Navleen Gill

The immunophenotype of amniotic fluid leukocytes in normal and complicated pregnancies

The immune cellular composition of amniotic fluid is poorly understood. Herein, we determined: 1) the immunophenotype of amniotic fluid immune cells during the second and third trimester in the absence of intra‐amniotic infection/inflammation; 2) whether amniotic fluid T cells and ILCs display different phenotypical characteristics to that of peripheral cells; and 3) whether the amniotic fluid immune cells are altered in women with intra‐amniotic infection/inflammation.

Racial disparities in the optimal for induction of labor in low-risk term pregnancies: a national population-based study

Abstract Objective: The recommendation for elective induction of labor (IOL) is to await ≥39 weeks. Studies show earlier maturity of Blacks compared to Whites. The objective was to examine the effect of the Black race on the risk of intrapartum and neonatal complications after IOL. Methods: Black women with non-indicated IOL at 37–42 weeks were selected from the CDC-Birth Cohorts 2007–2010. Congenital anomalies, hypertension/diabetes, low-birth weight, breech presentation, previous cesarean and premature rupture of membranes were excluded. Intrapartum/neonatal complications were analyzed. Logistic regression was used to calculate adjusted odds ratios, using 39 weeks as reference. Results: 311 264 black were compared with 2 451 774 deliveries of other races. For Blacks, the risks of cesarean delivery and intrapartum complications were lower at 38 weeks. Chance of vaginal delivery was greater at 38 weeks. Risks of neonatal complications was not increased at 38 compared to 39 weeks. Conclusions: Intrapartum complications were lower at 38 than at 39 weeks in Blacks with no increased risk of neonatal complications. Meconium staining and fetal distress were higher as early as at 40 weeks, perhaps due to accelerated maturation. While a 39-week goal is simple and benefits many patients, a more “personalized medicine” approach may benefit even more mothers and babies.

Labor and neonatal outcomes after term induction of labor in gestational diabetes.

Objective:To identify the optimal gestational age (GA) for induction of labor (IOL) at term among patients with gestational diabetes (GDMA) according to perinatal outcomes.Study Design:The US Natality Database from 2007 to 2010 was reviewed. Inclusion criteria were singleton delivery, IOL at 37 to 42 weeks and GDMA. Exclusion criteria included congenital anomalies, pre-gestational diabetes, hypertensive disorders, previous cesarean, breech presentation and rupture of membranes. Controls were non-GDMA cases delivered in geographic and temporal proximity. Delivery mode, macrosomia and perinatal complications were analyzed. Logistic regression adjusted for confounders was used to calculate odds ratios by GA using 39 weeks non-GDMA as reference.Results:In all, 96 964 cases and 176 079 controls were included. Increased risk for all adverse outcomes among GDMA cases was found. The nadir for intrapartum and neonatal complications was 38 and 40 weeks, respectively, whereas for cesarean and macrosomia was 39 weeks.Conclusion:The optimal timing for IOL at term in GDMA appears to be 39 to 40 weeks.

Outcomes following intra-amniotic instillation with indigo carmine to diagnose prelabor rupture of membranes in singleton pregnancies: A single center experience

Abstract Objective: To evaluate clinical outcomes of women with singleton pregnancies that underwent intra-amniotic dye instillation (amniodye test) following equivocal diagnosis of prelabor rupture of membranes (PROM). Method: Records of 34 pregnant women who underwent amniodye test for equivocal PROM were reviewed. Comparisons of characteristics, amniotic fluid (AF) cultures, AF interleukin (IL)-6 concentrations, and placenta pathology results between women who tested positive and those who tested negative were performed. A sub-analysis of women who were amniodye test-negative was also performed. Results: (1) Commonest indication for amniodye test was a typical history of PROM with positive conventional tests and persistently normal AF volume, (2) amniodye test-positive women had a shorter procedure-to-delivery interval (p = 0.008), and a greater proportion of histologic acute chorioamnionitis (p = 0.04) and funisitis (p = 0.01) than amniodye-negative women, and (3) in addition to similarities to women with amniodye-positive test, amniodye test-negative women who delivered <34 weeks, had a greater proportion of women with risk for preterm birth (p = 0.04), than their counterparts who delivered between 34 0/7 and 36 6/7 weeks. Conclusion: Equivocal diagnosis of PPROM should warrant an amniodye test to avoid iatrogenic intervention in women with intact amniotic membranes. AF analysis should be performed in amniodye test-negative women.

Optimal visualization of the fetal four-chamber and outflow tract views with transabdominal ultrasound in the morbidly obese: Are we there yet?

To compare optimal visualization of the four‐chamber and outflow‐tract views of the fetal heart on sonographic examination between morbidly obese (body mass index [BMI] ≥ 40 kg/m2) and nonobese (BMI < 25 kg/m2) pregnant women.

Prenatal Diagnosis of Dextrocardia with Complex Congenital Heart Disease Using Fetal Intelligent Navigation Echocardiography (FINE) and a Literature Review

Fetal dextrocardia is a type of cardiac malposition where the major axis from base to apex points to the right side. This condition is usually associated with a wide spectrum of complex cardiac defects. As a result, dextrocardia is conceptually difficult to understand and diagnose on prenatal ultrasound. The advantage of four-dimensional sonography with spatiotemporal image correlation (STIC) is that this modality can facilitate fetal cardiac examination. A novel method known as fetal intelligent navigation echocardiography (FINE) allows automatic generation of nine standard fetal echocardiography views in normal hearts by applying intelligent navigation technology to STIC volume datasets. In fetuses with congenital heart disease, FINE is also able to demonstrate abnormal cardiac anatomy and relationships when there is normal cardiac axis and position. However, this technology has never been applied to cases of cardiac malposition. We report herein for the first time, a case of fetal dextrocardia and situs solitus with complex congenital heart disease in which the FINE method was invaluable in diagnosing multiple abnormalities and defining complex anatomic relationships. We also review the literature on prenatal sonographic diagnosis of dextrocardia (with an emphasis on situs solitus), as well as tricuspid atresia with its associated cardiac features.

Racial Disparities in Adverse Neonatal Outcomes After Elective Induction of Labor: A Population-Based Study [235]

OBJECTIVE: The current recommendation regarding the optimal timing for elective induction of labor is to await 39 weeks and above to decrease prematurity risks. Variations in fetal maturation rates and obstetric outcomes according to ethnicity and race are well documented. The objective was to analyze the effect of maternal race on neonatal outcomes after elective induction of labor. METHODS: Singleton deliveries after elective induction of labor at term (37–42 weeks of gestation) were selected from the National Center for Health Statistics Birth Cohorts 2007–2010. Cases with congenital anomalies, hypertensive or diabetic disorders, low birth weight, breech presentation, or premature preterm rupture of membranes were excluded. Adverse neonatal outcomes analyzed included: Apgar score, assisted ventilation, neonatal intensive care unit admission, surfactant or antibiotic use, neonatal seizures, and birth injury. Frequencies of neonatal outcomes were calculated for the overall population and according to race: whites, blacks, Native Americans, and Asians. RESULTS: A total of 2,556,464 cases were included for analysis: 2,094,489 whites, 328,114 blacks, 25,908 Native Americans, and 107,953 Asians. For the overall population and whites, the distribution of adverse neonatal outcomes frequencies is U-shaped with the nadir at 39 weeks of gestation, as previously described in the literature. However, for the minority groups (blacks, Native Americans, and Asians), the distribution is also U-shaped, but with the nadir of neonatal complications mostly at 38 weeks of gestation. CONCLUSION: We provide more evidence that neonatal outcomes vary according to race, most likely as a result of a difference in maturity rates. Maternal race should be considered in the optimal timing for elective obstetric interventions. Further studies focusing on minorities and postmaturity risks are warranted.

Differences in Clinical Presentation and Obstetric Outcomes Between Antepartum and New-Onset Postpartum Preeclampsia: Same Disorder? [259]

OBJECTIVE: Postpartum preeclampsia is a condition with a poorly understood etiology that accounts for a significant percentage of eclampsia cases. It is unclear whether new-onset postpartum and antepartum preeclampsia belong to the same spectrum or represent different disorders. The objective was to investigate whether differences exist in clinical presentation, laboratory data, and obstetric and neonatal outcomes between antepartum and new-onset postpartum preeclampsia. METHODS: A retrospective study involving 150 patients with antepartum and 80 patients with new-onset postpartum preeclampsia was performed. Demographics, clinical presentation, laboratory data, and obstetric and neonatal outcomes were compared. &khgr;2 and Students t tests were used to compare categorical and numerical variables, respectively. A P value <.05 was used to consider statistical significance. RESULTS: New-onset postpartum preeclampsia presented significantly higher blood pressure ranges; more frequent headache, edema, shortness of breath, and nausea and vomiting; platelet count was higher and platelet volume lower; and delivered most frequently female newborns at term with higher birth weights. Delivery mode and rates of abdominal pain, visual changes, and seizures were not statistically different. CONCLUSION: In the first study of its kind, new-onset postpartum and antepartum preeclampsia display significant differences in terms of clinical presentation, laboratory data, and obstetric and neonatal outcomes, suggesting that they may represent different disorders. Further characterization, including molecular studies, is warranted.