Deborah Feldman

Evaluation and follow-up of fetal hydronephrosis.

To determine the antenatal course and neonatal follow‐up of isolated fetal hydronephrosis.

Irreversible maternal brain injury during pregnancy: a case report and review of the literature.

Maternal brain death or massive injury leading to persistent vegetative state during pregnancy is a rare event. Since 1979, 11 cases, including the current one, of irreversible maternal brain damage in pregnancy have been reported. In all but one, the pregnancies were prolonged with a goal of achieving delivery of a viable infant. Current advances in medicine and critical care enable today’s physician to offer prolonged life-support to maximize the chances for survival in the neonate whose mother is technically brain dead. We present a case at our institution and review all previously published cases in the English literature for comparison as well as make management recommendations. Target Audience Obstetrics & Gynecologists, Family Physicians

Resident education and training in urogynecology and pelvic reconstructive surgery: a survey

The aim of the study is to assess satisfaction with urogynecology education among obstetrics and gynecology residents. An Internet-based survey was designed to obtain a cross-sectional sample of third- and fourth-year residents. Didactic and surgical training as well as perceived surgical competency were assessed. Responses were received from 205 residents for this convenience sample. Nearly half (46%) of the respondents were unsatisfied with urogynecology resident education. There was no significant difference between respondents from academic programs and community programs with regard to overall satisfaction, the opportunity to work with the presence of a fellowship-trained urogynecologist or having a dedicated urogynecology rotation. Respondents were more satisfied with their education if they did a urogynecology rotation or worked with a fellowship-trained urogynecologist. Female pelvic medicine and reconstructive surgery fellows were involved in the education of 23.9% of the respondents. Most respondents indicated comfort performing cystoscopy, anterior and posterior repairs, and McCall’s culdoplasty following graduation. Overall, respondents indicated that residency training in urogynecology is less and later than desired, although they did feel competent at some urogynecologic surgeries.

Is an isolated fetal cardiac echogenic focus an indication for fetal echocardiography

To determine whether the presence of an isolated fetal cardiac echogenic focus should be an indication for fetal echocardiography.

Rotational versus nonrotational forceps: Maternal and neonatal outcomes☆☆☆

OBJECTIVE Our purpose was to evaluate maternal and neonatal morbidity associated with rotations performed with Leff forceps in comparison with nonrotational forceps deliveries. STUDY DESIGN A review of 267 rotational and nonrotational forceps deliveries from August 1996 through February 1998 was performed. Multiple maternal and neonatal outcome measures were compared and results were analyzed by chi(2) with the Fisher exact test and the Student t test. RESULTS One hundred sixty-three traditional low-forceps or outlet forceps deliveries were compared with 104 rotational forceps deliveries performed with Leff forceps. There were no significant differences between the 2 groups in maternal age, gestational age, gravidity, parity, total labor duration, birth weight, and Apgar scores. There were significantly lower rates of episiotomy, third- and fourth-degree lacerations, and sulcus lacerations in the rotation group, and the second stage of labor was also shorter. The neonatal intensive care unit admission rate was higher in the rotation group; however, none of the admissions were directly related to the mode of delivery. CONCLUSION Rotational deliveries performed with Leff forceps are associated with less maternal morbidity and shorter second stage of labor than are deliveries performed with traditional forceps. Leff forceps are a safe option for rotation of the persistent occipitoposterior fetal position.

Increased neonatal morbidity despite pulmonary maturity for deliveries occurring before 39 weeks

Objective: To compare neonatal outcomes following deliveries <39 weeks after confirmation of fetal lung maturity with scheduled deliveries ≥39 weeks. Methods: A retrospective cohort study examining neonatal outcomes of women who were delivered following documented fetal pulmonary maturity at 36, 37, and 38 weeks compared to women undergoing a scheduled delivery at 39, 40, and 41 weeks. The χ2-test and Student’s t-test were used to compare categorical and continuous data, respectively. Results: Delivery prior to 39 weeks following fetal pulmonary maturity was associated with a 8.4% composite neonatal morbidity rate as compared to 3.3% for deliveries at 39 weeks or greater (relative risk [RR] 2.9; confidence interval [CI] 2.4–3.6). Neonatal respiratory morbidity was significantly higher (5.4%) for those delivering at less than 39 weeks with documented fetal pulmonary maturity as compared to 2.1% for those delivering at 39 weeks or greater (RR 3.0; CI 2.3–3.9). Increased neonatal morbidity persisted for those delivered prior to 39 weeks even after excluding all diabetics (p < 0.001). Significant increases in neonatal morbidity were noted for deliveries prior to 39 weeks regardless of the mode of delivery. Conclusion: Despite fetal pulmonary maturity, delivery before 39 weeks is associated with significantly increased neonatal morbidity when compared to scheduled deliveries at 39 weeks or greater.

Resolution of Human Parvovirus B19-Induced Nonimmune Hydrops After Intrauterine Transfusion

Our objective is to report our experience with cases of prolonged recovery from nonimmune hydrops secondary to human parvovirus B19 infection occurring after intrauterine transfusion. We reviewed cases referred to our unit over a 10 year period for exposure to parvovirus B19 infection. Those cases with serologic evidence of recent infection were identified. The cases requiring intrauterine transfusion were reviewed for demographic details, time of exposure, parvovirus B19 serology, gestational age at detection of nonimmune hydrops, number and results of fetal blood samples, duration from intrauterine transfusion to resolution of hydrops, and neonatal outcome. Of 38 cases identified through serologic evidence of recent parvovirus B19 infection, 35 (92.1%) did not develop hydrops, and these were followed by serial ultrasonography for 8 weeks from the time of exposure. Three cases (7.9%) developed hydrops and required intrauterine transfusion; in two the transfusion was intravascular and in one it was intraperitoneal. The mean duration from intrauterine transfusion to resolution of hydrops was 8 weeks 2 days. Pregnancy outcome in all cases was normal. In cases of nonimmune hydrops secondary to parvovirus B19 infection, resolution of the hydrops after intrauterine transfusion may take up to 12 weeks with a normal pregnancy outcome.

Full-term neonatal intenstive care unit admission in an urban community hospital: the role of respiratory morbidity

Objective. To investigate the incidence of respiratory morbidity among full-term neonatal intenstive care unit (NICU) admissions and identify risk factors for such admissions. Methods. We performed a retrospective cohort study of NICU admissions between 1/06 and 12/08. We included neonates between 37 and 40 weeks with a diagnosis of transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), pneumonia, pneumothorax, and meconium aspiration syndrome. Obstetrical outcomes were compared with a control group of women during the same period whose neonates were not admitted to the NICU. Results. Two-hundred two infants admitted to the NICU with respiratory morbidity were compared with 9580 controls. TTN comprised the majority of the respiratory morbidity. Only RDS was associated with cesarean delivery. Conclusion. RDS remains a significant morbidity in full-term NICU admission. When compared with controls, admissions to our NICU with any respiratory morbidity were more likely to be delivered by cesarean to a mother with hypertension or diabetes during pregnancy.

Efficacy of the Genetic Sonogram in a Stepwise Sequential Protocol for Down Syndrome Screening

The purpose of this study was to evaluate the efficacy of the genetic sonogram in Down syndrome screening for women who have received the stepwise sequential test.

Fetal growth restriction: risk factors for unplanned primary cesarean delivery

Abstract Objective: The purpose of this study was to identify risk factors before or during labor to predict primary cesarean delivery for non-reassuring fetal heart tracing in cases of fetal growth restriction (FGR) undergoing a trial of labor. Study design: We reviewed charts of all patients with singleton, non-anomalous fetuses found to have FGR and delivered from January 2008 to December 2012. Characteristics of patients delivered by cesarean were compared to those who had delivered vaginally. Results: Two hundred and twenty-two patients were delivered with FGR. Fifty-nine patients were excluded due to cesarean delivery prior to labor. Of the remaining 153 patients, 84% delivered vaginally and 16% underwent cesarean delivery. Of the 131 patients who underwent induction, 83% delivered vaginally. Rates of cesarean were higher for primigravity, oligohydramnios and prostaglandin use. However, logistic regression showed that oligohydramnios (odds ratio [OR]: 3.98; CI: 1.35–11.76) and prostaglandin use (OR: 3.67; CI: 1.07–12.60) were significantly associated with cesarean delivery. Conclusions: The rate of vaginal delivery is high in cases of FGR undergoing a trial of labor. We recommend that these patients undergo a trial of labor. Patients with oligohydramnios and those requiring prostaglandins for cervical ripening should be counseled regarding a significantly higher risk of cesarean delivery.