We excluded stillbirths due to congenital anomalies, women with hypertensive disorders or diabetes, and plural births, to focus on fetuses and women without these known contributing conditions.
Separate models were run for stillbirths delivered at , , , , weeks, relative to liveborn deliveries at weeks. For stillbirth at weeks, RRs were elevated for all race-ethnicity and parity groups. At weeks, the association was significant p View details for DOI To examine the relationship between maternal characteristics, serum biomarkers and preterm birth PTB by spontaneous and medically indicated subtypes. Population-based cohort. California, United States of America.
From a total population of 1 live singleton births in and , pregnancies with linked birth certificate and hospital discharge records were included. First-trimester and second-trimester serum marker levels were analysed in a subset of pregnancies with available first-trimester and second-trimester serum biomarker results. PTB by subtype.
These risks occurred in The number of neonatal survivors was analyzed based on this classification as well as Quintero staging. The overall neonatal survival rate was Overall neonatal survival including survival of at least two fetuses occurred with equal frequency between the different groups. Preterm delivery is often performed by Caesarean section. We investigated modes of anaesthesia and risk factors for general anaesthesia among women undergoing preterm Caesarean delivery.
The mode of anaesthesia was classified as neuraxial anaesthesia spinal, epidural, or combined spinal and epidural or general anaesthesia. Logistic regression was used to identify patient characteristic, obstetric, and peripartum risk factors associated with general anaesthesia.
Within the study cohort, 11 women had preterm Caesarean delivery; In our study cohort, nearly one in five women received general anaesthesia for preterm Caesarean delivery. Although potential confounding by unmeasured factors cannot be excluded, our findings suggest that early gestational age at delivery, emergent Caesarean delivery indications, hypertensive disease, and non-Caucasian race or ethnicity are associated with general anaesthesia for preterm Caesarean delivery.
To examine associations with morbidly adherent placenta MAP among women with placenta previa. Logistic binomial regression was used to compare cases with controls. In all, 37 cases with MAP and controls with previa alone were included. Maternal, antepartum, perioperative, and neonatal variables were compared between women with and without prolonged postpartum LOS.
Several antepartum, perioperative, and neonatal variables were associated with a prolonged postpartum LOS. Strategies to reduce perioperative complications are needed to decrease the health care burden of prolonged post-CD LOS.
This study aims to evaluate the relationship between early-onset severe preeclampsia and first trimester serum levels of pregnancy-associated plasma protein A PAPP-A and total human chorionic gonadotropin hCG. Logistic binomial regression was used to estimate the relative risk RR of early-onset severe preeclampsia in pregnancies with abnormal levels of first trimester PAPP-A or total hCG as compared with controls.
Regardless of parity, women with low first trimester PAPP-A or high total hCG were at increased risk for early-onset severe preeclampsia. Routinely collected first trimester measurements of PAPP-A and total hCG provide unique risk information for early-onset severe preeclampsia. Neonates with gastroschisis are often small-for-gestational-age SGA based on population nomograms. Our objective was to evaluate the effect of SGA on perinatal and neonatal outcomes in cases of gastroschisis.
Retrospective study of neonates with prenatally diagnosed gastroschisis from two academic centers between Perinatal and neonatal outcomes of neonates with SGA at birth were compared with appropriate for gestational age AGA neonates. The primary composite outcome was defined as any of: neonatal sepsis, short bowel syndrome at discharge, prolonged mechanical ventilation upper quartile for the cohort , bowel atresia, or death.
Uterine atony is a leading cause of postpartum hemorrhage PPH. Although most cases of PPH respond to first line therapy with uterine massage and oxytocin administration, second line uterotonics including methylergonovine and carboprost are integral for the management of refractory uterine atony.
Despite their ubiquitous use, it is uncertain whether the risk of hemorrhage-related morbidity differs in women exposed to methylergonovine or carboprost at Cesarean delivery CD.
We identified women who underwent CD and received either methylergonovine or carboprost for refractory uterine atony. The primary outcome was hemorrhage-related morbidity defined as intraoperative or postoperative red blood cells RBC transfusion or the need for additional surgical interventions including uterine artery ligation, hypogastric artery ligation, or peripartum hysterectomy for atony. We compared the risk of hemorrhage-related morbidity in those exposed to methylergonovine vs.
Propensity-score matching was used to account for potential confounders. The study cohort comprised 1, women; In this propensity-score matched analysis, methylergonovine was associated with reduced risk of hemorrhage-related morbidity during CD compared to carboprost. Based on these results, methylergonovine may be a more effective second line uterotonic. A baseline QA assessment was performed with a lead senior sonographer reviewing eight random OB examinations for each sonographer.
An electronic checklist was then instituted for all OB examinations on each ultrasound machine. It was mandated that each anatomical structure be checked off during real-time image acquisition. A repeat QA assessment of each sonographer was then performed quarterly.
All sonographers improved their image acquisition regardless of baseline skill level at the initial QA. Prior prenatal testing, ethnicity, and education level were significantly associated p View details for PubMedID Array comparative genomic hybridization aCGH is a molecular cytogenetic technique that is able to detect the presence of copy number variants CNVs within the genome. The detection rate of imbalances by aCGH compared to standard karyotyping and 22q11 microdeletion analysis by fluorescence in-situ hybridization FISH , in the setting of prenatally-diagnosed cardiac malformations, has been reported in several studies.
The objective of our study was to perform a systematic literature review and meta-analysis to document the additional diagnostic gain of using aCGH in cases of congenital heart disease CHD diagnosed by prenatal ultrasound examination, with the aim of assisting clinicians to determine whether aCGH analysis is warranted when an ultrasonographic diagnosis of CHD is made, and to guide counseling in this setting.
Search terms were: 'array comparative genomic hybridization', 'copy number variants' and 'fetal congenital heart defects'. Articles regarding karyotyping or 22q11 deletion only were excluded. Thirteen publications including cases of CHD met the inclusion criteria for the analysis. Meta-analysis indicated an incremental yield of 7. Subgroup results showed a 3.
There was an additional yield of 3. In this review we provide an overview of published data and discuss the benefits and limitations of using aCGH. To evaluate the accuracy of sonographic classification of chorionicity in a large cohort of twins and investigate which factors may be associated with sonographic accuracy.
We conducted a secondary analysis of a randomized trial of preterm birth prevention in twins. Sonographic classification of chorionicity was compared with pathologic examination of the placenta. Maternal age, body mass index, diabetes, and hypertension , obstetric prior cesarean delivery, gestational age at the first sonographic examination, and antepartum bleeding , and sonographic oligohydramnios, polyhydramnios, and twin-twin transfusion syndrome factors were assessed for their possible association with accuracy.
A total of twin sets in which chorionicity was classified by sonography before 20 weeks' gestation were included; were dichorionic and 90 were monochorionic based on pathologic examination. Sonography misclassified 35 of twin pregnancies 6. The sensitivity and specificity of sonographic diagnosis of monochorionicity were In a multivariable analysis, pregnancies with initial sonographic examinations before 14 weeks' gestation were less likely to have misclassified chorionicity than those with sonographic examinations at 15 to 20 weeks odds ratio [OR], 0.
In the multivariable analysis, maternal age, body mass index, parity, and prior cesarean delivery were not associated with sonographic accuracy. Sonography before 20 weeks incorrectly classified chorionicity in 6. Those with first sonographic examinations performed at earlier gestational ages had improved chorionicity diagnosis.
Circulating cell-free RNA in the blood provides a potential window into the health, phenotype, and developmental programs of a variety of human organs. We used high-throughput methods of RNA analysis such as microarrays and next-generation sequencing to characterize the global landscape circulating RNA in a cohort of human subjects. By focusing on genes whose expression is highly specific to certain tissues, we were able to identify the relative contributions of these tissues to circulating RNA and to monitor changes in tissue development and health.
As one application of this approach, we performed a longitudinal study on pregnant women and analyzed their combined cell-free RNA transcriptomes across all three trimesters of pregnancy and after delivery.
In addition to the analysis of mRNA, we observed and characterized noncoding species such as long noncoding RNA and circular RNA transcripts whose presence had not been previously observed in human plasma. We demonstrate that it is possible to track specific longitudinal phenotypic changes in both the mother and the fetus and that it is possible to directly measure transcripts from a variety of fetal tissues in the maternal blood sample.
We also studied the role of neuron-specific transcripts in the blood of healthy adults and those suffering from the neurodegenerative disorder Alzheimer's disease and showed that disease specific neural transcripts are present at increased levels in the blood of affected individuals.
Characterization of the cell-free transcriptome in its entirety may thus provide broad insights into human health and development without the need for invasive tissue sampling.
A retrospective cohort study of patients with pyelonephritis in pregnancy and immediately postpartum was conducted. Participants delivered between and at a single university center Lucile Packard Children's Hospital at Stanford were reviewed. Pyelonephritis was defined by a temperature greater than All patients with pyelonephritis and urine culture results were included. Means were compared with the Student's t test. One hundred thirteen patients were admitted with pyelonephritis and had a urine culture performed.
There were no differences in adverse outcomes preterm birth, anemia, bacteremia, acute respiratory distress syndrome, and hospital stay between those with positive and negative urine cultures. Among those with positive cultures, there was a statistically significant increase in preterm birth less than 37 weeks of gestation between those with resistant uropathogens and those with pan-sensitive pathogens Table is included in full-text article.
Women with resistant bacterial uropathogens are at increased risk for preterm birth compared with those with sensitive pathogens.
Given the labile nature of labor and delivery units, scheduled cesarean deliveries are often delayed. Our aim was to improve on-time scheduled cesarean delivery start times. A multidisciplinary team obstetrician-gynecologist, nursing, anesthesia, and hospital administration met to review scheduled cesarean delivery data, identify logistic barriers to on-time starts, and develop a plan to improve cesarean delivery start times.
The process launched on March 1, Data from scheduled cesarean deliveries 6 months before and 3 months after the initiative were reviewed and analyzed. Of 1, total cesarean deliveries, were scheduled, defined as cesarean delivery scheduled at least 24 hours in advance before and after the initiative.
Sixty-four of scheduled cesarean deliveries Objective:To compare the efficacy of oral misoprostol to vaginal dinoprostone for labor induction in nulliparous women.
Study design:Admissions for labor induction from January to December were reviewed. Patients receiving oral misoprostol were compared with those receiving vaginal dinoprostone. The primary outcome was time from induction agent administration to vaginal delivery.
Women who received oral misoprostol had a shorter interval to vaginal delivery A item prenatal diagnosis survey was emailed to associate members of the Society for Maternal-Fetal Medicine. About half Overall, Greater emphasis on ultrasound mentorship and formalized ultrasound training by MFM faculty during fellowships is needed. To assess maternal-fetal medicine MFM fellowship obstetrical ultrasound training, scope of practice and research. A item prenatal diagnosis survey was e-mailed to associate members of the Society for Maternal-Fetal Medicine on two separate occasions.
Most fellows are trained in ultrasound during their first year of fellowship and feel comfortable performing routine exams. However, ultrasound mentorship, structured training and research in prenatal ultrasound are limited in some programs.
Fetal goiter may arise from a variety of etiologies including iodine deficiency, overtreatment of maternal Graves' disease, inappropriate maternal thyroid replacement and, rarely, congenital hypothyroidism.
Fetal goiter is often associated with a retroflexed neck and polyhydramnios, raising concerns regarding airway obstruction in such cases. Prior reports have advocated for cordocentesis and intra-amniotic thyroid hormone therapy in order to confirm the diagnosis of fetal thyroid dysfunction, reduce the size of the fetal goiter, reduce polyhydramnios, aid with the assistance of maternal thyroid hormone therapy and reduce fetal malpresentation.
We report two cases of conservatively managed fetal goiter, one resulting in a vaginal delivery, and no evidence of postnatal respiratory distress despite the presence of polyhydramnios and a retroflexed neck on prenatal ultrasound. Karger AG, Basel. When a fetal anomaly is suspected, a multidisciplinary approach to diagnosis, counseling, pregnancy management, surveillance, delivery planning, and neonatal care is critical to creating a comprehensive management plan.
This article provides a basic framework for integrating prenatal diagnostic and maternal-fetal care considerations, delivery planning, special resuscitation needs, and immediate and later neonatal care and evaluation into developing a thoughtful management plan for infants with prenatally diagnosed complex anomalies including congenital heart disease, intrathoracic masses, fetal airway obstruction, neural tube defects, abdominal wall defects, and skeletal dysplasia.
In , the California Genetic Disease Branch introduced an aneuploidy screening program allowing Medi-Cal state insured patients access to state-sponsored first-trimester screening. The objective of this study was to assess the effect of greater access to prenatal screening on available resources at a single center. Data of prenatal screening and diagnostic procedures performed 4 months before the introduction of the program were compared with those of 12 months following the introduction.
Between December and March , women underwent first trimester screening, underwent amniocentesis and underwent chorionic villus sampling. Prenatal diagnostic procedures did not increase, but a greater proportion was performed for positive screen results.
Introduction of the California screening program was associated with increased NT procedures and fewer invasive procedures for advanced maternal age. The vast majority of prenatal genetic testing requires invasive sampling. However, this poses a risk to the fetus, so one must make a decision that weighs the desire for genetic information against the risk of an adverse outcome due to hazards of the testing process. These issues are not required to be coupled, and it would be desirable to discover genetic information about the fetus without incurring a health risk.
Here we demonstrate that it is possible to non-invasively sequence the entire prenatal genome. Our results show that molecular counting of parental haplotypes in maternal plasma by shotgun sequencing of maternal plasma DNA allows the inherited fetal genome to be deciphered non-invasively. We also applied the counting principle directly to each allele in the fetal exome by performing exome capture on maternal plasma DNA before shotgun sequencing.
This approach enables non-invasive exome screening of clinically relevant and deleterious alleles that were paternally inherited or had arisen as de novo germline mutations, and complements the haplotype counting approach to provide a comprehensive view of the fetal genome.
Non-invasive determination of the fetal genome may ultimately facilitate the diagnosis of all inherited and de novo genetic disease. The purpose of this study was to evaluate the effect of the rectus muscle and visceral peritoneum closure at cesarean delivery on adhesions. We performed a secondary analysis of a prospective cohort study of women who underwent first repeat cesarean delivery.
Surgeons scored the severity and location of adhesions. Records were abstracted to assess previous surgical techniques. The original cohort included patients. Rectus muscle closure was associated with fewer combined filmy and dense adhesions overall Visceral peritoneum closure was associated with increased dense fascia-to-omentum adhesions aOR, Closure of the rectus muscles at cesarean delivery may reduce adhesions, and visceral peritoneum closure may increase them.
Surgical techniques at cesarean delivery should be assessed independently, because they may have opposite effects on adhesion formation.
To investigate pregnant women's level of future interest in noninvasive prenatal diagnosis NIPD and what factors might affect expected uptake of this testing. Written questionnaires were administered to women in their third trimester. One hundred fourteen women returned the questionnaire Of these, The majority of pregnant women report hypothetical interest in NIPD, primarily because of increased safety for the fetus, although a significant minority are uninterested or ambivalent.
Discussions with healthcare providers regarding NIPD, and their recommendations, are likely to be an important factor in women's decisions about this testing. As such, adequate discussion of the implications of prenatal diagnostic testing will be critical. To estimate trends and risk factors for cesarean delivery for twins in the United States. This was a cross-sectional study in which we calculated cesarean delivery rates for twins from to using National Center for Health Statistics data.
We compared cesarean delivery rates by year and for vertex compared with breech presentation. The order of presentation for a given twin pair could not be determined from the available records and therefore analysis was based on individual discrete twin data. Multivariable logistic regression was used to estimate independent risk factors, including year of birth and maternal factors, for cesarean delivery.
Cesarean delivery rates for twin births increased steadily from Rates rose for the breech twin category The relative increase in the cesarean delivery rate for preterm and term neonates was similar. Cesarean delivery rates for twin births increased dramatically from to This increase is significantly higher than that which could be explained by an increase in cesarean delivery for breech presentation of either the presenting or second twin.
We sought to assess whether the presence and severity of adhesions at first repeat cesarean delivery are associated with delayed delivery of the newborn. We conducted secondary analysis of a prospective cohort of women undergoing first repeat cesarean. Severity and location of adhesions were reported by surgeons immediately postoperatively.
We compared adhesion density scores with delivery data. Of women analyzed, 92 Among women undergoing first repeat cesarean, severity of adhesions may delay delivery of the newborn. Study of techniques to reduce adhesions may be warranted to prevent delayed delivery at repeat cesarean.
To describe a case of bilateral ruptured heterotopic pregnancies presenting as persistent ovarian hyperstimulation syndrome in a quadruplet pregnancy. Case report. University hospital and clinic. An infertile patient who conceived using gonadotropin therapy. Culdocentesis with resultant aspiration of sanguinous fluid prompted laparoscopic exploration and bilateral salpingectomies. Not applicable.
Gross hemoperitoneum and ruptured bilateral heterotopic sextuplet pregnancy. Patients who conceive after gonadotropin therapy should be closely monitored during treatment and in early pregnancy to recognize and minimize morbidity and complications. After superovulation, the presence of an intrauterine pregnancy, either single or multiple, does not rule out the possibility of ectopic pregnancy, and this should always be considered as a possibility in the setting of acute anemia.
Appendicitis is the most common surgical emergency in pregnancy. Acute appendicitis is often difficult to diagnose clinically, and concerns regarding antenatal CT imaging limit its use resulting in high false negative rates at laparotomy. MRI has recently been reported as a reasonable alternative to CT imaging in cases of suspected appendicitis.
Our objective was to perform a meta-analysis of recently published data regarding the utility of MR imaging in cases of antenatal suspected acute appendicitis. Five case series describing the role of MRI in cases of antenatal appendicitis were included. The sensitivity, specificity, positive, and negative predictive values were calculated. Two hundred twenty-nine patients were included in the study.
In the first analysis in which non-diagnostic scans were excluded, the sensitivity, specificity, positive and negative predictive values of MRI for diagnosing appendicitis were In the second analysis, which included non-diagnostic scans, the sensitivity, specificity, positive and negative predictive values were Data are still limited and larger prospective studies are necessary to confirm this finding.
To estimate risk factors for premature neonates not receiving antenatal steroids in a population-based cohort and to determine whether the gains of a quality-improvement collaborative project on antenatal steroid administration were sustained long-term. Eligible neonates had a birth weight of less than 1, g or gestational age less than 34 weeks and were born at a Collaborative hospital. These data were linked to administrative data from California Vital Statistics.
Sociodemographic and medical risk factors for not receiving antenatal steroids were determined. We also examined the effect of birth hospital participation in a previous quality-improvement collaborative project. A random effects logistic regression model was used to determine independent risk factors.
Of 15, eligible neonates, Hispanic mothers Mothers giving birth vaginally Rupture of membranes before delivery and multiple gestations were associated with higher likelihood of antenatal steroid administration.
To estimate the effect of preterm premature rupture of membranes PROM on neonatal mortality. A cross-sectional study using a state perinatal database California Perinatal Quality Care Collaborative was performed.
Prenatal data, including ruptured membranes, corticosteroid administration, maternal age, maternal race, maternal hypertension, mode of delivery, and prenatal care, were recorded. Mortality rates were compared for neonates born between 24 and 34 weeks of gestation without preterm PROM to those with recent less than 18 hours before delivery and prolonged more than 18 hours before delivery preterm PROM. Neonatal sepsis rates were also examined.
When analyzed by 2-week gestational age groups, there were no differences in mortality rates between those born with and without membrane rupture before delivery. Sepsis rates did not differ between those with recent or prolonged preterm PROM at any gestational age. The presence of membrane rupture before delivery was not associated with increased neonatal mortality in any gestational age group. The effects of a prolonged latency period were not consistent across gestational ages.
Pharmacogenomics, the study of specific genetic variations and their effect on drug response, will likely give rise to many applications in maternal-fetal and neonatal medicine; yet, an understanding of these applications in the field of obstetrics and gynecology and neonatal pediatrics is not widespread. This review describes the underpinnings of the field of pharmacogenomics and summarizes the current pharmacogenomic inquiries in relation to maternal-fetal medicine-including studies on various fetal and neonatal genetic cytochrome P CYP enzyme variants and their role in drug toxicities for example, codeine metabolism, sepsis and selective serotonin reuptake inhibitor SSRI toxicity.
Potential future directions, including alternative drug classification, improvements in drug efficacy and non-invasive pharmacogenomic testing, will also be explored.
Noninvasive prenatal diagnosis with cell-free DNA in maternal plasma is challenging because only a small portion of the DNA sample is derived from the fetus. A few previous studies provided size-range estimates of maternal and fetal DNA, but direct measurement of the size distributions is difficult because of the small quantity of cell-free DNA.
We used high-throughput paired-end sequencing to directly measure the size distributions of maternal and fetal DNA in cell-free maternal plasma collected from 3 typical diploid and 4 aneuploid male pregnancies. As a control, restriction fragments of lambda DNA were also sequenced. Cell-free DNA had a dominant peak at approximately bp and a minor peak at approximately bp. Chromosome Y sequences were rarely longer than bp but were present in sizes of View details for DOI Approximately half of small for gestational age SGA cases are due to maternal or fetal pathology, and may result in significant neonatal morbidity and mortality.
The estimated fetal weight EFW measurement is the cornerstone of ultrasonographic findings when diagnosing and managing SGA pregnancies. A retrospective chart review was performed of all pregnancies complicated by SGA from a single institution Stanford University over a 2-year-period To determine the association between single-layer one running suture and double-layer second layer or imbricating suture hysterotomy closure at primary caesarean delivery and subsequent adhesion formation.
A secondary analysis from a prospective cohort study of women undergoing first repeat caesarean section. One hundred and twenty-seven pregnant women undergoing first repeat caesarean section. Patient records were reviewed to identify whether primary caesarean hysterotomies were closed with a single or double layer. Data were analysed by Fisher's exact tests and multivariable logistic regression.
Prevalence rate of pelvic and abdominal adhesions. Of the women, primary hysterotomy closure was single layer in 56 and double layer in Single-layer closure was associated in this study with a seven-fold increase in the odds of developing bladder adhesions odds ratio, 6.
There was no association between single-layer closure and other pelvic or abdominal adhesions. Primary single-layer hysterotomy closure may be associated with more frequent bladder adhesions during repeat caesarean deliveries. The severity and clinical implications of these adhesions should be assessed in large prospective trials. The majority of hospitalizations for H1N1 complications have been in people with high-risk comorbidities, including pregnancy.
Here we describe the obstetric and critical care treatment of three patients with confirmed H1N1 influenza virus infection complicated by acute respiratory failure. We describe the clinical and therapeutic courses of three patients with confirmed H1N1 influenza virus infection complicating singleton, twin, and triplet gestations, each of which were complicated by respiratory failure.
These three cases illustrate that a high index of suspicion, prompt treatment, timing and mode of delivery considerations, and interdisciplinary treatment are integral to the care of pregnant patients with H1N1 influenza infections complicated by acute respiratory failure. Over the past decade, first trimester screening has become the gold standard prenatal screening modality in the developed world. This shift toward earlier screening would not be possible without the availability of early diagnosis, namely, chorionic villus sampling CVS.
The purpose of this review is to highlight recent updates related to CVS technique, potential complications, and training.
Recent data highlight the importance of operator experience in reducing CVS-related complications and argues for the 'centralization' of CVS in experienced centers. On the other hand, despite over 30 years of clinical practice, there is still no consensus regarding optimal CVS technique and some variation exists between CVS providers. Moreover, there is a deficiency in adequate infrastructure geared toward the training and certification of future CVS providers.
CVS is the gold standard method of first trimester prenatal diagnosis. Recent data suggest that CVS loss rates are lower than what was previously reported and are lowest in centers that perform a large number of procedures.
The 'centralization' of this specialized procedure also offers the perfect opportunity for the safe, ongoing training of future CVS providers. The purpose of this study was to demonstrate that digital polymerase chain reaction PCR enables rapid, allele independent molecular detection of fetal aneuploidy. Twenty-four amniocentesis and 16 chorionic villus samples were used for microfluidic digital PCR analysis. Three thousand and sixty PCR reactions were performed for each of the target chromosomes X, Y, 13, 18, and 21 , and the number of single molecule amplifications was compared to a reference.
The difference between target and reference chromosome counts was used to determine the ploidy of each of the target chromosomes.
Digital PCR accurately identified all cases of fetal trisomy 3 cases of trisomy 21, 3 cases of trisomy 18, and 2 cases of triosmy 13 in the 40 specimens analyzed. The remaining specimens were determined to have normal ploidy for the chromosomes tested. Microfluidic digital PCR allows detection of fetal chromosomal aneuploidy utilizing uncultured amniocytes and chorionic villus tissue in less than 6 hours.
The preterm birth rate in the United States remains at an all-time high and continues to rise. Acute tocolysis has potential to delay preterm birth for 48 h, the critical period of antenatal steroid administration, or to arrest an episode of preterm labor, thus delaying birth and improving neonatal outcomes.
It is therefore paramount that medical providers remain up-to-date regarding the usefulness, indications and contraindications, and side-effects and adverse effects of all tocolytics. Magnesium sulfate remains the most common tocolyic agent in the United States.
Recent evidence comparing oral nifedipine with magnesium sulfate suggests equal efficacy with fewer maternal side-effects, thus supporting this oral medication as first-line treatment. This review will summarize the most common acute tocolytic drugs, their methods of action, and clinical data regarding their utility.
All tocolytic medications have side-effects, some of them potentially life-threatening. Decisions regarding whether to use a tocolytic and which tocolytic to use require the diagnosis of preterm labor, knowledge of the patient's gestational age, medical conditions, and cost. Once tocolysis is initiated, attention must be paid to the patient's response, side-effects, and adverse events.
Larger studies are needed which incorporate, in addition to efficacy, data on safety and side-effect profiles and cost. We directly sequenced cell-free DNA with high-throughput shotgun sequencing technology from plasma of pregnant women, obtaining, on average, 5 million sequence tags per patient sample.
This enabled us to measure the over- and underrepresentation of chromosomes from an aneuploid fetus. The sequencing approach is polymorphism-independent and therefore universally applicable for the noninvasive detection of fetal aneuploidy. Using this method, we successfully identified all nine cases of trisomy 21 Down syndrome , two cases of trisomy 18 Edward syndrome , and one case of trisomy 13 Patau syndrome in a cohort of 18 normal and aneuploid pregnancies; trisomy was detected at gestational ages as early as the 14th week.
Direct sequencing also allowed us to study the characteristics of cell-free plasma DNA, and we found evidence that this DNA is enriched for sequences from nucleosomes. To evaluate whether closure of the uterine incision with one or two layers changes uterine rupture or vaginal birth after cesarean section VBAC success rates. Subjects with one previous cesarean section by documented transverse uterine incision that attempted VBAC were identified.
Exclusion criteria included lack of documentation of the type of closure of the previous uterine incision, multiple gestation, more than one previous cesarean section, and previous scar other than low transverse. Uterine rupture and VBAC success rates were compared between those with single-layer and double-layer uterine closure.
Time interval between deliveries, birth weight, body mass index BMI , and history of previous VBAC were evaluated as possible confounders. Of subjects identified, had double-layer closure and 35 had single-layer closure. The uterine rupture rate was significantly higher in the single-layer closure group 8. There was no difference in VBAC success rate Single-layer uterine closure may be more likely to result in uterine rupture.
We describe a female neonate in whom a urinoma was first diagnosed at 20 weeks of gestation without any evidence of underlying urinary tract obstruction. The urinoma became apparent following the performance of a "bloody tap" amniocentesis. Sequential ultrasonography, both fetal and up to 3 months after birth, showed eventual resorption of the urinoma in parallel with the development of a shrunken, non-functioning kidney.
Except for the onset of high-renin hypertension, which spontaneously remitted at 1 year of age, the baby's postnatal course was uneventful. Renal function was normal. The presence of a fetal urinoma as a sign of a dysplastic kidney is discussed. Tab Menu. Contact Academic yairb stanford.
Additional Info Mail Code: Current Research and Scholarly Interests prenatal diagnosis, genetics, clinical obstetrics. Seminars in perinatology Jani, S. Abstract Early identification of pregnant women at risk for preeclampsia PE is important, as it will enable targeted interventions ahead of clinical manifestations. Abstract Objective: To investigate the effect of preterm gestational age on neonatal outcomes of gastroschisis and to compare the neonatal outcomes after spontaneous labor versus iatrogenic delivery both in the preterm and early term gestational periods.
Abstract Importance: Bilateral renal agenesis is a rare congenital anomaly associated with poor prognosis.
Abstract Approximately 0. Abstract Preeclampsia is one of the most severe pregnancy complications and a leading cause of maternal death. Abstract Our goal was to develop an approach that can systematically identify potential associations between medication prescribed in pregnancy and spontaneous preterm birth sPTB by mining large administrative "claims" databases containing hundreds of medications. Abstract Purpose: Fetal lung masses complicate approximately 1 in live births.
Abstract This work presents the workflow for generating single cell transcriptomes derived from primary human uterine and cervical tissue obtained during planned cesarean hysterectomies. Abstract To examine updates in fetal spina bifida surgical repair, as well as promising results emerging from translational medicine.
Abstract Patients with neonatal urea cycle defects UCDs typically experience severe hyperammonemia during the first days of life, which results in serious neurological injury or death.
Abstract Prenatal diagnosis in pregnancies at risk of single-gene disorders is currently performed using invasive methods such as chorionic villus sampling and amniocentesis.
Abstract Blood circulates throughout the human body and contains molecules drawn from virtually every tissue, including the microbes and viruses which colonize the body. Abstract To investigate the association between small-for-gestational age SGA and neurocognitive impairment at 2 years of corrected age among infants born at preterm gestational ages. Abstract Limited understanding of risk factors exists for postpartum hemorrhage PPH post-vaginal delivery. S in Business and an M.
A in Public Administration. He is responsible for managing the accounting activities for MNM. He also worked for 11 years in the Middle East thus having plenty of experience in working with diverse cultures and environment.
He a senior social sector practitioner with a career spanning almost three decades in the UN, International NGOs, Indian Government and the private sector. He also set up the NGO Sashakt Foundation that works with adolescent girls and sustainable development. He works on the Board or as an Advisor to several organisations. After his graduation in Electrical Engineering from the Indian Institute of Technology, Delhi he had a brief stint in the corporate sector.
He joined the Indian Civil services in the batch where remained associated with social sector ministries in most of his assignments. Dr Kaushik Sarkar is a global health expert and data engineer with leadership in programmes, policy, and partnerships in the healthcare and pharmaceutical industry. He has provided thought leadership and driven innovative solutions across various health and interdisciplinary interfaces e. He has a proven track-record of designing and scaling innovative real world research and business solitions for access improvement collaboratively with the governments, donors, and corporate, and third sector partners.
His research on health empowerment and resilience among tribal adolescents is considered as a landmark study in the field of resilience, and has received the Vijay Narayan Award. He is also an avid writer and knowledge expert, who has authored multiple landmark publications in prestigious medical journals, like Lancet, WHO Health Bulletin, Vaccine, etc.
As a Statistician in the National Vector Borne Disease Control Programme he has quantified the technical requirements in the preparation of strategy documents. Atul comes with strong experience in large scale data handling, analysis, report writing, trainings etc.
Atul has completed his post-graduation in Statistics, from Banaras Hindu University. Tejas is a marketing specialist with a focus on digital media. Biswajeet has 19 years of development experience working at the field, Sub-district, district and at state level.
With those organizations Biswajeet has focused on project implementation, monitoring, evaluation, partnership building with governments, local innovations, need based capacity building and strengthening stakeholders networking.
Before joining Malaria No More, he was the office assistant in Sebika Medicine Store, Acharya Vihar, Bhubaneswar, where he managed dispensing medicines according to prescription, handling stock, billing and inventory maintenance as well as scheduling of patient appointments.
Malaria No More is a c 3 nonprofit. EIN Thu Do Senior Manager of Global Policy and Advocacy As the senior manager of global policy and advocacy, Thu leads efforts with global partners outside of the United States to shape advocacy and policy with donor and endemic country governments and private sector stakeholders.
Johanna Simon Senior Policy Advisor Johanna works alongside the Policy and Advocacy team to shape global and domestic malaria public policy. Erin Leach-Kemon Senior Manager, Global Strategic Communications As part of the Communications team, Erin leads our digital and content strategies, manages the MNM brand and brand alignment across the organization as well as with partners, and leads and collaborates with partners on campaigns and new approaches to storytelling.
Alex Honjiyo Manager, Health Finance Coalition Alex is the Program Manager of the Health Finance Coalition, a group of leading philanthropies, donors, technical partners, and institutional investors hosted by Malaria No More seeking to use blended finance to attract an unprecedented level of commercial investment in order to achieve SDG 3. Kaushik Sarkar Technical Director Dr Kaushik Sarkar is a global health expert and data engineer with leadership in programmes, policy, and partnerships in the healthcare and pharmaceutical industry.
Tejas Tandon Communications Manager Tejas is a marketing specialist with a focus on digital media. Biswajeet Mohapatra Odisha Lead Biswajeet has 19 years of development experience working at the field, Sub-district, district and at state level. Why End Malaria? Our Impact. Country Programs. What is Malaria. Why It Matters. Your Impact. Our Story.
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