Faculty Bibliography

OBJECTIVE: This study aimed to evaluate the relationship between peripartum mean arterial pressure (MAP) and postpartum readmission for preeclampsia with severe features. STUDY DESIGN/METHODS: This is a retrospective case-control study comparing adult parturients readmitted for preeclampsia with severe features to matched nonreadmitted controls. Our primary objective was to evaluate the association between MAP at three time points during the index hospitalization (admission, 24-hour postpartum, and discharge) and readmission risk. We also evaluated readmission risk by age, race, body mass index, and comorbidities. Our secondary aim was to establish MAP thresholds to identify the population at highest risk of readmission. Multivariate logistic regression and chi-squared tests were used to determine the adjusted odds of readmission based on MAP. Receiver operating characteristic analyses were performed to evaluate risk of readmission relative to MAP; optimal MAP thresholds were established to identify those at highest risk of readmission. Pairwise comparisons were made between subgroups after stratifying for history of hypertension, with a focus on readmitted patients with new-onset postpartum preeclampsia. RESULTS: = 0.0018) were associated with increased risk of readmission. African American race and hypertensive disorder of pregnancy were independently associated with increased risk of readmission. Subjects with MAP > 99.5 mm Hg at admission or >91.5 mm Hg at 24-hour postpartum had a risk of at least 46% of requiring postpartum readmission for preeclampsia with severe features. CONCLUSION/CONCLUSIONS: Admission and 24-hour postpartum MAP correlate with risk of postpartum readmission for preeclampsia with severe features. Evaluating MAP at these time points may be useful for identifying women at higher risk for postpartum readmission. These women may otherwise be missed based on standard clinical approaches and may benefit from heightened surveillance. KEY POINTS/CONCLUSIONS:· Existing literature focuses on management of antenatal hypertensive disorders of pregnancy.. · Elevated peripartum MAP is associated with increased odds of readmission for preeclampsia.. · Peripartum MAP may predict readmission risk for de novo postpartum preeclampsia..

Abstract Objective: The placenta of mid-gestation mice is a known rich source of hematopoietic stem cells. We hypothesized that it is also a source of other multipotent stem cells. Methods: We isolated fetal cells from the murine placenta across the second half of gestation and characterized their expression of surface antigens known to be associated with mesenchymal stem cells (MSCs) on a subset of hematopoietic lineage-negative cells. Using real-time reverse-transcriptase quantitative polymerase chain reaction, we also evaluated the expression of intracellular transcription factors (TFs) known to be associated with renal development and/or multipotent stem cells. Results: Cell phenotypes with surface marker and TF expression consistent with multipotent stem cells of a mesenchymal lineage as well as renal cell progenitors were found in the placenta. The expression of MSC and renal progenitor surface markers varied throughout gestation, but was highest on E12-15 where such cells represented a small but significant percentage of the population. Of the studied TFs, 10 of 11 renal TFs were found at moderate to high levels, and all stem cell TFs were found. Conclusion: The mid-gestation murine placenta may serve as a source of multipotent stem cells and also contains cells which may be renal cell progenitors.

Objective: Cervical sampling could furnish tissue-based information regarding premature cervical ripening and effacement. This report assesses the effect of cervical fine needle biopsy (FNB) in the evaluation of cervical shortening. Methods: Retrospective cohort study evaluating adverse events during the first week following FNB in women with short cervix. Patients with a cervical length(CL) </=25 mm had a cervical FNB between 16 and 24 weeks. The risk of FNB was compared to a control group that was similarly evaluated but did not undergo FNB. Results: One hundred and thirty-two FNBs were performed in 94 participants. The mean gestational age and CL at enrollment were 20.4 +/- 2.3 weeks and 15.7 +/- 0.6 mm. Within 7 days of FNB, there were 3 adverse events (2.3%) in the study group compared to 5 in the control group (2.1%). Conclusions: FNB of the cervix in high risk gravidae is feasible in clinical situations. It did not increase the risk of adverse events compared to women studied under a similar protocol without FNB

Preterm birth (PTB) is a leading cause of adverse perinatal outcome, including both neonatal morbidity and mortality. This condition has been directly associated with the consistently rising incidence of multiple gestations over the past three decades. Twin gestation, the most common form of multiple gestation, represents a unique subgroup of fetuses at high risk for prematurity. Extensive research has been dedicated to understanding the pathophysiological pathways leading to preterm birth as well as to developing efficient screening tests and treatments aimed to prevent or to halt it. This review summarizes epidemiological data regarding the etiology and outcomes associated with the different subtypes of PTB in twin gestations. Additionally, we provide information regarding both the different screening modes available for early detection, as well as the modalities for either prevention or treatments available for this condition

Imaging the fallopian tube with transvaginal sonography is a daunting task for any sonologist. High-frequency ultrasound transducers, the advancement of color and power Doppler, as well as 3D surface rendering, have advanced the assessment of fallopian tubes in healthy and pathologic states. This review focuses on fallopian tube anatomy, imaging modalities available for its assessment and common pathologic processes, including infection/inflammation, ectopic pregnancy, salpingitis isthmica nodosum, tubal torsion and prolapse, and fallopian tube carcinoma. The natural history of pelvic inflammatory disease is discussed in detail with a sonographic representation of the disease process. 2009 Expert Reviews Ltd