Robert Bonebrake

Tuberculosis in pregnancy: current recommendations for screening and treatment in the USA

The main focus of this review is the management of active and latent tuberculosis in pregnancy in industrialized countries. The review is geared towards the healthcare professional taking care of the obstetric patient. The epidemiology of active and latent tuberculosis in the USA and recommendations for the screening of tuberculosis in pregnancy are considered. The history of treatment methodology and its relationship to the current treatment of active and latent tuberculosis in pregnancy is reviewed, and finally, a discussion of the best time to treat latent tuberculosis in a pregnant patient is undertaken, along with thoughts on future changes and advances in this field.

A false-positive diagnosis of a prenatal encephalocele on transvaginal ultrasonography.

The ability to correctly diagnose an encephalocele is important for both the management and outcome of a pregnancy. Not only has diagnostic evaluation with transvaginal ultrasonography been found to improve accuracy in the diagnosis of encephaloceles, but it has also helped in earlier diagnosis because of its high resolution and access to the fetal intracranial anatomy. It has been shown in previous case reports to correctly identify encephaloceles in cases in which the diagnosis was unable to be made on the basis of transabdominal ultrasonography. In the case presented, transvaginal ultrasonography proved not to be diagnostically superior to abdominal ultrasonography for the diagnosis of an encephalocele. On the basis of transvaginal ultrasonography, an incorrect diagnosis of an encephalocele was made, which was then refuted by transabdominal ultrasonographic findings. In this case, it was fetal hair that was initially misinterpreted as an encephalocele on transvaginal ultrasonography.

Upper gastrointestinal bleeding in acute pancreatitis.

Inflammatory pseudotumor is a pathological process whose cause is unknown, and whose macroscopic appearance is that of a malignant tumor, but it is in fact of inflammatory nature. Inflammatory pseudotumor of the liver is infrequent, but must be taken into account in the differential diagnosis of liver masses. A case report is presented, with review of the literature. Because of its benign nature, an aggressive approach is not recommended.

Does the 1-hour glucose screen predict macrosomia and fetal weight?

Objective: To determine whether the 1-hour postglucola (PG) is a predictor of macrosomia and absolute weight. Methods: A 12-month retrospective cohort study was conducted on all patients delivered at a tertiary hospital. Prenatal charts were reviewed for inclusion and exclusion criteria. Data were collected on patient demographics, 1-hour PG, mode of delivery, estimated gestation age (EGA) at delivery, infant weight, and Apgar scores. Statistical analyses were performed where appropriate. Results: Of 1,175 mother/infant pairs, 924 met inclusion criteria. Seventy-five infants (8%) were macrosomic. Student t tests performed on macrosomics versus nonmacrosomics in relation to 1-hour PG, maternal age at delivery, and EGA were statistically significant (P = 0.005, 0.017, and 0.001, respectively). Multiple logistic regression performed on the dependent-variable macrosomics showed that it could be predicted from a combination of the independent variables: maternal age, EGA, and 1-hour PG (P = 0.0153, 0.001, and 0.0099, with odds ratios of 1.052, 1.552, and 1.012, respectively). Multiple linear regression performed on the dependent-variable absolute birth weight showed that it could be predicted from independent variables: maternal age, EGA, and 1-hour PG (P <0.001; coefficients of 10.3, 188.3, and 2.7, respectively). Conclusion: Variables of EGA, maternal age, and 1-hour PG are statistically significant in their prediction value of macrosomia. However, the 1-hour PG appears to be the least predictive in regard to this neonatal outcome.