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INTRODUCTION Since its approval in 2011, 17-alpha hydroxyprogesterone caproate (17-OHPC, trade name Makena[R], AMAG Pharmaceuticals, Inc, Waltham, MA) has been designated the'standard of care' for treating pregnant patients with a [...]

Affecting 2–4% of pregnancies, pre-eclampsia is a leading cause of maternal death and morbidity worldwide. Using routinely available data, we aimed to develop and validate a novel machine learning-based and clinical setting-responsive time-of-disease model to rule out and rule in adverse maternal outcomes in women presenting with pre-eclampsia.

As the trend toward delayed childbearing continues, ObGyns will encounter more pregnancies among patients of advanced maternal age. Here, a guide for assessing risks and managing pregnancy and delivery. CASE [...]

Society for Maternal‐fetal medicine Consult Series (#46) states “antenatal fetal surveillance is not required for mild idiopathic” polyhydramnios defined as amniotic fluid index (AFI) of 24 cm or a deepest vertical pocket (DVP) between 8 and 11 cm. The objective of this study was to determine the cutoff for DVP which correlates with AFI ≥ 30 cm. This retrospective study of singleton third trimester ultrasounds included a study group randomly divided into test and validation. In the test group, DVP cutoffs correlating with AFI ≥ 30 cm which was used to define moderate–severe polyhydramnios were calculated in two ways, rounded to the nearest whole number: 1) a receiver operating curve and Youden's J statistic (DVP‐Youden) and 2) calculation of the DVP percentile that corresponded with AFI of 30 cm (DVP‐Percentile). Using the validation group, diagnostic characteristics were DVP‐Youden and DVP‐Percentile for diagnosis of AFI ≥ 30 cm and were compared against SMFM cutoffs (DVP‐SMFM). Seventy one thousand eight hundred and ninety three ultrasound exams in the 3rd trimester had assessment of AFI and DVP. Moderate–severe polyhydramnios occurred in 286 (1.2%) in test group and 571 (1.2%) in validation group. AFI of 30 cm corresponded to the 98.9th percentile, which in turn correlated to a DVP of 10 cm (DVP‐Percentile). The calculated cutoff for moderate–severe polyhydramnios was 8 cm for DVP‐Youden. Using 8.0 cm rather than 12.0 cm increased the detection of moderate–severe polyhydramnios to 100% with a false positive rate under 5%. For those utilizing DVP for amniotic fluid evaluation, identification of a DVP ≥ 8.0 cm should prompt further evaluation with complete AFI.

Avert eclamptic seizures by paying close attention to the patient's history, risk factors, vital signs, and symptoms. Here, an expert outlines a systematic response to eclampsia--one that can help preserve [...]

Cesarean delivery is not risk-free, despite its high prevalence (30% overall, but almost 100% in women who have more than two prior cesareans). It increases the risks of adhesions, severe [...]

Because eclampsia occurs but rarely during pregnancy and the postpartum period, most health-care providers have little to no personal experience with management of this life-threatening obstetric emergency. Knowledge about maternal [...]

By the time a pregnancy reaches term, approximately 500 to 800 mL of blood are circulating through the uterus and placenta every minute, thanks to the intricate network of blood [...]

Postpartum hypertension has a host of potential causes, some of which may be benign (such as the persistence of mild gestational hypertension or mild chronic hypertension) whereas others (such as [...]

In the last installment of the Master Class, I addressed the importance of clarity in the classification of hypertensive disorders in pregnancy, and proposed several key diagnostic definitions. Here, I [...]

CASE At risk, or just very pregnant? At her first prenatal visit, a 31-year-old gravida has blood pressure (BP) of 100/60 mm Hg, no proteinuria, and normal weight for her […]

Thrombosis is hypothesized to be the more common mechanism underlying cerebral palsy in many cases of maternal or fetal thrombophilia; for that reason, understanding the impact of maternal and fetal […]

CASE Life on the line A 32-year-old woman in the 24th week of her fourth pregnancy arrives at the emergency department complaining of cough and congestion, shortness of breath, and […]

A pregnant woman whose thyroid gland isn't doing its job presents a serious management problem for her obstetrician. If she has overt hypothyroidism, seen in between 0.3% and 2.5% of […]

A study is conducted to determine whether unscheduled cesarean deliveries have complication rates that vary by shift of occurrence, and morbidities are evaluated by delivery shift hypothesizing that such complications would be more frequent during the night shift (11 PM-7 AM) due to sleep deprivation of staff. Results indicate that though neonatal intensive care unit admissions increase at night, maternal and neonatal complications of cesarean delivery do not increase with delivery during the night shift.

The rate of successful trial of labor after previous cesarean delivery for dystocia is assessed in a large cohort based on the relative birth weights of the two pregnancies. It is likely that increased fetal size relative to previous birth weight plays a significant role in the outcome of a subsequent trial of labor for patients with previous cesarean delivery for dystocia, reducing chances of vaginal delivery.

The success rates of vaginal birth after cesarean (VBAC) delivery, uterine rupture and major maternal/perinatal outcomes are compared between women, with previous cesarean deliveries undergoing trial of labor (TOL) with preterm and term pregnancies, and also maternal and neonatal morbidities in women with preterm pregnancies undergoing a TOL versus repeat cesarean delivery without labor (RCD). The likelihood of VBAC success after TOL in preterm pregnancies is comparable to term gestations, with a lower risk of uterine rupture, and perinatal outcomes are similar with preterm TOL and RCD.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.07.049 Byline: Roberta B. Ness (a), Baha M. Sibai (b) Abstract: Intrauterine growth restriction (IUGR) and preeclampsia differ in their association with maternal disease but share a similar placental pathology. Moreover, mothers who have had pregnancies complicated by preeclampsia or IUGR are at elevated later-life cardiovascular risk. Why, then, do some women develop IUGR and others develop preeclampsia? In this clinical opinion, based on a review of the literature, we hypothesize that both women experiencing preeclampsia and IUGR enter pregnancy with some degree of endothelial dysfunction, a lesion that predisposes to shallow placentation. In our opinion, preeclampsia develops when abnormal placentation, through the mediator of elevated circulating cytokines, interacts with maternal metabolic syndrome, comprised of adiposity, insulin resistance/hyperglycemia, hyperlipidemia, and coagulopathy. IUGR develops in the absence of antenatal metabolic syndrome. Among these women, the baby is affected by shallow placentation but the mother does not develop clinically apparent disease. This conceptualization provides a testable framework for future etiologic studies of preeclampsia and IUGR. Author Affiliation: (a) Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (b) Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH Article History: Received 15 March 2005; Revised 25 May 2005; Accepted 13 July 2005 Article Note: (footnote) Funding by AI44151 and AI48909 from the NIAID; HD30367 from NICHD; and HS10592 from AHRQ.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2006.02.030 Byline: Helen Y. How, Leila Zafaranchi, Caroline L. Stella, Katherine Recht, Rose A. Maxwell, Baha M. Sibai, Joseph A. Spinnato Abstract: The purpose of this study was to determine whether intravenous magnesium sulfate (MgSO.sub.4) followed by oral nifidepine tocolysis in women with preterm labor between 32 0/7 and 34 6/7 weeks' gestation reduces neonatal hospital stay. Author Affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH Article History: Received 7 December 2005; Revised 21 February 2006; Accepted 23 February 2006 Article Note: (footnote) Presented at the 26th Annual Meeting of the Society for Maternal Fetal Medicine, Miami, FL, January 30-February 4, 2006. Reprints not available from the authors.

A study is conducted to determine whether intravenous magnesium sulfate (MgSO4) followed by oral nifidepine tocolysis in women with preterm labor between 32 0/7 and 34 6/7 weeks' gestation reduces neonatal hospital stay. Results reveal that tocolysis after 32 weeks gestation does not reduce neonatal hospital stay.

Few ob/gyns are prepared for the terrifying sight of a pregnant woman in the throes of an eclamptic convulsion. You can't predict which preeclamptic patients will go on to develop [...]

A study was conducted to estimate whether midpregnancy genitourinary tract infection with Chamydia trachomtis is associated with an increased risk of subsequent preterm delivery. The results revealed that the treatment of Chlamydia trachomtis was not associated with a decreased frequency of preterm birth.

The success rates and risks in women with a twin pregnancy who attempt a trial of labor after cesarean delivery are identified. A trial of labor with twins after previous cesarean delivery does not appear to increase maternal morbidity.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2004.12.035 Byline: Michael F. Fesenmeier (a), Kristin H. Coppage (a), Donna S. Lambers (b), John R. Barton (c), Baha M. Sibai (a) Abstract: The purpose of this study was to determine the demographics, clinical presentation, and maternal and neonatal outcomes in patients who were diagnosed with acute fatty liver of pregnancy over a 10-year period. Author Affiliation: (a) Department of Obstetrics and Gynecology, University of Cincinnati (b) Good Samaritan Hospital, Cincinnati, Ohio (c) Central Baptist Hospital, Lexington, Ky Article History: Received 31 August 2004; Revised 19 October 2004; Accepted 7 December 2004

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2004.06.043 Byline: Errol R. Norwitz (a), Mert O. Bahtiyar (a), Baha M. Sibai (b) Abstract: The purpose of this study was to describe current practice patterns for 7 controversial topics in Maternal-Fetal Medicine. Author Affiliation: (a) Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, Yale-New Haven Hospital and Yale University School of Medicine, New Haven, Conn (b) Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio Article Note: (footnote) Presented at the Twenty-Fourth Annual Meeting of the Society for Maternal-Fetal Medicine, February 2-7, 2004, New Orleans, La. Reprints not available from the authors.

The relationship between shorter midtrimester cervical length and the timing of spontaneous preterm birth is examined. Women with shorter cervix length of less than 30 mm before 22 weeks' gestation are at a higher risk of experiencing a spontaneous midtrimester birth.

The effect of number and gestational age of prior spontaneous preterm births on the significance of endovaginal sonographic cervical length less than 25 mm for the prediction of recurrent preterm birth less than 35 weeks' gestation is examined. The positive predictive value for a cervical length less than 25 mm was 80 percent in comparison with 71 percent on analysis in relation to the gestational age group of the prior preterm delivery.

A study was undertaken to determine pregnancy prolongation, and maternal and perinatal outcomes after expectant management of singleton pregnancies with severe preeclampsia between 24 and 33 weeks' gestation. It revealed that expectant management of severe preeclampsia at 24 and 33 weeks in a tertiary care center is associated with good perinatal mortality and neonatal outcome with a minimal risk for the mother.

Observational studies and randomized trials are used to analyze the use of various regiments of magnesium sulfate to prevent or reduce the rate of seizures and complications in women with preeclampsia. The results recommended that magnesium can be used intravenously as a 6 g loading dose over 20 to 30 minutes, and followed by a maintenance dose of 2 g/hour.

A descriptive study is conducted to determine recurrence risk and pregnancy outcome in 23 women with a history of stroke. The findings indicate that women with a history of stroke have a low risk of recurrent stroke.

The association of pregestational diabetes mellitus with the increased incidence of preeclampsia in the pregnant diabetic women is determined. It was observed that there was no increased rate of preeclampia in women with pregestational diabetes mellitus with early-pregnancy proteinuria of 190 to 499 mg/24 hours when compared with women with pregestational diabetes mellitus with proteinuria of less than 190 mg/24 hours.

A study conducted by reviewing the medical records of patients with acute fatty liver of pregnancy and/or pancreatitis over 15 years reveals that pancreatitis is a life threatening complication of acute fatty liver and the patients should undergo screening for abnormality. The appearance of pancreatic abnormalities is after the hepatic and renal dysfunction.

A study is conducted on 658 women with asymptomatic bacterial vaginosis to determine the time course of the regression of asymptomatic bacterial vaginosis in pregnancy with and without treatment and the probability of spontaneous resolution with placebo. Women undergoing placebo treatment had a significant remission of bacterial vaginosis over ten weeks and the remission is more common when the initial vaginal microbiologic disturbance is less.

Research has been conducted on preterm biths. The authors have investigated early pregnancy markers which could predict preterm births, and they report that women with vaginal pH of 4.5 or greater and Gram stain score of 9 to 10 have increased preterm births.

Women with a uterine infection called endometritis can be treated with a once-a-day dose of gentamicin and clindamycin instead of taking three doses every day, according to a study of 110 women. Endometritis can occur in up to 8% of all pregnant women after they have their baby. A once-a-day treatment is less expensive and is less likely to cause side effects.

Having sexual intercourse during pregnancy does not appear to affect the treatment of bacterial vaginosis or the risk of premature birth, according to two large studies of bacterial vaginosis. Bacterial vaginosis is a bacterial infection of the vagina. Some studies suggest that intercourse during pregnancy increases the risk of premature birth but other studies have not confirmed the association.

Pregnant women who have blood in their urine have twice the risk of developing preeclampsia as other pregnant women, according to a study of 4,307 women. Preeclampsia is a serious complication of pregnancy.

Women who smoke but who quit when they learn they are pregnant do not have a lower risk of hypertension or preeclampsia during pregnancy. This is the conclusion of a study of 4,589 women, which contradicts other studies showing a reduced risk of hypertension and preeclampsia in pregnant women who smoke during pregnancy.

Women who have preeclampsia in a second pregnancy have more severe symptoms and a higher risk of premature birth than women who are having their first case of preeclampsia. Women who have had preeclampsia in the past have a very high risk of having it in a subsequent pregnancy.

Pregnant women who have severe high blood pressure are more likely to have a premature delivery or a low-birth-weight baby than women who have mild preeclampsia. Preeclampsia is a complication of pregnancy characterized by high blood pressure and protein in the urine.

A vaginal suppository containing misoprostol is more effective than oral misoprostol in inducing labor, according to a study of 330 pregnant women. However, vaginal misoprostol can adversely affect the uterus.

Preeclampsia does not appear to be caused by excessive oxidation of fats, according to researchers who measured levels of a specific free radical in urine samples from 29 pregnant women with preeclampsia. Preeclampsia is a serious complication of pregnancy.

A predisposition toward increased blood clotting does not appear to increase a woman's risk of preeclampsia of the HELLP sydnrome, according to a study of 110 pregnant women with preeclampsia and 97 healthy pregnant women. Preeclampsia and the HELLP syndrome are serious complications of pregnancy that involve abnormal blood clotting, among other symptoms.

A mutation in the gene for tumor necrosis factor alpha is not more frequent in pregnant women with preeclampsia, nor are they more likely to have elevated blood levels of tumor necrosis factor alpha. Preeclampsia is a serious complication of pregnancy.

Pregnant women who have mild hypertension at any time during the pregnancy have a high risk of developing preeclampsia, a serious complication of pregnancy. In a study of 748 pregnant women with mild hypertension, 46% developed preeclampsia and 10% developed severe preeclampsia.

Antiphospholipid antibodies do not appear to be a risk factor for preeclampsia, a serious complication of pregnancy. This is true even in women with a history of preeclampsia. For this reason, it is probably not necessary to test pregnant women for these autoantibodies.

There appears to be no nutritional factor that can prevent preeclampsia, according to a study of 4,589 pregnant women. Preeclampsia is a serious complication of pregnancy.