Pregnant women who smoke and have thrombophilia may be more likely to experience adverse birth outcomes and receive more benefit from thromboprophylaxis than their nonsmoking counterparts.
Background: Cervical insufficiency, the dilation of the cervix in the absence of contractions or labor, can cause second-trimester pregnancy loss or preterm birth. Cervical cerclage is a common treatment for cervical insufficiency and has 3 indications for placement: history, physical examination, and ultrasound. The purpose of this study was to compare pregnancy and birth outcomes for physical examination-and ultrasound-indicated cerclage. Methods: We conducted a retrospective observational descriptive review of second-trimester obstetric patients with transcervical cerclage performed by residents at a single tertiary care medical center from January 1, 2006, to January 1, 2020. We present data on all patients and compare outcomes between the 2 study groups: patients who received physical examination-indicated cerclage vs those who received ultrasound-indicated cerclage. Results: Cervical cerclage was placed on 43 patients at a mean gestational age of 20.4 ± 2.4 weeks (range, 14 to 25 weeks) and with a mean cervical length of 1.53 ± 0.5 cm (range, 0.4 to 2.5 cm). With a latency period of 11.8 ± 5.7 weeks, mean gestational age at delivery was 32.1 ± 6.2 weeks. Fetal/neonatal survival rates were comparable: 80% (16/20) for the physical examination group compared to 82.6% (19/23) for the ultrasound group. No differences were found between groups for gestational age at delivery-31.5 ± 6.8 in the physical examination group vs 32.6 ± 5.8 in the ultrasound group (P=0.581)-or for preterm birth <37 weeks-65.0% (13/20) in the physical examination group vs 65.2% (15/23) in the ultrasound group (P=1.000). Rates of maternal morbidity and neonatal intensive care unit morbidity were similar between the groups. No cases of immediate operative complications or maternal deaths occurred. Conclusion: Pregnancy outcomes for physical examination-and ultrasound-indicated cerclage placed by residents at a tertiary academic medical center were similar. Fetal/neonatal survival and preterm birth rates were favorable for physical examinationindicated cerclage when compared to other published studies.
INTRODUCTION:
Other than diethylstilbestrol, there are no strong risk factors known to cause congenital uterine anomalies (CUA). Discrepancies in defining and diagnosing uterine anomalies also create difficulties in discerning the prevalence of CUA. The study objective was to explore prevalence and risk factors of CUA in a cohort of women from an area with a history of chemical and teratogen exposure.
METHODS:
This was a retrospective observational study of obstetric patients with uterine ultrasounds from 1 January 2006 to 31 December 2016 at a tertiary care center. An Optimized Hot Spot analysis and Ripley's K- Function was constructed to ascertain any association with environmental exposures.
RESULTS:
The study population consisted of 46.4% of women having an ultrasound for an anatomy scan and 22.6% due to abdominal pain. The mean age was 26.1 years. The prevalence of a CUA was 0.9% (118/13040), which is below the reported national average of 3%. The most common were septate (46; 39.8%) and bicornuate (47; 39.0%). A Ripley's K - Function showed a normal observable relationship between Environmental Protection Agency (EPA) facilities and cases of congenital uterine anomalies. However, the Optimized Hot Spot Analysis located several statistical significant zip-codes of CUA in relation to zip-codes that include EPA chemical sites with possible watershed exposure.
CONCLUSION:
While the rate of CUA may be below the national prevalence, this may be due to the discrepancies in diagnostic classification. There was a statistically significant association of cases of CUA and zip-codes with EPA dump sites with possible teratogenic chemical exposure effect.
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