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Objective: The purpose of this study was to examine the rate of and risks for abruption and adverse pregnancy outcome after minor trauma in pregnancy., Study Design: This is a 3-year prospective cohort study of patients after noncatastrophic trauma. Data collected included maternal demographics and history, trauma mechanism, and pregnancy outcome. Examination, lab tests including Kleihauer-Betke (KB), and a minimum of 4 hours of fetal monitoring were performed. The primary outcomes were placental abruption and a composite pregnancy morbidity outcome. Univariate and bivariate analysis were performed., Results: Of the 317 patients evaluated for minor trauma, 9 had a positive KB test (2.8%). Delivery information was available on 256 (81%) patients, and there was 1 placental abruption. The 49 cases (19.4%) of composite outcome could not be predicted., Conclusion: Perhaps it is time to reevaluate the extensive evaluations often done after minor trauma in pregnancy, particularly because none of the commonly used objective measures are predictive of adverse outcomes.

Objective: To determine if a policy of universal fetal echocardiography for all pregnant diabetic women is cost-effective as a screening tool for congenital heart defects., Study Design: Using a decision-analysis model, we compared the cost-effectiveness of four screening strategies: (1) none--no ultrasound is performed; (2) selective fetal echocardiography after abnormal detailed anatomic survey; (3) fetal echocardiography for only high hemoglobin A1C, and (4) universal fetal echocardiography for all diabetics. The sensitivity and specificity for each strategy were derived by literature search. The analysis was from a societal perspective using a willingness-to-pay threshold (50,000 dollars) and a theoretic cohort of 40,000 pregnant diabetics. Costs included costs of tests and the costs of complications and of raising a child with a cardiac defect. Outcomes were reported as cost per quality-adjusted life years (QALY) gained for each congenital heart defect prevented by each strategy and the number of congenital heart defects detected. One-way, multiway and probabilistic sensitivity analyses were performed., Results: Compared with the other strategies, selective fetal echocardiography after abnormal detailed anatomic survey costs less per QALY gained for cardiac defect screening. Although universal fetal echocardiography was associated with a higher detection rate for cardiac defects, it was more costly. The sensitivity analyses revealed a robust model over a wide range of values., Conclusion: Under the baseline assumptions, selective fetal echocardiography after an abnormal detailed anatomic survey is more cost-effective compared with universal fetal echocardiography as a screening strategy for cardiac defects in pregnant diabetics., (2006 John Wiley & Sons, Ltd.)

The objective of this study was to compare the perinatal outcomes in growth-restricted (IUGR) twins with a matched group of IUGR singletons. We performed a retrospective cohort study evaluating the perinatal outcomes in IUGR twins matched for gestational age at delivery to the next four IUGR singletons (1:4) in our perinatal database. The perinatal outcomes evaluated included rates of uncorrected perinatal mortality (PMR), admission to the neonatal intensive care unit (NICU), respiratory distress syndrome, grades 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, and length of NICU stay. A cohort of twins with IUGR were matched with a cohort of IUGR singletons and compared for perinatal outcomes. A p value < 0.05 was considered significant. During the study period, we identified 99 IUGR twins meeting our inclusion criteria. These were matched with 396 singletons with IUGR. The mean gestational age at delivery for the twins was 34 +/- 3.8 weeks and 35 +/- 3.5 weeks for the singletons ( p = 0.11). The PMR in twins was significantly higher than in singletons (OR, 2.2; 95% confidence interval, 1.1 to 5.7). Perinatal morbidity was similarly significantly higher in IUGR twins. Compared with age-matched singletons, twins with IUGR have higher perinatal mortality and morbidity rates.