IntroductionPlacental histologic examination can assist in revealing the mechanism leading to preterm birth. Accumulating evidence suggests an association between intrauterine pathological processes, morbidity and mortality of premature infants, and their long term outcome. Neonatal brain activity is increasingly monitored in neonatal intensive care units by amplitude integrated EEG (aEEG) and indices of background activity and sleep cycling patterns were correlated with long term outcome. We hypothesized an association between types of placental lesions and abnormal neonatal aEEG patterns.ObjectiveTo determine the association between the placental lesions observed in extreme preterm deliveries, and their neonatal aEEG patterns and survival.Patients and methodsThis prospective cohort study included extreme premature infants, who were born ≤ 28 weeks of gestation, their placentas were available for histologic examination, and had a continues aEEG, soon after birth)n = 34). Infants and maternal clinical data were collected. aEEG data was assessed for percentage of depressed daily activity in the first 3 days of life and for sleep cycling. Associations of placental histology with clinical findings and aEEG activity were explored using parametric and non-parametric statistics.ResultsTwenty two out of the 34 newborns survived to discharge. Preterm prelabor rupture of membranes (PPROM) or chorioamnionitis were associated with placental lesions consistent with fetal amniotic fluid infection (AFI) or maternal under perfusion (MUP) (P < 0.05). Lesions consistent with fetal response to AFI were associated with absence of SWC pattern during the 1st day of life. Fetal-vascular-thrombo-occlusive lesions of inflammatory type were negatively associated with depressed cerebral activity during the 1st day of life, and with aEEG cycling during the 2nd day of life (P<0.05). Placental lesions associated with MUP were associated with depressed neonatal cerebral activity during the first 3 days of life (P = 0.007).ConclusionsDepressed neonatal aEEG patterns are associated with placental lesions consistent with maternal under perfusion, and amniotic fluid infection of fetal type, but not with fetal thrombo-oclusive vascular disease of inflammatory type. Our findings highlight the association between the intrauterine mechanisms leading to preterm parturition and subsequent depressed neonatal cerebral function early after birth, which eventually may put premature infants at risk for abnormal neurodevelopmental outcome.

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Central descent due to a level 1 defect is a main component in pelvic organ prolapse (POP) reconstructive surgery, whether for symptomatic apical prolapse or for the prolapse repair of other compartments. A recent growth in the rate of native tissue repair procedures for POP, following the US Food and Drug Administration (FDA) warnings regarding the safety and efficacy of synthetic meshes, requires a re-evaluation of these procedures. The safety, efficacy, and determination of the optimal surgical approach should be the center of attention. Functional outcome measures and patient-centered results have lately gained importance and received focus. A comprehensive literature review was performed to evaluate objective and subjective outcomes of apical prolapse native tissue repair, with a special focus on studies reporting impact on patients' functional outcomes, quality of life, and satisfaction. We performed a MEDLINE search for articles in the English language by using the following key words: apical prolapse, sacrospinous ligament fixation, uterosacral ligament suspension, sacral colpopexy, McCall culdoplasty, iliococcygeus vaginal fixation, and functional outcomes. We reviewed references as well. Despite a prominent shortage of studies reporting standardized prospective outcomes for native tissue repair interventions, we noted a high rate of safety and efficacy, with a low complication rate for most procedures and low recurrence or re-treatment rates. The objective and subjective results of different procedures are reviewed. Functional outcomes of native tissue repair procedures have not been studied sufficiently, though existing data present those procedures as favorable and not categorically inferior to sacrocolpopexy. Apical compartment prolapse repair using native tissue is not a compromise. Functional outcomes of native tissue repair procedures are favorable, have a high rate of success, improve women's quality of life (QoL), and result in high rates of patient satisfaction. This subject requires further long-term, standardized prospective studies following the International Continence Society/International Urogynecologists Association guidelines for surgical outcomes report, with the focus on patient-centered functional outcomes.

Objective This study investigates the risk for long‐term respiratory hospitalizations of offspring born small for gestational age (SGA) at term. Study design A retrospective population‐based cohort analysis was performed to examine the risk of long‐term respiratory hospitalizations between SGA compared to appropriate for gestational age (AGA) newborns. The analysis included all term singleton deliveries occurring between 1991 and 2014 at a single tertiary medical center. Fetuses with congenital malformations, multiple gestation, cases of perinatal mortality and large for gestational age (LGA) were excluded. A Kaplan–Meier survival curve was used to compare cumulative morbidity incidence up to the age of 18 years, and a Cox hazards regression model was used to control for confounders. Results During the study period 216,671 deliveries met the inclusion criteria; of them 4.8% (n = 10,450) were diagnosed as SGA neonates. During the follow‐up period, the rate of hospitalization due to respiratory morbidity was significantly higher in the SGA group as compared to the AGA group (5.2% vs. 4.7%, OR = 1.13, 95% confidence interval [CI] = 1.03−1.24, p = 0.011). The Kaplan–Meier survival curve demonstrated a significantly higher cumulative incidence of respiratory morbidity in the SGA group (log‐rank p = 0.026). In the Cox hazards regression model, controlled for relevant clinical confounders, SGA was found to be an independent risk factor for long‐term pediatric respiratory morbidity (adjusted hazard ratio [HR] = 1.1, 95% CI = 1.001−1.19, p = 0.049). Conclusion Being delivered SGA at term is an independent long‐term risk factor for pediatric respiratory hospitalization.

The two procedures were comparable in terms of prevalence and risk factors for UTI during the postoperative period.

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with increased reward-based (hedonic) eating and obesity liability in MATOB-exposed offspring, with Fs more vulnerable. STUDY DESIGN: C57Bl/6J dams were assigned to a 60% high-fat or 10% fat control diet (CD) for 14 weeks pre-breeding and during pregnancy/lactation. Male (M) and F offspring were weaned at 3.5 weeks to CD. 15-30 offspring/sex/diet group were evaluated for all experiments. Hedonic eating was evaluated in adolescent (8wk) MATOB and CD offspring with palatable food and liquid consumption tests (peanut butter and chocolate beverage). Usual food consumption and metabolic rate were quantified in adult offspring using metabolic cages. Weekly weight gain was quantified from weaning to adulthood, and adult body composition was determined with EchoMRI. RESULTS: F but not M MATOB adult offspring were significantly heavier with significantly increased body fat percentage compared to sex-matched controls (Fig 1A/B). Metabolic rate was not significantly different between MATOB and CD adult offspring (Fig 1C). F offspring had both significantly increased hedonic eating (Fig 2A) and usual food consumption compared to sex-matched controls and MATOB Ms, respectively (Fig 2B). Patterns of hedonic eating differed by offspring sex (Fig 2A). CONCLUSION: F offspring have increased vulnerability to obesity when exposed to MATOB in utero. Together with our prior finding of persistently reduced mesolimbic dopamine release in F MATOB offspring only, these data suggest that reduced dopamine release may program F offspring to overeat, leading to a sex-biased increase in obesity risk. Future studies will focus on mesolimbic dopamine signaling as a therapeutic target to reduce offspring obesity.

OBJECTIVE: To evaluate maternal and neonatal morbidity and mortality in patients undergoing trial of labor after cesarean (TOLAC) using a more contemporary data set. STUDY DESIGN: This was a secondary analysis of the Consortium on Safe Labor database, a retrospective cohort study from 2002 to 2008. Women met inclusion criteria for our study if they had a history of any prior cesarean delivery (CD). Perinatal outcomes such as uterine rupture, uterine dehiscence, blood transfusion, hemorrhage, hysterectomy, endometritis, maternal death, neonatal intensive care unit (NICU) admission, neonatal respiratory distress syndrome, neonatal seizure, and neonatal death were evaluated based on desired delivery mode (planned elective CD or TOLAC). Multivariate logistic regression was used to describe the association between TOLAC and markers of maternal and neonatal morbidity and mortality. RESULTS: Of 9,858 patients who had a prior CD, our study population had 4,400 patients (44.6%) who desired TOLAC and 5,458 patients (55.4%) who underwent elective repeat CD. Of 4,400 patients who desired trial of labor, 3,162 (72%) achieved a vaginal birth. Women who attempted TOLAC compared to those who had an elective CD were more likely to have uterine rupture (OR 3.11; 95% CI 1.21 e 8.02), hemorrhage (OR 2.24; 95% CI 1.86 e 2.70), and blood transfusion (OR 2.33; 95% CI 1.70 e 3.19) (Table 1). Rate of uterine rupture was higher in patients undergoing TOLAC (0.34%), however it was still described in patients undergoing elective CD (0.11%). Rate of NICU admission was higher in patients undergoing TOLAC compared to elective CD, 12.9% and 11.3% respectively (OR 1.17; 95% CI 1.03 e 1.32). CONCLUSION: Patients undergoing TOLAC are two-times more likely to have a hemorrhage or require blood transfusion compared to women with elective repeat cesarean delivery. Compared to the Cesarean Registry data, women have half the rate of uterine rupture and a 30% higher risk for blood transfusion.