In a cohort of women requiring intensive care admission during pregnancy, MCCWG LOC, a simplified organ system based, triaging scoring system, predicted maternal outcomes and correlated with APACHE II score. Our data support initiatives for further development and testing of global obstetric triaging scoring systems for the purposes of risk stratification, monitoring of quality and resource allocation.
Objectives Relaxin H2 (RLN2) is a systemic hormone (sRLN) produced by the corpus luteum, whereas decidual (dRLN) only acts locally. Elevated sRLN is associated with spontaneous preterm birth (sPTB) and elevated dRLN with preterm premature rupture of membranes (PPROM). Associations were sought between single nucleotide polymorphisms (SNPs) in the RLN2 promoter with levels of dRLN and sRLN in Filipino patients with sPTB, PPROM or normal term delivery. Study Design Stringent selection of women with sPTB (n=20) or PPROM (n=20) and term controls (n=20) was made from over 8,000 samples from Filipino patients delivered at 34–36 weeks gestation. Twelve SNPs were genotyped on maternal blood with exclusion of nine based on high linkage disequilibrium (LD) or being the same as in the control population. Quantitative immunocytochemistry on parietal decidual tissue was performed (n=60) and sRLN measured by ELISA in a subset of patients (n=21). Results SNP rs4742076 was significantly associated with PPROM (p<0.001) and increased expression of dRLN (p<0.001). The genotype TT had increased dRLN in PPROM (p<0.05). SNP rs3758239 was significantly associated with both PPROM and sPTB (p<0.01), and genotype AA had increased dRLN expression (p<0.05). The sRLN showed a trend of higher levels in PPROM and sPTB, but was not significant. Conclusions SNP rs4742076 in the RLN2 promoter was associated with increased dRLN expression and PPROM while SNP rs3758239 was associated with both PPROM and sPTB in these Filipino patients. Specific homozygous genotypes were identified for both SNPs and were shown to be associated with increased dRLN tissue expression.
Introduction. Uterine leiomyomas, also called uterine fibroids or myomas, are the most common pelvic tumors in women. They are very rarely the cause of acute complications. However, when complications occur they cause significant morbidity and mortality. Thromboembolic disease has been described as a rare complication of uterine leiomyomas. DVT is a serious illness, sometimes causing death due to acute PE. Cases. We report a case series of 3 patients with thromboembolic disease associated with uterine leiomyoma at Hurley Medical Center, Flint, Michigan, during 2015 and conduct a literature review on the topic. A literature search was conducted using Medline, PubMed, and PMC databases from 1966 to 2015. Conclusion. The uterine leiomyoma is a very rare cause of PE and only few cases have been reported. DVT secondary to uterine leiomyoma should be considered in a female presenting with abdominal mass and pelvic pressure, if there is no clear common cause for her symptoms. Thromboembolic disease secondary to large uterine leiomyoma should be treated with acute stabilization and then hysterectomy. Prophylactic anticoagulation would be beneficial for lowering the risk of VTE in patients with large uterine leiomyoma.
IntroductionIt is well known that cervical incompetence and associated preterm birth confers greater morbidity and mortality on birth outcomes, with an additional increased risk of cervical incompetence in higher order gestations. While the pathophysiology of cervical incompetence has yet to be elucidated, research has identified risk factors and assessed outcomes of numerous interventions. Cervical cerclage has been shown, in certain situations involving singleton pregnancies, to improve outcomes. Conversely, rescue cerclage increases the risk of preterm birth in twin gestations. However, these studies did not consider the unique situation of infertile patients, with known cervical incompetence, who have utilized assisted reproductive technologies to attain pregnancy. This study aims to describe the outcomes of infertile patients with known cervical incompetence, carrying twin gestation, who have undergone cervical cerclage.MethodsThis case series includes eight infertile patients who have cervical incompetence resulting in fetal loss between 20-24 weeks after in vitro fertilization embryo transfer (IVF-ET). These patients continued with IVF treatments and subsequently conceived twins. All patients underwent prophylactic cervical cerclage placement before 12 weeks. The outcomes of these pregnancies are reviewed.ResultsAll pregnancies resulted in the delivery of viable twins. Six of the eight pregnancies (75%) were carried beyond 34 weeks. One pregnancy delivered at 31 weeks and one pregnancy delivered at 25 weeks after placental abruption.ConclusionsThis data suggest that the use of prophylactic cervical cerclage may be beneficial in improving reproductive outcomes in infertile patients with known cervical incompetence that subsequently conceived twin gestations via IVF-ET treatment.
Women of indigenous origin from North America and the Pacific had the highest rates of AWD. Within this group, women of Hawaiian descent had the highest point estimate of AWD when compared with other ethnic groups, though not significant.
INTRODUCTION: The opioid epidemic in continues to be a major public health concern. Opioid use during pregnancy increases risks of adverse neonatal and maternal outcomes, including neonatal abstinence syndrome (NAS). Methadone and Buprenorphine are used as maintenance therapy for opioid dependence during pregnancy. Our objective is to compare effects of Methadone and Buprenorphine on maternal and neonatal outcomes. METHODS: This is a retrospective cohort study that included patients with a singleton pregnancy who received opioid maintenance therapy and delivered at Hurley Medical Center from 2012 - 2017. IRB approval was obtained. Primary outcome was length of neonatal stay. Demographic characteristics, illicit drug use, and tobacco smoking were among variables analyzed in the Methadone and Buprenorphine groups. RESULTS: The study included 228 participants. 47 were on Buprenorphine and 181 on Methadone. Of the neonates, 71% required treatment for NAS. The median length of treatment in days was significantly less in Buprenorphine group (p= 0.001; 10 vs 16), along with median length of stay (p= 0.000001; 12 vs 20). There was no association between Buprenorphine dose and NAS treatment. In the Methadone group, the median dose increased with the level of treatment (p=0.004). After correcting for potential confounders, we noted that gestational age, dose of methadone, and illicit drug use, were associated with higher risk of requiring NAS treatment. CONCLUSION: Neonates exposed to Buprenorphine had significantly lower rates of NAS and shorter NICU stay compared to Methadone. Gestational age at delivery, Methadone dose, and illicit drug use seem to be associated with increased NAS treatment.
gestation and SAB were examined using Pearson/Spearman correlations, logistic regressions, and receiver-operating characteristic (ROC) curves. FHR_min, SAC_min, and CRL_min were positively correlated with each other (P,.05) and each was negatively correlated with SAB (P,.05). Regression analyses revealed that maternal age and CRL_min were not significant predictors for SAB unlike FHR_min and SAC_min. With one unit increase in FHR_min and SAC_min, the odds of SAB were reduced by 4% and 22%, respectively.CONCLUSION: FHR and SAC can be useful in predicting miscarriage after ART. There is a decrease in miscarriage rates as minimum FHR and minimum sac size increase. Further studies need to be conducted to determine which other parameters can predict a decrease risk of SAB.
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