Women following vaginal birth after cesarean (VBAC) benefit from lower morbidities and reduced risks for future pregnancies, with the expense of higher rates of post partum complications including post-partum hemorrhage (PPH). This study aimed to investigate the association between the timing of previous cesarean section (CS) and the risk of post-partum adverse maternal outcomes following a subsequent successful VBAC. Retrospective case-control study of women following term vaginal delivery in a university-affiliated medical center between 2008-2018. Post-partum complications were compared between women who had their first VBAC and a control group of women following a vaginal delivery without a prior CS. Additional analysis was performed to evaluate the association between the timing of previous CS and the severity of post-partum adverse outcomes. 2879 women met inclusion criteria , 1455 had VBAC and 1424 had a vaginal delivery without a prior CS. Overall, significant post-partum complications, primarily PPH, were observed in the VBAC group compared to controls. Women with previous CS during the 2nd stage of labor presented a higher rate of PPH with a higher drop in hemoglobin levels when compared to women who underwent either emergent CS during 1st stage of labor or an elective CS (4.3±0.9g/dL vs. 2.8±1.1g/dL vs. 2.4±0.8g/dL, respectively, p=0.033). A concomitant increase in the need for blood transfusion (8.1% vs. 3.5% vs. 2.9%, respectively, p< 0.0001) and uterine atony rates (12.6% vs. 6.2% vs. 4.4%, respectively, p=0.009) was also noted. No significant differences were shown in duration of hospitalization, rate of uterine revision, vacuum assisted deliveries, postpartum urinary retention, endometritis, and obstetric and anal sphincter injuries (OASIS) (Table 1). VBAC is associated with an increased rate of post-partum complications, primarily PPH. The risk is significantly increased in women who were previously operated during the 2nd stage of labor (Figure 1). These data should be considered when counseling women for trial of labor after cesarean (TOLAC).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

This study evaluated the association between timing and indication for previous cesarean section (C-section) and its association with postpartum risks for adverse maternal outcomes, primarily postpartum hemorrhage (PPH) in vaginal birth after cesarean (VBAC). This retrospective case–control study examined women following term vaginal delivery in a university-affiliated medical center between 2008 and 2018. Postpartum complications were compared between women who had their first VBAC and a control group comprised of women who had vaginal delivery without prior C-section. Additional analysis was performed to evaluate the association between the timing of previous C-section and the severity of postpartum adverse outcomes. Of the women meeting the inclusion criteria (n = 2879), 1,455 had VBAC and 1,424 were in the control group. Overall, significant postpartum complications, primarily PPH, were observed in the VBAC group compared to controls. Women who underwent C-section during second-stage of labor experienced higher PPH rates and increased drop in hemoglobin levels compared to women who underwent C-section during the first stage of labor or an elective C-Sect. (4.3 ± 0.9 g/dL vs. 2.8 ± 1.1 g/dL vs. 2.4 ± 0.8, p = 0.033). Concomitant increased need for blood transfusion (8.1% vs. 3.5% vs. 2.9%, respectively, p < 0.0001) and uterine atony (12.6% vs. 6.2% vs. 4.4%, respectively, p = 0.009) were also observed. No significant differences were demonstrated in other postpartum adverse effects evaluated. VBAC is associated with higher rates of postpartum complications, primarily PPH. The risk is significantly increased in VBAC following a second stage cesarean section. This data should be taken into consideration in the management of laboring women after C-section.

This article was corrected to update the spelling of author Ola Gutzeit’s name.

BACKGROUND: Asymptomatic short cervical length is an independent risk factor for spontaneous preterm birth. However, most studies have focused on the associated risk of a short cervical length when encountered between 16 and 23 weeks' gestation. The relationship between cervical length and risk of spontaneous preterm birth after 23 weeks is not well known. OBJECTIVE: To evaluate the risk of spontaneous preterm birth in asymptomatic women with a short cervix (<= 25 mm) at 23-28 weeks' gestation. MATERIALS AND METHODS: A retrospective cohort study of women with asymptomatic short cervix (cervical length <= 25 mm) at extreme prematurity, defined as 23-28 weeks' gestation, was performed at a single center from January 2015 to March 2018. Women with symptoms of preterm labor, multiple gestations, fetal or uterine anomalies, cervical cerclage, or those with incomplete data were excluded from the study. Demographic information as well as data on risk factors for spontaneous preterm birth were collected. Patients were divided into 4 groups based on the cervical length measurement (<= 10 mm, 11-15 mm, 16-20 mm, and 21-25 mm). The primary outcome was time interval from enrollment to delivery. Secondary outcomes included delivery within 1 and 2 weeks of enrollment, gestational age at delivery, and delivery prior to 32, 34, and 37 weeks, respectively. Continuous variables were compared using Kruskal-Wallis test, whereas categorical variables were compared using the chi(2) or Fisher exact test as appropriate. The Wilcoxon test for difference in survival time was used to compare gestational age at delivery among the 4 cervical length groups, with data stratified based on gestational age at enrollment. RESULTS: Of the 126 pregnancies that met inclusion criteria, 22 (17.4%) had a cervical length of <= 10 mm, 23 (18.3%) had a cervical length of 11-15 mm, 37 (29.4%) had a cervical length of 16-20 mm, and 44 (34.9%) had a cervical length of 21-25 mm. Baseline characteristics were similar among all 4 groups. The shorter cervical length group was associated with a shorter time interval from enrollment to delivery (cervical length <= 10 mm, 10 weeks; cervical length 11-15 mm, 12.7 weeks; cervical length of 16-20 mm, 13 weeks; cervical length of 21- 25 mm, 13.2 weeks; P = .006). Regardless of the cervical length measurement, delivery within 2 weeks was extremely uncommon (1 patient; 0.8%). The prevalence of spontaneous preterm birth at <32 weeks or <34 weeks was higher in women with a cervical length of <= 10 mm compared to those with a longer cervical length (P < .001). CONCLUSIONS: The risk of spontaneous preterm birth in asymptomatic women with a sonographic short cervix increases as cervical length decreases. The risk is substantially higher in women with a cervical length of <= 10 mm. Women with a cervical length of <= 10 mm also had the shortest time interval to delivery. Nevertheless, delivery within 1 or 2 weeks is highly unlikely, regardless of the cervical length at the time of enrollment. Therefore, based on our data, we suggest that management decisions such as timing of administration of antenatal corticosteroids in asymptomatic patients with a cervical length of <= 25 mm at 23-28 weeks' gestation may be delayed until additional indications are present.

Objective: In recent years, cell-free DNA screening has significantly reduced the number of invasive prenatal diagnostic testing in pregnancy. Preimplantation genetic testing for aneuploidies (PGT-A) is a commonly performed screening test in in vitro fertilization (IVF) pregnancies. Therefore, we aimed to determine the impact of PGT-A on subsequent utilization of prenatal diagnostic testing in IVF pregnancies. Methods: Retrospective cohort of singleton and twin IVF pregnancies at a single center from January 2014 to December 2017. The rate of invasive diagnostic genetic testing (chorionic villus sampling (CVS) and/or amniocentesis) was compared between patients with pregnancies achieved after transfer of a euploid embryo by PGT-A (n?=?71) and those with pregnancies achieved after transfer of an untested embryo (n?=?38). Wilcoxon rank sum and Fisher?s exact tests were used for statistical analysis. Results: There was no statistically significant difference in the number of prenatal diagnostic procedures (25.4% PGT-A euploid embryo versus 31.6% untested embryo, p?=?.51 and p?=?.32 for one-sided and two-sided analyses, respectively) between the two groups. Maternal age, nuchal translucency measurements and the rate of abnormal sonographic findings were similar between the two groups. Patients without PGT-A pregnancies had a higher BMI (mean 29.6, p?=?.01) and were ethnically different (p?=?.013) compared to those with PGT-A. Conclusion: The implementation of PGT-A in IVF patients did not reduce the number of invasive diagnostic tests performed at our institution.

While it is known that an asymptomatic short cervical length (CL) is an independent risk factor for spontaneous preterm birth (sPTB), it is unclear when the delivery will take place. Subsequently, management decisions such as timing of antenatal corticosteroid (ACS) administration or hospital admission may be suboptimal. Therefore, the purpose of this study was to determine the risk of anticipated delivery in asymptomatic women presenting with a short CL in early viability. A retrospective cohort study of asymptomatic women with short cervix, (CL ≤ 25mm) between 23 and 28 weeks' gestation, at a single center from January 2015 to March 2018 was performed. Women with multiple gestations, fetal anomalies and cervical cerclage were excluded. Demographic information as well as risk factors for sPTB were collected. Cases were divided into 4 groups based on CL measurement (≤ 10mm, 11-15mm, 16-20mm, 21-25mm). The primary outcome was time interval from presentation to delivery (Δt). Secondary outcomes included delivery within 2 weeks of presentation and gestational age (GA) at delivery. Continuous variables were compared using the Kruskal-Wallis test, while categorical variables were compared using Chi-squared or Fisher's exact test as appropriate. The Wilcoxon test for difference in survival time was used to compare GA at delivery among the 4 CL groups with data stratified based on GA at presentation. 126 pregnancies met inclusion criteria. Baseline characteristics were similar among all four groups. Primary and secondary outcomes are reported in Table 1. The probability of delivery as a function of Δt is presented in Figure 1. There was a direct correlation between shorter CL and shorter Δt (p = 0.003). Regardless of the CL at presentation, delivery within 2 weeks was uncommon (1 patient; 0.8%). As expected, the risk for sPTB in asymptomatic women with short cervix increases as the CL shortens, with CL ≤10mm associated with the highest risk. Nevertheless, regardless of the CL, delivery within 2 weeks is highly unlikely. Therefore, we suggest that the timing of administration of ACS in this population should be delayed until additional indications are present.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

INTRODUCTION: Efforts have been made to reduce the rate of cesarean delivery in nulliparous, term, singleton, vertex (NTSV) pregnancies. We set out to evaluate whether labor induction in this patient population is associated with an increased risk of cesarean delivery. METHODS: A meta-analysis was performed analyzing fourteen randomized controlled trials that met inclusion criteria. These included all randomized controlled trials of NTSV patients with intact or ruptured membranes that were randomized to induction of labor or control (i.e. expectant management). The primary outcome was the incidence of cesarean delivery. Secondary outcomes included incidence of cesarean delivery after induction of labor in ruptured versus intact membranes, as well as incidence of NICU admission. Results were reported as odds ratio (OR) with 95% confidence interval (CI). RESULTS: A total of 2,706 patients were analyzed. NTSV gestations undergoing induction of labor had a similar incidence of cesarean delivery compared to controls (24.6% versus 24.6%; OR 1.095; 95% CI 0.89–1.34). Rates of cesarean delivery in patients with intact membranes (28.7% versus 30.2%; OR 1.041; 95% CI 0.81–1.32) and ruptured membranes (15.1% versus 11.9%; OR 1.321; 95% CI 0.88–1.98) undergoing induction were also similar. Likewise, the incidence of NICU admission associated with labor induction was not statistically different compared to control group (6.3% versus 6.9%; OR 0.928; 95% CI 0.59–1.46). CONCLUSION: Hospitals are incentivized to reduce the rate of cesarean sections in NTSV pregnancies. Patients, practitioners and hospitals can be assured that labor induction in this population does not increase the risk of cesarean delivery or NICU admission.

Objective To determine whether abnormal levels of first-trimester maternal serum free beta-hCG and PAPP-A are associated with significant copy number variants (CNVs) on chromosomal microarray analysis (CMA). Methods Results Retrospective cohort of singleton prenatal CMA studies (n = 2880). Cases with an abnormal karyotype, benign familial or de novo variants, and absence of heterozygosity were excluded. The prevalence of abnormal serum analytes was compared between patients with significant CNVs (n = 56) and those with normal CMA (n = 884). Odds ratios (ORs) and 95% confidence intervals (CI) were calculated using Fisher's exact test. Mantel-Haenszel method was utilized to adjust ORs for prenatal diagnostic procedure type and indications for testing. Statistical significance was determined as P value Abnormally low serum free beta-hCG (<= 0.45 MoM) was associated with an increased risk of significant CNVs (OR 3.53, 95% CI, 1.25-8.66, P < 0.01). This association remained significant after adjusting for abnormal nuchal translucency and advanced maternal age (AMA) (adjusted OR 3.04, 95% CI, 1.05-7.48, P < 0.05) or procedure type and AMA (adjusted OR 3.21, 95% CI 1.13-8.16, P < 0.05). The associations of abnormally high serum free beta-hCG, low PAPP-A, and high PAPP-A with significant CNVs were not statistically significant. Conclusion Low first-trimester serum beta-hCG is associated with an increased risk of significant CNVs on CMA.

To determine whether abnormal first trimester serum analytes (low PAPP-A and/or beta-hCG) are associated with pathologic copy number variants (CNV) on chromosomal microarray (CMA). This retrospective cohort included all CMA studies (n = 2880) that were performed via chorionic villus sampling (CVS) or amniocentesis at a single institution in a single laboratory from 2011 to 2017. We excluded cases in which an abnormal karyotype was detected, as well as multiple gestations or those who had no prior nuchal translucency screening. The prevalence of abnormal serum analytes was compared between patients with pathologic CNVs (abnormal CMA, VOUS likely abnormal, and mosaics) i.e. study group (n = 56) and those with normal CMAs i.e. controls (n = 884). Odds ratios were calculated and statistical significance was determined as p < 0.05. Low serum free beta-hCG (<= 0.45 MoM) was associated with an increased risk for pathologic CNV (OR 3.53, p < 0.01), as well as for abnormal CNV (OR 4.7, p < 0.01) (Table 1). The association of pathologic CNV with low serum PAPP-A (<= 0.4 MoM) was not statistically significant (OR 1.26, p = 0.6) (Table 1). Low first trimester serum beta-hCG is associated with an increased risk of pathologic, as well as, abnormal CNVs on CMA testing. This strong association should be taken into consideration when counseling patients regarding abnormal serum beta-hCG levels.

In recent years, cell-free DNA screening has significantly reduced the number of diagnostic genetic testing in pregnancy, an integral part of fellowship training in maternal-fetal medicine. Pre-implantation genetic screening (PGS) is commonly performed in IVF pregnancies, therefore we aimed to determine the impact of this screening test on subsequent diagnostic genetic testing with chorionic villus sampling (CVS) and amniocentesis. We performed a retrospective cohort study of patients undergoing IVF at a single center from January 2014 to December 2016. Multiple gestations were excluded. All patients underwent routine prenatal screening, including early and late anatomy sonograms, and diagnostic genetic testing at our institution. The rate of invasive diagnostic genetic testing was compared between patients with pregnancies achieved after transfer of a PGS-tested euploid embryo (i.e. study group, n = 37) and those with pregnancies achieved after transfer of untested embryo (i.e. controls, n = 27). Wilcoxon rank sum tests and Fisher's exact tests were employed for statistical analysis. Maternal age (p = 0.85), ethnicity (p = 0.72) and nuchal translucency measurements (p = 0.73) were similar between the two groups. Patients with non-PGS tested pregnancies had a higher BMI (mean 29.7, p = 0.01) than those with PGS-tested pregnancies. The rate of abnormal sonographic findings (p = 0.61), cell-free DNA testing (p = 0.32) and abnormal diagnostic genetic test results (p = 0.85) were similar between the two groups. Most importantly, there was no significant difference in the rate of diagnostic genetic testing with CVS or amniocentesis (12 vs. 8, p = 0.69) between the two groups. The implementation of PGS in IVF patients did not reduce the number of invasive diagnostic tests performed in our study population.

INTRODUCTION: Fetal heart rate abnormalities and elevated nucleated red blood cells (nRBCs) have been suggested as markers of fetal asphyxia. Animal studies suggest that the time between the onset of hypoxia and FHR abnormalities is short. The time interval in humans is unknown. Our study aims to evaluate the association between nRBCs and acute intrapartum fetal asphyxia. METHODS: Study patients included consecutive NICU admissions (2013–2017) with cord gases indicating severe fetal asphyxia (n=35). Controls without asphyxia were NICU patients matched for gestational age (n=72). All had a category I FHR tracing on admission. Fetal asphyxia was defined by an umbilical cord pH <7.0 with a base excess <−9. We examined the time interval from the last FHR acceleration to the time of delivery. Fetuses with congenital or genetic abnormalities were excluded. Statistical analysis included χ 2 testing, T-testing and Spearman correlations. RESULTS: There was no significant association between delta t and nRBCs in either group ( P =.70 and P =.71 in study and control patients, respectively). Several additional variables were studied including maternal BMI, gestational age, maternal age, parity, mode of delivery, fetal sex, standardized birth weight. We found that delta T was significantly associated with asphyxia in patients with increased BMI and in Cesarean Sections. CONCLUSION: It is highly unlikely that nRBCs can serve as a marker of acute intrapartum fetal asphyxia. We believe that fetal nRBCs are the result of antepartum compensatory mechanisms responding to chronic inadequate fetal oxygenation.

Objectives: Multiple mechanisms have been proposed for the neuroprotective effects of magnesium sulfate (MgSO4). We aimed to examine the effects of lipopolysaccharide (LPS) and MgSO4 on the placental expression of nuclear factor κ light chain enhancer of activated B cells (NF-κB), interleukin (IL) 6, adrenocorticotropic hormone (ACTH), and nitric oxide synthase (NOS); all known to participate in the inflammatory cascade. Methods: Placentas were obtained and selected cotyledons cannulated and dually perfused ex vivo. Placentas were perfused with 4 perfusion protocols: culture medium (M-199; controls), LPS (1 μg/mL), MgSO4 (6 g/dL), and LPS + MgSO4. Each perfusion experiment continued for 3 hours. Sixteen perfusion experiments were analyzed, 4 separate placentas were studied for each protocol. The protein levels in the perfused cotyledons were studied by Western blot analysis and compared between the groups. Interleukin 6 levels were studied in the maternal and fetal perfusate. Results: The expression of NF-κB p65, IL-6, ACTH, and NOS proteins levels were significantly increased in placentas perfused with LPS as compared to placentas perfused with M-199, MgSO4 (P < .01 for all). Placentas perfused with LPS+ MgSO4 had similar proteins levels as in the controls and MgSO4 groups. Lipopolysaccharide significantly increased IL-6 levels in maternal perfusate. Conclusions: In the human placenta, MgSO4 blocks the increase in the proteins levels of NF-κB, IL-6, ACTH, and NOS in response to inflammatory stimuli. Magnesium sulfate attenuates excessive placental inflammatory response. The decrease in placental ACTH levels following perfusion with MgSO4 may point to an additional non-anti-inflammatory mechanism of MgSO4.

Objective To assess the additive value of prenatal chromosomal microarray analysis (CMA) for all indications and the likelihood of detecting pathologic copy number variations (CNVs) based on specific indications.Methods A retrospective analysis was performed on amniocentesis and chorionic villi sampling results obtained between 2010 and 2014 in a single institution. A total of 3,314 consecutive patients undergoing invasive genetic testing for different indications were offered CMA in addition to standard karyotype. The prevalence of pathologic CNVs was compared between patients with low-risk indications and those with high-risk indications. Likewise, the prevalence of pathologic CNVs among patients with different sonographic abnormalities was calculated and compared with the low-risk group. Chi-square and Fisher exact tests were used for statistical analysis.Results The prevalence of pathologic CNVs was significantly higher in patients with high-risk indications and specifically those with sonographic abnormalities, compared with the low-risk group (2.8 and 5.9% vs. 0.4%, respectively; all p < 0.05).Conclusion Prenatal CMA detected clinically relevant CNVs in fetuses with a normal karyotype. Major structural malformations and nuchal translucency (NT) >= 3.0 mm are associated with the highest risk for a CMA abnormality. Nevertheless, the prevalence of pathologic CNVs in the low-risk population was high enough (1:250) to consider genetic counseling in this group.

Objective To examine the relationship between duration of fetal hypoxia, nucleated red blood cell (NRBC) count, and fetal growth. Methods Pregnant rats were exposed to a severe hypoxia (9.5%–10% O2) for varying time intervals (2, 6, 12, 24, 48, and 120 hours; n=4 for each time interval) immediately prior to delivery at term. Normoxic controls were exposed to room air (21% O2) and matched for all other study variables (n=4 rats for each time interval). Pups were delivered via hysterotomy while maintaining exposure gas concentrations. Blood gas analysis and NRBC counts were performed, and fetal body and liver weights were recorded. Student’s t test and simple regression were used for statistical analysis. Results As the duration of hypoxia increased, fetal weight, liver weight, blood bicarbonate, and base excess levels decreased significantly; concomitantly, NRBC counts increased. This increase in NRBCs became statistically significant after 24 hours of exposure. After 48 hours of hypoxia there was a 2.5-fold rise in NRBC count, and after 120 hours of hypoxia there was a 4.5-fold rise in NRBC count over control levels. After 12 or more hours of hypoxia, fetal body weights were significantly reduced; 120 hours of hypoxia resulted in a 35% reduction in fetal body weight, a 34% reduction in fetal liver weight, and 356% increase in NRBC count. Conclusion In a pregnant rat model, chronic maternal hypoxia (≥24 hours) results in a significant increase in fetal NRBC counts as well as reduced fetal body weight and organ growth.

There are essentially no published data on the impact of the indication for the delivery and the associated admission to delivery time intervals. Therefore, we sought to evaluate the impact of the indication for delivery on the admission to delivery and admission to discharge time intervals. Retrospective case series. Jan 2015 to Oct 2015. All patients admitted to labor and delivery were evaluated for inclusion. Exclusion Criteria: IUFD, twins gestation, preterm delivery, non vertex presentation. Time in hours from admission to delivery and from admission to discharge was calculated. Study population was divided into 6 groups based on indication. Variables were expressed as median interquartile range. Due to multiple comparisons, the level of statistical significance was set at p<0.003. 2666 patients comprised the study population. Group I included patients who were admitted in active labor. Group II - early labor, Group III -elective induction, Group IV - medically indicated induction, Group V - PROM and Group VI -schedule cesarean section. See table1. All comparisons were statistically significant other than admit to delivery between groups 3&4 (induction groups); admit to discharge between groups 1 & 2 (early and active labor),3&5 (elective induction and PROM) 4&6 (Cesarean section and medically indicated induction). Our results indicate that induction of labor (be it indicated or elective), significantly increases the admission to delivery time interval. In fact, the overall length of stay associated with induction of labor approaches that of a cesarean delivery. The clinical and financial aspects of our results will be discussed.

The surgeons’ visual estimation is the most widely used method for estimating blood loss (BL) while performing cesarean deliveries (CDs). Major BL underestimation may adversely influence obstetric decision making, and result in delaying interventions. Major BL overestimation may result in unnecessary costly interventions. Therefore, we aimed to identify independent predictors for major BL underestimation and overestimation during CDs.

Objective: To compare pregnancy outcome and placental pathology in pregnancies complicated by gestational diabetes mellitus (GDM A1 and A2), with and without hypertensive disorders.Methods: Pregnancy outcome and placental pathology from term deliveries of women complicated with GDM with (GDM+H) and without (GDM-H) hypertensive disorders were compared. Results of the GDM+H group were compared also with the non-diabetic patients but with hypertensive disorders (non-GDM+H). Composite neonatal outcome was defined as one or more of early complications: respiratory distress or need of ventilation support, sepsis, phototherapy, transfusion, seizure, hypoxic-ischemic encephalopathy. Placental lesions were categorized to lesions related to maternal and fetal vascular supply abnormalities, and maternal and fetal inflammatory responses.Results: Of the 192 women with GDM, the GDM+H group (n=41) were more obese, p<0.001, with higher rate of placental maternal and fetal vascular supply lesions, p=0.008, p=0.03, respectively, but similar neonatal outcome, compared to the GDM-H (n=151) group. Compared to the non-GDM+H group (n=41), the GDM+H group had higher birth weights, similar neonatal outcome and similar rate of placental vascular lesions.Conclusions: Higher rate of placental maternal and fetal vascular supply lesions express underlying placental pathology in women with diabetes and hypertensive disorders, similar to women without DM and with hypertensive complications.

To evaluate the hypothesis that BW discordancy in dichorionic diamniotic (DiDi) twins, is associated with compensatory mechanisms in response to increased placental impedance to blood flow. Retrospective case series. 2012 to July 2015. All NICU admitted DiDi twins were included. Exclusion Criteria: IUFD of one twin and twins with structural or chromosomal anomalies. BW discordancy was defined as a BW difference of ≥ 15%. Umbilical artery S/D ratio was used to evaluate placental impedance to blood flow. NRBC per 100 WBCs (NRBCs) and platelets were used to evaluate fetal hematologic compensatory mechanisms. 93 pairs of DiDi twins comprised the study population. Group I (n=72) included pairs with at least one BW above the 10th percentile. Group II (n=21) included twins that were both below the 10th percentile BW. In group I, twins were further subdivided into discordant (n=23), with gestational age at delivery of 34w, and non-discordant (n=49), with gestational age at delivery of 35w (p=N.S.). No BW discordancy was seen in group II. No significant differences in NRBCs, Platelets, or S/D ratios were found in group II. See table for group I results. Our results indicate that birth weight discordance in NICU admitted DiDi twins is not a normal variant. When BW discordance is as low as 15%, the smaller twin faces a significant increased placental impedance (reflected by an increased S/D ratio) and its compensatory mechanisms include a significant increase in NRBCs combined with a significant decrease in platelets.

Objective: To evaluate if hospitalization of pregnant women, involved in minor trauma, for 24 h of surveillance, is warranted.Study Design: The medical files of pregnant women involved in minor trauma, during 2009-2014, at 22-42 gestational weeks, were reviewed. Minor trauma was defined as an injury severity score <3, no immediate complains, normal ultrasound evaluation, reactive non-stress test, and no regular contractions. Patients were divided into those who, according to our departmental protocol, were hospitalized for 24 h observation (hospitalized group), and those who refused to be hospitalized, (non hospitalized group). Pregnancy, delivery and neonatal outcomes were compared between the groups.Results: Included in the study were 946 minor trauma patients that met the inclusion criteria. Gestational age (GA) at the trauma event was lower in the non-hospitalized group (n = 331) compared to the hospitalized group (n = 615), 29.1 vs. 30.8 weeks, p < 0.001, respectively. There were no between groups differences in the rate of preterm birth, vaginal bleeding, GA at delivery, or cesarean delivery. There were no cases of placental abruption or intrauterine fetal death in both groups. Neonatal outcome did not differ between the groups.Conclusion: Minor trauma during pregnancy, with normal initial assessment, is not associated with adverse pregnancy outcomes. Therefore, routine hospitalization is probably not warranted. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

OBJECTIVE:Maternal chorioamnionitis is associated with newborn neurologic injury. Recent evidence suggests that maternal administration of magnesium sulphate (MG) may protect fetuses from white matter injury. Previously we demonstrated evidence by magnetic resonance imaging that MG may prevent maternal inflammation-induced gray matter injury of offspring. Thus, we sought to determine the potential of maternal inflammation to induce fetal neurological/behavioral deficits and assess whether maternal MG attenuates these effects.STUDY DESIGN:Pregnant rats at day 18 received injections of intraperitoneal lipopolysaccharide (LPS) or saline. Dams were treated with subcutaneous saline/MG (270 mg/kg followed by 27 mg/kg every 20 minutes) for 2 hours before and following LPS/saline injections. Pups were delivered spontaneously. At 1 and 3 months of age, 11-12 offspring of each group (saline, LPS, MG, LPS-MG) underwent a 2-way shuttle box avoidance testing. The shuttle box is divided in half and the animal moves between compartments to avoid an electric shock in response to an auditory stimulus.RESULTS:Control offspring demonstrated significantly improved learning and memory abilities from age 1 to 3 months. At 1 month, LPS-treated dams' offspring were similar to controls with no improvement in learning abilities at 3 months. MG treatment of LPS dams significantly improved offspring learning at 3 months, to equal or better than that of controls.CONCLUSION:LPS-stimulated inflammation during pregnancy impairs offspring learning ability and memory, which is ameliorated by maternal MG treatment. These results suggest that maternal MG therapy may prevent white and gray matter injuries associated with maternal infection/inflammation.