia with maternal fever or clinical chorioamnionitis are not well studied. We evaluated the association between perinatal morbidity and fetal tachycardia in the setting of intrapartum fever.

Study Design: Secondary analysis of a multicenter randomized control trial that enrolled 5,341 healthy laboring nulliparous women ≥36 weeks' gestation.

Outcomes in Twins Compared With Singletons Subsequent to Preterm Prelabor Rupture of Membranes.

Objective: To compare maternal and neonatal outcomes after preterm prelabor rupture of membranes (PROM) from 23 to 34 weeks of gestation in twin compared with singleton gestations.

Methods: We conducted a secondary analysis of an obstetric cohort of 115,502 individuals and their singleton or twin neonates born in 25 hospitals nationwide (2008-2011). Those with preterm PROM from 23 0/7 through 33 6/7 weeks of gestation were included; neonates with major fetal anomalies were excluded.

Lessons Learned During the Pandemic: Correlation of QT Intervals Between Telemetry and 12-Lead Electrocardiogram.

Background and objective QT prolongation is associated with an increased risk of ventricular arrhythmias. Since some patients on contact or droplet precautions require QT-prolonging medications, monitoring the QT interval may become imperative to prevent fatal arrhythmias. To limit the exposure of staff to patients during and even after the coronavirus disease 2019 (COVID-19) pandemic and judiciously use personal protective equipment (PPE), it is important to find alternatives to frequent 12-lead electrocardiograms (ECG).

Intrapartum Fetal Electrocardiogram in Small- and Large-for-Gestational Age Fetuses.

Objective: This study aimed to evaluate whether intrapartum fetal electrocardiogram (ECG) tracings with ST-elevation or depression occur more frequently in each stage of labor in small-for-gestational age (SGA) or large-for-gestational age (LGA), as compared with appropriate-for-gestational age (AGA) fetuses.

Study Design: We conducted a secondary analysis of a large, multicenter trial in which laboring patients underwent fetal ECG waveform-analysis. We excluded participants with diabetes mellitus and major fetal anomalies.

Maternal and Neonatal Outcomes in Nulliparous Participants Undergoing Labor Induction by Cervical Ripening Method.

Objective: This study aimed to evaluate maternal and neonatal outcomes by method of cervical ripening for labor induction among low-risk nulliparous individuals.

Study Design: This is a secondary analysis of a multicenter randomized trial of labor induction at 39 weeks versus expectant management in low-risk nulliparous participants. Participants undergoing cervical ripening for labor induction in either group were included.

Intrapartum Resuscitation Interventions for Category II Fetal Heart Rate Tracings and Improvement to Category I.

Objective: To evaluate intrapartum resuscitation interventions and improvement in category II fetal heart rate (FHR) tracings.

Methods: This secondary analysis of a randomized trial of intrapartum fetal electrocardiographic ST-segment analysis included all participants with category II FHR tracings undergoing intrauterine resuscitation: maternal oxygen, intravenous fluid bolus, amnioinfusion, or tocolytic administration. Fetal heart rate pattern-recognition software was used to confirm category II FHR tracings 30 minutes before intervention and to analyze the subsequent 60 minutes.

Postoperative Myocardial Injury in Patients Classified as Low Risk Preoperatively Is Associated With a Particularly Increased Risk of Long-Term Mortality After Noncardiac Surgery.

Background Prior studies have shown an association between myocardial injury after noncardiac surgery (MINS) and all-cause mortality in patients following noncardiac surgery. However, the association between preoperative risk assessments, Revised Cardiac Risk Index and American College of Surgeons National Surgical Quality Improvement Program, and postoperative troponin elevations and long-term mortality is unknown. Methods and Results A retrospective chart review identified 548 patients who had a troponin I level drawn within 14 days of noncardiac surgery that required an overnight hospital stay.

A case of inferior vena cava atresia complicated by bilateral deep vein thrombosis.

In this report, we describe a case of deep vein thrombosis with suspected congenital inferior vena cava atresia treated with thrombolysis, angioplasty, and bilateral "kissing" iliac stent placement. An 18-year-old male presented with left common iliac vein thrombus and suspected congenital inferior vena cava atresia. He was treated over 4 days and discharged on anticoagulation which was continued long-term.

The risk and severity of stroke in patients with atrial fibrillation and gout: A National Representative Database study.

Background: It has been shown that gout is associated with left atrium remodeling and a pro-inflammatory state leading to the development of atrial fibrillation (AF). There is limited evidence whether gout increases the risk of stroke in patients with AF. We assessed the incidence of gout and the risk of stroke in patients with AF.

Lactate as a mediator of prehospital plasma mortality reduction in hemorrhagic shock.

Background: Prehospital plasma transfusion in trauma reduces mortality. However, the underlying mechanism remains unclear. Reduction in shock severity may play a role.

Diagnosis and Management of Renal Cystic Disease of the Newborn: Core Curriculum 2021.

Renal cystic disease encompasses a large variety of illnesses with various phenotypic expressions that can manifest in utero, in infancy, and in childhood. These diseases may be unilateral or bilateral and present with single or multiple cysts. Various cystic diseases may also progress to chronic kidney disease (CKD), including kidney failure, and hepatic disease, thus potentially being life threatening.

A Primary Care Provider's Guide to Pain After Spinal Cord Injury: Screening and Management.

Individuals with spinal cord injury (SCI) often experience chronic pain as a secondary complication. It can significantly impair mental health, sleep, mood, and overall quality of life. It is important for providers within a primary care setting to recognize the different types of pain such as nociceptive and neuropathic.

Interrupted versus continuous magnesium sulfate and blood loss at cesarean delivery.

Objective: Magnesium sulfate is standard of care for prevention of eclampsia in women with preeclampsia with severe features. The American College of Obstetrics and Gynecology endorses its use throughout labor, delivery and the immediate postpartum period. Some providers pause magnesium sulfate infusion preoperatively due to concern for increased risk of uterine atony and postpartum hemorrhage.

A Model to Predict Vaginal Delivery and Maternal and Neonatal Morbidity in Low-Risk Nulliparous Patients at Term.

Objective: This study aimed to develop and validate a model to predict the probability of vaginal delivery (VD) in low-risk term nulliparous patients, and to determine whether it can predict the risk of severe maternal and neonatal morbidity.

Methods: Secondary analysis of an obstetric cohort of patients and their neonates born in 25 hospitals across the United States ( = 115,502). Trained and certified research personnel abstracted the maternal and neonatal records.

Anticoagulation for stroke prevention in patients with hypertrophic cardiomyopathy and atrial fibrillation: A review.

Atrial fibrillation is the most common arrhythmia in patients with hypertrophic cardiomyopathy, with a prevalence of 23% and incidence of 3.1%. The risk of thromboembolism is high in patients with hypertrophic cardiomyopathy regardless of CHADS-VASc score.