BACKGROUND:Prenatal ultrasonography allows for timely identification of fetal abnormalities that can have an effect on securing the neonatal airway at delivery. We illustrate the role of antenatal three-dimensional printing in cases with fetal airway obstruction.CASE:We present two cases that highlight the utility of a three-dimensional printing technique to aid in ex utero intrapartum treatment procedures during cesarean delivery.CONCLUSION:Three-dimensional printing plays a complementary role to standard imaging options in optimizing presurgical planning, prenatal parental counseling, personalized patient care, and education of the multidisciplinary team in cases of fetal congenital airway obstruction.
INTRODUCTION: In the age of evidence-based medicine, physicians are expected to adapt quickly to changing recommendations. The Society of Gynecologic Oncology (SGO) released a practice statement in November 2013 recommending providers consider performing salpingectomy concurrently with other pelvic surgeries for prevention of epithelial ovarian cancers. This study evaluates practice changes from tubal ligation to salpingectomy for surgical sterilization at an academic center following these recommendations. METHODS: This IRB approved, retrospective cohort study evaluated interval surgical sterilization procedures performed in an academic medical center between 1/1/2012 and 12/31/2018. Descriptive statistics compared rates of salpingectomy with tubal ligation before and after 1/1/2014, as well as annually. A multivariable regression model was fit to the data to adjust for potential confounding differences between populations. RESULTS: 243 surgical sterilization procedures were performed during the study time period. Salpingectomy accounted for 0/64 (0%) prior to the recommendation release and 86/168 (51.19%) after the release, (PP=.0279). Mean surgical duration was 8.5 minutes longer after the recommendation release, (P=.0019). There were no differences in blood loss, intraoperative or postoperative complications. CONCLUSION: Significant practice change in sterilization method from tubal ligation to salpingectomy occurred immediately following the SGO recommendations, however complete adoption of these recommendations (defined as 95% of procedures) took 4 years to achieve.
INTRODUCTION: Our study models the trade-off between preterm neonatal morbidity and stillbirth for women with intrahepatic cholestasis of pregnancy (ICP) with total bile acids (TBA) between 40 and 99 µmol/L in order to determine the optimal gestational age for delivery. METHODS: A decision analytic model was created to compare the outcomes of delivery at 33 through 40 weeks gestation in women with TBA between 40 and 99 µmol/L. Baseline morbidity and mortality risks were derived from the literature and adjusted where appropriate for peak TBA and administration of antenatal steroids. We assumed a population of 10,000 women with ICP and calculated total quality-adjusted life years (QALYs) for each strategy, taking into account both maternal and neonatal perspectives. Univariate sensitivity analysis was performed for all variables to test the robustness of the model. RESULTS: In women with TBA between 40 and 99 µmol/L, delivery at 39 weeks maximized QALYs, resulting in 700.6 more QALYs but 5.3 more stillbirths than delivery at 36 weeks. Sensitivity analysis demonstrated that delivery at 38 weeks became optimal when the relative risk of stillbirth given TBA between 40 and 99 µmol/L rose from a baseline of 1.00 to 4.91. Monte Carlo analysis demonstrated that when variation was incorporated into the model, delivery at 39 weeks was optimal 38% of the time and delivery at 38 weeks 25% of the time. CONCLUSION: In women with ICP with TBA between 40 and 99 µmol/L, delivery between 38 and 39 weeks may be optimal.
INTRODUCTION: Clear guidelines for toxicology testing of pregnant women are lacking, despite significant repercussions associated with positive tests. Implicit bias may lead to inconsistent ordering of urine toxicology (UTox) in pregnancy. METHODS: We reviewed all births from 1/1/2015 to 12/31/2018, and identified mothers with UTox sent outside of routine prenatal care. Demographic data was compared in women with UTox and without. Sociodemographic characteristics were examined with Chi-square, fisher's exact, or Wilcoxon rank sum test; adjusted logistic regression models were used for multivariate analysis. Models were adjusted for age, race, marital status, and mean income by residential ZIP code. RESULTS: UTox was sent on 2.8% (574) of 20,274 mothers. Women with UTox were younger (PPPP CONCLUSION: Maternal age, race, marital and socioeconomic status may impacted providers' decisions to order urine toxicology testing. Evidence-based guidelines for toxicology evaluation are essential to more appropriately triage women for whom testing is medically indicated, and to decrease implicit bias in decision making.
BACKGROUND: Fetal tachycardia can occur with maternal fever (hyperthermia); therefore, a low maternal temperature (hypothermia) might produce fetal bradycardia. CASES: Five cases of fetal bradycardia are presented in gestations complicated by maternal hypothermia. The fetal heart rate (FHR) tracings demonstrated stable baselines of 88-96 beats per minute with moderate variability and accelerations. All baselines returned to normal after maternal warming measures. CONCLUSION: A possible cause for fetal bradycardia with a stable baseline and moderate variability is maternal hypothermia, a pattern not indicative of fetal hypoxia. Delivery is not indicated, and maternal warming results in FHR baseline normalization.
