American Journal of Obstetrics and Gynecology

BACKGROUND: Obstetrical levator ani muscle avulsion is detected after 10-30% of vaginal deliveries and is associated with pelvic organ prolapse later in life. However, the mechanism by which levator avulsion may contribute to prolapse is unknown. OBJECTIVES: This study investigated the extent by which size of the levator hiatus and pelvic muscle weakness may explain the association between levator avulsion and pelvic organ prolapse. STUDY DESIGN: This was a supplementary study of a longitudinal cohort of parous women enrolled 5-10 years after first delivery and assessed annually for prolapse (defined as descent beyond the hymen) for up to 9 annual visits...

BACKGROUND: Contraception use among postpartum women is important to prevent unintended pregnancies and optimize birth spacing. Long-acting reversible contraception (LARC), including intrauterine devices and implants, is highly effective, yet compared to less effective methods utilization rates are low. OBJECTIVES: We sought to estimate prevalence of LARC use among postpartum women and examine factors associated with LARC use among those using any reversible contraception...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Open maternal-fetal surgery (OMFS) for fetal myelomeningocele (fMMC) results in reduction in neonatal morbidity related to spina bifida but may be associated with fetal, neonatal, and maternal complications in subsequent pregnancies. OBJECTIVE: The objective of this study was to ascertain obstetric risk in subsequent pregnancies after OMFS for fMMC closure. STUDY DESIGN: An international multicenter prospective observational registry created to track and report maternal, obstetric, fetal/neonatal and subsequent pregnancy outcomes following OMFS for fMMC, was evaluated for subsequent pregnancy outcome variables...

BACKGROUND: Pregnancy interventions that improve maternal and infant outcomes are urgently needed in populations with high rates of obesity. We undertook the Healthy Mums and Babies (HUMBA) randomized controlled trial to assess the effect of dietary interventions and or probiotics in a multiethnic population of pregnant women with obesity, living in an area of high deprivation. OBJECTIVES: To determine whether a culturally-tailored dietary intervention and or daily probiotic capsules in pregnant women with obesity reduces the co-primary outcomes of a) excessive gestational weight-gain (mean >0...

BACKGROUND: Third trimester studies in selected high-risk pregnancies have reported that low cerebroplacental ratio (CPR), due to high pulsatility index (PI) in the umbilical artery (UA), and or decreased PI in the fetal middle cerebral artery (MCA), is associated with increased risk of adverse perinatal outcomes. OBJECTIVE: To investigate the predictive performance of screening for adverse perinatal outcome by the cerebroplacental ratio (CPR) measured routinely at 35 - 37 weeks' gestation...

BACKGROUND: Ex-vivo uterine environment (EVE) therapy is an experimental life support platform designed to reduce the risk of morbidity and mortality for extremely preterm infants born at the border of viability (21-24 weeks gestation). To spare the functionally immature lung, this platform performs gas exchange via a membranous oxygenator connected to the umbilical vessels, and the fetus is submerged in a protective bath of artificial amniotic fluid. We and others have demonstrated the feasibility of extended survival with EVE therapy in late preterm fetuses; however, there is presently no evidence to show that the use of such a platform can support extremely preterm fetuses, the eventual translational target for therapy of this nature...

BACKGROUND: Occult uterine cancer at the time of benign hysterectomy poses unique challenges in patient care. There is large variability and uncertainty in estimated risk of occult uterine cancer in the literature and prior research often did not differentiate/include all subtypes. OBJECTIVES: To thoroughly examine the prevalence of occult uterine cancer in a large population-based sample of women undergoing hysterectomy for presumed benign indications and to identify associated risk factors...

Maternal mortality continues to be a public health priority in national and international communities. Maternal death rates secondary to medical illnesses such as cardiovascular disease, preeclampsia, and postpartum hemorrhage are well documented. The rates of maternal death secondary to self-harm, including suicide and overdose, have been omitted from published rates of maternal mortality, despite growing attention to the prevalence of perinatal mood disorders, estimated at up to 15% of pregnant and postpartum women in the United States...

No abstract text is available yet for this article.

The worldwide incidence of abnormally invasive placenta is rapidly rising following the trend of increasing caesarean delivery. It is a heterogeneous condition and has a high maternal morbidity and mortality rate, presenting specific intra-partum challenges. Its rarity makes developing individual expertise difficult for the majority of clinicians. The International Society for Abnormally Invasive Placenta aims to improve clinicians understanding and skills in managing this difficult condition. By pooling knowledge, experience and expertise gained within a variety of different healthcare systems the society seeks to improve the outcomes for women with abnormally invasive placenta globally...

BACKGROUND: The transfer of pathogenic immunoglobulin G antibodies from mother to fetus is a critical step in the pathophysiology of alloimmune and autoimmune diseases of the fetus and neonate. Immunoglobulin G transfer across the human placenta to the fetus is mediated by the neonatal Fc receptor, and blockade of the neonatal Fc receptor may provide a therapeutic strategy to prevent or minimize pathological events associated with immune-mediated diseases of pregnancy. M281 is a fully human, aglycosylated monoclonal immunoglobulin G1 anti-neonatal Fc receptor antibody that has been shown to block the neonatal Fc receptor with high affinity in nonclinical studies and in a phase 1 study in healthy volunteers...

BACKGROUND: Supplemental oxygen is administered to pregnant women in many different clinical scenarios in obstetric practice. Despite the accepted uses for maternal hyperoxygenation, the impact of hyperoxia on maternal hemodynamic indices has not been evaluated. As a result, there is a paucity of data in the literature in relation to the physiological changes to the maternal circulation in response to supplemental oxygen. OBJECTIVE: The hemodynamic effects of oxygen therapy are under-recognized and the impact of hyperoxygenation (HO) on maternal hemodynamics is currently unknown...

The Centers for Disease Control and Prevention have demonstrated continuous increased risk for maternal mortality and severe morbidity with racial disparities among non-Hispanic black women an important contributing factor. More than 50,000 women experienced severe maternal morbidity in 2014 with a mortality rate of 18.0 per 100,000, higher than many other developed countries. In 2012 the first "Putting the 'M' back in Maternal Fetal Medicine" session was held at the Society for Maternal Fetal Medicine's (SMFM) Annual Meeting...

BACKGROUND: Primary gynecological neuroendocrine tumors (gNET) are uncommon malignant neoplasms associated with poor prognosis. Clinically these tumors present a significant challenge due to the lack of standardized management guidelines. OBJECTIVE: The objective of this study is to evaluate the clinicopathologic features, incidence and survival trends in gNET. STUDY DESIGN: Surveillance, Epidemiology and End Results (SEER) cancer registry was queried for women diagnosed with primary gNET from 1987-2012...

BACKGROUND: Surgical site infections are associated with significant healthcare cost and burden. Silver impregnated dressings have been associated with a decrease in surgical site infections in select populations but it is unknown if the benefit can be observed after cesarean deliveries. OBJECTIVE: We sought to evaluate the impact of silver nylon dressings in reducing superficial surgical site infections after cesarean delivery. STUDY DESIGN: A blinded randomized clinical trial of women undergoing scheduled or unscheduled cesarean delivery at a single site was conducted...

BACKGROUND: Menstrual symptoms like dysmenorrhea, heavy menstrual bleeding, and perimenstrual mood disorders are known to be widespread among the general population. From studies in patients with endometriosis and premenstrual disorder, it has been shown that these symptoms can have a large impact on women's quality of life and account for substantial healthcare use. Furthermore, it is estimated that many women initially do not consult a doctor while facing menstrual symptoms. Consequently, the impact of menstrual symptoms on daily activities in the general population is unknown...

BACKGROUND: Maternal-embryonic crosstalk between the endometrium and the preimplantation embryo is required for normal pregnancy. Our previous results demonstrated that maternal microRNAs secreted into the endometrial fluid, and specifically miR-30d, act as transcriptomic regulator of the pre-implantation embryo by the maternal intrauterine environment. OBJECTIVE: To investigate the reproductive and fetal effects of murine miR-30d deficiency at the maternal-embryonic interface according to the origin of its maternal or embryonic default...

BACKGROUND: Although the evidence regarding the benefit of using ST waveform analysis of the fetal electrocardiogram is conflicting, ST waveform analysis is considered as adjunct to identify fetuses at risk for asphyxia in our center. Most randomized controlled trials and meta-analyses have not shown a significant decrease in umbilical metabolic acidosis while some observational studies have shown a gradual decrease of this outcome over a longer period of time. Observational studies can give more insight into the effect of implementation of the ST technology in daily clinical practice...