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Objectives The diagnosis of fetal growth restriction (FGR) is managed with close fetal surveillance and often requires iatrogenic delivery, as there is an associated increased risk of fetal demise. However, there is no standard reference for fetal growth. We sought to compare the intrauterine growth curve of Hadlock et al (Radiology 1991; 181:129-133) to other known growth curves to determine which one best identifies fetuses at risk without overburdening the patient and health care system with unnecessary intervention. Methods We retrospectively reviewed charts of singleton euploid pregnancies with a diagnosis of FGR (per Hadlock) at a tertiary care center from June 2014 to May 2015. We applied the estimated fetal weights from ultrasound at diagnosis of FGR to 4 population-based growth curves by Brenner et al (Am J Obstet Gynecol 1976; 126:555-564), Williams et al (Obstet Gynecol 1982; 59:624-632), Alexander et al (Obstet Gynecol 1996; 87:163-168), and Duryea et al (Obstet Gynecol 2014; 124:16-22) and reassessed the incidence of FGR using each curve. We reviewed pregnancy demographics, risk factors, pregnancy management, and outcomes of FGR cohorts on each curve to evaluate whether poor outcomes may be missed or interventions may be avoided using the population-based curves. A sensitivity analysis was also done to see how well each curve predicted small-for-gestational-age birth weights. Results Applying any of the population-based growth curves decreased the number of FGR diagnoses, iatrogenic deliveries, and primary cesarean deliveries. Brenner's growth curve identified the least number of FGR diagnoses at 22 of the 107 identified by Hadlock. Williams' growth curve performed best in the sensitivity analysis with sensitivity of 99% and specificity of 97%. A small number of patients with absent/reversed end-diastolic flow would have been missed by applying the population curves. Conclusions Applying the population-based growth curves instead of Hadlock's for diagnosis of FGR decreases its incidence, therefore decreasing the number of visits for ultrasound and fetal surveillance and the number of iatrogenic deliveries. However, using these curves could miss a few fetuses with increased risk of fetal demise.

OBJECTIVES: To evaluate short- and long-term growth in fetuses with growth restriction (FGR) and elevated umbilical artery Doppler (UAD) systolic/diastolic (S/D) ratios. METHODS: In this prospective observational study, two UAD waveforms were obtained from each umbilical artery weekly and were classified as normal or abnormal. Fetal growth was assessed every 3 weeks. Short-term growth was calculated from the first visit with elevated ratios until next growth assessment. Results were grouped by number of initial elevated S/D ratios (maximum, 4). Long-term growth was evaluated by change in estimated fetal weight from diagnosis of FGR to birth weight. Fetuses were grouped by average number of elevated S/D ratios and compared to a reference population of growth restricted fetuses with normal testing. RESULTS: Of 241 fetuses evaluated, 105 demonstrated elevated S/D ratios. Short-term growth was impaired when fetuses had elevated S/D ratios. Long-term growth was affected when the average number of elevated S/D ratios was ≥1 per visit. Progressive 3 or 4 growth delay was noted as the average number of abnormal S/D ratios increased. CONCLUSIONS: Short- and long-term fetal growth are affected by elevated UAD S/D ratios. Fetuses with more abnormal values initially and those with a higher average of elevated values over pregnancy demonstrate decreased growth.

To compare the accuracy of a new combination monoclonal/polyclonal immunoassay point-of-care test with that of current conventional clinical assessment for diagnosis of ruptured amniotic membranes.This was a multicenter prospective observational study performed in patients presenting with signs or symptoms of ruptured amniotic membranes. This clinical trial included 3 sites in the United States. Initial evaluation included both the standard clinical assessment for rupture of membranes (ROM) (speculum examination for fluid pooling, ferning, and nitrazine test), as well as the use of a new combination immunoassay test containing a combination monoclonal/polyclonal antibody approach to detect placental protein 12 (PP12) and alpha-fetoprotein (AFP). ROM was diagnosed if fluid was seen leaking from the cervical os, or if 2 of the 3 conditions were present: pooling of fluid, positive nitrazine test, or ferning. ROM was confirmed on review of the medical records following delivery.Of the 285 patients (15-42 weeks of gestation), the false positive rate for the new combination immunoassay test was 9% and the false negative rate was 0.5%, sensitivity 99%, specificity 91%, positive and negative predictive values of 95% and 99%, respectively. The conventional clinical evaluation's sensitivity was 85%, specificity 98%, with positive and negative predictive values of 99% and 77%. Ferning's sensitivity was 99%, specificity 72%, with positive and negative predictive values of 80% and 99%. Nitrazine testing's sensitivity was 93%, specificity 83%, with positive and negative predictive values of 90% and 88%.This combination monoclonal and polyclonal immunoassay test that detects PP12 and AFP has an efficacy comparable to conventional testing and better than the individual components of conventional testing (ferning, nitrazine), is a quick and easy-to-use test that can be performed by a wider variety of care providers, and can improve triage and management of patients suspected of ROM.

Objective. To determine whether performance of endovaginal sonography for the measurement of cervical length results in a statistically significant change in endocervical culture results. Methods. Women attending a routine prenatal clinic were offered enrollment in the study. Exclusion criteria included the presence of a cervical cerclage, vaginal examination or coitus within the preceding 24 hours, antibiotic therapy within the preceding 7 days, or the presence of ruptured membranes. A sterile speculum examination and collection of cervical cultures were performed before (initial) and immediately after (final) endovaginal sonographic measurement of cervical length. Quantitative cultures were completed and evaluated for differences in growth by a standardized 4-quadrant technique. Results. A total of 25 women enrolled and completed the study protocol. Quantitative assessment of colony growth showed that the mean growth in the initial samples ± SD was 3.48 ± 1.74, with 1+ indicating growth in 1 quadrant; 2+, growth in the first and second quadrants; 3+, growth in the first, second, and third quadrants; and 4+, growth in all quadrants. The mean growth cultured in the final sample was 3.79 ± 2.26 (P = .364; 95% confidence interval of the difference, ‐1.00 to +.381). Conclusions. The results of this study do not show a statistically significant inoculation effect associated with performance of endovaginal sonography for the measurement of cervical length. Key words: cervical cultures; cervical length; endovaginal sonography; preterm premature rupture of

The objective of this work was to study the prevalence of the Factor V Leiden mutation in an obstetrical clinic largely comprised of African-American women. A cross-sectional study was performed evaluating a total of 231 consecutive women of African-American origin. Of these patients, 21 were considered at high risk for thrombosis, but none was found to carry the mutation. One patient (0.4 per cent) of the total was heterozygous for the Factor V Leiden mutation. African-American women do not appear to be at an increased risk of being heterozygous or homozygous for the Leiden mutation. This low prevalence may be confounded by ascertainment bias in a population of pregnant women.

UNLABELLED Obesity is dramatically increasing throughout the world and is known to be a major cause of preventable morbidity and mortality. By screening women for obesity and obesity-related complications, the obstetrician/gynecologist can help improve health outcomes for women and their infants. Many pregnancy complications have been linked to obesity ranging from increased risk of gestational diabetes and hypertension to increased risk of cesarean delivery and postoperative wound infection. This article reviews antepartum, intrapartum, and postpartum complications associated with obesity in pregnancy and offers suggestions to optimize care and improve outcomes. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES After completion of this article, the reader should be able to define obesity in pregnancy, to list the various complications associated with obesity, and to describe the limitations of ultrasonography in obese gravidas.

Background: Fetal infection by human parvovirus B19 is a common cause of fetal anemia, nonimmune hydrops fetalis, and spontaneous abortion and can result in fetal death. Recent improvements in diagnosing parvovirus infections and the availability of intrauterine transfusion have reduced the overall rate of fetal loss after maternal exposure. Methods: We report two cases of maternal parvovirus infection with classic findings of hydrops fetalis and review various aspects of parvovirus infection with emphasis on the developing management options in pregnancy. Results and Conclusions: Different management led to different results. In the first case there was normal neonatal and infantile development, and in the second case, the fetus died. With accurate laboratory testing, obstetric sonography, and fetal transfusion, the fetal mortality from parvovirus infection has been reduced considerably, and most pregnancies complicated by maternal parvovirus infection result in healthy outcomes.

Background: Because GDMA2 pregnancies are believed to be at increased risk of perinatal morbidity and mortality, fetal surveillance is initiated in the third trimester. Objectives: To correlate the results of antepartum fetal surveillance with glycemic control and fetal outcomes. Materials and Methods: A retrospective chart study of 421 pregnant women with diabetes was performed over a 7-year period. Patients with GDMA1, preexisting hypertension, diabetes, severe preeclampsia, fetal growth restriction, noncompliance, and substance abuse were excluded. For study purposes good glycemic control was fasting (F) and 2-hour postprandial (PP) glucose values of 150 mg/dL. The mean of the F and 2-hour PP values was noted on the day of and the day preceding the nonstress test (NST). The number of NSTs and biophysical profile(s) (BPPs) each patient underwent, the frequency of abnormal test results dictating further testing/delivery, and the fetal outcomes were recorded and correlated with glycemic control. Results: One hundred fifty-two patients in the study underwent 1,555 NSTs. Of the NSTs, 7.4 % were nonreactive, and glycemic control was good in 4.2% and fair or poor in 3.0%. There was no statistically significant difference. Further data, including glycemic control in reactive NSTs and fetal outcomes, will be presented. Conclusions: The role of antepartum fetal surveillance in GDMA2 patients, especially well-controlled patients, remains to be determined.