Conservative treatment for placenta accreta can help women avoid hysterectomy and involves a low rate of severe maternal morbidity in centers with adequate equipment and resources.

We report a highly reproducible, quantitative tool to objectively analyze vaginal flora that uses cutoff values for the concentrations of A. vaginae and G. vaginalis to establish the molecular diagnosis of BV.

Assistance Publique-Hôpitaux de Paris and the University of Geneva.

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Background. Q fever is a zoonosis caused by Coxiella burnetii. During pregnancy, it may result in obstetric complications, such as spontaneous abortion, intrauterine growth retardation, intrauterine fetal death, and premature delivery. Pregnant women are exposed to the risk of chronic Q fever.Methods. We included 53 pregnant women who received a diagnosis of Q fever. We compared the incidence of obstetric and maternal Q fever complications for women who received long-term cotrimoxazole treatment ( ) with that for women who did not receive long-term cotrimoxazole treatment ( ); long-term n p 16 n p 37 cotrimoxazole treatment was defined as oral administration of trimethoprim-sulfamethoxazole during at least 5 weeks of pregnancy.Results. Obstetric complications were observed in 81.1% of pregnant women who did not receive long-term cotrimoxazole therapy: 5 (13.5%) women experienced spontaneous abortions, 10 (27%) experienced intrauterine growth retardation, 10 (27%) experienced intrauterine fetal death, and 10 (27%) experienced premature delivery. Oligoamnios was observed in 4 patients (10.8%). Obstetric complications were found to occur significantly more often in patients infected during their first trimester of pregnancy than in those infected later ( ). The P p .032 outcome of the pregnancy was found to depend on placental infection by C. burnetii ( ). Long-term P p .013 cotrimoxazole treatment protected against maternal chronic Q fever ( ), placental infection ( ), P p .001 P p .038 and obstetric complications ( ), especially intrauterine fetal death ( ), which was found to be related P p .009 P p .018 to placental infection ( ). P p .008 Conclusions. Q fever during pregnancy results in severe obstetric complications, including oligoamnios. Because of its ability to protect against placental infection, intrauterine fetal death, and maternal chronic Q fever, longterm cotrimoxazole treatment should be used to treat pregnant women with Q fever.

P erinatal asphyxia, a major cause of neonatal and childhood death and morbidity (eg, hypoxic ischemic encephalopathy, seizures, intraventricular hemorrhage, cerebral palsy, and delayed development), is predicted by fetal acidosis measured by umbilical cord pH at birth. The cord pH (about <7.00) and base deficit (about Z12 mmol/L) levels commonly used to judge risk, were derived by consensus, and the longterm implications of a low arterial cord pH are uncertain. Despite this, cord pH values are commonly used as an outcome measure in obstetric clinical trials, are a benchmark for judging obstetricians' clinical performance, and are used to support medicolegal claims of harm due to intrapartum events that might lead to long-term child disability. The authors of this systematic review and meta-analysis evaluated more closely the association between umbilical cord pH readings at birth and short-term and long-term childhood outcomes.Data were obtained from Medline, Embase, the Cochrane Library (2008 issue 8), and Medion, without language restrictions. Reference lists of selected articles were recorded, follow-up contact with authors was performed and review articles, the SIGLE, Web of Science, the national research register, and medical conferences register were all examined. Eligible studies were those (cohort, case-controlled, review) in which cord pH at birth was compared with any neonatal or long-term outcome. Criteria for inclusion also included a study population of >5 subjects in whom cord blood was obtained at birth, performance of an index test (cord blood examined for arterial or venous pH or base excess); a recording of outcomes (any measure of compromise of neonatal or childhood well-being); and inclusion of a study design that allowed generation of a 2 Â 2 table to compute estimates of associations between test results and outcomes. The primary outcome measures were neonatal mortality, an author created composite of neonatal morbidity, and cerebral palsy.A total of 51 primary articles (with 481,753 infants) were found, with widely variable design, quality, outcome definition, and results. Meta-analyses carried out within predefined groups from 43 studies showed that low arterial cord pH was significantly associated with neonatal mortality [odds ratio (OR), 16.9; 95% confidence interval (CI), 9.7-29.5]; hypoxic ischemic encephalopathy (OR, 13.8; 95% CI, 6.6-28.9); intraventricular hemorrhage or periventricular leukomalacia (OR, 2.9; 95% CI, 2.1-4.1); and cerebral palsy (OR, 2.3; 95% CI, 1.3-4.2). Longterm (1 to 8 y) adverse outcomes found in 15 studies included cerebral palsy, unspecified neurologic abnormalities, intelligent quotient (IQ) deficits, and developmental problems.

Successful conservative treatment for placenta accreta does not appear to compromise the patients' subsequent fertility or obstetrical outcome. Nevertheless, patients should be advised of the high risk that placenta accreta may recur during future pregnancies.

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