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Maternal-Fetal Medicine

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https://www.readbyqxmd.com/read/28079791/a-possible-new-approach-in-the-prediction-of-late-gestational-hypertension-the-role-of-the-fetal-aortic-intima-media-thickness
#1
Silvia Visentin, Ambrogio P Londero, Martina Camerin, Enrico Grisan, Erich Cosmi
The aim was to determine the predictive role of combined screening for late-onset gestational hypertension by fetal ultrasound measurements, third trimester uterine arteries (UtAs) Doppler imaging, and maternal history. This prospective study on singleton pregnancies was conducted at the tertiary center of Maternal and Fetal Medicine of the University of Padua during the period between January 2012 and December 2014. Ultrasound examination (fetal biometry, fetal wellbeing, maternal Doppler study, fetal abdominal aorta intima-media thickness [aIMT], and fetal kidney volumes), clinical data (mother age, prepregnancy body mass index [BMI], and parity), and pregnancy outcomes were collected...
January 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28079773/pregnancies-after-the-diagnosis-of-mild-gestational-diabetes-mellitus-and-risk-of-cardiometabolic-disorders
#2
Michael W Varner, Madeline Murguia Rice, Mark B Landon, Brian M Casey, Uma M Reddy, Ronald J Wapner, Dwight J Rouse, Alan T N Tita, John M Thorp, Edward K Chien, George R Saade, Alan M Peaceman, Sean C Blackwell, J Peter Vandorsten
OBJECTIVE: To assess the association of subsequent pregnancy with subsequent metabolic syndrome and type II diabetes mellitus after a pregnancy complicated by mild gestational diabetes mellitus (GDM). METHODS: We conducted a prospective observational follow-up study of women with mild GDM randomized from 2002 to 2007 to usual care or dietary intervention and glucose self-monitoring. Women were evaluated 5-10 years after the parent study. Participants were grouped according to the number of subsequent pregnancies (group A, none [reference]; group B, one; group C, two or greater)...
January 9, 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28065816/development-of-customized-fetal-growth-charts-in-twins
#3
Tullio Ghi, Federico Prefumo, Anna Fichera, Mariano Lanna, Enrico Periti, Nicola Persico, Elsa Viora, Giuseppe Rizzo
BACKGROUND: Twin gestations are at significantly higher risk of fetal growth restriction in comparison with singletons. Using fetal biometric charts customized for obstetrical and parental characteristics may facilitate accurate assessment of fetal growth. OBJECTIVE(S): To construct reference charts for gestation of fetal biometric parameters stratified by chorionicity and customized for obstetrical and parental characteristics. STUDY DESIGN: Fetal biometric measurements obtained from serial ultrasound examinations in uncomplicated twin pregnancies delivering after 36 weeks of gestation were collected by 19 Italian fetal medicine units under the auspices of the Società Italiana di Ecografia Ostetrica e Ginecologica...
January 5, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28062023/we-should-proceed-with-caution-when-it-comes-to-antenatal-corticosteroids-after-34-weeks
#4
Christina M Nowik, Gregory A L Davies, Graeme N Smith
The Society for Maternal-Fetal Medicine recently released a statement supporting the use of antenatal corticosteroids for women at high risk of late preterm birth. This followed a trend of increasing use of antenatal corticosteroids after 34 weeks' gestation, based on evidence for decreased respiratory morbidity. The absolute benefits, however, are relatively small. We should balance this against the possible long-term harms of corticosteroids after 34 weeks before expanding the indications for their antenatal use...
January 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/28042822/enduring-sexually-dimorphic-impact-of-in-utero-exposure-to-elevated-levels-of-glucocorticoids-on-midbrain-dopaminergic-populations
#5
REVIEW
Glenda E Gillies, Kanwar Virdee, Ilse Pienaar, Felwah Al-Zaid, Jeffrey W Dalley
Glucocorticoid hormones (GCs) released from the fetal/maternal glands during late gestation are required for normal development of mammalian organs and tissues. Accordingly, synthetic glucocorticoids have proven to be invaluable in perinatal medicine where they are widely used to accelerate fetal lung maturation when there is risk of pre-term birth and to promote infant survival. However, clinical and pre-clinical studies have demonstrated that inappropriate exposure of the developing brain to elevated levels of GCs, either as a result of clinical over-use or after stress-induced activation of the fetal/maternal adrenal cortex, is linked with significant effects on brain structure, neurological function and behaviour in later life...
December 30, 2016: Brain Sciences
https://www.readbyqxmd.com/read/27997256/ultrasound-functional-evaluation-of-fetuses-with-myelomeningocele-study-of-the-interpretation-of-results
#6
A Maroto, T Illescas, M Meléndez, S Arévalo, C Rodó, J L Peiró, M Belfort, A Cuxart, E Carreras
OBJECTIVE: To assess the reliability of the interpretation of a new technique for the ultrasound evaluation of the level of neurological lesion in fetuses with myelomeningocele. METHODS: Observational study including myelomeningocele fetuses, referred to our center for the sonographic assessment of the fetal lower-limb movements, made and recorded by an expert in Maternal-fetal medicine and a specialist in Rehabilitation. Two observers, with different levels of expertise and blinded to each other's results, interpreted each recorded scan two different times...
December 20, 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27992943/hyperechogenic-bowel-etiologies-management-and-outcome-according-to-gestational-age-at-diagnosis-in-279-consecutive-cases-in-a-single-center
#7
Vincenzo Davide Catania, Alessandra Taddei, Marcella Pellegrino, Erika Adalgisa De Marco, Laura Merli, Carlo Manzoni, Lorenzo Nanni, Lucia Masini
Introduction The aim of the study was to investigate perinatal outcome of fetuses with hyperechogenic bowel (HB) in relation to gestational age at diagnosis. Materials and Methods This is a retrospective observational study of fetal HB cases from 2002 to 2012. Patients were divided into three groups according to trimester at diagnosis. For each group, data from fetal ultrasound examination, fetal medicine investigations, intrapartum cares, and neonatal outcome were obtained. Results A diagnosis of HB was made in 279 fetuses among them 17 (6%) during the first trimester, 186 (67%) during the second trimester, and 75 (27%) during the third trimester...
December 19, 2016: European Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27969554/obstetric-and-anaesthesia-checklists-for-the-management-of-morbidly-adherent-placenta
#8
Melissa G Walker, Lindsay Pollard, Chiraag Talati, Jose C A Carvalho, Lisa M Allen, John Kachura, Ally Murji, John C Kingdom, Rory Windrim
OBJECTIVE: To develop an integrated checklist for the management of patients with suspected morbidly adherent placenta (MAP). METHODS: A checklist process was developed incrementally by clinicians in the disciplines of maternal-fetal medicine, gynaecology, medical imaging, and anaesthesia for management of women with suspected MAP. RESULTS: Over a five-year period of debriefing after individual cases, a comprehensive checklist system was developed...
November 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/27930278/for-love-not-money-the-financial-implications-of-surgical-fellowship-training
#9
Paul M Inclan, Adam S Hyde, Michael Hulme, Jeffrey E Carter
Surgical residents cite increased income potential as a motivation for pursuing fellowship training, despite little evidence supporting this perception. Thus, our goal is to quantify the financial impact of surgical fellowship training on financial career value. By using Medical Group Management Association and Association of American Medical Colleges physician income data, and accounting for resident salary, student debt, a progressive tax structure, and forgone wages associated with prolonged training, we generated a net present value (NPV) for both generalist and subspecialist surgeons...
September 2016: American Surgeon
https://www.readbyqxmd.com/read/27926975/large-for-gestational-age-infants-and-adverse-outcomes-among-uncomplicated-pregnancies-at-term
#10
Hector Mendez-Figueroa, Van Thi Thanh Truong, Claudia Pedroza, Suneet P Chauhan
Background While traumatic delivery with large for gestational age (LGA; birth weight above 90%) is acknowledged, there is paucity of data regarding other morbidity and mortality associated with LGA. Our hypothesis was that compared with appropriate for gestational age (AGA), LGA have a significantly higher rate of composite neonatal morbidity (CNM). Objective Our objective was to compare the CNM among uncomplicated LGA versus AGA at term (37 weeks or more) among all available Maternal-Fetal Medicine Units (MFMU) databases...
December 7, 2016: American Journal of Perinatology
https://www.readbyqxmd.com/read/27913487/venous-thromboembolism-and-stroke-in-pregnancy
#11
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
#12
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
#13
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
#14
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...
December 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
#15
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...
December 2016: Prenatal Diagnosis
https://www.readbyqxmd.com/read/27855463/association-of-maternal-obesity-with-child-cerebral-palsy-or-death
#16
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
#17
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...
January 2017: Journal of Inherited Metabolic Disease
https://www.readbyqxmd.com/read/27836660/decreased-nutrient-intake-is-associated-with-premature-cervical-remodeling
#18
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...
January 2017: 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
#19
Lauren Welke, Mary Dawn Koenig, Jessica L Thomson, Elizabeta Nemeth, Rosemary White-Traut, Barbara L McFarlin, Carmen Giurgescu, Christopher G 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...
January 2017: 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
#20
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
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