Preeclampsia is a multiorgan, heterogeneous disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Optimal strategies in the care of the women with preeclampsia have not been fully elucidated, leaving physicians with incomplete data to guide their clinical decision making. Because preeclampsia is a progressive disorder, in some circumstances, delivery is needed to halt the progression to the benefit of the mother and fetus. However, the need for premature delivery has adverse effects on important neonatal outcomes not limited to the most premature infants. Late-preterm infants account for approximately two thirds of all preterm deliveries and are at significant risk for morbidity and mortality. Reviewed is the current literature in the diagnosis and obstetrical management of preeclampsia, the outcomes of late-preterm infants, and potential strategies to optimize fetal outcomes in pregnancies complicated by preeclampsia.

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Simulation of EVAR leads to decreased fluoroscopy times for novice and experienced operators. Side of femoral access did not affect precision of proximal endograft landing. The angulated aortic neck leads to decreased proximal seal zone coverage regardless of infrarenal or suprarenal fixation devices.

The scattered radiation is several-fold higher with FI than MI across all levels of case complexity. Radiation exposure decreases with distance from the radiation source, and is negligible outside of a 6-foot radius. Modern endovascular suites allow high-fidelity imaging, yet additional strategies to minimize exposure and occupational risk are needed.

ObjectivePressures on academic faculty to perform beyond their role as educators has stimulated interest in complementary approaches in resident medical education. While fellows are often believed to detract from resident learning and experience, we describe our preliminary investigations utilizing clinical fellows as a positive force in pediatric resident education. Our objectives were to implement a practical approach to engage fellows in resident education, evaluate the impact of a fellow-led education program on pediatric resident and fellow experience, and investigate if growth of a fellowship program detracts from resident procedural experience.MethodsThis study was conducted in a neonatal intensive care unit (NICU) where fellows designed and implemented an education program consisting of daily didactic teaching sessions before morning clinical rounds. The impact of a fellow-led education program on resident satisfaction with their NICU experience was assessed via anonymous student evaluations. The potential value of the program for participating fellows was also evaluated using an anonymous survey.ResultsThe online evaluation was completed by 105 residents. Scores were markedly higher after the program was implemented in areas of teaching excellence (4.44 out of 5 versus 4.67, p<0.05) and overall resident learning (3.60 out of 5 versus 4.61, p<0.001). Fellows rated the acquisition of teaching skills and enhanced knowledge of neonatal pathophysiology as the most valuable aspects of their participation in the education program. The anonymous survey revealed that 87.5% of participating residents believed that NICU fellows were very important to their overall training and education.ConclusionsWhile fellows are often believed to be a detracting factor to residency training, we found that pediatric resident attitudes toward the fellows were generally positive. In our experience, in the specialty of neonatology a fellow-led education program can positively contribute to both resident and fellow learning and satisfaction. Further investigation into the value of utilizing fellows as a positive force in resident education in other medical specialties appears warranted.

Cancer during pregnancy represents a potential conflict between optimal maternal treatment and fetal development. Traditionally, clinicians operated under the assumption that cancer treatment during pregnancy is incompatible with normal fetal development. However, recent evidence suggests that many diagnostic and treatment modalities cause little or no harm to the developing fetus. As such, both maternal and neonatal interests should be considered when developing management strategies for pregnant cancer patients. In this review, we will discuss issues related to fetal and neonatal health associated with conventional diagnostic and treatment approaches in the care of pregnant women with cancer. In addition, we offer recommendations on strategies to maximize fetal outcomes in pregnancies complicated by cancer.

aortic aneurysm repair. Our institution has utilized the superficial femoral artery (SFA) as our access of choice for EVAR (not randomized). Our objective was to analyze all EVARs to assess if type of access or artery produced preferential results intra-and postoperatively. Patient populations reviewed were percutaneous EVAR (PEVAR), SFA cut-down, and CFA cut-down.Methods: EVAR procedures at our institution from 2004 to 2014 were retrospectively reviewed for blood loss, transfusions, access location, accessed artery, follow-up imaging, length of stay (LOS), patency, 30-day mortality, and wound infection rates. Data were analyzed using two-tailed unpaired Student t-test.Results: A total of 484 EVAR procedures identified (73 PEVAR, 337 SFA cut-down, 74 CFA cut-down) with a distribution of 4.6% thoracic and 95.4% abdominal. Overall EVAR 30-day mortality was 0.39%. All 30-day wound infections (2.96% of all EVAR) were in cut-down access patients (0 PEVAR, 1 SFA, 1 CFA). Fifteen 30-day wound infections were found in cut-down patients (3.86% SFA; 2.70% CFA) and none in PEVARs, but this was not statistically significant (P > .05). SFA cut-down resulted in the least blood loss (median, 96.44 mL; P < .05), followed by PEVAR and CFA cut-down (233.82 mL and 291.67 mL, respectively; P < .5). There was no significant difference in transfusion rates (P > .05). Conversion rates for PEVARs were 17% in SFA accessed and 16% in CFA. The percutaneous approach did have a reduction in LOS from procedure date to discharge (P < .05). All but one patient maintained patency at latest follow-up imaging (mean, 30.0 months).Conclusions: EVAR procedures utilizing the cut-down approach may benefit from utilizing the SFA in terms of blood loss and LOS. PEVAR resulted in significantly less postoperative hospital days, and, while PEVAR did result in less wound infections, this was not statistically significant. Further studies will be needed.