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Maternal-Fetal Medicine

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https://www.readbyqxmd.com/read/27913487/venous-thromboembolism-and-stroke-in-pregnancy
#1
Kelley McLean, Mary Cushman
Pregnancy and the postpartum period substantially increase the risk for thrombotic events. Although the absolute risk for thrombosis is low, these events comprise a significant portion of maternal morbidity and mortality. The vast majority of such events are venous, although the risk for ischemic stroke also appears to be increased in pregnancy. This review will explore the overlapping and unique risk factors for venous and arterial thrombosis in pregnancy. Diagnosis and prevention will be discussed, and treatment will be briefly touched on...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27889462/maternal-and-umbilical-cord-blood-levels-of-mercury-manganese-iron-and-copper-in-southern-taiwan-a-cross-sectional-study
#2
Shih-Hui Huang, Ken-Pen Weng, Ching-Chiang Lin, Chung-Cheng Wang, Charles Tzu-Chi Lee, Luo-Ping Ger, Ming-Tsang Wu
BACKGROUND: The effect of maternal exposure to essential minerals and heavy metals on fetus is an important issue, which affects women around the world. Few data are available on the concentration of both essential minerals and heavy metals in maternal/fetal medicine. The aims of this study were to (1) assess the correlation of mercury (Hg), manganese (Mn), iron (Fe), and copper (Cu) in paired maternal/fetal blood samples, and (2) study potential confounding factors during pregnancy. METHODS: Our study recruited 145 healthy pregnant women with a mean age of 28...
November 23, 2016: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/27874184/antenatal-ultrasound-features-in-fetuses-with-gastroschisis-and-its-prediction-in-neonatal-outcome
#3
Jessica A Robertson, Roy M Kimble, Kellie Stockton, Renuka Sekar
BACKGROUND: Gastroschisis is the most common major congenital anomaly managed by paediatric surgeons. The significance of certain associated antenatal ultrasound features in determining fetal outcome is under discussion. AIM: The study aims to define if associated antenatal ultrasound features of gastroschisis are useful prognostic markers for fetal outcome. By establishing the significance of features, including extra- and intra-abdominal bowel dilatation, stomach herniation, stomach dilatation, bowel matting, growth restriction, abnormal umbilical artery (UA) Doppler ultrasounds, and abnormal amniotic fluid volume, it is hoped clinicians will have enhanced ability to counsel parents about the likely outcomes for their infant...
November 22, 2016: Australian & New Zealand Journal of Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27862084/intra-and-inter-observer-reproducibility-and-generalizability-of-first-trimester-uterine-artery-pulsatility-index-by-transabdominal-and-transvaginal-ultrasound
#4
Laura Marchi, Eva Zwertbroek, Judith Snelder, Maaike Kloosterman, Caterina Maddalena Bilardo
OBJECTIVES: The primary aim of the study was to assess intra-observer and inter-observer reproducibility and generalizability (general reliability) of first trimester Doppler measurements of uterine arteries (UtA) performed both transabdominally (TA) and transvaginally (TV). Secondary aims were to investigate whether maternal BMI and acquisition modality (transabdominal or transvaginal) affect feasibility and reliability of UtA Doppler evaluation. METHODS: Singleton pregnancies between 11(+0) and 13(+6) weeks underwent TA and TV Doppler measurements of UtA prospectively, blindly and independently by Fetal Medicine Foundation-accredited operators...
November 16, 2016: Prenatal Diagnosis
https://www.readbyqxmd.com/read/27859463/how-many-procedures-does-it-take-success-of-a-cvs-training-program-for-maternal-fetal-medicine-fellows
#5
Alexis C Gimovsky, Sindy C Moreno, Sara Nicholas, Amanda Roman, Stuart Weiner
OBJECTIVES: To quantify the learning curve for a training program for Maternal Fetal Medicine (MFM) fellows in obtaining successful transvaginal chorionic villus sampling (CVS) results in women with early pregnancy failure (EPF). METHODS: Retrospective observational cohort study of transvaginal CVS and subsequent manual vacuum aspiration (MVA) performed by MFM fellows. CVS samples were sent for karyotype, and products of conception (POC) were sent if CVS sample did not yield a result...
November 16, 2016: Prenatal Diagnosis
https://www.readbyqxmd.com/read/27855463/association-of-maternal-obesity-with-child-cerebral-palsy-or-death
#6
Jessica A McPherson, Marcela C Smid, Sarah Smiley, David M Stamilio
Objective The primary aim of this study was to determine if there is an association between maternal obesity and cerebral palsy or death in children. Study Design This is a retrospective cohort analysis of a randomized controlled clinical trial previously performed by the Maternal-Fetal Medicine Units Network. Women in the original trial were included if at high risk for preterm delivery. The present study included singletons enrolled in the original study with complete data. Obese and nonobese women were compared...
November 17, 2016: American Journal of Perinatology
https://www.readbyqxmd.com/read/27853988/antenatal-manifestations-of-inborn-errors-of-metabolism-prenatal-imaging-findings
#7
Laurent Guibaud, Sophie Collardeau-Frachon, Audrey Lacalm, Mona Massoud, Massimiliano Rossi, Marie Pierre Cordier, Christine Vianey-Saban
Prenatal manifestations of inborn errors of metabolism (IEM) are related to severe disorders involving metabolic pathways active in the fetal period and not compensated by maternal or placental metabolism. Some prenatal imaging findings can be suggestive of such conditions-especially in cases of consanguinity and/or recurrence of symptoms-after exclusion of the most frequent nonmetabolic etiologies. Most of these prenatal imaging findings are nonspecific. They include mainly ascites and hydrops fetalis, intrauterine growth restriction (IUGR), central nervous system (CNS) anomalies, echogenic kidneys, epiphyseal stippling, craniosynostosis, and a wide spectrum of dysostoses...
November 16, 2016: Journal of Inherited Metabolic Disease
https://www.readbyqxmd.com/read/27836660/decreased-nutrient-intake-is-associated-with-premature-cervical-remodeling
#8
Mary Dawn Koenig, Barbara L McFarlin, Alana D Steffen, Lisa Tussing-Humphreys, Carmen Giurgescu, Christopher G Engeland, Michelle A Kominiarek, Christina Ciezczak-Karpiel, William D O'Brien, Rosemary White-Traut
OBJECTIVE: To examine the direct relationship between nutrient intake and cervical remodeling. DESIGN: Longitudinal descriptive design. SETTING: Maternal-fetal medicine clinic in a Midwestern urban city. PARTICIPANTS: Forty-seven pregnant African American women. METHODS: Participants completed the Block brief food frequency questionnaire at 19 to 24 weeks and 27 to 29 weeks gestation and had quantitative ultrasonic attenuation estimates at 19 to 21 weeks, 23 to 25 weeks, 27 to 29 weeks, 31 to 33 weeks, and 35 to 37 weeks gestation...
November 8, 2016: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
https://www.readbyqxmd.com/read/27836659/iron-metabolism-in-african-american-women-in-the-second-and-third-trimesters-of-high-risk-pregnancies
#9
Lauren Welke, Mary Dawn Koenig, Jessica L Thomson, Elizabeta Nemeth, Rosemary White-Traut, Barbara L McFarlin, Carmen Giurgescu, Christopher Engeland, Michelle A Kominiarek, Lisa Tussing-Humphreys
OBJECTIVE: To examine iron metabolism during the second and third trimesters in African American women with high-risk pregnancies. DESIGN: Longitudinal pilot study. SETTING: Large, university-based, urban Midwestern U.S. medical center. PARTICIPANTS: Convenience sample of 32 African American women with high-risk pregnancies seeking care at an urban maternal-fetal medicine clinic. METHODS: Nonfasting venous blood was collected in the second and third trimesters to assess iron status, hepcidin, and systemic inflammation...
November 8, 2016: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
https://www.readbyqxmd.com/read/27824768/relationship-between-excessive-gestational-weight-gain-and-neonatal-adiposity-in-women-with-mild-gestational-diabetes-mellitus
#10
Sean C Blackwell, Mark B Landon, Lisa Mele, Uma M Reddy, Brian M Casey, Ronald J Wapner, Michael W Varner, Dwight J Rouse, John M Thorp, Anthony Sciscione, Patrick Catalano, George Saade, Steve N Caritis, Yoram Sorokin, William A Grobman
OBJECTIVE: To evaluate the relationships among excessive gestational weight gain, neonatal adiposity, and adverse obstetric outcomes in women with mild gestational diabetes mellitus. METHODS: This is a secondary analysis of a multicenter randomized clinical trial of women with mild gestational diabetes mellitus. Based on self-reported prepregnancy body weight, gestational weight gain was categorized as excessive if it was greater than 2009 Institute of Medicine guidelines...
December 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27824747/social-contributors-to-glycemic-control-in-gestational-diabetes-mellitus
#11
Laura C Colicchia, Kristiina Parviainen, Judy C Chang
OBJECTIVE: To evaluate the association of social factors with glycemic control in women with gestational diabetes mellitus (GDM). METHODS: A survey instrument assessing social support, access to healthy food, cooking and meal preparation, chaotic lifestyle, employer support, and physical and emotional responses to food was developed and administered to women with GDM at maternal-fetal medicine office visits. Validated scales were used to measure social support and life chaos (defined as organization, instability, and the ability to plan and prepare for the future)...
December 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27822088/the-danish-fetal-medicine-database
#12
REVIEW
Charlotte Kvist Ekelund, Tine Iskov Kopp, Ann Tabor, Olav Bjørn Petersen
AIM: The aim of this study is to set up a database in order to monitor the detection rates and false-positive rates of first-trimester screening for chromosomal abnormalities and prenatal detection rates of fetal malformations in Denmark. STUDY POPULATION: Pregnant women with a first or second trimester ultrasound scan performed at all public hospitals in Denmark are registered in the database. MAIN VARIABLES/DESCRIPTIVE DATA: Data on maternal characteristics, ultrasonic, and biochemical variables are continuously sent from the fetal medicine units' Astraia databases to the central database via web service...
2016: Clinical Epidemiology
https://www.readbyqxmd.com/read/27819164/current-trends-in-the-diagnosis-and-management-of-gestational-diabetes-mellitus-in-the-united-states
#13
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/27816156/cardiac-lesions-in-the-critical-care-setting
#14
REVIEW
Manisha Gandhi, Amir A Shamshirsaz
The long-held belief that pregnancy is absolutely contraindicated in maternal cardiovascular disease is no longer justifiable using evidence-base medicine. There are some conditions in which pregnancy is contraindicated, and high maternal risk and poor fetal outcome can be predicted. However, in many women with heart disease, a more favorable maternal and fetal outcome is expected. This article focusses on the cardiac conditions that require more attention and have the potential to require observation in the intensive care unit setting...
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27813114/the-value-of-the-first-trimester-ultrasound-in-the-era-of-cell-free-dna-screening
#15
Rashmi R Rao, Stephanie G Valderramos, Neil S Silverman, Christina S Han, Lawrence D Platt
OBJECTIVE: To describe the clinically relevant findings detected by the first trimester ultrasound (FTU) and to determine the additional value of the FTU compared to cell free DNA (cfDNA) alone. METHOD: Retrospective cohort study of patients undergoing a FTU at a maternal-fetal medicine referral practice. Fetal, gynecologic, and placental findings detected by ultrasound were analyzed with available cfDNA and diagnostic testing results. A subgroup analysis of positive ultrasound findings and cfDNA results was performed to assess the additional benefit of ultrasound evaluation in FT prenatal screening...
November 3, 2016: Prenatal Diagnosis
https://www.readbyqxmd.com/read/27773712/perinatal-regionalization-a-geospatial-view-of-perinatal-critical-care-united-states-2010-2013
#16
Mary D Brantley, Nicole L Davis, David A Goodman, William M Callaghan, Wanda D Barfield
BACKGROUND: Perinatal services exist today as a dyad of maternal and neonatal care. When perinatal care is fragmented or unavailable, excess morbidity and mortality may occur in pregnant women and newborns. OBJECTIVE: The objective of the study was to describe spatial relationships between women of reproductive age, individual perinatal subspecialists (maternal-fetal medicine and neonatology), and obstetric and neonatal critical care facilities in the United States to identify gaps in health care access...
October 20, 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27749550/evaluating-the-effectiveness-and-safety-of-ursodeoxycholic-acid-in-treatment-of-intrahepatic-cholestasis-of-pregnancy-a-meta-analysis-a-prisma-compliant-study
#17
Xiang Kong, Yan Kong, Fangyuan Zhang, Tingting Wang, Jin Yan
BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is a specific pregnancy-related disorder without standard medical therapies. Ursodeoxycholic acid (UDCA) is the most used medicine, but the efficacy and safety of UDCA remain uncertain. Several meta-analyses had been made to assess the effects of UDCA in ICP. However, the samples were not large enough to convince obstetricians to use UDCA. We conducted a meta-analysis to evaluate the effects and safety of UDCA in patients with ICP, which included only randomized controlled trials (RCTs)...
October 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27743029/calculation-of-optimal-gestation-weight-gain-in-pre-pregnancy-underweight-women-due-to-body-mass-index-change-in-relation-to-mother-s-height
#18
Zoran Meštrović, Damir Roje, Marko Vulić, Mirela Zec
BACKGROUND: Optimal gestational weight gain has not yet been clearly defined and remains one of the most controversial issues in modern perinatology. The role of optimal weight gain during pregnancy is critical, as it has a strong effect on perinatal outcomes. PURPOSE: In this study, gestational body mass index (BMI) change, accounting for maternal height, was investigated as a new criterion for gestational weight gain determination, in the context of fetal growth assessment...
October 14, 2016: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/27741996/diagnosis-of-acute-neurologic-emergencies-in-pregnant-and-postpartum-women
#19
Andrea G Edlow, Brian L Edlow, Jonathan A Edlow
Acute neurologic symptoms in pregnant and postpartum women may be caused by exacerbation of a preexisting neurologic condition, the initial presentation of a non-pregnancy-related problem, or a new neurologic problem. Pregnant and postpartum patients with headache and neurologic symptoms are often diagnosed with preeclampsia or eclampsia; however, other etiologies must also be considered. A team approach with close communication between emergency physicians, neurologists, maternal-fetal medicine specialists, and radiologists is the key to obtaining best outcomes...
November 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27741203/maternal-and-neonatal-outcomes-with-early-compared-with-delayed-pushing-among-nulliparous-women
#20
Lynn M Yee, Grecio Sandoval, Jennifer Bailit, Uma M Reddy, Ronald J Wapner, Michael W Varner, Steve N Caritis, Mona Prasad, Alan T N Tita, George Saade, Yoram Sorokin, Dwight J Rouse, Sean C Blackwell, Jorge E Tolosa
OBJECTIVE: To describe factors associated with delayed pushing and evaluate the relationship between delayed pushing and perinatal outcomes in nulliparous women with singleton term gestations. METHODS: This was a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Assessment of Perinatal Excellence cohort of 115,502 women and their neonates born in 25 U.S. hospitals from 2008 to 2011. Nulliparous women with singleton, cephalic, nonanomalous term births who achieved 10-cm cervical dilation were included...
November 2016: Obstetrics and Gynecology
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