Objective To determine, in women with proteinuric pre-eclampsia, whether a discriminant value of proteinuria at the time of diagnosis predicts the presence or absence of subsequent adverse maternal and fetal outcomes. Design Retrospective cohort study.Setting One teaching hospital and two primary referral hospitals in Sydney, Australia.Sample Three hundred and twenty-one pregnant women with proteinuric pre-eclampsia, managed according to a uniform management protocol. Methods All women with the diagnosis of proteinuric pre-eclampsia in the years 1998-2001 were studied.After exclusion of women with pre-eclampsia superimposed on pre-existing hypertension, a twin pair, unavailable spot urine results, 353 women were analysed using logistic regression to determine separately the predictors of any adverse maternal or fetal outcomes at the time of delivery. Receiver operating characteristic (ROC) curves, sensitivity and specificity were then calculated from the data. Main outcome measures Adverse maternal outcomes: severe maternal hypertension (BP ! 170/110 mmHg), renal insufficiency, liver disease, cerebral irritation, haematological disturbances. Adverse fetal outcomes: small for gestational age, perinatal mortality. Results There were 108 (34%) adverse maternal outcomes and 60 (19%) adverse fetal outcomes including two stillbirths. In multivariate analysis, an adverse maternal outcome was significantly associated with higher spot urine protein/creatinine ratio at diagnosis (P < 0.0001) with an odds ratio (OR) of 1.003 per mg/mmol (95% confidence interval [CI] 1.002 -1.004) and with older maternal age (P ¼ 0.014) with OR 1.06 per year (95% CI 1.01 -1.11). An increased risk of adverse fetal outcome was associated with higher spot urine protein/creatinine (P ¼ 0.013; OR 1.44 per log [mg/mmol], 95% CI 1.08 -1.92), gestation at diagnosis <34 weeks (P < 0.0001; OR 3.60, 95% CI 1.90 -6.82) and early pregnancy systolic blood pressure 115 mmHg (P ¼ 0.0002; OR 3.41, 95% CI 1.77-6.57). The area under the receiver operating characteristic (ROC) curve was 0.67 for adverse maternal outcomes and 0.72 for adverse fetal outcomes. Conclusions With increasing proteinuria, there is increased risk of adverse maternal and fetal outcomes.Although we did not identify a specific spot protein/creatinine ratio that could be used as a definitive screening value for adverse outcomes, it is possible to utilise data from this study to predict the likelihood of adverse maternal and fetal outcomes. A high spot urine protein/creatinine ratio in pre-eclamptic women of greater than 900 mg/mmol (f9 g/day), or greater than 500 mg/mmol (f5 g/day) in women over 35 years, is associated with a greatly increased likelihood of adverse maternal outcomes.

Objective. To determine relative influences of intrauterine growth restriction (IUGR) and preterm birth on risks of cardiovascular, renal, or metabolic dysfunction in adolescent children. Study Design. Retrospective cohort study. 71 periadolescent children were classified into four groups: premature small for gestational age (SGA), premature appropriate for gestational age (AGA), term SGA, and term AGA. Outcome Measures. Systolic blood pressure (SBP), augmentation index (Al), glomerular filtration rate (GFR) following protein load; plasma glucose and serum insulin levels. Results. SGA had higher SBP (average 4.6 mmHg) and lower GFR following protein load (average 28.5 mL/min/1.73 m2) than AGA. There was no effect of prematurity on SBP (P = .4) or GFR (P = .9). Both prematurity and SGA were associated with higher AI (average 9.7%) and higher serum insulin levels 2 hr after glucose load (average 15.5 mIU/L) than all other groups. Conclusion. IUGR is a more significant risk factor than preterm birth for later systolic hypertension and renal dysfunction. Among children born preterm, those who are also SGA are at increased risk of arterial stiffness and metabolic dysfunction.

A 34-year-old Greek Cypriot lady (Mrs. AMC) P(2+0) booked at 10 weeks gestation with spontaneously conceived dizygotic twins. Her two previous uncomplicated pregnancies resulted in normal vaginal deliveries of male infants weighing 3.2 and 3.4 kg, respectively. Immediately following her second delivery, she underwent a manual removal of placenta (MRP) under general anaesthesia and sustained a fracture of the triquetral bone of her left wrist while being lifted off the operating table. Although she had complained of pain and restricted movement in her left hand after the MRP, the fracture remained undiagnosed for several weeks until an X-ray of her left wrist showed signs of delayed fracture healing of the triquetral bone. The pathological fracture was suggestive of osteoporosis during pregnancy but this was not investigated further at this stage. In 2004, she was referred to an orthopaedic surgeon with concern over a height loss of 3 cm in the preceding 6 months, as well as with generalised bony tenderness over her hips and lower back. Dual Energy X ray Absorptiometry (DEXA) to measure bone mineral density (BMD) revealed a T score of -1.6 SD (which is the WHO definition of osteopenia) in her right hip, which subsequently deteriorated to -1.8 SD (Table 1)

Background: Prior studies contrasting oncoplastic reduction (OCR) to traditional lumpectomy have validated oncoplastic reduction surgery with similar survival and oncological outcomes. The purpose of this study was to evaluate if there was a significant difference in the time to initiation of radiation therapy after OCR in comparison with the standard breast-conserving therapy (lumpectomy). Methods: The patients included were from a database of breast cancer patients who all underwent postoperative adjuvant radiation after either OCR or lumpectomy at a single institution between 2003 and 2020. Patients who experienced delays in radiation for nonsurgical reasons were excluded. Comparisons were made between the groups in the time to radiation and complication rates. Results: A total of 487 patients underwent breast-conserving therapy, with 220 having undergone OCR and 267 lumpectomy patients. There was no significant difference in days to radiation between patient cohorts (60.5 OCR, 56.2 lumpectomy, P = 0.059). There was a significant difference in the number of complications between OCR and lumpectomy patients (20.4% OCR, 2.2% lumpectomy, P < 0.001). However, of patients who had complications, there was no significant difference in the number of days to radiation (74.3 OCR, 69.3 lumpectomy, P = 0.732). Conclusions: Compared with lumpectomy, OCR was not associated with an increased time to radiation but was associated with higher complications. Statistical analysis did not reveal surgical technique or complications to be independent, significant predictors of increased time to radiation. Surgeons should be aware that although complications may remain higher in OCR, this does not necessarily translate to delays in radiation.