Objective: The goal of this study was to delineate the epidemiology of echocardiographically diagnosed pulmonary hypertension (PH) in extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) requiring prolonged positive pressure ventilation (PPV), and to determine the independent relationship between PH and mortality in these patients. Result:We identified 216 patients (19%) with BPD requiring prolonged PPV among 1156 ELBW infants. Of these patients, 41% received echocardiography after 4 weeks of life, with 37% showing evidence of PH. Logistic regression analysis demonstrated that infants with BPD requiring prolonged PPV, with PH detectable by echocardiogram, were four times more likely to die (adjusted odds ratio): 4.6, 95% confidence interval: 1.3-16.5) when compared with infants with BPD requiring prolonged PPV without echocardiographic evidence of PH.Conclusion: Pulmonary hypertension appears to be an important, independent determinant of death in infants with BPD requiring prolonged PPV.

Heavy menstrual bleeding (HMB) is a common gynecological problem that has a significant impact on a woman’s quality of life and the activities of daily living. Due to the difficulty in accurately describing menstrual bleeding abnormalities using older terminology, the PALM-COEIN classification system of the Federation Internationale de Gynecologie et d’Obstetrique was proposed to describe and identify the etiology of abnormal endometrial bleeding. As there is no single pathway that is associated with HMB, there are several therapeutic interventions involving different molecular pathways to reduce HMB. This article will highlight the current evidence as it relates to the etiology of HMB as well as medical modalities of treatment.

Hysteroscopic resection of submucous uterine fibroids should be a simple, well tolerated and effective procedure. Innovations to the existing hysteroscopic techniques and the development of the hysteroscopic morcellator will hopefully result in a greater number of gynecologic surgeons being able to safely perform hysteroscopic resection of submucous uterine fibroids.

Preterm birth is a profound public health issue. Despite a decrease in the mortality rate after extremely preterm birth, the morbidity is increasing. 1 Preterm births contribute to 75% of all perinatal mortality and more than half the long-term morbidity in infant survivors. 2 It has been estimated that $30 to 35% of preterm births are medically indicated, 40 to 45% are attributed to spontaneous preterm labor, and 25 to 30% follow preterm premature rupture of membranes (PROM). 3 Based on U.S. birth records, Martin et al found that in 2006, one of every eight twins and one of three triplets were born at less than 32 weeks compared with 1 of 50 singletons. 4 The rates of preterm birth at <37 weeks of gestation and at <32 weeks of gestation are 11.1% and 1.6% for singletons, 92.6% and 12.1% for twins, 92.6% and 36.3% for triplets, 94.9% and 79.2% for quadruplets, and 89.6% and 79.1% for quintuplet pregnancies, respectively. 4 PROM is defined as rupture of the amniotic membranes before the onset of labor. Preterm PROM occurs at less than 37 weeks of gestation. PROM occurs in 1 to 2% of pregnancies nationally and is reported to recur in 21% of cases. 5 It is well known that PROM is associated with an increase in complications of pregnancy such as cord prolapse, placental Keywords ► PROM ► preterm/premature birth ► multifetal gestation ► preterm rupture of membranes ► preterm labor AbstractObjective To compare the relative contribution of premature rupture of membranes (PROM) to preterm births in singleton compared with multifetal gestations. Study Design A population-based retrospective cohort study of 291,782 nonanomalous live births in the state of Ohio from January 1, 2006, to December 31, 2007, identified through birth certificate data. Frequency of PROM was compared between singleton and multifetal gestations and then stratified by gestational age at birth. Multivariate regression analysis estimated the risk of PROM by plurality in each gestational age group, accounting for influential risk factors. Results The frequency of PROM increased with increasing plurality of gestation. The relative proportion of preterm birth <37 weeks complicated by PROM increased with gestational plurality 13.2% singletons, 16.8% twins, 20.0% triplets, 19.6% quadruplets, and 100% for higher-order multiples (p < 0.001). The frequency of PROM increased with earlier gestational age at birth, regardless of plurality. The increased risk of PROM in multifetal gestation persisted even after adjustment for influential concomitant risk factors. Conclusion The proportion of preterm birth attributable to PROM increases by plurality of gestation, with its most significant contribution in higher-order multiples and at earliest gestational ages when outcomes are the poorest.