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For patients hospitalized with life-threatening illnesses and their families, palliative care consultants can provide critical support by providing information about prognosis, ensuring that symptoms are managed, helping to clarify goals of care, and addressing psychosocial and spiritual concerns. However, once patients leave the hospital, many hospital-based palliative care teams (PCTs) cannot continue to play active roles in patient care. Gaps in discharge planning not only decrease quality of life for patients, but also translate into lack of support for caregivers. The palliative care population would be expected to benefit from a customized approach to hospital discharge. The aim of this study was to identify the range of health care experiences of family caregivers and patients who received palliative care consultations after they left the hospital, and to understand how PCTs might best prepare patients and caregivers for the post-hospital experience.

Objective To investigate whether maternal obstructive sleep apnea (OSA) is associated with changes in fetal growth trajectory. Study Design Retrospective review of pregnant women who underwent overnight polysomnography. Fetal growth was estimated using sonographic biometric measurements obtained during routine prenatal care. Customized estimated fetal weight and birth weight centiles were calculated and impaired fetal growth was defined as birth weight <10th centile or a slowing of fetal growth by >33% during the last trimester. Logistic regression models were used to determine the relationship between maternal OSA and altered fetal growth after adjusting for potential covariates. Results There were 48 women without and 31 women with OSA. There were no differences in the proportion of infants with birth weight <10th centile between women with and without OSA (23% vs. 25%, p=1.0), However, the presence of maternal OSA was predictive of impaired fetal growth (aOR 3.9, 95% CI 1.2–12.6). Logistic regression models were repeated using only a slowing of fetal growth in the 3rd trimester (excluding birth weight <10th centile) and OSA predicted a slowing in fetal growth across the 3rd trimester (aOR 3.6, 95% CI 1.4–9.4). Fourteen additional women were treated with positive airway pressure during pregnancy; fetal growth was not significantly different in these women compared to controls. Conclusion Obstructive sleep apnea is independently associated with altered fetal growth, which appears to be ameliorated with use of positive airway pressure.

Results indicate that mean depth-corrected, weight-normalized umbilical vein volume flow is reduced in pregnancies complicated by preeclampsia and that volume flow may indicate hypertensive disorder earlier in gestation. Volume flow measurements are highly reproducible, and further study in a larger clinical population is encouraged to determine whether 3D volume flow can complement the management of preeclampsia and, in general, at-risk pregnancy.

Noonan syndrome is a multisystem genetic disorder caused by genes encoding proteins involved in the RAS-MAPK pathway. Affected fetuses have variable presentations ranging from the absence of prenatal findings to increased nuchal fold, cystic hygromas, pleural effusions, cardiac malformations, or skin edema. We describe a male fetus who had features consistent with Noonan syndrome at the time of fetal anatomic survey, including hydrops and a possible cardiac defect. Subsequent scan revealed persistent bilateral pleural effusions (with predominance of lymphocytes). After bilateral thoracoamniotic shunt placement, the fetus did well and delivered at term. Prenatal testing revealed an S650F missense mutation in the RAF1 gene, which had not previously been associated with Noonan syndrome.

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METHODS:We performed a case-control study of pregnant women who received prenatal care in an academic center. Pregnancy records were reviewed for patient demographics, medical and social history. The EPDS scores of subjects with a history of mood disorder (anxiolytic/antidepressant use, untreated depression) or substance use (ethanol, illicit drug use) were compared to controls to determine likelihood of probable depression (score .12) using a chi square test. Principal component analysis (PCA) was used to identify the individual EPDS survey items and question themes that were commonly associated with depressive symptoms.RESULTS: 297 subjects were reviewed. Subjects in the mood disorder and substance use groups were more likely to have EPDS scores .12 than controls in both the antepartum (P5.001, P5.030, respectively) and postpartum (P5.016, P5.008). PCA of EPDS scores for the mood disorders group identified 3 themes (anhedonia, anxiety, sadness) that accounted for 59% and 67% of variance in the antepartum and postpartum scores, respectively. PCA of EPDS scores in the substance use group identified 2 themes that accounted for 58% variance in the antepartum and 66% in the postpartum scores.CONCLUSION: Patients with a history of mood disorder or substance use are at increased risk of peripartum depression and may have characteristic symptom complexes. Recognition of patterns in at-risk populations may facilitate early intervention.