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Systemic lupus erythematosus (SLE) is a chronic, multisystem, inflammatory autoimmune disease characterized by relapses (commonly called "flares") and remission. Many organs may be involved and although the manifestations are highly variable, the kidneys, joints, and skin are commonly affected. Immunologic abnormalities, including the production of antinuclear antibodies (ANA), are also characteristic of the disease. Maternal morbidity and mortality are substantially increased in patients with SLE, and an initial diagnosis of SLE during pregnancy is associated with increased morbidity. Common complications of SLE include nephritis, hematologic complications such as thrombocytopenia, and a variety of neurologic abnormalities. The purpose of this document is to examine potential pregnancy complications and to provide recommendations on treatment and management of SLE during pregnancy. The following are the SMFM recommendations: we recommend low-dose aspirin beginning at 12 weeks of gestation until delivery in patients with SLE to decrease the occurrence of preeclampsia (GRADE 1B); we recommend that all patients with SLE, other than those with quiescent disease, either continue or initiate HCQ in pregnancy (GRADE 1B); we suggest that for patients with quiescent disease, shared decision making is used to decide whether to initiate HCQ during pregnancy (GRADE 2B); we recommend that prolonged use (48 hours) of NSAIDs should be avoided during pregnancy (GRADE 1A); we recommend that Cox-2 inhibitors and full dose aspirin should be avoided during pregnancy (GRADE 1B); we recommend discontinuing methotrexate and mycophenolate mofetil/mycophenolic acid at least three months prior to attempting pregnancy (GRADE 1A); we suggest against initiating newer biologic medications with pregnancy unless alternatives with better safety profiles are ineffective (GRADE 2C); we suggest treatment with a combination of prophylactic unfractionated or low molecular weight heparin and low-dose aspirin for patients without a prior thrombotic event who meet obstetric criteria for APS (GRADE 2B); we recommend therapeutic unfractionated or low molecular weight heparin for patients with a history of thrombosis and aPL antibodies (GRADE 1B); we suggest treatment with low-dose aspirin alone in patients with SLE and antiphospholipid antibodies without clinical events meeting criteria for APS (GRADE 2C); we recommend that steroids should not be routinely used for the treatment of fetal heart block due to anti-SSA/SSB antibodies, given their unproven benefit and the known risks for both the pregnant patient and fetus (GRADE 1C); we recommend that serial fetal echocardiograms for assessment of the PR interval not be routinely performed in patients with anti-SSA or anti-SSB antibodies (GRADE 1B); we recommend that patients with SLE undergo prepregnancy counseling with both maternal-fetal medicine and rheumatology specialists that includes a discussion regarding maternal and fetal risks (GRADE 1C); we recommend that pregnancy should be generally discouraged in patients with severe maternal risk, including patients with active nephritis; severe pulmonary, cardiac, renal, or neurologic disease; recent stroke; or pulmonary hypertension (GRADE 1C); we recommend antenatal testing and serial growth scans in pregnant patients with SLE due to the increased risk of FGR and stillbirth (GRADE 1B); and we recommend adherence to the Centers for Disease Control and Prevention (CDC) medical eligibility criteria for contraceptive use in patients with SLE (GRADE 1B).

Ventriculomegaly is defined as dilation of the fetal cerebral ventricles and is a relatively common finding on prenatal ultrasound. The purpose of this document is to review the diagnosis, evaluation, and management of mild fetal ventriculomegaly. When enlargement of the lateral ventricles (≥10 mm) is identified, a thorough evaluation should be performed, including detailed sonographic evaluation of fetal anatomy, amniocentesis for karyotype and chromosomal microarray analysis, and a workup for fetal infection. In some cases, fetal magnetic resonance imaging may identify other central nervous system abnormalities and should be considered when this technology as well as expert interpretation is available. Follow-up ultrasound examination should be performed to assess for progression of the ventricular dilation. In the setting of isolated ventriculomegaly of 10-12 mm, the likelihood of survival with normal neurodevelopment is >90%. With moderate ventriculomegaly (13-15 mm), the likelihood of normal neurodevelopment is 75-93%. The following are Society for Maternal-Fetal Medicine recommendations: We suggest that ventriculomegaly be characterized as mild (10-12 mm), moderate (13-15 mm), or severe (>15 mm) for the purposes of patient counseling, given that the chance of an adverse outcome and potential for other abnormalities are higher when the ventricles measure 13-15 mm vs 10-12 mm (GRADE 2B); we recommend that diagnostic testing (amniocentesis) with chromosomal microarray analysis should be offered when ventriculomegaly is detected (GRADE 1B); we recommend testing for cytomegalovirus and toxoplasmosis when ventriculomegaly is detected, regardless of known exposure or symptoms (GRADE 1B); we suggest that magnetic resonance imaging be considered in cases of mild or moderate fetal ventriculomegaly when this modality and expert radiologic interpretation are available; magnetic resonance imaging is likely to be of less value if the patient has had a detailed ultrasound performed by an individual with specific experience and expertise in sonographic imaging of the fetal brain (GRADE 2B); we recommend that timing and mode of delivery be based on standard obstetric indications (GRADE 1C); we recommend that with isolated mild ventriculomegaly of 10-12 mm, after a complete evaluation, women be counseled that the outcome is favorable, and the infant is likely to be normal (GRADE 1B); we recommend that with isolated moderate ventriculomegaly of 13-15 mm, after a complete evaluation, women be counseled that the outcome is likely to be favorable but that there is an increased risk of neurodevelopmental disabilities (GRADE 1B).

A case of Twin Reversed Arterial Perfusion (TRAP Sequence) is presented. This phenomenon occurs rarely in monochorionic twin pregnancies. TRAP sequence should be considered in cases where fetal "demise" is present. Ultrasound plays an important role in diagnosis of in-utero disorders affecting twin pregnancies.

The American Academy of Pediatrics (AAP) Task Force on Circumcision published its policy statement and technical report on newborn circumcision in September 2012.1 ,2 Since that time, some individuals and groups have voiced objections to the work of the Task Force, while others have conveyed their support. The AAP task force is pleased that the policy statement and technical reports on circumcision have stimulated debate on this topic and welcomes respectful discussion and dialogue about the scientific and ethical issues that surround neonatal circumcision. We believe this is a complex issue that does not lend itself to simplistic solutions. The Task Force encourages those of all viewpoints to contribute to a vibrant, thoughtful and respectful evidence-based dialogue. We appreciate that the free exchange of competing ideas is a necessary component of scientific discovery. We also recognise that all clinical decisions carry ethical dimensions and that a respectful and thoughtful dialogue about these issues is important. However, the Task Force also feels strongly that this debate and the academic literature are demeaned when those with an ideological agenda disseminate inaccurate information, misapply scientific principles, make accusations that are unsupported, communicate in a vitriolic tone, and attempt to discredit and mischaracterise alternative views and those who hold them. Healthy debate and …