MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'American Journal of Perinatology' source. Thu, 09 Feb 2012 17:49:14 +0100 http://www.medworm.com/index.php?rid=5664343&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1300969 Amer J PerinatolDOI: 10.1055/s-0031-1300969We conducted this study to compare the strong ion gap (SIG) with base excess (BE) and lactate for predicting neurologic outcome measured by magnetic resonance imaging (MRI) in newborns with hypoxic-ischemic encephalopathy (HIE). In a retrospective cohort of 39 newborns with HIE treated with whole-body surface cooling (n = 17) and no cooling (n = 22), we measured blood SIG, BE, and lactate at 4, 24, and 48 hours after birth, and determined cerebral injury severity by T1-, T2-, and diffusion-weighted MRI scores at age 5 days. Lower SIG levels correlated with better neurologic outcome. The highest correlation coefficient (0.63) was in the “no cooling” subcohort between diffusion-weighted scores and SIG levels at 24 hours; the latter also ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5664343 Fri, 03 Feb 2012 05:00:00 +0100 5664343 http://www.medworm.com/index.php?rid=5664342&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1300971 We examined whether the number of HCMV DNA copies in BM is related to HCMV infection in very low birth weight (VLBW) infants. We identified 11 pairs of VLBW infants and mothers. BM samples were collected every week until 10 weeks postpartum. Urine samples were collected from the infants within 1 week, at 6 to 8 weeks, at discharge, and whenever HCMV infection was suspected. HCMV DNA in BM was positive in 7 of 11 mothers and reached a peak at 4 to 5 weeks postpartum. Of the 11, 5 infants were determined to be infected from positive HCMV DNA in the urine, despite the fact that BM was used after being frozen. Of the five, four infected infants exhibited symptoms between 35 and 60 days of age. Symptomatic infants had longer stays and slower weight gain. The HCMV infection rate is high in very ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5664342 Fri, 03 Feb 2012 05:00:00 +0100 5664342 http://www.medworm.com/index.php?rid=5664341&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1300970 Amer J PerinatolDOI: 10.1055/s-0031-1300970Infants born with intrauterine growth restriction are at increased risk for adverse cardiovascular outcomes in neonatal and later life. Although circadian rhythm is a prognostic marker of cardiovascular health, the concern over the circadian rhythm of these infants is rarely observed. To determine the influence of intrauterine growth retardation on the pattern of circadian rhythm, heart rate (HR) circadian rhythmicity was analyzed in 39 small for gestational age (SGA; birth weight and height below <−2.0 standard deviation score [SDS]) and 117 appropriate for gestational age (AGA; >−1.5 to <1.5 SDS) infants within 72 hours of birth using spectral analysis and cosinor analysis. Amplitude, midline estimating statistic of rhythm, and acro... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5664341 Fri, 03 Feb 2012 05:00:00 +0100 5664341 http://www.medworm.com/index.php?rid=5624868&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1301056 Amer J Perinatol 2012; 29: 01-02DOI: 10.1055/s-0031-1301056Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5624868 Mon, 23 Jan 2012 05:00:00 +0100 5624868 http://www.medworm.com/index.php?rid=5483335&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295643 Amer J PerinatolDOI: 10.1055/s-0031-1295643We prospectively correlated the 24-hour ambulatory blood pressure measurements (ABPM) to conventional sphygmomanometer blood pressure measurements (CSM) in women at risk for gestational hypertensive disorders (GHTNDs) and identified predictive factors from ABPM for GHTND. We analyzed 73 women with ≥1 risk factor for developing a GHTND. Using both the CSM and ABPM, the systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), and heart rate (HR) were measured for 24 hours during three periods (14 to 24 weeks; 24 to 32 weeks; and 33 weeks to delivery). Correlation between the CSM and ABPM lessened as pregnancy progressed. Seventeen (25%) of women developed a GHTND. MAP variability increased in the GHTND group versus those wi... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5483335 Tue, 06 Dec 2011 05:00:00 +0100 5483335 http://www.medworm.com/index.php?rid=5483333&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295660 Amer J PerinatolDOI: 10.1055/s-0031-1295660Due to disproportionately high mortality from 2009 H1N1 influenza, pregnant women were given highest priority for H1N1 vaccination. We surveyed postpartum women to determine vaccine uptake and reasons for lack of vaccination. We performed a cross-sectional survey of postpartum women delivering at our institution from February 1 to April 15, 2010. The 12-question survey ascertained maternal characteristics and vaccination concerns. Among 307 postpartum women, 191 (62%) had received H1N1 vaccination and 98 (32%) had declined. Factors associated with H1N1 vaccination included older age (relative risk [RR] 1.3, 95% confidence interval [CI] 1.1 to 1.5 for age ≥35 years compared with 20 to 34 years), at least college education (RR 1.5, 95% CI 1.3 to 1... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5483333 Tue, 06 Dec 2011 05:00:00 +0100 5483333 http://www.medworm.com/index.php?rid=5483332&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295636 The objective of this study was to determine if hydrographic MRI provides better conspicuity of fetal eye structures compared with ssFSE MRI. ssFSE and hydrographic images were retrospectively examined in 82 consecutive fetal studies with normal central nervous system without sensitivity encoding. Relative signal intensity values on ssFSE and hydrographic MRI were obtained for vitreous and sclera. Ratios of the signal intensity of vitreous to the signal intensity of sclera were calculated to determine conspicuity. Similar measurements were obtained in a smaller separate data set (n = 41) using hydrographic imaging with sensitivity encoding techniques. The hydrographic images significantly demonstrated greater conspicuity (ratio of vitreous to sclera) than ssFSE images. This was consist... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5483332 Tue, 06 Dec 2011 05:00:00 +0100 5483332 http://www.medworm.com/index.php?rid=5483329&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295654 This study demonstrated a strong positive correlation between exposure of the fetus to a severe inflammatory response and the development of chronic lung disease of prematurity.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5483329 Tue, 06 Dec 2011 05:00:00 +0100 5483329 http://www.medworm.com/index.php?rid=5483334&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295661 Amer J PerinatolDOI: 10.1055/s-0031-1295661Therapeutic hypothermia initiated at <6 hours of age reduces death and disability in newborns ≥36 weeks’ gestation with moderate to severe hypoxic ischemic encephalopathy. Given the limited therapeutic window, cooling during transport becomes a necessity. Our goal was to describe the current practice of therapeutic hypothermia during transport used in the state of California. All level III neonatal intensive care units (NICUs) were contacted to identify those units providing therapeutic hypothermia. An electronic questionnaire was sent to obtain basic information. Responses were received from 28 (100%) NICUs performing therapeutic hypothermia; 26 NICUs were cooling newborns and two were in the process of program development. Eighteen (64%) ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5483334 Mon, 05 Dec 2011 05:00:00 +0100 5483334 http://www.medworm.com/index.php?rid=5483331&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295655 Amer J PerinatolDOI: 10.1055/s-0031-1295655We sought to determine the morbidity, frequency, and demographics of pregnant patients with pyelonephritis not yet receiving prenatal care compared with patients with prenatal care. We performed a retrospective cohort analysis of 254 consecutive admissions for pyelonephritis from January 2004 to June 2007 at a single tertiary hospital comparing patients with prenatal care versus patients with no prenatal care. The sample size was adequate to detect a 1-day difference in length of admission between the two groups with an α of 0.05 and 80% power. Categorical variables were compared by Fisher exact test, and continuous variables were compared by the Wilcoxon rank sum or Kruskal-Wallis test. Of the 254 cases, 35 (13.8%) occurred in women who had not ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5483331 Mon, 05 Dec 2011 05:00:00 +0100 5483331 http://www.medworm.com/index.php?rid=5483330&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295640 In conclusion, early fetal echocardiography appears to be a reasonable screening tool for major cardiac defects.[...]Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5483330 Mon, 05 Dec 2011 05:00:00 +0100 5483330 http://www.medworm.com/index.php?rid=5465261&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295657 Amer J PerinatolDOI: 10.1055/s-0031-1295657We compared maternal and neonatal outcomes in women who received prophylactic antibiotics prior to skin incision to those who received antibiotics at cord clamp. We performed a randomized clinical trial at two sites. Eligible women included those undergoing nonemergency cesarean at 36 weeks’ gestation or greater. Subjects were randomized (permuted blocks) into one of two treatments: “preoperative antibiotics” (cefazolin 1 g given <30 minutes prior to skin incision) or “intraoperative antibiotics” (cefazolin 1 g at cord clamping). Patients who reported an allergy to penicillin received clindamycin 900 mg. The trial primary outcome was a composite of maternal infectious morbidities, defined as having any one of the following: (1) postop... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5465261 Thu, 01 Dec 2011 05:00:00 +0100 5465261 http://www.medworm.com/index.php?rid=5465264&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295650 Amer J PerinatolDOI: 10.1055/s-0031-1295650We studied the incidence of umbilical venous catheterization (UVC)-related infection and pathogens in a neonatal intensive care unit (NICU) in China. Patients were grouped into <2000-g UVC or <2000-g non-UVC groups or ≥2001-g UVC or ≥2001-g non-UVC groups. Blood culture and umbilical root skin swab culture were taken following UVC insertion and extraction. UVCs were removed after 7 days and cultures of UVC tips were performed then. A total of 516 patients were enrolled. The incidence of UVC-related septicemia was 9.5%. The incidence of UVC-related septicemia per 1000 UVC days was 13.6. No significant difference was noted between <2000-g UVC and <2000-g non-UVC groups and between ≥2001-g UVC group and ≥2001-g non-UVC groups, in ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5465264 Wed, 30 Nov 2011 05:00:00 +0100 5465264 http://www.medworm.com/index.php?rid=5465263&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295662 Amer J PerinatolDOI: 10.1055/s-0031-1295662To determine whether fetal presentation affects the accuracy of ultrasonographic estimated fetal weight (EFW). This is a retrospective cohort study of singleton pregnancies that underwent ultrasonographic EFW within 3 weeks of delivery at a single institution from 1993 to 2008. Breech presenting fetuses were compared with those presenting cephalic. EFW using the Hadlock formula was compared with actual birth weight (ABW) and reported as mean difference and mean percentage difference. Differences were also considered categorically. Subgroup analyses were performed of women who delivered within 4 days of scan and excluding women with comorbidities. Ability to detect small and large for gestational age infants was compared. Evaluation of 3770 patient... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5465263 Wed, 30 Nov 2011 05:00:00 +0100 5465263 http://www.medworm.com/index.php?rid=5465262&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295641 Amer J PerinatolDOI: 10.1055/s-0031-1295641Ovarian tumors first diagnosed during pregnancy often present a challenge for both the obstetrician and gynecologists providing pregnancy care and for the consulting subspecialists. Although the vast majority of these tumors is benign, on rare occasions, patients present with tumors that turn out to be malignant requiring more comprehensive and extensive surgical procedures that are more likely to lead to pregnancy loss. Hence accurate knowledge of tumor characteristics, especially the ultrasound appearance and gestational age at diagnosis, are key prerequisite for establishing the most effective management plan not just for the index but also for future pregnancies. The primary objective of the current review is to provide practical guidelines fo... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5465262 Wed, 30 Nov 2011 05:00:00 +0100 5465262 http://www.medworm.com/index.php?rid=5465260&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295647 Amer J PerinatolDOI: 10.1055/s-0031-1295647To compare the effect of small for gestational age (SGA) on mortality, major morbidity and resource utilization among singleton very preterm infants (<33 weeks gestation) admitted to neonatal intensive care units (NICUs) across Canada. Infants admitted to participating NICUs from 2003 to 2008 were divided into SGA (defined as birth weight <10th percentile for gestational age and sex) and non-small gestational age (non-SGA) groups. The risk-adjusted effects of SGA on neonatal outcomes and resource utilization were examined using multivariable analyses. SGA infants (n = 1249 from a cohort of 11,909) had a higher odds of mortality (adjusted odds ratio [AOR] 2.46; 95% confidence interval [CI], 1.93–3.14), necrotizing enterocolitis (AOR 1.5... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5465260 Wed, 30 Nov 2011 05:00:00 +0100 5465260 http://www.medworm.com/index.php?rid=5465259&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295646 Amer J PerinatolDOI: 10.1055/s-0031-1295646We sought to identify factors associated with readiness to discontinue supplemental oxygen and to gain weight in very low-birth-weight (VLBW) infants with bronchopulmonary dysplasia (BPD) approaching neonatal intensive care unit (NICU) discharge. From 2004 to 2009, VLBW infants ≥34 weeks’ postmenstrual age (PMA) on nasal cannula supplemental oxygen were challenged with room air at rest, during activity, and feeding as routine care. Outcome and clinical data were collected retrospectively. Challenges were divided into derivation and validation cohorts. We performed comparative and hierarchical logistic regression analyses, constructing a predictive model with passed challenge as outcome. Of 233 infants (birth weight 901 ± 245 g, gestational ag... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5465259 Wed, 30 Nov 2011 05:00:00 +0100 5465259 http://www.medworm.com/index.php?rid=5437329&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295659 Amer J PerinatolDOI: 10.1055/s-0031-1295659Although mother’s milk is the optimal nutrition for preterm infants, the amount of protein, calcium, and phosphorus become inadequate for the growth of preterm infants, such that fortification is recommended when enteral feeding is established. Recently, intestinal obstruction due to calcium soap formation has been reported. All the reported cases were fed fortified thawed human milk. It has not been elucidated how human milk fortifier reacts with milk fat globules (MFGs) in thawed human milk. Therefore, we investigated whether freezing durations and time between fortification and enteral feeding denatured MFGs. Six samples of preterm mothers’ milk of each type (fresh unfrozen, 1-month frozen, and 12-month frozen) were analyzed. Fortifier was ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5437329 Mon, 21 Nov 2011 05:00:00 +0100 5437329 http://www.medworm.com/index.php?rid=5437328&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295649 Amer J PerinatolDOI: 10.1055/s-0031-1295649The use of plain radiographs in assessing the correct position of peripherally inserted central catheter (PICC) line tips is not always accurate. Ultrasound may be a better modality in detecting tip position and aid in line manipulation. We assessed the accuracy of plain radiographs in determining PICC line tip position compared with using targeted neonatal echocardiography (TnECHO) in a tertiary neonatal intensive care unit. Following PICC insertion, tip position was confirmed using TnECHO after the first radiograph. A 2 × 2 table was constructed to compare the two modalities’ ability to detect line position. A total of 22 infants were included in the study with a gestation of 26.5 weeks (25.4 to 28.8) and birth weight of 833 g (710 to 193... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5437328 Mon, 21 Nov 2011 05:00:00 +0100 5437328 http://www.medworm.com/index.php?rid=5437327&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295656 The objective of this study was to compare the frequency of abnormal fetal growth in women with diabetes mellitus (DM) using population-based birth weight (pop BW) percentiles compared with customized birth weight (cust BW) percentiles, which include adjustments for maternal race, parity, height, weight, and fetal sex. The study design comprised a retrospective cohort of singleton DM pregnancies delivered over a 1-year period (June 2007 to May 2008) from a single tertiary care university-based medical center. Inclusion criteria were gestational age >20 weeks at delivery, live birth, and absence of major chromosomal/structural abnormalities. Small for gestational age (SGA), <10th percentile, and large for gestational age (LGA), >90th percentile pregnancies were categorized based on... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5437327 Mon, 21 Nov 2011 05:00:00 +0100 5437327 http://www.medworm.com/index.php?rid=5437326&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295653 Amer J PerinatolDOI: 10.1055/s-0031-1295653We compared the duration of labor among nulliparous women with varying body mass index (BMI). Laboring nulliparous women at >37 weeks were included. First visit BMI was used to categorize weight as normal (≤24), overweight (25 to 29.9), or obese (≥30 kg/m2). Chi-square, one-way analysis of variance, and Bonferroni multiple comparisons tests were used. During 15 months, 375 women met the inclusion criteria, and 38% were obese. Duration of first stage of labor was significantly longer for obese versus normal-weight women (26.76 ± 0.77 versus 23.87 ± 0.66 hours; p = 0.024) but not between normal versus overweight women (p = 1.00) or overweight versus obese women (p = 0.114). The cesarean delivery rate was significantly different ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5437326 Mon, 21 Nov 2011 05:00:00 +0100 5437326 http://www.medworm.com/index.php?rid=5437325&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295637 We examined the relationship between type of skin incision at time of cesarean delivery and postoperative wound complications in the obese parturient. Women with a body mass index (BMI) of greater than 29 who had undergone cesarean delivery at The University of North Carolina were identified from the Pregnancy, Infection and Nutrition study. Inpatient and outpatient medical records were reviewed for maternal demographics as well as intrapartum and intraoperative characteristics. The exposure of interest was type of incision, classified as vertical or transverse. The primary outcome was wound complication, defined as partial or complete wound separation. Logistic regression analysis was used to create a final model of risk factors for wound complications while controlling for potentially co... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5437325 Mon, 21 Nov 2011 05:00:00 +0100 5437325 http://www.medworm.com/index.php?rid=5437324&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295645 Amer J PerinatolDOI: 10.1055/s-0031-1295645Hirschsprung’s disease (HD) presents with severe constipation due to absent ganglion cells in the distal rectum. We sought to determine whether maternal chimeric cells are present in aganglionic bowel. We hypothesize that chimeric cells are part of the unfavorable microenvironment that leads to the destruction of enteric neurons in HD. Intestinal biopsies and resections from seven male patients with HD were compared with four male patients with chronic constipation and six with bowel atresia. Fluorescence in situ hybridization was used to identify chimeric cells based on male/female (XX/XY) differences. The location and immunophenotype of chimeric cells were also studied. Chimeric cells were present more often in the small intestine and rectum, ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5437324 Mon, 21 Nov 2011 05:00:00 +0100 5437324 http://www.medworm.com/index.php?rid=5437323&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295644 The objective of this article is to determine if coexistence of periodontal disease (PD) and bacterial vaginosis (BV) is synergistic on the risk of spontaneous preterm delivery (sPTD). The study design was secondary analysis of a prospective cohort study. Women were screened 6 to 20 weeks gestation for PD and BV. Groups were defined by presence of BV and stratified on PD. The primary outcome was sPTD <37 weeks gestation. Univariable, stratified, and multivariable analyses were performed to estimate the main and interaction effects of BV and PD on sPTD. Of 1453 women screened, 792 (54.5%) were diagnosed with BV. Neither women with BV in the first trimester nor PD was at higher risk of sPTD (risk ratio [RR] for BV 1.1; 95% confidence interval (CI), 0.8–1.5, and RR for PD 0.9; 95% CI, 0.... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5437323 Mon, 21 Nov 2011 05:00:00 +0100 5437323 http://www.medworm.com/index.php?rid=5437322&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295658 The objective of this study was to examine the association between SDB and APO. Women who had a delivery as well as an in-laboratory polysomnogram (PSG) were identified. Demographics, PSG results, and pregnancy outcomes were abstracted from the medical record. Absence of SDB was defined as an apnea hypopnea index (AHI) of <5, mild SDB as an AHI of 5 to 14.9, and moderate to severe SDB as an AHI of ≥15. The primary outcome was a composite measure of APO: pregnancy-related hypertension, gestational diabetes, or preterm birth ≤34 weeks. We identified 143 women who had undergone a PSG and a delivery. Increasing severity of SDB was associated with an increasing risk of the composite APO: AHI <5, 18.1%; AHI 5 to 14.9, 23.5%; AHI ≥15, 38.5% (p = 0.038). Obese women (body mass inde... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5437322 Mon, 21 Nov 2011 05:00:00 +0100 5437322 http://www.medworm.com/index.php?rid=5437321&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295648 Amer J PerinatolDOI: 10.1055/s-0031-1295648We prospectively evaluated the differences in clinical responses and short-term outcomes in preterm infants with respiratory distress syndrome (RDS) treated with poractant alfa or beractant. Premature infants with RDS were randomized to poractant alfa or beractant treatment between July 2008 and June 2009. Patients were followed until 40 weeks of corrected gestational age or death. The fraction of inspired oxygen (Fio 2) after surfactant treatment, need for repeat doses, and duration of respiratory support and hospitalization were evaluated between groups. Sixty-one infants received poractant alfa and 65 received beractant. Significantly more patients in the beractant group required ≥2 doses of surfactant compared with the poractant alfa group (... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5437321 Mon, 21 Nov 2011 05:00:00 +0100 5437321 http://www.medworm.com/index.php?rid=5428194&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295638 We examined the association between midtrimester intra-amniotic sludge and spontaneous preterm birth (PTB) in asymptomatic women undergoing amniocentesis. We performed a prospective cohort study of women having an amniocentesis for fetal karyotyping between 14 and 24 weeks’ gestation. Cervical length and the presence of amniotic sludge were assessed by transvaginal ultrasound. Amniotic fluid concentrations of matrix metalloproteinase-8, glucose and lactate were measured. Early (<32 weeks) and late (32 to 36 weeks) preterm premature rupture of membranes (PPROM) and spontaneous PTB constituted primary outcomes. Nonparametric analyses were conducted. Three hundred ten women, including 94 (30%) with free-floating echogenic particles and 16 (5%) with dense amniotic sludge, were recruited. ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5428194 Thu, 17 Nov 2011 05:00:00 +0100 5428194 http://www.medworm.com/index.php?rid=5428193&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295651 The objective of this review is to determine whether premature infants have an increased risk of chronic kidney disease (CKD). A literature review was performed by searching PubMed (U.S. National Library of Medicine) and the Cochrane Library, using the keywords “prematurity,” “kidney,” “nephrogenesis,” “oligonephropathy,” and “kidney impairment.” Articles published in English since 1990 were reviewed. Increasing evidence suggests that prematurity causes oligonephropathy independently of, and coexisting with, intrauterine growth restriction. Animal studies show that nephrogenesis continues for up to 3 weeks in extrauterine life, but with up to 18% abnormal glomeruli. Nephrogenesis is further impaired in preterm infants who develop renal impairment in the early postnatal ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5428193 Thu, 17 Nov 2011 05:00:00 +0100 5428193 http://www.medworm.com/index.php?rid=5428192&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295642 Amer J PerinatolDOI: 10.1055/s-0031-1295642To compare the timing, duration, and severity of corticosteroid-associated hyperglycemia in pregnant women with and without diabetes mellitus (DM). An observational study was conducted of pregnant women with DM and controls who received corticosteroids. Median glucose levels were calculated over 4-hour intervals after the first dose of corticosteroid with a continuous glucose monitor. A glucose level increase of at least 15% above baseline was considered significant. Nine pregnant women participated in this study (six with DM and three without DM). Elevations of glucose levels occurred at hour 20, 44, and 68 in both groups and lasted for up to 4 hours. In those with DM, glucose levels increased 33 to 48%, whereas in those without DM, glucose level... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5428192 Thu, 17 Nov 2011 05:00:00 +0100 5428192 http://www.medworm.com/index.php?rid=5428191&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295652 Amer J PerinatolDOI: 10.1055/s-0031-1295652We evaluated short-term neonatal outcomes among preterm infants according to type of feeding administered (human milk or formula). Retrospective data were collected on 400 preterm infants at gestational age ≤32 weeks. Groups were chosen and compared according to feeding type. The premature infants who were fed human milk had lower gestational age and birth weight than those who were formula fed. Lower rates of necrotizing enterocolitis (NEC) were detected in the group of infants fed human milk (p = 0.044). Lower rates of retinopathy of prematurity (ROP) were detected in a subgroup of breast-fed infants born at 24 to 28 weeks’ gestational age, but the results did not reach statistical significance using univariate analysis (p = 0.06). U... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5428191 Thu, 17 Nov 2011 05:00:00 +0100 5428191 http://www.medworm.com/index.php?rid=5428190&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1295639 Amer J PerinatolDOI: 10.1055/s-0031-1295639Optimal preclosure fluid resuscitation in gastroschisis (GS) is unknown. The purpose of our study was to evaluate effects of preclosure intravenous fluid resuscitation on GS outcome. Cases were accrued from a national GS database. Risk variables analyzed included gestational age (GA), birth weight (BW), neonatal illness severity score, and bolus fluid administration within 6 hours of neonatal intensive care unit admission. Outcomes analyzed included closure success, days of ventilation/total parenteral nutrition (TPN), and bacteremic episodes. Linear and logistic regression analyses were performed. Four hundred seven live-born GS cases were identified (362 with complete resuscitative fluids data). Mean BW, GA, and Score for Neonatal Acute Physiolo... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5428190 Thu, 17 Nov 2011 05:00:00 +0100 5428190 http://www.medworm.com/index.php?rid=5179252&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1286183 Amer J PerinatolDOI: 10.1055/s-0031-1286183ABSTRACTMeasurement of patient safety serves to identify opportunities to improve safety within a neonatal intensive care unit (NICU), compare the safety of care provided by different NICUs, determine changes in response to safety interventions or programs, follow safety trends over time, and potentially deny payment for specific events. The ideal patient safety measures are rates of events derived from surveillance with valid and reliable detection of numerators (errors or adverse events) and denominators (the opportunities for errors or adverse events to occur). Methods used to identify these numerators and denominators include reporting, direct observation, videotaping, chart review, trigger tools, and automated methods. However, there are sign... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5179252 Mon, 29 Aug 2011 23:00:00 +0100 5179252 http://www.medworm.com/index.php?rid=5179251&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1286182 Amer J PerinatolDOI: 10.1055/s-0031-1286182ABSTRACTPreviously considered unavoidable complications of hospital care (reflecting an “entitlement” mental model), health care–associated infections are now considered as medical errors and cause significant preventable morbidity and mortality in neonates. Prevention of such infections, particularly central line–associated bloodstream infections (CLABSI), should be an important patient safety priority for all neonatal intensive care units (NICUs). An important first step is to promote a mental model of CLABSIs as preventable complications of care. Other general strategies are (1) promoting an organizational culture of safety and empowerment of staff; (2) hand hygiene; (3) avoiding overcrowding and understaffing; (4) using... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5179251 Mon, 29 Aug 2011 23:00:00 +0100 5179251 http://www.medworm.com/index.php?rid=5179250&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1286184 Amer J PerinatolDOI: 10.1055/s-0031-1286184ABSTRACTRecent data indicate that as many as 180,000 patients die each year due to harm suffered as a result of medical care. Between 40 and 60% of these deaths—and the millions of injuries due to medical care—are preventable. In the neonatal intensive care unit (NICU), neonates' size and fragility makes them especially susceptible to serious medical errors, which occur at a far higher rate in this population than elsewhere in hospitals. A growing body of literature demonstrates that the work schedules and sleep deprivation of physicians are important contributors to this epidemic of error. Nowhere is there a higher risk of adverse outcomes due to provider sleep deprivation than in the NICU, where even minor lapses of attention or misc... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5179250 Mon, 29 Aug 2011 23:00:00 +0100 5179250 http://www.medworm.com/index.php?rid=5155803&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285831 Amer J PerinatolDOI: 10.1055/s-0031-1285831ABSTRACTNewborn intensive care units (NICUs) are high-risk areas of care, where complex medical interventions are performed, and are recognized as a resource for improved outcome in premature and low-birth-weight infants or those presenting with acute conditions. This critical environment, along with the vulnerable nature of the population it serves, places patients at risk for medication errors, which can result in permanent harm or death. Promoting safe medication practices requires participation of all individuals involved in the medication use process (e.g., physicians, nurses, nurse practitioners, physician assistants, pharmacists, respiratory therapists, pharmacy technicians). The following recommendations, organized in accordance with the I... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5155803 Sun, 21 Aug 2011 23:00:00 +0100 5155803 http://www.medworm.com/index.php?rid=5155802&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285830 Amer J PerinatolDOI: 10.1055/s-0031-1285830ABSTRACTThe balance of maternal, fetal, and neonatal risks of continued pregnancy versus iatrogenic delivery must be based on best evidence. Although avoiding elective deliveries prior to 39 weeks is well established to improve neonatal outcomes, several “soft” conditions are commonly considered to require delivery prior to 39 weeks. Review of existing literature suggests that with some of these conditions, delivery can be safely delayed until later in pregnancy or even allowed to proceed without intervention. Late preterm and early term deliveries contribute substantially to neonatal morbidity and health care costs and should be considered only if the risks of continuing the pregnancy exceed the neonatal risks related to early birth. ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5155802 Sun, 21 Aug 2011 23:00:00 +0100 5155802 http://www.medworm.com/index.php?rid=5117221&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285095 Amer J PerinatolDOI: 10.1055/s-0031-1285095ABSTRACTWe analyzed the frequency and possible causes of false-negative (Fn) screening results in first-trimester combined Down syndrome screening in Finland. During the study period (May 1, 2002, to December 31, 2008), 76,949 voluntary women with singleton pregnancies participated in screening. Maternal age at screening, week of gestation, levels of pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (fβ-hCG), and nuchal translucency (NT) measurement were compared and statistically analyzed between true-positive (Tp) and Fn cases. There were a total of 188 Down syndrome cases (1:409) in the screened population; 154 confirmed Tp and 34 Fn cases. Most Fn cases (n = 25) occurred at 12 +&#82... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5117221 Tue, 09 Aug 2011 23:00:00 +0100 5117221 http://www.medworm.com/index.php?rid=5117220&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285829 Amer J PerinatolDOI: 10.1055/s-0031-1285829ABSTRACTWe reviewed the risks and benefits of vaginal and cesarean delivery to help frame the inherent trade-offs that should be considered as part of the informed consent discussion between patients and providers. We performed a targeted literature review for common complications of childbirth. Approximately 30% of women will experience a maternal or neonatal complication during childbirth. Both cesarean and vaginal delivery is associated with well-known measurable short- and long-term maternal and neonatal complications and benefits. Childbirth is not risk free. There are data available that can guide the informed consent process with objective quantifiable data that patients and providers can use to weigh risks and benefits of delivery methods.... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5117220 Tue, 09 Aug 2011 23:00:00 +0100 5117220 http://www.medworm.com/index.php?rid=5117219&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285825 Amer J PerinatolDOI: 10.1055/s-0031-1285825ABSTRACTThe Institute of Medicine has recommended a change in culture from “name and blame” to patient safety. This will require system redesign to identify and address errors, establish performance standards, and set safety expectations. This approach, however, is at odds with the present medical malpractice (tort) system. The current system is outcomes-based, meaning that health care providers and institutions are often sued despite providing appropriate care. Nevertheless, the focus should remain to provide the safest patient care. Effective peer review may be hindered by the present tort system. Reporting of medical errors is a key piece of peer review and education, and both anonymous reporting and confidential reporting of errors... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5117219 Tue, 09 Aug 2011 23:00:00 +0100 5117219 http://www.medworm.com/index.php?rid=5102791&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285094 We examined the effects of prenatal methamphetamine (MA) exposure on growth parameters from birth to age 3 years. The 412 subjects included (n = 204 exposed) were enrolled at birth in the Infant Development, Environment and Lifestyle study, a longitudinal study assessing the effects of prenatal MA exposure on childhood outcomes. Individual models were used to examine the effects of prenatal MA exposure on weight, head circumference, height, and weight-for-length growth trajectories. After adjusting for covariates, height trajectory was lower in the exposed versus the comparison children (p = 0.021) over the first 3 years of life. Both groups increased height on average by 2.27 cm per month by age 3 years. In term subjects, MA exposure was also associated with a lowe... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5102791 Wed, 03 Aug 2011 23:00:00 +0100 5102791 http://www.medworm.com/index.php?rid=5102790&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285826 Amer J PerinatolDOI: 10.1055/s-0031-1285826ABSTRACTDespite an increased focus on the quality and safety of care, the United States health care system does not reliably deliver safe, high-quality care for all women and infants. In many cases, a gap still exists between best evidence and routine practice and pregnant women and neonates continue to experience preventable harm. Effective change strategies targeting individuals, groups or teams, organizations, and the larger system or environment have been used in the setting of perinatal care to improve quality and safety. In addition, strategies focused on aligning change efforts across multiple levels are increasingly being used to more effectively change practice in the context of the complex health care system. This review examines some of... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5102790 Wed, 03 Aug 2011 23:00:00 +0100 5102790 http://www.medworm.com/index.php?rid=5102789&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285828 Amer J PerinatolDOI: 10.1055/s-0031-1285828ABSTRACTPatient safety, defined as “the absence of the potential for, or the occurrence of, health care associated injury to the patient,” is a part of the larger concept of health care quality. Achieving safe patient care has become an increasing focus of the obstetric community, in part due to the realization of the number of preventable adverse events that occur as well as the pressures of the professional liability climate. Studies of obstetric care have revealed that multiple factors contribute to the occurrence of adverse obstetric events, although communication is one factor that consistently has been found to prominently contribute to these events. The data that exist also suggest that although most women who give birth on a la... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5102789 Wed, 03 Aug 2011 23:00:00 +0100 5102789 http://www.medworm.com/index.php?rid=5102788&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285827 We examined 244 patients with twin pregnancies and a normal CL (>25 mm) between 22 and 32 weeks and compared outcomes based on the fFN result. Fourteen (5.7%) patients had a positive fFN and 230 (94.3%) patients had a negative fFN. Positive fFN was associated with an increased the risk of spontaneous preterm birth <37 weeks (85.7% versus 38.3%, p = 0.001), <35 weeks (50% versus 11.8%, p < 0.001), <34 weeks (35.7% versus 6.9%, p < 0.001), and <32 weeks (21.4% versus 2.2%, p < 0.001). On adjusted analysis, a positive fFN was independently associated with preterm birth <32 weeks (odds ratio 6.8, 95% confidence interval 1.42, 32.2) and gestational age at delivery (p = 0.001). In the setting of a normal CL, a... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5102788 Wed, 03 Aug 2011 23:00:00 +0100 5102788 http://www.medworm.com/index.php?rid=5102787&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285099 Amer J PerinatolDOI: 10.1055/s-0031-1285099ABSTRACTNeonatal infection with Streptococcus agalactiae (group B streptococcus [GBS]) causes significant morbidity and mortality. A truly rapid diagnostic test for identifying GBS would allow for more timely initiation of antibiotic prophylaxis and also reduce the administration of antibiotics for the prevention of early onset neonatal GBS infection. A stock culture was formed from a laboratory reference strain of GBS and was diluted from 107 to 101 bacteria/mL. Specific concentrations were used to inoculate nitrocellulose membranes (NCMs) that had been coated previously with polyclonal rabbit antibody against GBS. After specific times, the NCMs were removed from the sheep blood agar medium, and horseradish-peroxidase conjugate polyclonal antibod... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5102787 Wed, 03 Aug 2011 23:00:00 +0100 5102787 http://www.medworm.com/index.php?rid=5102786&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285097 Amer J PerinatolDOI: 10.1055/s-0031-1285097ABSTRACTCompounds that are systemically absorbed during the course of cigarette smoking, and their metabolites, affect the coagulation system and cause endothelial dysfunction, dyslipidemia, and platelet activation leading to a prothrombotic state. In addition, smoking increases the activity of fibrinogen, homocysteine, and C-reactive protein. We hypothesize that smoking may affect functional coagulation testing during pregnancy. A secondary analysis of 371 women pregnant with a singleton pregnancy and enrolled in a multicenter, prospective observational study of complications of factor V Leiden mutation subsequently underwent functional coagulation testing for antithrombin III, protein C antigen and activity, and protein S antigen and activity. S... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5102786 Wed, 03 Aug 2011 23:00:00 +0100 5102786 http://www.medworm.com/index.php?rid=5102785&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284225 This study suggests that, in the postsurfactant era, males remain at higher risk of respiratory complications and may have higher mortality when born between 24 and 26 weeks of gestation.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5102785 Wed, 03 Aug 2011 23:00:00 +0100 5102785 http://www.medworm.com/index.php?rid=5094359&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284226 Amer J PerinatolDOI: 10.1055/s-0031-1284226ABSTRACTWe sought to predict neonatal metabolic acidosis at birth using antepartum obstetric characteristics (model 1) and additional characteristics available during labor (model 2). In 5667 laboring women from a multicenter randomized trial that had a high-risk singleton pregnancy in cephalic presentation beyond 36 weeks of gestation, we predicted neonatal metabolic acidosis. Based on literature and clinical reasoning, we selected both antepartum characteristics and characteristics that became available during labor. After univariable analyses, the predictors of the multivariable models were identified by backward stepwise selection in a logistic regression analysis. Model performance was assessed by discrimination and calibration. To correct fo... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5094359 Tue, 02 Aug 2011 23:00:00 +0100 5094359 http://www.medworm.com/index.php?rid=5094358&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284230 Amer J PerinatolDOI: 10.1055/s-0031-1284230ABSTRACTEndothelial dysfunction of the maternal vasculature induced by pro-oxidants may contribute to the development of preeclampsia. Obesity results in vascular inflammation and oxidative stress and is therefore a risk factor for preeclampsia. Regular exercise is known to induce antioxidants. We recently demonstrated that stretchers (subjects who performed low-intensity exercises) had a lower incidence of preeclampsia as opposed to walkers (moderate-intensity exercise; 2.6% versus 14.6%). We now seek to determine the possible protective mechanisms. We hypothesized that stretchers will have higher vascular levels of the antioxidant superoxide dismutase (SOD) and plasma transferrin levels, an antioxidant marker. We conducted immunohistochemical an... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5094358 Tue, 02 Aug 2011 23:00:00 +0100 5094358 http://www.medworm.com/index.php?rid=5094357&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284228 In this report, we describe the PM procedure designed and used in the NICHD-supported Stillbirth Cooperative Research Network (SCRN). Perinatal pathologists, clinicians, epidemiologists, and biostatisticians at four tertiary care centers, a data coordinating center, and NICHD developed a standardized approach to perinatal PM, which was applied to a population-based study of stillbirth as part of the SCRN. The SCRN PM protocol was successfully instituted and used at the four medical centers. A total of 663 women with stillbirth were included: 620 delivered a single stillborn infant, 42 delivered twins, and one delivered triplets for a total of 676 stillborn infants. Of these women, 560 (84.5%) consented to PM (572 stillborn infants) that was conducted according to the SCRN protocol. A stand... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5094357 Tue, 02 Aug 2011 23:00:00 +0100 5094357 http://www.medworm.com/index.php?rid=5085307&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285101 Amer J PerinatolDOI: 10.1055/s-0031-1285101ABSTRACTAssisted reproductive technology using donor-egg in vitro fertilization (D-IVF) has enabled women 50 years and above to successfully achieve pregnancy. We examine the safety profile of these pregnancies through a large, single-center case series and retrospective cohort analysis in which all participants were carefully screened medically prior to conception. Consecutive women aged ≥ 50 years (n = 101) who achieved a viable pregnancy via D-IVF were identified and their perinatal outcomes were recorded. These data were compared with control data from younger (≤ 42 years) recipients of D-IVF (n = 41) who also achieved a viable pregnancy at our center during the same period. Compared with the you... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5085307 Sun, 31 Jul 2011 23:00:00 +0100 5085307 http://www.medworm.com/index.php?rid=5085306&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285096 Amer J PerinatolDOI: 10.1055/s-0031-1285096ABSTRACTOur aim was to improve the reliability of recording gestational age (GA) in the mother's obstetric record, as this record is used for clinical management, research databases, and eventual transmission to the Ohio Department of Health birth certificates. We performed a prospective cohort study, including all hospital births. We began quality improvement interventions in October 2009. Improvement test cycles were targeted to four working groups, including nursing staff, community obstetric providers, and the process itself. Test cycle results were evaluated to determine which successful interventions could spread further. Rates of process outcome measurements were compared by statistical process control and univariate analysis pre- and posti... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5085306 Sun, 31 Jul 2011 23:00:00 +0100 5085306 http://www.medworm.com/index.php?rid=5085305&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285103 Amer J PerinatolDOI: 10.1055/s-0031-1285103ABSTRACTWe analyzed complete blood count (CBC) data obtained from neonates with Down syndrome (DS) in a primarily Hispanic population over a 10-year period to determine the incidence of hematologic abnormalities and the relationship of abnormalities to the presence of circulating blasts (CB). Hematologic values obtained during the first 10 days were analyzed. Definitions were: CB, ≥ 1% blasts manually counted on peripheral smear; elevated white blood cell count (WBC), >30,000 cells/mm3; thrombocytopenia, platelet count <150,000/mm3; polycythemia, hematocrit >65%. Two hundred thirty-two neonates (88% Hispanic) with DS had 692 CBCs available for analysis. The presence of CB (11.6%) and the incidence of thrombocytopenia (60.2%) w... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5085305 Sun, 31 Jul 2011 23:00:00 +0100 5085305 http://www.medworm.com/index.php?rid=5085304&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285098 Amer J PerinatolDOI: 10.1055/s-0031-1285098ABSTRACTWe sought external validation of a prediction model for the probability of a successful external cephalic version (ECV). We evaluated the performance of the prediction model with calibration and discrimination. For clinical practice, we developed a score chart to calculate the probability of a successful ECV. We studied 320 women undergoing ECV, of which 117 (37%) were successful. The model underestimated the success rate by 4 to 14%. The area under the receiver operating characteristic curve was moderate (0.66; 95% confidence interval: 0.60 to 0.72), but the model was able to make good distinction between women with a higher predicted probability of a successful ECV (more than 50%) compared with women with a lower predicted probability of... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5085304 Sun, 31 Jul 2011 23:00:00 +0100 5085304 http://www.medworm.com/index.php?rid=5085303&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285102 This study investigated the utilization of health information technology (HIT) to enhance resource utilization in a geographically dispersed tertiary care system with extensive outpatient and delivery services. It was initiated as a result of a systems change implemented after Hurricane Ike devastated southeast Texas. A retrospective database and electronic medical record review was performed, which included data collection from all patients evaluated 18 months prior (epoch I) and 18 months following (epoch II) the landfall of Hurricane Ike. The months immediately following the storm were omitted from the analysis, allowing time to establish a new baseline. We analyzed a total of 21,201 patients evaluated in triage at the University of Texas Medical Branch. Epoch I consisted of 11,280 pati... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5085303 Sun, 31 Jul 2011 23:00:00 +0100 5085303 http://www.medworm.com/index.php?rid=5085302&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1285100 We describe trends in the rates of admission of preterm twin and triplet infants to neonatal intensive care units (NICUs) across Canada and compare their neonatal outcomes over a 6-year period. Temporal trends of admission rates for 5193 twins and triplets <33 weeks' gestational age to participating NICUs in the Canadian Neonatal Network between 2003 and 2008 were assessed. Trends in infant outcomes were evaluated using logistic regression. The proportion of twins increased from 26.1 to 28.0 per 100 admissions between 2003 and 2008 (7% increase, p = 0.02). In contrast, the proportion of triplets decreased from 5.0 to 3.3 per 100 admissions (34% reduction, p = 0.04). These trends were significant in mothers ≥ 35 years of age. Neonatal outcomes improved... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5085302 Sun, 31 Jul 2011 23:00:00 +0100 5085302 http://www.medworm.com/index.php?rid=5057272&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284224 Amer J PerinatolDOI: 10.1055/s-0031-1284224ABSTRACTWe sought to estimate the association between prepregnancy body mass index (BMI) and small-for-gestational-age (SGA) neonates and to determine if there is a synergistic effect of tobacco use on SGA across all BMI strata. We performed a retrospective cohort study of 65,104 patients seen for second-trimester ultrasound. BMI was categorized into underweight, normal weight, overweight, and obese. SGA was defined as birth weight <10th percentile and <5th percentile. Univariable and multivariable logistic regression analyses were used to evaluate the association between BMI and SGA. Stratified analyses and tests for effect modification were performed to evaluate for a potential synergistic effect between tobacco use and abnormal prepregnan... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5057272 Thu, 21 Jul 2011 23:00:00 +0100 5057272 http://www.medworm.com/index.php?rid=5057271&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284227 This article describes the mechanism of action of indomethacin and its clinical applications as a tocolytic agent in women with PTL and cerclage and its use in the context of polyhydramnios. The fetal and neonatal side effects of this drug are also summarized and guidelines for its use are proposed.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5057271 Thu, 21 Jul 2011 23:00:00 +0100 5057271 http://www.medworm.com/index.php?rid=5057273&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1284229 We describe the neuropathologic procedure utilized in the Stillbirth Collaborative Research Network (SCRN), focusing on the examination of central nervous system (CNS) in stillbirth (SB). The SCRN was organized to perform a case-control study to determine the scope and causes of SB. Pathologists at all the participating centers agreed on and used the same standardized neuropathologic techniques. Standardized sections were taken and detailed data were collected. Fresh brain tissue was saved for investigative purposes. A total of 663 women with SB were enrolled into the case-control study: 620 delivered a single stillborn, 42 delivered twins, and 1 delivered triplets. Of the 560 (84.5%) who consented to postmortem examination, 465 (70.1%) also gave consent to the examination of the CNS. In t... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5057273 Wed, 20 Jul 2011 23:00:00 +0100 5057273 http://www.medworm.com/index.php?rid=5006407&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280858 Amer J PerinatolDOI: 10.1055/s-0031-1280858ABSTRACTWe sought to quantify how often women with late preterm birth (LPTB) receive antenatal corticosteroid (ACS) therapy prior to 34 weeks and to determine its effects on neonatal respiratory morbidity. LPTBs (340/7 to 366/7 weeks) over a 1-year period at a single tertiary care hospital were studied. A composite neonatal respiratory outcome was defined as mechanical ventilation, continuous positive airway pressure with fraction of inspired oxygen (FIO2) >40% for >2 hours or FIO2 >40% for >4 hours within the first 72 hours of life. Multivariate logistic regression analysis was used to evaluate the association between ACS therapy and neonatal respiratory morbidity. Over the study period, 503 LPTBs met the study criteria and 6.8% (n&#8... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006407 Wed, 29 Jun 2011 23:00:00 +0100 5006407 http://www.medworm.com/index.php?rid=5006408&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1281509 The objective of this report is to describe the approach used for the placental examination performed as part of the study. The SCRN consists of a multidisciplinary team of investigators from five clinical sites, the National Institute of Child Health and Human Development, and the Data Coordination and Analysis Center. The study is a population-based cohort and nested case-control study, with prospective enrollment of women with SB and live births (LB) at the time of delivery. Detailed and standardized postmortem examination was performed on SB and placental examination in both groups. A total of 663 women with SB and 1932 women with LB were enrolled into the case-control study. In the SB group, there were 707 fetuses. Of these cases, 654 (98.6%) had placental examination. Of these LB con... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006408 Tue, 28 Jun 2011 23:00:00 +0100 5006408 http://www.medworm.com/index.php?rid=5006412&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280596 This study evaluates the timing of the first course of antenatal corticosteroids in clinical practice. We performed a retrospective cohort study of consecutive women who had received antenatal corticosteroids and/or delivered between 24 and 34 weeks of gestation. Time between administration of corticosteroids and delivery was compared between women with different causes of anticipated preterm deliveries: symptomatic preterm labor with intact membranes; preterm premature rupture of the membranes; (pre)eclampsia; hemolysis, elevated liver enzymes, and low platelet count; intrauterine growth restriction; vaginal blood loss; and suspected fetal distress. We included 439 women of whom 348 (79%) completed the course of corticosteroids. In women with a complete course, 143 (41%) delivered within ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006412 Tue, 21 Jun 2011 23:00:00 +0100 5006412 http://www.medworm.com/index.php?rid=5006411&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280597 We describe the epidemiological characteristics and identify maternal–fetal outcomes in pregnancies complicated by gastroschisis. We retrospectively reviewed 115 cases of gastroschisis at the University of Mississippi Medical Center. The incidence of gastroschisis trended upward between 2000 and 2008. Significant proportions of mothers were nonobese, nulliparous, teenagers, smokers, and nonconsumers of alcohol. Infants delivered at >36 weeks or without sepsis had shorter hospital stay (HS) and interval to full enteral feeding (FEF). The rates of low birth weight (LBW), fetal growth restriction, and spontaneous preterm birth (PTB) were 63%, 45%, and 24%, respectively. Bowel atresia was noted in 9%. Rates of primary closure (25%), neonatal sepsis (29%), fetal death (2%), and infant ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006411 Tue, 21 Jun 2011 23:00:00 +0100 5006411 http://www.medworm.com/index.php?rid=5006410&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280857 Amer J PerinatolDOI: 10.1055/s-0031-1280857ABSTRACTWe sought to determine the frequency of excessive gestational weight gain (GWG) and its impact on perinatal outcomes in women with gestational (GDM) and pregestational diabetes mellitus (DM). A retrospective cohort of diabetic women was studied. GWG was categorized by the 2009 Institute of Medicine guidelines. Perinatal outcomes were compared between those women with and without excessive GWG. There were 153 women who met study criteria. There was no difference in excessive GWG between women with GDM and pregestational DM (44.4% versus 38.5%, p = 0.51) or based on White's class (p = 0.17). After adjusting for confounders, excessive GWG was not associated with an increased rate of adverse perinatal outcomes (odds rat... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006410 Tue, 21 Jun 2011 23:00:00 +0100 5006410 http://www.medworm.com/index.php?rid=5006409&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280856 Amer J PerinatolDOI: 10.1055/s-0031-1280856ABSTRACTWe sought to determine preventability for cases of obstetric hemorrhage, identify preventable factors, and compare differences between levels of hospital. We retrospectively reviewed a 1-year cohort of severe and near-miss obstetric hemorrhage in an urban perinatal network. An expert panel, using a validated preventability model, reviewed all cases. Preventability and distribution of preventability factors were compared between levels of hospital care. Sixty-three severe and near-miss obstetric hemorrhage cases were identified from 11 hospitals; 54% were deemed potentially preventable. Overall preventability was not statistically different by level of hospital, and 88% were provider related. The only treatment-related preventability factor... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006409 Tue, 21 Jun 2011 23:00:00 +0100 5006409 http://www.medworm.com/index.php?rid=5006413&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280859 Amer J PerinatolDOI: 10.1055/s-0031-1280859ABSTRACTWe sought to determine if maternal body mass index (BMI; kg/m2) identifies newborns with abnormal fetal growth (small for gestational age [SGA], large for gestational age [LGA], or macrosomia) at ≥37 weeks. Singletons with reliable gestational age and without diabetes or hypertension were analyzed. Areas under the receiver-operating characteristic (AUC) curves were calculated for BMI (first visit, delivery, and the change during pregnancy) to identify abnormal growth. If the AUC was ≤0.75 then the diagnostic test was not useful. Among 3582 cohorts, SGA occurred in 10%, LGA in 9%, and 11% were macrosomic. AUC indicates that BMI at delivery is significantly better than BMI at first visit for identification of aberrant growth, but... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006413 Mon, 20 Jun 2011 23:00:00 +0100 5006413 http://www.medworm.com/index.php?rid=5006414&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280855 Amer J PerinatolDOI: 10.1055/s-0031-1280855ABSTRACTWe investigated multiple sources of folate and folic acid to determine whether their periconceptional intakes were associated with preterm delivery. Studied were controls from the National Birth Defects Prevention Study delivered September 1998 to December 2005. Telephone interviews were conducted with 5952 (68% of eligible) mothers. Women were queried about intake of vitamin supplements in the 12 weeks before conception through delivery. A version of the Nurse's Health Study food frequency questionnaire was used to assess food sources. Eight percent of infants (n = 487) were preterm (<37 weeks). Compared with women who began intake of supplements with folic acid before pregnancy, those who began any time during pregnancy ha... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006414 Wed, 15 Jun 2011 23:00:00 +0100 5006414 http://www.medworm.com/index.php?rid=5006416&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280595 Amer J PerinatolDOI: 10.1055/s-0031-1280595ABSTRACTPartial exchange transfusion (PET) is traditionally suggested as treatment for neonates diagnosed with polycythemia. Nevertheless, justification of this treatment is controversial. We evaluated the risk for short-term complications associated with a restrictive treatment protocol for neonatal polycythemia. A retrospective cross-sectional analytical study was conducted. Three treatment groups were defined and managed according to their degree of polycythemia, defined by capillary tube filled with venous blood and manually centrifuged hematocrit: group 1, hematocrit 65 to 69% and no special treatment was recommended; group 2, hematocrit 70 to 75% and intravenous fluids were given and feedings were withheld until hematocrit decreased to <7... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006416 Thu, 09 Jun 2011 23:00:00 +0100 5006416 http://www.medworm.com/index.php?rid=5006415&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280594 We examined treatment outcomes in women with severe nausea and vomiting of pregnancy (NVP) receiving outpatient nursing support and either subcutaneous metoclopramide or subcutaneous ondansetron via a microinfusion pump. Among women receiving outpatient nursing services, we identified those diagnosed with severe NVP having a Pregnancy-Unique Quantification of Emesis (PUQE) score of greater than 12 at enrollment and prescribed either metoclopramide (n = 355) or ondansetron (n = 521) by their physician. Maternal characteristics, response to treatment, and start versus stop values were compared between the medication groups. Allocation to group was based on intention-to-treat protocol. Maternal characteristics were similar between the groups. Days to reduction in PUQE ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006415 Thu, 09 Jun 2011 23:00:00 +0100 5006415 http://www.medworm.com/index.php?rid=5006423&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280854 Amer J PerinatolDOI: 10.1055/s-0031-1280854ABSTRACTWe compared the rates of abnormal 1-hour glucose challenge tests (GCT) and gestational diabetes (GDM) between women receiving 17α-hydroxyprogesterone caproate (17-P) and women who did not receive 17-P to determine if the effect varies based on the number of doses received or in a group of high-risk obese women. We performed a secondary analysis of a prospective cohort study where women with a history of a previous preterm delivery in the antecedent pregnancy followed at a high-risk clinic were offered 17-P. GCT was performed after the initiation of 17-P, and doses given prior to testing were recorded. Rates of abnormal GCT and GDM were compared between those receiving 17-P (n = 67) and controls (n = 140). Mean ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006423 Wed, 08 Jun 2011 23:00:00 +0100 5006423 http://www.medworm.com/index.php?rid=5006422&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280598 We describe maternal childbirth goals among women planning either cesarean or vaginal birth. Women in the third trimester planning cesarean or vaginal birth were asked to report up to five childbirth goals. Goal achievement was assessed postpartum. Based on free-text responses, discrete goal categories were identified. Goals and goal achievement were compared between the two groups. Satisfaction was rated on a visual analogue scale and was compared with goal achievement. The sample included 163 women planning vaginal birth and 69 women planning cesarean. Twelve goal categories were identified. Only women planning vaginal birth reported a desire to achieve fulfillment related to childbirth. Women planning cesarean were less likely to express a desire to maintain control over their own respo... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006422 Wed, 08 Jun 2011 23:00:00 +0100 5006422 http://www.medworm.com/index.php?rid=5006421&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280852 We examined the prevalence of cesarean delivery (CD) among women with morbid obesity and extreme morbid obesity. Using Kentucky birth certificate data, a cross-sectional analysis of nulliparous singleton gestations at term was performed. We examined the prevalence of CD by body mass index (BMI; in kg/m2) using the National Institutes of Health/World Health Organization schema and a modified schema that separates extreme morbid obesity (BMI ≥50) from morbid obesity (BMI ≥40 to <50). Bivariate and multivariate analyses were performed. Multivariate modeling controlled for maternal age, estimated gestational age, birth weight, diabetes, and hypertensive disorders. Overall, 83,278 deliveries were analyzed. CD was most common among women with a prepregnancy BMI ≥50 (56.1%, 9... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006421 Wed, 08 Jun 2011 23:00:00 +0100 5006421 http://www.medworm.com/index.php?rid=5006420&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280853 Amer J PerinatolDOI: 10.1055/s-0031-1280853ABSTRACTWe identify characteristics that predict resolution of placenta previa and develop a clinical model for likelihood of resolution. We conducted a retrospective study of 366 singleton pregnancies complicated by placenta previa diagnosed with resolution of the previa as the primary outcome. Regression analyses were performed to determine variables associated with resolution and optimal timing for repeat sonographic evaluation. A likelihood of resolution model was created using a parametric survival model with Weibull hazard function. Of the 366 cases, 84% of complete placentae previae and 98% of marginal placentae previae resolved at a mean gestational age of 28.6 ± 5.3 weeks. Only gestational age and distance from the internal c... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006420 Wed, 08 Jun 2011 23:00:00 +0100 5006420 http://www.medworm.com/index.php?rid=5006419&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280592 Amer J PerinatolDOI: 10.1055/s-0031-1280592ABSTRACTWe sought to identify rates, associated morbidities, and preventable causes of late preterm birth (LPB) in a defined population. We conducted a retrospective cross-sectional analysis using deidentified delivery data for all who delivered in San Antonio/Bexar County, Texas between 2000 and 2008 (n = 259,576). LPB was defined as a live birth from 340/7 to 366/7 weeks. Variables analyzed included age, race/ethnicity, weight gain, hypertensive disease, diabetes, and preterm labor including premature rupture of membranes. From 2000 to 2006, the LPB rate in San Antonio/Bexar County, Texas, was slightly higher than the national average, 9% versus 8.7% (p < 0.01). From 2000 to 2008, 23,312 LPBs occurred in San Antonio/Be... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006419 Wed, 08 Jun 2011 23:00:00 +0100 5006419 http://www.medworm.com/index.php?rid=5006418&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280851 Amer J PerinatolDOI: 10.1055/s-0031-1280851ABSTRACTWe evaluated the impact of maternal obesity on the characteristics and results of nonstress tests (NST). This prospective 1-year cohort study included 2026 NSTs performed on 575 consecutively chosen women with singleton gestations ≥32 weeks and no known fetal anomalies. Body mass index (BMI) class was determined at the first prenatal visit. The primary outcome was the duration of fetal heart rate monitoring before a reactive result. Obese women were not more likely to have nonreactive NST results. The mean duration before obtaining a reactive result was unaffected by obesity after controlling for diabetes and gestational age. The overall number of NSTs per patient was higher in obese than in nonobese women (3.9 versus 3.1, p &l... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006418 Wed, 08 Jun 2011 23:00:00 +0100 5006418 http://www.medworm.com/index.php?rid=5006417&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1280593 Amer J PerinatolDOI: 10.1055/s-0031-1280593ABSTRACTWe delineate the natural history of a right-to-left or bidirectional (RL/BD) patent ductus arteriosus (PDA) in preterm infants and compare outcomes of an RL/BD and a left-to-right (LR) ductal shunt. We performed a retrospective chart review of preterm infants (<32 weeks), who, between 2 and 30 days of age, had an RL/BD PDA >1.5 mm (study group; n = 74) or an LR PDA (n = 87) on echocardiogram (ECHO). In the study group, 27% of infants who were of significantly lower gestational age and birth weight had a “prolonged” RL/BD PDA on two or more ECHOs. Infants with RL/BD PDA required significantly greater surfactant (98.6% versus 94.2%) and less PDA therapy (27% versus 92%) and had higher mortality (48.6... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=5006417 Wed, 08 Jun 2011 23:00:00 +0100 5006417 http://www.medworm.com/index.php?rid=4788203&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1276732 Amer J PerinatolDOI: 10.1055/s-0031-1276732ABSTRACTWe sought to determine the rate of Staphylococcus aureus rectovaginal colonization and positive newborn blood cultures. Routinely obtained group B streptococcus (GBS) rectovaginal specimens were cultured for S. aureus using standard microbiology procedures. S. aureus– and GBS-positive blood cultures in infants less than 3 days old were determined from our microbiology database. Overall, 1488 rectovaginal cultures were obtained. Rates of positive GBS, S. aureus, and methicillin-resistant S. aureus (MRSA) cultures were 20.2%, 8.2%, and 1.7%, respectively. Cultures were positive for methicillin-susceptible S. aureus (MSSA) and GBS or MRSA and GBS in 1.6% and 0.3% of women, respectively. There was no association between GBS and MSSA or M... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4788203 Mon, 02 May 2011 23:00:00 +0100 4788203 http://www.medworm.com/index.php?rid=4788202&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1276737 Amer J PerinatolDOI: 10.1055/s-0031-1276737ABSTRACTWe compared perinatal outcomes between live-born nonisolated and isolated omphaloceles diagnosed during a prenatal ultrasound. Fetuses (n = 86) with omphalocele were identified between 1995 and 2007 at a single institution. Inclusion criteria were an omphalocele > 14 weeks' gestation, available fetal and/or neonatal karyotype, and a live-born infant (n = 46). Perinatal outcomes were compared in nonisolated (n = 23) and isolated omphaloceles (n = 23). For all omphaloceles, the majority delivered after 34 weeks by cesarean. Mean birth weight (2782 versus 2704 g), median length of stay (27 versus 25 days), and mortality (two deaths in each group) were not different between the nonisolat... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4788202 Mon, 02 May 2011 23:00:00 +0100 4788202 http://www.medworm.com/index.php?rid=4788201&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1276733 Amer J PerinatolDOI: 10.1055/s-0031-1276733ABSTRACTIt is unclear whether neonates born to women with thrombocytopenia during pregnancy are themselves at increased risk for thrombocytopenia at birth. In the current retrospective study, platelet count reference ranges were developed for pregnant women according to trimester, and correlations were sought between the platelet counts of mothers at delivery and their neonates. During the study period, 92,518 platelet counts were recorded on 41,887 pregnant women. A progressive shift toward lower platelet counts in a similarly shaped histogram occurred during pregnancy, with the lower reference range (2.5 percentile) for platelets during the third trimester being 113 × 109/L. Among 11,797 maternal–neonatal pairs following deliv... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4788201 Mon, 02 May 2011 23:00:00 +0100 4788201 http://www.medworm.com/index.php?rid=4788200&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1276739 The objective of our study was to evaluate the incidence and effect of maternal age on the risk of stillbirth. We conducted a population-based cohort study using the Centers for Disease Control and Prevention's “Linked Birth-Infant Death” and “Fetal Death” data files. We excluded all births of gestational age under 24 weeks and those with reported congenital malformations. We estimated the adjusted effect of maternal age on the risk of stillbirth using logistic regression analysis. There were 37,504,230 births that met study criteria, of which 130,353 (3.5/1,000) were stillbirths. Rates of stillbirth remained constant throughout the 10 years. As compared with women between the ages of 25 and 30, decreasing maternal age was associated with the following risk of still... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4788200 Mon, 02 May 2011 23:00:00 +0100 4788200 http://www.medworm.com/index.php?rid=4741788&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1276738 Amer J PerinatolDOI: 10.1055/s-0031-1276738ABSTRACTWe compared postnatal growth and neurodevelopment in extremely low-birth-weight (<1000 g) neonates who did or did not receive postnatal steroid (PNS) therapy for bronchopulmonary dysplasia (BPD). One hundred seventy-three neonates with Bayley Scales of Infant Development II (BSID II) testing performed at 18- to 22-month adjusted age were studied. Growth parameters and BSID II scales were compared among three groups: group I, no BPD; group II, BPD, no PNS; group III, BPD and PNS exposure. A subset of 77 neonates' growth parameters were retrieved at 12-month adjusted age. Psychomotor Development Index (PDI) and Mental Development Index (MDI) scales were lower in group III versus groups I and II. Growth velocity (GV) was lower in group III... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4741788 Wed, 20 Apr 2011 23:00:00 +0100 4741788 http://www.medworm.com/index.php?rid=4718976&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1276741 Amer J PerinatolDOI: 10.1055/s-0031-1276741ABSTRACTWe studied the effect of incremental infusion of fluid volume in a tamponade balloon on intraluminal pressure and uterine blood flow. Following placental delivery, a tamponade balloon was inserted into the uterus and incrementally inflated. Intraluminal pressure was measured at incremental volumes. Ultrasound was used to determine positioning of the catheter, uterine wall thickness, and uterine artery velocity waveforms in eight patients. Pressure-volume relationship was estimated by regression analysis. Significance was p < 0.05. There was a significant exponential curvilinear relationship between balloon pressure and infused volume at the maximum volume for each subject (R = 0.64, p = 0.01). Doppler ultrasound showed that at or above ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4718976 Thu, 14 Apr 2011 23:00:00 +0100 4718976 http://www.medworm.com/index.php?rid=4718975&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1276731 Amer J PerinatolDOI: 10.1055/s-0031-1276731ABSTRACTWe assessed if first-trimester vitamin D deficiency is more prevalent in women who experienced a spontaneous preterm birth compared with women who delivered at term. We conducted a nested case-control study of pregnant women who had previously given blood for first-trimester combined screening for trisomy 21 and subsequently delivered at a tertiary hospital between November 2004 and July 2009. From an overall cohort of 4225 women, 40 cases of spontaneous preterm birth (≥ 230/7 and ≤ 346/7 weeks) were matched by race/ethnicity with 120 women delivering at term (≥ 370/7 weeks) with uncomplicated pregnancies. Banked maternal serum was used to measure maternal 25-hydroxyvitamin D [25(OH)D]. The prevalence of first-trimester m... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4718975 Thu, 14 Apr 2011 23:00:00 +0100 4718975 http://www.medworm.com/index.php?rid=4718974&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1276736 Amer J PerinatolDOI: 10.1055/s-0031-1276736ABSTRACTThe aim of this study was to investigate the genotypic distribution of organic anion transporting polypeptide 2 (OATP-2) gene mutations and the relationship with hyperbilirubinemia of unknown etiology. Polymerase chain reaction, restriction fragment length polymorphism, and agarose gel electrophoresis techniques were used for detection of OATP-2 gene mutations in 155 newborn infants: 37 with unexplained hyperbilirubinemia, 65 with explained hyperbilirubinemia, and 53 without hyperbilirubinemia. In the OATP-2 gene, we identified A→G transitions at nucleotide positions 388 and 411 and observed six polymorphic forms. The 388/411-411 mutation was the most common form (43%) in subjects with hyperbilirubinemia of unknown etiology. Male sex... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4718974 Thu, 14 Apr 2011 23:00:00 +0100 4718974 http://www.medworm.com/index.php?rid=4714052&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1276735 Amer J PerinatolDOI: 10.1055/s-0031-1276735ABSTRACTWe retrospectively assessed the yield of early postnatal ultrasound scans in neonates with documented antenatal hydronephrosis. We reviewed recording data of prenatal renal ultrasound for 178 newborn infants and the results of renal ultrasound performed during the first days of life. Of 119 infants with prenatal diagnosis of mild hydronephrosis (renal pelvic diameter < 10 mm), 116 (97.5%) had postnatal ultrasound results showing normal or mild hydronephrosis. Prenatal diagnosis of severe hydronephrosis (renal pelvic diameter > 20 mm; 10 infants) was correlated with high incidence (90%) of moderate and severe postnatal hydronephrosis. Prenatal diagnosis of moderate hydronephrosis (renal pelvic diameter 10 to 20 mm) resulted in moderat... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4714052 Wed, 13 Apr 2011 23:00:00 +0100 4714052 http://www.medworm.com/index.php?rid=4714051&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1276734 The objective of this study was to analyze the cumulative effects of GC and chorioamnionitis on lung development and infectious process. In a model of Escherichia coli chorioamnionitis controlled by antibiotics, pregnant rabbits were randomized among five groups: (1) E. coli infection alone, (2) infection plus one betamethasone injection (0.1 mg.kg−1), (3) infection plus two betamethasone injections, (4) betamethasone alone, (5) control. Lung morphometric analysis, bronchoalveolar lavage, and bacteriologic tissue cultures were performed after spontaneous delivery. In the context of chorioamnionitis, one betamethasone treatment significantly decreased birth weight and lung volume versus controls (30 ± 1.40 versus 52.40 ± 2.54 g, and 1.92 ± 0.67 versus 2.15 ± 0.74 cm3, respectively... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4714051 Wed, 13 Apr 2011 23:00:00 +0100 4714051 http://www.medworm.com/index.php?rid=4692533&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1276740 Amer J PerinatolDOI: 10.1055/s-0031-1276740ABSTRACTWe employed accepted, validated symptom-based screening measures to discern attributable risk of obstructive sleep apnea (OSA) to adverse pregnancy outcomes, taking into account potential maternal confounders. Commonly employed OSA screening measures (Berlin and Epworth scales) were performed in the second and third trimesters; maternal and neonatal outcome data were thereafter obtained. The relationship between OSA and outcomes of interest were explored in stratified and multivariate models controlling for potential confounders. The overall prevalence of OSA was 25.4%. Given a nonlinear increase by body mass index (BMI) strata (8.9%, 46%; p < 0.0001), stratified multivariate analysis was subsequently performed. Among nonobese (BMI <... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4692533 Thu, 07 Apr 2011 23:00:00 +0100 4692533 http://www.medworm.com/index.php?rid=4621508&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275385 Amer J PerinatolDOI: 10.1055/s-0031-1275385ABSTRACTWe tested the hypothesis that an open lung strategy with recruitment maneuvers will improve oxygenation and decrease lung injury in comparison with a permissive hypercapnia strategy in preterm lambs. Preterm lambs born by operative delivery at 131 ± 1 days of gestational age (term = 150 days) were randomized to an open lung group (OLG, n = 5) or a permissive hypercapnia group (PHG, n = 4). In the OLG, ramp recruitment maneuvers were performed by increasing and then decreasing peak inspiratory pressure and positive end-expiratory pressure (adjusting for expiratory tidal volume [VT] 6 to 8 mL/kg). In the PHG, lambs received ventilation with VT of 6 to 8 mL/kg, adapting pressures and respiratory rate according to arterial blood gases results... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4621508 Mon, 21 Mar 2011 00:00:00 +0100 4621508 http://www.medworm.com/index.php?rid=4610222&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275384 Amer J PerinatolDOI: 10.1055/s-0031-1275384ABSTRACTWe investigated the cerebrovascular effects of continuous infusion of low-dose oxytocin in normal pregnant women undergoing induction of labor. In our prospective observational study, middle cerebral artery velocity was measured with transcranial Doppler ultrasound in 25 healthy, normotensive, nonsmoking patients undergoing induction of labor. No vasoactive drugs were used before or during the study period. Measurements were made at baseline and 15, 30, 60, and 120 minutes after oxytocin initiation. Mean arterial pressure, cerebral perfusion pressure, resistance index, resistance area product, and cerebral flow index at different times were calculated and compared using one-way analysis of variance (ANOVA) for repeated measures or Friedman... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4610222 Fri, 18 Mar 2011 00:00:00 +0100 4610222 http://www.medworm.com/index.php?rid=4610221&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1275386 Amer J PerinatolDOI: 10.1055/s-0031-1275386ABSTRACTWe assessed the rate of uterine rupture in patients undergoing labor induction for attempted vaginal birth after cesarean (VBAC). A retrospective study was performed of data from a computerized database. Deliveries from January 1, 1998, to June 30, 2001, in the Southern California Kaiser Permanente system were reviewed and various perinatal characteristics analyzed. A total of 16,218 patients had a prior low transverse cesarean section. Of these, 6832 (42.1%) had a trial of labor. Successful VBAC occurred in 86% of patients with spontaneous onset of labor and 66% of patients with labor induction (p < 0.001). The uterine rupture rate was not different between patients with spontaneous or induced labor (1.0% versus 1.2%, p = 0.51). Simila... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4610221 Fri, 18 Mar 2011 00:00:00 +0100 4610221 http://www.medworm.com/index.php?rid=4590473&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1272968 We examined body mass index (BMI) as a screening tool for gestational diabetes (GDM) and its sensitivity among different racial/ethnic groups. In a retrospective cohort study of 24,324 pregnant women at University of California, San Francisco, BMI was explored as a screening tool for GDM and was stratified by race/ethnicity. Sensitivity and specificity were examined using chi-square test and receiver-operator characteristic curves. BMI of ≥ 25.0 kg/m2 as a screening threshold identified GDM in > 76% of African-Americans, 58% of Latinas, and 46% of Caucasians, but only 25% of Asians (p < 0.001). Controlling for confounders and comparing to a BMI of ≤ 25, African-Americans had the greatest increased risk of GDM (adjusted odds ratio [AOR] 5.1, 95% confidence interval [CI]: 3... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4590473 Mon, 14 Mar 2011 00:00:00 +0100 4590473 http://www.medworm.com/index.php?rid=4590472&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1274503 Amer J PerinatolDOI: 10.1055/s-0031-1274503ABSTRACTThe possible correlation between the mean platelet volume (MPV) and the occurrence of bronchopulmonary dysplasia (BPD) and intraventricular hemorrhage (IVH) in a cohort of preterm infants was assessed. We studied infants with gestational age <30 weeks. Enrolled infants were divided into BPD and no-BPD groups and IVH and no-IVH groups. MPV was evaluated at birth and at 24 to 48 hours of life. MPV measured at birth was similar in BPD and no-BPD groups, but at 24 to 48 hours of life was higher in the BPD than in the no-BPD group (11.1 ± 0.9 versus 10.8 ± 0.9 fL, p = 0.033) and multivariate analysis demonstrated that MPV >11 fL increases (relative risk 1.40, 95% confidence interval 1.08 to 1.80) the risk of developing BPD. MPV was simi... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4590472 Mon, 14 Mar 2011 00:00:00 +0100 4590472 http://www.medworm.com/index.php?rid=4549386&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1272964 Amer J PerinatolDOI: 10.1055/s-0031-1272964ABSTRACTThrombophilias have been implicated in complications related to ischemic placental disease including recurrent pregnancy loss, intrauterine fetal demise, preeclampsia, fetal growth restriction, placental abruption, and preterm delivery. Maternal screening and treatment may lower the recurrence of these outcomes. Our objective was to estimate if antenatal screening for thrombophilias with the intention to offer treatment among women with a prior adverse pregnancy outcome (APO) is preferable to no screening. A decision-analytical model was constructed for pregnant women with prior APO, comparing screening for thrombophilia with intention to treat with no screening. Values obtained from previously published studies include probability of posi... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4549386 Fri, 04 Mar 2011 00:00:00 +0100 4549386 http://www.medworm.com/index.php?rid=4549385&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1272967 Amer J PerinatolDOI: 10.1055/s-0031-1272967ABSTRACTWe sought to determine if 17α-hydroxyprogesterone caproate (17P) reduces the rate of preterm birth (PTB) in women with an ultrasound-indicated cerclage (UIC). We retrospectively reviewed a cohort of women with a previous spontaneous PTB and current UIC placement for cervical length (CL) < 25 mm at < 236/7 weeks. The study group consisted of women treated with 17P; the control group consisted of women not treated with 17P. Primary outcome was spontaneous PTB < 35 weeks. Secondary outcomes included PTB < 32 weeks, PTB < 28 weeks, gestational age at delivery, and birth weight. A total of 58 women were identified; 15 (25.9%) received 17P, and 43 (74.1%) did not. 17P did not have a significant effect on PTB < 35 weeks (od... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4549385 Fri, 04 Mar 2011 00:00:00 +0100 4549385 http://www.medworm.com/index.php?rid=4549384&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1274510 Amer J PerinatolDOI: 10.1055/s-0031-1274510ABSTRACTComplement activation is thought to contribute to the pathogenesis of preterm labor (PTL). Decay-accelerating factor (DAF) is a natural complement pathway inhibitor. Our hypothesis was that DAF expression on maternal white blood cells (WBCs) in women with preterm labor is elevated compared with women with no preterm labor. Our secondary objective was to determine if differences in upregulation of DAF levels correlated with clinical outcomes. Serial blood samples were obtained from 30 patients with a clinical diagnosis of PTL and a control group of 30 pregnant individuals (same gestational age range) to determine DAF expression in peripheral WBCs in both groups. DAF expression was higher in women with PTL (less than 37 weeks) compared with ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4549384 Fri, 04 Mar 2011 00:00:00 +0100 4549384 http://www.medworm.com/index.php?rid=4549383&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1274507 The objective of this analysis was to determine if a significant decline in the fetal death rate or an increase in the live born death rate at previable gestational ages of 17 to 22 weeks has occurred. U.S. public use fetal death files and linked birth and infant death files were obtained for the years 2000 to 2005 for gestations of 17 to 22 weeks. The fetal death rate declined from 53.8% in the 2000 to 2002 period to 52.6% for the period 2003 to 2005 and the live birth mortality rate increased from 46.2 to 47.4% (p < 0.02). The average annual live birth death rate increased significantly only at 17 weeks gestation (p < 0.02). Although there was a small but statistically significant change in the fetal and live birth death rates for infants considered to be previable for the period f... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4549383 Fri, 04 Mar 2011 00:00:00 +0100 4549383 http://www.medworm.com/index.php?rid=4549382&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1274511 Amer J PerinatolDOI: 10.1055/s-0031-1274511ABSTRACTOutside pregnancy, acute caffeine consumption is associated with insulin resistance. We investigated if during pregnancy plasma concentrations of caffeine and its metabolite, paraxanthine, were associated with insulin resistance. Caffeine, paraxanthine, glucose, and insulin were measured and insulin resistance estimated by homeostasis model assessment (HOMA) in banked samples from 251 fasting subjects at mean gestational age of 20.3 ± 2.0 weeks. Analysis of covariance and adjusted logistic regression were performed. Most (96.4%) women had caffeine and/or paraxanthine present. Caffeine concentrations in the upper two quartiles (> 266 ng/mL) were associated with threefold higher odds of having higher insulin resistance estimated by log H... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4549382 Fri, 04 Mar 2011 00:00:00 +0100 4549382 http://www.medworm.com/index.php?rid=4549381&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1272966 Amer J PerinatolDOI: 10.1055/s-0031-1272966ABSTRACTWe sought to estimate if there is an association between cerclage and cesarean delivery. We performed a retrospective cohort study of women with high-risk factors for preterm birth. Those with a cerclage were compared with those without. Outcomes included overall incidence of cesarean delivery and incidence of cesarean delivery secondary to labor arrest. We identified 724 women at high risk for preterm birth; 232 (32%) women had cerclage placement, and 492 (68%) did not. There was no significant difference in the overall incidence of cesarean delivery between the two groups (odds ratio 1.15; 95% confidence interval 0.81 to 1.63). When comparison was limited to women who underwent a cesarean section secondary to labor arrest, the incidence ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4549381 Fri, 04 Mar 2011 00:00:00 +0100 4549381 http://www.medworm.com/index.php?rid=4549380&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1274505 Amer J PerinatolDOI: 10.1055/s-0031-1274505ABSTRACTWe sought to determine the rate of corticosteroid administration in preterm births in our institution and to describe factors associated with lack of corticosteroid exposure. We performed a retrospective case-control analysis. Of the 312 eligible women who delivered between 24 and 34 weeks' gestation, maternal corticosteroid administration was documented in 262 (84%) and no exposure in 50 (16%). A shorter admission to delivery interval (< 48 hours) decreased the likelihood of corticosteroid administration (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.03 to 0.28, p < 0.001). Use of tocolytics was associated with a lower risk of corticosteroid nonexposure (OR 0.21, 95% CI 0.04 to 0.69, p = 0.006). Lack of prenatal care was asso... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4549380 Fri, 04 Mar 2011 00:00:00 +0100 4549380 http://www.medworm.com/index.php?rid=4549379&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1274509 Amer J PerinatolDOI: 10.1055/s-0031-1274509ABSTRACTWe sought to evaluate the effectiveness of daily oral micronized progesterone (MP) in preventing recurrent spontaneous preterm birth (RSPB) and whether MP increases maternal serum progesterone. We performed a pilot, single-center, randomized, double-blind, placebo-controlled trial in women with a prior preterm birth and current singleton gestation at 16 to 20 weeks (n = 33). The primary outcome was the rate of RSPB. Subjects were given either daily MP (400 mg) or placebo from 16 to 34 weeks. Serum progesterone was obtained at enrollment and in the late second/early third trimester. Pregnancy outcome data were collected. RSPB occurred in 5/19 (26.3%) in the MP group versus 8/14 (57.1%) in placebo group (p = 0.15). The mean age at delivery w... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4549379 Fri, 04 Mar 2011 00:00:00 +0100 4549379 http://www.medworm.com/index.php?rid=4549378&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1272971 Amer J PerinatolDOI: 10.1055/s-0031-1272971ABSTRACTWe evaluated the birth outcomes of planned home births. We conducted a retrospective cohort study using Missouri vital records from 1989 to 2005 to compare the risk of newborn seizure and intrapartum fetal death in planned home births attended by physicians/certified nurse midwives (CNMs) or non-CNMs with hospitals/birthing center births. The study sample included singleton pregnancies between 36 and 44 weeks of gestation without major congenital anomalies or breech presentation (n = 859,873). The adjusted odds ratio (aOR) of newborn seizures in planned home births attended by non-CNMs was 5.11 (95% confidence interval [CI]: 2.52, 10.37) compared with deliveries by physicians/CNMs in hospitals/birthing centers. For intrapartum fetal death,... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4549378 Fri, 04 Mar 2011 00:00:00 +0100 4549378 http://www.medworm.com/index.php?rid=4549377&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1272970 Amer J PerinatolDOI: 10.1055/s-0031-1272970ABSTRACTPreterm infants need the achievement of adequate lung volume. Lung recruitment maneuver (LRM) is applied during high-frequency oscillatory ventilation. We investigated the effect of an LRM with positive end-expiratory pressure (PEEP) on oxygenation and outcomes in infants conventionally ventilated for respiratory distress syndrome (RDS). Preterm infants in assisted controlled ventilation + volume guarantee for RDS after surfactant randomly received an LRM (group A) or did not (group B). LRM entailed increments of 0.2 cm H2O PEEP every 5 minutes, until fraction of inspired oxygen (Fio2) = 0.25. Then PEEP was reduced and the lung volume was set on the deflation limb of the pressure/volume curve. When saturation of peripheral oxygen fell and ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4549377 Fri, 04 Mar 2011 00:00:00 +0100 4549377 http://www.medworm.com/index.php?rid=4549376&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1274508 Amer J PerinatolDOI: 10.1055/s-0031-1274508ABSTRACTWe sought to describe maternal satisfaction with childbirth among women planning either cesarean or vaginal birth. We enrolled primiparous women planning cesarean birth and a comparison group planning vaginal birth. After delivery, the maternal subjective experience was assessed with a visual analogue satisfaction scale and the Salmon questionnaire, with scale scores for these aspects of the maternal experience of birth: fulfillment, distress, and difficulty. The sample included 160 women planning vaginal birth and 44 women planning cesarean. Eight weeks postpartum, women planning cesarean reported higher satisfaction ratings (p = 0.023), higher scores for fulfillment (p = 0.017), lower scores for distress (p = 0.010), and lower scores for... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4549376 Fri, 04 Mar 2011 00:00:00 +0100 4549376 http://www.medworm.com/index.php?rid=4549375&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1272965 This study demonstrated comparable results in blood and urine samples. This suggests that subsequent studies on levels of marinobufagenin as a screening test for preeclampsia could be done utilizing urine samples, which are easier to obtain, less invasive, more cost-effective, and as accurate as the serological tests.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4549375 Fri, 04 Mar 2011 00:00:00 +0100 4549375 http://www.medworm.com/index.php?rid=4535520&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1274506 In conclusion, this study quantitatively verified the potential risks for adverse outcome of neonatal hyperbilirubinemia.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4535520 Tue, 01 Mar 2011 00:00:00 +0100 4535520 http://www.medworm.com/index.php?rid=4535519&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1272973 Amer J PerinatolDOI: 10.1055/s-0031-1272973ABSTRACTWe sought to reduce long-term complications after cesarean delivery by improving myometrial healing. Eight sheep (three with twins) underwent cesarean delivery. Hysterotomy sites were repaired in equal parts by suture alone or suture with a juxtaposed graft (Cook Medical, Bloomington, IN). At 90 days postsurgery, scar characteristics and tensile strength testing were assessed. The mean hysterotomy closure time was on average 1 minute, 14 seconds longer for those undergoing graft placement (p = 0.36). The mean scar thickness was 3.0 ± 0.4 mm for controls versus 3.8 ± 1.2 mm for the intervention group (p = 0.047). Tensile strength testing did not demonstrate a significant difference between groups. Histological examination of the myometria... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4535519 Tue, 01 Mar 2011 00:00:00 +0100 4535519 http://www.medworm.com/index.php?rid=4535518&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1272972 Amer J PerinatolDOI: 10.1055/s-0031-1272972ABSTRACTWe sought to determine if pyelonephritis and preterm delivery occur more frequently among pregnant women with polymicrobial growth from screening urine culture than among women with negative urine culture. A retrospective cohort study was performed. Three hundred eighty pregnant women with greater than 100,000 colony-forming units per milliliter of polymicrobial growth from urine culture performed at less than 20 weeks of pregnancy were compared with 375 women with negative urine culture. Admissions for pyelonephritis were identified from discharge records. Gestational age at delivery was determined from a research registry. Frequency of pyelonephritis and preterm delivery did not differ between the two groups. Frequencies of pyelonephriti... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4535518 Tue, 01 Mar 2011 00:00:00 +0100 4535518 http://www.medworm.com/index.php?rid=4535517&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1274504 In conclusion, PHS continues to be a problem observed in neonatal intensive care units, particularly in at-risk populations. PHS and PET are associated with significant complications. Well-designed studies with long-term follow up are needed to assess the risks and benefits of PET for PHS.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4535517 Tue, 01 Mar 2011 00:00:00 +0100 4535517 http://www.medworm.com/index.php?rid=4438817&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0031-1272553 Amer J Perinatol 2011; 28: 089-090DOI: 10.1055/s-0031-1272553© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4438817 Fri, 04 Feb 2011 00:00:00 +0100 4438817 http://www.medworm.com/index.php?rid=4377022&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1271213 Amer J PerinatolDOI: 10.1055/s-0030-1271213ABSTRACTThe aim of our study was to investigate the influence of malpractice premiums paid by obstetricians on obstetric care across the United States. We conducted a retrospective cross-sectional population-based study using patient-level data obtained from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample on every woman who delivered in 2006. Mode of delivery was compared with the average state medical liability insurance premium paid by obstetricians (Medical Liability Monitor and the National Association of Insurance Commissioners) using a generalized estimating equation to calculate crude and adjusted odds ratios. Our cohort included 890,266 women who delivered across 37 states in 2006. Average state malpractice premium ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4377022 Wed, 19 Jan 2011 00:00:00 +0100 4377022 http://www.medworm.com/index.php?rid=4342366&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1271211 Amer J PerinatolDOI: 10.1055/s-0030-1271211ABSTRACTWe evaluated the impact of adherence to the new Institute of Medicine weight gain guidelines within each prepregnancy body mass index (PPBMI) category on the development of pregnancy-related hypertension (PRH). Patients with singleton term deliveries (≥37 weeks) with documented PPBMI and pregnancy weight gain information were identified from a database of women enrolled for outpatient nursing services. Included were women without history of cardiovascular disease, PRH, or diabetes at initiation of services (n = 7676). Data were stratified by PPBMI (underweight = < 18.5 kg/m2; normal weight = 18.5 to 24.9 kg/m2; overweight = 25.0 to 29.9 kg/m2; obese = ≥ 30.0 kg/m2). PRH rates were compared overall and within each PPBMI group... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4342366 Wed, 12 Jan 2011 00:00:00 +0100 4342366 http://www.medworm.com/index.php?rid=4337137&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1271210 Amer J PerinatolDOI: 10.1055/s-0030-1271210ABSTRACTProviders occasionally screen women thought to be at particularly increased risk of gestational diabetes mellitus (GDM) with a first- or second-trimester (“early”) glucose tolerance test (GTT). We sought to describe how the frequency of abnormal early GTT varies by indication for testing. This is a retrospective cohort study of women receiving prenatal care in our clinic who underwent a 50-g GTT at less than 24 weeks between 2003 and 2006. Three hundred five women received an early GTT. The most common indications for early screening were obesity (53%), family history of diabetes (15%), prior history of GDM (10%), and multifetal gestation (5%). The frequency of abnormal testing in patients with multifetal gestations and a perso... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4337137 Tue, 11 Jan 2011 00:00:00 +0100 4337137 http://www.medworm.com/index.php?rid=4337136&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1271215 Amer J PerinatolDOI: 10.1055/s-0030-1271215ABSTRACTWe compared two biochemical tests of premature rupture of membranes (PROM) in vitro: Actim PROM (Medix Biochemica, Kauniainen, Finland), which detects insulin-like growth factor binding protein-1, and AmniSure (AmniSure International LLC, Cambridge, MA), which detects placental alpha microglobulin-1. Samples of amniotic fluid were collected during caesarean section in 41 patients. A dilution series was prepared and both tests were performed twice at each dilution. Sensitivity, detection limit, response time, and reproducibility of both tests were compared. Both tests' sensitivity was 100% at dilution 1:10 and 1:20. AmniSure sensitivity was higher at dilution 1:40 and 1:80 (p < 0.05). In 29 of 40 cases, AmniSure had a lower detection lim... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4337136 Tue, 11 Jan 2011 00:00:00 +0100 4337136 http://www.medworm.com/index.php?rid=4337135&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1271212 This study evaluates a real-time polymerase chain reaction (PCR) for the detection of amniotic fluid infection and neonatal complications by amniocentesis following PPROM. A total of 61 singleton pregnancies with PPROM were analyzed retrospectively, including histopathologic examination of the placenta and neonatal complications. The real-time PCR detects a highly conserved sequence of the bacterial 16S ribosomal DNA, and its efficacy was compared with standard tests including amniotic fluid glucose concentration, lactate dehydrogenase level, and maternal white cells count and C-reactive protein levels. Sensitivity and specificity were similar for PCR (64% and 85%) and standard tests (58% and 80%). However, the PCR technique has the additional advantage of possible identification of the ba... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4337135 Tue, 11 Jan 2011 00:00:00 +0100 4337135 http://www.medworm.com/index.php?rid=4337134&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1271214 Amer J PerinatolDOI: 10.1055/s-0030-1271214ABSTRACTWe sought to validate a proposed vaginal birth after cesarean (VBAC) prediction model that includes variables available “at or close to delivery” and compare its accuracy to one that only uses variables available at “entry to care.” We performed a retrospective cohort study of term pregnant women with a vertex singleton gestation attempting a trial of labor (TOL) after a single prior low transverse cesarean delivery. VBAC rates, predicted using the “close to delivery” model, were partitioned into deciles. The observed VBAC rate in each partition was compared with the predicted one. The accuracy of the two models was compared using the receiver operating characteristics curve. The predicted VBAC probabili... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4337134 Tue, 11 Jan 2011 00:00:00 +0100 4337134 http://www.medworm.com/index.php?rid=4337133&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1271209 Amer J PerinatolDOI: 10.1055/s-0030-1271209ABSTRACTOur objectives were to describe the obstetric complications of women who delivered an extremely low-birth-weight infant by comparing two consecutive 5-year periods and infants appropriate for gestational age (AGA) versus infants small for gestational age (SGA). This descriptive study included women (n = 261) who delivered an infant ≤750 g (major structural and chromosomal anomalies excluded) between 1996 and 2000 (cohort I, n = 145) and 2001 to 2005 (cohort II, n = 116) in the University Hospital Utrecht, the Netherlands. Of these, 84.3% of the multigravidas (n = 121) had a complicated obstetric history: 46.3% miscarriage(s), 22.3% preterm deliveries, and 16.5% hypertensive disorders. In the index pregnancies (n = 261), the most prev... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4337133 Tue, 11 Jan 2011 00:00:00 +0100 4337133 http://www.medworm.com/index.php?rid=4337132&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1271208 Amer J PerinatolDOI: 10.1055/s-0030-1271208ABSTRACTWe evaluate the likelihood of cesarean delivery and identify risks of retaining a sustained-release dinoprostone vaginal insert beyond 12 hours. In a secondary analysis of outcomes, data were collected during a large, randomized trial comparing different sustained-release prostaglandin vaginal inserts for labor induction. Outcomes were compared between cases in whom the dinoprostone insert was removed early (within 12 hours) or late (12 to 24 hours). A total of 431 subjects had the dinoprostone vaginal insert in place for 12 to 24 hours (n = 226, 52.4%) or within 12 hours (n = 205, 47.6%). Insert removal for labor complications was less frequent in the late group than in the early group (5.8% versus 21.5%; p ≤ 0.001). Abnormal uterin... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4337132 Tue, 11 Jan 2011 00:00:00 +0100 4337132 http://www.medworm.com/index.php?rid=4330291&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1270622 Amer J Perinatol 2011; 28: 003-006DOI: 10.1055/s-0030-1270622© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4330291 Wed, 29 Dec 2010 00:00:00 +0100 4330291 http://www.medworm.com/index.php?rid=4330290&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1270562 Amer J Perinatol 2011; 28: 001-002DOI: 10.1055/s-0030-1270562© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4330290 Wed, 29 Dec 2010 00:00:00 +0100 4330290 http://www.medworm.com/index.php?rid=4330289&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1270111 This article reviews the available literature on the pharmacokinetics, mode of administration, and clinical utility of oxytocin antagonists for acute and maintenance tocolysis with special emphasis on its safety profile.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4330289 Fri, 17 Dec 2010 00:00:00 +0100 4330289 http://www.medworm.com/index.php?rid=4330288&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1270115 Amer J PerinatolDOI: 10.1055/s-0030-1270115ABSTRACTWe sought to determine the effect of neonatal transport on the incidence of adverse events of transient tachypnea of the newborn (TTN) in term neonates. A retrospective study was performed of neonates who had TTN and were admitted to Neonatal Intensive Care Unit (NICU) of Sami Ulus Maternity, Children's Education and Research Hospital by land-based transport. Data from 208 newborns with TTN were evaluated, and clinical and laboratory findings were compared between patients who were transported from within the city (group 1) or from outside of the city (group 2). In the present study, long-distance land-based neonatal transport increased the adverse effects of TTN in newborns. Arterial blood gas parameters of the neonates in both groups bef... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4330288 Fri, 17 Dec 2010 00:00:00 +0100 4330288 http://www.medworm.com/index.php?rid=4330287&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1270118 This study was concluded prematurely due to slow accrual after a total of 50 subjects were enrolled. A total of 23/25 (92%) subjects in the indomethacin group remained pregnant beyond 48 hours compared with 20/22 (90.9%) in the placebo group (relative risk, 1.01; 95% confidence interval, 0.84 to 1.21). The latency period medians and interquartile ranges were similar between the two groups [indomethacin 193 (92 to 376.5) hours versus placebo 199 (77.5 to 459) hours, p = 0.91], and no differences were noted in any maternal or neonatal secondary outcomes. This limited study demonstrates no benefit with the use of prophylactic indomethacin tocolysis for women with PPROM.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: Am... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4330287 Fri, 17 Dec 2010 00:00:00 +0100 4330287 http://www.medworm.com/index.php?rid=4236896&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1270110 Amer J PerinatolDOI: 10.1055/s-0030-1270110ABSTRACTWe sought to determine the relationship between cervical length and delivery outcome in patients who received prophylactic cervical cerclage. We performed a retrospective cohort study of patients with singleton gestations who underwent cerclage during calendar years 1999 to 2008. A total of 78 patients were included in the study. Multiple clinical characteristics and their relationships to delivery outcome were analyzed using multivariable logistic regression analysis. Cervical length at the time of surgery and history of one or more prior second-trimester losses were strongly associated with delivery at or after 32 weeks gestation (p = 0.005 and p = 0.01, respectively). In fact, a cervical length greater than 2 cm ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4236896 Mon, 06 Dec 2010 00:00:00 +0100 4236896 http://www.medworm.com/index.php?rid=4236895&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1270117 Amer J PerinatolDOI: 10.1055/s-0030-1270117ABSTRACTWe sought to determine if outcomes of nulliparous twin pregnancies differ based on maternal age. Nulliparous women with current twin pregnancies were identified from a database of women enrolled for outpatient nursing surveillance. Data were stratified into four groups by maternal age: less than 20, 20 to 34, 35 to 39, and greater than or equal to 40 years. Maternal and neonatal outcomes for women less than 20, 35 to 39, and 40 or more were compared with 20- to 34-year-old controls using Kruskal-Wallis, Mann-Whitney, and Pearson chi-square analyses. We analyzed 2144 nulliparous twin pregnancies. Patients ≥35 years (34 to 39, 78.5% or ≥40, 85.9%) were more likely to have cesarean deliveries compared with controls 20 to 34 years ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4236895 Mon, 06 Dec 2010 00:00:00 +0100 4236895 http://www.medworm.com/index.php?rid=4236894&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1270114 Amer J PerinatolDOI: 10.1055/s-0030-1270114ABSTRACTWe studied the pattern of indeterminate HIV serological tests among pregnant women with follow-up testing in the postpartum period. Medical records of pregnant women were reviewed over a 2-year period. Of 16,596 pregnant women, 127 (0.8%) had positive HIV enzyme-linked immunoassay (ELISA) result. With Western blot (WB) test, 54 (0.33%) were positive, 43 (0.26%) were negative, and 30 (0.18%) were indeterminate. One of the 30 women (3.3%) with indeterminate WB converted to positive WB during pregnancy. White and black women were more likely to have an unconfirmed positive ELISA (indeterminate or negative WB) than Hispanics (p = 0.021). The positive WB rate for black women was significantly higher (p < 0.001) than o... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4236894 Mon, 06 Dec 2010 00:00:00 +0100 4236894 http://www.medworm.com/index.php?rid=4236893&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1270119 In this study, biological measures of stress assessed in the second trimester were not associated with overall psychosocial status or perceived stress. The factors contributing to the elevation in CRH that precedes some preterm birth are complex and poorly understood.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4236893 Mon, 06 Dec 2010 00:00:00 +0100 4236893 http://www.medworm.com/index.php?rid=4236892&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1270113 We report the case of neutropenia in a newborn discovered because of fetomaternal infection. The bone marrow biopsy showed normal cellularity. Granulocyte typing, granulocyte cross-matching, and serum assays showed anti-neutrophil antibodies specific for human neutrophil antigen-1c, an antigen rarely involved in this disease. This NAN was refractory to G-CSF but responded to intravenous immunoglobulin (IVIG). IVIG should be considered as a second-line treatment in NAN refractory to G-CSF. Clinical trials, however, are required to define the optimal management of NAN, a rare but probably underestimated life-threatening situation for newborns.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinato... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4236892 Mon, 06 Dec 2010 00:00:00 +0100 4236892 http://www.medworm.com/index.php?rid=4224120&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1270112 Amer J PerinatolDOI: 10.1055/s-0030-1270112ABSTRACTWe sought to assess risk-adjusted neonatal outcomes of extremely preterm infants who received opioid infusion during early postnatal period. A retrospective analysis of preterm infants ≤28 weeks' gestational age (GA) admitted to neonatal intensive care units in the Canadian Neonatal Network was conducted comparing infants on the basis of receipt of opioid infusion during day 1 and day 3 after birth. Rates of mortality, severe neurological injury, severe retinopathy of prematurity, and chronic lung disease were compared. A total 362 infants received opioid infusion on day 1 and day 3, whereas 4419 infants did not receive opioid infusion. Baseline comparison revealed higher number of males, infants of GA <26 weeks, low Apgar score, ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4224120 Thu, 02 Dec 2010 00:00:00 +0100 4224120 http://www.medworm.com/index.php?rid=4224119&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1270116 Amer J PerinatolDOI: 10.1055/s-0030-1270116ABSTRACTWe sought to estimate the association of several maternal risk factors with intrauterine growth restriction (IUGR) in twin pregnancies. This is a case-control study of 313 patients with twin pregnancies delivered greater than 24 weeks between June 2005 and January 2010. We used three definitions of IUGR: (1) either twin with a birth weight < 10th percentile for gestational age; (2) either twin with a birth weight < 5th percentile for gestational age; and (3) birth-weight discordance ≥ 20%. Using each definition of IUGR, we estimated the association between IUGR and maternal age, weight, monochorionicity, in vitro fertilization, pregnancy reduction, thrombophilia, hypertension, and diabetes. Overall, 47% of pat... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4224119 Thu, 02 Dec 2010 00:00:00 +0100 4224119 http://www.medworm.com/index.php?rid=4212864&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268715 Amer J PerinatolDOI: 10.1055/s-0030-1268715ABSTRACTNewer bedside pulmonary mechanics using conventional ventilators allow for continuous serial determinations of tidal volume (VT). We sought to determine whether the degree of pulmonary hypoplasia could be measured using bedside pulmonary graphics and whether survival could be predicted in potential extracorporeal membrane oxygenation (ECMO) candidates. Data on all neonates considered for or treated with ECMO at our center between April 2000 and March 2005 were collected. The “maximal bedside VT” was measured daily at the peak pressure where “beaking” began with a peak end expiratory pressure of 4 cm H2O. Twenty-two patients were reviewed: eight ECMO plus fourteen similar patients in whom the threshold for ECMO inter... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4212864 Mon, 29 Nov 2010 00:00:00 +0100 4212864 http://www.medworm.com/index.php?rid=4212863&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268714 Amer J PerinatolDOI: 10.1055/s-0030-1268714ABSTRACTWe sought to delineate the in-hospital outcome for infants born alive and universally resuscitated at an estimated gestational age (GA) of 230/7 to 236/7 weeks and to document when and why death occurred. We performed a cohort study of prospectively collected data on 100 consecutive infants born alive at 23 weeks GA from June 16, 1990 through August 6, 2006. All deliveries were attended by a neonatologist and resuscitation was universally attempted. At the time of death, a primary cause was determined by the attending neonatologist. Forty infants survived and 60 died prior to hospital discharge. Survivors were more likely to have higher Apgar scores and be male gender. Ten infants could not be resuscitated and died in the delivery room. Tw... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4212863 Mon, 29 Nov 2010 00:00:00 +0100 4212863 http://www.medworm.com/index.php?rid=4212862&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268711 We examined the relationship between the use of nasal continuous positive airway pressure (CPAP) and nasal colonization among low-birth-weight (LBW) infants. We prospectively cultured the nares of LBW infants on admission and weekly until hospital discharge. The modality of respiratory support during each culture was recorded. Bivariate and multivariate analyses were conducted to test the relationship between CPAP and nasal colonization. Analyses were repeated after stratifying infants into three birth-weight categories: 1500 to 2499 g, 1000 to 1499 g, and < 1000 g. In total, 766 nasal cultures were obtained from 167 infants. Nasal colonization with gram-negative bacilli was increased with the use of CPAP in all birth-weight categories (p < 0.05) and with vaginal de... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4212862 Mon, 29 Nov 2010 00:00:00 +0100 4212862 http://www.medworm.com/index.php?rid=4182655&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268710 We present the clinical course of three neonates with proven enteroviral infection and an initial clinical picture suggestive of hemophagocytic lymphohistiocytosis (HLH). After a complete workup, only one was treated for HLH. Of particular interest, the first newborn presented with hemophagocytic cells in the cerebrospinal fluid (CSF) and proved to have enteroviral meningoencephalitis but was ultimately not diagnosed with HLH. A fourth infant, who fulfilled the diagnostic criteria for HLH but did not have enteroviral infection, is included for comparison. We suggest that severe neonatal enteroviral infection and HLH are difficult to distinguish. Careful assessment is recommended, as prognosis and treatment differ between these two entities. Literature regarding neonatal enteroviral infecti... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4182655 Thu, 18 Nov 2010 00:00:00 +0100 4182655 http://www.medworm.com/index.php?rid=4182654&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268713 Amer J PerinatolDOI: 10.1055/s-0030-1268713ABSTRACTWe performed multifractal analysis of fetal heart rate (FHR) variability in fetuses with and without acidosis during labor. Multifractal analysis was performed on fetal electrocardiograms in 10-minute sliding windows within the last 2 hours before delivery in 45 term fetuses divided in three groups according to umbilical arterial pH and FHR pattern: group A had pH ≥7.30 and normal FHR, group B had pH ≥7.30 and intermediate or abnormal FHR, and group C had acidosis (pH ≤7.05) and intermediate or abnormal FHR. Six multifractal parameters were compared using Wilcoxon rank sum test. Multifractal parameters were significantly different between the three groups in the last 10 minutes before delivery (p <0.05). Two para... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4182654 Thu, 18 Nov 2010 00:00:00 +0100 4182654 http://www.medworm.com/index.php?rid=4182653&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268712 In this study, the Cockcroft-Gault, the Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas were evaluated for their accuracy in determining GFR in the setting of preeclampsia. The estimated GFRs calculated from the above formulas were compared with the creatinine clearance values obtained from a 24-hour urine collections in 543 preeclamptic patients recruited from several large hospitals. Additionally, a set of new equations, preeclampsia GFR (PGFR), based on ethnicity, was created. The Cockcroft-Gault, MDRD, and CKD-EPI formulas were inaccurate in predicting GFR and both were significantly less accurate than PGFR. The latter formula provided an estimated GFR that was much closer to the creatinine clearance. Current GFR es... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4182653 Thu, 18 Nov 2010 00:00:00 +0100 4182653 http://www.medworm.com/index.php?rid=4175165&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268707 Amer J PerinatolDOI: 10.1055/s-0030-1268707ABSTRACTWe evaluated the impact of assisted reproductive technology (ART) on the association between first-trimester pregnancy-associated plasma protein A (PAPP-A) and human chorionic gonadotropin (β-hCG) and adverse pregnancy outcomes. PAPP-A and β-hCG levels were obtained between 11 and 136/7 weeks' gestation and converted to multiples of the median (MoM). MoM < 5th percentile was defined as low PAPP-A or β-hCG and those > 90th percentile as high. Adverse outcomes included small-for-gestational-age (SGA) infants, preeclampsia, pregnancy loss, and preterm delivery (PTD). Univariate and multivariate analyses were used to estimate the association. Of 4000 women meeting the inclusion criteria, 265 (7.6%) pregnancies ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4175165 Tue, 16 Nov 2010 00:00:00 +0100 4175165 http://www.medworm.com/index.php?rid=4175164&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268717 Amer J PerinatolDOI: 10.1055/s-0030-1268717ABSTRACTWe sought to determine whether computerized physician order entry (CPOE) improves the induction agent turnaround time on the labor and delivery unit (L&D) compared with paper-based order entry (PBOE). We conducted a retrospective study of singleton, term pregnancies admitted to L&D for induction of labor. Outcomes of women who delivered 3 months before or 3 months after universal CPOE implementation were compared including induction agent turnaround time. The induction agent turnaround time was significantly shorter in the CPOE group (n = 83) compared with PBOE group (n = 71) [71 (range 8 to 411) versus 100 (2 to 442) minutes, p = 0.004]. There were no differences in cesarean section rate or leng... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4175164 Tue, 16 Nov 2010 00:00:00 +0100 4175164 http://www.medworm.com/index.php?rid=4175163&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268709 Amer J PerinatolDOI: 10.1055/s-0030-1268709ABSTRACTIt is not uncommon that the peripherally inserted central catheter (PICC) needs to be replaced either due to blockage or migration to a peripheral position. In such circumstances, there are two methods of PICC placement: new-site insertion and exchange by using the old PICC as a guide wire. Our objective was to investigate risk of infection associated with the exchange method. In this retrospective study, data on all PICC insertions in the neonatal intensive care unit in 2004 to 2008 were obtained. In the population who needed removal of existing PICC and insertion of a new one, we compared central line-associated bloodstream infection (CLABSI) within 1 week of insertion between the two insertion methods. Of 1148 PICC insertions reviewed, ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4175163 Tue, 16 Nov 2010 00:00:00 +0100 4175163 http://www.medworm.com/index.php?rid=4175162&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268706 Amer J PerinatolDOI: 10.1055/s-0030-1268706ABSTRACTWe sought to determine if maternal periodontal disease is associated with oxidative stress as measured by serum 8-isoprostane. A secondary analysis was conducted using prospective data from the Oral Conditions and Pregnancy Study. Healthy women enrolled at < 26 weeks' gestational age underwent oral examination and serum sampling. Maternal periodontal disease status was categorized as healthy, mild, or moderate to severe by clinical criteria. Maternal serum was analyzed for 8-isoprostane using ultrasensitive enzyme-linked immunosorbent assay. Elevated 8-isoprostane level was defined as ≥ 75th percentile. Maternal factors associated with elevated 8-isoprostane were determined using chi-square or t test. Multivariable log... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4175162 Tue, 16 Nov 2010 00:00:00 +0100 4175162 http://www.medworm.com/index.php?rid=4175161&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268708 Amer J PerinatolDOI: 10.1055/s-0030-1268708ABSTRACTThe type and timing of respiratory support in the first week affecting bronchopulmonary dysplasia (BPD)/death have not been evaluated. We compared outcomes of premature infants on nasal intermittent positive pressure ventilation (NIPPV) or nasal continuous positive airway pressure (NCPAP) to those on endotracheal tube (ETT). We retrospectively reviewed data (1/2004 to 6/2009) of infants ≤ 30 weeks' gestational age (GA) who received NIPPV in the first postnatal week. National Institutes of Health consensus definition was used for BPD. Infants were categorized into three groups based on their being on a particular respiratory support mode for majority of days in the first week. There was no difference in the mean GA and body weig... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4175161 Tue, 16 Nov 2010 00:00:00 +0100 4175161 http://www.medworm.com/index.php?rid=4175160&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268718 Amer J PerinatolDOI: 10.1055/s-0030-1268718ABSTRACTInterest in centralized monitoring in labor and delivery units is growing because it affords the opportunity to monitor multiple patients simultaneously. However, a long history of research on sustained attention reveals these types of monitoring tasks can be problematic. The goal of the present experiment was to examine the ability of individuals to detect critical signals in fetal heart rate (FHR) tracings in one or more displays over an extended period of time. Seventy-two participants monitored one, two, or four computer-simulated FHR tracings on a computer display for the appearance of late decelerations over a 48-minute vigil. Measures of subjective stress and workload were also obtained before and after the vigil. The results showed... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4175160 Tue, 16 Nov 2010 00:00:00 +0100 4175160 http://www.medworm.com/index.php?rid=4175159&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268716 We report a case of antenatally detected bidirectional fetal ductus arteriosus flow diagnosed concomitantly with polyhydramnios. Amnioreduction was performed due to severe maternal symptoms, which resulted in correction of the fetal ductus arteriosus flow. Postnatal diagnosis of a Morgagni diaphragmatic hernia indicates that our sonographic findings collectively may have been a diagnostic clue.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4175159 Tue, 16 Nov 2010 00:00:00 +0100 4175159 http://www.medworm.com/index.php?rid=4212865&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268900 Amer J PerinatolDOI: 10.1055/s-0030-1268900© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  FREE: Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4212865 Thu, 11 Nov 2010 00:00:00 +0100 4212865 http://www.medworm.com/index.php?rid=4158439&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268900 Amer J PerinatolDOI: 10.1055/s-0030-1268900© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  FREE: Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4158439 Thu, 11 Nov 2010 00:00:00 +0100 4158439 http://www.medworm.com/index.php?rid=4132582&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268239 Amer J PerinatolDOI: 10.1055/s-0030-1268239ABSTRACTWe compared survival and outcomes in process of care in female versus male infants born ≤32 weeks gestational age (GA). Data were obtained from the Alere database for infants born ≤32 weeks GA. Females were compared with males for demographics, complications, and care processes. Univariate and multivariate analysis was conducted using chi-square analysis, analysis of variance, or logistic regression. Of the infants included, 6086 female and 6721 males were included. Mean GA did not differ, males were born larger than females, and females were more likely to be born SGA. Males received more surfactant, developed more CLD, received more steroids, and more often required oxygen at discharge. Females were more likely to develop a p... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4132582 Tue, 02 Nov 2010 00:00:00 +0100 4132582 http://www.medworm.com/index.php?rid=4117142&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268237 Amer J PerinatolDOI: 10.1055/s-0030-1268237ABSTRACTLate-onset bloodstream infection (LOBI) is a significant problem in very low-birth-weight (VLBW) infants and can lead to increased mortality and morbidity. The incidence of LOBI in VLBW infants in our unit was >35% before 2004, much higher than 20% reported in other studies. A comprehensive infection control measure was introduced in our unit in 2005. Here we report the effects of comprehensive infection control measures on the rate of LOBI in VLBW infants. Infants in the preintervention group (born 2001 to 2004) were compared with the intervention group (born 2005 to 2008) for baseline demographics, risk factors for infection, and the rate of LOBI. LOBI was defined as a positive blood and/or cerebrospinal fluid culture after 3 days of ... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4117142 Tue, 26 Oct 2010 23:00:00 +0100 4117142 http://www.medworm.com/index.php?rid=4117145&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268235 Amer J PerinatolDOI: 10.1055/s-0030-1268235ABSTRACTCongenital diaphragmatic hernia (CDH) is a severe neonatal anomaly. The aim of this study was to evaluate the frequency and types of malformations associated with CDH. The outcome was compared with that in newborns with CDH alone. The study included 362 fetuses and newborns at a single national center for CDH. Associated malformations and chromosomal aberrations were noted prenatally and postnatally. The neonatal outcome was assessed relative to the use of extracorporeal membrane oxygenation (ECMO) and the mortality rate. At least one associated malformation was diagnosed in 143 cases (39.5%). Altogether, 272 associated malformations were found. Only 50 (18.4%) anomalies were diagnosed antenatally. In 62 (17.1%) cases, 102 major malformati... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4117145 Mon, 25 Oct 2010 23:00:00 +0100 4117145 http://www.medworm.com/index.php?rid=4117144&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268238 Amer J PerinatolDOI: 10.1055/s-0030-1268238ABSTRACTWe sought to determine the efficacy and safety of tranexamic acid (TA) in reducing blood loss during elective cesarean section (CS). We performed a randomized, double-blind, placebo-controlled study of 660 women who underwent elective CS. The patients were randomly selected to receive an intravenous infusion of either TA (1 g/10 mL in 20 mL of 5% glucose; n = 330) or 30 mL 5% glucose prior to surgery. The primary outcome was the estimated blood loss following CS. No demographic difference was observed between groups. The mean estimated blood loss was significantly lower in women treated with TA compared with women in the placebo group (499.9 ± 206.4 mL versus 600.7 ± 215.7 mL, respectively; p &lt... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4117144 Mon, 25 Oct 2010 23:00:00 +0100 4117144 http://www.medworm.com/index.php?rid=4117143&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1268236 Amer J PerinatolDOI: 10.1055/s-0030-1268236ABSTRACTWe studied the effect of a low- to moderate-volume, level III-B neonatal intensive care unit (NICU) on very low-birth-weight (VLBW) outcomes. We performed a retrospective analysis of the King Abdulaziz Hospital (KAH) NICU electronic database. Short-term outcomes of all inborn VLBW infants (501 to 1500 g) in the well-equipped, well-staffed KAH NICU (2003 to 2008) were benchmarked with data (1997 to 2002) from the National Institute of Children Health and Human Development and Neonatal Research Network (NICHD-NRN). Survival without major neonatal morbidity was defined as survival without bronchopulmonary dysplasia (BPD), grade III to IV intraventricular hemorrhage (IVH), and Bell's stage II to III necrotizing enterocolitis (NEC). The surviva... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=4117143 Mon, 25 Oct 2010 23:00:00 +0100 4117143 http://www.medworm.com/index.php?rid=3976070&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1265829 We report on two cases of low-birth-weight preterm infants with patent ductus venosus associated with hepatic hypoechoic lesions of the fourth segment in an otherwise normal liver. Although tumorlike hepatic lesions have been previously reported in association with portosystemic shunts in children and adults, they were never described in preterm infants during physiological patency of ductus venosus. In our patients, hepatic lesions disappeared shortly after the spontaneous ductus closure. Physiopathologic interactions are discussed regarding altered portal blood supply caused by ductus venosus shunt.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinatology) American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=3976070 Wed, 15 Sep 2010 23:00:00 +0100 3976070 http://www.medworm.com/index.php?rid=3968580&cid=s_36603_69_f&fid=36603&url=http%3A%2F%2Fdx.doi.org%2F10.1055%2Fs-0030-1266159 Amer J PerinatolDOI: 10.1055/s-0030-1266159ABSTRACTAttempting vaginal birth after cesarean section (VBAC) places women at an increased risk for complications. We set out to identify factors that are predictive of major morbidity in women who attempt VBAC. A nested case-control study was performed within a large retrospective cohort study of women with a history of at least one cesarean. Women who attempted VBAC were identified and those who experienced at least one complication of a composite adverse outcome consisting of uterine rupture, bladder injury, and bowel injury (cases) were compared with those who did not experience one of these adverse outcomes (controls). We analyzed risk factors for major maternal morbidity using univariable and multivariable methods. The accuracy of the multi... American Journal of Perinatology journals http://www.medworm.com/rss/comments.php?id=3968580 Mon, 13 Sep 2010 23:00:00 +0100 3968580