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Purpose of Review: Asthma remains the most common respiratory disease in pregnancy. Identifying risk factors for asthma exacerbations during pregnancy is critical, as uncontrolled asthma can have detrimental effects for both mother and baby. In this review, we discuss recent literature exploring risk factors, fetal and maternal effects, and treatment options for asthma during pregnancy., Recent Findings: Recent literature suggests that optimizing asthma during pregnancy improves outcomes for both mother and baby, as well as later in childhood. Current research affirms that the benefit of asthma medication use outweighs any potential risks related to the medications themselves. Limited information is available regarding the use of newer therapies such as biologics during pregnancy., Summary: Identifying risk factors for asthma exacerbations during pregnancy is critical to prevent adverse outcomes for both mother and baby. Recent evidence continues to affirm the safety of asthma medication use; more studies are needed regarding the use of new therapies during pregnancy., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To estimate the diagnostic accuracy of blind ultrasound sweeps performed with a low-cost, portable ultrasound system by individuals with no prior formal ultrasound training to diagnose common pregnancy complications., Methods: This is a single-center, prospective cohort study conducted from October 2020 to January 2022 among people with second- and third-trimester pregnancies. Nonspecialists with no prior formal ultrasound training underwent a brief training on a simple eight-step approach to performing a limited obstetric ultrasound examination that uses blind sweeps of a portable ultrasound probe based on external body landmarks. The sweeps were interpreted by five blinded maternal-fetal medicine subspecialists. Sensitivity, specificity, and positive and negative predictive values for blinded ultrasound sweep identification of pregnancy complications (fetal malpresentation, multiple gestations, placenta previa, and abnormal amniotic fluid volume) were compared with a reference standard ultrasonogram as the primary analysis. Kappa for agreement was also assessed., Results: Trainees performed 194 blinded ultrasound examinations on 168 unique pregnant people (248 fetuses) at a mean of 28±5.85 weeks of gestation for a total of 1,552 blinded sweep cine clips. There were 49 ultrasonograms with normal results (control group) and 145 ultrasonograms with abnormal results with known pregnancy complications. In this cohort, the sensitivity for detecting a prespecified pregnancy complication was 91.7% (95% CI 87.2-96.2%) overall, with the highest detection rate for multiple gestations (100%, 95% CI 100-100%) and noncephalic presentation (91.8%, 95% CI 86.4-97.3%). There was high negative predictive value for placenta previa (96.1%, 95% CI 93.5-98.8%) and abnormal amniotic fluid volume (89.5%, 95% CI 85.3-93.6%). There was also substantial to perfect mean agreement for these same outcomes (range 87-99.6% agreement, Cohen κ range 0.59-0.91, P<.001 for all)., Conclusion: Blind ultrasound sweeps of the gravid abdomen guided by an eight-step protocol using only external anatomic landmarks and performed by previously untrained operators with a low-cost, portable, battery-powered device had excellent sensitivity and specificity for high-risk pregnancy complications such as malpresentation, placenta previa, multiple gestations, and abnormal amniotic fluid volume, similar to results of a diagnostic ultrasound examination using a trained ultrasonographer and standard-of-care ultrasound machine. This approach has the potential to improve access to obstetric ultrasonography globally., Competing Interests: Financial Disclosure The Butterfly iQ ultrasound system and Apple iPad used in this study were purchased by the study team. The authors and university report no conflicts of interest regarding this equipment. None of the authors are or were in any contractual agreement with Butterfly or Apple regarding the study equipment (other than purchasing) and none serve as speakers/experts for any of the companies. Neither the authors nor the university received any payment, support, or benefits in relation to this study from these companies. Butterfly and Apple did not have any involvement in development of this study, the analysis or review of the data, writing of the manuscript, and did not have any approval or decision making in the submission of this manuscript., (Copyright © 2023 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Objective: We sought to assess whether lack of workplace support for clinical work reductions during pregnancy was associated with major pregnancy complications., Background: Surgeons are at high risk of major pregnancy complications. Although rigorous operative schedules pose increased risk, few reduce their clinical duties during pregnancy., Methods: An electronic survey was distributed to US surgeons who had at least 1 live birth. Lack of workplace support was defined as: (1) desiring but feeling unable to reduce clinical duties during pregnancy due to failure of the workplace/training program to accommodate and/or concerns about financial penalties, burden on colleagues, requirement to make up missed call, being perceived as weak; (2) disagreeing colleagues and/or leadership were supportive of obstetrician-prescribed bedrest. Multivariate logistic regression determined the association between lack of workplace support and major pregnancy complications., Results: Of 671 surgeons, 437 (65.13%) reported lack of workplace support during pregnancy and 302 (45.01%) experienced major pregnancy complications. Surgeons without workplace support were at higher risk of major pregnancy complications than those who had workplace support (odds ratio: 2.44; 95% confidence interval: 1.58-3.75). Bedrest was prescribed to 110/671 (16.39%) surgeons, 38 (34.55%) of whom disagreed that colleagues and/or leadership were supportive. Of the remaining surgeons, 417/560 (74.5%) desired work reductions but were deterred by lack of workplace support., Conclusions: Lack of workplace support for reduction in clinical duties is associated with adverse obstetric outcomes for surgeons. This is a modifiable workplace obstacle that deters surgeons from acting to optimize their infant's and their own health. To ensure the health of expectant surgeons, departmental policies should support reduction of clinical workload in an equitable manner without creating financial penalties, requiring payback for missed call duties, or overburdening colleagues., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

The opioid epidemic is a public health crisis, and pregnancy-associated morbidity and mortality due to substance use highlights the need to prioritize substance use as a major patient safety issue. To assist health care providers with this process and mitigate the effect of substance use on maternal and fetal safety, the National Partnership for Maternal Safety within the Council on Patient Safety in Women's Health Care has created a patient safety bundle to reduce adverse maternal and neonatal health outcomes associated with substance use. The Consensus Bundle on Obstetric Care for Women with Opioid Use Disorder provides a series of evidence-based recommendations to standardize and improve the quality of health care services for pregnant and postpartum women with opioid use disorder, which should be implemented in every maternity care setting. A series of implementation resources have been created to help providers, hospitals, and health systems translate guidelines into clinical practice, and multiple state-level Perinatal Quality Collaboratives are developing quality improvement initiatives to facilitate the bundle-adoption process. Structure, process, and outcome metrics have also been developed to monitor the adoption of evidence-based practices and ensure consistency in clinical care.

Objective: To compare risks of adverse birth outcomes among pregnancies conceived with and without medically assisted reproduction treatments., Methods: Birth certificates were used to study birth outcomes of all neonates born in Utah from 2009 through 2017. Of the 469,919 deliveries, 52.8% (N=248,013) were included in the sample, with 5.2% of the neonates conceived through medically assisted reproduction. The outcome measures included birth weight, gestational age, low birth weight (LBW, less than 2,500 g), preterm birth (less than 37 weeks of gestation), and small for gestational age (SGA, birth weight less than the 10th percentile). Linear models were estimated for the continuous outcomes (birth weight, gestational age), and linear probability models were used for the binary outcomes (LBW, preterm birth, SGA). First, we compared the birth outcomes of neonates born after medically assisted reproduction and natural conception in the overall sample (between-family analyses), before and after adjustment for parental background and neonatal characteristics. Second, we employed family fixed effect models to investigate whether the birth outcomes of neonates conceived through medically assisted reproduction differed from those of their naturally conceived siblings (within-family comparisons)., Results: Neonates conceived through medically assisted reproduction weighed less, were born earlier, and were more likely to be LBW, preterm, and SGA than neonates conceived naturally. More invasive treatments (assisted reproductive technology [ART] and artificial insemination [AI] or intrauterine insemination) were associated with worse birth outcomes; for example, the proportion of LBW and preterm birth was 6.1% and 7.9% among neonates conceived naturally and 25.5% and 29.8% among neonates conceived through ART, respectively. After adjustments for various neonatal and parental characteristics, the differences in birth outcomes between neonates conceived through medically assisted reproduction and naturally were attenuated yet remained statistically significant; for example, neonates conceived through ART were at 3.2 percentage points higher risk for LBW (95% CI 2.4-4.1) and 4.8 percentage points higher risk for preterm birth (95% CI 3.9-5.7). Among siblings, the differences in the frequency of adverse outcomes between neonates conceived through medically assisted reproduction and neonates conceived naturally were small and statistically insignificant for all types of treatments., Conclusion: Medically assisted reproduction treatments are associated with adverse birth outcomes; however, those risks are unlikely to be associated with the infertility treatments itself., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

This review summarizes high-quality evidence supporting delayed umbilical cord clamping to promote placental transfusion to preterm and term neonates. In preterm neonates, delayed cord clamping may decrease mortality and the need for blood transfusions. Although robust data are lacking to guide cord management strategies in many clinical scenarios, emerging literature is reviewed on numerous topics including delivery mode, twin gestations, maternal comorbidities (eg, gestational diabetes, red blood cell alloimmunization, human immunodeficiency virus [HIV] infection, and severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and neonatal complications (eg, fetal growth restriction, congenital heart disease, and the depressed neonate). Umbilical cord milking is an alternate method of rapid placental transfusion, but has been associated with severe intraventricular hemorrhage in extremely preterm neonates. Data on long-term outcomes are discussed, as well as potential contraindications to delayed cord clamping. Overall, delayed cord clamping offers potential benefits to the estimated 140 million neonates born globally every year, emphasizing the importance of this simple and no-cost strategy., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To evaluate the associations of depressive symptoms and antidepressant use during pregnancy with the risks of preterm birth, low birth weight, small for gestational age (SGA), and low Apgar scores., Data Sources: MEDLINE, EMBASE, ClinicalTrials.gov, and PsycINFO up to June 2016., Methods of Study Selection: Data were sought from studies examining associations of depression, depressive symptoms, or use of antidepressants during pregnancy with gestational age, birth weight, SGA, or Apgar scores. Authors shared the raw data of their studies for incorporation into this individual participant data meta-analysis., Tabulation, Integration, and Results: We performed one-stage random-effects meta-analyses to estimate odds ratios (ORs) with 95% CIs. The 215 eligible articles resulted in 402,375 women derived from 27 study databases. Increased risks were observed for preterm birth among women with a clinical diagnosis of depression during pregnancy irrespective of antidepressant use (OR 1.6, 95% CI 1.2-2.1) and among women with depression who did not use antidepressants (OR 2.2, 95% CI 1.7-3.0), as well as for low Apgar scores in the former (OR 1.5, 95% CI 1.3-1.7), but not the latter group. Selective serotonin reuptake inhibitor (SSRI) use was associated with preterm birth among women who used antidepressants with or without restriction to women with depressive symptoms or a diagnosis of depression (OR 1.6, 95% CI 1.0-2.5 and OR 1.9, 95% CI 1.2-2.8, respectively), as well as with low Apgar scores among women in the latter group (OR 1.7, 95% CI 1.1-2.8)., Conclusion: Depressive symptoms or a clinical diagnosis of depression during pregnancy are associated with preterm birth and low Apgar scores, even without exposure to antidepressants. However, SSRIs may be independently associated with preterm birth and low Apgar scores., Systematic Review Registration: PROSPERO, CRD42016035711., Competing Interests: Financial Disclosure Hanan El Marroun disclosed that she received a NARSAD Young Investigator Grant 27853 from the Brain & Behavior Research Foundation. Money was paid to her institution under grant agreement 733206 (LifeCycle) from the European Union's Horizon 2020 Research and Innovation Program and from Erasmus University Rotterdam Fellowship 2014. They also disclosed receiving funding from Stichting Volksbond Rotterdam, ongoing, paid to the institution. Frank M.M.A. van der Heijden disclosed receiving funding from Janssen-Cilag, and Recordati. J. Jo Kim disclosed their institution received funding from the Patient-Centered Outcomes Research Institute and the National Institute of Mental Health. Marius Lahti-Pulkkinen received funding from the Academy of Finland. Dawn Misra disclosed receiving funding from the NIH. Kate E. Pickett disclosed that money was paid to her institution from UKRI and Wellcome Trust. Henning Tiemeier disclosed money was paid to their institution from the Dutch Research Medical Council. Heather J. Zar disclosed that money was paid to her institution from the Bill & Melinda Gates Foundation and the SA MRC. The other authors did not report any potential conflicts of interest., (Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Liver and biliary disease complicates pregnancy in varying degrees of severity to the mother and fetus, and anesthesiologists may be asked to assist in caring for these patients before, during, and after birth of the fetus. Therefore, it is important to be familiar with how different liver diseases impact the pregnancy state. In addition, knowing symptoms, signs, and laboratory markers in the context of a pregnant patient will lead to faster diagnosis and treatment of such patients. This review article discusses changes in physiology of parturients, patients with liver disease, and parturients with liver disease. Next, general treatment of parturients with acute and chronic liver dysfunction is presented. The article progresses to specific liver diseases with treatments as they relate to pregnancy. And finally, important aspects to consider when anesthetizing parturients with liver disease are discussed., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 International Anesthesia Research Society.)

Purpose: Drug use during pregnancy is a critical global challenge, capable of severe impacts on neonatal development. However, the consumption of cannabis and synthetic cannabinoids is on the rise in pregnant women. Obstetric complications with increased risks of miscarriage, fetal growth restriction, and brain development impairment have been associated with perinatal cannabis exposure, but data on synthetic cannabinoid use during pregnancy are limited., Methods: We reviewed studies that investigated the risks associated with cannabis and synthetic cannabinoid use and those that reported the concentrations of cannabinoids and synthetic cannabinoids in maternal (breast milk) and neonatal (placenta, umbilical cord, meconium, and hair) matrices during human pregnancy. A MEDLINE and EMBASE literature search to identify all relevant articles published in English from January 1998 to April 2019 was performed., Results: Cannabis use during pregnancy is associated with increased risks of adverse obstetrical outcomes, although neurobehavioral effects are still unclear. Analyses of cannabinoids in meconium are well documented, but further research on other unconventional matrices is needed. Adverse effects due to perinatal synthetic cannabinoid exposure are still unknown, and analytical data are scarce., Conclusions: Awareness of the hazards of drug use during pregnancy should be improved to encourage health care providers to urge pregnant women to abstain from cannabis and, if cannabis-dependent, seek treatment. Moreover, substances used throughout pregnancy should be monitored as a deterrent to cannabis use, and potential cannabis-dependent women should be identified, so as to limit cannabis-fetal exposure during gestation, and provided appropriate treatment.

It is the position of the International Nurses Society on Addictions that all nurses, in all settings, should be prepared to provide care to patients with alcohol use problems, especially for women of childbearing age. [ABSTRACT FROM AUTHOR]

To conduct a comprehensive bibliometric analysis of research published on intrahepatic cholestasis of pregnancy (ICP) and explore the related frontiers and critical issues concerning it, we searched the Web of Science Core Collection for ICP-related publications from the beginning of 2001 until August of 2023. CiteSpace and VOSviewer were utilized to evaluate the contribution and co-occurrence relationships of various countries and regions, institutes and so on to identify new frontiers and currently exciting topics. Our bibliometric analysis scrutinized 933 articles from 59 countries/regions. China has generated the largest number of publications (31.6% of the total), whereas Germany ranked first when it came to citations per publication. The Imperial College London ranked first with respect to publication output on ICP and betweenness centrality. The Journal of Maternal-Fetal & Neonatal Medicine was the journal with the highest plurality of papers. Authors such as Williamson, Beuers, Ulrich, and Shao were the most influential. Pregnancy, ursodeoxycholic acid, and ICP were principally noted in publications. Cluster analysis of the references that correlated with the 933 publications showed that they clustered into mortality, ABCB11, BSEP, MRP2, bile acid, and intrahepatic cholestasis. ICP is associated with adverse clinical outcomes for both the mother and fetus. This study provides a critical analysis of the current status and future research trends regarding ICP. It can serve as a useful reference, allowing researchers to conduct in-depth investigations into this promising field., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Rationale: Pregnant patients with epilepsy are prone to preterm delivery, stillbirth, or cesarean section, and their mortality rate is almost 10 times higher than that of normal pregnant women. The potential negative influences of antiepileptic drugs (AEDs) on the fetus are weighed against the necessity for achieving optimal control of seizures. Treatment with AEDs during pregnancy is a major challenge for pregnant women and healthcare teams., Patient Concerns: This paper reports two cases of young women diagnosed with pregnancy and epilepsy., Intervention: The dose of levetiracetam was adjusted under the guidance of therapeutic drug monitoring to reduce the effects of seizures on the fetus and the incidence of reproductive toxicity caused by adverse drug reactions., Outcomes: Epilepsy was well controlled in the two pregnant patients, and the newborns had no genetic disorders., Lessons: It is recommended to regularly monitor the serum LEV level in pregnant patients with epilepsy. This practice serves as a foundation for adjusting the drug treatment plan and offering more precise guidance for medication management during pregnancy., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Transient osteoporosis of the hip is indubitably a comparatively infrequent entity affecting both men and women worldwide. Its occurrence in the course of pregnancy, specifically in the third trimester, and lactation are of paramount concernment. The exact association between transient hip osteoporosis and pregnancy is precarious. Etiology and potential pathophysiological mechanisms behind this correlation are still to be utterly defined. Magnetic resonance imaging is highly regarded as the gold standard imaging method for assiduous assessment of this disorder. Physicians of copious medical specialties should practice scrupulous techniques for early and pertinent diagnosis when pregnant women are presented with persistent hip pain, as differential diagnosis with femoral head avascular necrosis can be exceedingly arduous. Treatment is predominantly conservative with protected weight-bearing and analgesic medication in the first line of management. In terms of prognosis, the disease ordinarily resolves spontaneously after a few months. Further research is required in order to elucidate the ambiguity surrounding the establishment of globally approved diagnosis and treatment guidelines for pregnancy-associated transient hip osteoporosis. This paper aims to accentuate the significance of this particular disorder by providing a succinct review of the existing literature, augmenting clinicians' knowledge about the features of pregnancy-related transient proximal femur osteoporosis., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose of Review: A diagnosis of schizophrenia has significant implications for women of childbearing age, pregnant or considering a pregnancy, ranging from sexual health, psychopharmacological treatment, to the occurrence of negative pregnancy and foetal outcomes. We provide a short narrative review of recent papers focusing on these issues., Recent Findings: Although pregnancy rates have been increasing in women with a diagnosis of schizophrenia, they also tend to have altogether fewer pregnancies and fewer live births than women without this diagnosis, and also higher rates of induced abortions.Use of antipsychotics in pregnancy has also increased, and evidence suggests lack of significant contraindications for their use in this period. However, drug levels monitoring may be recommended across the three trimesters, as levels may change in relation to pregnancy-related physiology.Monitoring of physical health is an increasingly crucial issue, given higher risk of gestational diabetes, negative obstetric and infant outcomes in these women., Summary: There is an urgent need to generate valid and reproducible research that could help implement appropriate treatment protocols and relapse-prevention approaches, and interventions based on strong pharmaceutical targets for the benefit of pregnant women with a diagnosis of schizophrenia, their families and their children., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Cleft lip and palate is the most common craniofacial birth defect, and its etiology has been the focus of many reports in the literature. It is well accepted that both genetics and environment play a role in the condition; however, the authors still have not been able to translate what have been learned into clinical applications. This paper provides an interpretation of 2 possible mechanisms leading to cleft lip and palate in humans. First, the authors reflect on the known association between maternal cigarette smoking and risk for cleft lip and palate and the proposed hypoxic mechanism put forward to explain this association. Second, the authors reflect on the difference in frequency between left and right cleft lip and propose that without more extensive clinical definitions, it will be difficult to definitely unveil genetic targets that can be used for counseling.

With the increasing prevalence of obesity, including among women of childbearing age, there is increasing concern regarding the short-term and long-term effects on the offspring of women who are overweight and obese. In this paper we report the results of our review of the recent literature suggesting important adverse short-term and long-term consequences of maternal obesity on their children.

The paper by Robinson posits that risks from prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants are not different from the risks encountered in the general population and that untoward effects of SSRIs are difficult to distinguish from those of the mood disorder. Indeed, maternal depression and anxiety can have negative consequences for fetal and postnatal development. Fortunately, experimental evidence suggests that mood and anxiety disorder symptoms often respond to psychosocial interventions. If pharmacotherapy becomes necessary, it is, however, important to know that even if SSRI drugs have been shown to be safe overall, research has shown that fetal development can be adversely affected by in utero exposure to SSRIs in a subgroup of neonates. Examples would be the transient neonatal adaptation syndrome, an increased risk of persistent pulmonary hypertension of the newborn, and small, albeit measurable, changes in motor and social adaptability in infancy and childhood.

The health and nutritional status of women of reproductive age has tremendous impact on the health of future populations; therefore, special attention should be paid to promoting women's health, especially a healthy weight at this critical time period. The purpose of the paper is to provide information on the nutritional needs of women at various stages of the reproductive age spectrum, including preconception/interconception and during pregnancy to achieve and maintain a healthy weight. The Socio-Ecological Model (SEM) is presented to help practitioners understand the importance of intervening where women of reproductive age live, work, and frequent.

Purpose of Review: Nausea and vomiting of pregnancy (NVP) affects 90% of pregnant women and its impact is often underappreciated. Hyperemesis gravidarum, the most severe end of the spectrum, affects 0.5-2% of pregnancies. The pathogenesis of this condition remains obscure and its management has largely been empirical. This review aims to provide an update on advances in pregnancy hyperemesis focusing on papers published within the past 2 years., Recent Findings: The cause of hyperemesis is continuing to be elaborated. Recent data attest to the effectiveness of the oral doxylamine-pyridoxine in NVP. Follow-up data of children exposed in early pregnancy to doxylamine-pyridoxine for NVP are reassuring. Evidence is increasing for ginger as an effective herbal remedy for NVP. Metoclopramide is effective in NVP and hyperemesis gravidarum, with a good balance of efficacy and tolerability. A recent large-scale study on first trimester exposure to metoclopramide is reassuring of its safety. Evidence is emerging for the treatment of acid reflux to ameliorate NVP. The role of corticosteroids for hyperemesis gravidarum remains controversial. Transpyloric feeding may be warranted for persistent weight loss, despite optimal antiemetic therapy., Summary: Women with significant NVP should be identified so that they can be safely and effectively treated.

Perinatal depression is a serious and disabling disorder that has enduring consequences for both women and their children. Although efficacious pharmacologic strategies are available, many perinatal women are reluctant to continue or start antidepressant medications because of the concern about impact on the fetus or, later, the nursing infant. Weighing the costs and benefits of pharmacologic strategies often requires complex-decision making on the part of obstetric providers and patients. Nonpharmacologic intervention and prevention strategies offer the potential of beneficial outcomes without substantial risk profiles. This paper reviews the evidence base for nonpharmacologic intervention and prevention strategies for depression during pregnancy and the postpartum. The evidence base suggests that efficacious nonpharmacologic options are available for women during pregnancy and postpartum; however, important research questions remain.

Cerebral palsy (CP) affects 2/1000 live-born children. Multiple antenatal factors, including preterm delivery, low birth weight, infection/inflammation, multiple gestation, and other pregnancy complications, are mostly associated with CP in both the preterm and term infant, with birth asphyxia playing a minor role. Owing to the increasing survival of the very preterm and very low birth weight infant secondary to improvements in neonatal and obstetric care, the incidence of CP may be increasing. The focus of this paper is to explore antenatal antecedents as etiologies of CP and the impact of obstetric care on the prevention of CP.

Purpose of Review: This paper reviews the effect of in-vitro fertilization on maternal and perinatal outcomes of pregnancy., Recent Findings: Few randomized, controlled trials have been published in this area due to inherent difficulties in studying this population of infertile women who require in-vitro fertilization. Systematic review of the literature identified published studies that consistently highlighted the higher incidence of maternal and perinatal morbidity associated with pregnancies following in-vitro fertilization., Summary: Some prospective observational studies compare maternal and perinatal outcomes in in-vitro fertilization pregnancies. Larger studies show that adverse pregnancy outcomes such as preeclampsia, gestational hypertension, placental abruption, placenta praevia, and preterm delivery increase significantly with in-vitro fertilization. Perinatal adverse outcomes such as prematurity and those related to plurality of the pregnancy also increase. All patients undergoing in-vitro fertilization should have careful counselling regarding these increased risks prior to treatment.

Purpose of Review: Pregnancy may cause ocular changes, both physiologic and pathologic, and may be associated with the development of new disease or may alter the course of preexisting disease. This paper discusses these changes and reviews diabetic retinopathy, uveitis, preeclampsia, cortical blindness and central serous chorioretinopathy., Recent Findings: Recent reports have contributed to our understanding of the pathophysiology of diabetic retinopathy and cortical blindness associated with preeclampsia, the impact of pregnancy on the course of inflammatory eye disease, and the use of optical coherence tomography in following central serous chorioretinopathy in pregnant women., Summary: This improved understanding of the pathophysiology of ocular disease in pregnancy and the impact of pregnancy on the course of preexisting ocular disease offers the opportunity for meaningful counseling of women who are pregnant or planning to become pregnant.

Objective: The high rate of preterm births is an imposing public health issue in the United States. Past research has suggested that prenatal stress, anxiety, and elevated levels of maternal plasma corticotropin-releasing hormone (CRH) are associated with preterm delivery in humans and animals. Studies to date have not examined all three variables together; that is the objective of this paper., Methods: Data from 282 pregnant women were analyzed to investigate the effect of maternal prenatal anxiety and CRH on the length of gestation. It was hypothesized that at both 18 to 20 weeks (Time 1) and 28 to 30 weeks gestation (Time 2), CRH and maternal prenatal anxiety would be negatively associated with gestational age at delivery. CRH was also expected to mediate the relationship between maternal prenatal anxiety and gestational age at delivery., Results: Findings supported the mediation hypothesis at Time 2, indicating that women with high CRH levels and high maternal prenatal anxiety at 28 to 30 weeks gestation delivered earlier than women with lower CRH levels and maternal prenatal anxiety. Women who delivered preterm had significantly higher rates of CRH at both 18 to 20 weeks gestation and 28 to 30 weeks gestation (p <.001) compared with women who delivered term., Conclusions: These findings are the first to link both psychosocial and neuroendocrine factors to birth outcomes in a prospective design.

Purpose of Review: Neurological disorders are common in women of childbearing age and can lead to maternal death, as evident from previous reports of the Confidential Enquiry into Maternal Deaths in England and Wales. In the last report (1997-1999) alone, there were 34 deaths indirectly caused by neurological disorders., Recent Findings: With the new developments in drugs, investigations and research, clinicians are now more able than ever before to diagnose and treat some disorders. A recent example is the French Study Group on Stroke in Pregnancy., Summary: This paper reviews the current concepts and outlines appropriate management of conditions such as epilepsy, headache, benign intracranial hypertension, myasthenia gravis, multiple sclerosis, Bell's palsy and cerebrovascular disorders.

A conference paper about screening and diagnostic approaches for gestational diabetes mellitus (GDM). This paper, which is the statement issued by National Institutes of Health Consensus Development Conference, discusses the glycemic thresholds for each approach, the effects of these approaches for patients, providers and health care systems in the U.S. and the health pregnant women with or without GDM. The side effects of treating GDM are described.

Objectives: Given the efficacy and safety of recombinant human activated protein C (rhAPC) in the systemic inflammatory response syndrome, this study was designed to review the evidence for a role for APC in the pathogenesis of preeclampsia. Preeclampsia is a proinflammatory and procoagulant state, and it is a pregnancy-specific condition that mimics the systemic inflammatory response syndrome. rhAPC reduces mortality in patients with systemic inflammatory response syndrome and could potentially have a role as disease-modifying therapy in preeclampsia. To determine which patients would be offered rhAPC, the literature pertaining to fetal/neonatal outcomes for preeclampsia remote from term, transplacental transport of protein C, and pregnancy experience with the compound were reviewed., Data Sources: MEDLINE, review papers, hand searches of relevant nonindexed journals, and the bibliographies of relevant textbooks and articles reviewed., Study Selection: Randomized controlled trials were considered to provide the best quality of clinical data. Case-control series were considered over uncontrolled data. Some data were not available in the published literature (e.g., neonatal outcomes at various gestational ages and birthweights after a hypertensive pregnancy; and transplacental transfer of protein C), and these data were determined by us., Data Extraction: Data were extracted by systematic review onto data collection sheets. Because of the quality of the data, this review is primarily qualitative., Data Synthesis: APC levels fall during normal gestation, returning to normal values by 6 wks postpartum. Limited data suggest that early onset preeclampsia is a state of further, and inappropriate, reduction in APC. Preeclampsia resembles systemic inflammatory response syndrome in this regard. After hypertensive pregnancies, neonates have a 50% chance of intact survival if delivered after 27 + 0 wks of gestation with a birthweight of >600 g. It would seem ethical to offer women with preeclampsia with <50% chance of intact perinatal survival novel and potentially disease-modifying therapy such as rhAPC, especially as there is no transplacental transfer of protein C. Limited evidence would support the use of rhAPC in women with severe postpartum preeclampsia., Conclusions: Sufficient data exist to support the use of rhAPC in phase II clinical studies for women with either early onset preeclampsia or severe or deteriorating postpartum disease.

The continuous change in the treatment and management of ovarian tumours is an excellent example of the changes that have occurred in gynaecological laparoscopic surgery. This paper evaluates the management of the adnexal mass in 2001. Second, it reviews ovarian tumours treated at the Department of Obstetrics and Gynaecology, University of Kiel, between January 1997 and December 1998, and the place of laparoscopy in the management of these lesions. Third, the review attempts to give an insight into the long-term follow-up of patients treated laparoscopically for the removal of ovarian cysts. Finally, a retrospective survey is given of the clinical pathology and prognostic features of adnexal masses operated on during pregnancy. With regard to long-term follow-up, no difference was found between laparoscopic or laparotomic treatment of ovarian tumours.

OBJECTIVE: To determine whether antibiotic treatment for bacterial vaginosis or Trichomonas vaginalis during pregnancy decreases the risk of preterm birth and associated adverse outcomes. DATA SOURCES: Pre-MEDLINE and MEDLINE (1966–2003), EMBASE (1980–2003), and the Cochrane Library were searched using the keywords ‘bacterial vaginosis,’ ‘Trichomonas,’ ‘Trichomonas vaginalis,’ ‘Trichomonas vaginitis,’ ‘Trichomonas infections,’ ‘pregnancy,’ ‘pregnant,’ ‘antibiotics,’ and ‘antibiotic prophylaxis.’ METHODS OF STUDY SELECTION: The search produced 1,888 tides, of which 1,256 abstracts were reviewed further. Of these, 1,217 were ineligible. Inclusion criteria were the following: randomized controlled trials in which antibiotics were compared with no antibiotic or placebo, for women in the second or third trimester of pregnancy with symptomatic or asymptomatic bacterial vaginosis or Trichomonas vaginalis, intact membranes, and not in labor. Exclusion criteria were as follows: published in a language other than English, dropout rate of more than 20% of women in either group, and lack of usable outcomes. Of the 39 papers reviewed in detail, 14 studies were included in the meta-analysis. TABULATION, INTEGRATION, AND RESULTS: One of the authors reviewed tides obtained from the searches, and 2 reviewers independently reviewed the abstracts, excluded those that were ineligible, identified eligible papers, and abstracted the data. For women with bacterial vaginosis, antibiotics reduced the risk of persistent infection but did not reduce the risk of preterm birth or the incidence of associated adverse outcomes for the general population or for any subgroup analyzed. For women with Trichomonas vaginalis, metronidazole reduced the risk of persistent infection but increased the incidence of preterm birth. CONCLUSION: Contrary to the conclusions of 3 recent systematic reviews, we found no evidence to support the use of antibiotic treatment for bacterial vaginosis or Trichomonas vaginalis in pregnancy to reduce the risk of preterm birth or its associated morbidities in low- or high-risk women. [ABSTRACT FROM AUTHOR]

Objective: To summarize existing data about the effectiveness of bed rest when used to improve various pregnancy outcomes and to determine how often bed rest is used and the cost associated with its use., Data Sources: We used the MEDLINE data base to search for all English language papers evaluating the effectiveness of bed rest in pregnancy. We also reviewed a number of textbooks and the 1988 National Infant Mortality Survey., Methods of Study Selection: We reviewed these sources for recommendations about using bed rest in various obstetric conditions. We used the 1988 National Infant Mortality Survey to determine how often bed rest was used either to prevent or to treat various obstetric conditions and estimated the costs associated with its use., Data Extraction and Synthesis: Bed rest is used in nearly 20% of all pregnancies to prevent or treat a wide variety of conditions, including spontaneous abortion, preterm labor, fetal growth retardation, edema, chronic hypertension, and preeclampsia. There is little evidence of effectiveness. The estimated costs associated with bed rest, including hospitalization, lost wages, and lost domestic productivity, range from more than $250 million to billions of dollars per year., Conclusions: Bed rest is used extensively to treat a wide variety of pregnancy conditions, at substantial cost but with little proof of effectiveness. We recommend that because this intervention has failed the test of effectiveness, its use during pregnancy should be curtailed unless randomized trials demonstrate improvement in a specific outcome.

As we enter a new era of health care in the United States with limited economic resources, there will be an increasing demand for thoughtful and critical evaluation of the diagnostic tests used in clinical medicine. To interpret the clinical utility of diagnostic tests, the physician must understand the fundamental concepts of sensitivity, specificity, and predictive values. The purpose of this paper is to define these terms, demonstrate the use of receiver operating characteristic curves and Bayes' theorem, and provide clinical examples in obstetrics and gynecology to illustrate their use. Practitioners must be able to interpret the results of diagnostic tests to provide accurate information to their patients.

Articles are reviewed that give the clinician new guidelines to diagnose neural tube defects without using amniocentesis. Cervical measurement using ultrasound as a tool to objectively evaluate and follow patients at risk for premature labor and incompetent cervix are reviewed. The utility of transabdominal versus transvaginal ultrasound is discussed. Two papers are presented that look at the use of aspirin in preeclampsia. One study looks at metabolic degradation of the prostaglandins associated with pregnancy-induced hypertension and shows that there is a heterogeneity in response to aspirin therapy. However, once the patient has pregnancy-induced hypertension, aspirin does not seem to be effective. A paper is presented that looks at the safety of autologous blood donation for both the mother and the baby and confirms its usefulness in obstetrics as in the nonpregnant patient.

SS-A antibody has been found to bind to fetal cardiac tissue and is thought to mediate congenital heart block via transplacental passage. Recent papers have identified various risk factors thought to define subclasses of SS-A antibody-positive mothers at greater risk of delivering children with congenital heart block. Treatment modalities for antibody-mediated fetal insult are now expanding and being used clinically. We report a case of a clinically asymptomatic SS-A antibody-producing mother who gave birth to two SS-A antibody-positive children with congenital heart block. It is our hope that ongoing refinement of risk factors and effective therapy will result in successful in utero palliation of the effects of SS-A antibody.

Pregnancy can be complicated by affective or psychotic illnesses severe enough to threaten the health and life of both mother and fetus. In many cases, nonbiological interventions like psychotherapy or hospitalization in a supportive milieu will be insufficient, and use of a psychotropic drug will be indicated. This paper outlines the characteristics of maternal and fetal physiology that influence drug risks and then reviews the specific risks and benefits associated with antipsychotics, antidepressants, and lithium.

Physical assault by a woman or her partner upon their unborn child has received minimal attention in the psychiatric or obstetric literature. The spectrum concept facilitates the application of knowledge about one type of fetal abuse (e.g., physical assault in response to fetal movements) to other types (e.g., neglect or failure to protect the fetus from chemical assault by alcohol, nicotine, or drugs). Three illustrative case histories are presented, including two cases of assault by the mother via the anterior abdominal wall. Fetal abuse may be one antecedent of child abuse, and this paper attempts to transpose the known correlates of child abuse into an antenatal time framework. The resultant preliminary etiological model also draws upon research findings from neonaticide, the psychology of pregnancy, and the psychology of aggression. In addition, recent research on the maternal-paternal-fetal triad is reviewed in an attempt to delineate under what circumstances ambivalence in the parental-fetal relationship may find expression as fetal abuse. The characteristics of individuals most at risk of perpetrating fetal abuse are outlined.

Thirty-three cases of Asherman syndrome from Yale-New Haven Hospital are presented. Restoration of menses occurred in 91% of patients with pregnancy resulting in 79% of all treated patients. Spontaneous abortion occurred in only one patient (4%), whereas viable pregnancies resulted 96% of the time. Severe obstetric complications excluding premature labor occurred in three cases (12%) and included placenta increta, uterine sacculation, and a paper-thin uterine fundus (ie, uterine dehiscence). These cases are discussed to reinforce considering treated patients with Asherman syndrome to be a high-risk obstetric population, and to counsel and manage these patients accordingly.

The use of ultrasound in obstetrics is well established; however, its use in nonobstetric disease during pregnancy has not been emphasized. A diagnostic work-up during pregnancy is complicated by the fact that many of the usual tests require radiation to the fetus. This paper presents 3 cases in which ultrasonic scanning contributed to the diagnosis of nonobstetric disease during pregnancy. Postitive findings included enlarged edematous pancreas, gallstones, and splenomegaly. In 1 case, the finding of a normal gallbladder was helpful. When usual diagnostic procedures such as oral cholecystogram, retrograde endoscopic pancreatography, and nuclear medicine scans are perhaps contraindicated during pregnancy, the ultrasound scan is the diagnostic test of choice.

Traumatic rupture of the diaphragm may result from trauma or from direct penetrating injuries. The rupture is often an occult injury, which can have a symptom-free interval that may last for years. This paper presents the first 2 reported cases of delayed rupture associated with intrauterine pregnancy. A review of clinical signs and symptoms is presented along with typical radiological findings. Mortality in the nonpregnant state approaches 50% and varies directly with the number of organs involved, the presence of strangulation, and the interval of time from rupture to surgical intervention. The authors conclude that all obstetrical patients with a history of penetrating wounds of the chest or upper abdomen require special evaluation and prompt surgical intervention if delayed rupture of the diaphragm is established.

High-risk pregnancies require specialized obstetric and anesthetic care. A basic understanding of how specific pathophysiology and pharmacologic therapy interact with anesthetic care is essential for both obstetrician and anesthesiologist. This paper selectively focuses on preeclampsia/eclampsia, diabetes mellitus, prematurity, multiple gestations, infectious disease, preexisting neurologic disease, and preexisting cardiac disease, reviewing anesthesia for labor and vaginal and cesarean delivery for each high-risk problem, as practiced at a Level III perinatal unit. Emphasis will be placed, when appropriate, on recent experience with monitoring and aggressive pharmacologic therapy of the critically ill parturient.

The article presents a study which evaluates the quality of logistic regression in the obstetrics and gynecology literature. This paper used logic regression of all articles published in 2005 and 2006. It has been found that logistic regression has become a standard method in obstetrics and gynecology literature.

The article presents a study which investigates maternal cardiac output in the first trimester as a predictor of preeclampsia and delivery of small for gestational age (SGA) infants. In this paper, the authors recorded maternal variables and measured cardiac output by echocardiography among women attending for routine care of gestation. It was found that maternal cardiac output in the first trimester is increased in women who develop preeclampsia and decreased in women who deliver SGA infants.

OBJECTIVE: Conventional antiemetics are burdened with the potential of teratogenic effects during the critical embryogenic period of pregnancy. Thus, a safe and effective medication would be a welcome addition to the therapeutic repertoire. This systematic review was aimed at assessing the evidence for or against the efficacy and safety of ginger (Zingiber officinale) therapy for nausea and vomiting during pregnancy. DATA SOURCES: Systematic literature searches were conducted in 3 computerized databases (MEDLINE, EMBASE, and Cochrane Library), and the reference lists of all papers located were checked for further relevant publications. METHODS OF STUDY SELECTION: For the evaluation of efficacy, only double-blind, randomized controlled trials (RCTs) were included. All retrieved clinical data, including uncontrolled trials, case reports, observational studies, and RCTs, were included in the review of safety. TABULATION, INTEGRATION, AND RESULTS: Six double-blind RCTs with a total of 675 participants and a prospective observational cohort study (n = 187) met all inclusion criteria. The methodological quality of 4 of 5 RCTs was high. Four of the 6 RCTs (n = 246) showed superiority of ginger over placebo; the other 2 RCTs (n = 429) indicated that ginger was as effective as the reference drug (vitamin B6) in relieving the severity of nausea and vomiting episodes. The observational study retrieved and RCTs (including follow-up periods) showed the absence of significant side effects or adverse effects on pregnancy outcomes. There were no spontaneous or case reports of adverse events during ginger treatment in pregnancy. CONCLUSION: Ginger may be an effective treatment for nausea and vomiting in pregnancy. However, more observational studies, with a larger sample size, are needed to confirm the encouraging preliminary data on ginger safety. [ABSTRACT FROM AUTHOR]

The article presents abstracts of various research papers on medical sciences including patients with early-stage breast cancer, use of antidepressants during pregnancy and similar reoperation rates of the pressure used to irrigate open wound fractures.

The article describes the case of a 31-year-old pregnant woman at high risk for opioid use disorder in the hospital setting. Topics discussed include the patient's medical history which is notable for polycystic ovarian syndrome, chronic lower back pain and chronic pancreatitis, several symptoms presented by the woman, and opioid use history.

Background Anal incontinence ( AI) is the involuntary loss of a liquid or solid stool and flatus, resulting in a lifelong profound negative impact on a person's quality of life. One million Australians, half of whom are women, are affected by AI. The aetiology of AI is reported within research literature. Importantly obstetric anal sphincter injury following vaginal delivery is a predominant cause of AI. Factors cited as major risk factors of anal sphincter damage include instrumental delivery, macrosomia and primiparity. The incidence of AI increases with age and with further vaginal delivery. The impact lasts for life. Aim This study aims to identify women's experiences of AI following obstetric anal sphincter injury and their impact on quality of life. Method An extensive online literature search was undertaken within the medical and nursing databases including the Cumulative Index of Nursing and Allied Health Literature, Scopus, Pub Med and Medline. Key search terms included AI, faecal incontinence, anal sphincter injuries, obstetric complications, trauma, obstetric, postnatal care, experiences, women's experience and quality of life. The literature search was further refined through fields that included English language only, literature published between 2000 and 2012 and full-text articles. Findings The review identified a significant amount of research literature that addressed the prevalence and cause of AI. While quality of life questionaries and symptom severity scores have been utilised to assess the impact of AI on a person's life, there are inherent weaknesses in providing the experience of AI on a person's life. Furthermore, there is limited in-depth research that addresses women's experiences of AI following a history of obstetric anal sphincter injury and the impact on their quality of life. Conclusion Research findings contribute to understanding the prevalence, physical, social and emotional impact of AI. While alterations in clinical practice can improve the identification and management of AI, further research that builds on the state of knowledge and seeks a deeper understanding of the issues for women with AI as a result of obstetric anal sphincter injury is required. [ABSTRACT FROM AUTHOR]

Presents an abstract of the paper "A Cost-Benefit Analysis, Diagnosing Bacterial Vaginosis in Pregnancy, Wet-Mount Versus FemExam Card," by Raksha Joshi et al to be presented at the ACOG 52nd Annual Clinical Meeting on May 3, 2004.

Presents an abstract of the paper "Outcomes in Human Immunodeficiency Virus-Infected Pregnant Women Treated with Protease Inhibitors," by Francine H. Einstein to be presented at the ACOG Annual Clinical Meeting on May 2004.