Background. Plasminogen activator inhibitor-1 (PAI-1) inhibits tPA and creates a prothrombotic state. Gene polymorphisms of PAI-1 are associated with elevated levels and adverse pregnancy outcomes. Case. A 36-year-old gravida 6, para 1-1-3-1 with elevated prepregnancy PAI-1 levels, a history of early-onset preeclampsia with severe features superimposed on chronic hypertension, intrauterine growth restriction (IUGR), and recurrent pregnancy loss (RPL), presented with a dichorionic-diamniotic twin gestation. She was managed with aspirin and enoxaparin and delivered appropriately grown twins at 36 weeks and 3 days, due to the development of preeclampsia superimposed on chronic hypertension. She was discharged not on enoxaparin and represented with pulmonary edema on postoperative day 8. Conclusion. It is reasonable to consider testing certain patients with recurrent pregnancy loss and/or early preeclampsia with severe features for PAI-1. If levels are elevated, treatment with prophylactic enoxaparin may be beneficial. Further research is needed to determine the effect of this therapy in patients with exceedingly poor perinatal outcomes to better assess for any impact on improved outcomes.
Purpose of reviewOrofacial clefts (OCs) are among the most common congenital anomalies, however, prenatal detection of cleft palate without cleft lip (CP) remains low. CP is associated with a higher risk of associated structural anomalies, recurrence risk and genetic aberrations. There is opportunity to optimize prenatal diagnosis, counseling and diagnostic genetic testing for OCs.Recent findingsImproving prenatal diagnosis of CP requires understanding that embryologically, the secondary palate develops from the 6th to the 10th week and fuses with the primary palate by the 12th week. Multiple first, second and third trimester 2D ultrasonographic markers for OCs have been described including the maxillary gap, frontal space, maxilla-nasion-mandible angle, retronasal triangle, palatino-maxillary diameter, equal sign, nonvisualization or gap in the soft to hard palate interface and loss of the superimposed line. We discuss the technique, evidence and limitations of each.SummaryPrenatal detection of OC can be optimized by employing 2D sonographic markers. Prenatal detection of CP may be improved by recognizing its high association with retrognathia/micrognathia.
Objective: Evaluate the association between small for gestational age (SGA) severity and morbidity and mortality in a contemporary, unselected population of very preterm infants. Study Design: This secondary analysis of a California statewide database evaluated singleton infants born during 2008-2018 at 24-32 weeks’ gestation, with a birthweight <15th percentile. We analyzed neonatal outcomes in relation to weight for gestational age (WGA) and symmetry of growth restriction. Results: An increase in WGA by one z-score was associated with decreased major morbidity or mortality risk (aRR 0.73, 95% CI 0.68-0.77) and other adverse outcomes. The association was most pronounced for WGA percentile <3 and did not differ by fetal growth restriction diagnosis. Symmetric growth restriction was not associated with neonatal outcomes after standardizing for gestational age at birth. Conclusions: Increasing SGA severity, particularly below the 3rd WGA percentile, had a significant impact on neonatal outcomes among very preterm infants.
INTRODUCTION:
The purpose of this study is to compare early (≤4 cm) versus late (>4cm) amniotomy in obese women undergoing induction of labor and the effect on mode of delivery.
METHODS:
This is a secondary analysis of a retrospective cohort study that obtained IRB approval to investigate induction and augmentation of labor and BMI. Obese women undergoing induction of labor, with term, vertex, singleton pregnancies, with amniotomy as an intervention from 2012 to 2017 were included. Our primary outcome was mode of delivery. Secondary outcomes included length of labor, maximum dose of oxytocin required, adverse neonatal and maternal outcomes. Comparisons were made between those with early amniotomy at cervical exam ≤4 cm, and late amniotomy with cervical exam >4cm.
RESULTS:
The sub-analysis included 286 women. There was no difference in cesarean delivery rates between early and late amniotomy (21% vs. 12.7%, P=.075). Early amniotomy was associated with longer time from amniotomy to delivery (6.6 hours vs. 3.7 hours, P <.001). Early amniotomy was not associated with a statistically significant reduction in time to vaginal delivery, or vaginal delivery <24 hours from initiation of induction. Early amniotomy was associated with higher maximum dose of oxytocin. There was no statistically significant difference in hemorrhage, chorioamnionitis, NICU admissions or APGAR scores <7 at 1 minute.
CONCLUSION:
In an obese population, early amniotomy was not associated with an increase in cesarean delivery or increases in maternal or neonatal complications, but it did not appear to be associated with shorter labor course.
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