Terri-Ann Bennett

Cardiac Arrest and Resuscitation Unique to Pregnancy

Maternal cardiopulmonary arrest (MCPA) is a catastrophic event that can cause significant morbidity and mortality. A prepared, multidisciplinary team is necessary to perform basic and advanced cardiac life support specific to the anatomic and physiologic changes of pregnancy. MCPA is a challenging clinical scenario for any provider. Overall, it is an infrequent occurrence that involves 2 patients. However, key clinical intervention performed concurrently can save the life of both mother and baby.

Prehypertension in early versus late pregnancy

Abstract Introduction: Hypertensive disorders play a significant role in maternal morbidity and mortality. Limited data on prehypertension (preHTN) in pregnancy exist. We examine the risk of adverse outcomes in patients with preHTN in early (<20 weeks) versus late pregnancy (>20 weeks). Materials and methods: Retrospective cohort study of singleton gestations between August 2013 and June 2014. Patients were divided based on when they had the highest blood pressure in pregnancy, as defined per the Joint National Committee 7 (JNC-7). Groups were compared using χ2, Fisher’s exact, Student’s t-test, and Mann–Whitney U test with p < .05 used as significance. Results: There were 125 control, 95 early preHTN, 136 late preHTN, and 21 chronic hypertension (CHTN). Early preHTN had an increased risk of pregnancy-related hypertension (PRH) (OR 12.26, p < .01) and composite adverse outcomes (OR 2.32, p < .01). Late preHTN had an increased risk for PRH (OR 4.39, p = .02) compared with normotensive and decreased risk for PRH (OR 0.26, p = .02), and composite adverse outcomes (OR 0.379, p = .04) compared with CHTN. Compared with late preHTN, early preHTN had more PRH (OR 2.85, p < .01), and composite adverse outcomes (OR 1.68, p = .04). Conclusions: Early prehypertension increases the risk of adverse obstetrical outcomes. Other than an increased risk of PRH, patients with late prehypertension have outcomes similar to normotensive women.

Fifth recurrent Cesarean scar pregnancy: observations of a case and historical perspective

The increase in the rate of Cesarean delivery (CD), from 5% in 1970 to 32% in 2015, has been associated with an increase in Cesarean scar pregnancies (CSP); approximately 1 in 1800–2500 pregnancies is complicated by a previous CD. There is currently no consensus on the optimal management of CSP or recurrent CSP. We describe a case of a 35-year-old woman with two prior CDs and four prior CSPs with positive fetal heart activity, all treated with intragestational injection of methotrexate in accordance with the practice of favoring termination of CSP. After diagnosis of a fifth recurrent CSP and preference to continue the pregnancy, the patient delivered a viable neonate via Cesarean hysterectomy performed for morbidly adherent placenta (MAP). This case displays how the counseling of CSP has changed over time, indicating that patients with CSP can be offered continuation of pregnancy after counseling on the perinatal risks. A 35-year-old woman, gravida 7 para 2, with a history of two CDs and four live CSPs that were terminated via intraembryonic injection of methotrexate under transvaginal ultrasound guidance (Figure 1) was diagnosed with a fifth recurrent CSP at 6 + 4 weeks’ gestation. The previous CSPs have been reported on previously1. In the index pregnancy, the gestational sac was implanted in the Cesarean scar niche with mostly posterior placenta previa but wrapping around anteriorly at the level of the bladder (Figure 2a). By 9 + 4 weeks the placenta had multiple

A Consequence of Cesarean Delivery: First-Trimester Cesarean Scar Pregnancy

Cesarean scar pregnancy (CSP) is a serious, iatrogenic and late consequence of a previous cesarean delivery (CD), which may result in clinical complications throughout all three trimesters of the pregnancy when unrecognized or untreated. Its rate of occurrence parallels the number of CDs. If untreated it may progress and result in a live offspring; however, it is the main cause of morbidly adherent placentae in the late second and in the third trimesters of the pregnancy.