Placenta membranacea is a rare placental disorder characterized by the presence of fetal membranes (complete or partially) covered by chorionic villi. A 35-year-old woman, gravida 1, was admitted for preterm labor at 24 weeks and 5 days. She subsequently developed heavy vaginal bleeding and underwent a classical cesarean delivery for suspected abruption. Postpartum inspection of the placenta demonstrated a small placenta with tan colored membranes, and diffusely scattered placental cotyledons. Histologic examination revealed chorionic villi directly attached to the fetal membranes on the periphery,consistent with the diagnosis of a partial placenta membranacea. Placenta membranacea should be considered in the etiology of painless vaginal bleeding in the second and third trimester. This condition can be associated with other placental abnormalities, such as placenta previa or accreta. Perinatal outcome may include stillbirth, preterm delivery, or neonatal death.
In BriefScreening for gestational diabetes mellitus is controversial. In their high-risk obstetrical practice, the authors did not find a difference in delivery or neonatal outcomes when using a one-step versus a two-step screening process. They did find lower rates of compliance with screening when using the one-step method.
able to receive a full course (≥ 48 hours to seven days) of ACS prior to delivery. With advances in both obstetrical and neonatal medicine, the present authors sought to determine a current minimal interval required from ACS administration to delivery to see an improvement in neonatal outcomes. Their primary hypothesis was that neonatal outcomes are improved prior to 48 hours after ACS administration. Materials and MethodsThis was a retrospective cohort study of all infants that delivered between 23 0/7 weeks and 33 6/7 weeks gestational age between January 1, 2009 and August 31, 2013 at a tertiary level hospital, Hartford Hospital. The policy at the present facility is to
ntenatal Down syndrome screening began in the 1970s using advanced maternal age as the sole risk factor. 1 Since then, screening has expanded to include maternal serum analytes drawn in the first trimester (pregnancy-associated plasma protein A and total β-human chorionic gonadotropin [β-hCG] or free β-hCG) or the second trimester (α-fetoprotein, unconjugated estriol, β-hCG, and inhibin A). A sonographic marker used in the first trimester involves measurement of nuchal translucency, and this marker may be supplemented with nasal bone assessment or other measures. [2][3][4][5] In the second trimester, the presence or absence Alireza A. Shamshirsaz, MD, Samadh F. Ravangard, DO, Garry Turner, MD, Adam Borgida, MD, Mary Beth Janicki, MD, Winston A. Campbell, MD, Carolyn Zelop, MD, Amirhoushang A. Shamshirsaz, MD, Melissa Spiel, DO, Anne Marie Prabulos, MD, Deborah Feldman, MD, John Rodis, MD, Charles J. Ingardia, MD, Padmalatha Gurram, MD, Kisti Fuller, MD, Yu M. Fang, MD, Peter Benn, PhD, James F. X. Egan, MD Received June 12, 2012, ORIGINAL RESEARCHObjectives-The purpose of this study was to evaluate the efficacy of the genetic sonogram in Down syndrome screening for women who have received the stepwise sequential test.Methods-This retrospective cohort study included women with singleton pregnancies who underwent stepwise sequential (first-trimester combined and second-trimester serum) screening and then had a genetic sonogram between March 2005 and January 2010. Stepwise sequential Down syndrome risks were multiplied by either a positive or negative likelihood ratio based on the second-trimester sonographic findings to determine the final Down syndrome risk. A final Down syndrome risk of 1:270 or higher was considered screen positive.Results-A total of 6286 women fulfilled our criteria, including 17 with Down syndrome-affected fetuses. After stepwise sequential testing, the Down syndrome detection rate was 88.2% (15 of 17), and after the genetic sonogram, there was a nonsignificant reduction in detection to 82.4% (14 of 17; P > .05). For the 6269 unaffected pregnancies, the genetic sonogram converted 58 screen-negative results (1%) to positive and 183 screen-positive results (3.1%) to negative. The net effect was a change in the false-positive rate from 6.2% (390 of 6269) after stepwise sequential screening to 4.2% (266 of 6269) after the genetic sonogram.Conclusions-The genetic sonogram should be applied cautiously for women who have received prior prenatal screening tests. Women with screen-positive results need to be counseled that a negative sonographic result can be falsely reassuring. Conversely, for women with screen-negative results who have a risk close to the cutoff, a sonographic examination could assist in the decision of whether to accept or reject amniocentesis.
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