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Background: The definition for anemia in pregnancy is outdated, derived from Scandinavian studies in the 1970's to 1980's. To identity women at risk of blood transfusion, a common cause of Severe Maternal Morbidity, a standard definition of anemia in pregnancy in a modern, healthy United States cohort is needed. Objective: To define anemia in pregnancy in a United States population including a large county vs. private hospital population using uncomplicated patients. Materials and methods: Inclusion criteria were healthy women with the first prenatal visit before 20 weeks. Exclusion criteria included preterm birth, preeclampsia, hypertension, diabetes, short interval pregnancy (<18 months), multiple gestation, abruption, and fetal demise. All women had iron fortification (Ferrous sulfate 325 mg daily) recommended. The presentation to care and pre-delivery hematocrits were obtained, and the percentiles determined. A total of 2000 patients were included, 1000 from the public county hospital and 1000 from the private hospital. Each cohort had 250 patients in each 2011, 2013, 2015, and 2018. The cohorts were compared for differences in the fifth percentile for each antepartum epoch. Student's t-test and chi-squared statistical tests were used for analysis, p-value of ≤0.05 was considered significant. Results: In the public and private populations, 777 and 785 women presented in the first trimester while 223 and 215 presented in the second. The women at the private hospital were more likely to be older, Caucasian race, nulliparous, and present earlier to care. The fifth percentile was compared between the women in the private and public hospitals and were clinically indistinguishable. When combining the cohorts, the fifth percentile for hemoglobin/hematocrit was 11 g/dL/32.8% in the first trimester, 10.3 g/dL/30.6% in the second trimester, and 10.0 g/dL/30.2% pre-delivery. Conclusions: Fifth percentile determinations were made from a combined cohort of normal, uncomplicated pregnancies to define anemia in pregnancy. Comparison of two different cohorts confirms that the same definition for anemia is appropriate regardless of demographics or patient mix. [ABSTRACT FROM AUTHOR]

Objective This study aims to evaluate whether magnesium sulfate administration for neuroprotection prolongs latency in women with preterm premature rupture of membranes (PPROM) between 24 and 316/7 weeks' gestation. Study Design This is a secondary analysis of a randomized controlled trial of magnesium sulfate for prevention of cerebral palsy. Gravid women with a singleton pregnancy between 24 and 316/7 weeks' gestation with PPROM without evidence of labor were randomized to receive magnesium sulfate, administered intravenously as a 6-g bolus followed by a constant infusion of 2 g per hour up to 12 hours, or placebo. Maternal outcomes for this analysiswere delivery in less than 48 hours and in less than 7 days from randomization. Neonatal outcomes included a composite of respiratory distress syndrome, interventricular hemorrhage grades 3 or 4, periventricular leukomalacia, sepsis, necrotizing enterocolitis, retinopathy of prematurity, or death. Results A total of 1,259 women were included. The rate of delivery < 48 hours was not different in the magnesium sulfate and the placebo groups (22.2 and 20.7%, p ј 0.51). Delivery < 7 days was similar between groups (55.4 and 51.4%, p ј 0.16). Median latency was also similar between groups (median [interquartile range], 6.0 days [range, 2.4-13.8 days] and 6.6 days [range, 2.4-15.1 days], p ј 0.29). Composite neonatal outcomes did not differ between groups. Conclusion Magnesium sulfate administration given for neuroprotection in women with a singleton gestation with PPROM and without labor before 32 weeks does not impact latency. [ABSTRACT FROM AUTHOR]

In the article, the authors discusses the prevention of the first cesarean delivery. They cite the forum organized by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists to tackle the concept of preventing the first cesarian delivery. They claim that cesarian delivery is the most commonly performed major surgery in the U.S.

The article highlights a workshop about pregnancy in women with physical disabilities, sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development in the U.S., held on January 25-26, 2010. Department of Health and Human Services Principal Deputy Assistant Secretary Wanda K. Jones opened the workshop. Some of the topics discussed include epidemiology and sociodemographic characteristics, pregnancy outcomes and general risks to both mother and child.

The article discusses the highlights of a workshop about disparities in perinatal medicine, sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development in the U.S., held on August 5-6, 2010. The workshop aimed to identify factors associated with disparities in preterm birth, stillbirth and infant mortality, based on race and ethnicity.

Elevated concentrations of interleukin-6 (IL-6), C-reactive protein (CRP), and matrix metalloproteinase-9 (MMP-9) in fetal and neonatal compartments have been associated with an increased risk for preterm birth (PTB) and/or neonatal morbidity. The purpose of this study was to determine if the maternal serum concentration of IL-6, CRP, and MMP-9 in women at risk for PTB, who are not in labor and have intact membranes, are associated with an increased risk for PTB <32 weeks and/or neonatal morbidity. Maternal serum samples collected from 475 patients enrolled in a multicenter randomized controlled trial of single versus weekly corticosteroids for women at increased risk for preterm delivery were assayed. Serum was collected at randomization (24 to 32 weeks' gestation). Maternal serum concentrations of IL-6, CRP, and MMP-9 were subsequently determined using enzyme-linked immunoassays. Multivariate logistic regression analysis was performed to explore the relationship between maternal serum concentrations of IL-6, CRP, and MMP-9 and PTB <32 weeks, respiratory distress syndrome (RDS), chronic lung disease (CLD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and any sepsis. Maternal serum concentrations of IL-6 and CRP, but not MMP-9, above the 90th percentile at the time of randomization were associated with PTB <32 weeks. In contrast, there was no significant relationship between RDS and NEC and the maternal serum concentration of IL-6, CRP, or MMP-9 (univariate analysis). The development of CLD was associated with a high (above 90th percentile) IL-6 and CRP in maternal serum, even after adjustment for gestational age (GA) at randomization and treatment group. However, when GA at delivery was added to the model, this finding was nonsignificant. Neonatal sepsis was more frequent in neonates born to mothers with a high maternal serum concentration of CRP (>90th percentile). However, there was no significant association after adjustment for GA at randomization and treatment group. Logistic regression analysis for each analyte indicated that high maternal serum concentrations of IL-6 and CRP, but not MMP-9, were associated with an increased risk of IVH (odds ratio [OR] 4.60, 95% confidence interval [CI] 1.86 to 10.68; OR 4.07, 95% CI 1.63 to 9.50) after adjusting for GA at randomization and treatment group. Most babies (25/30) had grade I IVH. When GA at delivery was included, elevated IL-6 remained significantly associated with IVH (OR 2.77, 95% CI 1.02 to 7.09). An elevated maternal serum concentration of IL-6 and CRP are risk factors for PTB <32 weeks and subsequent development of neonatal IVH. An elevated maternal serum IL-6 appears to confer additional risk for IVH even after adjusting for GA at delivery. [ABSTRACT FROM AUTHOR]

The article presents a survey which investigates the factors affecting authors' satisfaction regarding assessment of editorial review in the U.S. The online survey is participated by 445 corresponding author of research manuscripts submitted consecutively during a seven-month period. The survey reveals that the author feedback was more favorable among authors of accepted manuscripts and responses differentiated among aspects of editorials review and reviewers.

The article examines the risk of uterine rupture with a trial of labor in women with multiple and single prior cesarean delivery in the United States. A history of multiple ceserean deliveries is not associated with an increased rate of uterine rupture in women attempting vaginal birth compared with those with a single prior operation.

Objective: To quantify anesthesia-related complications associated with cesarean delivery in a well-described, prospectively ascertained cohort from multiple university-based hospitals in the United States and to evaluate whether certain factors would identify women at increased risk for a failed regional anesthetic. Methods: A prospective observational study was conducted of women (n = 37,142) with singleton gestations undergoing cesarean delivery in the centers forming the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Detailed information was collected regarding choice of anesthesia and procedure-related complications, including failed regional anesthetic and maternal death. Potential risk factors for a failed regional anesthetic were analyzed. Results: Of the women studied, 34,615 (93%) received a regional anesthetic. Few (3.0%) regional procedures failed, and related maternal morbidity was rare. Increased maternal size, higher preoperative risk, rapid decision-to-incision interval, and placement later in labor were all significantly related to an increased risk of a failed regional procedure. Of the general anesthetics, 38% were administered when the decision-to-incision interval was less than 15 minutes. Women deemed at the greatest preoperative risk (American Society of Anesthesiologists score ≥ 4) were approximately 7-fold more likely to receive a general anesthetic (odds ratio 6.9, 95% confidence interval 5.83–8.07). There was one maternal death, due to a failed intubation, in which the anesthetic procedure was directly implicated. Conclusion: Regional techniques have become the preferred method of anesthesia for cesarean delivery. Procedure-related complications are rare and attest to the safety of modern obstetric anesthesia for cesarean delivery in the United States. [ABSTRACT FROM AUTHOR]

This Viewpoint discusses the need to fund and conduct clinical trials that focus on the needs of pregnant women, children, people older than 65 years, and people with intellectual, functional or physical disabilities given that these populations comprise more than half of the US population. [ABSTRACT FROM AUTHOR]

The author reflects on the effort of the government and the people in addressing preterm birth issues in the U.S. She states that Congress has submitted the Prematurity Research Expansion and Education for Mothers who Deliver Infants Early Act, as well as notes that public health campaigns and research studies have been conducted to address the issue. She believes that accepting the challenge, understanding the issue and educating the patients and communities are needed to reduce preterm birth.

Information about the "2008 National Institute of Child of Child Health and Human Development Workshop" which was held in the U.S. in April. The workshop focuses on nomenclature, interpretation and research recommendations for intrapartum electronic fetal heart rate monitoring. The workshop discusses terminology and nomenclature for the description of fetal heart tracings and uterine contractions for use in clinical practice and research.

The article measures decision-to-incision time intervals and maternal and infant outcomes at multiple university-based hospitals comprising the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network in the United States. Approximately one-third of primary cesarean deliveries performed for emergency indications are commenced more than 30 minutes after the decision to operate.

Tort laws aim to deter risky medical practices and increase accountability for harm. This research examines their effects on deterrence of a high-risk obstetric practice in the United States: elective early-term (37-38 weeks gestation) induction of labor. Using birth certificate data from the Natality Detail Files and state-level data from publicly available sources, this study analyzes the effects of tort laws on labor induction with multilevel models (MLM) of 665,491 early-term births nested in states. Results reveal that caps on damages are associated with significantly higher odds of early-term induction and Proportionate Liability (PL) is associated with significantly lower odds compared to Joint and Several Liability (JSL). The findings suggest that clinicians are more likely to engage in practices that defy professional guidelines in tort environments with lower legal burdens. I discuss the implications of the findings for patient safety and the deterrence of high-risk practices. [ABSTRACT FROM AUTHOR]

The article presents a study which analyzed the composite maternal and neonatal results of repeat cesarean deliveries at 19 centers in the U.S. over a period of four years. Composite maternal outcomes include pulmonary edema, cesarean hysterectomy, pelvic abscess, pneumonia and death. Composite neonatal outcomes include respiratory distress, sepsis, ventilation, seizure among others. The study concluded that 39 weeks of gestation is the optimal time for repeat cesarean delivery.

The article discusses a study which investigated the trends in and treatment of preterm births in 39 countries with very high human development index (VHHDI). Study authors examined the factors that increase preterm births in the U.S. between 1989 and 2004, and the prevalence of preterm birth in 39 countries based on target population, incremental coverage increase and intervention efficacy. They suggested a conservative target of five percent relative reduction in preterm birth rates by 2015.

The article presents a study that examines the association between excessive early gestational weight gain and the development of gestation diabetes mellitus (GDM) and excessive fetal growth. It shows that excessive early gestational weight gain occurred in 93% of women who had total gestational weight gain greater than the Institute of Medicine guidelines. It reveals that excessive early gestational weight gain in low-risk nulliparous women is associated with the development of GDM,