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Objective: The aim of this study is to describe the impact of maternal weight gain on infant birth weight among women with Class III obesity., Study Design: Retrospective cohort of women with body mass index (BMI) ≥40 kg/m 2 at initial prenatal visit, delivered from July 2013 to December 2017. Women presenting 14/0 weeks of gestational age (GA), delivering preterm, or had multiples or major fetal anomalies excluded. Maternal demographics and complications, intrapartum events, and neonatal outcomes abstracted. Primary outcomes were delivery of large for gestational age or small for gestational age (SGA) infant. Bivariate statistics used to compare women gaining less than Institute of Medicine (IOM) recommendations (LTR) and women gaining within recommendations (11-20 pounds/5-9.1 kg) (at recommended [AR]). Regression models used to estimate odds of primary outcomes., Results: Of included women ( n  = 230), 129 (56%) gained LTR and 101 (44%) gained AR. In sum, 71 (31%) infants were LGA and 2 (0.8%) were SGA. Women gaining LTR had higher median entry BMI (46 vs. 43, p  < 0.01); other demographics did not differ. LTR women were equally likely to deliver an LGA infant (29 vs. 34%, p  = 0.5) but not more likely to deliver an SGA infant (0.8 vs. 1%, p  > 0.99). After controlling for confounders, the AOR of an LGA baby for LTR women was 0.79 (95% CI: 0.4-1.4)., Conclusion: In this cohort of morbidly obese women, gaining less than IOM recommendations did not impact risk of having an LGA infant, without increasing risk of an SGA infant., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: Excessive gestational weight gain (GWG) increases risk of postpartum weight retention in normal and overweight women but little is known about weight retention in morbidly obese women. We evaluated the impact of GWG on postpartum weight retention in women with class-III obesity., Study Design: This is a retrospective cohort of pregnancies at a single institution from July 2013 to December 2017 complicated by body mass index (BMI) ≥ 40 at entry to care. Women were classified as GWG within (WITHIN), less than (LESS), or greater than (MORE) Institute of Medicine's (IOM) recommendations. Women were excluded for multiples, late prenatal care, preterm birth, fetal anomalies, intrauterine demise, weight loss, and missing data. Primary outcome was achievement of intake weight at the postpartum visit. Logistic regression was used to adjust for confounding factors., Results: Among 338 women, 93 (28%) gained WITHIN, 129 (38%) LESS, and 144 (43%) MORE. Women in the MORE group were less likely to achieve their intake weight at the postpartum visit (adjusted odds ratio [AOR] = 0.09 95% confidence interval [CI]: 0.05-0.17, p  < 0.01). Women gaining MORE were the only group who did not lose weight from intake to postpartum (Median weight change [LESS: -14 lbs (IQR: -20 to -7)] vs. [WITHIN: -7 lbs (IQR: -13 to -1)] vs. [MORE: 5 lbs (IQR: 0-15)]; p  < 0.01)., Conclusion: Excessive GWG in women with class-III obesity is associated with postpartum weight retention., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objective: We investigated the association between gestational weight gain (GWG) and postpartum depression (PPD) in women with class III obesity., Study Design: This is a retrospective cohort of women with body mass index (BMI) ≥ 40 kg/m 2 at entry to care, first prenatal visit ≤14 weeks gestation, with singleton, nonanomalous pregnancies who delivered at term from July 2013 to December 2017. Women missing data regarding PPD were excluded. Primary outcome was PPD; classified as Edinburgh Postnatal Depression Scale (EPDS) score >13/30 or provider's report of depression. Participants were classified, according to Institute of Medicine GWG guidelines (11-20 pounds), as either less than 11 pounds (LT11) or at/more than 11 pounds (GT11). Bivariate statistics compared demographics and pregnancy characteristics. Logistic regression used to estimate odds of primary outcome., Results: Of 275 women, 96 (34.9%) gained LT11 and 179 (65.1%) gained GT11 during pregnancy. The rate of PPD was 8.7% ( n  = 24), 9 (9.4%) in the LT11 group and 15 (8.4%) in the GT11 group ( p  = 0.82, odds ratio: 1.13, 95% confidence interval [CI]: 0.48, 2.69). When controlling for entry BMI and multiparity, adjusted odds of PPD was 1.07 (95% CI: 0.44, 2.63). No correlation was found between GWG and EPDS., Conclusion: A relationship between GWG and PPD in class III obese women was not found in this cohort., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Our purpose was to evaluate the impact of intravenous and oral tocolysis on prolongation of gestation for women with preterm uterine contractions and/or labor. Candidates for evaluation and treatment including women with contractions between 24 and 35 weeks. Two hundred women (group I) without cervical changes met the protocol criteria and 175 women (group II) who presented with or developed cervical changes were treated by protocol. A representative sample of both groups received oral terbutaline maintenance therapy until 37 weeks' gestation. Primary outcome variables included the length of gestation obtained following initial treatment and the preterm birth rate. Women in group II were twice as likely to deliver before 35 weeks, 23% versus 9.5%, respectively, and to have a delivery before 37 weeks' gestation, 45% versus 22%, respectively, (p < 0.05). There was no significant difference in days gained in utero for women on oral terbutaline for either group. Women in group II on oral therapy were more likely to be readmitted and retreated with parenteral tocolysis. In conclusion, oral maintenance tocolysis has no significant impact on further prolongation of pregnancy after intravenous tocolysis.

We studied 16 women, at 32 weeks' or more gestation who required magnesium sulfate (MgSO4) therapy for preterm labor or preeclampsia. A 60-minute Doppler fetal heart rate (FHR) tracing, analyzed by the Oxford Sonicaid System 8000, was obtained for 1 hour before and 2 hours after each patient received intravenous MgSO4 therapy. Maternal serum Mg2+ levels were obtained at the second monitoring session. Matched paired measures of FHR parameters were compared with the Student's t test. After MgSO4 administration, we noted significant falls in long-term variability, short-term variability, and total acceleration (more than 10 beats/min) counts. Reduced short-term and overall variability occurred in all cases with maternal serum Mg2+ levels more than 4.6 mg/dL. Therapeutic maternal serum Mg2+ levels are linked with decreases in long-term and short-term FHR variability and acceleration counts. These findings should be considered when evaluating resting FHR baseline of patients thus treated.

Examination of paired umbilical arterial and umbilical venous blood gases for 147 term, healthy newborns revealed a strong correlation of pH, bicarbonate, and base excess with the 1-minute Apgar score. Although significantly different from each other, a strong correlation existed between the gas measurements of the two vessels. The lower limit of pH for the umbilical artery was 7.12 and for the vein, 7.25. The arterial-venous difference for bicarbonate but not pH, oxygen or carbon dioxide tension, or base excess was correlated with the 1-minute Apgar score.

To study the involvement of 6 keto prostaglandin F1 alpha (6 keto PGF1 alpha) and thromboxane B2 (TxB2) in mild pregnancy-induced hypertension (PIH), we measured amniotic fluid and plasma concentration of these prostanoids by radioimmunoassay in PIH subjects and normotensive pregnant controls. The results suggest no difference in plasma or amniotic fluid 6 keto PGF1 alpha or plasma TxB2 in PIH and control subjects. The concentration of TxB2 (mean +/- SE) in amniotic fluid, however, were 189.5 +/- 27.7 for PIH and 107.4 +/- 9.7 for controls (P less than 0.05). This increase in vasoconstrictor TxB2 over vasodilator 6 keto PGF1 alpha may have implications in the hypertensive vascular response of mild PIH.

Among 246 term patients undergoing ultrasonic evaluation within 1 week of delivery, a grade-three placenta was found in 39.4%. Advanced placental maturity was not associated with altered fetal growth rates or an increase in small- or large-for-gestational infants. At term, advanced placental maturity is not associated with aberrant fetal growth.

In a cross-sectional study of 210 pregnancies resulting in above-average-sized term infants, ponderal and ponderal-like indices were found to be highly correlative with fetal overgrowth. Clinical usefulness, however, is limited because for each index, most large-for-gestational age infants remain unidentified.