Search

Objective: To examine the practices and attitudes of obstetric providers in the state of Michigan on their approach to perinatal oral health.Methods: An online survey was distributed using health care provider databases in the state of Michigan. Descriptive statistics were tabulated and Fisher's Exact Test was used for categorical variables.Results: There were 146 respondents, 80 obstetrician-gynecologist (OB/GYN) and 66 certified nurse midwife (CNM) providers. Eighty percent acknowledged that perinatal oral health is an important consideration for optimal prenatal care, while only 53% reported having questions specific to oral health on their intake documents. Only 35% discussed oral health, 29% performed an oral cavity exam and 42% recommended oral health assessment by a dentist. CNMs were more likely than OB/GYNs to discuss the importance of oral health (48% versus 24%, (p <.05)) and recommend a formal dental assessment (61% versus 26% (p<.05)). These findings demonstrate a dichotomy of care in that obstetric providers recognize the importance of oral health care in pregnancy, but only a minority routinely incorporates these surveillance practices.Conclusion: These data highlight a gap in obstetric services that needs attention through specific educational initiatives and further research endeavors that address health care provider practice and patient barriers. [ABSTRACT FROM AUTHOR]

Nitric oxide (NO) is reported to play significant a role in oocyte activation and maturation, implantation, and early embryonic development. Previously we have shown that NO forms an important component of the oocyte microenvironment, and functions effectively to delay oocyte aging. Thus, precise information about intra-oocyte NO concentrations [NO] will result in designing more accurate treatment plans in assisted reproduction. In this work, the direct, real-time and quantitative intra-oocyte [NO] was measured utilizing an L-shaped amperometric integrated NO-selective electrode. This method not only provides an elegant and convenient approach to real-time the measurement of NO in physiological environments, but also mimics the loss of NO caused by rapid NO diffusion combined with its reactivity in the biological milieu. This experiment suggests that the NO levels of oocytes obtained from young animals are significantly higher than those of oocytes obtained from old animals. Additionally the NO levels stay constant during the measurements; however, the intra-oocyte [NO] is reduced significantly (70–75% reduction) in response to L-NAME incubation, suggesting that NO measurements are truly NOS based rather than caused by an unknown interfering substance in our system. We believe this first demonstration of the direct quantitative measurement of [NO] in situ in an intact cellular complex should be useful in tracking real-time and rapid changes at nanomolar levels. Moreover, this finding confirms and extends our previous work showing that supplementation with NO delays the oocyte aging process. [ABSTRACT FROM AUTHOR]

Despite increased prenatal and postnatal use of array comparative genomic hybridization (aCGH), isolated 8p23.1 duplication remains rare and has been associated with a widely variable phenotype. Here, we report an isolated 8p23.1 duplication in a fetus with an omphalocele and encephalocele that were incompatible with life. Prenatal aCGH demonstrated a 3.75 Mb de novo duplication of 8p23.1. This region encompassed 54 genes, 21 of which are described in OMIM, including SOX7 and GATA4. The summarized case demonstrates phenotypic features not previously described in 8p23.1 duplication syndrome and is reported in order to enhance understanding of the phenotypic variation. [ABSTRACT FROM AUTHOR]

Neonatal brachial plexus injury (BPI) is a birth outcome characterized by injury to the brachial plexus identified after delivery. Though uncommon, its potential occurrence following delivery is concerning for both the delivering clinician as well as the pediatric team. Considerable research looking at delivery factors, including forces applied at the time of delivery and management of the BPI after it has occurred, has led to a better understanding, if not a lower rate, of BPI. This information is reviewed below. [ABSTRACT FROM AUTHOR]

Pregnant women and infants are at an increased risk for the complications of influenza. Severe disease, emergency department visits and hospitalizations occur as frequently in these groups as in the elderly and those with chronic diseases. None of the US FDA-licensed influenza vaccines are approved for use in infants under 6 months of age and, despite long-standing recommendations, pregnant women are rarely immunized against influenza. The paper under evaluation has an important place in scientific understanding and advancement. These data not only help to reassure providers and pregnant women that the current Advisory Committee on Immunization Practices recommendation for influenza vaccination in pregnancy is well founded, but also provide strong evidence for a neonatal benefit to maternal influenza vaccination. [ABSTRACT FROM AUTHOR]

Objective: Much of our understanding and knowledge of shoulder dystocia has been blurred by inconsistent and scientific studies that are of limited scientific quality. In an evidence-based format, we sought to answer the following questions: (1) is shoulder dystocia predictable? (2) Can shoulder dsytocia be prevented? (3) When shoulder dystocia does occur, what maneuvers should be performed? and (4) What are the sequelae of shoulder dystocia? Studs, design: Electronic databases, including PUBMED and the Cochrane Database, were searched using the key word "shoulder dystocia." We also performed a manual review of articles included in the bibliographies of these selected articles to further define articles for review. Only those articles published in the English language were eligible for inclusion. Results: There is a significantly increased risk of shoulder dystocia as birth weight linearly increases. From a prospective point of view, however, prepregnancy and antepartum risk factors have exceedingly poor predictive value for the prediction of shoulder dystocia. Late pregnancy ultrasound likewise displays low sensitivity, decreasing accuracy with increasing birth weight, and an overall tendency to overestimate the birth weight. Induction of labor for suspected fetal macrosomia has not been shown to alter the incidence of shoulder dystocia among nondiabetic patients. The concept of prophylactic cesarean delivery as a means to prevent shoulder dystocia and therefore avoid brachial plexus injury has not been supported by either clinical or theoretic data. Although many maneuvers have been described for the successful alleviation of shoulder dystocia, there have been no randomized controlled trials or laboratory experiments that have directly compared these techniques. Despite the introduction of ancillary obstetric maneuvers, such as McRoberts maneuver and a generalized trend towards the avoidance of fundal pressure, it has been shown that the rate of shoulder-dystocia associated brachial plexus palsy has not decreased. The simple occurrence of a shoulder dystocia event before any iatrogenic intervention may be associated with brachial plexus injury. [ABSTRACT FROM AUTHOR]

Detroit has recently been distinguished as having the highest congenital syphilis rate in the United States (250.3 cases per 100 000 live births in Detroit versus 10.3 in the US). However, depending on each health department's followup and CDC reporting, these data may not accurately reflect the true congenital syphilis rate. This study examines the reported cases over a three-year time period with focus on the criteria used for diagnosis. All local health department congenital syphilis CDC collection forms (form 73.126) were reviewed for the years in question. The reported congenital syphilis cases in the year 2002--2004 in Detroit were reviewed. No cases met confirmed case criteria and few probable cases were based on neonatal evaluations. The majority of "congenital syphilis" cases were established based on incomplete maternal data such as missing followup serologic titers in the absence of complete neonatal information. In conclusion, although the reported congenital syphilis rate in Detroit is alarmingly high, the true occurrence of congenital syphilis is likely to have been overstated. A health department reporting program that includes more diligent neonatal followup would allow for a more accurate representation of this public health concern. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to determine clinical characteristics and factors associated with suboptimal viral suppression at delivery in human immunodeficiency virus (HIV)-infected women. Study design: All HIV-infected women who delivered at a single urban tertiary care center from January 1999 to June 2004 were studied. Women were divided into 2 groups based on HIV viral load (VL) proximate to delivery: VL < 1000 copies per milliliter and VL ⩾ 1000 copies per milliliter. Demographic and clinical factors were analyzed and compared between the 2 groups. Results: A total of 146 women had adequate data available for analysis: 102 (69.9%) had VL < 1000 copies per milliliter and 44 (30.1%) had VL ⩾ 1000 copies per milliliter at delivery. Women with a viral load ⩾ 1000 copies per milliliter at delivery were more likely to have a baseline viral load VL ⩾ 10,000 copies per milliliter (66.7% vs 32%, P < .001) and less likely to report medication adherence, (50% vs 87.8%, P < .001). Conclusion: Our findings support the concept that in addition to antiviral medical therapy, intervention to improve adherence and maintaining a low baseline VL are key components to VL suppression in pregnancy. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the usefulness of the endometrial trilaminar pattern and thickness in the diagnosis of ectopic pregnancy. We reviewed patient records for clinical and ultrasonographic data for patients with the suspicion of ectopic pregnancy. The trilaminar pattern and endometrial thickness were tested as predictors for the diagnosis of ectopic pregnancy. Results: The trilaminar pattern had a specificity of 94% and sensitivity of 38% (n = 403 women). The mean endometrial thickness was thinner in patients with ectopic, compared with normal pregnancy (9.5 ± 5.7 mm vs 12.4 ± 5.9 mm; P = .035). Patients with normal pregnancy or first-trimester losses had comparable thicknesses (12.4 ± 5.9 mm vs 12.5 ± 8.0 mm). The receiver operator curve showed that there was no thickness value useful for the diagnosis of ectopic pregnancy. The trilaminar pattern is specific for the diagnosis of ectopic pregnancy, but it is associated with low sensitivity. The endometrial thickness tends to be thinner in patients with an ectopic pregnancy. [ABSTRACT FROM AUTHOR]

Objective: The purpose was to study the impact of maternal endogenous and clinician-applied exogenous delivery forces on brachial plexus stretching during a shoulder dystocia event.Study Design: A computer software crash dummy model (MADYMO, version 5.4, TNO Automotive, Delft, The Netherlands) was modified on the basis of established maternal pelvis and fetal anatomic specifications. The brachial plexus was modeled as a spring, with mechanical properties that were based on previously reported experimental data. Increasing amounts of endogenous or exogenous loading forces were applied until delivery of the anterior fetal shoulder occurred. Brachial plexus deformation was assessed as percent stretch in the nerve (Change in length/Original length x 100).Results: With lithotomy positioning, both maternal endogenous and clinician-applied exogenous delivery forces were associated with brachial plexus stretching (15.7% vs 14.0%, respectively). McRoberts positioning reduced needed loading forces for delivery and resulted in 53% less brachial plexus stretch (6.6%). Downward lateral displacement of the fetal head was associated with a 30% increase in brachial plexus stretch (18.2%) compared with axial positioning of the head (14.0%).Conclusion: Brachial plexus stretch varied as a result of the load required for delivery, the source of the applied force, pelvic orientation, and fetal head positioning. Maternally derived and clinician-applied delivery forces can both lead to brachial plexus deformation when shoulder dystocia is encountered. The McRoberts maneuver can reduce brachial plexus stretching. Management of fetal head position may also be important in reducing unnecessary brachial plexus stretch. [ABSTRACT FROM AUTHOR]

Objective: A computer model was modified to study the impact of maternal endogenous and clinician-applied exogenous delivery loads on the contact force between the anterior fetal shoulder and the maternal symphysis pubis.Study Design: Varying endogenous and exogenous loads were applied, and the contact force was determined. Experiments also examined the effect of pelvic orientation and the direction of load application on contact force behind the symphysis pubis.Results: Exogenous loading forces (50-100 N) resulted in anterior shoulder contact forces of 107 to 127 N, with delivery accomplished at 100 N of applied load. Higher contact forces (147-272 N) were noted for endogenously applied loads (100-400 N), with delivery occurring at 400 N of maternal force. Pelvic rotation from lithotomy to McRoberts' positioning resulted in reduced contact forces. Downward lateral flexion of the fetal head led to little difference in contact force but required 30% more exogenous load to achieve delivery.Conclusion: Compared with clinician-applied exogenous force, larger maternally derived endogenous forces are needed to clear the impacted anterior fetal shoulder. This is associated with >2 times more contact force by the obstructing symphysis pubis. McRoberts' positioning reduces shoulder-symphysis pubis contact force. Lateral flexion of the fetal head results in the larger forces that are needed for delivery but has little effect on contact force. Model refinements are needed to examine delivery forces and brachial plexus stretching more specifically. [ABSTRACT FROM AUTHOR]

Vaccine-preventable diseases (VPDs) account for significant morbidities and mortalities in the United States on an annual basis. Despite generally successful childhood vaccine programs, adults remain underimmunized against a variety of common VPDs. Lack of both physician and patient awareness contribute to this deficiency. All primary care providers, including obstetrician-gynecologists, must address this need in their office practices. Clear and authoritative adult vaccine recommendations are established and easily accessible by the clinician. Pregnancy is not an absolute contraindication to vaccine administration. In fact, certain vaccines are specifically indicated during pregnancy in the interest of the mother and her unborn child. Women frequently identify gynecologists as their sole providers of care, further emphasizing the need for attention to this health maintenance activity. New vaccine initiatives, in particular those focused on early newborn infectious conditions, sexually transmitted diseases, and cancer prevention, will likely place the obstetrician-gynecologist at the forefront of this important clinical issue. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess whether the treatment of deliveries at the traditional threshold of viability has become more interventional since the publication of higher survival rates.Study Design: State vital statistic data from 1995 to 2000 were reviewed to identify deliveries at 22 to 25 weeks of gestation with a birth weight of <1 kg. Demographic data and frequency of cesarean delivery, antepartum bleeding, breech presentation, fetal distress, and cord prolapse were recorded. The cesarean delivery rate and the neonatal mortality rate were calculated for each year. Linear regression for cesarean delivery rate versus year and for neonatal mortality rate versus year were performed at each gestational age.Results: Of 2924 births that met the study criteria, 1005 births (34.4%) were by cesarean delivery. The cesarean delivery rate at 23 weeks rose from 15.9% in 1995 to 28.2% in 2000 (P =.023). Demographic/obstetric factors did not vary with year of delivery. The neonatal mortality rate remained unchanged.Conclusion: These data suggest an increasingly aggressive approach to deliveries at the threshold of viability, beginning at 23 weeks of gestation. [ABSTRACT FROM AUTHOR]