Christine Farinelli

The impact of change in pregnancy body mass index on the development of gestational hypertensive disorders.

Objective:To examine the impact of change in body mass index (BMI) during pregnancy on the incidence of gestational hypertension/preeclampsia.Study Design:This is a retrospective cohort study using linked California birth certificate and discharge diagnosis data from the year 2007. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated for the outcome of gestational hypertension/preeclampsia, as a function of a categorical change in pregnancy BMI: BMI loss (<−0.5), no change (−0.5 to 0.5), minimal (0.6 to 5), moderate (5.1 to 10) and excessive (>10). The impact of change in pregnancy BMI was evaluated for the entire cohort and then as a function of prepregnancy BMI category. Women with no change in pregnancy BMI served as the reference group.Result:The study population consisted of 436 414 women with singleton gestations. Overall, women with excessive BMI change had a nearly twofold increased odds of gestational hypertension/preeclampsia (aOR=1.94; 95% CI=1.72 to 2.20). By prepregnancy BMI class, overweight and obese women who had a moderate change in pregnancy BMI also had increased odds of developing gestational hypertension/preeclampsia with aOR ranging from 1.73 to 1.97.Conclusion:Regardless of prepregnancy BMI category, women with excessive BMI change have a higher chance of developing gestational hypertension/preeclampsia. Overweight and obese women with moderate BMI change may also be at increased risk.

Cardiopulmonary Resuscitation in Pregnancy

Cardiac arrest in pregnancy is not only uncommon but also catastrophic. Early aggressive resuscitation by well-trained health care providers improves the chances of successful outcomes for both the patient and her fetus. Significant physiologic changes that occur normally in pregnancy require several modifications to standard cardiopulmonary resuscitation, and urgent cesarean delivery may be indicated to benefit both the mother and the infant.

The impact of change in pregnancy body mass index on macrosomia

To examine the impact of change in body mass index (BMI) during pregnancy on the incidence of macrosomia.

The impact of change in pregnancy body mass index on cesarean delivery

Abstract Objective: To examine the impact of pregnancy changes in body mass index (BMI) on the incidence of cesarean delivery. Methods: This is a retrospective cohort study using linked birth certificate and discharge diagnosis data from the year 2007. Adjusted odds ratios (aOR) were calculated for the outcome of cesarean delivery, as a function of a categorical change in pregnancy BMI (kg/m2): BMI loss (BMI change<−0.5), no change (−0.5 to 0.5), minimal (0.6 to 5), moderate (5.1 to 10) and excessive (>10). The impact of pregnancy change in BMI was determined for the entire cohort and then stratified by prepregnancy BMI category. Results: The study population consisted of 436 414 women with singleton gestations. When compared to women with no net change in BMI, women with excessive BMI changes collectively had a 80% increased incidence of cesarean delivery (aOR = 1.78). By prepregnancy obesity class, the aOR for cesarean delivery in women with excessive BMI change were: normal weight (aOR = 2.25), overweight (aOR = 2.39), obese class I (aOR = 2.23), obese class II (aOR = 2.56) and obese class III (aOR = 2.08). Conclusions: The odds of cesarean delivery were uniformly increased in all prepregnancy BMI categories as net BMI change increased. These data illustrate that all women, not just the overweight and obese, are at significantly increased risk of cesarean delivery with excessive BMI change during pregnancy.

Fetal epignathus: the case of an early EXIT (ex utero intrapartum treatment).

BACKGROUND: Fetal epignathus, a teratoma arising from the oropharynx that may be lethal, can be diagnosed prenatally. CASE: A 29-year-old woman, gravida 1, was evaluated for an elevated alpha-fetoprotein level. Imaging evaluation revealed a fetal epignathus without intracranial extension. Preterm labor necessitated delivery at 27 5/7 weeks of gestation with ex utero intrapartum treatment (EXIT) procedure using a classical incision. The neonates small size and short umbilical cord required complete exteriorization to secure the airway. Pathology revealed an immature teratoma. CONCLUSION: Prenatal diagnosis of fetal epignathus is imperative so that all options can be discussed. An EXIT procedure may be necessary for airway management at birth. If preterm delivery is necessary, choice of uterine incision and fetal size are important factors to consider for a successful outcome.