Genetic counselors (GCs) have reported an increase in discussion of insurance-related, or "genesurance," topics during genetic counseling sessions. Despite increasing frequency, there have been no studies examining patient expectations of GCs in these discussions. This study aimed to explore patient expectations of GCs in these discussions, as well as examine factors that may impact expectations. A 38-item survey was administered prior to patients receiving prenatal or cancer genetic counseling at 11 clinic sites across UTHealth, Baylor College of Medicine, and Sanford Health, with 360 responses analyzed. Key variables were analyzed using descriptive statistics, chi-square analysis, and multivariate logistic regression to assess associations between factors and control for potential confounders. Over 75% of patients expected GCs to discuss genesurance topics during a genetic counseling session. The majority of patients (78%) expected GCs to provide an estimated out-of-pocket cost, know if a test is a covered benefit (77%), and provide referral information for further questions (76%). Two additional expectations, considered to be unrealistic in most clinical settings, included expecting GCs to know the patient's specific insurance plan and coverage information (57%) and provide an exact out-of-pocket cost (41%). Ethnicity was the only significant predictor of response for these two expectations, as African Americans and Hispanics were more likely than Caucasians to have these beliefs. While the patient participants felt that GCs were primarily responsible for initiating these conversations, they also reported a personal sense of responsibility for raising questions. This study demonstrates that patients may expect GCs to address genesurance topics in a genetic counseling session, with specific expectations about the cost and coverage of genetic tests. Further studies will establish the most effective way to communicate this information to patients and examine whether and where within the scope of GC practice, genesurance discussions fall.

Objectives To describe and compare ultrasound and Doppler findings in pregnant women who were positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) with findings in those who were SARS‐CoV‐2‐negative, evaluated during the pandemic period. Methods In this retrospective case–control study, we analyzed data from 106 pregnant women who tested positive for SARS‐CoV‐2 at the time of, or within 1 week of, an ultrasound scan between 1 May and 31 August 2020. Scans were either performed for routine fetal evaluation or indicated due to a positive SARS‐CoV‐2 test. Forty‐nine women were symptomatic and 57 were asymptomatic. For comparison, we analyzed data from 103 pregnant women matched for maternal age, parity, body mass index and gestational age at the time of the ultrasound scan. These control women did not report symptoms of SARS‐CoV‐2 infection at the time of the ultrasound scan or at the time of admission for delivery and had a negative SARS‐CoV‐2 test at admission for delivery. Fetal biometry, fetal anatomy, amniotic fluid volume and Doppler parameters, including umbilical and fetal middle cerebral artery pulsatility indices, cerebroplacental ratio and biophysical profile (BPP), were evaluated as indicated. Biometric and Doppler values were converted to Z‐scores for comparison. Our primary outcome, an adverse prenatal composite outcome (APCO) included any one or more of: small‐for‐gestational‐age (SGA) fetus, oligohydramnios, abnormal BPP, abnormal Doppler velocimetry and fetal death. Comorbidities, delivery information and neonatal outcome were compared between the two groups. Results Eighty‐seven (82.1%) women who were positive for SARS‐CoV‐2 had a body mass index > 25 kg/m2. SARS‐CoV‐2‐positive women had a higher prevalence of diabetes (26/106 (24.5%) vs 13/103 (12.6%); P = 0.03), but not of pre‐eclampsia (21/106 (19.8%) vs 11/103 (10.7%); P = 0.08), compared with controls. The prevalence of APCO was not significantly different between SARS‐CoV‐2‐positive women (19/106 (17.9%)) and controls (9/103 (8.7%)) (P = 0.06). There were no differences between SARS‐CoV‐2‐positive women and controls in the prevalence of SGA fetuses (12/106 (11.3%) vs 6/103 (5.8%); P = 0.17), fetuses with abnormal Doppler evaluation (8/106 (7.5%) vs 2/103 (1.9%); P = 0.08) and fetuses with abnormal BPP (4/106 (3.8%) vs 0/103 (0%); P = 0.14). There were two fetal deaths in women who were positive for SARS‐CoV‐2 and these women had a higher rate of preterm delivery ≤ 35 weeks of gestation (22/106 (20.8%) vs 9/103 (8.7%); odds ratio, 2.73 (95% CI, 1.19–6.3); P = 0.01) compared with controls. Conclusions There were no significant differences in abnormal fetal ultrasound and Doppler findings observed between pregnant women who were positive for SARS‐CoV‐2 and controls. However, preterm delivery ≤ 35 weeks was more frequent among SARS‐CoV‐2‐positive women. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Doppler techniques are needed for the evaluation of the intraplacental circulation and can be of great value in the diagnosis of placental anomalies. Highly sensitive Doppler techniques can differentiate between the maternal (spiral arteries) and fetal (intraplacental branches of the umbilical artery) components of the placental circulation and assist in the evaluation of the placental functional units. A reduced number of placental functional units can be associated with obstetric complications, such as fetal growth restriction. Doppler techniques can also provide information on decidual vessels and blood movement. Abnormal decidual circulation increases the risk of placenta accreta.Doppler evaluation of the placenta greatly contributes to the diagnosis and clinical management of placenta accreta, vasa previa, placental infarcts, placental infarction hematoma, maternal floor infarction, massive perivillous fibrin deposition and placental tumors. However, it has a limited role in the diagnosis and clinical management of placental abruption, placental hematomas, placental mesenchymal dysplasia and mapping of placental anastomoses in monochorionic twin pregnancies.

Objective This study aimed to compare pregnancy outcomes in obese and nonobese women with preterm prelabor rupture of membranes (PPROM) ≥34 weeks. Study Design The present study is a secondary analysis of a multicenter retrospective cohort of singletons with PPROM from 2011 to 2017. Women with a delivery body mass index (BMI) ≥30 kg/m2 (obese) were compared with women with a BMI < 30 kg/m2 (nonobese). Pregnancies were stratified based on delivery policies of expectant management until 35 weeks versus immediate delivery ≥34 weeks. The primary outcome was a composite neonatal outcome (neonatal sepsis, antibiotic administration for duration >72 hours after delivery or respiratory support). Univariate analysis and general estimating equations models including maternal age, delivery timing, mode of delivery, hospital, and gestational age were used with p < 0.05 level of significance. Results Among 259 pregnancies, 47% were obese. Pregnant women with obesity had increased composite neonatal outcome versus nonobese pregnancies (adjusted odds ratio [aOR] = 1.48 [95% confidence interval (CI): 1.01–2.17]). Obesity was also associated with increased neonatal antibiotic administration for a duration >72 hours after delivery, respiratory support, ventilation, oxygen supplementation, and surfactant administration. When stratified by delivery policies there was no significant difference in perinatal outcomes based on obesity. Conclusion Obese women with PPROM ≥34 weeks have an increased odds of adverse neonatal respiratory and infectious outcomes compared with nonobese women.

Objective To evaluate outcomes with expectant management of preterm prelabor rupture of membranes (PROM) until 35 weeks versus immediate delivery at ≥34 weeks. Study Design This was a multicenter retrospective cohort study of singletons with preterm PROM at >20 weeks from 2011 through 2017. Groups were defined as expectant management until 35 weeks versus immediate delivery at ≥34 weeks. Primary outcome was composite neonatal morbidity: need for respiratory support, culture positive neonatal sepsis, or antibiotic administration for >72 hours. Univariate and general estimating equation models were used with p < 0.05 considered significant. Results A total of 280 mother–infant dyads were included. There was no difference in composite neonatal outcome in pregnancies managed with expectant management compared with immediate delivery (43.4 vs. 37.5%; p = 0.32). Those with expectant management had shorter length of neonatal intensive care unit (NICU) admission but higher rates of neonatal antibiotics for > 72 hours, endometritis, and histological chorioamnionitis. There were no cases of fetal demise, neonatal death, or maternal sepsis, and only three cases of neonatal sepsis. Conclusion There is no difference in composite neonatal morbidity in pregnancies with preterm PROM managed with expectant management until 35 weeks as compared with immediate delivery at 34 weeks. Expectant management is associated with a decreased length of NICU admission but increased short-term infectious morbidity.

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Letters to the Editor Concomitant spontaneous chorioamniotic membrane separation, velamentous cord insertion and vasa previaMisdiagnosis and/or mismanagement of vasa previa can result in significant fetal compromise, including death 1 . Associated factors, such as chorioamniotic membrane separation, might increase this risk. We present a unique case of a woman who had vasa previa due to a velamentous cord insertion and concurrent significant spontaneous chorioamniotic separation.A 28-year-old woman with a singleton pregnancy and history of two prior uncomplicated full-term vaginal deliveries was evaluated at 20 weeks of gestation. The ultrasound scan showed normal fetal anatomy and

INTRODUCTION: Morbidity associated with preterm prelabor rupture of membranes (PPROM) is primarily related to infectious complications and gestational age at delivery. Obesity is a known risk factor for adverse pregnancy outcomes. There is no data on the impact of obesity on outcomes in pregnancies with PPROM after 34 weeks. METHODS: Secondary analysis of a multicenter retrospective cohort study of singletons with PPROM from January 2011-April 2017. Women with a delivery BMI of ≥30 kg/m2 (obese) were compared to women with a delivery BMI of <30 kg/m2 (non-obese). Pregnancies were also stratified based on hospital delivery policies of expectant management (EM) until 35 weeks versus immediate delivery (ID) ≥34 weeks. The primary outcome was neonatal ventilation. Univariate and general estimating equations models were used with p<0.05 level of significance. RESULTS: 259 mother-infant dyads were included and 122 (47%) women were obese. Pregnancies complicated by obesity had increased need for neonatal ventilation as compared to non-obese pregnancies (15.4% in obese versus 8.2% in non-obese, adjusted p<0.001). Obesity was also associated with increased neonatal supplemental oxygen administration, surfactant administration and neonatal antibiotic use >72 hours. However, when stratified by delivery practice and obesity only neonatal antibiotic use >72 hours was significantly lower in obese pregnancies with ID (5.9%) as compared to obese pregnancies with EM (25.0%, p=0.004). CONCLUSION: Pregnancies complicated by PPROM and obesity have an increased risk for neonatal respiratory and infectious morbidity. These findings suggest that obesity and delivery timing impact perinatal outcomes in pregnancies with late PPROM.