American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Feb 2015
Review Practice GuidelineSociety for maternal-fetal medicine (SMFM) clinical guideline #7: nonimmune hydrops fetalis.
Nonimmune hydrops is the presence of ≥2 abnormal fetal fluid collections in the absence of red cell alloimmunization. The most common etiologies include cardiovascular, chromosomal, and hematologic abnormalities, followed by structural fetal anomalies, complications of monochorionic twinning, infection, and placental abnormalities. We sought to provide evidence-based guidelines for the evaluation and management of nonimmune hydrops fetalis. ⋯ Evaluation of hydrops begins with an antibody screen (indirect Coombs test) to determine if it is nonimmune, detailed sonography of the fetus(es) and placenta, including echocardiography and assessment for fetal arrhythmia, and middle cerebral artery Doppler evaluation for anemia, as well as fetal karyotype and/or chromosomal microarray analysis, regardless of whether a structural fetal anomaly is identified. Recommended treatment depends on the underlying etiology and gestational age; preterm delivery is recommended only for obstetric indications including development of mirror syndrome. Candidates for corticosteroids and antepartum surveillance include those with an idiopathic etiology, an etiology amenable to prenatal or postnatal treatment, and those in whom intervention is planned if fetal deterioration occurs. Such pregnancies should be delivered at a facility with the capability to stabilize and treat critically ill newborns. The prognosis depends on etiology, response to therapy if treatable, and the gestational age at detection and delivery. Aneuploidy confers a poor prognosis, and even in the absence of aneuploidy, neonatal survival is often <50%. Mirror syndrome is a form of severe preeclampsia that may develop in association with fetal hydrops and in most cases necessitates delivery.
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Am. J. Obstet. Gynecol. · Feb 2015
The impact of adoption of the international association of diabetes in pregnancy study group criteria for the screening and diagnosis of gestational diabetes.
The objective of the study was to compare the International Association of Diabetes in Pregnancy Study Group (IADPSG) and the Canadian Diabetes Association (CDA) criteria for the diagnosis of gestational diabetes mellitus (GDM). ⋯ The use of the IADPSG criteria instead of the CDA criteria would result in a considerable increase in the rate of GDM, but this also appears to identify additional women at similar risk of adverse pregnancy outcome. Further studies are needed to determine whether this observation persists after controlling for confounders such as body mass index as well as whether treatment in these cases would improve perinatal outcome.
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Am. J. Obstet. Gynecol. · Feb 2015
Comparative StudySeverity of influenza and noninfluenza acute respiratory illness among pregnant women, 2010-2012.
The objective of the study was to identify characteristics of influenza illness contrasted with noninfluenza acute respiratory illness (ARI) in pregnant women. ⋯ Influenza had a greater negative impact on pregnant women than noninfluenza ARIs, as indicated by symptom severity and greater likelihood of elevated temperature. These results highlight the importance of preventing and treating influenza illnesses in pregnant women.
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Am. J. Obstet. Gynecol. · Feb 2015
Mode of delivery and postpartum depression: the role of patient preferences.
The purpose of this study was to explore the relationship between strength of preference for vaginal delivery, delivery mode undergone, and postpartum depression. ⋯ Women who have a strong antepartum preference for vaginal delivery and deliver by cesarean may be at increased risk for depression in the early postpartum period.
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Am. J. Obstet. Gynecol. · Feb 2015
Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique.
Multiple reports suggest that laparoendoscopic single-site surgery is technically feasible, safe, and effective in treating a variety of gynecological disease processes. The study purpose was to assess the feasibility and safety of a novel robotic single-site platform (R-LESS) for the surgical treatment of benign and malignant gynecological conditions. ⋯ We present one of the first series of robotic laparoendoscopic single-site surgery for the treatment of various gynecological conditions. When performed by experienced minimally invasive surgeons, R-LESS is feasible and safe in select patients. Further studies are needed to better define the ideal gynecological procedures to perform using robotic single-site surgery and to assess the benefits and costs of R-LESS compared with multiport robotic and conventional laparoscopic approaches.