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Publisher: Elsevier   (Total: 3177 journals)

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Showing 1 - 200 of 3177 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 28, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 33, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 378, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 237, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 131, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 28, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 14)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 10)
Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 21)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 6)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 42, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 7)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 53, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 7)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 15, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 6, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 18, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 378, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 333, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 431, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 50, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 43, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 42, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 190, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 37, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 61, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 39, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 164, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)

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Journal Cover American Journal of Obstetrics and Gynecology
  [SJR: 2.255]   [H-I: 171]   [190 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9378
   Published by Elsevier Homepage  [3177 journals]
  • A Profile of Dennis Lo, DM, DPhil, FRCP, FRCPath, FRS
    • Authors: Roberto Romero
      Pages: 371 - 378
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Roberto Romero


      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.01.027
       
  • Diet and fertility: a review
    • Authors: Audrey J. Gaskins; Jorge E. Chavarro
      Pages: 379 - 389
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Audrey J. Gaskins, Jorge E. Chavarro
      The literature on the relationship between diet and human fertility has greatly expanded over the last decade, resulting in the identification of a few clear patterns. Intake of supplemental folic acid, particularly at doses higher than those recommended for the prevention of neural tube defects, has been consistently related to lower frequency of infertility, lower risk of pregnancy loss, and greater success in infertility treatment. On the other hand and despite promising evidence from animal models, vitamin D does not appear to exert an important role in human fertility in the absence of deficiency. Antioxidant supplementation does not appear to offer any benefits to women undergoing infertility treatment, but it appears to be beneficial when it is the male partner who is supplemented. However, the available evidence does not allow discerning which specific antioxidants, or at which doses, are responsible for this benefit. Long-chain omega-3 fatty acids appear to improve female fertility, although it remains unclear to what extent contamination of shared food sources, such as fish with high levels of environmental toxicants, can dampen this benefit. Lastly, adherence to healthy diets favoring seafood, poultry, whole grains, fruits, and vegetables are related to better fertility in women and better semen quality in men. The cumulative evidence has also piled against popular hypotheses. Dairy and soy, once proposed as reproductive toxicants, have not been consistently related to poor fertility. In fact, soy and soy supplements appear to exert a beneficial effect among women undergoing infertility treatment. Similarly, because data from large, high-quality studies continue to accumulate, the evidence of a potentially deleterious effect of moderate alcohol and caffeine intake on the ability to become pregnant seems less solid than it once did. While a complete picture of the role of nutrition on fertility is far from complete, much progress has been made. The most salient gaps in the current evidence include jointly considering female and male diets and testing the most consistent findings in randomized trials.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2017.08.010
       
  • Nonsteroidal antiinflammatory drug resistance in dysmenorrhea:
           epidemiology, causes, and treatment
    • Authors: Folabomi A. Oladosu; Frank F. Tu; Kevin M. Hellman
      Pages: 390 - 400
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Folabomi A. Oladosu, Frank F. Tu, Kevin M. Hellman
      Although nonsteroidal antiinflammatory drugs can alleviate menstrual pain, about 18% of women with dysmenorrhea are unresponsive, leaving them and their physicians to pursue less well-studied strategies. The goal of this review is to provide a background for treating menstrual pain when first-line options fail. Research on menstrual pain and failure of similar drugs in the antiplatelet category suggested potential mechanisms underlying nonsteroidal antiinflammatory drug resistance. Based on these mechanisms, alternative options may be helpful for refractory cases. This review also identifies key pathways in need of further study to optimize menstrual pain treatment.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2017.08.108
       
  • Vulvar vesicles in an elderly female: cutaneous manifestation of a past
           malignancy
    • Authors: Anuradha Bishnoi; Davinder Parsad; Debajyoti Chatterjee
      Pages: 455 - 456
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Anuradha Bishnoi, Davinder Parsad, Debajyoti Chatterjee


      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2017.12.212
       
  • The most important quality of a physician
    • Authors: Emmet Hirsch
      First page: 459
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Emmet Hirsch


      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2017.12.237
       
  • Pulmonary vascular obstruction by squamous cells is not involved in
           amniotic fluid embolism
    • Authors: Mark Funk; Alexander Damron; Venkata Bandi; Kjersti Aagaard; Reka Szigeti; Steven Clark
      Pages: 460 - 461
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Mark Funk, Alexander Damron, Venkata Bandi, Kjersti Aagaard, Reka Szigeti, Steven Clark


      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2017.12.225
       
  • Fellow perceptions of residency training in obstetrics and gynecology
    • Authors: Renata R. Urban; Amin A. Ramzan; David W. Doo; Henry L. Galan; Lorie Harper; Kenan Omurtag; Tyler M. Muffly; Jeannelle Sheeder; Saketh R. Guntupalli
      Pages: 461 - 462
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Renata R. Urban, Amin A. Ramzan, David W. Doo, Henry L. Galan, Lorie Harper, Kenan Omurtag, Tyler M. Muffly, Jeannelle Sheeder, Saketh R. Guntupalli


      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.01.021
       
  • Management of sexuality, intimacy, and menopause symptoms after ovarian
           cancer
    • Authors: Martha F. Goetsch
      First page: 463
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Martha F. Goetsch


      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.01.001
       
  • Acetylsalicylic acid in pregnant women with chronic hypertension
    • Authors: Federico Prefumo; Tiziana Frusca; Herbert Valensise
      Pages: 463 - 464
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Federico Prefumo, Tiziana Frusca, Herbert Valensise


      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.01.020
       
  • Human placentophagy: a review
    • Authors: Alex Farr; Frank A. Chervenak; Laurence B. McCullough; Rebecca N. Baergen; Amos Grünebaum
      Pages: 401.e1 - 401.e11
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Alex Farr, Frank A. Chervenak, Laurence B. McCullough, Rebecca N. Baergen, Amos Grünebaum
      Placentophagy or placentophagia, the postpartum ingestion of the placenta, is widespread among mammals; however, no contemporary human culture incorporates eating placenta postpartum as part of its traditions. At present, there is an increasing interest in placentophagy among postpartum women, especially in the United States. The placenta can be eaten raw, cooked, roasted, dehydrated, or encapsulated or through smoothies and tinctures. The most frequently used preparation appears to be placenta encapsulation after steaming and dehydration. Numerous companies offer to prepare the placenta for consumption, although the evidence for positive effects of human placentophagy is anecdotal and limited to self-reported surveys. Without any scientific evidence, individuals promoting placentophagy, especially in the form of placenta encapsulation, claim that it is associated with certain physical and psychosocial benefits. We found that there is no scientific evidence of any clinical benefit of placentophagy among humans, and no placental nutrients and hormones are retained in sufficient amounts after placenta encapsulation to be potentially helpful to the mother postpartum. In contrast to the belief of clinical benefits associated with human placentophagy, the Centers for Disease Control and Prevention recently issued a warning due to a case in which a newborn infant developed recurrent neonatal group B Streptococcus sepsis after the mother ingested contaminated placenta capsules containing Streptococcus agalactiae. The Centers for Disease Control and Prevention recommended that the intake of placenta capsules should be avoided owing to inadequate eradication of infectious pathogens during the encapsulation process. Therefore, in response to a woman who expresses an interest in placentophagy, physicians should inform her about the reported risks and the absence of clinical benefits associated with the ingestion. In addition, clinicians should inquire regarding a history of placenta ingestion in cases of postpartum maternal or neonatal infections such as group B Streptococcus sepsis. In conclusion, there is no professional responsibility on clinicians to offer placentophagy to pregnant women. Moreover, because placentophagy is potentially harmful with no documented benefit, counseling women should be directive: physicians should discourage this practice. Health care organizations should develop clear clinical guidelines to implement a scientific and professional approach to human placentophagy.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2017.08.016
       
  • Both patients and maternity care providers can benefit from payment
           reform: four steps to prepare
    • Authors: Malini A. Nijagal; Neel T. Shah; Jeff Levin-Scherz
      Pages: 411.e1 - 411.e6
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Malini A. Nijagal, Neel T. Shah, Jeff Levin-Scherz
      Many Medicaid programs and private health plans are implementing new models of maternity care reimbursement, and clinicians face mounting pressure to demonstrate high-quality care at a lower cost. Clinicians will be better prepared to meet these challenges with a fuller understanding of new payment models and the opportunities they present. We describe the structure of maternity care episode payments and recommend 4 ways that clinicians can prepare for success as value-based payment models are implemented: identify opportunities to improve outcomes and experience, measure quality, reduce waste, and work in teams across settings.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.01.014
       
  • Applying surgical antimicrobial standards in cesarean deliveries
    • Authors: Kathryn E. Fay; Lynn Yee
      Pages: 416.e1 - 416.e4
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Kathryn E. Fay, Lynn Yee
      Antimicrobial prophylaxis practices are critical to surgical site infection risk-reduction strategies. Included in these practices is antibiotic redosing following prolonged procedures or after large blood losses. Guidelines have been published by several professional associations, with most endorsing repeat antibiotic administration after an estimated blood loss of 1500 mL or following 2 half-lives of the select agent. These conventions have been widely adopted by surgeons with the exception of obstetricians at the time of cesarean delivery. This Viewpoint explores existing guidelines, reviews the data for these recommendations, and questions the tradition of abstinence from redosing in cesarean deliveries despite the burden of infection in this cohort.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.01.016
       
  • Pelvic floor functional outcomes after total abdominal vs total
           laparoscopic hysterectomy for endometrial cancer
    • Authors: Peta Higgs; Monika Janda; Rebecca Asher; Val Gebski; Peta Forder; Andreas Obermair
      Pages: 419.e1 - 419.e14
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Peta Higgs, Monika Janda, Rebecca Asher, Val Gebski, Peta Forder, Andreas Obermair
      Background Pelvic floor functioning is an important concern for women requiring a hysterectomy for endometrial cancer. The incidence of pelvic floor symptoms has not been reported in women who have undergone a hysterectomy for early-stage endometrial cancer. Objective We sought to evaluate pelvic floor function in women who have had surgical treatment for early-stage endometrial cancer as part of the multinational Laparoscopic Approach to Cancer of the Endometrium trial and to compare patients’ outcomes who had total abdominal vs total laparoscopic hysterectomy. Study Design A multinational, phase III, randomized noninferiority trial compared disease-free survival of patients who had total abdominal hysterectomy vs total laparoscopic hysterectomy. This substudy analyzes the results from a self-administered validated questionnaire on pelvic floor symptoms (Pelvic Floor Distress Inventory) administered preoperatively, and at follow-up visits 6, 18, 30, 42, and 54 months postoperatively. Results Overall, 381 patients with endometrial cancer were included in the analysis (total abdominal hysterectomy, n = 195; total laparoscopic hysterectomy, n = 186). At 6 months postsurgery both groups experienced an improvement in Pelvic Floor Distress Inventory scores compared to presurgical pelvic floor well-being (total abdominal hysterectomy: mean change –11.17; 95% confidence interval, –17.11 to –5.24; total laparoscopic hysterectomy: mean change –10.25; 95% confidence interval, –16.31 to –4.19). The magnitude of change from baseline in pelvic floor symptoms did not differ between both treatment groups up to 54 months postsurgery. Conclusion These findings suggest that pelvic floor function in terms of urinary, bowel, and prolapse symptoms are unlikely to deteriorate following abdominal or laparoscopic hysterectomy and are reassuring for women undergoing hysterectomy for early-stage endometrial cancer.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2017.12.233
       
  • Regular exercisers have stronger pelvic floor muscles than nonregular
           exercisers at midpregnancy
    • Authors: Kari Bø; Marie Ellstrøm Engh; Gunvor Hilde
      Pages: 427.e1 - 427.e5
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Kari Bø, Marie Ellstrøm Engh, Gunvor Hilde
      Background Today all healthy pregnant women are encouraged to be physically active throughout pregnancy, with recommendations to participate in at least 30 minutes of aerobic activity on most days of the week in addition to performing strength training of the major muscle groups 2–3 days per week and also pelvic floor muscle training. There is, however, an ongoing debate whether general physical activity enhances or declines pelvic floor muscle function. Objectives The objectives of the study were to compare vaginal resting pressure, pelvic floor muscle strength, and endurance in regular exercisers (exercise ≥30 minutes 3 or more times per week) and nonexercisers at midpregnancy. Furthermore, another objective was to assess whether regular general exercise or pelvic floor muscle strength was associated with urinary incontinence. Study Design This was a cross-sectional study at mean gestational week 20.9 (±1.4) including 218 nulliparous pregnant women, with a mean age of 28.6 years (range, 19–40 years) and prepregnancy body mass index of 23.9 kg/m2 (SD, 4.0). Vaginal resting pressure, pelvic floor muscle strength, and pelvic floor muscle endurance were measured by a high-precision pressure transducer connected to a vaginal balloon. The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form was used to assess urinary incontinence. Differences between groups were analyzed using an independent-sample Student t test. Linear regression analysis was conducted to adjust for prepregnancy body mass index, age, smoking during pregnancy, and regular pelvic floor muscle training during pregnancy. The significance value was set to P ≤ .05. Results Regular exercisers had statistically significant stronger (mean 6.4 cm H2O [95% confidence interval, 1.7–11.2]) and more enduring (mean 39.9 cm H2Osec [95% confidence interval, 42.2–75.7]) pelvic floor muscles. Only pelvic floor muscle strength remained statistically significant, when adjusting for possible confounders. Pelvic floor muscle strength and not regular general exercise was associated with urinary continence (adjusted B, –6.4 [95% confidence interval, –11.5 to –1.4]). Conclusion Regular exercisers at midpregnancy have stronger pelvic floor muscles than their sedentary counterparts. However, pelvic floor muscle strength and not regular general exercise was associated with urinary incontinence. There is a need for additional studies in elite athletes and women performing more strenuous exercise regimens.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2017.12.220
       
  • Evidence of cardiac involvement in the fetal inflammatory response
           syndrome: disruption of gene networks programming cardiac development in
           nonhuman primates
    • Authors: Timothy Mitchell; James W. MacDonald; Sengkeo Srinouanpranchanh; Theodor K. Bammler; Sean Merillat; Erica Boldenow; Michelle Coleman; Kathy Agnew; Audrey Baldessari; Jennifer E. Stencel-Baerenwald; Jennifer Tisoncik-Go; Richard R. Green; Michael J. Gale; Lakshmi Rajagopal; Kristina M. Adams Waldorf
      Pages: 438.e1 - 438.e16
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Timothy Mitchell, James W. MacDonald, Sengkeo Srinouanpranchanh, Theodor K. Bammler, Sean Merillat, Erica Boldenow, Michelle Coleman, Kathy Agnew, Audrey Baldessari, Jennifer E. Stencel-Baerenwald, Jennifer Tisoncik-Go, Richard R. Green, Michael J. Gale, Lakshmi Rajagopal, Kristina M. Adams Waldorf
      Background Most early preterm births are associated with intraamniotic infection and inflammation, which can lead to systemic inflammation in the fetus. The fetal inflammatory response syndrome describes elevations in the fetal interleukin-6 level, which is a marker for inflammation and fetal organ injury. An understanding of the effects of inflammation on fetal cardiac development may lead to insight into the fetal origins of adult cardiovascular disease. Objective The purpose of this study was to determine whether the fetal inflammatory response syndrome is associated with disruptions in gene networks that program fetal cardiac development. Study Design We obtained fetal cardiac tissue after necropsy from a well-described pregnant nonhuman primate model (pigtail macaque, Macaca nemestrina) of intrauterine infection (n=5) and controls (n=5). Cases with the fetal inflammatory response syndrome (fetal plasma interleukin-6 >11 pg/mL) were induced by either choriodecidual inoculation of a hypervirulent group B streptococcus strain (n=4) or intraamniotic inoculation of Escherichia coli (n=1). RNA and protein were extracted from fetal hearts and profiled by microarray and Luminex (Millipore, Billerica, MA) for cytokine analysis, respectively. Results were validated by quantitative reverse transcriptase polymerase chain reaction. Statistical and bioinformatics analyses included single gene analysis, gene set analysis, Ingenuity Pathway Analysis (Qiagen, Valencia, CA), and Wilcoxon rank sum. Results Severe fetal inflammation developed in the context of intraamniotic infection and a disseminated bacterial infection in the fetus. Interleukin-6 and -8 in fetal cardiac tissues were elevated significantly in fetal inflammatory response syndrome cases vs controls (P<.05). A total of 609 probe sets were expressed differentially (>1.5-fold change, P<.05) in the fetal heart (analysis of variance). Altered expression of select genes was validated by quantitative reverse transcriptase polymerase chain reaction that included several with known functions in cardiac injury, morphogenesis, angiogenesis, and tissue remodeling (eg, angiotensin I converting enzyme 2, STEAP family member 4, natriuretic peptide A, and secreted frizzled-related protein 4; all P<.05). Multiple gene sets and pathways that are involved in cardiac morphogenesis and vasculogenesis were downregulated significantly by gene set and Ingenuity Pathway Analysis (hallmark transforming growth factor beta signaling, cellular morphogenesis during differentiation, morphology of cardiovascular system; all P<.05). Conclusion Disruption of gene networks for cardiac morphogenesis and vasculogenesis occurred in the preterm fetal heart of nonhuman primates with preterm labor, intraamniotic infection, and severe fetal inflammation. Inflammatory injury to the fetal heart in utero may contribute to the development of heart disease later in life. Development of preterm labor therapeutics must also target fetal inflammation to lessen organ injury and potential long-term effects on cardiac function.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.01.009
       
  • Clinical assessment and brain findings in a cohort of mothers, fetuses and
           infants infected with ZIKA virus
    • Authors: Magdalena Sanz Cortes; Ana Maria Rivera; Mayel Yepez; Carolina V. Guimaraes; Israel Diaz Yunes; Alexander Zarutskie; Ivan Davila; Anil Shetty; Arun Mahadev; Saray Maria Serrano; Nicolas Castillo; Wesley Lee; Gregory Valentine; Michael Belfort; Guido Parra; Carrie Mohila; Kjersti Aagaard; Miguel Parra Saavedra
      Pages: 440.e1 - 440.e36
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Magdalena Sanz Cortes, Ana Maria Rivera, Mayel Yepez, Carolina V. Guimaraes, Israel Diaz Yunes, Alexander Zarutskie, Ivan Davila, Anil Shetty, Arun Mahadev, Saray Maria Serrano, Nicolas Castillo, Wesley Lee, Gregory Valentine, Michael Belfort, Guido Parra, Carrie Mohila, Kjersti Aagaard, Miguel Parra Saavedra
      Background Congenital Zika virus (ZIKV) infection can be detected in both the presence and absence of microcephaly and manifests as a number of signs and symptoms that are detected clinically and by neuroimaging. However, to date, qualitative and quantitative measures for the purpose of diagnosis and prognosis are limited. Objectives Main objectives of this study conducted on fetuses and infants with confirmed congenital Zika virus infection and detected brain abnormalities were (1) to assess the prevalence of microcephaly and the frequency of the anomalies that include a detailed description based on ultrasound and magnetic resonance imaging in fetuses and ultrasound, magnetic resonance imaging, and computed tomography imaging postnatally, (2) to provide quantitative measures of fetal and infant brain findings by magnetic resonance imaging with the use of volumetric analyses and diffusion-weighted imaging, and (3) to obtain additional information from placental and fetal histopathologic assessments and postnatal clinical evaluations. Study Design This is a longitudinal cohort study of Zika virus–infected pregnancies from a single institution in Colombia. Clinical and imaging findings of patients with laboratory-confirmed Zika virus infection and fetal brain anomalies were the focus of this study. Patients underwent monthly fetal ultrasound scans, neurosonography, and a fetal magnetic resonance imaging. Postnatally, infant brain assessment was offered by the use of ultrasound imaging, magnetic resonance imaging, and/or computed tomography. Fetal head circumference measurements were compared with different reference ranges with <2 or <3 standard deviations below the mean for the diagnosis of microcephaly. Fetal and infant magnetic resonance imaging images were processed to obtain a quantitative brain volumetric assessment. Diffusion weighted imaging sequences were processed to assess brain microstructure. Anthropometric, neurologic, auditory, and visual assessments were performed postnatally. Histopathologic assessment was included if patients opted for pregnancy termination. Results All women (n=214) had been referred for Zika virus symptoms during pregnancy that affected themselves or their partners or if fetal anomalies that are compatible with congenital Zika virus syndrome were detected. A total of 12 pregnant patients with laboratory confirmation of Zika virus infection were diagnosed with fetal brain malformations. Most common findings that were assessed by prenatal and postnatal imaging were brain volume loss (92%), calcifications (92%), callosal anomalies (100%), cortical malformations (89%), and ventriculomegaly (92%). Results from fetal brain volumetric assessment by magnetic resonance imaging showed that 1 of the most common findings associated with microcephaly was reduced supratentorial brain parenchyma and increased subarachnoid cerebrospinal fluid. Diffusion weighted imaging analyses of apparent diffusion coefficient values showed microstructural changes. Microcephaly was present in 33.3–58.3% of the cases at referral and was present at delivery in 55.6–77.8% of cases. At birth, most of the affected neonates (55.6–77.8%) had head circumference measurements >3 standard deviations below the mean. Postnatal imaging studies confirmed brain malformations that were detected prenatally. Auditory screening results were normal in 2 cases that were assessed. Visual screening showed different anomalies in 2 of the 3 cases that were examined. Pathologic results that were obtained from 2 of the 3 cases who opted for termination showed similar signs of abnormalities in the central nervous system and placental analyses, including brain microcalcifications. Conclusion Congenital microcephaly is not an optimal screening method for congenital Zika virus syndrome, because it may not accompany other evident and preceding brain findings; microcephaly could be an endpoint of the disease that results...
      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.01.012
       
  • Postmortem microfocus computed tomography for early gestation fetuses: a
           validation study against conventional autopsy
    • Authors: John C. Hutchinson; Xin Kang; Susan Cheng Shelmerdine; Valerie Segers; Claudio M. Lombardi; Mieke M. Cannie; Neil J. Sebire; Jacques C. Jani; Owen J. Arthurs
      Pages: 445.e1 - 445.e12
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): John C. Hutchinson, Xin Kang, Susan Cheng Shelmerdine, Valerie Segers, Claudio M. Lombardi, Mieke M. Cannie, Neil J. Sebire, Jacques C. Jani, Owen J. Arthurs
      Background Perinatal autopsy provides useful clinical information in up to 40% of cases. However, there is a substantial unmet clinical need with regards to postmortem investigation of early gestation fetal loss for parents for whom standard autopsy is either not available or not acceptable. Parents dislike the invasive nature of autopsy, but current clinical imaging techniques do not provide high-enough imaging resolution in small fetuses. We hypothesized that microfocus computed tomography, which is a rapid high-resolution imaging technique, could give accurate diagnostic imaging after early gestation fetal loss. Objective The objective of the study was to evaluate the diagnostic accuracy of microfocus computed tomography for noninvasive human fetal autopsy for early gestation fetuses, with the use of conventional autopsy as the reference standard. Study Design We compared iodinated whole body microfocus computed tomography in 20 prospectively recruited fetuses (11–21 weeks gestation from 2 centers) with conventional autopsy in a double-blinded manner for a main diagnosis and findings in specific body organs. Fetuses were prepared with 10% formalin/potassium tri-iodide. Images were acquired with a microfocus computed tomography scanner with size-appropriate parameters. Images were evaluated independently by 2 pediatric radiologists, who were blinded to formal perinatal autopsy results, across 40 individual indices to reach consensus. The primary outcome was agreement between microfocus computed tomography and conventional autopsy for overall diagnosis. Results Postmortem whole body fetal microfocus computed tomography gave noninvasive autopsy in minutes, at a mean resolution of 27μm, with high diagnostic accuracy in fetuses at <22 weeks gestation. Autopsy demonstrated that 13 of 20 fetuses had structural abnormalities, 12 of which were also identified by microfocus computed tomography (92.3%). Overall, microfocus computed tomography agreed with overall autopsy findings in 35 of 38 diagnoses (15 true positive, 18 true negative; sensitivity 93.8% [95% confidence interval, 71.7–98.9%], specificity 100% [95% confidence interval, 82.4–100%]), with 100% agreement for body imaging diagnoses. Furthermore, after removal of nondiagnostic indices, there was agreement for 700 of 718 individual body organ indices that were assessed on microfocus computed tomography and autopsy (agreement, 97.5%; 95% confidence interval, 96.1–98.4%), with no overall differences between fetuses at ≤14 or >14 weeks gestation (agreement, 97.2% and 97.9%, respectively). Within first-trimester fetal loss cases (<14 weeks gestation), microfocus computed tomography analysis yielded significantly fewer nondiagnostic indices than autopsy examination (22/440 vs 48/348, respectively; P<.001). Conclusion Postmortem whole-body fetal microfocus computed tomography gives noninvasive, detailed anatomic examinations that are achieved in minutes at high resolution. Microfocus computed tomography may be preferable to magnetic resonance imaging in early gestation fetuses and may offer an acceptable method of examination after fetal loss for parents who decline invasive autopsy. This will facilitate autopsy and subsequent discussions between medical professionals who are involved in patient care and counselling for future pregnancies.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.01.040
       
  • The impact of a daily smartphone-based feedback system among women with
           gestational diabetes on compliance, glycemic control, satisfaction, and
           pregnancy outcome: a randomized controlled trial
    • Authors: Hadas Miremberg; Tal Ben-Ari; Tal Betzer; Hagit Raphaeli; Rose Gasnier; Giulia Barda; Jacob Bar; Eran Weiner
      Pages: 453.e1 - 453.e7
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Hadas Miremberg, Tal Ben-Ari, Tal Betzer, Hagit Raphaeli, Rose Gasnier, Giulia Barda, Jacob Bar, Eran Weiner
      Background Patient compliance and tight glycemic control have been demonstrated to improve outcome in pregnancies complicated by gestational diabetes mellitus. The use of advanced technological tools, including smartphone-based platforms, to improve medical care and outcomes has been demonstrated in various fields of medicine, but only a few small studies were performed with gestational diabetes mellitus patients. Objective We aimed to study the impact of introducing a smartphone-based daily feedback and communication platform between gestational diabetes mellitus patients and their physicians, on patient compliance, glycemic control, pregnancy outcome, and patient satisfaction. Study Design This is a prospective, single-center, randomized controlled trial. Newly diagnosed gestational diabetes mellitus patients presenting to our multidisciplinary diabetes-in-pregnancy clinic were randomized to: (1) routine biweekly prenatal clinic care (control group); or (2) additional daily detailed feedback on their compliance and glycemic control from the clinic team via an application installed on their smartphone (smartphone group). The primary outcome was patient compliance defined as the actual blood glucose measurements/instructed measurements ×100. The secondary outcomes included diabetes-control parameters, pregnancy, and neonatal outcomes. The study was adequately powered to detect a 20% difference in patient compliance, based on a preliminary phase that demonstrated 70% baseline compliance to glucose measurements. Results A total of 120 newly diagnosed gestational diabetes mellitus patients were analyzed. The 2 groups did not differ in terms of age, parity, education, body mass index, family history, maternal comorbidities, oral glucose tolerance test values, and hemoglobin A1C at randomization. The smartphone group demonstrated higher level of compliance (84 ± 0.16% vs 66 ± 0.28%, P < .001); lower mean blood glucose (105.1 ± 8.6 mg/dL vs 112.6 ± 7.4 mg/dL, P < .001); lower rates of off-target measurements both fasting (4.7 ± 0.4% vs 8.4 ± 0.6%, P < .001) and 1-hour postprandial (7.7 ± 0.8% vs 14.3 ± 0.8%, P < .001); and a lower rate of pregnancies requiring insulin treatment (13.3% vs 30.0%, P = .044). The rates of macrosomia, neonatal hypoglycemia, shoulder dystocia, and other delivery and neonatal complications did not differ between the groups. Patients in the smartphone group reported excellent satisfaction from the use of the application and from their overall prenatal care. Conclusion Introduction of a smartphone-based daily feedback and communication platform between gestational diabetes mellitus patients and the multidisciplinary diabetes-in-pregnancy clinic team improved patient compliance and glycemic control, and lowered the rate of insulin treatment.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.01.044
       
  • The anatomy of the sacral promontory
    • Authors: Géraldine Giraudet; Aurore Protat; Michel Cosson
      Pages: 457.e1 - 457.e3
      Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4
      Author(s): Géraldine Giraudet, Aurore Protat, Michel Cosson
      Because of problems with vaginal meshes and the high rate of recurrences of native tissue repair, more and more surgeons treat pelvic organ prolapse with laparoscopic sacrocolpopexy. This surgery requires skilled surgeons. The first step of sacrocolpopexy is the dissection of tissues in front of the sacral promontory to reach the anterior longitudinal ligament. Some complications can occur during this dissection and the attachment of the mesh. This step is dangerous for surgeons because of the proximity of vessels, nerves, and ureters. The lack of knowledge of anatomy can lead to severe complications such as vascular, ureteral, or nerve injuries. These complications can be life-threatening. To show anatomic concerns when surgeons dissect and affix the mesh on the anterior longitudinal ligament, we have developed a video of the promontory anatomy. By reviewing anatomic articles about vessels, nerves, and ureters in this localization, we propose an educational tool to increase the anatomic knowledge to avoid severe complications. In this video, we show an alternative location for dissection and graft fixation when the surgeon believes that mesh cannot be fixed safely on the anterior surface of S1, as currently recommended.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2017.12.236
       
  • Infection-Induced Thrombin Production: A Potential Novel Mechanism for
           Preterm Premature Rupture of Membranes (PPROM)
    • Authors: Liping Feng; Terrence K. Allen; William P. Marinello; Amy P. Murtha
      Abstract: Publication date: Available online 13 April 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Liping Feng, Terrence K. Allen, William P. Marinello, Amy P. Murtha
      Background Preterm premature rupture of membranes (PPROM) is a leading contributor to maternal and neonatal morbidity and mortality. Epidemiologic and experimental studies have demonstrated that thrombin causes fetal membrane weakening and subsequently PPROM. Although blood is suspected as the likely source of thrombin in fetal membranes and amniotic fluid of patients with PPROM, this has not been proven. Ureaplasma Parvum (U. parvum) is emerging as a pathogen involved in prematurity, including PPROM, but until now, prothrombin production directly induced by bacteria in fetal membranes has not been described. Objectives This study was designed to investigate whether U. parvum exposure can induce prothrombin production in fetal membranes cells. Study Design Primary fetal membrane cells (amnion epithelial, chorion trophoblast, and decidua stromal) or full-thickness fetal membrane tissue explants from elective, term, uncomplicated cesarean deliveries were harvested. Cells or tissue explants were infected with live U. parvum (1 x 105, 1 x 106, or 1 x 107 colony forming units (cfu)/ml) or lipopolysaccharide (Escherichia coli J5, L-5014, Sigma, 100 ng/ml or 1000 ng/ml) for 24 hours. Tissue explants were fixed for immunohistochemistry staining of thrombin/prothrombin. Fetal membrane cells were fixed for confocal immunofluorescent staining of the biomarkers of fetal membrane cell types and thrombin/prothrombin. Protein and mRNA were harvested from the cells and tissue explants for Western blot or qRT-PCR to quantify thrombin/prothrombin protein or mRNA production, respectively. Data are presented as mean values ± standard errors of mean. Data were analyzed using one-way ANOVA with post hoc Dunnett’s test. Results Prothrombin production and localization was confirmed by Western blot and immunostainings in all primary fetal membrane cells and tissue explants. Immunofluorescence observations revealed a perinuclear localization of prothrombin in amnion epithelial cells. Localization of prothrombin in chorion and decidua cells was perinuclear and cytoplasmic. Prothrombin mRNA and protein expression in fetal membranes was significantly increased by U. parvum, but not lipopolysaccharide, treatments in a dose-dependent manner. Specifically, U. parvum at a dose of 1x107 cfu/ml significantly increased both prothrombin mRNA (fold changes in amnion: 4.1±1.9; chorion: 5.7±4.2; decidua: 10.0±5.4; FM: 9.2±3.0) and protein expression (fold changes in amnion: 138.0±44.0; chorion: 139.6±15.1; decidua: 56.9±29.1; fetal membrane: 133.1±40.0) compared to untreated controls. U. parvum at a dose of 1x106 cfu/ml significantly upregulated prothrombin protein expression in chorion cells (fold change: 54.9±5.3) and prothrombin mRNA expression in decidua cells (fold change: 4.4±1.9). Conclusions Our results demonstrate that prothrombin can be directly produced by fetal membrane amnion, chorion, and decidua cells. Further, prothrombin production can be stimulated by U. parvum exposure in fetal membranes. These findings represent a potential novel underlying mechanism of U. parvum-induced rupture of fetal membranes.

      PubDate: 2018-04-15T18:56:18Z
      DOI: 10.1016/j.ajog.2018.04.014
       
  • Abortion Training in US Obstetrics and Gynecology Residency Programs
    • Authors: Jody E. Steinauer; Jema K. Turk; Tali Pomerantz; Kristin Simonson; Lee A. Learman; Uta Landy
      Abstract: Publication date: Available online 12 April 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Jody E. Steinauer, Jema K. Turk, Tali Pomerantz, Kristin Simonson, Lee A. Learman, Uta Landy
      Background Nearly 15 years ago, 51% of US obstetrics and gynecology residency training program directors reported that abortion training was routine, 39% reported training was optional, and 10% did not have training. The status of abortion training now is unknown. Objective To determine the current status of abortion training in obstetrics and gynecology residency programs. Study Design Through surveying program directors of US obstetrics and gynecology residency training programs, we conducted a cross-sectional study on the availability and characteristics of abortion training. Training was defined as routine if included in residents’ schedules with individuals permitted to opt out, optional as not in the residents’ schedules but available for individuals to arrange, and not available. Findings were compared between types of programs using bivariate analyses. Results One hundred and ninety residency program directors (79%) responded. 64% reported routine training with dedicated time, 31% optional, and 5% not available. Routine, scheduled training was correlated with higher median numbers of uterine evacuation procedures. While the majority believed their graduates to be competent in first-trimester aspiration (71%), medication abortion (66%), and induction termination (67%), only 22% thought graduates were competent in D&E. Abortion procedures varied by clinical indication, with some programs limiting cases to pregnancy complication, fetal anomaly, or demise. Conclusion Abortion training in obstetrics and gynecology residency training programs has increased since 2004, yet many programs graduate residents without sufficient training to provide abortions for any indication, as well as D&E. Professional training standards and support for family planning training have coincided with improved training, but there are still barriers to understand and overcome.

      PubDate: 2018-04-15T18:56:18Z
      DOI: 10.1016/j.ajog.2018.04.011
       
  • There is insufficient evidence to claim that cerclage is the treatment of
           choice for patients with a cervical length <10mm
    • Authors: Roberto Romero; Agustin Conde-Agudelo; Kypros H. Nicolaides
      Abstract: Publication date: Available online 12 April 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Roberto Romero, Agustin Conde-Agudelo, Kypros H. Nicolaides


      PubDate: 2018-04-15T18:56:18Z
      DOI: 10.1016/j.ajog.2018.04.009
       
  • February 2018 (vol. 218, no. 2, page 244)
    • Abstract: Publication date: Available online 12 April 2018
      Source:American Journal of Obstetrics and Gynecology


      PubDate: 2018-04-15T18:56:18Z
       
  • Infant Outcome after Complete Uterine Rupture
    • Authors: Iqbal Al-Zirqi; Anne Kjersti Daltveit; Siri Vangen
      Abstract: Publication date: Available online 12 April 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Iqbal Al-Zirqi, Anne Kjersti Daltveit, Siri Vangen
      Background Complete uterine rupture is a rare peripartum complication often associated with a catastrophic outcome for both mother and child. However, little has been written based on large data sets about maternal and infant outcome after complete ruptures. This is partly due to the rarity of the event and the serious maternal and infant outcome; it is also partly due to the use of international diagnostic codes that do not differentiate between the less catastrophic partial rupture and more catastrophic complete uterine rupture. As uterine rupture is expected to increase due to increased cesarean section rates worldwide, it is important to know more completely about the outcome following complete uterine rupture. Objective To explore risk factors associated with poor infant outcome in cases of complete uterine rupture. Study Design This population-based study used data from the Medical Birth Registry of Norway, the Patient Administration System, and medical records. We included births with complete uterine rupture after start of labor in all maternity units in Norway during the period 1967–2008 (n = 244 births), identified among 2,455,797 births. Uterine ruptures were identified and further studied through a review of medical records. We estimated the associations between infant outcomes and demographic and labor risk factors using logistic regression analyses. Odds ratios (ORs) with 95% confidence intervals (CIs) for each risk factor were determined after adjustment for demographic factors and period of birth. The main outcome measure was infant outcome: healthy infant, intrapartum/infant deaths, hypoxic ischemic encephalopathy (HIE), and admission to the neonatal intensive care unit (NICU). Results We identified 109 (44.7%) healthy infants, 56 (23.0%) infants needing NICU admission, 64 (26.2%) intrapartum/infant deaths, and 15 (6.1%) infants with HIE. The highest number of intrapartum/infant deaths occurred in 1967-1977 (51.6%) and the fewest in 2000-2008 (15.0%). Unscarred uterine ruptures did not significantly increase intrapartum/infant deaths compared to scarred uterine ruptures. Placental separation and/or fetal extrusion had the highest OR for intrapartum/infant deaths (OR 17.9; 95% CI 7.5-42.4). Time to delivery interval < 20 minutes resulted in fewest intrapartum/infant deaths (9.9%), although there were two deaths at 10 minutes interval. Time to delivery >30 minutes vs. <20 minutes increased risk of death (OR 16.7; 95% CI 6.4-43.5). Conclusion Intrapartum/infant death after complete uterine rupture decreased significantly over the decades. Time to delivery >30 minutes and placental separation and/or fetal extrusion had the highest association with intrapartum/infant deaths after complete uterine rupture. Time to delivery <20 minutes limited the incidence of intrapartum/infant deaths.

      PubDate: 2018-04-15T18:56:18Z
      DOI: 10.1016/j.ajog.2018.04.010
       
  • Antenatal Corticosteroids: An assessment of anticipated benefits and
           potential risks
    • Authors: Alan H. Jobe; Robert L. Goldenberg
      Abstract: Publication date: Available online 7 April 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Alan H. Jobe, Robert L. Goldenberg
      Antenatal corticosteroids (ACS) are standard of care for pregnancies at risk of preterm delivery between 24-34 weeks gestational age. Recent trials demonstrate modest benefits from ACS for late preterm and elective C-section deliveries, and ACS for periviable deliveries should be considered with discussion with the family. However, many women with threatened preterm deliveries receive ACS but do not deliver until after 34 weeks or at term. The net effect is that a substantial fraction of the delivery population will be exposed to ACS. There are gaps in accurate assessments of benefits of ACS because the randomized controlled trials were performed prior to about 1990 in pregnancies generally >28 weeks. The care practices for the mother and infant survival were different than today. The RCT data also do not strongly support the optimal interval from ACS treatment to delivery of 1 to 7 days. Epidemiology based studies using large cohorts with >85% of at risk pregnancies treated with ACS probably overestimate the benefits of ACS. Although most of the prematurity associated mortality is in low-resource environments, the efficacy and safety of ACS in those environments remain to be evaluated. The short-term benefits of ACS for high-risk pregnancies in high-resource environments certainly justify ACS as few risks have been identified over many years. However, cardiovascular and metabolic abnormalities have been identified in large animal models and cohorts of children exposed to ACS that are consistent with fetal programming for adult diseases. These late effects of ACS suggest caution for the expanded use of ACS beyond at-risk pregnancies at 24-34 weeks. A way forward is to develop noninvasive fetal assessments to identify pregnancies across a wider gestational age that could benefit from ACS.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.04.007
       
  • Perhaps Cerclage Is the Ideal Treatment for the Cervix less than 1 cm
    • Authors: Jennifer Powel; Carlos W. Benito; Yinka Oyelese
      Abstract: Publication date: Available online 7 April 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Jennifer Powel, Carlos W. Benito, Yinka Oyelese


      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.04.004
       
  • Opioid Prescribing Patterns among Postpartum Women
    • Authors: Nevert Badreldin; William A. Grobman; Katherine T. Chang; Lynn M. Yee
      Abstract: Publication date: Available online 7 April 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Nevert Badreldin, William A. Grobman, Katherine T. Chang, Lynn M. Yee
      Background Women commonly receive opioid prescriptions following hospitalization. The rise of the opioid epidemic in the United States underscores the importance of a better understanding of prescribing patterns. Although delivery is the most frequent reason for hospitalization in the United States, there is inadequate knowledge regarding opioid prescribing at postpartum hospital discharge. Objective To describe opioid prescribing patterns at the time of discharge following delivery in a large, diverse cohort, and to describe the relationship of these patterns with objective and subjective measures of pain prior to discharge. Study Design This is a retrospective cohort study of all deliveries at a single, high volume tertiary care center over a one-year period. Women were excluded from analysis if they had evidence of recent opioid use, or their labor, delivery or postpartum course was notable for rare, non-routine events anticipated to increase pain. Medical records were queried for demographic and clinical data, including whether an opioid prescription was provided at discharge, and if so, details of that prescription. The primary outcome was amount of opioid morphine milligram equivalents prescribed at discharge, described separately for women post vaginal and cesarean deliveries. Among women who received a prescription, we additionally assessed associations between prescription quantity and subjective (patient-reported pain score) and objective (inpatient opioid requirement during the final 24 hours of hospitalization) assessments of pain. Descriptive and bivariable analyses were performed. Results Of the total 12,611 women, 12,326 were eligible for inclusion. Of 9,038 women post vaginal delivery and 3,288 women post cesarean delivery, 30.4% and 86.7% received an opioid prescription at discharge, respectively. Of women receiving discharge opioid prescriptions, median morphine milligram equivalents received was 200 (interquartile range: 120 to 300) following vaginal and 300 (interquartile range: 200 to 300) following cesarean delivery. Nearly half (45.7%) of women post vaginal delivery and 18.5% of women post cesarean delivery who received an opioid prescription used 0 MME during the final hospital day. Similarly, 26.5% and 18.5% of women post vaginal and cesarean delivery, respectively, reported a pain score of 0 out of 10 prior to discharge. Regardless of delivery mode, the amount of opioids prescribed did not differ between those who reported a pain score of 0 out of 10 and those who reported a pain score of greater than 0 out of 10 immediately prior to discharge. Similarly, for women who underwent cesarean delivery, the morphine milligram equivalents prescribed did not differ between those who used 0 morphine milligram equivalents and those who used great than 0 in the 24 hours prior to hospital discharge. Conclusion Postpartum women are commonly prescribed opioids at the time of postpartum hospital discharge. There is a wide range of morphine milligram equivalents prescribed at hospital discharge following delivery, highlighting a lack of standardization. Furthermore, regardless of objective and subjective measures of pain prior to discharge, women received similar amounts of prescription morphine milligram equivalents following either vaginal or cesarean deliveries.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.04.003
       
  • Perioperative pregnancy interval, contraceptive counseling experiences and
           contraceptive use in women undergoing bariatric surgery
    • Authors: Biftu M. Mengesha; Jonathan T. Carter; Christine E. Dehlendorf; Amanda J. Rodriguez; Jody E. Steinauer
      Abstract: Publication date: Available online 7 April 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Biftu M. Mengesha, Jonathan T. Carter, Christine E. Dehlendorf, Amanda J. Rodriguez, Jody E. Steinauer
      Background Reproductive-aged women represent about half of those undergoing bariatric surgery in the United States (US). Obstetric and bariatric professional societies recommend that women avoid pregnancy for 12-18 months postoperatively due to concern for increased pregnancy risks, and that providers should counsel women about these recommendations and their contraceptive options. However, knowledge about women’s experience with perioperative counseling and postoperative contraceptive use is limited. Objectives 1) Determine prevalence of perioperative contraceptive and pregnancy interval discussions among women who have recently undergone bariatric surgery, 2) Describe postoperative contraceptive use within the first year of surgery in this population. Study Design We performed a cross-sectional study of US women, aged 18-45 years and recruited through Facebook, who underwent bariatric surgery within the last 24 months. Results We enrolled 363 geographically-diverse women. Three-quarters recalled perioperative pregnancy or contraceptive discussions, the majority with a bariatric provider. Half felt it was “very important” to discuss these issues perioperatively, and 41% of those who reported discussions wished they had had more. Of the 66% of women who reported using contraception in the first 12 months postoperatively; 27% used oral contraceptives and 26% used an intrauterine device. One-third of contraceptive users who had undergone Roux-en-Y gastric bypass, a combined restrictive-malabsorptive procedure, were using oral contraceptives. Perioperative contraceptive or pregnancy discussions were independently associated with increased postoperative contraceptive use (OR 2.5, 95% CI 1.5-4.3, P<0.001). Conclusions A substantial proportion of women who had undergone bariatric surgery reported having had no perioperative pregnancy or contraception counseling, and many women who had felt the discussions were insufficient. Those who had had perioperative discussions were more likely to use contraception postoperatively. Reproductive-aged women should be routinely counseled perioperatively about pregnancy and contraception in the context of their reproductive desires, so they can make informed decisions about perioperative pregnancy prevention and contraceptive method use.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.04.008
       
  • Physical activity for primary dysmenorrhea: a systematic review and
           meta-analysis of randomized controlled trials
    • Authors: Gemma Matthewman; Alexandra Lee; Jaidev G. Kaur; Amanda J. Daley
      Abstract: Publication date: Available online 7 April 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Gemma Matthewman, Alexandra Lee, Jaidev G. Kaur, Amanda J. Daley
      Background Primary dysmenorrhea is cramping abdominal pain associated with menses. It is prevalent, affects quality of life, and can cause absenteeism. Although evidence based medical treatment options exist, women may not tolerate these or may prefer to use non-medical treatments. Physical activity has been recommended by clinicians for primary dysmenorrhea since the 1930s, but there is still no high quality evidence on which to recommend its use. Objective We sought to determine the effectiveness of physical activity for the treatment of primary dysmenorrhea. Data sources Systematic literature searches of Medline, Embase, Cochrane, Web of Science, CINAHL, PsycINFO, SPORTDiscus, PEDro, AMED, WHO ICTRP, Clinicaltrials.gov and OpenGrey were performed, from database inception to 24th May 2017. Google searches and citation searching of previous reviews were also conducted. Study eligibility criteria Studies were selected using the following PICOS criteria: Participants: non-athlete females experiencing primary dysmenorrhea; Intervention: Physical activity delivered for at least two menstrual cycles; Comparator: Any comparator; Outcomes: Pain intensity or pain duration; Study type: Randomized controlled trials. Study appraisal and synthesis methods Study quality was assessed using the Cochrane Risk of Bias Tool. Random effects meta-analyses for pain intensity and pain duration were conducted, with pre-specified subgroup analysis by type of physical activity intervention. Strength of the evidence was assessed using GRADE. Results Searches identified 15 eligible randomized controlled trials totalling 1681 participants. Data from 11 studies was included in the meta-analyses. Pooled results demonstrated effect estimates for physical activity versus comparators for pain intensity (-1.89cm on Visual Analogue Scale, 95% CI -2.96 to -1.09) and pain duration (-3.92 hours, 95% CI -4.86 to -2.97). Heterogeneity for both of these results was high and only partly mitigated by subgroup analysis. Primary studies were of low or moderate methodological quality but results for pain intensity remained stable during sensitivity analysis by study quality. GRADE assessment found moderate quality evidence for pain intensity and low quality evidence for pain duration. Conclusion Clinicians can inform women that physical activity may be an effective treatment for primary dysmenorrhea but there is a need for high quality trials before this can be confirmed.

      PubDate: 2018-04-11T18:48:12Z
      DOI: 10.1016/j.ajog.2018.04.001
       
  • Information for Readers
    • Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4


      PubDate: 2018-04-11T18:48:12Z
       
  • November 2017 (vol. 217, no. 5, page 586)
    • Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4


      PubDate: 2018-04-11T18:48:12Z
       
  • December 2006 (vol. 195 , no. 6, page S202)
    • Abstract: Publication date: April 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 4


      PubDate: 2018-04-11T18:48:12Z
       
 
 
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