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Society for Maternal-Fetal Medicine (SMFM)

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https://www.readbyqxmd.com/read/29079144/society-for-maternal-fetal-medicine-smfm-consult-series-44-management-of-bleeding-in%C3%A2-the-late-preterm-period
#1
Cynthia Gyamfi-Bannerman
Third-trimester bleeding is a common complication arising from a variety of etiologies, some of which may initially present in the late preterm period. Previous management recommendations have not been specific to this gestational age window, which carries a potentially lower threshold for delivery. The purpose of this document is to provide guidance on management of late preterm (34 0/7-36 6/7 weeks of gestation) vaginal bleeding. The following are Society for Maternal-Fetal Medicine recommendations: (1) we recommend delivery at 36-37 6/7 weeks of gestation for stable women with placenta previa without bleeding or other obstetric complications, such as preeclampsia or fetal growth restriction (Grade 1B); (2) we do not recommend routine cervical length screening for women with placenta previa in the late preterm period because of a lack of data on an appropriate management strategy (Grade 2C); (3) we recommend a planned delivery between 34 and 37 weeks of gestation for stable women with placenta accreta (Grade 1C); (4) we recommend delivery between 34 and 37 weeks of gestation for stable women with vasa previa (Grade 1C); (5) we recommend that in women with active hemorrhage in the late preterm period, delivery should not be delayed for the purpose of administering antenatal corticosteroids (Grade 1B); (6) we recommend that fetal lung maturity testing should not be used to guide management in the late preterm period when an indication for delivery is present (Grade 1B); and (7) we recommend that antenatal corticosteroids should be administered to women who are eligible and are managed expectantly if delivery is likely within 7 days, the gestational age is between 34 0/7 and 36 6/7 weeks of gestation, and antenatal corticosteroids has not previously been administered (Grade 1A)...
October 25, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28993175/research-to-knowledge-promoting-the-training%C3%A2-of-physician-scientists-in-the-biology%C3%A2-of%C3%A2-pregnancy
#2
Yoel Sadovsky, Aaron B Caughey, Michelle DiVito, Mary E D'Alton, Amy P Murtha
Common disorders of pregnancy, such as preeclampsia, preterm birth, and fetal growth abnormalities, continue to challenge perinatal biologists seeking insights into disease pathogenesis that will result in better diagnosis, therapy, and disease prevention. These challenges have recently been intensified with discoveries that associate gestational diseases with long-term maternal and neonatal outcomes. Whereas modern high-throughput investigative tools enable scientists and clinicians to noninvasively probe the maternal-fetal genome, epigenome, and other analytes, their implications for clinical medicine remain uncertain...
October 7, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28961562/maternal-death-due-to-amniotic-fluid-embolism-a-national-study-in-france
#3
Marie-Pierre Bonnet, Diane Zlotnik, Monica Saucedo, Dominique Chassard, Marie-Hélène Bouvier-Colle, Catherine Deneux-Tharaux
BACKGROUND: A structured definition of amniotic fluid embolism (AFE) based on 4 criteria was recently proposed for use in research by the Society for Maternal-Fetal Medicine (SMFM) and the Amniotic Fluid Embolism Foundation. The main objective of this study was to review all AFE-related maternal deaths in France during 2007-2011 according to the presence or not of all these 4 diagnostic criteria. METHODS: Maternal deaths due to AFE were identified by the national experts committee of the French Confidential Enquiry into Maternal Deaths during 2007-2011 (n = 39)...
September 28, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28782502/hepatitis-c-in-pregnancy-screening-treatment-and-management
#4
Brenna L Hughes, Charlotte M Page, Jeffrey A Kuller
In the United States, 1-2.5% of pregnant women are infected with hepatitis C virus, which carries an approximately 5% risk of transmission from mother to infant. Hepatitis C virus can be transmitted to the infant in utero or during the peripartum period, and infection during pregnancy is associated with increased risk of adverse fetal outcomes, including fetal growth restriction and low birthweight. The purpose of this document is to discuss the current evidence regarding hepatitis C virus in pregnancy and to provide recommendations on screening, treatment, and management of this disease during pregnancy...
August 4, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28549984/the-development-and-implementation-of-checklists-in-obstetrics
#5
Peter S Bernstein, C Andrew Combs, Laurence E Shields, Steven L Clark, Catherine S Eppes
Checklists have been long used as a cognitive aid in various high-stakes environments to improve the reliability and performance of individuals and teams. When designed well, implemented thoughtfully, and monitored closely, they offer the opportunity to improve the performance of health care teams and advance patient safety. There are different types of checklists; examples include task lists, troubleshooting lists, coordination lists, discipline lists, and to-do lists. Each is useful in different situations and requires different implementation strategies...
August 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28412084/coding-update-of-the-smfm-definition-of-low%C3%A2-risk%C3%A2-for-cesarean-delivery-from-icd-9-cm-to%C3%A2-icd-10-cm
#6
Joanne Armstrong, Patricia McDermott, George R Saade, Sindhu K Srinivas
In 2015, the Society for Maternal-Fetal Medicine developed a low risk for cesarean delivery definition based on administrative claims-based diagnosis codes described by the International Classification of Diseases, Ninth Revision, Clinical Modification. The Society for Maternal-Fetal Medicine definition is a clinical enrichment of 2 available measures from the Joint Commission and the Agency for Healthcare Research and Quality measures. The Society for Maternal-Fetal Medicine measure excludes diagnosis codes that represent clinically relevant risk factors that are absolute or relative contraindications to vaginal birth while retaining diagnosis codes such as labor disorders that are discretionary risk factors for cesarean delivery...
July 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28198038/likelihood-of-cesarean-delivery-after-applying-leading-active-labor-diagnostic-guidelines
#7
Jeremy L Neal, Nancy K Lowe, Julia C Phillippi, Sharon L Ryan, Amy M Knupp, Mary S Dietrich, Stephen F Thung
BACKGROUND: Friedman, the United Kingdom's National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) support different active labor diagnostic guidelines. Our aims were to compare likelihoods for cesarean delivery among women admitted before vs in active labor by diagnostic guideline (within-guideline comparisons) and between women admitted in active labor per one or more of the guidelines (between-guideline comparisons)...
June 2017: Birth
https://www.readbyqxmd.com/read/28142152/improving-safe-and-effective-use-of-drugs-in-pregnancy-and-lactation-workshop-summary
#8
Laura E Riley, Alison G Cahill, Richard Beigi, Renate Savich, George Saade
In February 2015, given high rates of use of medications by pregnant women and the relative lack of data on safety and efficacy of many drugs utilized in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the Society for Maternal-Fetal Medicine (SMFM), the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Pediatrics (AAP) convened a group of experts to review the "current" state of the clinical care and science regarding medication use during the perinatal period...
July 2017: American Journal of Perinatology
https://www.readbyqxmd.com/read/28126365/prenatal-acetaminophen-use%C3%A2-and-outcomes%C3%A2-in%C3%A2-children
#9
(no author information available yet)
No abstract text is available yet for this article.
March 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28108156/the-role-of-ultrasound-in-women-who-undergo-cell-free-dna-screening
#10
Mary E Norton, Joseph R Biggio, Jeffrey A Kuller, Sean C Blackwell
The introduction of cell-free DNA screening for aneuploidy into obstetric practice in 2011 revolutionized the strategies utilized for prenatal testing. The purpose of this document is to review the current data on the role of ultrasound in women who have undergone or are considering cell-free DNA screening. The following are Society for Maternal-Fetal Medicine recommendations: (1) in women who have already received a negative cell-free DNA screening screen, ultrasound at 11-14 weeks of gestation solely for the purpose of nuchal translucency measurement (Current Procedural Terminology code 76813) is not recommended (grade 1B); (2) we recommend that diagnostic testing should not be recommended to patients solely for the indication of an isolated soft marker in the setting of a negative cell-free DNA screen (grade 2B); (3) in women with an isolated soft marker without other clinical implications (ie, choroid plexus cyst or echogenic intracardiac focus) and a negative cell-free DNA screen, we recommend describing the finding as not clinically significant or as a normal variant (grade 2B); (4) in women with an isolated soft marker that has no other clinical implication (ie, choroid plexus cyst or echogenic intracardiac focus) and a negative first- or second-trimester screening result, we recommend describing the finding as not clinically significant or as a normal variant (grade 2B); (5) we recommend that all women in whom a structural abnormality is identified by ultrasound should be offered diagnostic testing with chromosomal microarray (grade 1A); and (6) we recommend against routine screening for microdeletions with cell-free DNA screening (grade 1B)...
March 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27819164/current-trends-in-the-diagnosis-and-management-of-gestational-diabetes-mellitus-in-the-united-states
#11
Brianne E Bimson, Barak M Rosenn, Sara A Morris, Elizabeth B Sasso, Rachelle A Schwartz, Lois E Brustman
OBJECTIVE: To assess current practice patterns among members of the Society for Maternal-Fetal Medicine (SMFM) with respect to the diagnosis and management of gestational diabetes mellitus (GDM). METHODS: A 38 question survey on GDM diagnosis and management was distributed to SMFM members. RESULTS: 2330 SMFM members were surveyed with a 40% response rate. Overall, 90.6% of respondents recommend a 2-step (versus a 1-step) diagnostic test. Cutoff values for the 1-h-50 g glucose challenge test vary from 130-140 mg/dL, but the majority (83%) adopts Carpenter Coustan criteria for the 3-h-100 g oral glucose tolerance test...
November 24, 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27662643/prenatal-screening-for-microcephaly-an-update-after-three-decades
#12
Shari E Gelber, Amos Grünebaum, Frank A Chervenak
BACKGROUND: Due to the recent outbreak of Zika virus, there has been a newfound interest in fetal and neonatal microcephaly. In 1984, Chervenak et al. proposed criteria for the prenatal ultrasound diagnosis of microcephaly as ≤3 standard deviations (SD) from the mean. Despite improvements in medicine these criteria have not been reevaluated in 30 years. OBJECTIVE: To examine how the original 1984 Chervenak et al. criteria for the diagnosis of fetal microcephaly apply to a current population utilizing modern ultrasound equipment and techniques...
February 1, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/27638987/joint-sogc-ccmg-opinion-for-reproductive-genetic-carrier-screening-an-update-for-all-canadian-providers-of-maternity-and-reproductive-healthcare-in-the-era-of-direct-to-consumer-testing
#13
R Douglas Wilson, Isabelle De Bie, Christine M Armour, Richard N Brown, Carla Campagnolo, June C Carroll, Nan Okun, Tanya Nelson, Rhonda Zwingerman, Francois Audibert, Jo-Ann Brock, Richard N Brown, Carla Campagnolo, June C Carroll, Isabelle De Bie, Jo-Ann Johnson, Nan Okun, Melanie Pastruck, Karine Vallée-Pouliot, R Douglas Wilson, Rhonda Zwingerman, Christine Armour, David Chitayat, Isabelle De Bie, Sara Fernandez, Raymond Kim, Josee Lavoie, Norma Leonard, Tanya Nelson, Sherry Taylor, Margot Van Allen, Clara Van Karnebeek
OBJECTIVE: This guideline was written to update Canadian maternity care and reproductive healthcare providers on pre- and postconceptional reproductive carrier screening for women or couples who may be at risk of being carriers for autosomal recessive (AR), autosomal dominant (AD), or X-linked (XL) conditions, with risk of transmission to the fetus. Four previous SOGC- Canadian College of Medical Geneticists (CCMG) guidelines are updated and merged into the current document. INTENDED USERS: All maternity care (most responsible health provider [MRHP]) and paediatric providers; maternity nursing; nurse practitioner; provincial maternity care administrator; medical student; and postgraduate resident year 1-7...
August 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/27530804/first-stage-of-labour-management-practices-a-survey-of-australian-obstetric-providers
#14
Louise White, Nigel Lee, Michael Beckmann
AIMS: To report on the opinions and reported practices of Australian obstetricians and general practice (GP) obstetricians, in the definition and management of spontaneous first stage of labour, in low-risk nulliparous women. MATERIALS AND METHODS: Cross-sectional survey sent electronically to all Australian Specialist obstetricians (FRANZCOG) and Diplomates. Respondents answered questions regarding care of nulliparous women in spontaneous labour at term across three domains: (i) practitioners' characteristics; (ii) current practice; (iii) opinion regarding joint statement by ACOG/SMFM (Society of Maternal Fetal Medicine) 'Safe prevention of primary caesarean section'...
August 17, 2016: Australian & New Zealand Journal of Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27427470/the-use-of-chromosomal-microarray-for%C3%A2-prenatal%C3%A2-diagnosis
#15
Lorraine Dugoff, Mary E Norton, Jeffrey A Kuller
Chromosomal microarray analysis is a high-resolution, whole-genome technique used to identify chromosomal abnormalities, including those detected by conventional cytogenetic techniques, as well as small submicroscopic deletions and duplications referred to as copy number variants. Because chromosomal microarray analysis has a greater resolution than conventional karyotyping, it can detect deletions and duplications down to a 50- to 100-kb level. The purpose of this document is to discuss the technique, advantages, and disadvantages of chromosomal microarray analysis and its indications and limitations...
October 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27418448/society-for-maternal-fetal-medicine-smfm-special-report-current-approaches-to-measuring-quality-of-care-in-obstetrics
#16
Jennifer L Bailit, Kimberly D Gregory, Sindhu Srinivas, Thomas Westover, William A Grobman, George R Saade
Heath care measurement and evaluation is an integral piece of the health care system. The creation and assessment of care performance metrics are important and relevant for the obstetric community including both clinicians and patients. Careful deliberation is required to create a measurement system that results in optimal care for women and families. This article reviews the current approaches to measuring quality in obstetrics.
September 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27133011/the-role-of-routine-cervical-length-screening-in-selected-high-and-low-risk-women-for-preterm-birth-prevention
#17
REVIEW
Jennifer McIntosh, Helen Feltovich, Vincenzo Berghella, Tracy Manuck
Preterm birth remains a major cause of neonatal death and short and long-term disability in the US and across the world. The majority of preterm births are spontaneous and cervical length screening is one tool that can be utilized to identify women at increased risk who may be candidates for preventive interventions. The purpose of this document is to review the indications and rationale for CL screening to prevent preterm birth in various clinical scenarios. The Society for Maternal-Fetal Medicine recommends (1) routine transvaginal cervical length screening for women with singleton pregnancy and history of prior spontaneous preterm birth (grade 1A); (2) routine transvaginal cervical length screening not be performed for women with cervical cerclage, multiple gestation, preterm premature rupture of membranes, or placenta previa (grade 2B); (3) practitioners who decide to implement universal cervical length screening follow strict guidelines (grade 2B); (4) sonographers and/or practitioners receive specific training in the acquisition and interpretation of cervical imaging during pregnancy (grade 2B)...
September 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/26987420/amniotic-fluid-embolism-diagnosis-and-management
#18
Luis D Pacheco, George Saade, Gary D V Hankins, Steven L Clark
OBJECTIVE: We sought to provide evidence-based guidelines regarding the diagnosis and management of amniotic fluid embolism. STUDY DESIGN: A systematic literature review was performed using MEDLINE, PubMed, EMBASE, and the Cochrane Library. The search was restricted to English-language articles published from 1966 through March 2015. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries were consulted...
August 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/26902990/diagnosis-and-antenatal-management-of-congenital-cytomegalovirus-infection
#19
REVIEW
Brenna L Hughes, Cynthia Gyamfi-Bannerman
Congenital cytomegalovirus (CMV) is the most common viral infection, affecting nearly 40,000 infants each year in the United States. Of seronegative women, 1-4% will acquire a primary infection during pregnancy, and the majority of these women will be asymptomatic. Prior maternal exposure to CMV does not preclude neonatal infection. The purpose of this document is to review diagnosis of primary maternal CMV infection, diagnosis of fetal CMV infection, and whether antenatal therapy is warranted. We recommend the following: (1) that women with a diagnosis of primary CMV infection in pregnancy be advised that the risk of congenital infection is 30-50%, on average, and that the severity of infection varies widely (Best Practice); (2) for women suspected of having primary CMV infection in pregnancy, we recommend that diagnosis should be either by IgG seroconversion or with positive CMV IgM, positive IgG, and low IgG avidity (grade 1B); (3) amniocentesis is the best option as a prenatal diagnostic tool to detect fetal congenital CMV infection, performed >21 weeks of gestation and >6 weeks from maternal infection (grade 1C); (4) we do not recommend routine screening of all pregnant women for evidence of primary CMV infection at this time (grade 1B); and (5) we do not recommend antenatal treatment with ganciclovir or valacyclovir; and we recommend that any antenatal therapy, either with antivirals or CMV hyperimmune globulin, should only be offered as part of a research protocol (Best Practice)...
June 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/26593970/comparing-variation-in-hospital-rates-of-cesarean-delivery-among-low-risk-women-using-3-different-measures
#20
COMPARATIVE STUDY
Joanne C Armstrong, Katy B Kozhimannil, Patricia McDermott, George R Saade, Sindhu K Srinivas
This report describes the development of a measure of low-risk cesarean delivery by the Society for Maternal-Fetal Medicine (SMFM). Safely lowering the cesarean delivery rate is a priority for maternity care clinicians and health care delivery systems. Therefore, hospital quality assurance programs are increasingly tracking cesarean delivery rates among low-risk pregnancies. Two commonly used definitions of "low risk" are available, the Joint Commission (JC) and the Agency for Healthcare Research and Quality (AHRQ) measures, but these measures are not clinically comprehensive...
February 2016: American Journal of Obstetrics and Gynecology
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