Primary adenomas are common in the gastrointestinal tract but exceedingly rare on the periurethral surface and vagina. The pathogenesis remains unknown but vaginal adenomas are hypothesized to arise from vaginal adenosis or embryonic cloacal remnants and possess malignant potential. We present a case of a large primary vaginal tubulovillous adenoma in an eighty-one-year-old, likely diethylstilbestrol naïve patient. To the best of our knowledge the patient's 7.4 x 4.5 × 1.4 cm primary vaginal tubulovillous adenoma is the largest ever reported in literature.
OBJECTIVE: To quantify the frequency and risk of serious maternal complications associated with tobacco use during pregnancy. STUDY DESIGN: We performed a retrospective population-based cohort study of all live births in the US, 2012-2016, using vital statistics birth records. Maternal sociodemographic and pregnancy characteristics were compared for births to women who smoked Poster Session III ajog.org
INTRODUCTION:
We sought to examine the rate of pregnancy-associated hypertension according to weight gain between pregnancies among obese women.
METHODS:
This was a retrospective cohort study of all women who had at least two pregnancies at 23 weeks' gestation or greater at a single academic institution. Women with prepregnancy body mass index (BMI kg/m2) less than 30 kg/m2 in the first pregnancy, a history of chronic hypertension, or pregestational diabetes in the first pregnancy were excluded. Women were stratified based on weight change between pregnancies. Our primary outcome was the rate of pregnancy-associated hypertension (gestational hypertension or preeclampsia). A multivariable logistic regression analysis was performed to calculate adjusted odds ratios (OR) and 95% confidence intervals (95% CI), controlling for predefined covariates.
RESULTS:
Of 1,046 women, 248 (23.7%), 453 (43.3%), and 345 (33.0%) had weight loss (BMI>2 kg/m2), stable weight (BMI change -2 to +2 kg/m2), and weight gain (BMI>2 kg/m2), respectively. Women with weight gain compared to those with stable weight were more likely to have pregnancy-associated hypertension (14.5% vs. 7.1%; adjusted OR 1.96 [95% CI 1.20–3.22]). Women with weight loss compared to those with stable weight had a similar rate of pregnancy-associated hypertension (2.1% vs. 7.1%; adjusted OR 0.96 [95% CI 0.52–1.78]).
CONCLUSION:
In our cohort of obese multiparous women, weight gain was associated with increased odds of pregnancy-associated hypertension compared to a stable weight.
INTRODUCTION:
The vaginal birth after cesarean (VBAC) calculator developed by the MFMU Network helps to identify the likelihood of VBAC. It is not clear if undergoing a trial of labor after cesarean section (TOLAC) is associated with adverse maternal outcomes if the VBAC success rate is low. We compared maternal outcomes of TOLAC to those of elective repeat cesarean delivery after stratifying by the VBAC likelihood.
METHODS:
This was a retrospective cohort study of all women whose primary cesarean delivery and subsequent singleton delivery occurred at our academic center. Data from the second pregnancy were analyzed. The likelihood of VBAC success was categorized using the MFMU VBAC calculator, (less than 60% and 60–100%). The primary outcome was a composite of maternal complications (uterine rupture, postpartum hemorrhage). Multivariable logistic regression was used to calculate adjusted odds ratio (OR) and 95% confidence interval (CI).
RESULTS:
Of 626 women, 469 (75%) and 157 (25%) had VBAC likelihood of 60–100% and less than 60%, respectively. Women with VBAC likelihood less than 60% and likelihood of 60–100% who had underwent TOLAC were compared with those who had an elective repeat cesarean. Both groups had similar rates of the primary outcomes; likelihood less than 60% (25% vs. 16.5%; adjusted OR 1.51 [95% CI 0.60–3.78]) and likelihood 60–100% (14.3% vs 13.8%; adjusted OR 1.04 [95% CI 0.60–1.79]).
CONCLUSION:
Women with a history of a primary cesarean delivery, who underwent TOLAC compared to those who had an elective repeat cesarean had similar odds of maternal adverse outcomes regardless of the VBAC likelihood.
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