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Frequent postpartum ultrasonographic findings include a thickened endometrial stripe and echogenic material in the uterine cavity. The echogenic material commonly seen in the endometrial cavity of asymptomatic patients was not associated with the development of bleeding complications.

OBJECTIVE -We investigated the association between functional health literacy and markers of pregnancy preparedness in women with pregestational diabetes.RESEARCH DESIGN AND METHODS -English-and Spanish-speaking pregnant women with pregestational diabetes were recruited. Women completed the Test of Functional Health Literacy in Adults (TOFHLA) short form and a questionnaire. A TOFHLA score of Յ30 was defined as low functional health literacy.RESULTS -Of 74 women participating in the study, 16 (22%) were classified as having low functional health literacy. Compared with women with adequate health literacy, those with low health literacy were significantly more likely to have an unplanned pregnancy (P ϭ 0.02) and significantly less likely to have either discussed pregnancy ahead of time with an endocrinologist or obstetrician (P ϭ 0.01) or taken folic acid (P ϭ 0.001).CONCLUSIONS -The results of this study suggest that low functional health literacy among women with pregestational diabetes is associated with several factors that may adversely impact birth outcomes. Diabetes Care 27:331-334, 2004A pproximately 19,000 pregnancies in the U.S. occur annually in women with pregestational diabetes. Although this represents a small proportion of total births, pregnancies in women with diabetes are important because of the potential for adverse outcomes, including spontaneous abortions, stillbirths, congenital anomalies, and the requirement for neonatal intensive care (1). The risk of these outcomes may be minimized with preconceptional planning. Specifically, periconceptional folic acid supplementation and good glycemic control before pregnancy have been shown to reduce these risks to a level only slightly higher than that of the baseline population (2-11).Many women with diabetes unfortunately fail to receive preconceptional counseling or to achieve good glucose control before pregnancy. Health care providers have attempted to determine the barriers to ideal diabetes care. Diabetes is a chronic disease that can be very confusing and frustrating for patients. Many patients may not understand their disease, the information their health care providers give them, or the importance of tight glucose control. Studies in nonpregnant diabetic subjects have confirmed the relationship between low socioeconomic status, low literacy, and poorer glycemic control with a higher risk of complications (12-15). Two studies (16,17) specifically evaluating functional health literacy in nonpregnant diabetic patients found very high rates of inadequate and marginal health literacy at 50 to 75%.Functional health literacy has not been studied in pregnant women with diabetes. We therefore performed a pilot study evaluating the association between low functional health literacy in women with pregestational diabetes and markers for adverse pregnancy outcome. RESEARCH DESIGN AND METHODS -Pregnant patients withpregestational diabetes, class B or higher, either type 1 or type 2, were prospectively recruited from three sites: two universitybased clini...

Context.-Thromboelastography (TEG) is a whole blood, real-time analyzer measuring the viscoelastic properties of the hemostasis process and allowing for individualized goal-directed therapy. However, routine use of TEG requires validation of sample storage effect on clot parameters.Objectives.-To establish the minimum time required for equilibration time and the maximum time for sample storage for all commercially available TEG tests for the new-generation TEG 6s and to determine how those times compare with the older generation TEG 5000.Design.-Citrated and heparinized whole blood samples obtained from 20 healthy donors were analyzed for clot parameters at multiple time points for both the TEG 6s and the TEG 5000. Samples were activated with the citrated multichannel cartridge or the platelet-mapping cartridge in the TEG 6s or with recalcified kaolin in the TEG 5000.Results.-All blood samples yielded TEG parameter results within reference ranges and had a tendency toward hypercoagulable profiles with increased storage time. Sample storage resulted in increased platelet inhibition with significant differences at 4 hours in the plateletmapping cartridge (arachidonic acid percentage of inhibition, P ¼ .002; adenosine diphosphate percentage of inhibition, P ¼ .02).Conclusions.-For nonemergent cases or in a central laboratory setting, all tests provided reliable results for up to 4 hours in the citrated multichannel cartridge and for 3 hours for platelet function information in the plateletmapping cartridge. In emergent/urgent situations in which the sample needs to be run immediately, RapidTEG and functional fibrinogen tests may be preferred.

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Mid-trimester termination by D&E does not increase the rate of clinically significant subsequent pregnancy complications.

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