<b><i>Objective:</i></b> Function of the lower extremities after prenatal myelomeningocele (MMC) repair is best assessed with ambulatory function at 30–36 months of age, but parents often ask about function before this milestone. Lower extremity movement can be assessed by ultrasound (US) and at the newborn exam (NE), but correlation between US, NE, and ambulation is not firmly established. <b><i>Methods:</i></b> This was a retrospective correlation study of fetuses that underwent open prenatal MMC repair at SSM Cardinal Glennon Fetal Care Institute, St. Louis, MO, between January 2011 and June 2017. Movement at the ankles, knees, and hips was assessed by US after open repair on postoperative days (PODs) 0–5 and at 32 weeks gestation. NE was performed by physical therapy or neurosurgery within the first month of life, and pediatric follow-up between 30 and 36 months of age was obtained to document ambulation. <b><i>Results:</i></b> Forty-two fetuses were included. Joint movement seen on US varied by POD: it was present on POD 1 in 7% of fetuses and 62% by POD 5. Degree of ventriculomegaly, lesion level, and lesion length did not have a significant effect on US, NE, or ambulation. Knee movement on POD 3 correlated with knee movement at NE (<i>k</i> = 0.58, <i>p</i> < 0.01), but only later knee movement correlated with ambulation (<i>k</i> = 0.28–0.46, <i>p</i> = 0.01). Hip movement at 32 weeks was the only single joint assessment that correlated with NE and ambulation (<i>k</i> = 0.45 and 0.46, <i>p</i> = 0.03 and 0.01, respectively). <b><i>Conclusion:</i></b> Lower extremity movement increases between POD 1 and POD 5 in fetuses after open fetal MMC repair. Knee and hip movement on US at 32 weeks correlates with ambulation at 30–36 months. These data may inform counseling, and direct therapy and spark prospective investigations.
RESULTS: There were 118 patients identified (55% class A1). 58% were African-American and 52% had medical assistance insurance. 83% attended the postpartum visit. Screening was discussed at 68% of postpartum visits, but a screening test was only ordered at 55% of visits. 77% of these were 2H-OGTTs. 38% of 2H-OGTTs ordered were completed, of which 38% were abnormal. In multivariate analyses, patients with A2 GDM were more likely to be screened (odds ratio [OR] 2.8 [95% CI: 1.1-7.3]). Attendance at resident clinic was significantly associated with performance of the 2H-OGTT (OR 11.7, 95% CI: 1.6-84.8).CONCLUSION: Rates of postpartum screening for GDM patients are low, both because providers are not ordering screening and because patients do not complete the test. Further efforts must be made to improve follow-up for these vulnerable patients.
INTRODUCTION: To evaluate the impact of a tertiary care vaginitis clinic with standardized protocols on health care utilization and prescription antifungal and antimicrobials for vaginitis-related concerns. METHODS: A retrospective analysis of electronic medical records of women with complaints of vaginitis attending a tertiary care vaginitis clinic (VC) in an integrated healthcare system. Women had vaginal microscopy, vaginal pH, an amine test, and vaginal mycology cultures at the index VC visit. Vulvovaginal candidiasis diagnoses required a positive mycology culture and bacterial vaginosis required 3 of 4 Amsel's criteria. Records were analyzed to compare the number of vaginitis-related encounters (clinic and telephone), fluconazole, and metronidazole (oral and vaginal) prescriptions in the 12 months before and the 12 months after the index VC visit. RESULTS:Out of 207 women identified over an 18 month time frame, age range 16-77 years (mean 38.5 years), 71.5% had at least 1 vaginitis-related encounter in the 12 months before the index VC visit; 47.3% in the 12 months after. The mean number of visits dropped from 2.06 to 0.98 (P,.0001, paired t test). The number of women with at least one fluconazole prescription and one metronidazole prescription decreased from 53.6% to 43.0% and 39.6%-18.8% respectively (P,.0001, paired t test).CONCLUSION: Attending a tertiary care vaginitis clinic resulted in a statistically significant reduction in vaginitis-related encounters and both fluconazole and metronidazole prescriptions for 12 months. A standardized vaginitis clinic may help reduce the burden of inappropriate diagnosis and treatment of vaginitis. INTRODUCTION:To examine the effect of maternal glucose variability on gestational weight gain in obese DM women according to the Institute of Medicine (IOM) guidelines and its impact on adverse maternal and neonatal outcomes.
to evaluate patterns of pathway dysregulation in paired sibling placentas from twin pregnancies. RESULTS: A signature of 613 transcripts differentiated sPE from non-PE singleton placentas, independent of GA. When compared against a composite average of non-PE expression values, individual twins showed varying degrees of heterogeneity in pathway dysregulation. The figure illustrates 3 representative twin sPE pregnancies with different top dysregulated pathways vs. baseline, and between the two sibling placentas. When the transcriptomes of twin placentas retrieved from individual pregnancies were compared to one another using N-of-1 pathway analysis, instances of pathway dysregulation between sibling pair placentas could be resolved. Overall, mo-di twins displayed the highest concordance of pathway dysregulation among sibling placentas. CONCLUSION: The N-of-1 pathway analysis could provide a precision medicine analytical framework to uncover placental dysregulation relevant to PE and other pregnancy complications.
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