Michael A. Schellpfeffer

Standardized Severe Maternal Morbidity Review: Rationale and Process

Severe maternal morbidity and mortality have been rising in the United States. To begin a national effort to reduce morbidity, a specific call to identify all pregnant and postpartum women experiencing admission to an intensive care unit or receipt of four or more units of blood for routine review has been made. While advocating for review of these cases, no specific guidance for the review process was provided. Therefore, the aim of this expert opinion is to present guidelines for a standardized severe maternal morbidity interdisciplinary review process to identify systems, professional, and facility factors that can be ameliorated, with the overall goal of improving institutional obstetric safety and reducing severe morbidity and mortality among pregnant and recently pregnant women. This opinion was developed by a multidisciplinary working group that included general obstetrician–gynecologists, maternal–fetal medicine subspecialists, certified nurse–midwives, and registered nurses all with experience in maternal mortality reviews. A process for standardized review of severe maternal morbidity addressing committee organization, review process, medical record abstraction and assessment, review culture, data management, review timing, and review confidentiality is presented. Reference is made to a sample severe maternal morbidity abstraction and assessment form.

Microbubble contrast imaging of the cardiovascular system of the chick embyro.

Ultrasound imaging of the chick embryo cardiovascular system is limited to B-scan and Doppler technologies. This study demonstrates microbubble contrast imaging of the embryonic cardiovascular anatomy and physiology. Day 8-19 (Hamburger & Hamilton Stage 34-43) chick embryos are examined in ovo using high-frequency ultrasound imaging through an opening in the blunt end (air cell) of the egg. A chorioallantoic vein is cannulated, and small boluses of octofluoropropane lipid microspheres (Definity®) are injected to visualize the chick embryo cardiovascular system. The entire chick embryo cardiovascular system including the two embryologic arteriovenous (AV) shunts can be visualized. More accurate physiologic measurements of ejection fractions and cardiac output measurements can be obtained using this technology. Microbubble contrast ultrasound imaging in the chick embryo greatly expands the ability to study cardiovascular development. Also, the two natural embryonic A-V shunts provide an excellent model to study the bioeffects of microbubbles in the arterial system.

Sonographic detection of free pelvic peritoneal fluid.

Transvaginal ultrasonography was performed on 113 women prior to laparoscopic sterilization. The amount and character of the peritoneal fluid present in the pelvis was assessed at the end of the operative procedure. Sonographically, free pelvic peritoneal fluid was seen in 42.5% of the patients. Laparoscopically, the average amount of fluid present was 11.2 ml with an average of 16.5 ml present in patients with FPPF and 7.2 ml present in patients without FPPF (P < 0.0001). Sonographic measurement of fluid volume was found to significantly underestimate the amount of fluid present at laparoscopy (P < 0.0001). Endometriosis and pelvic adhesions significantly changed the sonographic findings.

Ultrasound imaging in research and clinical medicine

The use of ultrasound imaging in clinical obstetrics continues to grow at an almost exponential rate. Ultrasound imaging in developmental biology has only begun to be used to enhance the traditional methodologies to study the developing embryo/fetus. The various modalities of ultrasound imaging are reviewed as they apply to current uses in clinical obstetrics and developmental biologic research. New modalities are also discussed in both clinical obstetrics and developmental biologic research as well as the current limitations of ultrasound imaging faced in both of these fields.

A novel laparoscopic tissue retrieval device.

The author describes an obstetrical forceps-like device that may be successful in removing surgical specimens following a laparoscopic procedure.

The teratology society 2012–2017 strategic plan: Pushing the boundaries

The Teratology Society held its fourth strategic planning session in Albuquerque, NM, April 10-12, 2012, and launched the 2012-2017 Strategic Plan in conjunction with the 2012 annual meeting in Baltimore, MD. Building on the energy of the successful implementation of prior strategic plans (San Diego, 2007; Nashville,TN 2002; Cincinnati, OH 1998), session participants worked to identify barriers to success as a scientific society, as well as impending challenges and opportunities to which the Society needs to respond. The following report provides an overview of the Strategic Planning process, objectives, activities, and conclusions. A total of 23 members were present at the session, and the group included representation from Council, various committees, and different member constituencies. This plan, Pushing the Boundaries, and its three strategic intents: Broaden Our Identity, Expand Our Membership, and Increase Our Influence, will drive the direction of the Teratology Society for the next five years.