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BACKGROUND: Dynamic cerebral autoregulation and cerebral perfusion pressure are altered in pregnancies complicated by preeclampsia compared with normotensive pregnancies, but the connections of dynamic cerebral autoregulation, cerebral perfusion pressure, and cerebral complications in preeclampsia remain unclear. OBJECTIVE: This study aimed to assess dynamic cerebral autoregulation and cerebral perfusion pressure after delivery in women with eclampsia, in women with preeclampsia both with and without severe features, and in normotensive women. STUDY DESIGN: This was a prospective case control study at a large referral hospital in Cape Town, South Africa. The recruitment of participants was done at diagnosis (cases) or at admission for delivery (controls). Transcranial Doppler examinations with continuous noninvasive blood pressure measurements and end-tidal CO2 monitoring were conducted for cases and controls after delivery. Cerebral perfusion pressure and dynamic cerebral autoregulation index were calculated, and values were compared among groups. RESULTS: We included 16 women with eclampsia, 18 women with preeclampsia with severe features, 32 women with preeclampsia without severe features, and 21 normotensive women with uncomplicated pregnancies. Dynamic cerebral autoregulation was depressed in pregnant women with eclampsia; (autoregulation index, 3.9; interquartile range, 3.1-5.2) compared with all other groups (those with preeclampsia with severe features, autoregulation index, 5.6 [interquartile range, 4.4-6.8]; those with preeclampsia without severe features, autoregulation index, 6.8 [interquartile range, 5.1-7.4]; and normotensive controls, autoregulation index, 7.1 [interquartile range, 6.1-7.9]). Pregnant women with eclampsia had increased cerebral perfusion pressure (109.5 mm Hg; interquartile range, 91.2-130.9) compared with those with preeclampsia without severe features and those with normal blood pressure (84 mm Hg [interquartile range, 73.0-122.0] a

BACKGROUND: Dynamic cerebral autoregulation and cerebral perfusion pressure are altered in pregnancies complicated by preeclampsia compared with normotensive pregnancies, but the connections of dynamic cerebral autoregulation, cerebral perfusion pressure, and cerebral complications in preeclampsia remain unclear. OBJECTIVE: This study aimed to assess dynamic cerebral autoregulation and cerebral perfusion pressure after delivery in women with eclampsia, in women with preeclampsia both with and without severe features, and in normotensive women. STUDY DESIGN: This was a prospective case control study at a large referral hospital in Cape Town, South Africa. The recruitment of participants was done at diagnosis (cases) or at admission for delivery (controls). Transcranial Doppler examinations with continuous noninvasive blood pressure measurements and end-tidal CO2 monitoring were conducted for cases and controls after delivery. Cerebral perfusion pressure and dynamic cerebral autoregulation index were calculated, and values were compared among groups. RESULTS: We included 16 women with eclampsia, 18 women with preeclampsia with severe features, 32 women with preeclampsia without severe features, and 21 normotensive women with uncomplicated pregnancies. Dynamic cerebral autoregulation was depressed in pregnant women with eclampsia; (autoregulation index, 3.9; interquartile range, 3.1-5.2) compared with all other groups (those with preeclampsia with severe features, autoregulation index, 5.6 [interquartile range, 4.4-6.8]; those with preeclampsia without severe features, autoregulation index, 6.8 [interquartile range, 5.1-7.4]; and normotensive controls, autoregulation index, 7.1 [interquartile range, 6.1-7.9]). Pregnant women with eclampsia had increased cerebral perfusion pressure (109.5 mm Hg; interquartile range, 91.2-130.9) compared with those with preeclampsia without severe features and those with normal blood pressure (84 mm Hg [interquartile range, 73.0-122.0] a

Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. The burden of disease lies mainly in low-middle income countries. The aim of this project is to establish a pre-eclampsia biobank in South Africa to facilitate research in the field of pre-eclampsia with a focus on phenotyping severe disease.The approach of our biobank is to collect biological specimens, detailed clinical data, tests, and biophysical examinations, including magnetic resonance imaging (MRI) of the brain, MRI of the heart, transcranial Doppler, echocardiography, and cognitive function tests.Women diagnosed with pre-eclampsia and normotensive controls are enrolled in the biobank at admission to Tygerberg University Hospital (Cape Town, South Africa). Biological samples and clinical data are collected at inclusion/delivery and during the hospital stay. Special investigations as per above are performed in a subset of women. After two months, women are followed up by telephonic interviews. This project aims to establish a biobank and database for severe organ complications of pre-eclampsia in a low-middle income country where the incidence of pre-eclampsia with organ complications is high. The study integrates different methods to investigate pre-eclampsia, focusing on improved understanding of pathophysiology, prediction of organ complications, and potentially future drug evaluation and discovery.

BACKGROUND: Dynamic cerebral autoregulation and cerebral perfusion pressure are altered in pregnancies complicated by preeclampsia compared with normotensive pregnancies, but the connections of dynamic cerebral autoregulation, cerebral perfusion pressure, and cerebral complications in preeclampsia remain unclear. OBJECTIVE: This study aimed to assess dynamic cerebral autoregulation and cerebral perfusion pressure after delivery in women with eclampsia, in women with preeclampsia both with and without severe features, and in normotensive women. STUDY DESIGN: This was a prospective case control study at a large referral hospital in Cape Town, South Africa. The recruitment of participants was done at diagnosis (cases) or at admission for delivery (controls). Transcranial Doppler examinations with continuous noninvasive blood pressure measurements and end-tidal CO2 monitoring were conducted for cases and controls after delivery. Cerebral perfusion pressure and dynamic cerebral autoregulation index were calculated, and values were compared among groups. RESULTS: We included 16 women with eclampsia, 18 women with preeclampsia with severe features, 32 women with preeclampsia without severe features, and 21 normotensive women with uncomplicated pregnancies. Dynamic cerebral autoregulation was depressed in pregnant women with eclampsia; (autoregulation index, 3.9; interquartile range, 3.1-5.2) compared with all other groups (those with preeclampsia with severe features, autoregulation index, 5.6 [interquartile range, 4.4-6.8]; those with preeclampsia without severe features, autoregulation index, 6.8 [interquartile range, 5.1-7.4]; and normotensive controls, autoregulation index, 7.1 [interquartile range, 6.1-7.9]). Pregnant women with eclampsia had increased cerebral perfusion pressure (109.5 mm Hg; interquartile range, 91.2-130.9) compared with those with preeclampsia without severe features and those with normal blood pressure (84 mm Hg [interquartile range, 73.0-122.0] a

Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. The burden of disease lies mainly in low-middle income countries. The aim of this project is to establish a pre-eclampsia biobank in South Africa to facilitate research in the field of pre-eclampsia with a focus on phenotyping severe disease.The approach of our biobank is to collect biological specimens, detailed clinical data, tests, and biophysical examinations, including magnetic resonance imaging (MRI) of the brain, MRI of the heart, transcranial Doppler, echocardiography, and cognitive function tests.Women diagnosed with pre-eclampsia and normotensive controls are enrolled in the biobank at admission to Tygerberg University Hospital (Cape Town, South Africa). Biological samples and clinical data are collected at inclusion/delivery and during the hospital stay. Special investigations as per above are performed in a subset of women. After two months, women are followed up by telephonic interviews. This project aims to establish a biobank and database for severe organ complications of pre-eclampsia in a low-middle income country where the incidence of pre-eclampsia with organ complications is high. The study integrates different methods to investigate pre-eclampsia, focusing on improved understanding of pathophysiology, prediction of organ complications, and potentially future drug evaluation and discovery.

BACKGROUND: Dynamic cerebral autoregulation and cerebral perfusion pressure are altered in pregnancies complicated by preeclampsia compared with normotensive pregnancies, but the connections of dynamic cerebral autoregulation, cerebral perfusion pressure, and cerebral complications in preeclampsia remain unclear. OBJECTIVE: This study aimed to assess dynamic cerebral autoregulation and cerebral perfusion pressure after delivery in women with eclampsia, in women with preeclampsia both with and without severe features, and in normotensive women. STUDY DESIGN: This was a prospective case control study at a large referral hospital in Cape Town, South Africa. The recruitment of participants was done at diagnosis (cases) or at admission for delivery (controls). Transcranial Doppler examinations with continuous noninvasive blood pressure measurements and end-tidal CO2 monitoring were conducted for cases and controls after delivery. Cerebral perfusion pressure and dynamic cerebral autoregulation index were calculated, and values were compared among groups. RESULTS: We included 16 women with eclampsia, 18 women with preeclampsia with severe features, 32 women with preeclampsia without severe features, and 21 normotensive women with uncomplicated pregnancies. Dynamic cerebral autoregulation was depressed in pregnant women with eclampsia; (autoregulation index, 3.9; interquartile range, 3.1-5.2) compared with all other groups (those with preeclampsia with severe features, autoregulation index, 5.6 [interquartile range, 4.4-6.8]; those with preeclampsia without severe features, autoregulation index, 6.8 [interquartile range, 5.1-7.4]; and normotensive controls, autoregulation index, 7.1 [interquartile range, 6.1-7.9]). Pregnant women with eclampsia had increased cerebral perfusion pressure (109.5 mm Hg; interquartile range, 91.2-130.9) compared with those with preeclampsia without severe features and those with normal blood pressure (84 mm Hg [interquartile range, 73.0-122.0] a

Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. The burden of disease lies mainly in low-middle income countries. The aim of this project is to establish a pre-eclampsia biobank in South Africa to facilitate research in the field of pre-eclampsia with a focus on phenotyping severe disease.The approach of our biobank is to collect biological specimens, detailed clinical data, tests, and biophysical examinations, including magnetic resonance imaging (MRI) of the brain, MRI of the heart, transcranial Doppler, echocardiography, and cognitive function tests.Women diagnosed with pre-eclampsia and normotensive controls are enrolled in the biobank at admission to Tygerberg University Hospital (Cape Town, South Africa). Biological samples and clinical data are collected at inclusion/delivery and during the hospital stay. Special investigations as per above are performed in a subset of women. After two months, women are followed up by telephonic interviews. This project aims to establish a biobank and database for severe organ complications of pre-eclampsia in a low-middle income country where the incidence of pre-eclampsia with organ complications is high. The study integrates different methods to investigate pre-eclampsia, focusing on improved understanding of pathophysiology, prediction of organ complications, and potentially future drug evaluation and discovery.

BACKGROUND: Dynamic cerebral autoregulation and cerebral perfusion pressure are altered in pregnancies complicated by preeclampsia compared with normotensive pregnancies, but the connections of dynamic cerebral autoregulation, cerebral perfusion pressure, and cerebral complications in preeclampsia remain unclear. OBJECTIVE: This study aimed to assess dynamic cerebral autoregulation and cerebral perfusion pressure after delivery in women with eclampsia, in women with preeclampsia both with and without severe features, and in normotensive women. STUDY DESIGN: This was a prospective case control study at a large referral hospital in Cape Town, South Africa. The recruitment of participants was done at diagnosis (cases) or at admission for delivery (controls). Transcranial Doppler examinations with continuous noninvasive blood pressure measurements and end-tidal CO2 monitoring were conducted for cases and controls after delivery. Cerebral perfusion pressure and dynamic cerebral autoregulation index were calculated, and values were compared among groups. RESULTS: We included 16 women with eclampsia, 18 women with preeclampsia with severe features, 32 women with preeclampsia without severe features, and 21 normotensive women with uncomplicated pregnancies. Dynamic cerebral autoregulation was depressed in pregnant women with eclampsia; (autoregulation index, 3.9; interquartile range, 3.1-5.2) compared with all other groups (those with preeclampsia with severe features, autoregulation index, 5.6 [interquartile range, 4.4-6.8]; those with preeclampsia without severe features, autoregulation index, 6.8 [interquartile range, 5.1-7.4]; and normotensive controls, autoregulation index, 7.1 [interquartile range, 6.1-7.9]). Pregnant women with eclampsia had increased cerebral perfusion pressure (109.5 mm Hg; interquartile range, 91.2-130.9) compared with those with preeclampsia without severe features and those with normal blood pressure (84 mm Hg [interquartile range, 73.0-122.0] a

Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. The burden of disease lies mainly in low-middle income countries. The aim of this project is to establish a pre-eclampsia biobank in South Africa to facilitate research in the field of pre-eclampsia with a focus on phenotyping severe disease.The approach of our biobank is to collect biological specimens, detailed clinical data, tests, and biophysical examinations, including magnetic resonance imaging (MRI) of the brain, MRI of the heart, transcranial Doppler, echocardiography, and cognitive function tests.Women diagnosed with pre-eclampsia and normotensive controls are enrolled in the biobank at admission to Tygerberg University Hospital (Cape Town, South Africa). Biological samples and clinical data are collected at inclusion/delivery and during the hospital stay. Special investigations as per above are performed in a subset of women. After two months, women are followed up by telephonic interviews. This project aims to establish a biobank and database for severe organ complications of pre-eclampsia in a low-middle income country where the incidence of pre-eclampsia with organ complications is high. The study integrates different methods to investigate pre-eclampsia, focusing on improved understanding of pathophysiology, prediction of organ complications, and potentially future drug evaluation and discovery.

BACKGROUND: Dynamic cerebral autoregulation and cerebral perfusion pressure are altered in pregnancies complicated by preeclampsia compared with normotensive pregnancies, but the connections of dynamic cerebral autoregulation, cerebral perfusion pressure, and cerebral complications in preeclampsia remain unclear. OBJECTIVE: This study aimed to assess dynamic cerebral autoregulation and cerebral perfusion pressure after delivery in women with eclampsia, in women with preeclampsia both with and without severe features, and in normotensive women. STUDY DESIGN: This was a prospective case control study at a large referral hospital in Cape Town, South Africa. The recruitment of participants was done at diagnosis (cases) or at admission for delivery (controls). Transcranial Doppler examinations with continuous noninvasive blood pressure measurements and end-tidal CO2 monitoring were conducted for cases and controls after delivery. Cerebral perfusion pressure and dynamic cerebral autoregulation index were calculated, and values were compared among groups. RESULTS: We included 16 women with eclampsia, 18 women with preeclampsia with severe features, 32 women with preeclampsia without severe features, and 21 normotensive women with uncomplicated pregnancies. Dynamic cerebral autoregulation was depressed in pregnant women with eclampsia; (autoregulation index, 3.9; interquartile range, 3.1-5.2) compared with all other groups (those with preeclampsia with severe features, autoregulation index, 5.6 [interquartile range, 4.4-6.8]; those with preeclampsia without severe features, autoregulation index, 6.8 [interquartile range, 5.1-7.4]; and normotensive controls, autoregulation index, 7.1 [interquartile range, 6.1-7.9]). Pregnant women with eclampsia had increased cerebral perfusion pressure (109.5 mm Hg; interquartile range, 91.2-130.9) compared with those with preeclampsia without severe features and those with normal blood pressure (84 mm Hg [interquartile range, 73.0-122.0] a

Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. The burden of disease lies mainly in low-middle income countries. The aim of this project is to establish a pre-eclampsia biobank in South Africa to facilitate research in the field of pre-eclampsia with a focus on phenotyping severe disease.The approach of our biobank is to collect biological specimens, detailed clinical data, tests, and biophysical examinations, including magnetic resonance imaging (MRI) of the brain, MRI of the heart, transcranial Doppler, echocardiography, and cognitive function tests.Women diagnosed with pre-eclampsia and normotensive controls are enrolled in the biobank at admission to Tygerberg University Hospital (Cape Town, South Africa). Biological samples and clinical data are collected at inclusion/delivery and during the hospital stay. Special investigations as per above are performed in a subset of women. After two months, women are followed up by telephonic interviews. This project aims to establish a biobank and database for severe organ complications of pre-eclampsia in a low-middle income country where the incidence of pre-eclampsia with organ complications is high. The study integrates different methods to investigate pre-eclampsia, focusing on improved understanding of pathophysiology, prediction of organ complications, and potentially future drug evaluation and discovery.

Objective: Develop a core outcome set of international consensus definitions for severe maternal morbidities. Design: Electronic Delphi study. Setting: International. Population: Eight expert panels. Methods: All 13 high-income countries represented in the International Network of Obstetric Surveillance Systems (INOSS) nominated five experts per condition of morbidity, who submitted possible definitions. From these suggestions, a steering committee distilled critical components: eclampsia: 23, amniotic fluid embolism: 15, pregnancy-related hysterectomy: 11, severe primary postpartum haemorrhage: 19, uterine rupture: 20, abnormally invasive placentation: 12, spontaneous haemoperitoneum in pregnancy: 16, and cardiac arrest in pregnancy: 10. These components were assessed by the expert panel using a 5-point Likert scale, following which a framework for an encompassing definition was constructed. Possible definitions were evaluated in rounds until a rate of agreement of more than 70% was reached. Expert commentaries were used in each round to improve definitions. Main outcome measures: Definitions with a rate of agreement of more than 70%. Results: The invitation to participate in one or more of eight Delphi processes was accepted by 103 experts from 13 high-income countries. Consensus definitions were developed for all of the conditions. Conclusion: Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. These should be used in national registrations and international studies, and should be taken up by the Core Outcomes in Women's and Newborn Health initiative. Tweetable abstract: Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process.

Kathleen M Antony,1,2 Judy Levison,1 Melissa A Suter,1 Susan Raine,1 Grace Chiudzu,3 Henry Phiri,3 Joseph Sclafani,1,3,4 Michael Belfort,1 Peter Kazembe,4 Kjersti M Aagaard1 1Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA; 2Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Wisconsin-Madison, Madison, WI, USA; 3Department of Obstetrics and Gynecology, Kamuzu Central Hospital, Lilongwe, Malawi; 4Baylor College of Medicine Children’s Clinical Center of Excellence, Kamuzu Central Hospital, Lilongwe, Malawi Background: In 2012, we performed a needs assessment and gap analysis to qualitatively assess providers’ and patients’ knowledge and perceptions regarding preterm birth (PTB). During the study, we identified knowledge gaps surrounding methods to reduce the risk of occurrence of PTB and management options if preterm labor/birth occur. We targeted health messages toward these gaps. The objective of the present study was to assess the impact of our community health worker-based patient education program 3 years after it was implemented.Methods: Fifteen focus groups including 70 participants were included in the study. The groups comprised either patients/patient couples or health providers. A minimum of two facilitators led each group using 22 a priori designed and standardized lead-in prompts for participants with four additional prompts for providers only. A single researcher recorded responses, and transcript notes were reviewed by the facilitators and interpreters immediately following each group discussion to ensure accuracy.Results: The understanding of term vs preterm gestation was generally accurate. Every participant knew of women who had experienced PTB, and the general perception was that two to three women out of every ten had this experience. The majority of respondents thought that women should present to their local health clinic if they experienc

Background: Congenital diaphragmatic hernia (CDH) is a congenital anomaly with high mortality and morbidity mainly due to pulmonary hypoplasia and hypertension. Temporary fetal tracheal occlusion to promote prenatal lung growth may improve survival. Entrapment of lung fluid stretches the airways, leading to lung growth. Methods: Fetal endoluminal tracheal occlusion (FETO) is performed by percutaneous sono-endoscopic insertion of a balloon developed for interventional radiology. Reversal of the occlusion to induce lung maturation can be performed by fetoscopy, transabdominal puncture, tracheoscopy, or by postnatal removal if all else fails. Results: FETO and balloon removal have been shown safe in experienced hands. This paper deals with the technical aspects of balloon insertion and removal. While FETO is invasive, it has minimal maternal risks yet can cause preterm birth potentially offsetting its beneficial effects. Conclusion: For left-sided severe and moderate CDH, the procedure is considered investigational and is currently being evaluated in a global randomized clinical trial (https://www.totaltrial.eu/). The procedure can be clinically offered to fetuses with severe right-sided CDH.

Background: Congenital diaphragmatic hernia (CDH) is a congenital anomaly with high mortality and morbidity mainly due to pulmonary hypoplasia and hypertension. Temporary fetal tracheal occlusion to promote prenatal lung growth may improve survival. Entrapment of lung fluid stretches the airways, leading to lung growth. Methods: Fetal endoluminal tracheal occlusion (FETO) is performed by percutaneous sono-endoscopic insertion of a balloon developed for interventional radiology. Reversal of the occlusion to induce lung maturation can be performed by fetoscopy, transabdominal puncture, tracheoscopy, or by postnatal removal if all else fails. Results: FETO and balloon removal have been shown safe in experienced hands. This paper deals with the technical aspects of balloon insertion and removal. While FETO is invasive, it has minimal maternal risks yet can cause preterm birth potentially offsetting its beneficial effects. Conclusion: For left-sided severe and moderate CDH, the procedure is considered investigational and is currently being evaluated in a global randomized clinical trial (https://www.totaltrial.eu/). The procedure can be clinically offered to fetuses with severe right-sided CDH.

BACKGROUND The preferred timing of umbilical-cord clamping in preterm infants is unclear. METHODS We randomly assigned fetuses from women who were expected to deliver before 30 weeks of gestation to either immediate clamping of the umbilical cord (=10 seconds after delivery) or delayed clamping (=60 seconds after delivery). The primary composite outcome was death or major morbidity (defined as severe brain injury on postnatal ultrasonography, severe retinopathy of prematurity, necrotizing enterocolitis, or late-onset sepsis) by 36 weeks of postmenstrual age. Analyses were performed on an intention-to-treat basis, accounting for multiple births. RESULTS Of 1634 fetuses that underwent randomization, 1566 were born alive before 30 weeks of gestation; of these, 782 were assigned to immediate cord clamping and 784 to delayed cord clamping. The median time between delivery and cord clamping was 5 seconds and 60 seconds in the respective groups. Complete data on the primary outcome were available for 1497 infants (95.6%). There was no significant difference in the incidence of the primary outcome between infants assigned to delayed clamping (37.0%) and those assigned to immediate clamping (37.2%) (relative risk, 1.00; 95% confidence interval, 0.88 to 1.13; P=0.96). The mortality was 6.4% in the delayed-clamping group and 9.0% in the immediate-clamping group (P=0.03 in unadjusted analyses; P=0.39 after post hoc adjustment for multiple secondary outcomes). There were no significant differences between the two groups in the incidences of chronic lung disease or other major morbidities. CONCLUSIONS Among preterm infants, delayed cord clamping did not result in a lower incidence of the combined outcome of death or major morbidity at 36 weeks of gestation than immediate cord clamping.

BACKGROUND The preferred timing of umbilical-cord clamping in preterm infants is unclear. METHODS We randomly assigned fetuses from women who were expected to deliver before 30 weeks of gestation to either immediate clamping of the umbilical cord (=10 seconds after delivery) or delayed clamping (=60 seconds after delivery). The primary composite outcome was death or major morbidity (defined as severe brain injury on postnatal ultrasonography, severe retinopathy of prematurity, necrotizing enterocolitis, or late-onset sepsis) by 36 weeks of postmenstrual age. Analyses were performed on an intention-to-treat basis, accounting for multiple births. RESULTS Of 1634 fetuses that underwent randomization, 1566 were born alive before 30 weeks of gestation; of these, 782 were assigned to immediate cord clamping and 784 to delayed cord clamping. The median time between delivery and cord clamping was 5 seconds and 60 seconds in the respective groups. Complete data on the primary outcome were available for 1497 infants (95.6%). There was no significant difference in the incidence of the primary outcome between infants assigned to delayed clamping (37.0%) and those assigned to immediate clamping (37.2%) (relative risk, 1.00; 95% confidence interval, 0.88 to 1.13; P=0.96). The mortality was 6.4% in the delayed-clamping group and 9.0% in the immediate-clamping group (P=0.03 in unadjusted analyses; P=0.39 after post hoc adjustment for multiple secondary outcomes). There were no significant differences between the two groups in the incidences of chronic lung disease or other major morbidities. CONCLUSIONS Among preterm infants, delayed cord clamping did not result in a lower incidence of the combined outcome of death or major morbidity at 36 weeks of gestation than immediate cord clamping.

Alex C Vidaeff, Michael A BelfortDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USAAbstract: Prevention of preterm delivery is a major desiderate in contemporary obstetrics and a societal necessity. The means to achieve this goal remain elusive. Progesterone has been used in an attempt to prevent preterm delivery since the 1970s, but the evidence initially accumulated was fraught by mixed results and was based on mostly underpowered studies with variable eligibility criteria, including history of spontaneous abortion as an indication for treatment. More recent randomized controlled clinical trials restimulated the interest in progesterone supplementation, suggesting that progesterone may favorably influence the rate of preterm delivery. Preterm delivery is a complex disorder and consequently it is unlikely that one generalized prevention strategy will be effective in all patients. Further, an additional impediment in accepting progesterone as the "magic bullet" in the prevention of preterm delivery is that its mechanism of action is not fully understood and the optimal formulations, route of administration, and dose have yet to be established. We have concerned ourselves in this review with the most recent status of 17 alpha-hydroxyprogesterone caproate (17OH-PC) supplementation for prevention of preterm delivery. Our intention is to emphasize the efficacy, safety, and patient acceptability of this intervention, based on a comprehensive and unbiased review of the available literature. Currently there are insufficient data to suggest that 17OH-PC is superior or inferior to natural progesterone. Based on available evidence, we suggest a differential approach giving preferential consideration to either 17OH-PC or other progestins based on obstetric history and cervical surveillance. Progestin therapy for risk factors other than a history of pr

Background: Eclampsia continues to be a major cause of maternal death. Abnormal cerebral blood flow and autoregulation may play an important role in the causation. Doppler ultrasound now allows assessment of the pathophysiology of preeclampsia, and the mechanisms of action of drugs used to treat it. Objectives: The objectives of this thesis were to: (1) define normal ranges for middle cerebral artery velocity, resistance indices, and perfusion pressure in pregnancy, (2) validate a non- invasive method for the measurement of cerebral perfusion pressure (CPP), (3) evaluate cerebral arterial resistance in the middle cerebral artery (MCA) distribution in preeclampsia, (4) contrast CPP in mild and severe preeclampsia, (5) research the hemodynamics of headache in preeclampsia, and (6) compare the effects of magnesium sulfate (MgSO4) and nimodipine on CPP in preeclampsia. Materials and Methods: Normal pregnant and preeclamptic patients were recruited. Vital signs, epidural pressure, and the velocities in cerebral and orbital arteries were measured. Indices of resistance and cerebral perfusion pressure (CPP) were calculated for both groups and compared. Preeclamptic women were studied before and after they had been randomly assigned to receive MgSO4, or nimodipine. Appropriate parametric and non-parametric tests were used in the analysis of the data. A two-tailed p<0.05 denoted statistical significance. Major Findings and Conclusions: 1. Normal pregnancy is associated with a decrease in systolic and mean velocity, no change in the diastolic velocity, a decrease in resistance indices, and an increase in MCA CPP. 2. CPP may be reliably measured in the MCA using a simple Doppler and non-invasive blood pressure technique. 3. Preeclampsia preferentially effects the MCA and disturbs autoregulation in this artery. 4. More than 50% of women with preeclampsia have a normal CPP. In mild preeclampsia, the CPP may be low or high, but in severe preeclampsia, if abnormal, CPP is always h

Background: Eclampsia continues to be a major cause of maternal death. Abnormal cerebral blood flow and autoregulation may play an important role in the causation. Doppler ultrasound now allows assessment of the pathophysiology of preeclampsia, and the mechanisms of action of drugs used to treat it. Objectives: The objectives of this thesis were to: (1) define normal ranges for middle cerebral artery velocity, resistance indices, and perfusion pressure in pregnancy, (2) validate a non- invasive method for the measurement of cerebral perfusion pressure (CPP), (3) evaluate cerebral arterial resistance in the middle cerebral artery (MCA) distribution in preeclampsia, (4) contrast CPP in mild and severe preeclampsia, (5) research the hemodynamics of headache in preeclampsia, and (6) compare the effects of magnesium sulfate (MgSO4) and nimodipine on CPP in preeclampsia. Materials and Methods: Normal pregnant and preeclamptic patients were recruited. Vital signs, epidural pressure, and the velocities in cerebral and orbital arteries were measured. Indices of resistance and cerebral perfusion pressure (CPP) were calculated for both groups and compared. Preeclamptic women were studied before and after they had been randomly assigned to receive MgSO4, or nimodipine. Appropriate parametric and non-parametric tests were used in the analysis of the data. A two-tailed p<0.05 denoted statistical significance. Major Findings and Conclusions: 1. Normal pregnancy is associated with a decrease in systolic and mean velocity, no change in the diastolic velocity, a decrease in resistance indices, and an increase in MCA CPP. 2. CPP may be reliably measured in the MCA using a simple Doppler and non-invasive blood pressure technique. 3. Preeclampsia preferentially effects the MCA and disturbs autoregulation in this artery. 4. More than 50% of women with preeclampsia have a normal CPP. In mild preeclampsia, the CPP may be low or high, but in severe preeclampsia, if abnormal, CPP is always h

Background: Eclampsia continues to be a major cause of maternal death. Abnormal cerebral blood flow and autoregulation may play an important role in the causation. Doppler ultrasound now allows assessment of the pathophysiology of preeclampsia, and the mechanisms of action of drugs used to treat it. Objectives: The objectives of this thesis were to: (1) define normal ranges for middle cerebral artery velocity, resistance indices, and perfusion pressure in pregnancy, (2) validate a non- invasive method for the measurement of cerebral perfusion pressure (CPP), (3) evaluate cerebral arterial resistance in the middle cerebral artery (MCA) distribution in preeclampsia, (4) contrast CPP in mild and severe preeclampsia, (5) research the hemodynamics of headache in preeclampsia, and (6) compare the effects of magnesium sulfate (MgSO4) and nimodipine on CPP in preeclampsia. Materials and Methods: Normal pregnant and preeclamptic patients were recruited. Vital signs, epidural pressure, and the velocities in cerebral and orbital arteries were measured. Indices of resistance and cerebral perfusion pressure (CPP) were calculated for both groups and compared. Preeclamptic women were studied before and after they had been randomly assigned to receive MgSO4, or nimodipine. Appropriate parametric and non-parametric tests were used in the analysis of the data. A two-tailed p<0.05 denoted statistical significance. Major Findings and Conclusions: 1. Normal pregnancy is associated with a decrease in systolic and mean velocity, no change in the diastolic velocity, a decrease in resistance indices, and an increase in MCA CPP. 2. CPP may be reliably measured in the MCA using a simple Doppler and non-invasive blood pressure technique. 3. Preeclampsia preferentially effects the MCA and disturbs autoregulation in this artery. 4. More than 50% of women with preeclampsia have a normal CPP. In mild preeclampsia, the CPP may be low or high, but in severe preeclampsia, if abnormal, CPP is always h

Background: Eclampsia continues to be a major cause of maternal death. Abnormal cerebral blood flow and autoregulation may play an important role in the causation. Doppler ultrasound now allows assessment of the pathophysiology of preeclampsia, and the mechanisms of action of drugs used to treat it. Objectives: The objectives of this thesis were to: (1) define normal ranges for middle cerebral artery velocity, resistance indices, and perfusion pressure in pregnancy, (2) validate a non- invasive method for the measurement of cerebral perfusion pressure (CPP), (3) evaluate cerebral arterial resistance in the middle cerebral artery (MCA) distribution in preeclampsia, (4) contrast CPP in mild and severe preeclampsia, (5) research the hemodynamics of headache in preeclampsia, and (6) compare the effects of magnesium sulfate (MgSO4) and nimodipine on CPP in preeclampsia. Materials and Methods: Normal pregnant and preeclamptic patients were recruited. Vital signs, epidural pressure, and the velocities in cerebral and orbital arteries were measured. Indices of resistance and cerebral perfusion pressure (CPP) were calculated for both groups and compared. Preeclamptic women were studied before and after they had been randomly assigned to receive MgSO4, or nimodipine. Appropriate parametric and non-parametric tests were used in the analysis of the data. A two-tailed p<0.05 denoted statistical significance. Major Findings and Conclusions: 1. Normal pregnancy is associated with a decrease in systolic and mean velocity, no change in the diastolic velocity, a decrease in resistance indices, and an increase in MCA CPP. 2. CPP may be reliably measured in the MCA using a simple Doppler and non-invasive blood pressure technique. 3. Preeclampsia preferentially effects the MCA and disturbs autoregulation in this artery. 4. More than 50% of women with preeclampsia have a normal CPP. In mild preeclampsia, the CPP may be low or high, but in severe preeclampsia, if abnormal, CPP is always h

Background: Eclampsia continues to be a major cause of maternal death. Abnormal cerebral blood flow and autoregulation may play an important role in the causation. Doppler ultrasound now allows assessment of the pathophysiology of preeclampsia, and the mechanisms of action of drugs used to treat it. Objectives: The objectives of this thesis were to: (1) define normal ranges for middle cerebral artery velocity, resistance indices, and perfusion pressure in pregnancy, (2) validate a non- invasive method for the measurement of cerebral perfusion pressure (CPP), (3) evaluate cerebral arterial resistance in the middle cerebral artery (MCA) distribution in preeclampsia, (4) contrast CPP in mild and severe preeclampsia, (5) research the hemodynamics of headache in preeclampsia, and (6) compare the effects of magnesium sulfate (MgSO4) and nimodipine on CPP in preeclampsia. Materials and Methods: Normal pregnant and preeclamptic patients were recruited. Vital signs, epidural pressure, and the velocities in cerebral and orbital arteries were measured. Indices of resistance and cerebral perfusion pressure (CPP) were calculated for both groups and compared. Preeclamptic women were studied before and after they had been randomly assigned to receive MgSO4, or nimodipine. Appropriate parametric and non-parametric tests were used in the analysis of the data. A two-tailed p<0.05 denoted statistical significance. Major Findings and Conclusions: 1. Normal pregnancy is associated with a decrease in systolic and mean velocity, no change in the diastolic velocity, a decrease in resistance indices, and an increase in MCA CPP. 2. CPP may be reliably measured in the MCA using a simple Doppler and non-invasive blood pressure technique. 3. Preeclampsia preferentially effects the MCA and disturbs autoregulation in this artery. 4. More than 50% of women with preeclampsia have a normal CPP. In mild preeclampsia, the CPP may be low or high, but in severe preeclampsia, if abnormal, CPP is always h

Background: Eclampsia continues to be a major cause of maternal death. Abnormal cerebral blood flow and autoregulation may play an important role in the causation. Doppler ultrasound now allows assessment of the pathophysiology of preeclampsia, and the mechanisms of action of drugs used to treat it. Objectives: The objectives of this thesis were to: (1) define normal ranges for middle cerebral artery velocity, resistance indices, and perfusion pressure in pregnancy, (2) validate a non- invasive method for the measurement of cerebral perfusion pressure (CPP), (3) evaluate cerebral arterial resistance in the middle cerebral artery (MCA) distribution in preeclampsia, (4) contrast CPP in mild and severe preeclampsia, (5) research the hemodynamics of headache in preeclampsia, and (6) compare the effects of magnesium sulfate (MgSO4) and nimodipine on CPP in preeclampsia. Materials and Methods: Normal pregnant and preeclamptic patients were recruited. Vital signs, epidural pressure, and the velocities in cerebral and orbital arteries were measured. Indices of resistance and cerebral perfusion pressure (CPP) were calculated for both groups and compared. Preeclamptic women were studied before and after they had been randomly assigned to receive MgSO4, or nimodipine. Appropriate parametric and non-parametric tests were used in the analysis of the data. A two-tailed p<0.05 denoted statistical significance. Major Findings and Conclusions: 1. Normal pregnancy is associated with a decrease in systolic and mean velocity, no change in the diastolic velocity, a decrease in resistance indices, and an increase in MCA CPP. 2. CPP may be reliably measured in the MCA using a simple Doppler and non-invasive blood pressure technique. 3. Preeclampsia preferentially effects the MCA and disturbs autoregulation in this artery. 4. More than 50% of women with preeclampsia have a normal CPP. In mild preeclampsia, the CPP may be low or high, but in severe preeclampsia, if abnormal, CPP is always h

Background: Eclampsia continues to be a major cause of maternal death. Abnormal cerebral blood flow and autoregulation may play an important role in the causation. Doppler ultrasound now allows assessment of the pathophysiology of preeclampsia, and the mechanisms of action of drugs used to treat it. Objectives: The objectives of this thesis were to: (1) define normal ranges for middle cerebral artery velocity, resistance indices, and perfusion pressure in pregnancy, (2) validate a non- invasive method for the measurement of cerebral perfusion pressure (CPP), (3) evaluate cerebral arterial resistance in the middle cerebral artery (MCA) distribution in preeclampsia, (4) contrast CPP in mild and severe preeclampsia, (5) research the hemodynamics of headache in preeclampsia, and (6) compare the effects of magnesium sulfate (MgSO4) and nimodipine on CPP in preeclampsia. Materials and Methods: Normal pregnant and preeclamptic patients were recruited. Vital signs, epidural pressure, and the velocities in cerebral and orbital arteries were measured. Indices of resistance and cerebral perfusion pressure (CPP) were calculated for both groups and compared. Preeclamptic women were studied before and after they had been randomly assigned to receive MgSO4, or nimodipine. Appropriate parametric and non-parametric tests were used in the analysis of the data. A two-tailed p<0.05 denoted statistical significance. Major Findings and Conclusions: 1. Normal pregnancy is associated with a decrease in systolic and mean velocity, no change in the diastolic velocity, a decrease in resistance indices, and an increase in MCA CPP. 2. CPP may be reliably measured in the MCA using a simple Doppler and non-invasive blood pressure technique. 3. Preeclampsia preferentially effects the MCA and disturbs autoregulation in this artery. 4. More than 50% of women with preeclampsia have a normal CPP. In mild preeclampsia, the CPP may be low or high, but in severe preeclampsia, if abnormal, CPP is always h

Background: Eclampsia continues to be a major cause of maternal death. Abnormal cerebral blood flow and autoregulation may play an important role in the causation. Doppler ultrasound now allows assessment of the pathophysiology of preeclampsia, and the mechanisms of action of drugs used to treat it. Objectives: The objectives of this thesis were to: (1) define normal ranges for middle cerebral artery velocity, resistance indices, and perfusion pressure in pregnancy, (2) validate a non- invasive method for the measurement of cerebral perfusion pressure (CPP), (3) evaluate cerebral arterial resistance in the middle cerebral artery (MCA) distribution in preeclampsia, (4) contrast CPP in mild and severe preeclampsia, (5) research the hemodynamics of headache in preeclampsia, and (6) compare the effects of magnesium sulfate (MgSO4) and nimodipine on CPP in preeclampsia. Materials and Methods: Normal pregnant and preeclamptic patients were recruited. Vital signs, epidural pressure, and the velocities in cerebral and orbital arteries were measured. Indices of resistance and cerebral perfusion pressure (CPP) were calculated for both groups and compared. Preeclamptic women were studied before and after they had been randomly assigned to receive MgSO4, or nimodipine. Appropriate parametric and non-parametric tests were used in the analysis of the data. A two-tailed p<0.05 denoted statistical significance. Major Findings and Conclusions: 1. Normal pregnancy is associated with a decrease in systolic and mean velocity, no change in the diastolic velocity, a decrease in resistance indices, and an increase in MCA CPP. 2. CPP may be reliably measured in the MCA using a simple Doppler and non-invasive blood pressure technique. 3. Preeclampsia preferentially effects the MCA and disturbs autoregulation in this artery. 4. More than 50% of women with preeclampsia have a normal CPP. In mild preeclampsia, the CPP may be low or high, but in severe preeclampsia, if abnormal, CPP is always h