Vintzileos

This article examines the applicability of obstetrical randomized controlled trials (RCTs) in the real-world and proposes a classification of the value of these trials based on their potential for achieving sustainable practices. In the context of this discussion, real-world results pertain to the potential impact of the RCT on sustainable interventions and practices, and its implications for healthcare practice or policy, in the country (or countries) that was conducted. While RCTs are generally regarded as the gold standard of medical evidence, their effectiveness in producing meaningful real-world results depends, among various other factors, on the clarity and specificity of the trial definitions used for diagnosis (characteristics of the study group or enrollment criteria) and treatment (intervention)...

Hippocrates, an influential figure in ancient Greek medicine, is best known for his lasting contribution, the Hippocratic Oath, which includes a significant message about obstetrics and gynecology. Given the Oath's status as a widely regarded ethical code for medical practice, it requires critical evaluation. The message of the Oath, as it related to obstetrics and gynecology, is expressed in ancient Greek by the phrase "οὐδὲ γυναικὶ πεσσὸν φθόριον δώσω" which translates directly to "I will not give to any woman a harming pessary...

OBJECTIVE: To evaluate whether insemination via intracytoplasmic sperm injection provides any benefit over in vitro fertilization for non-male factor infertility with respect to pre-implantation genetic testing results and pregnancy outcome. DESIGN: Retrospective Cohort Study of the Society for Assisted Reproductive Technology database. SUBJECTS: Patients undergoing in vitro fertilization or intracytoplasmic sperm injection in non-male factor pre-implantation genetic testing for aneuploidy cycles...

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Fetal acidemia is a common final pathway to fetal death, and in many cases, to fetal central nervous system injury. However, certain fetal pathophysiological processes are associated with significant category II or category III fetal heart rate changes before the development of or in the absence of fetal acidemia. The most frequent of these processes include fetal infection and/or inflammation, anemia, fetal congenital heart disease, and fetal central nervous system injury. In the presence of significant category II or category III fetal heart rate patterns, clinicians should consider the possibility of the aforementioned fetal processes depending on the clinical circumstances...

BACKGROUND: Diabetes mellitus is a common medical complication of pregnancy, and its treatment is complex. Recent years have seen an increase in the application of mobile health tools and advanced technologies, such as remote patient monitoring, with the aim of improving care for diabetes mellitus in pregnancy. Previous studies of these technologies for the treatment of diabetes in pregnancy have been small and have not clearly shown clinical benefit with implementation. OBJECTIVE: Remote patient monitoring allows clinicians to monitor patients' health data (such as glucose values) in near real-time, between office visits, to make timely adjustments to care...

No abstract text is available yet for this article.

Growth-restricted fetuses are at risk of hypoxemia, acidemia, and stillbirth because of progressive placental dysfunction. Current fetal well-being, neonatal risks following delivery, and the anticipated rate of fetal deterioration are the major management considerations in fetal growth restriction. Surveillance has to quantify the fetal risks accurately to determine the delivery threshold and identify the testing frequency most likely to capture future deterioration and prevent stillbirth. From the second trimester onward, the biophysical profile score correlates over 90% with the current fetal pH, and a normal score predicts a pH >7...

BACKGROUND: Cesarean delivery rates have been used as obstetrical quality indicators. However, these approaches do not consider the accompanying maternal and neonatal morbidities. A challenge in the field of obstetrics has been to establish a valid outcomes quality measure that encompasses preexisting high-risk maternal factors and associated maternal and neonatal morbidities and is universally acceptable to all stakeholders, including patients, healthcare providers, payers, and governmental agencies...

AIM: We aimed to evaluate the addition of fetal thigh circumference (TC) to other ultrasound parameters to predict fetal weight compared to two standard formulae (Hadlock's and Vintzileos methods). METHODS: We conducted this prospective study on pregnant women between November 2018 and September 2019. The actual fetal weight was estimated within 48 h of delivery; then, it was compared to the estimated fetal weight by ultrasound. We used the Statistical Package for the Social Sciences (SPSS) software version 20...

BACKGROUND: Telemedicine (TM) in obstetrics has mostly been described in rural areas with limited access to subspecialties. During the COVID-19 pandemic, health systems rapidly expanded telemedicine services for urgent and non-urgent health care delivery even in urban settings. The NYU Health system implemented a prompt system -wide expansion of video-enabled telemedicine visits increasing TM to over 8000 visits daily within 6 weeks. Limited studies explore patient and provider satisfaction of telemedicine visits in obstetric patients during the COVID-19 epidemic, particularly in the United States...

One of the most important challenges in obstetrics is to determine the appropriate time to deliver the fetus without exposing the mother to unnecessary operative interventions. The use of continuous cardiotocography (cCTG) during labor has resulted in dramatic reductions in intrapartum fetal deaths, but fetal central nervous system (CNS) injury and cerebral palsy (CP) rates have remain relatively unchanged as related to the use of cCTG . In our view, this is due to continuing inability to recognize progressive fetal deterioration and intervene promptly prior to the development of fetal CNS injury...

BACKGROUND: Accurate identification of the women who will have spontaneous preterm birth continues to be a great challenge. The use of cervical elastography for prediction of preterm birth is promising, but several limitations exist. Newer cervical elastography technology has been developed that may prove useful in evaluation of risk of preterm birth. OBJECTIVE: This study aimed to develop standard cervical elastography nomograms for singleton pregnancies at 18 to 22 weeks' gestation using the E-Cervix ultrasound application, assess intraobserver reliability of the E-Cervix elastography parameters, and determine whether these cervical elastography measurements can be used in the prediction of spontaneous preterm birth...

OBJECTIVE: To compare the risk of intrauterine fetal death (20 weeks of gestation or later) and neonatal death among individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared with those who tested negative for SARS-CoV-2 on admission for delivery. DATA SOURCES: MEDLINE, Ovid, EMBASE, Cumulative Index to Nursing and Allied Health, and Cochrane Library were searched from their inception until July 17, 2020. Hand search for additional articles continued through September 24, 2020...

No abstract text is available yet for this article.

OBJECTIVE: The objectives of our study were to: (1) evaluate the prevalence of cesarean delivery due to maternal request among nulliparous, term, singleton, vertex (NTSV) patients; (2) identify the clinical profile, if any, of these patients; and (3) compare the perinatal outcomes between NTSV patients who requested a cesarean delivery versus patients who did not request cesarean delivery. STUDY DESIGN: This was a retrospective case control study performed at a single institution between November 2018 and July 2019...

BACKGROUND: There is a paucity of data describing the effects of coronavirus disease 2019 on placental pathology, especially in asymptomatic patients. Although the pathophysiology of coronavirus disease 2019 is not completely understood, there is emerging evidence that it causes a severe systemic inflammatory response and results in a hypercoagulable state with widespread microthrombi. We hypothesized that it is plausible that a similar disease process may occur in the fetal-maternal unit...

OBJECTIVE: To determine the incidence of fallopian tube endometriosis in patients undergoing laparoscopic surgery with a preoperative diagnosis of endometriosis, pelvic pain, infertility, or cystic adnexal mass. DESIGN: Retrospective cross-sectional study. SETTING: Gynecologic oncology and minimally invasive surgery practice. PATIENT(S): All patients who underwent surgery for endometriosis from July 2015 to June 2018 were included...

BACKGROUND: A significant number of infectious diseases display seasonal patterns in their incidence, including human coronaviruses. Betacoronaviruses such as MERS-CoV and SARS-CoV are not thought to be seasonal. METHODS: We examined climate data from cities with significant community spread of COVID-19 using ERA-5 reanalysis, and compared to areas that are either not affected, or do not have significant community spread. FINDINGS: To date, Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, has established significant community spread in cities and regions along a narrow east west distribution roughly along the 30-50o N' corridor at consistently similar weather patterns consisting of average temperatures of 5-11oC, combined with low specific (3-6 g/kg) and absolute humidity (4-7 g/m3)...

Importance: Coronavirus disease 2019 (COVID-19) infection has resulted in a global crisis. Investigating the potential association of climate and seasonality with the spread of this infection could aid in preventive and surveillance strategies. Objective: To examine the association of climate with the spread of COVID-19 infection. Design, Setting, and Participants: This cohort study examined climate data from 50 cities worldwide with and without substantial community spread of COVID-19...