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Publisher: Elsevier   (Total: 3118 journals)

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Showing 1 - 200 of 3118 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 7)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 25, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 89, 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: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 374, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
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: 234, 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   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
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: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 5)
Acute Pain     Full-text available via subscription   (Followers: 13)
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: 6)
Additive Manufacturing     Hybrid Journal   (Followers: 7, 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: 137, 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: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, 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: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, 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: 16, 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: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, 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: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, 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: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 46, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 26, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 44, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 52, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
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: 11)
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: 22, 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: 26)
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: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, 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: 5, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
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: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, 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: 13)
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: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, 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: 368, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 8, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 336, 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: 5, 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: 444, 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: 42, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
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: 5, 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: 8)
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: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, 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: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 41, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, 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: 32, 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: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, 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: 204, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 60, 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: 24, 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: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 35, 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: 59, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 13)
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: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 164, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
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  

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Journal Cover American Journal of Obstetrics and Gynecology
  [SJR: 2.255]   [H-I: 171]   [204 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9378
   Published by Elsevier Homepage  [3118 journals]
  • 1: Tranexamic acid for the prevention of postpartum hemorrhage after
           vaginal delivery: the TRAAP trial
    • Authors: Loïc Sentilhes; Norbert Winer; Elie Azria; Marie-Victoire Sénat; Camille Le Ray; Delphine Vardon; Franck Perrotin; Raoul Desbrière; Florent Fuchs; Gilles Kayem; Guillaume Ducarme; Muriel Doret-Dion; Cyril Huissoud; Caroline Bohec; Philippe Deruelle; Astrid Darsonval; Jean-Marie Chrétien; Aurélien Séco; Valérie Daniel; Catherine Deneux-Tharaux
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Loïc Sentilhes, Norbert Winer, Elie Azria, Marie-Victoire Sénat, Camille Le Ray, Delphine Vardon, Franck Perrotin, Raoul Desbrière, Florent Fuchs, Gilles Kayem, Guillaume Ducarme, Muriel Doret-Dion, Cyril Huissoud, Caroline Bohec, Philippe Deruelle, Astrid Darsonval, Jean-Marie Chrétien, Aurélien Séco, Valérie Daniel, Catherine Deneux-Tharaux


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.412
       
  • 2: DNA methylation of genes in the maternal HPA axis during pregnancy is
           linked with birth outcomes
    • Authors: Douglas Williamson; Nourhan M. Elsayed; Hyagriv Simhan; William Grobman; Lauren Keenan-Devlin; Emma Adam; Claudia Buss; Jennifer Culhane; Sonja Entringer; Pathik Wadhwa; Greg Miller; Ann Borders
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Douglas Williamson, Nourhan M. Elsayed, Hyagriv Simhan, William Grobman, Lauren Keenan-Devlin, Emma Adam, Claudia Buss, Jennifer Culhane, Sonja Entringer, Pathik Wadhwa, Greg Miller, Ann Borders


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.413
       
  • 3: Timing of Serial Ultrasound In At Risk Pregnancies: A Randomized
           Controlled Trial (SUN Trial)
    • Authors: Robyn P. Roberts; Baha M. Sibai; Sean C. Blackwell; Suneet P. Chauhan
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Robyn P. Roberts, Baha M. Sibai, Sean C. Blackwell, Suneet P. Chauhan


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.414
       
  • 4: Reducing time to treatment for severe maternal hypertension through
           statewide quality improvement
    • Authors: Patricia Lee King; Lauren Keenan-Devlin; Camille Gordon; Satyender Goel; Ann Borders
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Patricia Lee King, Lauren Keenan-Devlin, Camille Gordon, Satyender Goel, Ann Borders


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.415
       
  • 5: Valnoctamide rescues CMV-induced deafness in a murine model
    • Authors: Sara Ornaghi; Jun-Ping Bai; Dhasakumar Navaratnam; Joseph Santos-Sacchi; Patrizia Vergani; Anthony van den Pol; Michael J. Paidas
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Sara Ornaghi, Jun-Ping Bai, Dhasakumar Navaratnam, Joseph Santos-Sacchi, Patrizia Vergani, Anthony van den Pol, Michael J. Paidas


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.416
       
  • 6: The impact of the HYPITAT I trial on obstetric management and outcome
           for gestational hypertension and preeclampsia in the Netherlands
    • Authors: Catherine de Sonnaville; Ben Willem Mol; Henk Groen; Floortje Vlemmix; Joke Schutte; Chantal Hukkelhoven; Marielle van Pampus
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Catherine de Sonnaville, Ben Willem Mol, Henk Groen, Floortje Vlemmix, Joke Schutte, Chantal Hukkelhoven, Marielle van Pampus


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.417
       
  • 7: Maternal administration of melatonin for prevention of preterm birth
           and fetal brain injury associated with premature birth in a mouse model
    • Authors: Ji Yeon Lee; Eunna Kim; Jong Yun Hwang; Hang Seok Song
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Ji Yeon Lee, Eunna Kim, Jong Yun Hwang, Hang Seok Song


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.418
       
  • 8: Oxygen for category ii intrauterine fetal resuscitation: a randomized,
           noninferiority trial
    • Authors: Nandini Raghuraman; Leping Wan; Lorene A. Temming; Candice Woolfolk; George A. Macones; Methodius G. Tuuli; Alison G. Cahill
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Nandini Raghuraman, Leping Wan, Lorene A. Temming, Candice Woolfolk, George A. Macones, Methodius G. Tuuli, Alison G. Cahill


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.419
       
  • 9: The role of Nur77 in perinatal neuroinflammation in a preterm labor
           mouse model
    • Authors: Sarah M. Estrada; Andrew S. Thagard; Irina Burd; Peter G. Napolitano; Nicholas Ieronimakis
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Sarah M. Estrada, Andrew S. Thagard, Irina Burd, Peter G. Napolitano, Nicholas Ieronimakis


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.420
       
  • 10: Pessary to prevent preterm birth after an episode of threatened
           preterm labor (APOSTEL VI): a randomized controlled trial
    • Authors: Frederik J. Hermans; Ewoud Schuit; Hubertina Scheepers; Mallory Woiski; Marieke Sueters; Mireille Bekker; Maureen Franssen; Marjon de Boer; Eva Pajkrt; Ben Willem Mol; Marjolein Kok
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Frederik J. Hermans, Ewoud Schuit, Hubertina Scheepers, Mallory Woiski, Marieke Sueters, Mireille Bekker, Maureen Franssen, Marjon de Boer, Eva Pajkrt, Ben Willem Mol, Marjolein Kok


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.421
       
  • 11: Beyond preeclampsia: low dose aspirin reduces spontaneous preterm
           birth
    • Authors: Maria Andrikopoulou; Stephanie E. Purisch; Roxane Handal-Orefice; Cynthia Gyamfi-Bannerman
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Maria Andrikopoulou, Stephanie E. Purisch, Roxane Handal-Orefice, Cynthia Gyamfi-Bannerman


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.422
       
  • 12: The predictive capacity of Uterine artery Doppler for preterm birth -
           a prospective cohort study
    • Authors: Maud D. van Zijl; Bouchra Koullali; Ben Willem J. Mol; Rosalinde J. Snijders; Brenda M. Kazemier; Eva Pajkrt
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Maud D. van Zijl, Bouchra Koullali, Ben Willem J. Mol, Rosalinde J. Snijders, Brenda M. Kazemier, Eva Pajkrt


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.423
       
  • 13: Antenatal steroids and neonatal hypoglycemia
    • Authors: Kristina E. Sondgeroth; Molly J. Stout; Ebony B. Carter; George A. Macones; Alison G. Cahill; Methodius G. Tuuli
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Kristina E. Sondgeroth, Molly J. Stout, Ebony B. Carter, George A. Macones, Alison G. Cahill, Methodius G. Tuuli


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.11.117
       
  • 14: Extracellular vesicle proteomic markers obtained at 12 weeks predict
           spontaneous preterm birth less than 35 weeks gestation: a validation with
           specific characterization of marker behavior by fetal gender and parity
    • Authors: Thomas McElrath; David E. Cantonwine; Arun Jeyabalan; Robert Doss; Gail Page; James M. Roberts; Brian Brohman; Kevin P. Rosenblatt
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Thomas McElrath, David E. Cantonwine, Arun Jeyabalan, Robert Doss, Gail Page, James M. Roberts, Brian Brohman, Kevin P. Rosenblatt


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.425
       
  • 15: Gardnerella vaginalis and spontaneous preterm birth: New insights
    • Authors: Katheryne L. Downes; Jacques Ravel; Pawel Gajer; Michal A. Elovitz
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Katheryne L. Downes, Jacques Ravel, Pawel Gajer, Michal A. Elovitz


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.426
       
  • 16: Predicting vaginal delivery in women undergoing induction of labor at
           preterm
    • Authors: Tetsuya Kawakita; Chun-Chih Huang; Tamika C. Auguste; David Bauer; Rachael T. Overcash
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement
      Author(s): Tetsuya Kawakita, Chun-Chih Huang, Tamika C. Auguste, David Bauer, Rachael T. Overcash


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.427
       
  • Delayed vs early umbilical cord clamping for preterm infants: a systematic
           review and meta-analysis
    • Authors: Michael Fogarty; David A. Osborn; Lisa Askie; Anna Lene Seidler; Kylie Hunter; Kei Lui; John Simes; William Tarnow-Mordi
      Pages: 1 - 18
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Michael Fogarty, David A. Osborn, Lisa Askie, Anna Lene Seidler, Kylie Hunter, Kei Lui, John Simes, William Tarnow-Mordi
      Background The effects of delayed cord clamping of the umbilical cord in preterm infants are unclear. Objective We sought to compare the effects of delayed vs early cord clamping on hospital mortality (primary outcome) and morbidity in preterm infants using Cochrane Collaboration neonatal review group methodology. Study Design We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Chinese articles, cross-referencing citations, expert informants, and trial registries to July 31, 2017, for randomized controlled trials of delayed (≥30 seconds) vs early (<30 seconds) clamping in infants born <37 weeks’ gestation. Before searching the literature, we specified that trials estimated to have cord milking in >20% of infants in any arm would be ineligible. Two reviewers independently selected studies, assessed bias, and extracted data. Relative risk (ie, risk ratio), risk difference, and mean difference with 95% confidence intervals were assessed by fixed effects models, heterogeneity by I2 statistics, and the quality of evidence by Grading of Recommendations, Assessment, Development, and Evaluations. Results Eighteen randomized controlled trials compared delayed vs early clamping in 2834 infants. Most infants allocated to have delayed clamping were assigned a delay of ≥60 seconds. Delayed clamping reduced hospital mortality (risk ratio, 0.68; 95% confidence interval, 0.52–0.90; risk difference, –0.03; 95% confidence interval, –0.05 to –0.01; P = .005; number needed to benefit, 33; 95% confidence interval, 20–100; Grading of Recommendations, Assessment, Development, and Evaluations = high, with I2 = 0 indicating no heterogeneity). In 3 trials in 996 infants ≤28 weeks’ gestation, delayed clamping reduced hospital mortality (risk ratio, 0.70; 95% confidence interval, 0.51–0.95; risk difference, –0.05; 95% confidence interval, –0.09 to –0.01; P = .02, number needed to benefit, 20; 95% confidence interval, 11–100; I2 = 0). In subgroup analyses, delayed clamping reduced the incidence of low Apgar score at 1 minute, but not at 5 minutes, and did not reduce the incidence of intubation for resuscitation, admission temperature, mechanical ventilation, intraventricular hemorrhage, brain injury, chronic lung disease, patent ductus arteriosus, necrotizing enterocolitis, late onset sepsis or retinopathy of prematurity. Delayed clamping increased peak hematocrit by 2.73 percentage points (95% confidence interval, 1.94–3.52; P < .00001) and reduced the proportion of infants having blood transfusion by 10% (95% confidence interval, 6–13%; P < .00001). Potential harms of delayed clamping included polycythemia and hyperbilirubinemia. Conclusion This systematic review provides high-quality evidence that delayed clamping reduced hospital mortality, which supports current guidelines recommending delayed clamping in preterm infants. This review does not evaluate cord milking, which may also be of benefit. Analyses of individual patient data in these and other randomized controlled trials will be critically important in reliably evaluating important secondary outcomes.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.231
       
  • Premenstrual disorders
    • Authors: Kimberly Ann Yonkers; Michael K. Simoni
      Pages: 68 - 74
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Kimberly Ann Yonkers, Michael K. Simoni
      Premenstrual disorders include premenstrual syndrome, premenstrual dysphoric disorder, and premenstrual worsening of another medical condition. While the underlying causes of these conditions continue to be explored, an aberrant response to hormonal fluctuations that occurs with the natural menstrual cycle and serotonin deficits have both been implicated. A careful medical history and daily symptom monitoring across 2 menstrual cycles is important in establishing a diagnosis. Many treatments have been evaluated for the management of premenstrual disorders. The most efficacious treatments for premenstrual syndrome and premenstrual dysphoric disorder include serotonin reuptake inhibitors and contraceptives with shortened to no hormone-free interval. Women who do not respond to these and other interventions may benefit from gonadotropin-releasing hormone agonist treatment.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.05.045
       
  • Placenta accreta spectrum: pathophysiology and evidence-based anatomy for
           prenatal ultrasound imaging
    • Authors: Eric Jauniaux; Sally Collins; Graham J. Burton
      Pages: 75 - 87
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Eric Jauniaux, Sally Collins, Graham J. Burton
      Placenta accreta spectrum is a complex obstetric complication associated with high maternal morbidity. It is a relatively new disorder of placentation, and is the consequence of damage to the endometrium-myometrial interface of the uterine wall. When first described 80 years ago, it mainly occurred after manual removal of the placenta, uterine curettage, or endometritis. Superficial damage leads primarily to an abnormally adherent placenta, and is diagnosed as the complete or partial absence of the decidua on histology. Today, the main cause of placenta accreta spectrum is uterine surgery and, in particular, uterine scar secondary to cesarean delivery. In the absence of endometrial reepithelialization of the scar area the trophoblast and villous tissue can invade deeply within the myometrium, including its circulation, and reach the surrounding pelvic organs. The cellular changes in the trophoblast observed in placenta accreta spectrum are probably secondary to the unusual myometrial environment in which it develops, and not a primary defect of trophoblast biology leading to excessive invasion of the myometrium. Placenta accreta spectrum was separated by pathologists into 3 categories: placenta creta when the villi simply adhere to the myometrium, placenta increta when the villi invade the myometrium, and placenta percreta where the villi invade the full thickness of the myometrium. Several prenatal ultrasound signs of placenta accreta spectrum were reported over the last 35 years, principally the disappearance of the normal uteroplacental interface (clear zone), extreme thinning of the underlying myometrium, and vascular changes within the placenta (lacunae) and placental bed (hypervascularity). The pathophysiological basis of these signs is due to permanent damage of the uterine wall as far as the serosa, with placental tissue reaching the deep uterine circulation. Adherent and invasive placentation may coexist in the same placental bed and evolve with advancing gestation. This may explain why no single, or set combination of, ultrasound sign(s) was found to be specific for the depth of abnormal placentation, and accurate for the differential diagnosis between adherent and invasive placentation. Correlation of pathological and clinical findings with prenatal imaging is essential to improve screening, diagnosis, and management of placenta accreta spectrum, and standardized protocols need to be developed.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.05.067
       
  • Drug interactions between non-rifamycin antibiotics and hormonal
           contraception: a systematic review
    • Authors: Katharine B. Simmons; Lisa B. Haddad; Kavita Nanda; Kathryn M. Curtis
      Pages: 88 - 97.e14
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Katharine B. Simmons, Lisa B. Haddad, Kavita Nanda, Kathryn M. Curtis
      Objective The purpose of this study was to determine whether interactions between non-rifamycin antibiotics and hormonal contraceptives result in decreased effectiveness or increased toxicity of either therapy. Study Design We searched MEDLINE, Embase, clinicaltrials.gov, and Cochrane libraries from database inception through June 2016. We included trials, cohort, case-control, and pharmacokinetic studies in any language that addressed pregnancy rates, pharmacodynamics, or pharmacokinetic outcomes when any hormonal contraceptive and non-rifamycin antibiotic were administered together vs apart. Of 7291 original records that were identified, 29 met criteria for inclusion. Study Appraisal and Synthesis Methods Two authors independently assessed study quality and risk of bias using the United States Preventive Services Task Force evidence grading system. Findings were tabulated by drug class. Results Study quality ranged from good to poor and addressed only oral contraceptive pills, emergency contraception pills, and the combined vaginal ring. Two studies demonstrated no difference in pregnancy rates in women who used oral contraceptives with and without non-rifamycin antibiotics. No differences in ovulation suppression or breakthrough bleeding were observed in any study that combined hormonal contraceptives with any antibiotic. No significant decreases in any progestin pharmacokinetic parameter occurred during co-administration with any antibiotic. Ethinyl estradiol area under the curve decreased when administered with dirithromycin, but no other drug. Conclusion Evidence from clinical and pharmacokinetic outcomes studies does not support the existence of drug interactions between hormonal contraception and non-rifamycin antibiotics. Data are limited by low quantity and quality for some drug classes. Most women can expect no reduction in hormonal contraceptive effect with the concurrent use of non-rifamycin antibiotics.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.07.003
       
  • Food and Drug Administration warning on anesthesia and brain development:
           implications for obstetric and fetal surgery
    • Authors: Olutoyin A. Olutoye; Byron Wycke Baker; Michael A. Belfort; Oluyinka O. Olutoye
      Pages: 98 - 102
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Olutoyin A. Olutoye, Byron Wycke Baker, Michael A. Belfort, Oluyinka O. Olutoye
      There has been growing concern about the detrimental effects of certain anesthetic agents on the developing brain. Preclinical studies in small animal models as well as nonhuman primates suggested loss or death of brain cells and consequent impaired neurocognitive function following anesthetic exposure in neonates and late gestation fetuses. Human studies in this area are limited and currently inconclusive. On Dec. 14, 2016, the US Food and Drug Administration issued a warning regarding impaired brain development in children following exposure to certain anesthetic agents used for general anesthesia, namely the inhalational anesthetics isoflurane, sevoflurane, and desflurane, and the intravenous agents propofol and midazolam, in the third trimester of pregnancy. Furthermore, this warning recommends that health care professionals should balance the benefits of appropriate anesthesia in young children and pregnant women against potential risks, especially for procedures that may last >3 hours or if multiple procedures are required in children <3 years old. The objective of this article is to highlight how the Food and Drug Administration warning may impact the anesthetic and surgical management of the obstetric patient. Neuraxial anesthesia (epidural or spinal anesthesia) is more commonly administered for cesarean delivery than general anesthesia. The short duration of fetal exposure to general anesthesia during cesarean delivery has not been associated with learning disabilities. However, the fetus can also be exposed to both intravenous and inhalation anesthetics during nonobstetric or fetal surgery in the second and third trimester; this exposure is typically longer than that for cesarean delivery. Very few studies address the effect of anesthetic exposure on the fetus in the second trimester when most nonobstetric and fetal surgical procedures are performed. It is also unclear how the plasticity of the fetal brain at this stage of development will modulate the consequences of anesthetic exposure. Strategies that may circumvent possible untoward long-term neurologic effects of anesthesia in the baby include: (1) use of nonimplicated (nongamma-aminobutyric acid agonist) agents for sedation such as opioids (remifentanil, fentanyl) or the alpha-2 agonist, dexmedetomidine, when appropriate; (2) minimizing the duration of exposure to inhalational anesthetics for fetal, obstetric, and nonobstetric procedures in the pregnant patient, as much as possible within safe limits; and (3) commencing surgery promptly and limiting the interval between induction of anesthesia and surgery start time will help decrease patient exposure to inhalational agents. While the Food and Drug Administration warning was based on duration and repetitive nature of exposure rather than concentration of inhalational agents, intravenous tocolytics can be considered for intraoperative use, to provide uterine relaxation for fetal surgery, in lieu of high concentrations of inhalational anesthetic agents. Practitioners should consider the type of anesthesia that will be administered and the potential risks when scheduling patients for nonobstetric and fetal surgery.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.08.107
       
  • Discussing sarcoma risks during informed consent for nonhysterectomy
           management of fibroids: an unmet need
    • Authors: Brandon-Luke L. Seagle; Amy L. Alexander; Anna E. Strohl; Shohreh Shahabi
      Pages: 103.e1 - 103.e5
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Brandon-Luke L. Seagle, Amy L. Alexander, Anna E. Strohl, Shohreh Shahabi
      There is no reliable way to distinguish symptomatic uterine fibroids from sarcoma without a surgical specimen. Many women with a uterine sarcoma are initially managed without hysterectomy under a presumed fibroid diagnosis, without understanding sarcoma risks. Currently many alternatives to hysterectomy, including medical and procedural interventions, for treatment of fibroids are promoted. The sarcoma incidence among women with presumed fibroids is 0.29% (1/340) to 0.05% (1/2000). Nonmetastatic leiomyosarcoma has a 63% 5-year survival rate whereas metastatic leiomyosarcoma has a 14% 5-year survival rate. In uterine sarcoma, we often cannot identify who has sarcoma before making a potentially cure-denying decision by delaying surgery. Therefore, women electing an alternative to hysterectomy for fibroids should undergo an informed consent process that specifically includes discussion of uterine sarcoma incidence and mortality. Alternatives to hysterectomy for presumed fibroids remain preferable treatment options for many women with symptomatic fibroids, so long as underlying sarcoma risks are adequately discussed. The challenge for obstetrician- gynecologists then is how to provide better informed consent and maintain the primacy of patient autonomy over our concern to “First, do no harm.” Major threats to patient’s autonomy are faced in the sarcoma risk discussion. How we should present sarcoma risk information to avoid being dismissive of sarcoma or frightening women toward hysterectomy is unstudied. Research is needed to determine how to provide sarcoma risk information with less bias during informed consent.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.09.014
       
  • Contraception after medication abortion in the United States: results from
           a cluster randomized trial
    • Authors: Corinne H. Rocca; Suzan Goodman; Daniel Grossman; Kara Cadwallader; Kirsten M.J. Thompson; Elizabeth Talmont; J. Joseph Speidel; Cynthia C. Harper
      Pages: 107.e1 - 107.e8
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Corinne H. Rocca, Suzan Goodman, Daniel Grossman, Kara Cadwallader, Kirsten M.J. Thompson, Elizabeth Talmont, J. Joseph Speidel, Cynthia C. Harper
      Background Understanding how contraceptive choices and access differ for women having medication abortions compared to aspiration procedures can help to identify priorities for improved patient-centered postabortion contraceptive care. Objective The objective of this study was to investigate the differences in contraceptive counseling, method choices, and use between medication and aspiration abortion patients. Study Design This subanalysis examines data from 643 abortion patients from 17 reproductive health centers in a cluster, randomized trial across the United States. We recruited participants aged 18–25 years who did not desire pregnancy and followed them for 1 year. We measured the effect of a full-staff contraceptive training and abortion type on contraceptive counseling, choice, and use with multivariable regression models, using generalized estimating equations for clustering. We used survival analysis with shared frailty to model actual intrauterine device and subdermal implant initiation over 1 year. Results Overall, 26% of participants (n = 166) had a medication abortion and 74% (n = 477) had an aspiration abortion at the enrollment visit. Women obtaining medication abortions were as likely as those having aspiration abortions to receive counseling on intrauterine devices or the implant (55%) and on a short-acting hormonal method (79%). The proportions of women choosing to use these methods (29% intrauterine device or implant, 58% short-acting hormonal) were also similar by abortion type. The proportions of women who actually used short-acting hormonal methods (71% medication vs 57% aspiration) and condoms or no method (20% vs 22%) within 3 months were not significantly different by abortion type. However, intrauterine device initiation over a year was significantly lower after the medication than the aspiration abortion (11 per 100 person-years vs 20 per 100 person-years, adjusted hazard ratio, 0.50; 95% confidence interval, 0.28–0.89). Implant initiation rates were low and similar by abortion type (5 per 100 person-years vs 4 per 100 person-years, adjusted hazard ratio, 2.41; 95% confidence interval, 0.88–6.59). In contrast to women choosing short-acting methods, relatively few of those choosing a long-acting method at enrollment, 34% of medication abortion patients and 53% of aspiration abortion patients, had one placed within 3 months. Neither differences in health insurance nor pelvic examination preferences by abortion type accounted for lower intrauterine device use among medication abortion patients. Conclusion Despite similar contraceptive choices, fewer patients receiving medication abortion than aspiration abortion initiated intrauterine devices over 1 year of follow-up. Interventions to help patients receiving medication abortion to successfully return for intrauterine device placement are warranted. New protocols for same-day implant placement may also help patients receiving medication abortion and desiring a long-acting method to receive one.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.09.020
       
  • Surgical outcomes among elderly women with endometrial cancer treated by
           laparoscopic hysterectomy: a NRG/Gynecologic Oncology Group study
    • Authors: Erin A. Bishop; James J. Java; Kathleen N. Moore; Nick M. Spirtos; Michael L. Pearl; Oliver Zivanovic; David M. Kushner; Floor Backes; Chad A. Hamilton; Melissa A. Geller; Jean Hurteau; Cara Mathews; Robert M. Wenham; Pedro T. Ramirez; Susan Zweizig; Joan L. Walker
      Pages: 109.e1 - 109.e11
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Erin A. Bishop, James J. Java, Kathleen N. Moore, Nick M. Spirtos, Michael L. Pearl, Oliver Zivanovic, David M. Kushner, Floor Backes, Chad A. Hamilton, Melissa A. Geller, Jean Hurteau, Cara Mathews, Robert M. Wenham, Pedro T. Ramirez, Susan Zweizig, Joan L. Walker
      Objective Tolerance of and complications caused by minimally invasive hysterectomy and staging in the older endometrial cancer population is largely unknown despite the fact that this is the most rapidly growing age group in the United States. The objective of this retrospective review was to compare operative morbidity by age in patients on the Gynecologic Oncology Group Laparoscopic Surgery or Standard Surgery in Treating Patients With Endometrial Cancer or Cancer of the Uterus (LAP2) trial. Study Design This is a retrospective analysis of patients from Gynecologic Oncology Group LAP2, a trial that included clinically early-stage uterine cancer patients randomized to laparotomy vs laparoscopy for surgical staging. Differences in the rates and types of intraoperative and perioperative complications were compared by age. Specifically complications between patients <60 vs ≥60 years old were compared caused by toxicity analysis showing a sharp increase in toxicity starting at age 60 years in the laparotomy group. Results LAP2 included 1477 patients ≥60 years old. As expected, with increasing age there was worsening performance status and disease characteristics including higher rates of serous histology, high-stage disease, and lymphovascular space invasion. There was no significant difference in lymph node dissection rate by age for the entire population or within the laparotomy or laparoscopy groups. Toxicity analysis showed a sharp increase in toxicity seen in patients ≥60 years old in the laparotomy group. Further analysis showed that when comparing laparotomy with laparoscopy in patients <60 years old vs ≥60 years old and controlling for race, body mass index, stage, grade, and performance status, patients <60 years old undergoing laparotomy had more hospital stays >2 days (odds ratio, 17.48; 95% confidence interval, 11.71–27.00, P < .001) compared with patients <60 years old undergoing laparoscopy. However, when comparing laparotomy with laparoscopy in patients ≥60 years old, in addition to hospital stay >2 days (odds ratio, 12.77; 95% confidence interval, 8.74–19.32, P < .001), there were higher rates of the following postoperative complications: antibiotic administration (odds ratio, 1.63; 95% confidence interval, 1.24–2.14, P < .001), ileus (odds ratio, 2.16; 95% confidence interval, 1.42–3.31, P <0.001), pneumonias (odds ratio, 2.36; 95% confidence interval, 1.01–5.66, P = .048), deep vein thromboses (odds ratio, 2.87; 95% confidence interval, 1.08–8.03, P = .035), and arrhythmias (odds ratio, 3.21; 95% confidence interval, 1.60–6.65, P = .001) in the laparotomy group. Conclusion Laparoscopic staging for uterine cancer is associated with decreased morbidity in the immediate postoperative period in patients ≥60 years old. These results allow for more accurate preoperative counseling. A minimally invasive approach to uterine cancer staging may decrease morbidity that could affect long-term survival.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.09.026
       
  • Refractory urgency urinary incontinence treatment in women: impact of age
           on outcomes and complications
    • Authors: Yuko M. Komesu; Cindy L. Amundsen; Holly E. Richter; Stephen W. Erickson; Mary F. Ackenbom; Uduak U. Andy; Vivian W. Sung; Michael Albo; W. Thomas Gregory; Marie Fidela Paraiso; Dennis Wallace; R. Edward Varner; Tracey S. Wilson; L. Keith Lloyd; Alayne D. Markland; Robert L. Holley; Alicia C. Ballard; David R. Ellington; Patricia S. Goode; Vivian W. Sung; Charles R. Rardin; B. Star Hampton; Nicole B. Korbly; Kyle J. Wohlrab; Cassandra L. Carberry; Emily Lukacz; Charles Nager; Shawn A. Menefee; Jasmine Tan-Kim; Karl M. Luber; Gouri B. Diwadkar; Keisha Y. Dyer; John N. Nguyen; Sharon Jakus-Walman; Bradley Gill; Matthew Barber; Sandip Vasavada; Marie F.R. Paraiso; Mark Walters; Cecile Unger; Beri Ridgeway; Amie Kawasaki; Nazema Y. Siddiqui; Anthony G. Visco; Alison C. Weidner; S. Renee Edwards; Mary Anna Denman; Kamran Sajadi; Rebecca Rogers; Gena Dunivan; Peter Jeppson; Sara Cichowski; Lily A. Arya; Ariana L. Smith; Michael Bonidie; Christopher Chermansky; Pamela Moalli; Jonathan Shepherd; Gary Sutkin; Halina Zyczynski
      Pages: 111.e1 - 111.e9
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Yuko M. Komesu, Cindy L. Amundsen, Holly E. Richter, Stephen W. Erickson, Mary F. Ackenbom, Uduak U. Andy, Vivian W. Sung, Michael Albo, W. Thomas Gregory, Marie Fidela Paraiso, Dennis Wallace
      Background Women with refractory urgency urinary incontinence (ie, unresponsive to behavioral and pharmacological interventions) are treated with onabotulinumtoxinA or sacral neuromodulation. Objective The objective of the study was to compare treatment efficacy and adverse events in women <65 and ≥65 years old treated with onabotulinumtoxinA or sacral neuromodulation. Study Design This study was a planned secondary analysis of a multicenter, randomized trial that enrolled community-dwelling women with refractory urgency urinary incontinence to onabotulinumtoxinA or sacral neuromodulation treatments. The primary outcome was a change in mean daily urgency urinary incontinence episodes on a bladder diary over 6 months. Secondary outcomes included ≥75% urgency urinary incontinence episode reduction, change in symptom severity/quality of life, treatment satisfaction, and treatment-related adverse events. Results Both age groups experienced improvement in mean urgency urinary incontinence episodes per day following each treatment. There was no evidence that mean daily urgency urinary incontinence episode reduction differed between age groups for onabotulinumtoxinA (adjusted coefficient, –0.127, 95% confidence interval, –1.233 to 0.979; P = .821) or sacral neuromodulation (adjusted coefficient, –0.698, 95% confidence interval, –1.832 to 0.437; P = .227). Among those treated with onabotulinumtoxinA, women <65 years had 3.3-fold greater odds of ≥75% resolution than women ≥65 years (95% confidence interval, 1.56 –7.02). Women <65 years had a greater reduction in Overactive Bladder Questionnaire Short Form symptom bother scores compared with women ≥65 years by 7.49 points (95% confidence interval, –3.23 to –11.74), regardless of treatment group. There was no difference between quality of life improvement by age. Women ≥65 years had more urinary tract infections following onabotulinumtoxinA and sacral neuromodulation (odds ratio, 1.9, 95% confidence interval, 1.2–3.3). There was no evidence of age differences in sacral neuromodulation revision/removal or catheterization following onabotulinumtoxinA treatment. Conclusion Younger women experienced greater absolute continence, symptom improvement, and fewer urinary tract infections; both older and younger women had beneficial urgency urinary incontinence episode reduction, similar rates of other treatment adverse events, and improved quality of life.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.006
       
  • Chronic pelvic pain in an interdisciplinary setting: 1-year
           prospective cohort
    • Authors: Catherine Allaire; Christina Williams; Sonja Bodmer-Roy; Sean Zhu; Kristina Arion; Kristin Ambacher; Jessica Wu; Ali Yosef; Fontayne Wong; Heather Noga; Susannah Britnell; Holly Yager; Mohamed A. Bedaiwy; Arianne Y. Albert; Sarka Lisonkova; Paul J. Yong
      Pages: 114.e1 - 114.e12
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Catherine Allaire, Christina Williams, Sonja Bodmer-Roy, Sean Zhu, Kristina Arion, Kristin Ambacher, Jessica Wu, Ali Yosef, Fontayne Wong, Heather Noga, Susannah Britnell, Holly Yager, Mohamed A. Bedaiwy, Arianne Y. Albert, Sarka Lisonkova, Paul J. Yong
      Background Chronic pelvic pain affects ∼15% of women, and presents a challenging problem for gynecologists due to its complex etiology involving multiple comorbidities. Thus, an interdisciplinary approach has been proposed for chronic pelvic pain, where these multifactorial comorbidities can be addressed by different interventions at a single integrated center. Moreover, while cross-sectional studies can provide some insight into the association between these comorbidities and chronic pelvic pain severity, prospective longitudinal cohorts can identify comorbidities associated with changes in chronic pelvic pain severity over time. Objective We sought to describe trends and factors associated with chronic pelvic pain severity over a 1-year prospective cohort at an interdisciplinary center, with a focus on the role of comorbidities and controlling for baseline pain, demographic factors, and treatment effects. Study Design This was a prospective 1-year cohort study at an interdisciplinary tertiary referral center for pelvic pain and endometriosis, which provides minimally invasive surgery, medical management, pain education, physiotherapy, and psychological therapies. Exclusion criteria included menopause or age >50 years. Sample size was 296 (57% response rate at 1 year; 296/525). Primary outcome was chronic pelvic pain severity at 1 year on an 11-point numeric rating scale (0-10), which was categorized for ordinal regression (none-mild 0–3, moderate 4–6, severe 7–10). Secondary outcomes included functional quality of life and health utilization. Baseline comorbidities were endometriosis, irritable bowel syndrome, painful bladder syndrome, abdominal wall pain, pelvic floor myalgia, and validated questionnaires for depression, anxiety, and catastrophizing. Multivariable ordinal regression was used to identify baseline comorbidities associated with the primary outcome at 1 year. Results Chronic pelvic pain severity decreased by a median 2 points from baseline to 1 year (6/10–4/10, P < .001). There was also an improvement in functional quality of life (42–29% on the pain subscale of the Endometriosis Health Profile-30, P < .001), and a reduction in subjects requiring a physician visit (73–36%, P < .001) or emergency visit (24–11%, P < .001) in the last 3 months. On multivariable ordinal regression for the primary outcome, chronic pelvic pain severity at 1 year was independently associated with a higher score on the Pain Catastrophizing Scale at baseline (odds ratio, 1.10; 95% confidence interval, 1.00–1.21, P = .04), controlling for baseline pain, treatment effects (surgery), age, and referral status. Conclusion Improvements in chronic pelvic pain severity, quality of life, and health care utilization were observed in a 1-year cohort in an interdisciplinary setting. Higher pain catastrophizing at baseline was associated with greater chronic pelvic pain severity at 1 year. Consideration should be given to stratifying pelvic pain patients by catastrophizing level (rumination, magnification, helplessness) in research studies and in clinical practice.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.002
       
  • Prolapse recurrence following sacrocolpopexy vs uterosacral ligament
           suspension: a comparison stratified by Pelvic Organ Prolapse
           Quantification stage
    • Authors: Erin Seifert Lavelle; Lauren E. Giugale; Daniel G. Winger; Li Wang; Charelle M. Carter-Brooks; Jonathan P. Shepherd
      Pages: 116.e1 - 116.e5
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Erin Seifert Lavelle, Lauren E. Giugale, Daniel G. Winger, Li Wang, Charelle M. Carter-Brooks, Jonathan P. Shepherd
      Background Insufficient evidence evaluates which pelvic organ prolapse surgery is best suited to an individual woman based on the stage of her prolapse. Objective We sought to compare prolapse recurrence rates following sacrocolpopexy and uterosacral ligament suspension after stratifying by preoperative Pelvic Organ Prolapse Quantification stage. Study Design We compared all women who underwent minimally invasive sacrocolpopexy or vaginal or minimally invasive uterosacral ligament suspension from 2009 through 2015 at a large academic center. All women with preoperative and postoperative Pelvic Organ Prolapse Quantification data were included. Patients were grouped by preoperative Pelvic Organ Prolapse Quantification stage for analysis. Recurrence rates following sacrocolpopexy and uterosacral ligament suspension were compared for patients presenting with stage II, III, and IV prolapse, adjusting for potential confounders in regression models. Prolapse recurrence was defined as any retreatment for prolapse or any Pelvic Organ Prolapse Quantification point beyond the hymen. Results Of 756 women, 633 underwent sacrocolpopexy (83.7%) and 123 (16.3%) underwent uterosacral ligament suspension. In all, 189 (25%) had preoperative Pelvic Organ Prolapse Quantification stage II prolapse, 527 (69.7%) stage III, and 40 (5.3%) stage IV. Patients were predominantly Caucasian (97.3%) with mean age 59.8 ± 9.5 years. Compared to uterosacral ligament suspension patients, more sacrocolpopexy patients had undergone prior prolapse repair (20.9% vs 5.7%, P < .001) and fewer had known diabetes mellitus (7.9% vs 13.8%, P = .034). Characteristics of the groups were otherwise similar. Median follow-up was 41.0 (interquartile range 13.0-88.8) weeks. Stage II prolapse patients had similar recurrence rates following sacrocolpopexy or uterosacral ligament suspension (6.0% vs 5.0, P = 1.00). However, stage III prolapse patients were more likely to experience recurrence following uterosacral ligament suspension (25.7% vs 7.8%, P < .001). This difference persisted after controlling for age, body mass index, smoking, diabetes, and prior prolapse repair (odds ratio, 4.3; 95% confidence interval, 2.2–8.2). There was no discernable difference in recurrence rates for women with stage IV prolapse, although sample size was limited. Conclusion Sacrocolpopexy resulted in a lower prolapse recurrence rate than uterosacral ligament suspension for stage III prolapse. However, there was no difference in recurrence rate among women with preoperative stage II prolapse, suggesting mesh augmentation may not be indicated for these patients. Larger prospective trials are necessary for confirmation.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.09.015
       
  • Trends in pelvic inflammatory disease emergency department visits, United
           States, 2006–2013
    • Authors: Kristen Kreisel; Elaine W. Flagg; Elizabeth Torrone
      Pages: 117.e1 - 117.e10
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Kristen Kreisel, Elaine W. Flagg, Elizabeth Torrone
      Background Pelvic inflammatory disease is a female genital tract disorder with severe reproductive sequelae. Because of the difficulties in diagnosing pelvic inflammatory disease, it is not a reportable condition in many states. Females seeking care in emergency departments are a sentinel population for pelvic inflammatory disease surveillance. Objective The objective of the study was to determine trends in diagnoses of acute pelvic inflammatory disease in a nationally representative sample of emergency departments. Study Design All emergency department visits among females aged 15–44 years with an International Classification of Diseases, ninth revision, Clinical Modification diagnosis code indicating pelvic inflammatory disease during 2006–2013 were assessed from the HealthCare Utilization Project Nationwide Emergency Department Sample. Total and annual percentage changes in the proportion of pelvic inflammatory disease emergency department visits were estimated using trend analyses. Results While the number of emergency department visits among females aged 15–44 years during 2006–2013 increased (6.5 million to 7.4 million), the percentage of visits due to pelvic inflammatory disease decreased from 0.57% in 2006 to 0.41% in 2013 (total percentage change, –28.4%; annual percent change, –4.3%; 95% confidence interval, –5.7% to –2.9%). The largest decreases were among those aged 15-19 years (total percent change, –40.6%; annual percentage change, –6.6%; 95% confidence interval, –8.6% to –4.4%) and living in the South (total percentage change, –38.0%; annual percentage change, –6.2%; 95% confidence interval, –7.8% to –4.6%). Females aged 15-19 years who lived in the South had a 47.9% decrease in visits due to pelvic inflammatory disease (annual percentage change, –8.4%, 95% confidence interval, –10.4 to –6.5). Patients living in ZIP codes with the lowest median income (<$38,000) had the highest percent of visits with a pelvic inflammatory disease diagnosis; the smallest declines over time were in patients living in ZIP codes with the highest median income (i.e., >$64,000, total percent change, –24.4%; annual percent change, –3.8%; 95% confidence interval, –5.2% to –2.4%). The percentage of emergency department visits due to pelvic inflammatory disease was highest among patients not charged for their visit, self-paying, or those covered by Medicaid, with total percentage changes in these 3 groups of –27.8%, –30.7%, and –35.1%, respectively. Patients with Medicaid coverage had the largest decrease in visits with a diagnosis of pelvic inflammatory disease (total percent change, –35.1%; annual percent change, –5.8%; 95% confidence interval, –7.2% to –4.3%). Conclusion Nationally representative data indicate the percentage of emergency department visits with a pelvic inflammatory disease diagnosis decreased during 2006–2013 among females aged 15-44 years, primarily driven by decreased diagnoses of pelvic inflammatory disease among females aged 15–19 years and among women living in the southern United States. Despite declines, a large number of females of reproductive age are receiving care for pelvic inflammatory disease in emergency departments. Patients with lower median income and no or public health insurance status, which may decrease access to and use of health care services, consistently had the highest percentage of emergency department visits due to pelvic inflammatory disease. Future research should focus on obtaining a better understanding of factors influencing trends in pelvic inflammatory disease diagnoses and ways to address the challenges surrounding surveillance for this condition.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.010
       
  • Validity of utility measures for women with pelvic organ prolapse
    • Authors: Heidi S. Harvie; Daniel D. Lee; Uduak U. Andy; Judy A. Shea; Lily A. Arya
      Pages: 119.e1 - 119.e8
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Heidi S. Harvie, Daniel D. Lee, Uduak U. Andy, Judy A. Shea, Lily A. Arya
      Background Pelvic organ prolapse is a common condition that frequently coexists with urinary and fecal incontinence. The impact of prolapse on quality of life is typically measured through condition-specific quality-of-life instruments. Utility preference scores are a standardized generic health-related quality-of-life measure that summarizes morbidity on a scale from 0 (death) to 1 (optimum health). Utility preference scores quantify disease severity and burden and are widely used in cost-effectiveness research. The validity of utility preference instruments in women with pelvic organ prolapse has not been established. Objective The objective of this study was to evaluate the construct validity of generic quality-of-life instruments for measuring utility scores in women with pelvic organ prolapse. Our hypothesis was that women with multiple pelvic floor disorders would have worse (lower) utility scores than women with pelvic organ prolapse only and that women with all 3 pelvic floor disorders would have the worst (lowest) utility scores. Study Design This was a prospective observational study of 286 women with pelvic floor disorders from a referral female pelvic medicine and reconstructive surgery practice. All women completed the following general health-related quality-of-life questionnaires: Health Utilities Index Mark 3, EuroQol, and Short Form 6D, as well as a visual analog scale. Pelvic floor symptom severity and condition-specific quality of life were measured using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire, respectively. We measured the relationship between utility scores and condition-specific quality-of-life scores and compared utility scores among 4 groups of women: (1) pelvic organ prolapse only, (2) pelvic organ prolapse and stress urinary incontinence, (3) pelvic organ prolapse and urgency urinary incontinence, and (4) pelvic organ prolapse, urinary incontinence, and fecal incontinence. Results Of 286 women enrolled, 191 (67%) had pelvic organ prolapse; mean age was 59 years and 73% were Caucasian. Among women with prolapse, 30 (16%) also had stress urinary incontinence, 39 (20%) had urgency urinary incontinence, and 42 (22%) had fecal incontinence. For the Health Utilities Index Mark 3, EuroQol, and Short Form 6D, the pattern in utility scores was noted to be lowest (worst) in the prolapse + urinary incontinence + fecal incontinence group (0.73-0.76), followed by the prolapse + urgency urinary incontinence group (0.77-0.85) and utility scores were the highest (best) for the prolapse only group (0.80-0.86). Utility scores from all generic instruments except the visual analog scale were significantly correlated with the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire total scores (r values –0.26 to –0.57), and prolapse, bladder, and bowel subscales (r values –0.16 to –0.50). Utility scores from all instruments except the visual analog scale were highly correlated with each other (r = 0.53-0.69, P < .0001). Conclusion The Health Utilities Index Mark 3, EuroQol, and Short Form 6D, but not the visual analog scale, provide valid measurements for utility scores in women with pelvic organ prolapse and associated pelvic floor disorders and could potentially be used for cost-effectiveness research.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.09.022
       
  • Detailed muscular structure and neural control anatomy of the levator ani
           muscle: a study based on female human fetuses
    • Authors: Krystel Nyangoh Timoh; David Moszkowicz; Mazen Zaitouna; Cedric Lebacle; Jelena Martinovic; Djibril Diallo; Maud Creze; Vincent Lavoue; Emile Darai; Gérard Benoit; Thomas Bessede
      Pages: 121.e1 - 121.e12
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Krystel Nyangoh Timoh, David Moszkowicz, Mazen Zaitouna, Cedric Lebacle, Jelena Martinovic, Djibril Diallo, Maud Creze, Vincent Lavoue, Emile Darai, Gérard Benoit, Thomas Bessede
      Background Injury to the levator ani muscle or pelvic nerves during pregnancy and vaginal delivery is responsible for pelvic floor dysfunction. Objective We sought to demonstrate the presence of smooth muscular cell areas within the levator ani muscle and describe their localization and innervation. Study Design Five female human fetuses were studied after approval from the French Biomedicine Agency. Specimens were serially sectioned and stained by Masson trichrome and immunostained for striated and smooth muscle, as well as for somatic, adrenergic, cholinergic, and nitriergic nerve fibers. Slides were digitized for 3-dimensional reconstruction. One fetus was reserved for electron microscopy. We explored the structure and innervation of the levator ani muscle. Results Smooth muscular cell beams were connected externally to the anococcygeal raphe and the levator ani muscle and with the longitudinal anal muscle sphincter. The caudalmost part of the pubovaginal muscle was found to bulge between the rectum and the vagina. This bulging was a smooth muscular interface between the levator ani muscle and the longitudinal anal muscle sphincter. The medial (visceral) part of the levator ani muscle contained smooth muscle cells, in relation to the autonomic nerve fibers of the inferior hypogastric plexus. The lateral (parietal) part of the levator ani muscle contained striated muscle cells only and was innervated by the somatic nerve fibers of levator ani and pudendal nerves. The presence of smooth muscle cells within the medial part of the levator ani muscle was confirmed under electron microscopy in 1 fetus. Conclusion We characterized the muscular structure and neural control of the levator ani muscle. The muscle consists of a medial part containing smooth muscle cells under autonomic nerve influence and a lateral part containing striated muscle cells under somatic nerve control. These findings could result in new postpartum rehabilitation techniques.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.09.021
       
  • Defining failed induction of labor
    • Authors: William A. Grobman; Jennifer Bailit; Yinglei Lai; Uma M. Reddy; Ronald J. Wapner; Michael W. Varner; John M. Thorp; Kenneth J. Leveno; Steve N. Caritis; Mona Prasad; Alan T.N. Tita; George Saade; Yoram Sorokin; Dwight J. Rouse; Sean C. Blackwell; Jorge E. Tolosa; G. Mallett; M. Ramos-Brinson; A. Roy; L. Stein; P. Campbell; C. Collins; N. Jackson; M. Dinsmoor; J. Senka; K. Paychek; A. Peaceman; M. Talucci; M. Zylfijaj; Z. Reid; R. Leed; J. Benson; S. Forester; C. Kitto; S. Davis; M. Falk; C. Perez; K. Hill; A. Sowles; J. Postma; S. Alexander; G. Andersen; V. Scott; V. Morby; K. Jolley; J. Miller; B. Berg; K. Dorman; J. Mitchell; E. Kaluta; K. Clark; K. Spicer; S. Timlin; K. Wilson; L. Moseley; M. Santillan; J. Price; K. Buentipo; V. Bludau; T. Thomas; L. Fay; C. Melton; J. Kingsbery; R. Benezue; H. Simhan; M. Bickus; D. Fischer; T. Kamon; D. DeAngelis; B. Mercer; C. Milluzzi; W. Dalton; T. Dotson; P. McDonald; C. Brezine; A. McGrail; C. Latimer; L. Guzzo; F. Johnson; L. Gerwig; S. Fyffe; D. Loux; S. Frantz; D. Cline; S. Wylie; J. Iams; M. Wallace; A. Northen; J. Grant; C. Colquitt; D. Rouse; W. Andrews; J. Moss; A. Salazar; A. Acosta; G. Hankins; N. Hauff; L. Palmer; P. Lockhart; D. Driscoll; L. Wynn; C. Sudz; D. Dengate; C. Girard; S. Field; P. Breault; F. Smith; N. Annunziata; D. Allard; J. Silva; M. Gamage; J. Hunt; J. Tillinghast; N. Corcoran; M. Jimenez; F. Ortiz; P. Givens; B. Rech; C. Moran; M. Hutchinson; Z. Spears; C. Carreno; B. Heaps; G. Zamora; J. Seguin; M. Rincon; J. Snyder; C. Farrar; E. Lairson; C. Bonino; W. Smith; K. Beach; S. Van Dyke; S. Butcher; E. Thom; M. Rice; Y. Zhao; P. McGee; V. Momirova; R. Palugod; B. Reamer; M. Larsen; C. Spong; S. Tolivaisa; J.P. Van Dorsten
      Pages: 122.e1 - 122.e8
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): William A. Grobman, Jennifer Bailit, Yinglei Lai, Uma M. Reddy, Ronald J. Wapner, Michael W. Varner, John M. Thorp, Kenneth J. Leveno, Steve N. Caritis, Mona Prasad, Alan T.N. Tita, George Saade, Yoram Sorokin, Dwight J. Rouse, Sean C. Blackwell, Jorge E. Tolosa
      Background While there are well-accepted standards for the diagnosis of arrested active-phase labor, the definition of a “failed” induction of labor remains less certain. One approach to diagnosing a failed induction is based on the duration of the latent phase. However, a standard for the minimum duration that the latent phase of a labor induction should continue, absent acute maternal or fetal indications for cesarean delivery, remains lacking. Objective The objective of this study was to determine the frequency of adverse maternal and perinatal outcomes as a function of the duration of the latent phase among nulliparous women undergoing labor induction. Study Design This study is based on data from an obstetric cohort of women delivering at 25 US hospitals from 2008 through 2011. Nulliparous women who had a term singleton gestation in the cephalic presentation were eligible for this analysis if they underwent a labor induction. Consistent with prior studies, the latent phase was determined to begin once cervical ripening had ended, oxytocin was initiated, and rupture of membranes had occurred, and was determined to end once 5-cm dilation was achieved. The frequencies of cesarean delivery, as well as of adverse maternal (eg, postpartum hemorrhage, chorioamnionitis) and perinatal (eg, a composite frequency of seizures, sepsis, bone or nerve injury, encephalopathy, or death) outcomes, were compared as a function of the duration of the latent phase (analyzed with time both as a continuous measure and categorized in 3-hour increments). Results A total of 10,677 women were available for analysis. In the vast majority (96.4%) of women, the active phase had been reached by 15 hours. The longer the duration of a woman’s latent phase, the greater her chance of ultimately undergoing a cesarean delivery (P < .001, for time both as a continuous and categorical independent variable), although >40% of women whose latent phase lasted ≥18 hours still had a vaginal delivery. Several maternal morbidities, such as postpartum hemorrhage (P < .001) and chorioamnionitis (P < .001), increased in frequency as the length of latent phase increased. Conversely, the frequencies of most adverse perinatal outcomes were statistically stable over time. Conclusion The large majority of women undergoing labor induction will have entered the active phase by 15 hours after oxytocin has started and rupture of membranes has occurred. Maternal adverse outcomes become statistically more frequent with greater time in the latent phase, although the absolute increase in frequency is relatively small. These data suggest that cesarean delivery should not be undertaken during the latent phase prior to at least 15 hours after oxytocin and rupture of membranes have occurred. The decision to continue labor beyond this point should be individualized, and may take into account factors such as other evidence of labor progress.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.11.556
       
  • Maternal hemodynamics: a method to classify hypertensive disorders of
           pregnancy
    • Authors: Enrico Ferrazzi; Tamara Stampalija; Lorenzo Monasta; Daniela Di Martino; Sharona Vonck; Wilfried Gyselaers
      Pages: 124.e1 - 124.e11
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Enrico Ferrazzi, Tamara Stampalija, Lorenzo Monasta, Daniela Di Martino, Sharona Vonck, Wilfried Gyselaers
      Background The classification of hypertensive disorders of pregnancy is based on the time at the onset of hypertension, proteinuria, and other associated complications. Maternal hemodynamic interrogation in hypertensive disorders of pregnancy considers not only the peripheral blood pressure but also the entire cardiovascular system, and it might help to classify the different clinical phenotypes of this syndrome. Objective This study aimed to examine cardiovascular parameters in a cohort of patients affected by hypertensive disorders of pregnancy according to the clinical phenotypes that prioritize fetoplacental characteristics and not the time at onset of hypertensive disorders of pregnancy. Study Design At the fetal-maternal medicine unit of Ziekenhuis Oost-Limburg (Genk, Belgium), maternal cardiovascular parameters were obtained through impedance cardiography using a noninvasive continuous cardiac output monitor with the patients placed in a standing position. The patients were classified as pregnant women with hypertensive disorders of pregnancy who delivered appropriate- and small-for-gestational-age fetuses. Normotensive pregnant women with an appropriate-for-gestational-age fetus at delivery were enrolled as the control group. The possible impact of obesity (body mass index ≥30 kg/m2) on maternal hemodynamics was reassessed in the same groups. Results Maternal age, parity, body mass index, and blood pressure were not significantly different between the hypertensive disorders of pregnancy/appropriate-for-gestational-age and hypertensive disorders of pregnancy/small-for-gestational-age groups. The mean uterine artery pulsatility index was significantly higher in the hypertensive disorders of pregnancy/small-for-gestational-age group. The cardiac output and cardiac index were significantly lower in the hypertensive disorders of pregnancy/small-for-gestational-age group (cardiac output 6.5 L/min, cardiac index 3.6) than in the hypertensive disorders of pregnancy/appropriate-for-gestational-age group (cardiac output 7.6 L/min, cardiac index 3.9) but not between the hypertensive disorders of pregnancy/appropriate-for-gestational-age and control groups (cardiac output 7.6 L/min, cardiac index 4.0). Total vascular resistance was significantly higher in the hypertensive disorders of pregnancy/small-for-gestational-age group than in the hypertensive disorders of pregnancy/appropriate-for-gestational-age group and the control group. All women with hypertensive disorders of pregnancy showed signs of central arterial dysfunction. The cardiovascular parameters were not influenced by gestational age at the onset of hypertensive disorders of pregnancy, and no difference was observed between the women with appropriate-for-gestational-age fetuses affected by preeclampsia or by gestational hypertension with appropriate-for-gestational-age fetuses. Women in the obese/hypertensive disorders of pregnancy/appropriate-for-gestational-age and obese/hypertensive disorders of pregnancy/small-for-gestational-age groups showed a significant increase in cardiac output, as well as significant changes in other parameters, compared with the nonobese/hypertensive disorders of pregnancy/appropriate-for-gestational-age and nonobese/hypertensive disorders of pregnancy/small-for-gestational-age groups. Conclusion Significantly low cardiac output and high total vascular resistance characterized the women with hypertensive disorders of pregnancy associated with small for gestational age due to placental insufficiency, independent of the gestational age at the onset of hypertension. The cardiovascular parameters were not significantly different in the women with appropriate-for-gestational-age or small-for-gestational-age fetuses affected by preeclampsia or gestational hypertension. These findings support the view that maternal hemodynamics may be a candidate diagnostic tool to identify hypertensive disorders in pregnancies associated with small-for-gestational-age fetuses. This additional tool matches other reported evidence provided by uterine Doppler velocimetry, low vascular growth factors in the first trimester, and placental pathology. Obesi...
      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.10.226
       
  • Management of sexuality, intimacy, and menopause symptoms after ovarian
           cancer
    • Authors: Martha F. Goetsch
      Abstract: Publication date: Available online 5 January 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Martha F. Goetsch


      PubDate: 2018-01-10T09:38:49Z
      DOI: 10.1016/j.ajog.2018.01.001
       
  • The Most Important Quality of a Physician
    • Authors: Emmet Hirsch
      Abstract: Publication date: Available online 3 January 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Emmet Hirsch


      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.12.237
       
  • Meta-analysis on the effect of aspirin use for prevention of preeclampsia
           on placental abruption and antepartum hemorrhage
    • Authors: Stephanie Roberge; Emmanuel Bujold; Kypros H. Nicolaides
      Abstract: Publication date: Available online 3 January 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Stephanie Roberge, Emmanuel Bujold, Kypros H. Nicolaides
      Background Impaired placentation in the first 16 weeks of pregnancy is associated with increased risk of subsequent development of preeclampsia, birth of small for gestational age neonates and placental abruption. Previous studies reported that prophylactic use of aspirin reduces the risk of preeclampsia and small for gestational age neonates with no significant effect on placental abruption. However, meta-analyses of randomized controlled trials examining the effect of aspirin in relation to gestational age at onset of therapy and dose of the drug reported that significant reduction in the risk of preeclampsia and small for gestational age neonates is achieved only if the onset of treatment is at ≤16 weeks of gestation and the daily dose of the drug is ≥100 mg. Objective To estimate the effect of aspirin on the risk of placental abruption or antepartum hemorrhage, in relation to gestational age at onset of therapy and the dose of the drug. Study design We performed a systematic review and meta-analysis of randomized controlled trials that evaluated the prophylactic effect of aspirin during pregnancy using PubMed, Cinhal, Embase, Web of Science and Cochrane library from 1985 to September 2017. Relative risks (RR) of placental abruption or antepartum hemorrhage with their 95% confidence intervals (95% CI) were calculated using random effect models. Analyses were stratified according to daily dose of aspirin (<100 and ≥100 mg) and the gestational age at the onset of therapy (≤16 and >16 weeks) and compared using subgroup difference analysis. Results The entry criteria were fulfilled by 20 studies on a combined total of 12,585 participants. Aspirin at a dose of <100 mg per day had no impact on the risk of placental abruption or antepartum hemorrhage, irrespective of whether it was initiated at ≤16 weeks’ gestation (RR 1.11, 95% CI 0.52 to 2.36) or at >16 weeks (RR 1.32, 95% CI 0.73 to 2.39). At ≥100 mg per day, aspirin was not associated with a significant change on the risk of placental abruption or antepartum hemorrhage, whether the treatment was initiated at ≤16 weeks of gestation (RR 0.62, 95% CI 0.31 to 1.26), or at >16 weeks (RR 2.08 95% CI 0.86 to 5.06), but the difference between the subgroups was significant (p=0.04). Conclusion Aspirin at a daily dose of ≥100 mg for prevention of preeclampsia, initiated at ≤16 weeks of gestation rather than >16 weeks may decrease the risk of placental abruption or antepartum hemorrhage.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.12.238
       
  • Cardiac Arrest during pregnancy: Ongoing Clinical Conundrum An Expert
           Review
    • Authors: Carolyn M. Zelop; Sharon Einav; Jill M. Mhyre; Stephanie Martin
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Carolyn M. Zelop, Sharon Einav, Jill M. Mhyre, Stephanie Martin
      While global maternal mortality has decreased in the last 25 years, the maternal mortality ratio in the United States has actually increased. Maternal mortality is a complex phenomenon involving multifaceted socioeconomic and clinical parameters including inequalities in access to health care, racial and ethnic disparities, maternal comorbidities and epidemiologic ascertainment bias. Escalating maternal mortality underscores the importance of clinician preparedness to respond to maternal cardiac arrest that may occur in any maternal health care setting. Management of maternal cardiac arrest requires an interdisciplinary team familiar with the physiologic changes of pregnancy and the maternal resuscitation algorithm. Interventions intended to mitigate obstacles such as aortocaval compression which may undermine the success of resuscitation interventions must be performed concurrent to standard basic and advanced cardiac life support maneuvers. High quality chest compressions and oxygenation must be performed along with manual left lateral uterine displacement when the uterine size is greater than or equal to 20 weeks. While deciphering the etiology of maternal cardiac arrest, diagnoses unique to pregnancy and those of the nonpregnant state should be considered at the same time. If initial basic life support and advanced cardiac life support interventions fail to restore maternal circulation within four minutes of cardiac arrest, perimortem delivery is advised provided the uterus is greater than or equal to 20 weeks’ size. Preparations for perimortem delivery are best anticipated by the resuscitation team in order for the procedure to be executed opportunely. Following delivery, intraabdominal examination may reveal a vascular catastrophe, hematoma or both. If return of spontaneous circulation has not been achieved, additional interventions may include cardiopulmonary bypass and/ or extracorporeal membrane oxygenation. Simulation and team training enhance institution readiness for maternal cardiac arrest. Knowledge gaps are significant in the science of maternal resuscitation. Further research is required to fully optimize: relief of aortocaval compression during the resuscitation process, gestational age and timing of perimortem delivery and other interventions that deviate from non-pregnant standard resuscitation protocol to achieve successful maternal resuscitation. A robust detailed national and international prospective database was recommended by the International Liaison Committee on Resuscitation in 2015 to facilitate further research unique to cardiac arrest during pregnancy that will produce optimal resuscitation techniques for maternal cardiac arrest.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.12.232
       
  • Sonographic Large Fetal Head Circumference and Risk of Cesarean Delivery
    • Authors: Michal Lipschuetz; Sarah M. Cohen; Ariel Israel; Joel Baron; Shay Porat; Dan V. Valsky; Oren Yagel; Doron Kabiri; Yinon Gilboa; Eyal Sivan; Ron Unger; Eyal Schiff; Reli Hershkovitz; Simcha Yagel
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Michal Lipschuetz, Sarah M. Cohen, Ariel Israel, Joel Baron, Shay Porat, Dan V. Valsky, Oren Yagel, Doron Kabiri, Yinon Gilboa, Eyal Sivan, Ron Unger, Eyal Schiff, Reli Hershkovitz, Simcha Yagel
      Background Persistently high rates of cesarean deliveries are cause for concern for physicians, patients, and health systems. Prelabor assessment might be refined by identifying factors that help predict an individual patient’s risk of cesarean delivery. Such factors may contribute to patient safety and satisfaction as well as health system planning and resource allocation. In an earlier study, neonatal head circumference was shown to be more strongly associated with delivery mode and other outcome measures, than neonatal birth weight. Objective In the present study we aimed to evaluate the association of sonographically measured fetal head circumference measured within one week of delivery, with delivery mode. Study Design Multi-center electronic medical record-based study of birth outcomes of primiparous women with term (37-42 weeks) singleton fetuses presenting for ultrasound with fetal biometry within one week of delivery. Fetal head circumference and estimated fetal weight were correlated with maternal background, obstetric, and neonatal outcome parameters. Elective cesarean deliveries were excluded. Multinomial regression analysis provided adjusted odds ratios (aOR) for instrumental delivery and unplanned cesarean delivery when the fetal head circumference ≥ 35 cm or estimated fetal weight ≥ 3900 g, while controlling for possible confounders. Results 11,500 cases were collected; 906 elective cesarean deliveries were excluded. A FHC≥35 cm increased the risk for unplanned cesarean delivery: 174 fetuses with FHC≥35 cm (32%) were delivered by cesarean, vs. 1712 (17%) when FHC<35 cm (OR 2.49, 95% CI 2.04-3.03). A FHC≥35 cm increased the risk of instrumental delivery (OR 1.48, 95% CI 1.16-1.88), while EFW≥3900 tended to reduce it (non-significant). Multinomial regression analysis showed that FHC≥35 increased the risk of unplanned cesarean delivery by an adjusted odds ratio of 1.75 (95% CI 1.4-2.18) controlling for gestational age, fetal gender, and epidural anesthesia. The rate of prolonged second stage of labor was significantly increased when either the FHC≥35 cm or the EFW≥3900, from 22.7% in the total cohort to 30.9%. A FHC≥35 cm was associated with a higher rate of 5-minute Apgar score ≤7: 9 (1.7%) vs. 63 (0.6%) of infants with FHC<35 cm (p=0.01). The rate among fetuses with an EFW≥3900 was not significantly increased. The rate of admission to the NICU did not differ among the groups. Conclusions Sonographic fetal head circumference ≥35 cm, measured within one week of delivery, is an independent risk factor for unplanned cesarean delivery but not instrumental delivery. Both FHC≥35 cm and EFW≥3900 significantly increased the risk of a prolonged second stage of labor. FHC measurement in the last days before delivery may be an important adjunct to EFW in labor management.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.12.230
       
  • Pelvic floor functional outcomes after total abdominal versus total
           laparoscopic hysterectomy for endometrial cancer
    • Authors: Peta Higgs; Monika Janda; Rebecca Asher; Val Gebski; Peta Forder; Andreas Obermair
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Obstetrics and Gynecology
      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. Objectives 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 (LACE) trial and to compare patients’ outcomes who had total abdominal total versus total laparoscopic hysterectomy. Study Design Multinational, phase 3, randomized non-inferiority trial comparing disease-free survival of patients who had total abdominal hysterectomy versus total laparoscopic hysterectomy. This substudy analyses the results from a self-administered validated questionnaire on pelvic floor symptoms (Pelvic Floor Distress Inventory (PFDI)) administered pre-operatively, and at follow-up visits 6, 18, 30, 42, and 54 months post-operatively. 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 post-surgery both groups experienced an improvement in Pelvic Floor Distress Inventory scores compared to presurgical pelvic floor wellbeing (total abdominal hysterectomy: mean change -11.17, 95% CI: -17.11 to -5.24; total laparoscopic hysterectomy mean change -10.25, 95% CI: -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 post-surgery. 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: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.12.233
       
  • Chronic hypertension: first-trimester blood pressure control and
           likelihood of severe hypertension, preeclampsia and small for gestational
           age
    • Authors: Diane Nzelu; Dan Dumitrascu-Biris; Kypros H. Nicolaides; Nikos A. kametas
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Diane Nzelu, Dan Dumitrascu-Biris, Kypros H. Nicolaides, Nikos A. kametas
      Background There is extensive evidence that pre-pregnancy chronic hypertension is associated with high risk of development of severe hypertension and preeclampsia and birth of small for gestational age neonates. However, previous studies have not reported whether anti-hypertensive use, blood pressure control or normalization of blood pressure during early pregnancy influence the rates of these pregnancy complications. Objective To stratify women with pre-pregnancy chronic hypertension according to the use of antihypertensive medications and level of blood pressure control at the first hospital visit during the first-trimester of pregnancy and examine the rates of severe hypertension, preeclampsia and birth of small for gestational age neonates according to such stratification. Study Design Prospective study of 586 women with pre-pregnancy chronic hypertension, in the absence of renal or liver disease, booked at a dedicated clinic for the management of hypertension in pregnancy. The patients had singleton pregnancies and were subdivided according to findings in their first visit into group 1 (n=199), with blood pressure <140/90 mmHg without antihypertensive medication, group 2 (n=220), with blood pressure <140/90 mmHg with antihypertensive medication and group 3 (n=167), with systolic blood pressure >140 mmHg and or diastolic blood pressure >90 mmHg despite antihypertensive medication. In the subsequent management of these pregnancies our policy was to maintain the blood pressure at 130-140 / 80-90 mmHg with use of antihypertensive medication; antihypertensive drugs were stopped if the blood pressure was persistently less than 130/80 mmHg. The outcome measures were severe hypertension (systolic blood pressure >160 mmHg and / or diastolic blood pressure >110 mmHg), preterm and term preeclampsia (in addition to hypertension at least one of renal involvement, liver impairment, neurological complications or thrombocytopenia), and birth of small for gestational age neonates (birth weight <5th percentile for gestational age). The incidence of these complications was compared in the three strata. Results The median gestational age at presentation was 10.0 (interquartile range 9.1-11.0) weeks. In groups 2 and 3, compared to group 1, there was a significantly higher body mass index, incidence of black racial origin and history of preeclampsia in a previous pregnancy. There was a significant increase from group 1 to group 3 in incidence of severe hypertension (10.6%, 22.2% and 52.1%), preterm preeclampsia with onset at <37 weeks of gestation (7.0%, 15.9% and 20.4%), and small for gestational age (13.1%, 17.7% and 21.1%), but not term preeclampsia with onset at >37 weeks of gestation (9.5%, 9.1% and 6.6%). Conclusions In women with pre-pregnancy chronic hypertension, the rates of development of severe hypertension, preterm preeclampsia and small for gestational age are related to use of antihypertensive medications and level of blood pressure control at the first hospital visit during the first-trimester of pregnancy.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.12.235
       
  • Comparative analysis of gene expression in maternal peripheral blood and
           monocytes during spontaneous preterm labor
    • Authors: Alison G. Paquette; Oksana Shynlova; Mark Kibschull; Nathan D. Price; Stephen J. Lye
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Alison G. Paquette, Oksana Shynlova, Mark Kibschull, Nathan D. Price, Stephen J. Lye
      Background Preterm birth is the leading cause of newborn death worldwide, and is associated with significant cognitive and physiological challenges in later life. There is a pressing need to define the mechanisms that initiate spontaneous preterm labor , and for development of novel clinical biomarkers to identify high-risk pregnancies. Most preterm birth studies utilize fetal tissues, and there is limited understanding of the transcriptional changes that occur in mothers undergoing spontaneous preterm labor. Earlier work revealed that a specific population of maternal peripheral leukocytes (macrophages/monocytes) play an active role in the initiation of labor. Thus, we hypothesized that there are dynamic gene expression changes in maternal blood leukocytes during PTL. Objective Using next generation sequencing we aim to characterize the transcriptome in whole blood leukocytes and peripheral monocytes of women undergoing sPTL compared to healthy pregnant women that subsequently delivered at full term. Study Design RNA sequencing was performed in both whole blood and peripheral monocytes from women who underwent preterm labor (24-34 weeks of gestation, N=20) matched for gestational age to healthy pregnant controls (N=30). All participants were a part of the Ontario Birth Study cohort (Toronto, Canada). Results We identified significant differences in expression of 262 genes in peripheral monocytes and 184 genes in whole blood of women who were in active sPTL compared to pregnant women of the same gestational age not undergoing labor, with 43 of these genes differentially expressed in both whole blood and peripheral monocytes. ADAMTS2 expression was significantly increased in women actively undergoing sPTL, which we validated through digital droplet RT-PCR. Intriguingly, we have also identified a number of gene sets including signaling by SCF-Kit, nucleotide metabolism, and Trans-Golgi network vesicle budding, which exhibited changes in relative gene expression that was predictive of preterm labor status in both maternal whole blood and peripheral monocytes. Conclusion This study is the first to investigate changes in both whole blood leukocytes and peripheral monocytes of women actively undergoing spontaneous preterm labor through robust transcript measurements from RNA-sequencing. Our unique study design overcame confounding based on gestational age by collecting blood samples from women matched by gestational age, allowing us to study transcriptomics changes directly related to the active preterm parturition. We performed RNA profiling using whole genome sequencing; which is highly sensitive and allowed us to identify subtle changes in specific genes. ADAMTS2 expression emerged as a marker of prematurity within peripheral blood leukocytes; an accessible tissue which plays a functional role in signaling during the onset of labor. We identified changes in relative gene expression in a number of gene sets related to signaling in monocytes and whole blood of women undergoing sPTL compared to controls. These genes and pathways may help identify potential targets for the development of novel drugs for preterm birth prevention.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.12.234
       
  • The anatomy of the sacral promontory: how to avoid complications of the
           sacrocolpopexy procedure
    • Authors: Géraldine Giraudet; Aurore Protat; Michel Cosson
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Géraldine Giraudet, Aurore Protat, Michel Cosson
      Because of problems with vaginal meshes and high rate recurrences of native tissue repair, more and more surgeons treat pelvic organ prolapse performing 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 place is dangerous for surgeons because of the proximity of vessels, nerves and ureters. The lack of knowledge of the anatomy can lead to severe complications such as vascular, ureteral or nerve injuries. These complications can be life threatening. In order to show the anatomical concerns when surgeons dissect and fix the mesh on the anterior longitudinal ligament, we have developed a video of the promontory anatomy. By reviewing anatomical articles about vessels, nerves and ureters in this localization, we propose an educational tool to increase the anatomical knowledge to avoid severe complications. In this video, we show an alternative location for dissection and graft fixation when the surgeon feels mesh cannot be safely fixed on the anterior surface of S1, as currently recommended.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.12.236
       
  • Diagnosis and Treatment of Urinary Tract Infections Across Age Groups
    • Authors: Christine M. Chu; Jerry L. Lowder
      Abstract: Publication date: Available online 2 January 2018
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Christine M. Chu, Jerry L. Lowder
      Urinary tract infections (UTI) are the most common outpatient infections, but predicting the probability of UTI through symptoms and test results can be complex. The most diagnostic symptoms of UTI include change in frequency, dysuria, urgency, and presence or absence of vaginal discharge, but UTIs may present differently in older women. Dipstick urinalysis is popular for its availability and usefulness, but results must be interpreted in context of the patient’s pretest probability based on symptoms and characteristics. In patients with a high probability of UTI based on symptoms, negative dipstick urinalysis does not rule out UTI. Nitrites are likely more sensitive and specific than other dipstick components for UTI, particularly in the elderly. Positive dipstick testing is likely specific for asymptomatic bacteriuria in pregnancy, but urine culture is still the test of choice. Microscopic urinalysis is likely comparable to dipstick urinalysis as a screening test. Bacteriuria is more specific and sensitive than pyuria for detecting UTI, even in older women and during pregnancy. Pyuria is commonly found in the absence of infection, particularly in older adults with lower urinary tract symptoms such as incontinence. Positive testing may increase the probability of UTI, but initiation of treatment should take into account risk of UTI based on symptoms as well. In cases in which the probability of UTI is moderate or unclear, urine culture should be performed. Urine culture is the gold standard for detection of UTI. However, asymptomatic bacteriuria is common, particularly in older women, and should not be treated with antibiotics. Conversely, in symptomatic women, even growth as low as 102 cfu/ml could reflect infection. Resistance is increasing to fluoroquinolones, beta-lactams, and trimethoprim-sulfamethoxazole. Most uropathogens still display good sensitivity to nitrofurantoin. First-line treatments for UTI include nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole (when resistance levels are <20%). These antibiotics have minimal collateral damage and resistance. In pregnancy, beta-lactams, nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole can be appropriate treatments. Interpreting the probability of UTI based on symptoms and testing allows for greater accuracy in diagnosis of UTI, decreasing overtreatment and encouraging antimicrobial stewardship.

      PubDate: 2018-01-03T15:39:22Z
      DOI: 10.1016/j.ajog.2017.12.231
       
  • Information for Readers
    • Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1


      PubDate: 2018-01-03T15:39:22Z
       
  • Schedule of Oral Presentations
    • Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement


      PubDate: 2018-01-03T15:39:22Z
       
  • Oral Plenary Session I Divider Page
    • Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement


      PubDate: 2018-01-03T15:39:22Z
       
  • Proceedings: Beyond Ultrasound First Forum on improving the quality of
           ultrasound imaging in obstetrics and gynecology
    • Authors: Beryl Benacerraf; Katherine Minton Carol Benson Bryann Bromley Brian Coley
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Beryl R. Benacerraf, Katherine K. Minton, Carol B. Benson, Bryann S. Bromley, Brian D. Coley, Peter M. Doubilet, Wesley Lee, Samuel H. Maslak, John S. Pellerito, James J. Perez, Eric Savitsky, Norman A. Scarborough, Joseph Wax, Alfred Z. Abuhamad
      The Beyond Ultrasound First Forum was conceived to increase awareness that the quality of obstetric and gynecologic ultrasound can be improved, and is inconsistent throughout the country, likely due to multiple factors, including the lack of a standardized curriculum and competency assessment in ultrasound teaching. The forum brought together representatives from many professional associations; the imaging community including radiology, obstetrics and gynecology, and emergency medicine among others; in addition to government agencies, insurers, industry, and others with common interest in obstetric and gynecologic ultrasound. This group worked together in focus sessions aimed at developing solutions on how to standardize and improve ultrasound training at the resident level and beyond. A new curriculum and competency assessment program for teaching residents (obstetrics and gynecology, radiology, and any other specialty doing obstetrics and gynecology ultrasound) was presented, and performance measures of ultrasound quality in clinical practice were discussed. The aim of this forum was to increase and unify the quality of ultrasound examinations in obstetrics and gynecology with the ultimate goal of improving patient safety and quality of clinical care. This report describes the proceedings of this conference including possible approaches to resident teaching and means to improve the inconsistent quality of ultrasound examinations performed today.

      PubDate: 2018-01-03T15:39:22Z
       
  • Obstetric and gynecologic ultrasound curriculum and competency assessment
           in residency training programs: consensus report
    • Authors: Alfred Abuhamad; Katherine Minton Carol Benson Trish Chudleigh Lori Crites
      Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1
      Author(s): Alfred Abuhamad, Katherine K. Minton, Carol B. Benson, Trish Chudleigh, Lori Crites, Peter M. Doubilet, Rita Driggers, Wesley Lee, Karen V. Mann, James J. Perez, Nancy C. Rose, Lynn L. Simpson, Ann Tabor, Beryl R. Benacerraf
      Ultrasound imaging has become integral to the practice of obstetrics and gynecology. With increasing educational demands and limited hours in residency programs, dedicated time for training and achieving competency in ultrasound has diminished substantially. The American Institute of Ultrasound in Medicine assembled a multisociety task force to develop a consensus-based, standardized curriculum and competency assessment tools for obstetric and gynecologic ultrasound training in residency programs. The curriculum and competency assessment tools were developed based on existing national and international guidelines for the performance of obstetric and gynecologic ultrasound examinations and thus are intended to represent the minimum requirement for such training. By expert consensus, the curriculum was developed for each year of training, criteria for each competency assessment image were generated, the pass score was established at, or close to, 75% for each, and obtaining a set of 5 ultrasound images with pass score in each was deemed necessary for attaining each competency. Given the current lack of substantial data on competency assessment in ultrasound training, the task force expects that the criteria set forth in this document will evolve with time. The task force also encourages use of ultrasound simulation in residency training and expects that simulation will play a significant part in the curriculum and the competency assessment process. Incorporating this training curriculum and the competency assessment tools may promote consistency in training and competency assessment, thus enhancing the performance and diagnostic accuracy of ultrasound examination in obstetrics and gynecology.

      PubDate: 2018-01-03T15:39:22Z
       
  • Oral Concurrent Session I Divider Page
    • Abstract: Publication date: January 2018
      Source:American Journal of Obstetrics and Gynecology, Volume 218, Issue 1, Supplement


      PubDate: 2018-01-03T15:39:22Z
       
 
 
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