MedWorm: Perinatology & Neonatology Top 20

Strategies for Reducing Maternal Mortality

Seminars in Perinatology — Fri, 27 Jan 2012 22:41:28 +0100

The maternal death rate in the United States has shown no improvement in several decades and may be increasing. On the other hand, hospital systems that have instituted comprehensive programs directed at the prevention of maternal mortality have demonstrated rates that are half of the national average. These programs have emphasized the reduction of variability in the provision of care through the use of standard protocols, reliance on checklists instead of memory for critical processes, and an approach to peer review that emphasizes systems change. In addition, elimination of a small number of repetitive errors in the management of hypertension, postpartum hemorrhage, pulmonary embolism, and cardiac disease will contribute significantly to a reduction in maternal mortality. Attention to t...

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Domestic violence screening of obstetric triage patients in a military population

Journal of Perinatology — Thu, 02 Feb 2012 05:00:00 +0100

Authors: M A Lutgendorf, A Thagard, P D Rockswold, J M Busch & E F Magann (Source: Journal of Perinatology)

Fetoscopy and Risk of Iatrogenic Preterm Premature Rupture of Membranes: Not as High as It May Seem (in Experienced Hands)

Fetal Diagnosis and Therapy — Mon, 30 Jan 2012 23:00:00 +0100

Fetal Diagn Ther 2012;31:10–11 (DOI:10.1159/000335420) (Source: Fetal Diagnosis and Therapy)

Perimortem Cesarean Delivery: Its Role in Maternal Mortality

Seminars in Perinatology — Fri, 27 Jan 2012 22:41:28 +0100

Since Roman times, physicians have been instructed to perform postmortem cesarean deliveries to aid in funeral rites, baptism, and in the very slim chance that a live fetus might still be within the deceased mother's womb. This procedure was disliked by physicians being called to a dying mother's bedside. As births moved to hospitals, and modern obstetrics evolved, the causes of maternal death changed from sepsis, hemorrhage, and dehydration to a greater incidence of sudden cardiac arrest from medication errors or embolism. Thus, the likelihood of delivering a viable neonate at the time of a mother's death increased. Additionally, as cardiopulmonary resuscitation (CPR) became widespread, physicians realized that during pregnancy, with the term gravid woman lying on her back, chest compress...

Support and Counseling After Maternal Death

Seminars in Perinatology — Fri, 27 Jan 2012 22:41:28 +0100

Teamwork, communication, critical incident debriefing, and grief counseling surrounding the events of an unexpected maternal death are important continuing education and practice topics for health care employees working with pregnant women. Social technologies have impacted health care institutions and systems. Ethical dilemmas have been created in hospitals as they develop policies and procedures regarding electronic communications and social networking Web sites. (Source: Seminars in Perinatology)

Maternal Mortality From Hemorrhage

Seminars in Perinatology — Fri, 27 Jan 2012 22:41:28 +0100

Hemorrhage remains as one of the top 3 obstetrics related causes of maternal mortality, with most deaths occurring within 24-48 hours of delivery. Although hemorrhage related maternal mortality has declined globally, it continues to be a vexing problem. More specifically, the developing world continue to shoulder a disproportionate share of hemorrhage related deaths (99%) compared with industrialized nations (1%). Given the often preventable nature of death from hemorrhage, the cornerstone of effective mortality reduction involves risk factor identification, quick diagnosis, and timely management. In this monograph we will review the epidemiology, etiology, and preventative measures related to maternal mortality from hemorrhage. (Source: Seminars in Perinatology)

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Abnormal WT1 expression in human fetuses with bilateral renal agenesis and cardiac malformations

Birth Defects Research Part A: Clinical and Molecular Teratology — Fri, 13 Jan 2012 05:00:00 +0100

CONCLUSIONS: WT1 is widely expressed in mesothelial cells during development, and we hypothesized that some of the defects are caused by abnormal function of mesenchyme derived from mesothelial cells, similar to the mesothelium‐derived defects proposed in animal models. The methods we used are available to many laboratories and can be applied to archival paraffin tissue blocks. We suggest that future similar studies could help to expand the understanding of renal agenesis in humans and could help to subclassify this condition. This would be useful in patient management and counseling. Birth Defects Research (Part A) 2012. © 2012 Wiley Periodicals, Inc. (Source: Birth Defects Research Part A: Clinical and Molecular Teratology)

Proportion of Parents Agreeing to Delay Fetal Karyotyping until the Third Trimester of Pregnancy in Cases with an Indication

Fetal Diagnosis and Therapy — Mon, 30 Jan 2012 23:00:00 +0100

Fetal Diagn Ther (DOI:10.1159/000334067) (Source: Fetal Diagnosis and Therapy)

Decisions Required for Operating a Maternal Mortality Review Committee: The California Experience

Seminars in Perinatology — Fri, 27 Jan 2012 22:41:28 +0100

Maternal mortality is a current and important issue for obstetrics. The challenge is to structure case reviews so that they develop real data that can inform and direct quality improvement activities. In this article, we describe a series of decisions we have made in California to organize and run our maternal mortality review committee. These include defining the goal of the reviews, selection of cases, composition of the committee, basic review issues, and the definitions used for analysis (eg, cause of death, contributing factors, role of cesarean delivery, preventability, identifying quality improvement opportunities). It is expected that each maternal mortality review committee will have somewhat different approaches based on local resources and case mix. (Source: Seminars in Perinato...

Maternal Mortality Due to Trauma

Seminars in Perinatology — Fri, 27 Jan 2012 22:41:28 +0100

Maternal mortality is an important indicator of adequacy of health care in our society. Improvements in the obstetric care system as well as advances in technology have contributed to reduction in maternal mortality rates. Trauma complicates up to 7% of all pregnancies and has emerged as the leading cause of maternal mortality, becoming a significant concern for the public health system. Maternal mortality secondary to trauma can often be prevented by coordinated medical care, but it is essential that caregivers recognize the unique situation of providing simultaneous care to 2 patients who have a complex physiologic relationship. Optimal management of the pregnant trauma victim requires a multidisciplinary team, where the obstetrician plays a central role. This review focuses on the incid...

Pregnancy-Associated Mortality Review: The Florida Experience

Seminars in Perinatology — Fri, 27 Jan 2012 22:41:28 +0100

At the beginning of the 20th century, maternal mortality was a leading cause of death for women of reproductive age in the United States. Obstetrical care was not standardized, and there was a lack of universal systems for monitoring maternal deaths. Public health efforts of surveillance, along with advances in medicine and sanitation, resulted in a significant decrease in maternal deaths by the early 1980s. Today, maternal death is considered to be a rare event; however, the rates of maternal mortality have not improved in almost 3 decades. There is growing evidence that many maternal deaths can still be prevented through enhanced surveillance that influences improvements in overall health and delivery of care. This paper describes the experience of establishing and maintaining a pregnanc...

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Maternal Mortality From Preeclampsia/Eclampsia

Seminars in Perinatology — Fri, 27 Jan 2012 22:41:28 +0100

Preeclampsia/eclampsia is one of the 3 leading causes of maternal morbidity and mortality worldwide. During the past 50 years, there has been a significant reduction in the rates of eclampsia, maternal mortality, and maternal morbidity in the developed countries. In contrast, the rates of eclampsia, maternal complications, and maternal mortality remain high in the developing countries. These differences are mainly due to universal access to prenatal care, access to timely care, and proper management of patients with preeclampsia–eclampsia in the developed countries. In contrast, most of maternal deaths and complications are due to lack of prenatal care, lack of access to hospital care, lack of resources, and inappropriate diagnosis and management of patients with preeclampsia–eclampsia...

Prenatal Detection of Down Syndrome using Massively Parallel Sequencing (MPS): a rapid response statement from a committee on behalf of the Board of the International Society for Prenatal Diagnosis, 24 October 2011

Prenatal Diagnosis — Tue, 24 Jan 2012 05:00:00 +0100

(Source: Prenatal Diagnosis)

The Medical and Legal Aspects of Maternal Mortality

Seminars in Perinatology — Fri, 27 Jan 2012 22:41:28 +0100

Sudden unexpected changes in the life of a family create many different emotions in various family members. The death of a young woman during or after her pregnancy is especially difficult because of the strain it places on family dynamics. One of the consequences is that there is, commonly, a newborn, and perhaps other children, without a mother and caregiver. In families that relied on both parents working, there are financial hardships imposed by the death. There is the emotional void that is felt by her partner, parents, sisters, brothers, and extended family. This extreme stress leads to questions about the death that need to be addressed by the health care providers. If the anger that is part of the grieving process is not adequately resolved, healing cannot occur. It is then that th...

Patient Safety during Perinatal and Neonatal Care: Research, Education, and Clinical Care Issues

American Journal of Perinatology — Mon, 23 Jan 2012 05:00:00 +0100

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)

Changes in Respiratory Support of Preterm Infants in the Last Decade: Are We Improving?

Neonatology — Wed, 04 Jan 2012 05:00:00 +0100

Conclusion: The incidence of BPD in our cohort of preterm infants has decreased during the last decade and could be due to the changes in respiratory management. PMID: 22222256 [PubMed - as supplied by publisher] (Source: Neonatology)

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Effects of Smoking, Mother's Age, Body Mass Index, and Parity Number on Lipid, Protein, and Secretory Immunoglobulin A Concentrations of Human Milk

Breastfeeding Medicine — Wed, 14 Dec 2011 04:03:47 +0100

Breastfeeding Medicine , Vol. 0, No. 0. (Source: Breastfeeding Medicine)

Neonatal abdominal wall defects

Seminars in Fetal and Neonatal Medicine — Wed, 06 Apr 2011 23:00:00 +0100

Summary: Gastroschisis and omphalocele are the two most common congenital abdominal wall defects. Both are frequently detected prenatally due to routine maternal serum screening and fetal ultrasound. Prenatal diagnosis may influence timing, mode and location of delivery. Prognosis for gastroschisis is primarily determined by the degree of bowel injury, whereas prognosis for omphalocele is related to the number and severity of associated anomalies. The surgical management of both conditions consists of closure of the abdominal wall defect, while minimizing the risk of injury to the abdominal viscera either through direct trauma or due to increased intra-abdominal pressure. Options include primary closure or a variety of staged approaches. Long-term outcome is favorable in most cases; howeve...

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Neonatology — Fri, 09 Dec 2011 05:00:00 +0100

Authors: Rosychuk RJ, Hudson-Mason A, Lacaze-Masmonteil T PMID: 22156362 [PubMed - as supplied by publisher] (Source: Neonatology)

Sildenafil citrate, bronchopulmonary dysplasia and disordered pulmonary gas exchange: any benefits?

Journal of Perinatology — Thu, 22 Sep 2011 04:00:00 +0100

Sildenafil citrate, bronchopulmonary dysplasia and disordered pulmonary gas exchange: any benefits? Journal of Perinatology advance online publication, September 22, 2011. doi:10.1038/jp.2011.131 Authors: M Nyp, T Sandritter, N Poppinga, C Simon & W E Truog (Source: Journal of Perinatology)