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American Journal of Perinatology Reports

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https://www.readbyqxmd.com/read/30425881/recurrent-cholangiocarcinoma-in-pregnancy-a-case-report
#1
Antonia P Francis, Michelle Chang, Cara D Dolin, Judith Chervenak, Elyce Cardonick
Hepatobiliary malignancies during pregnancy are extremely rare and portend a poor prognosis. There are only seven published cases of cholangiocarcinoma in an obstetrical patient, all are cases of primary cholangiocarcinoma (1-7). Herein, we describe the first case of recurrent cholangiocarcinoma during pregnancy. The patient did not receive chemotherapy during pregnancy and required prolonged hospitalizations for nutritional and intensive medical support. She delivered preterm, at 30 2/7 weeks gestation, after developing pre-eclampsia with severe features...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30393580/understanding-if-how-and-why-women-with-prior-spontaneous-preterm-births-are-treated-with-progestogens-a-national-survey-of-obstetrician-practice-patterns
#2
Jack R Gallagher, Jennifer Gudeman, Kylee Heap, Joy Vink, Susan Carroll
Objective  In 2017, the Society for Maternal-Fetal Medicine (SMFM) Guideline Committee reaffirmed that 17 α -hydroxyprogesterone caproate (17-OHPC) to prevent preterm birth (PTB) is underutilized. We sought to determine what drove progestogen treatment choice of obstetricians managing pregnant women with histories of 1+ singleton spontaneous PTBs (< 37 weeks) who then delivered singleton gestations within the previous 12 months. Subjects  We recruited a nationally representative random sample of obstetricians to abstract medical records of study-qualified patients...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30393579/induction-of-labor-for-maternal-indications-at-a-periviable-gestational-age-survey-on-management-reporting-and-auditing-amongst-dutch-maternal-fetal-medicine-specialists-and-neonatologists
#3
Leonoor van Eerden, Christianne J M de Groot, Godelieve C M L Page-Christiaens, Eva Pajkrt, Gerda G Zeeman, Antoinette C Bolte
Background  In cases of life-threatening maternal conditions in the periviable period, professionals may consider immediate delivery with fetal demise as a consequence of the treatment. We sought the opinion of involved medical professionals on management, reporting, and auditing in these cases. Methods  We performed an online survey amongst all registered maternal-fetal medicine (MFM) specialists and neonatologists in the Netherlands. The survey presented two hypothetical cases of severe early-onset pre-eclampsia at periviable gestational ages...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30377555/clinical-insights-for-cervical-ripening-and-labor-induction-using-prostaglandins
#4
Stephanie Pierce, Ronan Bakker, Dean A Myers, Rodney K Edwards
Cervical ripening is often the first component of labor induction and is used to facilitate the softening and thinning of the cervix in preparation for labor. Common methods used for cervical ripening include both mechanical (e.g., Foley or Cook catheters) and pharmacologic (e.g., prostaglandins) methods. The choice of method(s) for ripening should take into account the patient's medical and obstetric history, clinical characteristics, and risk of adverse effects if uterine tachysystole were to occur. In this narrative review, we highlight the differences between the prostaglandins dinoprostone and misoprostol with respect to pharmacology and pharmacokinetics, efficacy, and potential safety concerns...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30377554/fetal-neonatal-pericardial-effusion-in-down-s-syndrome-case-report-and-review-of-literature
#5
Pramod Pharande, Kiran Kumar Balegar Virupakshappa, Bhavesh Mehta, Nadia Badawi
We report a preterm (35 4/7 weeks) male neonate with Down's syndrome (DS) diagnosed with isolated pericardial effusion (PE) at 20 weeks of gestation. He was born by precipitous delivery, needed no resuscitation and presented within first 24 hours of life with respiratory distress, anemia due to feto-maternal bleed, hypotension, hepatomegaly, and coagulopathy. Postnatal echocardiography confirmed a 5 mm rim of PE without tamponade, normal cardiac structure, and function. He was stabilized with ventilation, packed red cell, fresh frozen plasma, inotropes (dopamine, dobutamine, and adrenaline), and steroid (hydrocortisone)...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30377553/importance-of-individual-elements-for-perineal-protection-in-childbirth-an-interventional-prospective-trial
#6
Ole Bredahl Rasmussen, Annika Yding, Finn Lauszus, Charlotte Sander Andersen, Jacob Anhøj, Jane Boris
Objective  To analyze the association between each element of a hands-on intervention in childbirth and the incidence of obstetric anal sphincter injuries (OASIS). Study Design  We conducted a prospective, interventional quality improvement project and implemented a care bundle with five elements at an obstetric department in Denmark with 3,000 deliveries annually. We aimed at reducing the incidence of OASIS. In the preintervention period, 355 vaginally delivering nulliparous women were included. Similarly, 1,622 nulliparous women were included in the intervention period...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30377552/early-onset-neonatal-sepsis-with-extended-spectrum-beta-lactamase-producing-escherichia-coli-in-infants-born-to-south-and-south-east-asian-immigrants-a-case-series
#7
Kalsang Dolma, Thanh L Summerlin, Hansa Wongprasert, Charitharth Vivek Lal, Joseph B Philips Iii, Lindy Winter
Extended-spectrum β -lactamase (ESBL)-producing Enterobacteriaceae represent a major worldwide threat. We present three cases of early onset ESBL Escherichia coli sepsis in infants born to families from South and Southeast Asia to inform the practitioner community about this emerging threat. Infants with suspected sepsis, whose mother is from Asia or Southeast Asia, should be suspected of having an infection with an ESBL-producing organism, and practitioners should strongly consider adding a carbapenem to their usual initial antibiotic regimen...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30377551/fetal-mri-in-the-identification-of-a-fetal-ventral-wall-defect-spectrum
#8
Peter W Coleman, Megan B Marine, Jennifer N Weida, Brian W Gray, Deborah F Billmire, Brandon P Brown
Objective  To ascertain if useful criteria for prenatal diagnosis of fetal ventral body wall defects (VBWDs) exists by reviewing published literature on diagnosis of VBWD as compared with our own diagnostic experience. Study Design  A comprehensive literature review of diagnostic criteria of fetal VBWD including pentalogy of Cantrell (POC), omphalocele, exstrophy, imperforate anus, spina bifida (OEIS), cloacal exstrophy, limb-body wall complex (LBWC), and body stalk anomaly was performed followed by a retrospective review of all fetal magnetic resonance imaging (MRI) examinations from our medical center over a 2-year period...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30370179/structured-training-for-fetal-diagnostic-skills-in-a-maternal-fetal-medicine-fellowship
#9
Kathleen M Antony, Nauman Khurshid, Barbara Trampe, Vivek K Gupta, J Igor Iruretagoyena, Katharina S Stewart, Dinesh Shah
Objective  The American Institute of Ultrasound in Medicine has described what constitutes a detailed fetal anatomic examination but what comprises an appropriate physician training program has not been described. The purpose of this paper is to describe a highly-structured program developed by our center to train maternal-fetal medicine fellows in a systematic approach to fetal diagnostic imaging. Study Design  We describe this approach in three phases. Phase I: Development of Skills as a Perinatal Sonographer, Phase II: Mentored Evolution to a Perinatal Sonologist and Phase III: Supervised Independent Practice as Consultant-in-training...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30370178/decidual-vasculopathy-in-preeclampsia-and-spiral-artery-remodeling-revisited-shallow-invasion-versus-failure-of-involution
#10
Peilin Zhang
Decidual vasculopathy is commonly associated with preeclampsia and develops in the late pregnancy in the uterine spiral arteries, which were previously remodeled by the extravillous trophoblasts. In normal early pregnancy, trophoblasts invade into the spiral artery, leading to vascular transformation, and this transformation is found to be associated with phenotypic switch of the endovascular trophoblasts to express CD56, a maternal protein likely from the natural killer (NK) cells. These endovascular trophoblasts are diminished at term...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30345160/successful-management-of-giant-placental-chorangioma-by-microcoil-embolization
#11
Stephen P Emery, Philip D Orons, Jeffrey F Bonadio
Optimal prenatal management of giant placental chorangioma (also known as chorioangioma, angiomyxoma, fibroangiomyxoma, or fibroma) has yet to be determined. Interventions intended to devascularize the tumor such as interstitial laser, bipolar coagulation, fetoscopic laser photocoagulation, and chemical embolization have met mixed results. We report a minimally invasive, extra-amniotic approach, technically similar to cordocentesis, of microcoil embolization of the feeding vessel. These percutaneously placed microcoils initiate clot formation at the site of insertion and are unable to migrate through the tumor, thereby minimizing fetal harm by downstream embolic phenomena...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30345159/methemoglobinemia-during-the-use-of-glyceryl-trinitrate-patches-in-neonates-two-case-reports
#12
Alison Mintoft, Emma Williams, Christopher Harris, Nigel Kennea, Anne Greenough
Methemoglobinemia can result in severe hypoxia. It has been frequently reported during the use of inhaled nitric oxide, but can occur where nitrate containing medications are used. Glyceryl trinitrate (GTN) patches have been used in the treatment of digital and limb ischemia in prematurely born infants. Little is known about the pharmacokinetics of GTN when incorporated into patches. Studies of other topical forms of nitroglycerine have shown a wide range of absorption. It is likely that the increased permeability of the prematurely born infant's skin would facilitate absorption...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30345158/progressive-devascularization-a-novel-surgical-approach-for-placenta-previa
#13
Antonio F Saad, Nathan Kirsch, George R Saade, Gary D V Hankins
Background  The gold standard for antenatal diagnosis of placenta previa is the transvaginal ultrasonography. In placenta previa cases, separation of placental and uterine tissues is challenging even for the most experienced surgeons. Life-threatening obstetrical complications from cesarean deliveries with placenta previa include peripartum hemorrhage, coagulopathy, blood transfusion, peripartum hysterectomy, and multiple organ failure. Cases  We detailed the 3 cases of placenta previa that underwent bilateral uterine artery ligation; if hemostasis was not achieved, horizontal mattress sutures were placed in the lower uterine segment...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30345157/sildenafil-use-in-the-treatment-of-bronchopulmonary-dysplasia-associated-pulmonary-hypertension-a-case-series
#14
Amna Qasim, Soham Dasgupta, Ashraf M Aly, Sunil K Jain
Objective  This article studies the role of sildenafil in reducing myocardial stress (measured by serial N-terminal pro b-type natriuretic peptide [NTproBNP] levels) secondary to bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH). Study Design  This is a case series of three extremely low birth weight infants with severe BPD at 36 weeks' postmenstrual age. All infants had very elevated NTproBNP (> 2,000 ng/dL) levels and echocardiographic evidence of BPD-PH. Sildenafil was started and infants were followed up every 2 weeks clinically along with NTproBNP levels and echocardiograms...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30319925/safe-motherhood-initiative-early-impact-of-severe-hypertension-in-pregnancy-bundle-implementation
#15
Lynn L Simpson, Burton Rochelson, Cande V Ananth, Peter S Bernstein, Mary D'Alton, Cynthia Chazotte, Jessica A Lavery, Kristin Zielinski
Objective  To describe the implementation and early results of the American College of Obstetricians and Gynecologists District II Safe Motherhood Initiative's Severe Hypertension in Pregnancy bundle on the timely treatment of severe hypertension in New York State obstetric hospitals. Methods  This is a retrospective comparative study of two time periods during voluntary implementation of the Severe Hypertension in Pregnancy bundle in New York State's obstetric hospitals. The main outcome measure was the administration of an appropriate antihypertensive agent within 1 hour of the second elevated value for all pregnant or postpartum patients with severe hypertension...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30305983/visual-estimation-of-force-applied-during-simulated-deliveries-complicated-by-shoulder-dystocia
#16
Margaret Walters, Allison Eubanks, Elizabeth Weissbrod, John Fischer, Barton Staat, Shad Deering
Background  Shoulder dystocia occurs when the fetal head delivers, but the shoulder is lodged behind the pubic symphysis. Training for these emergency deliveries is not optimized, and litigation can occur around a shoulder dystocia delivery. Objective  Evaluate the ability of an outside observer to visually estimate the amount of traction applied to the fetal head during simulated deliveries complicated by shoulder dystocia. Study Design  Simulated deliveries with an objective measurement of traction were randomly organized for estimation of traction applied...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30305982/fetal-congenital-peripheral-bronchial-atresia-diagnosed-by-magnetic-resonance-imaging-two-case-reports
#17
Mitsuru Kozaki, Yuko Iraha, Hitoshi Masamoto, Hayase Nitta, Yukiko Chinen, Tadatsugu Kinjo, Keiko Mekaru, Yoichi Aoki
Two types of congenital bronchial atresia (proximal and peripheral) have been classified. We report two cases of peripheral bronchial atresia diagnosed by prenatal ultrasonography (US) and magnetic resonance imaging (MRI). Evaluating an enlarged lung mass that is homogeneously hyperechoic on US and hyperintense on T2-weighted MRI can help in determining whether bronchial atresia is present. Proximal type is suggested when a dilated main bronchus is observed as a tubule structure of an involved lung hilum. In our cases, T2-weighted MRI revealed homogeneously hyperintense lung lesion with decreased signal intensity of adjacent lobe, flattening diaphragm, and mediastinal shift...
October 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30258699/the-use-of-fetal-bronchoscopy-in-the-diagnosis-and-management-of-a-suspected-obstructive-lung-mass
#18
Andrew H Chon, James E Stein, Tammy Gerstenfeld, Larry Wang, Walter D Vazquez, Ramen H Chmait
Etiologies of fetal lung anomalies include congenital pulmonary airway malformation (CPAM), intra- or extralobar pulmonary sequestration, congenital high airway obstruction syndrome (CHAOS), bronchogenic cyst, and bronchial atresia. Fetal tracheobronchoscopy has been reported both as a diagnostic and therapeutic procedure in the setting of severe congenital lung lesions. In this case report, prenatal imaging of a fetus with a large chest mass was suspicious for an obstructive bronchial lesion. The absence of visible normal lung tissue on the right side and mass effect on the left side raised the concern for pulmonary hypoplasia...
July 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30250759/monitoring-of-blood-pressure-is-not-enough-to-avoid-neonatal-postoperative-encephalopathy
#19
Simón Pedro Lubián López, Amaya Zuazo Ojeda, Gema Jimenez Gómez, Isabel Benavente Fernández
Background  Neonatal encephalopathy with seizures after general anesthesia not occurring in infants undergoing cardiac or major neurosurgery is very uncommon. An ischemic origin due to cerebral hypoperfusion from perioperative hypotension has been suggested, but there is a lack of a consensus definition for intraoperatory hypotension in neonates. Case Report  We report the first case of neonatal encephalopathy with seizures in a neonate with anorectal malformation. He underwent a colostomy with caudal anesthesia combined with light general anesthesia...
July 2018: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/30250758/uterine-monitoring-techniques-from-patients-and-users-perspectives
#20
Kirsten M J Thijssen, Marion W C Vlemminx, Michelle E M H Westerhuis, Jeanne P Dieleman, M Beatrijs Van der Hout-Van der Jagt, S Guid Oei
Objective  To evaluate preferences from patients and users on 3 uterine monitoring techniques, during labor. Study Design  Women in term labor were simultaneously monitored with the intrauterine pressure catheter, the external tocodynamometer, and the electrohysterograph. Postpartum, these women filled out a questionnaire evaluating their preferences and important aspects. Nurses completed a questionnaire evaluating users' preferences. Results  Of all 52 participating women, 80.8% preferred the electrohysterograph, 17...
July 2018: American Journal of Perinatology Reports
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