American Journal of Obstetrics and Gynecology

BACKGROUND: Most fetal deaths are unexplained. Long QT syndrome (LQTS) is a genetic disorder of cardiac ion channels. Affected individuals, including fetuses, are predisposed to sudden death. We sought to determine the risk of fetal death in familial LQTS, in which the mother or father carries LQTS genotype. In addition, we assessed whether risk differed if the LQTS genotype was inherited from the mother or father. OBJECTIVE: (s): This was a retrospective review of pregnancies in families with the 3 most common heterozygous pathogenic LQTS genotypes in KCNQ1 (LQT1), KCNH2 (LQT2) or SCN5A (LQT3), which occur in ∼1/2000 individuals...

BACKGROUND: Fragmentation of care, wherein a patient is discharged from an index hospital and undergoes an unexpected readmission to a non-index hospital, is associated with increased risk of adverse outcomes. Fragmentation is not well characterized in ovarian cancer. OBJECTIVE: The objective of this study was to assess risk factors and outcomes associated with fragmentation of care among women who undergo surgical treatment of ovarian cancer. STUDY DESIGN: The Nationwide Readmission Database was used to identify all-cause 30-day and 90-day postoperative readmissions following surgical management of ovarian cancer between 2010-2014...

BACKGROUND: There is a robust association between altered angiogenic factor concentrations, including placental growth factor and clinically recognized preeclampsia. Alterations in concentrations of angiogenic factors precede the clinical onset of preeclampsia by several weeks. The temporal relationship between the measured angiogenic factors and the time to delivery in women presenting with suspected preeclampsia at <35weeks gestation, however remains to be clarified. OBJECTIVES: To examine the relationship between placental growth factor (PlGF) and time-to-delivery in women <35 weeks' gestation presenting with signs or symptoms of preeclampsia, and to compare the performance of PlGF to other clinical markers for prediction of time-to-delivery in preeclampsia...

Vaginitis is one of the most common causes of patient visits to gynecologists, primary care providers, and urgent care centers. However, many women leave without a clear diagnosis or experience recurrent symptoms despite treatment. The three most common etiologies of vaginitis are trichomonas, bacterial vaginosis, and vulvovaginal candidiasis, which account for an estimated 70% of cases. The remaining 30% may be related to other causes of vaginitis, including atrophic vaginitis, desquamative inflammatory vaginitis, and vaginal erosive disease...

Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge or malodor, affecting up to one-third of US women. Most women with BV are unaware of the infection, making it difficult to diagnose in the absence of a microscopic examination of vaginal discharge or using point-of-care testing. Untreated BV elevates the risk of postoperative surgical infections in women undergoing obstetric and gynecologic procedures. Treatment with antimicrobial agents that target BV has been shown to reduce the rate of postoperative infections following hysterectomy and surgical abortions...

The risk of maternal death in the U.S. is higher than peer nations and rising, and varies dramatically by the race and place of residence of the woman. Critical efforts to reduce maternal mortality include patient risk stratification and system-level quality improvement efforts targeting specific aspects of clinical care. These efforts are important for addressing the causes of an individual's risk, but research to date suggests that individual risk factors alone do not adequately explain between-group disparities in pregnancy-related death by race, ethnicity, or geography...

BACKGROUND: Extremely preterm infants born at <29 weeks gestational age (GA) are at high risk of death or severe neurological injury (SNI). Several individual evidence-based practices (EBPs) have been associated with neuroprotection. OBJECTIVE: To investigate the cumulative effect of four EBPs and their association with death and/or SNI among infants born at <29 weeks GA. STUDY DESIGN: Observational study of infants born at 230 -286 weeks GA admitted to NICUs participating in the Canadian Neonatal Network from 2015-2017...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

OBJECTIVE: DATA: Pre-conception or early administration of low-dose aspirin might improve endometrial growth, placental vascularization and organogenesis. Most studies have evaluated the potential benefit of pre-conception or early administration of low-dose aspirin in women with a history of recurrent pregnancy loss, women who have undergone in vitro fertilization or women with thrombophilia or antiphospholipid syndrome. These women are at an increased risk of placenta-associated complications of pregnancy, including preeclampsia, preterm delivery and fetal growth restriction...

OBJECTIVE: Antenatal corticosteroids (ACS) are the standard of care for maturing the fetal lung and improving outcomes for preterm infants. ACS dosing remains un-optimized, and there is little understanding of how different treatment to delivery intervals may affect treatment efficacy. The durability of a lung maturational response is important because the majority of women treated with ACS do not deliver within the widely accepted 1-7 day window of treatment efficacy. We used a sheep model to test duration of fetal exposures for efficacy at delivery intervals from 1 to 10 days...

Human papilloma virus is the primary causative agent for cervical cancer, and vaccination is the primary means of preventing anogenital cancers caused by human papilloma virus infection. Despite the availability of human papilloma virus vaccines for over a decade, coverage rates lag behind the other vaccines. Public concerns regarding safety of human papilloma virus vaccines have been identified as an important barrier to vaccination, including concerns that the human papilloma virus vaccine causes primary ovarian insufficiency, driven in part by isolated reports of ovarian failure following the human papilloma virus vaccine...

There has been a recent significant evolution in suggested practices for the management of labor due to the increased national cesarean delivery rate. One of the most significant changes was promulgated by the 2014 Obstetric Care Consensus titled, "Safe Prevention of Primary Cesarean Delivery" which recommended reconsideration of the upper limits of the length of labor in the second stage as well as the first stage. We previously published a 2016 Clinical Opinion challenging the second stage practice change...

No abstract text is available yet for this article.

Genitourinary syndrome of menopause is a condition describing the hypoestrogenic effects on the female genitals and lower urinary tract leading to symptoms such as vaginal dryness, vulvar and vaginal burning, dyspareunia and dysuria. Genitourinary syndrome of menopause is experienced by over half of postmenopausal women, and is even more pervasive in women with cancer. Due to treatments such as surgery, chemotherapy, radiation, and hormonal therapy, women may experience early menopause resulting in earlier and more severe symptoms...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Women treated for high-grade cervical intraepithelial neoplasia (CIN, grade 2 or 3) are at elevated risk of developing cervical cancer. Suggested factors identifying women at highest risk for recurrence post-therapeutically include incomplete lesion excision, lesion location, size and severity, older age, treatment modality and presence of high-risk human papilloma virus (hrHPV) after treatment. This question has been intensively investigated over decades, but there is still substantial debate as to which of these factors or combination of factors most accurately predict treatment failure...

No abstract text is available yet for this article.

No abstract text is available yet for this article.