Faculty Bibliography

OBJECTIVES/UNASSIGNED:To determine if the use of magnetic resonance imaging (MRI) changes the diagnosis of placenta accreta spectrum (PAS) made on prenatal ultrasound (US) leading to an improvement in clinical outcomes. METHODS/UNASSIGNED:-test and Chi-squared test were performed to compare the clinical outcomes of patients with an upgraded diagnosis by MRI to those whose diagnosis was downgraded or stayed the same. RESULTS/UNASSIGNED: = 0.001]. There were no complications from these procedures. CONCLUSION/UNASSIGNED:The use of MRI incorrectly changed the diagnosis as much as it correctly changed the diagnosis of PAS after US. MRI should not be used routinely as a clinical adjunct to ultrasound in the diagnosis of placenta accreta spectrum.

OBJECTIVES/OBJECTIVE:To determine if large for gestational age (LGA) diagnosed during second trimester ultrasound is associated with the development of gestational diabetes mellitus (GDM) and LGA at birth. METHODS:percentile. Prenatal and delivery records were reviewed and demographic and outcome variables were collected. Multivariable logistic regression models were performed to assess the impact of LGA at second trimester on the development of GDM and LGA at birth. RESULTS:There were 756 LGA and 756 AGA patients included in this study. In patients with LGA diagnosed during second trimester ultrasound, the incidence of GDM was 6% and the incidence of LGA at birth was 14.9%. Among patients with LGA in the second trimester, those who developed GDM or LGA at birth were significantly older, and were more likely to be obese. Moreover, parity was associated with neonatal LGA (P = 0.0003) but not with GDM at birth (P = 0.82). In adjusted analyses, LGA diagnosis during second trimester was significantly associated with GDM (OR 2.54; 95% CI: 1.29, 5.03) and neonatal LGA at birth (OR 6.85, 95% CI 3.60, 13.05; p<0.0001). CONCLUSIONS:LGA diagnosis during second trimester ultrasound is associated with the development of GDM and LGA at birth, independent of women with known risk factors, and could be used to identify these women earlier for intervention. This article is protected by copyright. All rights reserved.

Scant literature exists on prenatally diagnosed infantile myofibromatosis (IM). We report a case of multicentric IM, which was first recognized as a soft-tissue paraspinal mass on prenatal sonography and subsequently characterized by MRI with pathological confirmation.

OBJECTIVE: To determine if women under the care of obstetricians in solo practice have different delivery outcomes from women in a group practice. STUDY DESIGN/METHODS: This is a retrospective cohort of live, term, singleton, vertex (LTSV) deliveries at one hospital from 2011 to 2015. We compared outcomes between women whose obstetrician was in solo practice with women in a group practice model. RESULTS: < 0.001). Solo obstetricians had a significantly higher rate of cesarean delivery (35.7 vs. 27.2%, adjusted odds ratio, aOR: 1.53, 95% confidence interval, CI [1.32, 1.78]), but also had a significantly lower rate of shoulder dystocia (0.4 vs. 1.4, aOR: 0.42, 95% CI [0.19, 0.89]), third or fourth degree lacerations (1.6 vs. 2.4%, aOR: 0.56, 95% CI [0.35, 0.914]), and neonatal intensive care unit admission rates (3.2 vs. 6.2%, aOR: 0.57, 95% CI [0.42, 0.77]). CONCLUSION/CONCLUSIONS: In a large, tertiary care hospital, solo obstetricians have similar neonatal outcomes as group obstetricians. Their higher cesarean delivery rate is balanced by fewer shoulder dystocias and third/fourth degree lacerations, indicating a more conservative approach to labor management. Patient outcomes should not be a reason to discourage a solo practice model.