Our objective was to determine the incidence and rate of persistence of placenta previa diagnosed at 15-20 weeks' gestation by using transvaginal sonography (TVS), and to describe the characteristics of TVS that predict placenta previa at delivery. Patients having placental tissue within 20 mm of the cervical os were prospectively identified by transabdominal ultrasound and underwent TVS. The distance of the placental edge from the cervical os was measured in millimeters. Characteristics of TVS predicting placenta previa at delivery were analyzed by logistic regression. The incidence of placenta previa diagnosed by TVS at 15-20 weeks was 1.1%; 14% persisted until delivery. Gestational age at the time of TVS and the distance of the placental edge to the cervical os helped predict placenta previa at delivery. Between 15 and 24 weeks' gestation, placenta overlapping the internal os by > or = 10 mm identified patients at risk of placenta previa at delivery with 100% sensitivity and 85% specificity. The use of TVS in the second trimester to diagnose placenta previa resulted in a lower incidence than was historically reported with the use of transabdominal ultrasound. The distance of the placental edge from the cervical os helps identify patients at risk of previa at delivery.

For patients with premature rupture of membranes, the gestational age at time of rupture carries the highest risk correlation with subsequent pulmonary hypoplasia.

The purpose of this study was to determine in what percentage of cases the assessment of placental localization using transabdominal sonography (TAS) was changed after transvaginal sonography (TVS) was applied. TVS was prospectively performed on all pregnant women of at least 15 weeks' gestation, when the placental edge using TAS appeared to be over or within 2 cm (low-lying) of the internal cervical os. The time required for the TVS scan and the distance of the placental edge from the internal cervical os were recorded. Of the 168 patients entered into the study, 131 were analyzed. Landmarks were poorly seen in 50% of the cases when using TAS. In 66 cases, the placenta appeared low or possibly over the internal cervical os using TAS, but a definitive diagnosis could not be made due to suboptimal visualization. In the remaining 65 cases, visualization of the internal os and placental edge was possible using both TAS and TVS. In this group, there was a change in the diagnosis in 26% of the cases after TVS was performed. Our results suggest that optimal visualization of the placental edge and internal cervical os is usually difficult with TAS when the placenta appears low-lying or over the internal cervical os. The assessment of placental localization was changed in over one-quarter of cases (26%) after transvaginal sonography was performed. The use of transvaginal ultrasound should be seriously considered when the placenta appears to be low or over the internal cervical os by transabdominal ultrasound.

Objective The purpose of this study was to compare longitudinally sampled maternal angiogenic proteins between singleton and twin pregnancies. Study Design Placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), and soluble endoglin (sEng) from healthy pregnant women were quantified at 10, 18, 26 and 35 weeks’ gestation (n=91), and during the third trimester (31–39 weeks) and at delivery (33–41 weeks; n=41). Geometric means and 95% confidence intervals were calculated for gestational age adjusted angiogenic protein concentrations and compared between matched twin and singleton pregnancies. Results Maternal sFlt-1 concentrations and the sFlt-1/PlGF ratio were higher in twins than singletons across pregnancy and at delivery, with the greatest differences at week 35 [sFlt-1: 36916 vs. 10151 pg/mL; p<0.0001; sFlt-1/PlGF: 168.4 vs. 29.0; p<0.0001]. Maternal concentrations of s-endoglin also were higher in the third trimester and delivery. Maternal PlGF concentrations were lower in twin than singleton pregnancies at week 35 only [219.2 vs. 350.2 pg/mL; p<0.0001]. Placental weight appeared to be inversely correlated with maternal sFlt-1/PlGF ratio at the end of the pregnancy in both twins and singletons. Conclusions Higher maternal anti-angiogenic proteins in twin than singleton pregnancies does not appear to be due to greater placental mass in the former, and may be one explanation for the increased risk of preeclampsia in women carrying multiple gestations. Determining whether women with a history of multiple gestations have an altered cardiovascular disease and breast cancer risk, like those with a history of preeclampsia, is warranted.

Findings suggest adequate prenatal care may reduce PAMC risks. Results for groups with less prenatal care access were consistent with previous research using less refined indicators, such as low birth weight. PAMCs improve on earlier measures, and readily permit adjustments for mothers' ages and comorbidities.

The role of TNF-alpha in human embryo implantation is currently unknown. Our data demonstrate that TNF-alpha does alter trophoblast cell adhesion to laminin, but significantly inhibits trophoblast cell motility in vitro, suggesting that TNF-alpha may play a regulatory role in trophoblast cell invasion.

Background: Meniscal repair has become the treatment of choice for meniscal tears, especially in the subset of bucket-handle meniscal tears (BHMTs). However, a comprehensive estimate of the corresponding failure rate is not available, thus maintaining doubts about the healing potential of these tears. Furthermore, a wide range of factors to predict high failure rates have been reported but with conflicting evidence. Purpose: To determine the failure rate after arthroscopic repair of BHMTs as reported in the literature, compare this with the failure rate of simple meniscal tears extracted from the same studies, and analyze the influence of factors previously reported to be predictive of meniscal repair failure. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic search was conducted by 2 independent reviewers using principal bibliographic databases (PubMed, Scopus, Cochrane Library, and EMBASE). After a stepwise exclusion process, 38 articles met the inclusion criteria. Failure rate data were analyzed with a random-effects proportional meta-analysis (weighted for individual study size), and forest plots were constructed to determine any statistically significant differences between BHMTs versus simple tears (longitudinal, radial, or horizontal), medial versus lateral BHMTs, isolated procedures versus repairs with concomitant anterior cruciate ligament reconstruction, and tears in red-red versus red-white zones. Moreover, a meta-regression analysis was conducted to evaluate the effect of patient age and sex, suture technique (in-out or all-inside), time from injury to surgery, mean number of stitches, and length of follow-up on failure rates. Results: The pooled failure rate was 14.8% (95% CI, 11.3%-18.3%; I2 = 77.2%). A total of 17 studies provided failure rates of both BHMT repairs (46/311 repairs) and simple tear repairs (54/546 repairs), demonstrating a significantly higher failure rate for BHMT repairs (risk ratio [RR] = 1.50; 95% CI, 1.05-2.15; I2 = 0%; P = .03). Medial BHMT repairs (RR = 1.94; 95% CI, 1.25-3.01; I2 = 0%; P = .003) and isolated repairs (RR = 1.77; 95% CI, 1.15-2.72; I2 = 0%; P = .009) had statistically higher risk of failure, but no statistically significant difference was found between tears in red-red versus red-white zones. Among the other factors evaluated with meta-regression, only the mean number of stitches showed a statistically significant effect on failure rates. Conclusion: Based on the currently available literature, this systematic review provides a reasonably comprehensive analysis of failure rate after arthroscopic BHMT repair; failure is estimated to occur in 14.8% of cases. Medial tears and isolated repairs were the 2 major predictors of failure.

OBJECTIVE: To describe maternal plasma levels of adrenomedullin (AM), a hypotensive and natriuretic peptide, in normal and preeclamptic women at term. STUDY DESIGN: Maternal plasma AM levels were determined in 13 preeclamptic and 15 normotensive primigravidas by radioimmunoassay. Plasma samples were obtained with the patients in the lateral recumbent position before the administration of any medications.RESULTS: Women with preeclampsia had significantly elevated AM levels when compared with normotensive controls (42.3 ± 10.5 pg/mL versus 16.9 ± 3.1 pg/mL, P < .011).CONCLUSION: In this pilot study, AM levels were significantly increased at term in preeclamptic women.