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Maternal-Fetal Medicine

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https://www.readbyqxmd.com/read/29142784/the-value-of-implementing-multidisciplinary-perinatal-care-conference-in-the-private-practice-setting
#1
Robert C Johnston, Sina Haeri, Richard T Hale, William Lindsley, Annette McCormick, Eric Su
Objective  The objective of this study was to estimate the impact of multidisciplinary (Multi-D) perinatal care conference (PCC) implementation in the private practice setting. Methods  After the initial 12-month period following implementation of the monthly PCC by private maternal-fetal medicine and neonatology practitioners, conference attendees were asked to completed a modified version of the Attitudes Toward Health Care Teams Scale, involving 19 questions assessing their attitudes and opinions toward Multi-D team care on a five-point Likert's scale...
October 2017: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/29141482/obstetric-practice-guidelines-labor-s-love-lost
#2
Wayne R Cohen, Emanuel A Friedman
Implementation of clinical practice guidelines may moderate health care costs, improve care, reduce medicolegal liability, and provide a uniformity in care allowing meaningful investigation of treatments and outcomes. However, new guidelines are often uncritically embraced by clinicians, risk management organizations, insurance companies, and the courts as the standard of care. Adoption of incompletely vetted recommendations can lead to patient harm. Recent recommendations made by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine for assessment and management of labor provide an example of well-intended guidelines adopted uncritically...
November 15, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29138035/defining-failed-induction-of-labor
#3
William A Grobman, Jennifer Bailit, Yinglei Lai, Uma M Reddy, Ronald J Wapner, Michael W Varner, John M Thorp, Kenneth J Leveno, Steve N Caritis, Mona Prasad, Alan T N Tita, George Saade, Yoram Sorokin, Dwight J Rouse, Sean C Blackwell, Jorge E Tolosa
BACKGROUND: While there are well-accepted standards for the diagnosis of arrested active-phase labor, the definition of a "failed" induction of labor remains less certain. One approach to diagnosing a failed induction is based on the duration of the latent phase. However, a standard for the minimum duration that the latent phase of a labor induction should continue, absent acute maternal or fetal indications for cesarean delivery, remains lacking. OBJECTIVE: The objective of this study was to determine the frequency of adverse maternal and perinatal outcomes as a function of the duration of the latent phase among nulliparous women undergoing labor induction...
November 11, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29129033/infant-safe-sleep-a-survey-of-the-knowledge-attitudes-and-behaviors-of-obstetric-physicians
#4
Nichole L Hodges, Sarah E Anderson, Lara B McKenzie, Mira L Katz
Obstetricians may be a pregnant woman's primary professional source of information about her infant prior to the birth, but infant safe sleep knowledge, attitudes and behaviors of this population are unknown. This study explores obstetric physicians' knowledge, attitudes, and behaviors related to Sudden Infant Death Syndrome and infant safe sleep and identifies barriers as well as enabling and/or reinforcing factors associated with providing infant safe sleep education in the prenatal environment. A cross-sectional survey was conducted with obstetric physicians who provide prenatal healthcare to women in Ohio...
November 11, 2017: Journal of Community Health
https://www.readbyqxmd.com/read/29120459/informative-priors-on-fetal-fraction-increase-power-of-the-noninvasive-prenatal-screen
#5
Hanli Xu, Shaowei Wang, Lin-Lin Ma, Shuai Huang, Lin Liang, Qian Liu, Yang-Yang Liu, Ke-Di Liu, Ze-Min Tan, Hao Ban, Yongtao Guan, Zuhong Lu
PurposeNoninvasive prenatal screening (NIPS) sequences a mixture of the maternal and fetal cell-free DNA. Fetal trisomy can be detected by examining chromosomal dosages estimated from sequencing reads. The traditional method uses the Z-test, which compares a subject against a set of euploid controls, where the information of fetal fraction is not fully utilized. Here we present a Bayesian method that leverages informative priors on the fetal fraction.MethodOur Bayesian method combines the Z-test likelihood and informative priors of the fetal fraction, which are learned from the sex chromosomes, to compute Bayes factors...
November 9, 2017: Genetics in Medicine: Official Journal of the American College of Medical Genetics
https://www.readbyqxmd.com/read/29120454/hospital-volume-and-cesarean-delivery-among-low-risk-women-in-a-nationwide-sample
#6
M A Clapp, K E James, A Melamed, J L Ecker, A J Kaimal
OBJECTIVE: We sought to determine if hospital delivery volume was associated with a patient's risk for cesarean delivery in low-risk women. STUDY DESIGN: This study retrospectively examines a cohort of 1 657 495 deliveries identified in the 2013 Nationwide Readmissions Database. Hospitals were stratified by delivery volume quartiles. Low-risk patients were identified using the Society for Maternal-Fetal Medicine definition (n=845 056). A multivariable logistic regression accounting for hospital-level clustering was constructed to assess the factors affecting a patient's odds for cesarean delivery...
November 9, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29115686/inner-volume-echo-volumar-imaging-ivevi-for-robust-fetal-brain-imaging
#7
Rita G Nunes, Giulio Ferrazzi, Anthony N Price, Jana Hutter, Andreia S Gaspar, Mary A Rutherford, Joseph V Hajnal
PURPOSE: Fetal functional MRI studies using conventional 2-dimensional single-shot echo-planar imaging sequences may require discarding a large data fraction as a result of fetal and maternal motion. Increasing the temporal resolution using echo volumar imaging (EVI) could provide an effective alternative strategy. Echo volumar imaging was combined with inner volume (IV) imaging (IVEVI) to locally excite the fetal brain and acquire full 3-dimensional images, fast enough to freeze most fetal head motion...
November 8, 2017: Magnetic Resonance in Medicine: Official Journal of the Society of Magnetic Resonance in Medicine
https://www.readbyqxmd.com/read/29112649/racial-and-ethnic-differences-in-utilization-of-labor-management-strategies-intended-to-reduce-cesarean-delivery-rates
#8
Lynn M Yee, Maged M Costantine, Madeline Murguia Rice, Jennifer Bailit, Uma M Reddy, Ronald J Wapner, Michael W Varner, John M Thorp, Steve N Caritis, Mona Prasad, Alan T N Tita, Yoram Sorokin, Dwight J Rouse, Sean C Blackwell, Jorge E Tolosa
OBJECTIVE: To examine whether racial and ethnic differences exist in the frequency of and indications for cesarean delivery and to assess whether application of labor management strategies intended to reduce cesarean delivery rates is associated with patient's race and ethnicity. METHODS: This is a secondary analysis of a multicenter observational obstetric cohort. Trained research personnel abstracted maternal and neonatal records of greater than 115,000 pregnant women from 25 hospitals (2008-2011)...
November 3, 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29107981/prevalence-and-risk-factors-of-monochorionic-diamniotic-twinning-after-assisted-reproduction-a-six-year-experience-base-on-a-large-cohort-of-pregnancies
#9
Bing Song, Zhao-Lian Wei, Xiao-Feng Xu, Xue Wang, Xiao-Jin He, Huan Wu, Ping Zhou, Yun-Xia Cao
OBJECTIVE: To characterize the incidence and risk factors for monochorionic diamniotic(MC-DA) twinning after assisted reproductive technologies (ART). DESIGN: Retrospective population-based study. SETTING: The study was conducted in China; Department of Reproductive Medicine Center at The First Affiliated Hospital of Anhui Medical University. POPULATION: A cohort of 8860 clinical pregnancies after embryo transfer (ET) carried out in our center between 2011 and 2016 were retrospectively analyzed for the incidence of MC-DA twinning...
2017: PloS One
https://www.readbyqxmd.com/read/29102503/maternal-hemodynamics-a-method-to-classify-hypertensive-disorders-of-pregnancy
#10
Enrico Ferrazzi, Tamara Stampalija, Lorenzo Monasta, Daniela Di Martino, Sharona Vonck, Wilfried Gyselaers
BACKGROUND: The classification of hypertensive disorders of pregnancy (HDP) is based on the time at the onset of hypertension, proteinuria, and other associated complications. Maternal hemodynamic interrogation in HDP considers not only the peripheral blood pressure but also the entire cardiovascular system, and it might help to classify the different clinical phenotypes of this syndrome. OBJECTIVES: This study aimed to examine cardiovascular parameters in a cohort of patients affected by HDP according to the clinical phenotypes that prioritize fetoplacental characteristics and not the time at onset of HDP...
November 1, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29101225/weighing-the-social-and-ethical-considerations-of-maternal-fetal-surgery
#11
Ryan M Antiel, Alan W Flake, Christopher A Collura, Mark P Johnson, Natalie E Rintoul, John D Lantos, Farr A Curlin, Jon C Tilburt, Stephen D Brown, Chris Feudtner
OBJECTIVES: The ethics of maternal-fetal surgery involves weighing the importance of potential benefits, risks, and other consequences involving the pregnant woman, fetus, and other family members. We assessed clinicians' ratings of the importance of 9 considerations relevant to maternal-fetal surgery. METHODS: This study was a discrete choice experiment contained within a 2015 national mail-based survey of 1200 neonatologists, pediatric surgeons, and maternal-fetal medicine physicians, with latent class analysis subsequently used to identify groups of physicians with similar ratings...
November 3, 2017: Pediatrics
https://www.readbyqxmd.com/read/29100260/a-comparison-of-the-nulliparous-term-singleton-vertex-and-society-of-maternal-fetal-medicine-cesarean-birth-metrics-based-on-hospital-size
#12
Laurence E Shields, Suzan Walker, Herman L Hedriana, Suzanne Wiesner, Barbara Pelletreau, Jane Hitti, Thomas J Benedetti
No abstract text is available yet for this article.
November 3, 2017: American Journal of Perinatology
https://www.readbyqxmd.com/read/29100065/toward-noninvasive-monitoring-of-ongoing-electrical-activity-of-human-uterus-and-fetal-heart-and-brain
#13
S Lew, M S Hämäläinen, Y Okada
OBJECTIVE: To evaluate whether a full-coverage fetal-maternal scanner can noninvasively monitor ongoing electrophysiological activity of maternal and fetal organs. METHODS: A simulation study was carried out for a scanner with an array of magnetic field sensors placed all around the torso from the chest to the hip within a horizontal magnetic shielding enclosure. The magnetic fields from internal organs and an external noise source were computed for a pregnant woman with a 35-week old fetus...
September 19, 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/29090029/mode-of-delivery-in-stillbirth
#14
Natalia Florina Buinoiu, Sabrina Ioana Stoica, Corina Mat, Anca Panaitescu, Gheorghe Peltecu, Nicolae Gica
OBJECTIVE: In Romania, a national statistics report on the mode of delivery in pregnancies that ends in stillbirths has never been conducted. Thus, we decided to analyze the incidence of cesarean section versus vaginal delivery rate over a 10-year period in Filantropia Clinical Hospital of Bucharest. MATERIALS AND METHODS: We conducted a retrospective analysis over a period of 10 years from January 2005 to December 2015. Maternal age, parity, social status, place of origin, educational level, gestational age, fetal presentation and fetal sex were studied in order to see if there were a scientific correlation with death in utero...
June 2017: Mædica
https://www.readbyqxmd.com/read/29082782/how-do-maternal-factors-impact-preeclampsia-prediction-in-brazilian-population
#15
Karina Bilda de Castro Rezende, Antônio José Ledo Alves da Cunha, Cristos Pritsivelis, Edson Chaves Faleiro, Joffre Amim Junior, Rita Guérios Bornia
OBJECTIVE: To evaluate the impacts of maternal risk factors described by the Fetal Medicine Foundation's 2012 algorithm (FMF2012) in a Brazilian population. METHODS: All singleton pregnancies submitted to first-trimester preeclampsia (PE) screening using the FMF2012 algorithm were considered for study inclusion. Maternal factors, recorded via a patient questionnaire, were described and compared between PE outcome groups. A Gaussian regression model was derived to measure the effects of maternal factors, and to identify factors that contributed significantly (p < 0...
October 29, 2017: Journal of Maternal-fetal & Neonatal Medicine
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
#16
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/29065922/persisting-demand-and-supply-gap-for-maternal-and-newborn-care-in-eastern-uganda-a-mixed-method-cross-sectional-study
#17
Rornald Muhumuza Kananura, Suzanne Namusoke Kiwanuka, Elizabeth Ekirapa-Kiracho, Peter Waiswa
BACKGROUND: The slow progress in reducing maternal and newborn death in low and middle-income countries is attributed to both demand and supply-side factors. This study assessed the changes in maternal and newborn services in health facilities as well as demand for maternal and newborn health services in Eastern Uganda. METHODS: The health assessment data were collected in August 2013 and September 2015 in the districts of Kamuli, Pallisa, and Kibuku. We purposively collected data on the availability of services from 40 health facilities that provided maternal and newborn services...
October 24, 2017: Reproductive Health
https://www.readbyqxmd.com/read/29063738/cardiovascular-outcomes-of-pregnancy-in-marfan-s-syndrome-patients-a-literature-review
#18
REVIEW
So Yeon Kim, Diana S Wolfe, Cynthia C Taub
AIMS: Pregnancy in patients with Marfan's syndrome (MFS) carries an increased risk of cardiovascular complications, resulting in increased maternal and fetal mortality and morbidity. Literature on MFS pregnant patients is relatively sparse, and there has yet to be a concrete consensus on the management of this unique patient population. The purpose of our paper is to provide a literature review of case reports and studies on MFS during pregnancy (published between 2005 and 2015) and to explore cardiovascular outcomes of patients with MFS...
October 23, 2017: Congenital Heart Disease
https://www.readbyqxmd.com/read/29059453/what-s-new-in-prenatal-genetics-a-review-of-current-recommendations-and-guidelines
#19
Annalisa L Post, Amy T Mottola, Jeffrey A Kuller
Importance: The rapid development of prenatal genetic testing and screening tools and choices constantly challenges clinicians to stay up to date on current best practice. Objective: We sought to review, compare, and summarize recent national society guidelines on prepregnancy genetic screening and prenatal diagnosis for aneuploidy with a focus on changes and additions to previous guidelines. Evidence Acquisition: We performed a descriptive review of 8 recently published (2016-2017) national guidelines and updates on prenatal genetic screening and testing including American Congress of Obstetricians and Gynecologists committee opinions and practice bulletins, Society for Maternal-Fetal Medicine consult series publications, and an American College of Medical Genetics and Genomics position statement...
October 2017: Obstetrical & Gynecological Survey
https://www.readbyqxmd.com/read/29048133/vasa-previa-prenatal-diagnosis-and-outcomes-thirty-five-cases-from-a-single-maternal-fetal-medicine-practice
#20
Ankita Kulkarni, Jennifer Powel, Michael Aziz, Leena Shah, Susan Lashley, Carlos Benito, Yinka Oyelese
OBJECTIVES: To assess the accuracy and effectiveness of routine screening for vasa previa, to describe our experience, and to assess factors that contribute to missed cases of vasa previa. METHODS: A retrospective descriptive study of all cases of vasa previa from a single maternal-fetal medicine service between 2009 and 2017 was performed. Ultrasound findings and obstetric and neonatal outcomes were reviewed and analyzed. RESULTS: Thirty-five cases of vasa previa were identified...
October 19, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
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