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Objective: Although medications for opioid use disorder improve both maternal and neonatal outcomes, little is known about opioid-exposed infants born during episodes of incarceration. The study sought to ex- amine birth outcomes for infants born with opioid exposure during perinatal incarceration. Methods: Participants were identified from clinic rosters in a South- eastern women’s prison (2016–2019). Included infants born to preg- nant people with opioid use disorder incarcerated in the study facility at the time of delivery. We abstracted hospital length of stay, neonatal opioid withdrawal syndrome (NOWS) severity, and discharge plan from hospital records and report descriptive statistics, analysis of vari- ance F tests, and chi-square tests to compare outcomes by opioid expo- sure type. Results: There were 125 infants born after exposure to methadone (n = 34), buprenorphine (n = 15), oxycodone (n = 22), or no opioid medication (n = 54) during prenatal incarceration. Most infants ex- posed to methadone or buprenorphine had difficulty with eating, sleeping, or consoling (97% and 80%), and 59% and 47% were treated with medication for NOWS, respectively. The majority with prenatal opioid exposure required intervention for NOWS symptoms after their birthing parent was discharged to the prison. The average hospital length of stay was different for infants with no opioid, methadone, buprenorphine, and oxycodone exposure during incarceration (4, 15, 12, and 9 days, respectively, P < 0.001). Conclusions: Neonatal hospitalization experiences of infants with peri- natal opioid exposures during maternal incarceration mirror those of sim- ilarly exposed infants born outside the context of incarceration, except for hospital length of stay. Consideration of avoiding separation of the parent-infant dyad may be needed to improve outcomes for these infants. [ABSTRACT FROM AUTHOR]

Objective: Rapid evaporative ionization mass spectrometry (REIMS) is a metabolomic technique analyzing tissue metabolites, which can be applied intraoperatively in real-time. The objective of this study was to profile the lipid composition of colorectal tissues using REIMS, assessing its accuracy for real-time tissue recognition and risk-stratification. Summary Background Data: Metabolic dysregulation is a hallmark feature of carcinogenesis; however, it remains unknown if this can be leveraged for real-time clinical applications in colorectal disease. Methods: Patients undergoing colorectal resection were included, with carcinoma, adenoma and paired-normal mucosa sampled. Ex vivo analysis with REIMS was conducted using monopolar diathermy, with the aerosol aspirated into a Xevo G2S QToF mass spectrometer. Negatively charged ions over 600 to 1000 m/z were used for univariate and multivariate functions including linear discriminant analysis. Results: A total of 161 patients were included, generating 1013 spectra. Unique lipidomic profiles exist for each tissue type, with REIMS differentiating samples of carcinoma, adenoma, and normal mucosa with 93.1% accuracy and 96.1% negative predictive value for carcinoma. Neoplasia (carcinoma or adenoma) could be predicted with 96.0% accuracy and 91.8% negative predictive value. Adenomas can be risk-stratified by grade of dysplasia with 93.5% accuracy, but not histological subtype. The structure of 61 lipid metabolites was identified, revealing that during colorectal carcinogenesis there is progressive increase in relative abundance of phosphatidylglycerols, sphingomyelins, and mono-unsaturated fatty acid-containing phospholipids. Conclusions: The colorectal lipidome can be sampled by REIMS and leveraged for accurate real-time tissue recognition, in addition to riskstratification of colorectal adenomas. Unique lipidomic features associated with carcinogenesis are described. [ABSTRACT FROM AUTHOR]

Purpose: To assess perceptions of care from woman discharged from an obstetrical (OB) triage unit or a labor and delivery unit with a diagnosis of false or latent labor in order to determine factors that may increase or decrease the woman's satisfaction with care. Study Design: Descriptive, convenience sample. Methods: One hundred low-income pregnant women at term presenting for care in latent labor consented to participate in a telephone survey. The survey was based on the relevant research about care of women in early labor and the Donabedian quality improvement framework assessing structure, process, and outcomes of care. Results: Forty-one percent of women did not want to be discharged home in latent labor. Common reasons included women stating they were in too much pain or they were living too far from the birth setting. Eating, drinking, and comfort measures were the most common measures women cited that would have made them feel better when in the hospital. A reoccurring response from women was their desire for very clear and specific written instructions about how to stay comfortable at home and when to return to the hospital. Clinical Implications Comfort measures in the birth setting, including in triage, should include a variety of options including ambulation and oral nutrition. Detailed and specific written instructions about early labor and staying comfortable while at home have value for women in this survey regarding their perceptions of care. Results from this survey of low-income women suggest that a subset of women in latent labor just do not want to go home and this may be related to having too much pain and/or travel distance to the hospital. Hospital birth settings also have an opportunity to create a care environment that provides services and embodies attributes that women report as important for their satisfaction with care in latent labor. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 14-year old boy with winging scapular who was taken to the clinic following the recurrence of the symptoms. The boy got the bone tumor nine months ago after tackling his brother in a backyard football game. His mother immediately brought him to an emergency department after noticing the large "hump" on his shoulder. It also discusses the common causes of scapular swinging, osteochondroma, and bursa formation.

The article presents a study which compares the maternal and neonatal outcomes of women who underwent second stage cesarean after a failed operative vaginal delivery. Blood transfusion, maternal death, and wound complications were examined for the maternal outcomes. For the neonatal, umbilical artery, stillbirth, and neonatal death were assesed. It concludes there was no association between cesarean delivery after a failed operative vaginal delivery and neonatal adverse outcomes.

The article presents a study which examines the use of whole blood transfusion in the management of hypovolemia due to obstetric hemorrhage. The study observed 66,369 women who gave birth at the Parkland obstetrics service from March 24, 2002 and June 12, 2006. During the study period, 1,540 women received blood transfusion including whole blood and packed red blood cells. The study found out that the risk of tubular necrosis is reduced in mothers receiving whole blood transfusion.

The article presents a study which examines the demographic and clinical features of hantavirus pulmonary syndrome (HPS) from 1993-2006 in Texas. Case report forms and medical records of the patients submitted to the Department of State Health Services were reviewed. Respiratory symptoms, common laboratory features and distribution of the disease are described.

The article examines the infant outcomes when a mother has a vaginal delivery of the first twin and a cesarean delivery of the second twin, and how the delivery affects the short-term morbidity of the second twin. Results showed that endometritis and culture-proven sepsis in the second twin was common in mothers who had combined vaginal/cesarean delivery. However, more serious sequelae such as hypoxic ischemia encephalopathy and death were said to have not been affected in the second twin.

The article reports on a study comparing maternal and neonatal outcomes when primary cesarean delivery is performed in the second and the first stage of labor. Increased maternal but not neonatal composite morbidity is associated with cesarean delivery in the second stage of labor. The study was conducted at 13 university centers comprising the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.

The article presents clinical research on the incidence and type of fetal injury in women who underwent cesarean delivery with forceps or vacuum. Injuries include skin laceration, facial nerve palsy, skull fracture, cephalohematoma, brachial plexus, and clavicular fracture. Factors that influence injury include maternal body mass index and preterm delivery.

The article presents clinical research on the use of magnesium sulfate in the prevention of eclampsia in women experiencing gestational hypertension. The women participants were grouped into those that met the criteria for severe gestational hypertension and those who did not. Results suggest magnesium sulfate is effective in both the prevention and treatment of eclampsia.

OBJECTIVE: To study whether magnetic resonance imaging (MRI) pelvimetry has the ability to identify those women who require cesarean delivery for labor dystocia. METHODS: From July 2003 to April 2004, nulliparous women scheduled for a labor induction for prolonged pregnancy (42 weeks) were asked to participate in a pelvimetry study. Those who consented underwent fast-acquisition MRI that included two 90-second acquisitions to evaluate fetal biometry and volumetry and maternal pelvimetry, including novel measurements of pelvic bony and soft tissue volumes as determined by MRI. Information about each patient's pregnancy, labor course, and neonatal outcome was prospectively collected. Pelvimetry results for those women undergoing operative delivery for labor dystocia were compared with those who did not. Single fetal and maternal pelvic measurements, as well as ratios of both, were analyzed. In addition, previously described radiographic pelvimetry techniques and formulas to predict dystocia were used. RESULTS: One hundred one women underwent MRI, and 22 of these underwent cesarean delivery for dystocia. No single fetal measurement was statistically associated with dystocia. Several maternal pelvic measures, fetal-to-maternal ratios, and previously reported pelvimetric techniques were significantly associated with dystocia. The ratio of magnetic resonance (MR) fetal head volume to pelvic soft tissue volume had statistical significance (P = .04). Receiver operator characteristic curves were developed for the different measurements, ratios, and formulas studied to assess whether any of the techniques could accurately predict labor dystocia requiring operative delivery. The area under the curve values ranged from 0.6 to 0.8, with the ratio of MR head volume to pelvic soft tissue being 0.7. These values suggest that MRI can identify those women at greatest risk for dystocia, but it cannot with accuracy predict which ones will require a cesarean. CONCLUSION: We found significant associations with MRI pelvimetry and labor dystocia, but MRI was not a significant improvement over previously described pelvimetric techniques. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe naturally occurring birth patterns in low-risk women with singleton gestations and spontaneous onset of labor at term. MATERIALS AND METHODS: The timing of birth of women who delivered in the low-risk labor unit at Parkland Hospital, Dallas, Texas, between January 1, 2000, to December 31, 2000, was analyzed. Women admitted to this unit were between 360/7 and 416/7 weeks of gestation, were in spontaneous labor, and had a singleton gestation. Women with contraindications to labor, significant medical problems, a known fetal anomaly, and stillbirths were excluded from analysis. The frequency of birth was analyzed in relation to the time of day, day of week, and month of the year. RESULTS: Low-risk women (n = 6,608) met the study criteria and were included in the analysis. No association was found between the day of the week and the frequency of births (P = .31). Births were most common between the hours of 1 to 2 PM and least common between the hours of 10:00 to 12:00 hours (Central Standard Time, P = .04). Births were more common in the fall September through November, and least common in the winter, December through February. Daylight Saving Time did not affect these results. CONCLUSION: Birth after the spontaneous onset of labor is most common in the early afternoon, and most births occur in the fall. There is no natural association between spontaneous birth in low-risk women and the day of the week. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to determine whether the placental transfer of interleukin (IL)-1α, IL-6, and tumor necrosis factor-α (TNF-α) occurs. METHODS: Four normal-term placentas were perfused for maternal-fetal transfer of the cytokines, 2 placentas for fetal-maternal transfer, and 4 additional placentas were used for an endogenous control. The ex vivo isolated cotyledon human placental perfusion model was used. The reference compound antipyrine was used to determine the transport fraction and clearance index of the cytokines. The cytokines were added to either the maternal or fetal circulations, and samples were collected for 1 hour in a constant-flow open circulation. Cytokine levels were compared between the study and control placentas. Concentrations of the cytokines were measured by sandwich enzyme immunoassay. RESULTS: The clearance index for the maternal-fetal transfer of IL-1α and TNF-α was 0.001, suggesting minimal transfer to the fetal circulation. The clearance index for IL-6 was 0.30, indicating transfer to the fetal circulation. When the cytokines were added to the fetal circulation, the clearance index for IL-1α was 0.001, again indicating minimal transfer. The clearance index for TNF-α in the fetal-maternal study was not determined. IL-6 had a clearance index of 0.23, which was similar to that observed with maternal-fetal transfer. IL-6 concentrations in the study placentas were higher than the concentrations found in the controls. CONCLUSION: There appears to be bidirectional transfer of IL-6 in the healthy-term human placental perfusion model. [ABSTRACT FROM AUTHOR]

: ObjectiveTo estimate the effects of initiation of epidural analgesia on fetal heart rate (FHR) patterns compared with intravenous meperidine analgesia.: MethodsFetal heart rate patterns in 200 nulliparous women with term pregnancies randomized to epidural analgesia with 0.25% bupivacaine were compared with those of 156 similar women given intravenous meperidine. Fetal heart rate patterns occurring within 40 minutes of initiation of labor analgesia were retrospectively read by three maternal–fetal medicine specialists who were blind to clinical events, including type of labor analgesia.: ResultsMeperidine, compared with epidural analgesia, was associated with statistically significantly less beat-to-beat variability (absent or less than 5 beats per minute) of the FHR (30% versus 7% of fetuses, P < .001) in the first 40 minutes after initiation of analgesia, as well as with fewer FHR accelerations (88% versus 62% of fetuses, P < .001). Neither the incidence of FHR decelerations nor the type of deceleration were significantly different between methods of labor analgesia. Specifically, 41% of women given meperidine exhibited FHR decelerations within 40 minutes, compared with 34% given epidural analgesia (P = .353).: ConclusionEpidural analgesia does not have deleterious effects on FHR. [Copyright &y& Elsevier]

: ObjectiveTo determine if oral misoprostol can replace oxytocin for labor stimulation in women with ruptured membranes at term and without evidence of labor.: MethodsNulliparous women at 36 to 41 weeks with a singleton, cephalic-presenting fetus and ruptured membranes without evidence of labor were randomized to receive oral misoprostol (100 μg) or a placebo every 4 hours for a maximum of two doses. Intravenous oxytocin was initiated if active labor had not ensued within 8 hours of the initial study drug dose.: ResultsFifty-one women were randomized to oral misoprostol and 51 women to the placebo. Misoprostol reduced the use of oxytocin stimulation of labor from 90% to 37% (P < .001) and was associated with approximately a 7-hour shorter elapsed time in the labor unit. Uterine hyperactivity, defined as six or more contractions in 10 minutes without fetal heart rate decelerations, occurred in 25% of women randomized to misoprostol. However, uterine hyperactivity associated with fetal heart rate decelerations occurred in only three (6%) women, none of whom required emergency cesarean delivery. Route of delivery and infant outcomes were not related to misoprostol use.: ConclusionOral misoprostol (100 μg) given in a maximum of two doses 4 hours apart significantly reduced the use of oxytocin in the management of women with ruptured membranes without labor at term. [Copyright &y& Elsevier]

: ObjectiveTo determine if maternal serum inhibin-A can be used as a marker for subsequent development of superimposed preeclampsia in women with chronic hypertension.: MethodsSerum for measurement of inhibin-A was obtained at monthly intervals in women with chronic hypertension requiring antihypertensive medications. Superimposed preeclampsia, the primary outcome of interest, was diagnosed when hypertensive women developed proteinuria (at least 300 mg per 24-hour urine specimen). Serum inhibin-A was considered abnormally elevated when the value exceeded the mean plus two standard deviations of the log for chronically hypertensive women who did not develop preeclampsia.: ResultsA total of 61 women were enrolled in this study, and 21 (34%) developed superimposed preeclampsia. Inhibin-A levels increased with advancing gestational age. Ten women had abnormally increased inhibin-A levels; eight (80%) developed superimposed preeclampsia, compared with 13 of 51 (26%) women with normal inhibin-A levels (P < .001). Sensitivity and specificity were 38% and 95%, respectively, whereas the positive and negative predictive values were 80% and 75%, respectively.: ConclusionAlthough inhibin-A was abnormally increased an average of 3 weeks before the clinical onset of superimposed preeclampsia, the sensitivity of the test as a screen was too limited to be clinically useful. [Copyright &y& Elsevier]

OBJECTIVE:To evaluate the use of 3rd trimester inhibin-A levels as an adjunct to assess severity of hypertensive disorders due to pregnancy in women evaluated for preeclampsia.METHODS:Serum inhibin-A concentration was measured in a consecutive series of women evaluated for preeclampsia in the third trimester of pregnancy.RESULTS:Inhibin-A levels were significantly associated with the severity of proteinuric hypertensive disease due to pregnancy. Women with gestational hypertension or those with chronic hypertension without superimposed preeclampsia had levels comparable with normotensive women. The sensitivity to detect proteinuric hypertension was 16%.CONCLUSION:Although inhibin-A levels rise with increasing severity of disease, due to considerable overlap of normal and abnormal serum levels in women with and without preeclampsia, inhibin-A is not a useful adjunct for the classification of hypertensive disorders due to pregnancy. [Copyright &y& Elsevier]

OBJECTIVE:To estimate the effect of epidural analgesia on the Friedman labor curve.METHODS:This study was a secondary analysis of a previously reported randomized trial of the effects of patient-controlled epidural analgesia during labor compared with patient-controlled meperidine on cesarean delivery rate. All subjects had a singleton, cephalic, nonanomalous fetus at or beyond 37 weeks’ gestation. This secondary analysis was limited to women who had cervical dilatation commencing of at least 3 cm (ie, active phase of labor).RESULTS:A total of 459 women were randomized. Twenty-five women were excluded for a cervix less than 3 cm dilated, leaving 220 women allocated to patient-controlled epidural analgesia and 214 to patient-controlled intravenous meperidine available for analysis. There were no significant demographic differences between the two groups, including age, race, gestational age, and cervix on admission. The active phase of labor was 1 hour longer in the epidural-treated group (6.0 ± 3.2 hours versus 5.0 ± 3.2 hours, P < .001). The rate of cervical dilation was significantly less with epidural analgesia (1.4 cm/h versus 1.6 cm/h, P < .002). The duration of the second stage tended to be longer in the epidural group (1.1 ± 1.5 hours versus 0.9 ± 1.0 hours, P = .079).CONCLUSION:Epidural analgesia prolonged the active phase of labor by 1 hour compared with Friedman’s original criteria. [Copyright &y& Elsevier]

TennCare was implemented in Tennessee on January 1, 1994, as the state's replacement program for Medicaid. Created through a demonstration waiver under Section 1115(a) of the Social Security Act, TennCare is unlike any other state Medicaid program in the nation because it includes coverage of uninsured and uninsurable Tennesseans. By contracting with managed care organizations (MCOs) to administer the Medicaid benefit package to TennCare enrollees, the state virtually privatized the program and dramatically shifted the state's responsibility from one of total administration to an oversight function only. Amid provider lawsuits, MCO contract controversy, and general chaos surrounding the new program, the implementation of TennCare created one of the most significant health care events in the state's history. This article provides an overview of the TennCare program and its impact on enrollees, providers, and the state budget. [ABSTRACT FROM AUTHOR]