Faculty Bibliography

Most physicians have had little or no exposure to systematic teaching or training during the medical school and residency with respect to writing and publishing an original research article. The framework of every article should include the study objective(s), study design, results, and conclusion(s). The current "Clinical Opinion" article proposes a set of guidelines, based on the authors' experience, which can be useful to junior physicians who plan to publish their work. These guidelines should assist not only in the writing process of the initial manuscript but also in responding to reviews and in modifying the original manuscript.

OBJECTIVE:We evaluated the extent to which histologic lesions bearing a diagnosis of abruption conform to a diagnosis based on established clinical criteria. We further examined the profile of chronic and acute histologic lesions associated with clinical abruption. METHODS:Data from the New Jersey-Placental Abruption Study - a multi-center, case-control study - were utilized to compare the clinical and histologic criteria for abruption. The study was based on 162 women with clinically diagnosed abruption and 173 controls. We examined the concordance between clinical indicators for abruption with those of a histopathological diagnosis. The clinical criteria for a diagnosis of abruption included (i) evidence of retroplacental clot(s); (ii) abruption diagnosed on prenatal ultrasound; or (iii) vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity. The pathological criteria for abruption diagnosis included hematoma, fibrin deposition, compressed villi, and hemosiderin-laden histiocytes in cases with older hematomas. Acute lesions included chorioamnionitis, funisitis, acute deciduitis, meconium stained membranes, villous stromal hemorrhage, and villous edema. Chronic lesions included chronic deciduitis, decidual necrosis, decidual vasculopathy, placental infarctions, villous mal-development (delayed or accelerated maturation), hemosiderin deposition, intervillous thrombus, and chronic villitis. RESULTS:Of clinically diagnosed cases, the sensitivity and specificity for a histologic confirmation of abruption were 30.2% and 100%, respectively. Presence of retroplacental clots remained the single most common finding (77.1%) among clinically diagnosed cases. Among the acute lesions, chorioamnionitis and funisitis were associated with abruption. The only chronic histologic lesion associated with abruption was placental infarctions. CONCLUSIONS:The concordance between clinical and pathologic criteria for abruption diagnosis is poor. The criteria for diagnosing a clinical abruption should include sonographic visualization of abruption, evidence of retroplacental clots, or vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity.

Ultrasound machines are nowadays part of the armamentarium of all modern Labor and Delivery Suites. Due to their portability, these machines are ideal for use in emergencies which can occur at any of the labor and delivery rooms. Many of the emergencies in Labor and Delivery can be life threatening; thus, maternal and fetal safety requires efficient and timely ultrasound evaluation. The purpose of this article is to provide guidelines for quick and efficient use of ultrasound based on both the authors' experience and the published literature.

BACKGROUND:We explored the incidence of thromboembolic disease in relatives of women diagnosed with placental abruption, a condition that may be related to disordered coagulation. METHODS:Using data from a multicenter, case-control study of placental abruption, we assessed thromboembolic diseases in first-degree male and female relatives of women with and without abruption. The analysis was restricted to biologic parents and full siblings, below 65 years of age, and corrected for familial clustering. RESULTS:The prevalence of thromboembolic disease was 7.5% in 852 relatives of 212 placental abruption cases and 4.8% in 792 relatives of 206 controls. This increased risk was driven by an association among sisters of abruption probands (odds ratio = 6.8 [95% confidence interval = 1.8-26.0]), and to a lesser extent, among mothers (2.0 [1.0-4.2]). The risk of thromboembolic diseases was similar among the male relatives of placental abruption cases and controls. CONCLUSIONS:These data suggest that thromboembolic diseases aggregate within female relatives of women with placental abruption.