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A study was conducted to determine whether the obesity is associated with obstetric complications and cesarean delivery. The conclusion derived is that obesity is an independent risk factor for adverse obstetric outcome and is significantly associated with an increased cesarean delivery rate.

Doctors were able to preoperatively plan surgery for twin-twin transfusion syndrome by downloading MRI scans of the mother's abdomen into a computer and plan the entire operation using SNN 3.0 Planning and Navigation Software from Surgical Navigation Network of Ontario, Canada. Twin-twin transfusion syndrome occurs when one twin takes blood from the other twin.

Two new glucose measuring tests may be accurate enough to detect gestational diabetes and may be used in a doctor's office as opposed to a laboratory. Researchers tested the accuracy of three glucose measuring tests: HemoCue, OneTouch II, and ExacTech, on 62 pregnant women and compared the results to those obtained by laboratory tests. The HemoCue was found to be the most accurate, compared to laboratory tests, at detecting gestational diabetes blood sugar levels in vein and capillary whole blood and plasma. The OneTouch II could detect gestational diabetes in capillary whole blood but not in vein or capillary whole blood or capillary plasma. Both the HemoCue and OneTouch II could be used in a doctor's office and prevent the need for laboratory testing.

When a woman with a chronic disease becomes pregnant, how do you ensure a safe outcome? Here's what you need to know in four common diseases--hypertension, diabetes, lupus, and asthma. [...]

Different factors may be used to predict the risk of subsequent diabetes or impaired glucose tolerance in women who have had gestational diabetes. Gestational diabetes is the development of diabetes during pregnancy. A study examined different variables in 350 nonpregnant women who had gestational diabetes in the previous 10 years. Several variables were more effective than others in identifying women with an increased risk of later developing diabetes or impaired glucose tolerance. These variables were prepregnancy body mass index and fasting blood levels of glucose on a pregnant oral glucose tolerance test.

Monoamniotic twinning (twins that share a common amniotic sac, the membrane that surrounds the fetus) occurs rarely, and when it does, the event is associated with an increased risk of fetal complications and death. One approach to reducing this risk is to induce delivery early in the last trimester of pregnancy, however, few studies have systematically investigated the effectiveness of this method of treatment. To determine whether early delivery improves the survival of monoamniotic twins, a review of medical records was carried out for all women who gave birth at one hospital during a 13-year period (138,232 live births). Twenty-four sets of monoamniotic twins had both fetuses alive at some time prior to 18 weeks' gestation. At 30 weeks' gestation, 15 sets had both fetuses alive, two sets had one dead twin, one set was delivered and both survived, and in the remaining six sets both fetuses died. Among the 17 sets with at least one twin alive at week 30, no death occurred during the remaining gestational period. Both twins survived in 46 percent of the cases, with survival of at least one fetus in 63 percent. Twins had been diagnosed prenatally in only 29 percent of the cases, and monoamniotic twins, in 21 percent. Thus, it appears that the highest mortality occurs between 18 and 30 weeks' gestational age. Any advantage to early delivery must be weighed against the better survival of fetuses delivered later in gestation. There appears to be no support for the practice of early delivery of monoamniotic twins. (Consumer Summary produced by Reliance Medical Information, Inc.)

Byline: Stephen R. Carr Author Affiliation: Division of Maternal-Fetal Medicine, Women and Infants Hospital/Brown University School of Medicine, 101 Dudley St., Providence, RI 02905

Myelomeningocele (MMC) is the most frequent congenital abnormality of the central nervous system that leads to significant physical disabilities. Historically, treatment involved postnatal repair with management of the hydrocephalus with ventricular shunting. Animal and early human studies demonstrated the feasibility of fetal closure. The benefit of in-utero closure was debated until the results of the prospective randomized multicenter Management of Myelomeningocele Study (MOMS trial) were published, demonstrating a decreased need for shunting, reversal of hindbrain herniation, and better neurologic function in the prenatal repair group compared to postnatal repair. Fetal MMC closure has become a standard of care option for prenatally diagnosed spina bifida. The size of the spinal defect may require modification of the classic surgical technique requiring patching.

As laser ablation of placental vascular communications gains acceptance as treatment option for severe twin-to-twin transfusion syndrome (TTTS), pathologists are increasingly confronted with the interpretation of laser-treated placentas. We present our preliminary institutional experience with the gross and microscopic analysis of these specimens. Patients underwent selective ablation for severe TTTS (Quintero stages II to V) between 16 and 25 wk gestation and the placentas were examined between < 24 h and 19 wk postoperatively. The placental vasculature was injected with gelatin-dye mixtures. The type and number of vascular anastomoses were recorded, followed by routine histopathological analysis of the placenta. Foci of laser impact were identified in all placentas examined within 1 month after laser coagulation. Located along the recipient side of the dividing membrane, the laser-treated vessels appeared hemorrhagic and showed a characteristic abrupt interruption of dye filling after vascular injection. In placentas examined more than 1 month after intervention, the most frequent gross finding was the absence or relative paucity of intertwin anastomoses, associated with subchorionic fibrin deposition. Microscopically, laser-treated vessels showed varying degrees of necrosis, associated with focal hemorrhage, avascular villi, and fibrin deposition in the underlying parenchyma. In some cases of intrauterine fetal demise or placental disruption, no definite laser scars were identified. As expected, the number of residual anastomoses (all types) was significantly smaller in laser-treated placentas than in control monochorionic placentas (2.4 ± 2.2 [ n = 10] vs. 6.2 ± 3.2 [ n = 70], P < 0.01). Velamentous cord insertion was noted in 50% of cases; markedly uneven placental sharing in 60%. Detailed analysis of laser-treated placentas and clinicopathological correlation may lead to a better understanding of the pathophysiology of TTTS and continued refinement of therapeutic approaches for this often lethal condition.

As laser ablation of placental vascular communications gains acceptance as treatment option for severe twin-to-twin transfusion syndrome (TTTS), pathologists are increasingly confronted with the interpretation of laser-treated placentas. We present our preliminary institutional experience with the gross and microscopic analysis of these specimens. Patients underwent selective ablation for severe TTTS (Quintero stages II to V) between 16 and 25 wk gestation and the placentas were examined between < 24 h and 19 wk postoperatively. The placental vasculature was injected with gelatin-dye mixtures. The type and number of vascular anastomoses were recorded, followed by routine histopathological analysis of the placenta. Foci of laser impact were identified in all placentas examined within 1 month after laser coagulation. Located along the recipient side of the dividing membrane, the laser-treated vessels appeared hemorrhagic and showed a characteristic abrupt interruption of dye filling after vascular injection. In placentas examined more than 1 month after intervention, the most frequent gross finding was the absence or relative paucity of intertwin anastomoses, associated with subchorionic fibrin deposition. Microscopically, laser-treated vessels showed varying degrees of necrosis, associated with focal hemorrhage, avascular villi, and fibrin deposition in the underlying parenchyma. In some cases of intrauterine fetal demise or placental disruption, no definite laser scars were identified. As expected, the number of residual anastomoses (all types) was significantly smaller in laser-treated placentas than in control monochorionic placentas (2.4 ± 2.2 [n= 10] vs. 6.2 ± 3.2 [n= 70], P< 0.01). Velamentous cord insertion was noted in 50% of cases; markedly uneven placental sharing in 60%. Detailed analysis of laser-treated placentas and clinicopathological correlation may lead to a better understanding of the pathophysiology of TTTS and continued refinement of therapeutic approaches for this often lethal condition.

The American College of Obstetricians and Gynecologists (ACOG) has recommended screening for gestational diabetes, using a 50-g, 1-hour glucose challenge (threshold for further testing 140 mg/dL or higher), for all pregnant women aged 30 or older and for younger women with risk factors. In order to assess these recommendations, we collected demographic and historic data on 6214 pregnant women representing a population of universally screened individuals. Of 125 cases of gestational diabetes diagnosed (ACOG criteria), 70 patients (56) were under the age of 30. In addition, 44 of gestational diabetics had no risk factors. The cost per case diagnosed would be 190 with the ACOG recommendations, 192 if the age for routine screening were lowered to 25 years or more, and 222 if universal screening were practiced. Using the ACOG recommendations, 35 of gestational diabetes would go undiagnosed, with little cost savings. (Obstet Gynecol 73557, 1989)

Debate continues over whether to screen pregnant women for fetal Down syndrome in the first or the second trimester of pregnancy or in both trimesters. The First- and Second-Trimester Evaluation of Risk Factors (FASTER) Trial obtained direct comparative data on current screening methods from 38,167 women with singleton pregnancies who were cared for at 15 U.S. centers over approximately 3 years in 1999–2002. Down syndrome was found in 117 instances. Inclusion criteria included a maternal age of 16 or older and a fetal crown-rump length of 36 to 79 mm—consistent with a gestational age of 10 weeks 3 days through 13 weeks 6 days. First-trimester screening combined measurement of the nuchal translucency with maternal serum pregnancy-associated plasma protein A (PAPP-A) and free beta human chorionic gonadotropin (fhCG) levels. Quadruple screening in the second trimester, from 15 to 18 weeks gestation, included alpha-fetoprotein, total hCG, unconjugated estriol, and inhibin. Stepwise sequential screening, in which the Down syndrome risk estimate was provided after each test, was compared with “fully integrated” screening, which yielded only a single risk result after both the first- and second-trimester screening tests had been done.

A number of studies have reported an association between low concentrations of serum folate and preterm birth. Folate supplementation during pregnancy increased the length of pregnancy in some but not all clinical trials. This cohort study investigated whether preconceptional folate supplementation (as ascertained by patient questionnaire in the first trimester of pregnancy) lowers the risk of spontaneous preterm birth. The investigators analyzed data collected from a cohort of 34,480 low-risk singleton pregnancies in women enrolled in a previous prospective cohort study on Down syndrome screening conducted at 15 US centers between 1999 and 2002. Duration of pregnancy was estimated by ultrasound measurement in the first trimester. Spontaneous preterm birth was defined as preterm birth between 20 and 37 weeks with no medical or obstetrical complications that constituted indications for delivery. The effects of the duration of preconceptional folate supplementation of ≥1 year (long-term), <1 year and the effect of no supplementation on risk of spontaneous preterm birth were compared using time-to-event analysis. Data were subjected to analysis with multivariable logistic regression.

Placental function in early pregnancy reportedly is associated with a risk of low birth weight. This study was planned to learn whether fetal growth in the first trimester is associated with the duration of pregnancy, birth weight, and/or the risk of having a small for gestational age (SGA) infant. Among more than 38,000 women taking part in a prospective multicenter study in the years 1999–2003 were 976 who conceived by assisted reproductive technology, had crown-rump length measured by ultrasound in the first trimester, and delivered a live singleton infant with no evidence of congenital or chromosomal abnormality. The difference between actual and predicted crown-rump length or the difference in days of gestation (GA) was the postconceptional age as estimated by crown-rump length minus the actual days since conception.

Amniocentesis is the invasive test most commonly used for diagnosing genetic and chromosomal abnormalities prenatally. The incidence of pregnancy loss following mid-trimester amniocentesis has traditionally been estimated to be 0.5%. However, the older studies that indicated this rate were not randomized, ultrasound guidance was generally not used during the procedure, and ultrasonographic technology was substandard compared to that available today. To obtain a more accurate and current estimate of the procedure-related loss rate, the investigators evaluated all pregnancy losses in a total of 35,003 unselected women with viable singleton pregnancies who took part in the First And Second Trimester Evaluation of Risk for Aneuploidy (FASTER) trial. Study patients at 10½ and 14 weeks’ gestation were recruited to the study at 15 clinical centers throughout the United States, and after undergoing prenatal Down syndrome screening and prenatal diagnosis as indicated, were followed up prospectively to assess fetal losses before 24 gestational weeks.