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Maternal fetal medicine

Anthony R Gregg, Janice G Edwards
The Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists (ACOG), and American College of Medical Genetics and Genomics (ACMG) held a workshop entitled "Prenatal Genetic Testing" on January 25, 2017 to address several questions arising from the increasing implementation of preconception and prenatal expanded carrier screening (ECS). ECS allows for identification of a greater number of genetic sequencing changes (not all of which cause disease) and simultaneous testing for an increased number of genetic conditions without limitation to specific ethnic groups...
July 26, 2018: Seminars in Perinatology
Annie Penfield-Cyr, Carmen Monthe-Dreze, Marcela C Smid, Sarbattama Sen
PURPOSE: Maternal body mass index (BMI) and systemic fatty acid (FA) concentrations affect inflammatory balance in pregnancy and play a key role in fetal growth and well-being. Little is known about how maternal BMI may affect the association between key FA concentrations and neonatal outcomes. The objective of this study was to examine the associations between the maternal omega (n)6:n3 FA ratio and neonatal outcomes according to maternal pre-pregnancy BMI category. METHODS: This study is a secondary analysis of the Maternal-Fetal Medicine Units Network randomized controlled trial of omega-3 FA supplementation to prevent recurrent preterm birth...
September 18, 2018: Clinical Therapeutics
Necip Cihangir Yılanlıoglu, Altug Semiz, Resul Arisoy, Semra Kahraman, Ali Arslan Gürkan
OBJECTIVE: To review the results of fetal reduction procedures in our institution, evaluate its effects on the pregnancy outcome in terms of miscarriage, preterm delivery, taking home healthy babies and discuss the factors that may have contributed to the outcome. STUDY DESIGN: This is a retrospective study performed at the Fetal Medicine Unit of the Sisli Memorial Hospital in Istanbul after ART therapies in our unit from 2000 to 2011. RESULTS: The sample comprised 151 triplets, 35 quadruplets, 11 quintuplets, 3 twins, 1 sextuplet and 1 septuplet...
September 11, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Alvaro Sepúlveda-Martínez, Gustavo Rencoret, María C Silva, Paz Ahumada, Daniel Pedraza, Hernán Muñoz, Enrique Valdés, Mauro Parra-Cordero
AIM: To develop a combined predictive model for preterm and term pre-eclampsia (PE) during the first trimester of pregnancy. METHODS: This investigation was a nested case-control study in singleton pregnancies at the Maternal-Fetal Medicine Unit, University of Chile Hospital. A priori risks for preterm and term PE were calculated by multivariate logistic regression analyses. Biophysical markers were log10 -transformed and expressed as multiples of the median. A multivariate logistic regression analysis was used to estimate a combined predictive model of preterm and term PE...
September 19, 2018: Journal of Obstetrics and Gynaecology Research
Tony Y T Tan
These are consensus statements on screening for hyperglycemia in pregnancy derived from AOFOG MFM Committee's Hyperglycemia in Pregnancy Consensus Working Group during a workshop in Singapore on 13 January 2018.
September 19, 2018: Journal of Obstetrics and Gynaecology Research
Moshe Bronshtein, Ayala Gover, Ron Beloosesky, Hanin Dabaja, Yuval Ginsberg, Zeev Weiner, Nizar Khatib
BACKGROUND: Ptyalism gravidarum (PG) is a condition of hypersalivation that affects pregnant women early in gestation. Symptoms include massive saliva volumes (up to 2 liters per day), swollen salivary glands, sleep deprivation, significant emotional distress, and social difficulties. OBJECTIVES: To examine maternal and fetal characteristics and pregnancy outcomes of patients with PG. METHODS: Patients diagnosed with PG in our clinic during the years 2001-2016 were identified and contacted...
September 2018: Israel Medical Association Journal: IMAJ
Ravi Jhaveri, Tina Broder, Debika Bhattacharya, Marion G Peters, Arthur Y Kim, Maureen M Jonas
The epidemiology of hepatitis C virus (HCV) has changed significantly over the last decade. Once most prevalent among older adults, the current burden has disproportionately affected young adults including women of childbearing age (WOCA). The Society for Maternal-Fetal Medicine recently issued guidelines that made no change in the recommendation to screen pregnant women based on risk factors. The current burden in young adults including WOCA supports a change in strategy away from risk-based screening to universal HCV screening in pregnancy...
September 12, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Monica Tang, Kate Webber
Cancer survivors are increasing as improvements in cancer diagnosis and treatment translate to improved outcomes. As cancer survivors in their reproductive years contemplate pregnancy, it is important to understand the impact of cancer and its treatment on fertility and pregnancy outcomes. Cancer treatments such as chemotherapy and radiotherapy can affect patients' fertility, and strategies are available to help preserve the future fertility of survivors. The potential impact of previous cancer diagnoses and treatments on pregnancy and maternal and fetal outcomes needs to be assessed and discussed with survivors, with support from materno-fetal medicine specialists and high-risk antenatal services as needed...
September 2018: Obstetric Medicine
Katie Stoll, Mary E Norton
Screening and diagnostic testing for detection of fetal aneuploidy has been an integral part of prenatal care for over three decades. The recent introduction of new technologies, such as cell free DNA (cfDNA) screening and preimplantation genetic screening, has created increased complexity for obstetrical care providers. Inconsistencies among the professional society recommendations have caused confusion and disparities in practice. As we work to responsibly incorporate new technologies, clear guidelines with consensus among relevant professional societies are needed...
July 26, 2018: Seminars in Perinatology
William F Rayburn, Jose M Perez, Imam M Xierali
OBJECTIVE:  To examine patterns in relocation of maternal-fetal medicine (MFM) specialists during the recent 10 years. STUDY DESIGN:  This descriptive study analyzed the migration of MFM specialists between 2006 and 2016 based on county locations. Year-to-year comparisons of physicians in active clinical practice were performed. Demographic and county characteristics were gathered from three data resources. A multivariable logistic regression model was used to identify factors associated with relocation...
September 12, 2018: American Journal of Perinatology
Ida Vogel, Ann Tabor, Charlotte Ekelund, Stina Lou, Jon Hyett, Olav Bjørn Petersen
AIM: To examine the performance of the combined First Trimester Screening (cFTS) algorithm when outliers of 4 risk parameters (maternal age, nuchal translucency (NT) thickness, PAPP-A and β-hCG) were included in the classification of "high-risk". METHODS: A retrospective analysis of singleton pregnancies undergoing cFTS between 2008 and 2011 in Denmark. Abnormal karyotypes were classified as trisomy 21 (T21), trisomy 13 (T13) and trisomy 18 (T18), sex chromosome aberrations and atypical abnormal karyotypes...
September 10, 2018: Fetal Diagnosis and Therapy
Lucy R Van Otterloo, Cynthia D Connelly
Identification and referral of women with high-risk pregnancies to hospitals better equipped and staffed to provide care for them have been important steps to improve birth outcomes. Based on recent recommendations from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine to provide regionalized maternal care for pregnant women at high risk and reduce rates of maternal morbidity and mortality, health care organizations and providers have refocused their attention to women's well-being rather than solely on the well-being of the fetus or newborn...
September 2018: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
Erich T Wyckoff, Girard M Cua, Daniel J Gibson, Robert S Egerman
OBJECTIVE: As the cesarean delivery rate has risen future pregnancy outcomes are impacted including the decision to undergo a repeat cesarean or a vaginal birth after cesarean (VBAC) in the subsequent pregnancy. A calculator was developed by the maternal fetal medicine units (MFMUs) network in 2007 to estimate the chance of successful VBAC and is used widely. The purpose of this study was to investigate the calculator's validity on our obstetric patient population. STUDY DESIGN: This was a retrospective study of patients attempting a VBAC delivery at a single center from January 2012 to June 2014...
September 10, 2018: Journal of Maternal-fetal & Neonatal Medicine
Kathryn M Denize, Nina Acharya, Stephanie A Prince, Danilo Fernandes da Silva, Alysha L J Harvey, Zachary M Ferraro, Kristi B Adamo
Objective: To systematically review the literature and describe the discrepancies in achieving the 2009 Institute of Medicine (IOM) gestational weight gain (GWG) guidelines across cultures. Methods: Ten databases were searched from inception to April 2018. Observational cohort studies were included that examined adult women; reported on a measure of culture; compared cultural groups, and reported on GWG. Articles were broken down into papers that used the current 2009 IOM GWG guidelines and those that used others...
2018: PeerJ
Michael W Varner, Lisa Mele, Brian M Casey, Alan M Peaceman, Yoram Sorokin, Uma M Reddy, Ronald J Wapner, John M Thorp, George R Saade, Alan T N Tita, Dwight J Rouse, Baha Sibai, Jay D Iams, Brian M Mercer, Jorge Tolosa, Steve N Caritis
OBJECTIVE: To assess whether treatment of pregnant women with subclinical hypothyroidism or hypothyroxinemia alters neonatal TSH results. STUDY DESIGN: A planned secondary analysis of data from two multi-center randomized, double-masked, placebo-controlled thyroxine replacement trials in pregnant women with either subclinical hypothyroidism or hypothyroxinemia. Infant heel-stick specimens were obtained before discharge. We compared TSH levels between neonates born to mothers allocated to treatment or placebo within each trial and between neonates in the placebo groups...
September 5, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Teresa N Sparks, Aaron B Caughey
In January 2017, a group of experts in prenatal genetics attended a workshop at the Society of Maternal-Fetal Medicine meeting to review the evidence behind the costs and cost-effectiveness of prenatal genetic testing. Over the past decade, prenatal genetic testing options have dramatically expanded to include additional options with cell-free DNA (cfDNA) screening, as well as increased diagnostic abilities through chromosomal microarray analysis (CMA), gene panels, whole exome sequencing, and other tests. With these expanding technologies, it is important to consider the options available as well as the cost effectiveness of their use...
July 26, 2018: Seminars in Perinatology
Ashley Weeks, Rebecca H Liu, Zachary M Ferraro, Raywat Deonandan, Kristi B Adamo
Importance: Gestational weight gain (GWG) is an independent and modifiable factor for a healthy pregnancy. Gestational weight gain above or below the Institute of Medicine Guidelines has been shown to impact both maternal and fetal health (eg, gestational diabetes, hypertension, downstream obesity). Healthcare providers (HCPs) have the potential to be reliable sources of evidence-based weight information and advice during pregnancy. Objective: The aim of this study was to summarize the literature assessing GWG discussions between patients and their HCPs in a clinical setting to better understand the knowledge that is currently being exchanged...
August 2018: Obstetrical & Gynecological Survey
Andrew Sharp, Christine Cornforth, Richard Jackson, Jane Harrold, Mark A Turner, Louise C Kenny, Philip N Baker, Edward D Johnstone, Asma Khalil, Peter von Dadelszen, Aris T Papageorghiou, Zarko Alfirevic
BACKGROUND: Severe early-onset fetal growth restriction can lead to a range of adverse outcomes including fetal or neonatal death, neurodisability, and lifelong risks to the health of the affected child. Sildenafil, a phosphodiesterase type 5 inhibitor, potentiates the actions of nitric oxide, which leads to vasodilatation of the uterine vessels and might improve fetal growth in utero. METHODS: We did this superiority, placebo-controlled randomised trial in 19 fetal medicine units in the UK...
February 2018: The lancet child & adolescent health
Isil Uzun Cilingir, Cenk Sayin, Havva Sutcu, Cihan İnan, Selen Erzincan, Cem Yener, Fusun Varol
PURPOSE: Cervical cerclage treatment for cervical changes at mid trimester is a very controversial topic in twins. The aim of the study was to present our maternal and fetal outcomes of mid-trimester cervical cerclage in twin pregnancies. BASIC PROCEDURES: This study was performed using data extracted from the medical files of the twin pregnancies whom performed emergency cervical cerclage between January 2012 and March 2018 at Trakya University, Facuty of Medicine, Department of Perinatology...
August 23, 2018: Journal of Gynecology Obstetrics and Human Reproduction
Bekir Kahveci, Rauf Melekoglu, Ismail Cuneyt Evruke, Cihan Cetin
BACKGROUND: Pregnancy at advanced maternal age has become more common in both developed and developing countries over the last decades. The association between adverse perinatal outcomes and advanced maternal age has been a matter of controversy in several studies. The objective of this study is to investigate the impact of advanced maternal age on perinatal and neonatal outcomes of nulliparous singleton pregnancies. METHODS: Records of patients admitted to the Department of Obstetrics and Gynecology, University of Cukurova School of Medicine, between January 2011 and July 2015 for routine mid-trimester fetal ultrasonography were retrospectively reviewed...
August 22, 2018: BMC Pregnancy and Childbirth
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