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Data suggest that proactive patient contact via a health educator, a phone call, or even postal mail is associated with higher rates of postpartum diabetes testing. There may also be utility to changing the timing of postpartum diabetes testing. Despite the widespread knowledge regarding the importance of postpartum testing for women with GDM, testing rates remain low. Alternative testing strategies and large randomized trials addressing postpartum testing are warranted.

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Randomized controlled trial of intrapartum glucose management in women with gestational diabetes Dear Dr. Hamel: Your manuscript has been reviewed by the Editorial Board and by special expert referees. Although it is judged not control) for intrapartum glucose management among women with GDM on neonatal blood glucose concentrations shortly following birth." This was a prospective, randomized trial.

Topics: Maternal Morbidity and Mortality, Neonatal Morbidity and Mortality, Systems-based Practice I nhaled oxygen is frequently given to women in labor with a nonreassuring fetal heart rate to improve the fetal metabolic status. However, only 2 randomized controlled trials have investigated maternal oxygen administration, and neither provides evidence that it is beneficial for the fetus. This study provides an overview of the current literature and shows that this practice may actually be harmful to the fetus.Fetal hypoxia is considered to be the cause of late decelerations and much evidence has shown that maternal oxygen supplementation can increase fetal oxygen levels and reduce late decelerations. However, this therapy has not been shown to improve fetal pH. One study by Newman et al measured fetal scalp blood pH during maternal hypoxia after giving women 50% or 100% oxygen during the first stage of labor and found no change from baseline pH in either group. Another randomized trial by Thorp et al assigned 86 women to receive either 10 L/min of oxygen or no oxygen supplementation during the second stage of labor. Babies born to the women who received oxygen supplementation were significantly more likely to have a pH < 7.2. Similar results were found in a trial by Sirimai et al that investigated oxygen supplementation during the second stage of labor in 160 women and found a similar trend although it failed to reach statistical significance (P = 0.12). In a primate study where a group of fetuses were made hypoxic, hypertensive, and acidotic, maternal oxygen administration resolved late decelerations, but did not improve fetal pH. Another primate study found that maternal oxygen raised fetal oxygen levels and reduced decelerations without changing pH, but in the cases where it did not eliminate decelerations, oxygen had a significantly negative effect on pH.Maternal oxygen administration may cause an increase in free radical activity. Inhaling 50% oxygen for 5 minutes may lead to maternal hyperoxia, increasing free oxygen radicals. One study showed an increase in malondialdehyde, isoprostane, and organic hydroperoxides, markers of free radical activity, in infants born to oxygen-supplemented women. Two other trials of cord occlusion in lambs and goats showed higher levels of xanthine, a marker of free radical activity, in neonates after exposure to oxygen. In contrast, another double-blind trial of oxygen supplementation in 56 women found no difference in fetal pH or markers of free radicals, but 20% of the babies in the oxygen-supplemented group had to be resuscitated in the delivery room, whereas none from the control group required resuscitation. Newborn resucsciation is currently performed with room air, as 100% oxygen has been associated with a higher risk of mortality and is known to contribute to bronchopulmonary dysplasia and retinopathy of prematurity.This study concludes that inhaled oxygen should be given only for maternal hypoxia and not for nonreassuring fetal heart rate tracings. Randomized clinic...

Objective To define the temporal relationship between intrapartum intravenous vancomycin administration and vaginal group B streptococcus (GBS) colony counts. Study Design Prospective cohort study conducted from October 2014 to February 2017. Women with antenatal cultures demonstrating GBS colonization and a plan for vancomycin administration were eligible. Intrapartum vaginal cultures were collected prior to the first vancomycin infusion and every 2 hours up to five collections or delivery. Results were analyzed in two groups: participants with at least one positive intrapartum culture and those without any positive intrapartum cultures. Results A total of 63 women were enrolled. Among consented women, a total of 8 were excluded and 3 participants' cultures were never plated, thus leaving a total of 52 women for analysis. The degree of vaginal GBS colonization varied between subjects and was not normally distributed. Colony counts dropped rapidly from hour 0 to hour 2 (median: 6.0 × 108 vs. 1.0 × 108, p < 0.01). Standardizing hour 0 colony counts to 100%, the percent decline in colony counts from hour 0 to hour 2 was significant (p = 0.03), and at each subsequent time point fell further. Conclusion GBS vaginal colony counts fall rapidly after intrapartum vancomycin administration.

Introduction Biomarkers for early detection of renal cell carcinoma (RCC) may help diagnose minimal residual disease in patients at risk for RCC, can guide anti-angiogenic therapy, or may help identify candidates for adjuvant treatment. In this study, we investigated whether blood levels of carbonic anhydrase 9 (CA9) correlate with RCC tumor burden and therefore disease activity. Methods CA9 is a von Hippel–Lindau–hypoxia inducible factor target upregulated in clear cell RCC. We used an anti-CA9 antibody (M75)-based enzyme-linked immunosorbent assay test to measure CA9 levels in blood obtained before and after nephrectomy for clinically localized disease in patients with: (1) clear cell RCC, (2) papillary and chromophobe RCC or oncocytoma, or (3) benign kidney lesions, and we compared these samples to blood drawn from normal control individuals. Results We observed a significant (p < 0.006) decrease in the blood levels of CA9, after nephrectomy for localized disease, in the majority of patients with clear cell RCC (57%). In contrast, patients with nonclear cell RCC, benign disease, or those having undergone debulking nephrectomy for metastatic disease did not have a decrease in CA9 blood levels after nephrectomy. Preliminary longitudinal follow up measurements of CA9 levels in a small group of patients indicated that rising CA9 levels may correlate with disease progression. Conclusions Plasma CA9 levels correlate with disease activity in a subset of clear cell RCC patients and should be considered in future multiplex RCC biomarker development algorithms.