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Maternal fetal medicine

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https://www.readbyqxmd.com/read/28315665/physician-scientists-in-obstetrics-and-gynecology-predictors-of-success-in-obtaining-independent-research-funding
#1
Ijeoma Okeigwe, Cynthia Wang, Joseph A Politch, Linda J Heffner, Wendy Kuohung
BACKGROUND: Obstetrics and gynecology departments receive the smallest amount of National Institutes of Health (NIH) research funding and have significantly lower application success rates compared to pediatric, internal medicine, and surgery departments. The development of mentored early career development training grants (K awards) has been one strategy implemented by the NIH to help aspiring physician-scientists establish independent research careers. OBJECTIVE: The purpose of this study is to describe the cohort of ob/gyn physician-scientists who were K08, K12, and K23 recipients from 1988-2015 and to identify predictors of success in obtaining independent federal funding, as defined by acquisition of an R01, R21, R34, U01, U54, P01, or P50...
March 15, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28301892/evaluating-the-performance-of-ultrasound-screening-for-congenital-heart-disease-a-descriptive-cohort-study
#2
Rosemary J Froehlich, Lindsay Maggio, Phinnara Has, Erika F Werner, Dwight J Rouse
Objective The objective of this study was to evaluate the rate of abnormal fetal echocardiogram after normal detailed anatomy ultrasound when both are performed by maternal-fetal medicine specialists. Study Design Retrospective review of women who underwent detailed anatomy ultrasound and fetal echocardiography between 16 and 26 weeks' gestation at a single center. Women included had at least one indication for fetal echocardiography as recommended by the American Institute of Ultrasound in Medicine and normal cardiac anatomy on initial detailed anatomy ultrasound...
March 16, 2017: American Journal of Perinatology
https://www.readbyqxmd.com/read/28301843/specialty-based-variation-in-applying-maternal-fetal-surgery-trial-evidence
#3
Ryan M Antiel, Alan W Flake, Mark P Johnson, Nahla Khalek, Natalie E Rintoul, John D Lantos, Farr A Curlin, Jon C Tilburt, Chris Feudtner
INTRODUCTION: The Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for fetal myelomeningocele (MMC). We sought to understand how subspecialists interpreted the trial results and whether their practice has changed. MATERIALS AND METHODS: Cross-sectional, mailed survey of 1,200 randomly selected maternal-fetal medicine (MFM) physicians, neonatologists, and pediatric surgeons. RESULTS: Of 1,176 eligible physicians, 670 (57%) responded...
March 17, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28295782/multicenter-screening-for-preeclampsia-by-maternal-factors-and-biomarkers-at-11-13-weeks-gestation-comparison-to-nice-guidelines-and-acog-recommendations
#4
Neil O' Gorman, David Wright, Liona C Poon, Daniel L Rolnik, Argyro Syngelaki, Mercedes de Alvarado, Ilma F Carbone, Vivien Dutemeyer, Madgalena Fiolna, Alex Frick, Natalia Karagiotis, Sofia Mastrodima, Catalina de Paco Matallana, George Papaioannou, Andrea Pazos, Walter Plasencia, Kypros H Nicolaides
OBJECTIVE: To compare the performance of screening for preeclampsia (PE) based on risk factors from the medical history, as recommended by NICE and ACOG, with the method proposed by the Fetal Medicine Foundation (FMF), which uses Bayes theorem to combine the a priori risk from maternal factors, derived by a multivariable logistic model, with the results of various combinations of biophysical and biochemical measurements. METHODS: This was a prospective multicenter study of screening for PE in 8,775 singleton pregnancies at 11-13 weeks' gestation...
March 10, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28295159/first-and-second-trimester-serum-tests-with-and-without-first-trimester-ultrasound-tests-for-down-s-syndrome-screening
#5
REVIEW
S Kate Alldred, Yemisi Takwoingi, Boliang Guo, Mary Pennant, Jonathan J Deeks, James P Neilson, Zarko Alfirevic
BACKGROUND: Down's syndrome occurs when a person has three copies of chromosome 21 (or the specific area of chromosome 21 implicated in causing Down's syndrome) rather than two. It is the commonest congenital cause of mental disability. Non-invasive screening based on biochemical analysis of maternal serum or urine, or fetal ultrasound measurements, allows estimates of the risk of a pregnancy being affected and provides information to guide decisions about definitive testing.  Before agreeing to screening tests, parents need to be fully informed about the risks, benefits and possible consequences of such a test...
March 15, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28291876/unproven-technologies-in-maternal-fetal-medicine-and-the-high-cost-of-us-health-care
#6
COMMENT
Steven L Bloom, Kenneth J Leveno
No abstract text is available yet for this article.
March 14, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28283918/at-the-heart-of-the-pregnancy-what-prenatal-and-cardiovascular-genetic-counselors-need-to-know-about-maternal-heart-disease
#7
REVIEW
Ana Morales, Dawn C Allain, Patricia Arscott, Emily James, Gretchen MacCarrick, Brittney Murray, Crystal Tichnell, Amy R Shikany, Sara Spencer, Sara M Fitzgerald-Butt, Jessica D Kushner, Christi Munn, Emily Smith, Katherine G Spoonamore, Harikrishna S Tandri, W Aaron Kay
In the last decade, an increasing number of cardiac conditions have been shown to have a genetic basis. Cardiovascular genetic counseling has emerged as a subspecialty aiming to identify unaffected at-risk individuals. An important sector of this at-risk population also includes expectant mothers, in whom unique clinical challenges may arise. Genetic counselors, especially those in cardiovascular and prenatal settings, have an opportunity to identify and assist women who may benefit from cardiovascular care during pregnancy...
March 10, 2017: Journal of Genetic Counseling
https://www.readbyqxmd.com/read/28275100/maternal-supplementation-with-small-quantity-lipid-based-nutrient-supplements-compared-with-multiple-micronutrients-but-not-with-iron-and-folic-acid-reduces-the-prevalence-of-low-gestational-weight-gain-in-semi-urban-ghana-a-randomized-controlled-trial
#8
Seth Adu-Afarwuah, Anna Lartey, Harriet Okronipa, Per Ashorn, Ulla Ashorn, Mamane Zeilani, Mary Arimond, Stephen A Vosti, Kathryn G Dewey
Background: It is unclear whether maternal supplementation with small-quantity lipid-based nutrient supplements (SQ-LNSs; 118 kcal/d) affects maternal weight.Objective: We compared several secondary anthropometric measures between 3 groups of women in the iLiNS (International Lipid-based Nutrient Supplements)-DYAD trial in Ghana.Methods: Women (n = 1320; <20 wk of gestation) were randomly assigned to receive 60 mg Fe + 400 μg folic acid/d (IFA), 18 vitamins and minerals/d [multiple micronutrients (MMNs)], or 20 g SQ-LNSs with 22 micronutrients/d (LNS) during pregnancy and a placebo (200 mg Ca/d), MMNs, or SQ-LNSs, respectively, for 6 mo postpartum...
March 8, 2017: Journal of Nutrition
https://www.readbyqxmd.com/read/28255520/validation-of-a-prediction-model-for-vaginal-birth-after-cesarean-delivery-reveals-unexpected-success-in-a-diverse-american-population
#9
Melanie Mai Maykin, Amanda J Mularz, Lydia K Lee, Stephanie Gaw Valderramos
Objective To investigate the validity of a prediction model for success of vaginal birth after cesarean delivery (VBAC) in an ethnically diverse population. Methods We performed a retrospective cohort study of women admitted at a single academic institution for a trial of labor after cesarean from May 2007 to January 2015. Individual predicted success rates were calculated using the Maternal-Fetal Medicine Units Network prediction model. Participants were stratified into three probability-of-success groups: low (<35%), moderate (35-65%), and high (>65%)...
January 2017: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/28254480/effects-of-dichloromethane-and-butanol-fractions-of-gochnatia-polymorpha-subsp-floccosum-in-maternal-reproductive-outcome-embryo-fetal-development-and-dna-integrity-in-mice
#10
Lucas Roberto Pessatto, Sarah Alves Auharek, Caroline Amélia Gonçalves, Natan de David, Antônio Carlos Duenhas Monreal, Cândida Aparecida Leite Kassuya, AndreiaAndréia Conceição Milan Brochado Antoniolli-Silva, Maria Élida Alves Stefanello, Rodrigo Juliano Oliveira
ETHNOPHARMACOLOGICAL RELEVANCE: Gochnatia polymorpha ssp. floccosa (Asteraceae) also known as ''Cambará'' is used as medicinal plant in Brazil to treat infections and inflammation. Previous studies showed that its ethanolic extract could be bioprospecting of a new anti-inflammatory phytotherapy for use during pregnancy. This work aimed to evaluate dichloromethane (DCM) and butanolic (BT) fractions from G. polymorpha on embryo-fetal development and DNA integrity in mice. MATERIALS AND METHODS: Female mice were treated with 50 and 20mg/kg of the DCM and BT fractions, respectively, during organogenesis and gestational period...
February 27, 2017: Journal of Ethnopharmacology
https://www.readbyqxmd.com/read/28249134/treatment-of-subclinical-hypothyroidism-or-hypothyroxinemia-in-pregnancy
#11
RANDOMIZED CONTROLLED TRIAL
Brian M Casey, Elizabeth A Thom, Alan M Peaceman, Michael W Varner, Yoram Sorokin, Deborah G Hirtz, Uma M Reddy, Ronald J Wapner, John M Thorp, George Saade, Alan T N Tita, Dwight J Rouse, Baha Sibai, Jay D Iams, Brian M Mercer, Jorge Tolosa, Steve N Caritis, J Peter VanDorsten
Background Subclinical thyroid disease during pregnancy may be associated with adverse outcomes, including a lower-than-normal IQ in offspring. It is unknown whether levothyroxine treatment of women who are identified as having subclinical hypothyroidism or hypothyroxinemia during pregnancy improves cognitive function in their children. Methods We screened women with a singleton pregnancy before 20 weeks of gestation for subclinical hypothyroidism, defined as a thyrotropin level of 4.00 mU or more per liter and a normal free thyroxine (T4) level (0...
March 2, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28236651/intravenous-fluid-rate-for-reduction-of-cesarean-delivery-rate-in-nulliparous-women-a-systematic-review-and-meta-analysis
#12
Robert M Ehsanipoor, Gabriele Saccone, Neil S Seligman, Rebecca Pierce-Williams, Andrea Ciardulli, Vincenzo Berghella
The National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine have emphasized the need to promote vaginal delivery and have offered recommendations to safely prevent primary cesarean delivery. However, there has been limited discussion regarding management of intravenous fluids and other aspects of labor management that may influence labor. Therefore the aim of our study was to determine if an intravenous fluid rate of 250 vs 125 mL/hour is associated with a difference in cesarean delivery rate MATERIAL AND METHODS: Searches were performed in Medline, OVID, Scopus, ClinicalTrials...
February 25, 2017: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/28211155/utah-obstetricians-opinions-of-planned-home-birth-and-conflicting-nice-acog-guidelines-a-qualitative-study
#13
Emily Rainey, Sara Simonsen, Joseph Stanford, Kimberley Shoaf, Jami Baayd
BACKGROUND: The United Kingdom's National Institute for Health and Care Excellence (NICE) recently published recommendations that support planned home birth for low-risk women. The American College of Obstetricians and Gynecologists (ACOG) remains wary of planned home birth, asserting that hospitals and birthing centers are the safest birth settings. Our objective was to examine opinions of obstetricians in Salt Lake City, Utah about home birth in the context of rising home birth rates and conflicting guidelines...
February 17, 2017: Birth
https://www.readbyqxmd.com/read/28211140/anesthesia-for-fetal-surgery
#14
REVIEW
Monica A Hoagland, Debnath Chatterjee
Fetal therapy is an exciting and growing field of medicine. Advances in prenatal imaging and continued innovations in surgical and anesthetic techniques have resulted in a wide range of fetal interventions including minimally invasive, open mid-gestation, and ex-utero intrapartum treatment procedures. The potential for maternal morbidity is significant and must be carefully weighed against claimed benefits to the fetus. Appropriate patient selection is critical, and a multidisciplinary team-based approach is strongly recommended...
April 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28205414/avoidance-of-maternal-cell-contamination-and-overgrowth-in-isolating-fetal-chorionic-villi-mesenchymal-stem-cells-from-human-term-placenta
#15
Varda S Sardesai, Abbas Shafiee, Nicholas M Fisk, Rebecca A Pelekanos
Human placenta is rich in mesenchymal stem/stromal cells (MSC), with their origin widely presumed fetal. Cultured placental MSCs are confounded by a high frequency of maternal cell contamination. Our recent systematic review concluded that only a small minority of placental MSC publications report fetal/maternal origin, and failed to discern a specific methodology for isolation of fetal MSC from term villi. We determined isolation conditions to yield fetal and separately maternal MSC during ex vivo expansion from human term placenta...
February 16, 2017: Stem Cells Translational Medicine
https://www.readbyqxmd.com/read/28198038/likelihood-of-cesarean-delivery-after-applying-leading-active-labor-diagnostic-guidelines
#16
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)...
February 15, 2017: Birth
https://www.readbyqxmd.com/read/28191905/st-elevation-acute-myocardial-infarction-in-pregnancy-2016-update
#17
REVIEW
Sahar Ismail, Cynthia Wong, Priya Rajan, Mladen I Vidovich
Acute myocardial infarction (AMI) during pregnancy or the early postpartum period is rare, but can be devastating for both the mother and the fetus. There have been major advances in the diagnosis and treatment of acute coronary syndromes in the general population, but there is little consensus on the approach to diagnosis and treatment of pregnant women. This article reviews the literature relating to the pathophysiology of AMI in pregnant patients and the challenges in diagnosis and treatment of ST-elevation myocardial infarction (STEMI) in this unique population...
February 13, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28188771/twin-vaginal-delivery-innovate-or-abdicate
#18
Sarah Rae Easter, Laura Taouk, Jay Schulkin, Julian N Robinson
Neonatal safety data along with national guidelines have prompted renewed interest in vaginal delivery of twins, particularly in the case of the noncephalic second twin. Yet, the rising rate of twin cesarean deliveries, coupled with the national decline in operative obstetrics, raises concerns about the availability of providers who are skilled in twin vaginal birth. Providers are key stakeholders for increasing rates of twin vaginal delivery. We surveyed a group of practicing obstetricians to explore potential barriers to the vaginal birth of twins with a focus on delivery of the noncephalic second twin...
February 7, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28188592/redirecting-reproductive-immunology-research-toward-pregnancy-as-a-period-of-temporary-immune-tolerance
#19
Norbert Gleicher, Vitaly A Kushnir, David H Barad
Referring to two recent publications, we here propose that clinical reproductive immunology has for decades stagnated because reproductive medicine, including assisted reproduction (AR), has failed to accept embryo implantation as an immune system-driven process, dependent on establishment of maternal tolerance toward the implanting fetal semi-allograft (and complete allograft in cases of oocyte donation). Pregnancy represents a biologically unique period of temporary (to the period of gestation restricted) tolerance, otherwise only known in association with parasitic infections...
February 10, 2017: Journal of Assisted Reproduction and Genetics
https://www.readbyqxmd.com/read/28180199/ultrasound-and-mri-comprehensive-approach-in-prenatal-diagnosis-of-fetal-osteochondrodysplasias-cases-series
#20
Costin Berceanu, Ioana Andreea Gheonea, Simona Vlădăreanu, Monica Mihaela Cîrstoiu, Radu Vlădăreanu, Claudia Mehedinţu, Sabina Berceanu, Răzvan Ciortea, Elvira Brătilă
AIM: To present the systematic ultrasonographic assessment in fetal osteochondrodysplasias and to evaluate the fetal MRI intake, as a complementary exploration to US, in the prenatal diagnosis and perinatal prognosis of fetal nonlethal osteochondrodysplasias. Material and methods: In this tertiary multicentre study were included 37 cases diagnosed prenatally with various entities in the category of nonlethal fetal osteochondrodysplasias. The initial diagnosis was carried out by the routine or detailed ultrasound examination...
January 31, 2017: Medical Ultrasonography
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