No abstract

No abstract

Key Points Question Are prenatal ultrasonographic findings in maternal Zika virus infection associated with adverse neonatal outcomes? Findings In this cohort study of 92 women with confirmed Zika virus infection in pregnancy, 37 had an abnormal result on prenatal ultrasonography that was associated with adverse composite neonatal outcomes. However, 23 of 55 neonates who had normal results on prenatal ultrasonography still had adverse neonatal outcomes. Meaning Abnormal results on prenatal ultrasonography are associated with adverse neonatal outcomes; however, a comprehensive neonatal evaluation is recommended for all infants with suspected in utero Zika exposure.

These variations in recommendations reflect the heterogeneity of the literature on the prevention of alloimmunization and highlight the need for synthesis of evidence to create an international guideline on prevention of alloimmunization. This may improve safety, quality, optimize outcomes, and stimulate future trials.

After completing this activity, the learner should be better able to outline variations in indications and contraindications for cervical cerclage use by international guideline, identify variation in perioperative considerations for cervical cerclage use by international guideline, and recognize variation in timing of removal by international guideline.

Hypertensive disorders of pregnancy remain among the leading causes of maternal morbidity and mortality. The onset of headaches in patients with hypertensive disorders of pregnancy has been considered as a premonitory symptom for eclampsia and other adverse maternal outcomes. Headaches are very common symptoms during pregnancy and the postpartum period with a reported incidence of 39%; however, headache is absent in 30-50% of women before the onset of eclampsia and is a poor predictor of eclampsia and adverse maternal outcomes. If included in the definition of cerebral or visual disturbances, headache may be considered a symptom of preeclampsia, a diagnostic feature of preeclampsia with severe features, a premonitory symptom of eclampsia, and an indication for delivery. Inclusion of this nonspecific symptom in the diagnosis and management of hypertensive disorders of pregnancy in the absence of an evidence basis may lead to unintended consequences including excessive testing, visits to outpatient offices or emergency departments, additional hospitalization, and iatrogenic preterm delivery without proven benefit. If a cerebral disturbance such as severe or persistent headache presents for the first time during pregnancy or postpartum, an evaluation should be performed that considers a broad differential diagnosis, including but not limited to hypertensive disorders of pregnancy, and the diagnostic evaluation is similar to that in nonpregnant adults. This commentary draws attention to the implications of considering the cerebral disturbance of headache as a symptom that portends adverse pregnancy outcome in the current recommendations for diagnosing and managing hypertensive disorders of pregnancy.

Objective This study aimed to assess the association of preimplantation genetic testing (PGT) with abnormal placentation among a cohort of pregnancies conceived after frozen embryo transfer (FET). Study Design This is a retrospective cohort study of women who conceived via FET at the University of California, San Francisco from 2012 to 2016 with resultant delivery at the same institution. The primary outcome was abnormal placentation, including placenta accreta, retained placenta, abruption, placenta previa, vasa previa, marginal or velamentous cord insertion, circumvallate placenta, circummarginate placenta, placenta membranacea, bipartite placenta, and placenta succenturiata. Diagnosis was confirmed by reviewing imaging, delivery, and pathology reports. Our secondary outcome was hypertensive disease of pregnancy. Results A total of 311 pregnancies were included in analysis; 158 (50.8%) underwent PGT. Baseline demographic characteristics were similar between groups except for age at conception and infertility diagnosis. Women with PGT were more likely to undergo single embryo transfer (82.3 vs. 64.1%, p < 0.001). There were no statistically significant differences in the rate of the primary outcome (26.6 vs. 27.4%, p = 0.86) or hypertensive disorders of pregnancy (33.5 vs. 33.3%, p = 0.97), which remained true after multivariate analysis was performed. Conclusion Among pregnancies conceived after FET, PGT is not associated with a statistically significant increased risk of abnormal placentation or hypertensive disorders of pregnancy. Key Points

Objective To determine the loss rate after amniocentesis in twins. Methods This cohort study evaluated twin pregnancies with serum screening through the California Prenatal Screening Program. The primary outcome was loss of one or both twins at any gestational age. Exclusions were chromosomal/structural abnormalities, selective fetal reduction, terminations, neonatal deaths, ovum donation, and incomplete data. Loss rates were compared between three groups: (a) screen negative and no amniocentesis, (b) screen positive and accepted, or (c) declined amniocentesis. Multivariate logistic analysis generated adjusted odds ratios (aOR). Results Thirty‐six thousand eight hundred twenty‐one twin pregnancies had screening: 2698 (7.3%) were screen positive for aneuploidy or neural tube defects (NTD). Among screen‐positive women, 861 (31.9%) were offered amniocentesis and 274 (31.8%) accepted. The post‐procedure loss rate among screen‐negative women was lower than among screen‐positive women (3.0% vs 7.4%; P < .001; aOR 2.62; 95% CI, 1.16‐2.99). Among screen‐positive women, the loss rate was similar for those who underwent amniocentesis and for those who declined (8.8% vs 6.8%; .32; aOR 1.32; 95% CI, 0.66‐1.91). Conclusion Twins that are screen positive for aneuploidy or NTD have an increased risk of pregnancy loss. Those who are screen positive and undergo amniocentesis do not have an increased loss rate.