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Objective: To evaluate the association of social factors with glycemic control in women with gestational diabetes mellitus (GDM).Methods: A survey instrument assessing social support, access to healthy food, cooking and meal preparation, chaotic lifestyle, employer support, and physical and emotional responses to food was developed and administered to women with GDM at maternal-fetal medicine office visits. Validated scales were used to measure social support and life chaos (defined as organization, instability, and the ability to plan and prepare for the future). Glycemic control and pregnancy outcome were ascertained by chart review. Multivariable logistic regression was used to quantify the association of these factors with the primary outcome of satisfactory glycemic control, defined as greater than 70% of blood sugars within goal.Results: We approached 145 women, of whom 111 agreed to participate (76.5%). Seventy-seven percent of patients (86/111) achieved satisfactory glycemic control. Chaotic lifestyle (Confusion, Hubbub and Order Scale score 12.5±2.9 for those with good control, 16.3±3.9 for poor control; odds ratio [OR] 0.71, 95% confidence interval [CI] 0.59-0.85) and receipt of food stamps (11/86 [12.9%] for good control and 10/25 [40%] for poor control; OR 0.22, 95% CI 0.08-0.62) were associated with decreased likelihood of achieving glycemic control. Being married (67/86 [77.9%] for good control and 12/25 [48.0%] for poor control; OR 3.82, 95% CI 1.49-9.74) and regular exercise (49/86 [57.0%] for good control and 5/25 [20.0%] for poor control; OR 5.03, 95% CI 1.72-14.72) increased the likelihood of achieving glycemic control. Transportation time to food stores, home cooking, and social support were not associated with glycemic control or pregnancy outcomes.Conclusion: Social factors are associated with glycemic control in GDM and may be modifiable to improve glucose control. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationships among excessive gestational weight gain, neonatal adiposity, and adverse obstetric outcomes in women with mild gestational diabetes mellitus.Methods: This is a secondary analysis of a multicenter randomized clinical trial of women with mild gestational diabetes mellitus. Based on self-reported prepregnancy body weight, gestational weight gain was categorized as excessive if it was greater than 2009 Institute of Medicine guidelines. Maternal outcomes and neonatal anthropomorphic characteristics were compared between women with excessive weight gain and those without excessive weight gain. Multiple linear and logistic regression analyses were performed to adjust for confounding factors.Results: We studied 841 women who participated in the main trial and had prepregnancy body mass index (BMI) and delivery information available (n=431 treatment group, n=410 no treatment). After adjustment for factors including treatment and prepregnancy BMI, excessive weight gain remained associated with large for gestational age (adjusted odds ratio [OR] 2.94, 95% confidence interval [CI] 1.81-4.93), birth weight greater than 4,000 g (adjusted OR 2.56, 95% CI 1.54-4.40), preeclampsia (adjusted OR 2.96, 95% CI 1.35-7.03), and cesarean delivery for labor arrest (adjusted OR 2.37, 95% CI 1.30-4.44). In addition, excessive weight gain was independently associated with increased total neonatal fat (P<.001) and birth weight (P<.001).Conclusion: In women with both treated and untreated mild gestational diabetes mellitus, excessive gestational weight gain was independently associated with both greater birth weight and adiposity. [ABSTRACT FROM AUTHOR]

Objective: To estimate the accuracy of onsite tests to detect asymptomatic bacteriuria among pregnant women.Data Sources: We searched MEDLINE, EMBASE, Web of Science, Scopus, and Latin-American Literature from inception until June 2015 without language restrictions. The ClinicalTrials.gov register database was screened to identify any recently completed studies.Methods Of Study Selection: Two independent reviewers selected studies that recruited asymptomatic pregnant women to evaluate the accuracy of onsite tests in detecting the presence of bacteria in the urine using urine culture as a reference standard.Tabulation, Integration, and Results: Women's characteristics, study design, urine sample collection, and handling were extracted along with the test accuracy data. Where possible, we pooled the data using a bivariate, hierarchical random-effects model. Of 1,360 screened references, 27 articles (13,641 women) with test accuracy data on nine tests met the inclusion criteria. The most commonly evaluated test was urine dipstick. The pooled sensitivity and specificity of nitrites detected by dipstick to detect asymptomatic bacteriuria were 0.55 (95% confidence interval [CI] 0.42-0.67) and 0.99 (95% CI 0.98-0.99), respectively. The Griess test to detect nitrites had a sensitivity of 0.65 (95% CI 0.50-0.78) and specificity of 0.99 (95% CI 0.98-1.00). Dipslide with Gram staining had a pooled sensitivity of 0.86 (95% CI 0.80-0.91) and specificity of 0.97 (95% CI 0.93-0.99).Conclusion: The specificity of onsite tests is high; however, the sensitivity is not with the result that they will fail to detect a substantial number of cases of asymptomatic bacteriuria.Clinical Trial Registration: PROSPERO International prospective register of systematic reviews, http://www.crd.york.ac.uk/PROSPERO/, CRD42015027905. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the risk of pregnancy-associated venous thromboembolism in women with asymptomatic antithrombin deficiency.Data Sources: The search was performed on MEDLINE (Ovid and PubMed databases) for the period 1966 to June 2012 and ClinicalTrials.gov as of December 15, 2015.Methods Of Study Selection: A systematic review including randomized controlled trials, cohort studies, and case-control studies was conducted. Selection criteria included objectively diagnosed venous thromboembolism or venous thromboembolism treated with 3 months of anticoagulation before the availability of objective testing. The study population consisted of pregnant women with asymptomatic antithrombin deficiency.Tabulation, Integration, and Results: Seven publications were included in the review. No randomized controlled trials were identified. The best available data consist of three retrospective cohort studies and four case-control studies. Pooled results from case-control studies yielded an estimated odds ratio for venous thromboembolism of 6.09 (95% confidence interval 1.58-23.43). No pooled estimates could be obtained for cohort studies. Data on use of thromboprophylaxis were scarce.Conclusion: Despite the small number of patients included, and the variation in study designs, pooled results from case-control studies show a significant association between asymptomatic antithrombin deficiency and pregnancy-associated venous thromboembolism. Thromboprophylaxis during pregnancy and postpartum should be considered in these women. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the risks of selected adverse pregnancy outcomes among untreated women who met The International Association of the Diabetes and Pregnancy Study Groups (IADPSG)-defined glucose criteria at two different thresholds. METHODS: A retrospective cohort study of women tested for gestational diabetes mellitus (GDM) with the 75-g 2-hour glucose tolerance test (GTT) who delivered a live singleton neonate. Data of women who were treated because they met institutional criteria defining GDM (at least two GTT results greater than or equal to fasting 100 mg/dL, 1-hour 195 mg/dL, and 2-hour 160 mg/dL) were excluded. The data of the remaining women were analyzed in three groups. The prevalence of selected adverse pregnancy outcomes was compared for those with no GDM ("no GDM," n=7,943); those at least one of whose results were fasting 92-94 mg/dL, 1-hour 180-190 mg/dL, or 2-hour 153- 161 mg/dL ("GDM-1," n=771); and those at least one of whose results were greater than or equal to fasting 95 mg/dL, 1-hour 191 mg/dL, or 2-hour 162 mg/dL ("GDM-2," n=1,121). RESULTS: Of the 9,835 women, 1,892 (19.2%) met criteria for GDM, of whom 771 (40.8%) were categorized as GDM-1 and 1,121 (59.2%) GDM-2. After adjustment for confounders, women with GDM-2 were at significantly greater risk for preeclampsia or eclampsia, preterm delivery, primary cesarean delivery, shoulder dystocia, higher birth weight, ponderal index, large for gestational age, transient tachypnea, and neonatal hypoglycemia than women without GDM. Only birth weight and large for gestational age were significantly greater in the GDM-1 compared with the no GDM group. CONCLUSION: Fewer adverse outcomes are found at lower levels of the IADPSG-defined glucose intolerance spectrum. Determining whether these patients will benefit from treatment will require a randomized controlled trial. [ABSTRACT FROM AUTHOR]

The article discusses maternal cardiac disease. It explores the risks of congenital heart disease and ischemic heart disease for pregnant women on the fetal development, growth and survival. It looks into the increase in cardiac disease in pregnancy, associating it with the rise in obesity, hypertension and diabetes in young adults and delayed childbearing. It also offers recommendations on the approach to improve the pregnancy outcome for both the mother and the child.

The article discusses the incidence of thromboembolism during pregnancy. The prevalence of the disease occurs 80 percent in pregnant women. The main cause of maternal deaths in the U.S. is due to venous thromboembolism and pulmonary embolism. Treatment options may include management of acute thrombotic events and prophylaxis for those women who are at greatest risk of thrombotic events. Information on the risk factors, diagnosis, prevention and treatment of thromboembolism is noted.

The article presents a study which evaluates the economic efficiency of antiviral medications administration on pregnant women with possible influenza. It examines the effect of various influenza exposure risk, antiviral efficacy, antiviral cost and probability of various influenza outcomes upon administration of antiviral prophylaxis in the context of pandemic and seasonal influenza scenarios via computer-simulation model. The prophylaxis shows economic significance in treating influenza.

The article presents a study estimating the prevalence of group B streptococci (GBS) colonization in a subsequent pregnancy in women. In accordance to the conducted study, it is found out that the rate of recurrence for GBS colonization is statistically higher when evaluated against women with GBS negative in their index pregnancy. Therefore, based on the data gathered, it is analyzed that women with GBS colonization are more at risk of GBS colonization in a subsequent maternity.

The article reports on results of a study of the effective prediction of preeclampsia by a combined ratio of angiogenesis-related factors. A description of the study design and methods is presented. The study concluded that the combined ratio of angiogenesis-related factors showed the lowest false-positive rate and the highest odds ratio for prediction of preeclampsia.

The article reports on the results of a study designed to identify and estimated prevalence rates of maternal morbidities by pregnancy outcome and selected covariates during the antepartum, intrapartum and postpartum periods in a defined population of pregnant women. A description of the study methods is presented. The study concluded that a range of mild-to-severe pregnancy complications were identified using linked inpatient and outpatient databases.

The article reports on the results of a study which estimated whether magnesium therapy is the optimal management for women with mild pre-eclampsia. A description of the experimental setup and measurement method is given. The study concluded that the clinical decision of whether to use magnesium in patients with mild preeclampsia for seizure prophylaxis should be determined by the physician or institution.

The article describes the association between nephrolithiasis occurring during pregnancy and an elevated risk of preterm delivery and other adverse birth outcomes. Results indicate that women in the study have an increased risk of preterm delivery although the incidence of nephrolithiasis requiring hospital admission during pregnancy is relatively low. It may prompt definitive treatment of small, asymptomatic stones in women during reproductive years.

The article reports on five pregnancies complicated by concurrent cervical cancer. The abdominal radical trachelectomy (ART) procedure was performed to preserve the pregnancy and future fertility. For some, delay in treatment may be a safe alternative. For others, ART during pregnancy may prevent the loss of a wanted pregnancy, loss of fertility and loss of a maternal life.

The article investigates the magnitude of associations of acute and chronic processes with placental abruptions in preterm and term gestations. Results reveal that among women with placental abruption, conditions associated with acute inflammation are more prevalent at preterm than term gestations, while chronic processes are present throughout gestation.

The article discusses the results of a study from 1993 to 2003 in 15,104 women that investigated the association between leiomyomata and complications during pregnancy, delivery and puerperium. Second trimester prenatal ultrasonography in 401 women showed at least one leiomyomata. The presence of leiomyomata was associated with increased risks for cesarean delivery, breech presentation, malposition, preterm delivery, placenta previa and severe postpartum hemorrhage.

OBJECTIVE: The objective was to evaluate the relationships between all types of fetal fatty acid oxidation defects and maternal liver disease, including acute fatty liver of pregnancy and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. METHODS: This was a case-control study comparing fetal fatty acid oxidation defects to the outcome of maternal liver disease. Fifty case infants with fatty acid oxidation defects were identified, with 25 matched controls collected per case. This generated a total of 50 case infants and 1,250 control infants. Pregnancies were evaluated for the presence of maternal liver disease (comprised of acute fatty liver of pregnancy, HELLP syndrome, and preeclampsia evolving into HELLP syndrome) using a conditional logistic regression model. Subgroup analysis compared long chain to short and medium chain fatty acid defects. RESULTS: Maternal liver disease was noted in 16.00% of all fatty acid oxidation defect pregnancies compared with 0.88% in the general population (odds ratio 20.4, 95% confidence interval 7.82–53.2). These pregnancies demonstrated an 18.1-fold increase in maternal liver disease when compared with our matched population controls with unaffected fetuses. All classifications of fatty acid oxidation defects were at high risk of developing maternal liver disease. Long chain defects were 50 times more likely than controls to develop maternal liver disease and short and medium chain defects were 12 times more likely to develop maternal liver disease. CONCLUSION: Maternal liver disease is significantly higher across the entire spectrum of fatty acid oxidation defects pregnancies compared with the matched control population. Notably, there is significant risk to the pregnancies with fetuses affected with short and medium chain defects, not just those with fetal long chain fatty acid oxidation defects as previously reported. Future studies should examine the pathophysiology of all infant fatty acid oxidation defects and its implications for maternal liver disease for improved future health outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Intrahepatic cholestasis of pregnancy is associated with dyslipidemia, but the gestational lipid profile in relation to clinical diagnosis of the disease is unknown. The aim of this study was to undertake a detailed analysis of plasma lipids in women presenting with intrahepatic cholestasis of pregnancy and pruritus gravidarum. METHODS: Plasma lipid concentrations were assessed in nonfasting blood samples from 63 women with intrahepatic cholestasis of pregnancy (n = 54, recruited at the time of diagnosis, and n = 9, who later developed the disease), 43 women with pruritus gravidarum, and 26 healthy pregnant controls during pregnancy and at 4–6 weeks postpartum. RESULTS: Intrahepatic cholestasis of pregnancy was associated with an abnormal lipid profile. Low-density lipoprotein (LDL) cholesterol, apolipoprotein B-100, and total cholesterol concentrations were significantly raised during pregnancy in women with intrahepatic cholestasis of pregnancy compared with pruritus gravidarum and controls, and LDL-cholesterol was raised before clinical diagnosis. High-density lipoprotein cholesterol was lower in women with intrahepatic cholestasis of pregnancy compared with the pruritus gravidarum group. Ursodeoxycholic acid did not alter plasma lipid concentrations. CONCLUSION: Intrahepatic cholestasis is associated with dyslipidemia, which may contribute to the pathogenesis of the disease. The elevation of LDL cholesterol and reduction of high-density lipoprotein cholesterol before clinical diagnosis may prove to be a useful biomarker for the early identification of intrahepatic cholestasis of pregnancy and differentiation from pruritus gravidarum. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine if the rates of pregnancy complications, preterm birth, small for gestational age, perinatal mortality, and serious neonatal morbidity are higher among mothers aged 35–39 years or 40 years or older, compared with mothers 20–24 years. METHODS: We performed a population-based study of all women in Nova Scotia, Canada, who delivered a singleton fetus between 1988 and 2002 (N = 157,445). Family income of women who delivered between 1988 and 1995 was obtained through a confidential linkage with tax records (n = 76,300). The primary outcome was perinatal death (excluding congenital anomalies) or serious neonatal morbidity. Analysis was based on logistic models. RESULTS: Older women were more likely to be married, affluent, weigh 70 kg or more, attend prenatal classes, and have a bad obstetric history but less likely to be nulliparous and to smoke. They were more likely to have hypertension, diabetes mellitus, placental abruption, or placenta previa. Preterm birth and small-for-gestational age rates were also higher; compared with women aged 20–24 years, adjusted rate ratios for preterm birth among women aged 35–39 years and 40 years or older were 1.61 (95% confidence interval [CI] 1.42–1.82; P « .001) and 1.80 (95% CI 1.37–2.36; P « .001), respectively. Adjusted rate ratios for perinatal mortality/morbidity were 1.46 (95% CI 1.11–1.92; P = .007) among women 35–39 years and 1.95 (95% CI 1.13–3.35; P = .02) among women 40 years or older. Perinatal mortality rates were low at all ages, especially in recent years. CONCLUSION: Older maternal age is associated with relatively higher risks of perinatal mortality/morbidity, although the absolute rate of such outcomes is low. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of the present study was to evaluate the cardiovascular risk profile and the prevalence of metabolic syndrome among women with a history of pregnancy-induced hypertension (PIH). METHODS: From a cohort of 3,799 nulliparous women prospectively recruited between 1989 and 1997, we performed an observational study on 168 case-control pairs 7.8 years after delivery. Participants were scheduled for a visit with a research nurse to evaluate their cardiovascular risk profile using a questionnaire, anthropometric measurements and blood specimen analysis. RESULTS: One hundred sixty-eight women with prior PIH (105 with gestational hypertension and 63 with preeclampsia) and 168 controls matched for age and year of index delivery were evaluated. The women with PIH (34.6 ± 4.4 years) were more obese and had higher systolic (115 mm Hg versus 108 mm Hg) and diastolic (75 mm Hg versus 70 mm Hg) blood pressures (P < .001) than the 168 controls (35.1 ± 4.5 years). They had lower high-density lipoprotein cholesterol level (1.30 mmol/L versus 1.42 mmol/L; P < .001), increased fasting blood glucose concentration (5.2 mmol/L versus 5.0 mmol/L; P = .002), and higher insulin levels (119 versus 91 pmol/L; P « .001). The prevalence of the metabolic syndrome was higher in the PIH group (unadjusted adds ratio = 4.9; 95% confidence interval 2.1–10.9) compared with controls, even after adjustment for confounders (adjusted adds ratio = 3.6; 95% confidence interval 1.4–9.0). CONCLUSION: In white women in their mid-30s, the prevalence of the metabolic syndrome is 3- to 5-fold increased in those with a history of PIH in their first pregnancy. This emphasizes the importance of long-term follow-up assessment for cardiovascular risk factors in these women. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To estimate whether echocardiography findings at the time of diagnosis of peripartum cardiomyopathy are predictive of persistent cardiac dysfunction. METHODS: Chart review of patients with peripartum cardiomyopathy between 1988 and 2001 was performed. Data from echocardiography, including fractional shortening and left ventricular end diastolic dimension, were recorded both at the time of diagnosis and at follow-up. Left ventricular dysfunction was defined by echocardiography as fractional shortening less than 30% and left ventricular end diastolic dimension of 4.8 cm or more. RESULTS: Of 32 patients meeting our definition for peripartum cardiomyopathy and for whom follow-up data were available, 13 (41%) had recovery of ventricular function, while 19 (59%) continued to have persistent left ventricular dysfunction. Those who did not recover cardiac function had a higher left ventricular end diastolic dimension and a lower fractional shortening at diagnosis than those who recovered. A fractional shortening value less than 20% and a left ventricular end diastolic dimension 6 cm or greater at the time of diagnosis was associated with a more than 3-fold higher risk for persistent left ventricular dysfunction. CONCLUSION: Along with being an important diagnostic tool in peripartum cardiomyopathy, echocardiography may provide significant prognostic information with regards to recovery of cardiac function. [ABSTRACT FROM AUTHOR]

BACKGROUND: Identifying the etiologies of real or perceived adverse clinical events and undesired outcomes is an important step in improving patient safety and reducing malpractice risks. Systematic analysis of obstetrics and gynecology-related risk management files allows a more complete examination of ways that human and systems factors may contribute to adverse events. OBJECTIVE: To learn the medical complaints of patients who experienced apparent adverse events, the general causes of those adverse events, and the significant specific causal factors involved in obstetrics and gynecology-related risk management cases. METHODS: This was a retrospective analysis of 90 consecutive obstetrics and gynecology-related internal review files opened by a medical center's risk managers between 1995 and 2001. Each file was analyzed to identify factors that may have contributed to or caused unanticipated adverse events. The main outcome was the pattern of contributing factors when they were aggregated into categories. RESULTS: Fifty percent of cases were associated with inpatient obstetrics. Factors that may have contributed to adverse events were identified in 78% of cases, and most had more than one contributing factor. Thirty-one percent of adverse events were associated with apparent communication problems. Clinical performance issues were identified in 31% of cases, diagnostic issues in 18% of cases, and patient behavior contributed to 14% of adverse events. CONCLUSION: Diagnostic, therapeutic, and communication issues were the most common factors identified. Although the generalizability of these data are unknown, all obstetrics and gynecology departments face multiple challenges in assuring consistent quality care. Analysis of claims files may help identify opportunities for improvement. [ABSTRACT FROM AUTHOR]

Pregestational diabetes mellitus represents one of the most challenging medical complications of pregnancy. This document provides an overview of the current understanding of pregestational diabetes mellitus and suggests management guidelines during pregnancy. Because few well-designed studies have been performed, many of the guidelines are based on expert and consensus opinion. [ABSTRACT FROM AUTHOR]

Presents several abstracts related to obstetrics and gynecology. "Elective Single-Embryo Transfer Versus Double-Embryo Transfer in In Vitro Fertilization," by A. Thurin, J. Hausken, T. Hillensjo; "Effects of Repeated Prenatal Ultrasound Examinations of Childhood Outcome Up to 8 Years of Age: Follow-Up of a Randomized Controlled Trial," by J. P. Newham, D. A. Doherty, and G. E. Kendall; "Characterizing Ectopic Pregnancies That Rupture Despite Treatment With Methotrexate," by P. S. Dudley, M. J. Heard, and H. Sangi-Haghpeykar.

OBJECTIVE: We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution. METHODS: A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 160/7 and 236/7 weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow-up ligase chain reaction was performed between 240/7 and 296/7 weeks. RESULTS: A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79%) had ligase chain reaction performed both at randomization and follow-up. Women receiving antibiotics effective against Chlamydia between randomization and follow-up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9%) who were diagnosed as positive via the initial llgase chain reaction assay, 61 (44%) had spontaneous resolution of Chlamydia by the follow-up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow-up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater-than-5-week follow-up interval remained significant; for every 5-year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow-up decreased by 40% (odds ratio 0.6; 95% confidence interval 0.4–0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow-up also were not associated. CONCLUSION: The prevalence of asymptomatic C trachomatis in pregnancy was 9%; infection resolved spontaneously in almost half of these women. The association of older age and increasing lime interval to spontaneous resolution of Chlamydia is consistent with a host immune-response mechanism. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Our objective was to investigate the relationship between prepregnancy and obstetric body mass index (BMI) as well as fetal complications in a large, unselected cohort of Danish women with single cephalic pregnancies. METHODS: A cohort of 8,092 women from the Copenhagen First Trimester Study with a registered prepregnancy BMI and a single cephalic term delivery were stratified into 3 BMI groups: normal weight (BMI < 25 kg/m²), overweight (BMI 25–29.9 kg/m²), and obese (BMI > 30 kg/m²). The effects of BMI and parity on the outcome were analyzed using multivariate logistic regression analyses. RESULTS: Overweight women had an odds ratio (OR) of 3.4 for diabetes, 1.9 for hypertension, 1.7 for preeclampsia, and 1.5 for cesarean delivery. The corresponding figures for obese women were 15.3, 4.8, 2.7, and 1.7, respectively. No relationship was found between BMI and vacuum extraction. Obese women had an increased risk of delivering macrosomic but also low birth weight children. No differences existed among the 3 weight groups with regard to neonatal morbidity estimated by Apgar score, umbilical cord pH, or admittance to a neonatal intensive care unit. Nulliparous women had an increased incidence of preeclampsia (OR 2.8), hypertension (OR 1.9), emergency cesarean delivery (OR 3.4), vacuum extraction (OR 5.6), and perineal rupture (OR 1.7) but a lower frequency of elective cesarean delivery (OR 0.25). CONCLUSION: The rate of complications during pregnancy and delivery increases with an increasing prepregnancy BMI in women with single cephalic term pregnancies, particularly in nulliparous women. [ABSTRACT FROM AUTHOR]

The author reflects on the study of Elizabeth B. Magnussen and colleagues regarding the association between long maternal outcomes and hypertensive disorders in pregnancy. The study shows evidence that women with hypertension related to pregnancy are at high risk for the development of metabolic abnormalities and chronic diseases later in life. He cites that asymptomatic individuals with elevated high-sensitivity C-reactive protein (CRP) might benefit from statins treatment.

BACKGROUND: Uterine sacculation is a rare complication of pregnancy and may cause substantial peripartal morbidity. CASE: A possible diagnosis of posterior uterine sacculation was raised when a 34-year-old Gravida 1 Para 1 presented with bilateral flank pain at 29 weeks. Sonographic and magnetic resonance imaging findings confirmed the diagnosis and demonstrated bilateral dilated renal pelvises. Bilateral nephrostomas were placed, offering the patient considerable relief. A healthy female newborn was delivered by cesarean at 34 1⁄7 weeks. Operative findings confirmed the posterior sacculation of the uterus. CONCLUSION: Early diagnosis of sacculation of the uterus is necessary to limit maternal and fetal morbidity and mortality. For a detailed evaluation of the pelvic anatomy, we recommend the use of magnetic resonance imaging in the third trimester. [ABSTRACT FROM AUTHOR]

This document builds upon recommendations from peer organizations and outlines a process for identifying maternal cases that should be reviewed. Severe maternal morbidity is associated with a high rate of preventability, similar to that of maternal mortality. It also can be considered a near miss for maternal mortality because without identification and treatment, in some cases, these conditions would lead to maternal death. Identifying severe morbidity is, therefore, important for preventing such injuries that lead to mortality and for highlighting opportunities to avoid repeat injuries. The two-step screen and review process described in this document is intended to efficiently detect severe maternal morbidity in women and to ensure that each case undergoes a review to determine whether there were opportunities for improvement in care. Like cases of maternal mortality, cases of severe maternal morbidity merit quality review. In the absence of consensus on a comprehensive list of conditions that represent severe maternal morbidity, institutions and systems should either adopt an existing screening criteria or create their own list of outcomes that merit review. [ABSTRACT FROM AUTHOR]

Reviews of articles on preeclampsia are presented including "First-trimester prediction of preeclampsia in nulliparous women at low risk," by L. Myatt, et al, published in the 2012 issue of "Obstetrics & Gynecology," "Long-term cerebral imaging after pre-eclampsia," by A.M. Aukes, et al, published in the 2012 issue of "BJOG," and "Long-term visual functioning after eclampsia," by M.J. Wiegman, et al, published in the 2012 issue of Obstetrics & Gynecology."

The article presents an analysis on screening and its tools used for the evaluation of women's depression during and after their pregnancy. It states that there is deficient evidence to support the recommendation for universal antepartum or postpartum screening, as well as insufficient data to suggest how frequently screening should be made. It mentions that the tools including Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory have a specificity that ranges from 77%-100%.

The article reports on the case of a multiparous woman with milk-alkali syndrome caused by consumption of excess calcium and alkali for treatment of gastroesophageal reflux disease. She was treated with aggressive hydration with normal saline at 200 milliLiter per hour. Calcium intake was restricted. Her calcium and renal function normalized with no further complications. She had an uncomplicated vaginal delivery at 38 weeks of gestation.

BACKGROUND: Micturition syncope is a relatively uncommon cause of sudden and temporary loss of consciousness. Most prevalent in older males, this condition is extremely rare in women. CASES: Two pregnant women presented with recurrent syncope. The syncopal events were more common in the early morning and were precipitated by the presence of a distended bladder, urinary urgency, assuming a standing position after either being supine or sitting, or associated with travel motion. Extensive neurology and cardiology evaluations were negative, and the events were considered consistent with micturition syncope. Both patients responded favorably to conservative voiding behavior modification measures throughout the remainder of pregnancy. CONCLUSION: Micturition syncope during pregnancy may not be a rare occurrence. This potentially dangerous condition is amenable to voiding behavior modification measures. [ABSTRACT FROM AUTHOR]

The article reports that fellows of the American College of Obstetricians and Gynecologists have the option to limit the scope of their practices to gynecology. The organization considers early pregnancy care to be within the scope of gynecology and gynecologic practice. According to the article, liability insurers who provide coverage for gynecology-only practices should provide coverage for clinical practice activities that involve the management of early pregnancy and its complications.