Toxoplasmosis, Parvovirus, and Cytomegalovirus in Pregnancy.

There are several infections in adults that warrant special consideration in pregnant women given the potential fetal consequences. Among these are toxoplasmosis, parvovirus B19, and cytomegalovirus. These infections have an important impact on the developing fetus, depending on the timing of infection. This article reviews the modes of transmission as well as maternal and neonatal effects of each of these infections. In addition, the article outlines recommended testing, fetal surveillance, and treatment where indicated.

Ultrasound evaluation of the postpartum endometrial cavity.

OBJECTIVE: To establish normal ultrasonographic findings for the postpartum uterus. STUDY DESIGN: We performed a prospective cohort study on women delivering during the study period. Ultrasounds were performed abdominally within 48 hours of delivery. Measurements of the endometrial cavity and remarkable findings such as echogenic debris or uterine abnormalities were documented. Additionally, we followed patients during their hospital course for bleeding complications and the need for medical or surgical treatment of such complications. RESULTS: Of the 114 patients enrolled during our study period, 79 (69%) delivered vaginally and 35 (31%) delivered by cesarean; 39 (34%) were primiparous and 75 (66%) were multiparous. The mean endometrial cavity measurement was 1.15 ± 0.3 cm. There was no difference in endometrial cavity when evaluating parity (p = 0.26) or vaginal versus cesarean delivery (p = 0.8). Echogenic material in the endometrial cavity was noted in 22 (19%) of the 114 patients. The presence of echogenic material was significantly higher following vaginal delivery (p = 0.008). None of the patients had a complication in the postpartum period. CONCLUSION: Air endometrial cavity measurement of < 1.2 cm after a vaginal or cesarean delivery should be considered normal. Presence of echogenic material in the endometrial cavity appears to be a normal variant.

Use of oral hypoglycemic and insulin agents in pregnant patients.

Although insulin remains the standard medication for the treatment of all types of patients with diabetes during pregnancy, oral hypoglycemics may be considered as alternative medications in the treatment of some types of diabetes in pregnancy.

Toxoplasmosis, parvovirus, and cytomegalovirus in pregnancy.

Several infections in adults warrant special consideration in pregnant women given the potential fetal consequences. Among these are toxoplasmosis, parvovirus B19, and cytomegalovirus. These infections have an important effect on the developing fetus depending on the timing of infection. This article reviews the modes of transmission as well as maternal and neonatal effects of each of these infections. In addition, recommended testing, fetal surveillance, and treatment where indicated are outlined.

Betamethasone vs dexamethasone for the prevention of morbidity in very-low-birthweight neonates.

OBJECTIVE: The purpose of this study was to compare neonatal outcomes in very-low-birthweight infants who were exposed to antenatal betamethasone vs dexamethasone. STUDY DESIGN: We reviewed all inborn very-low-birthweight infants from January 1997 through February 2006. Maternal medical records were reviewed to determine the type of antenatal steroids that each patient received; neonatal outcomes were compared using chi-square and Student t tests. RESULTS: There were 334 very-low-birthweight infants who met the criteria for evaluation: 186 infants received betamethasone, and 148 infants received dexamethasone. There were no differences in race, gestational age at delivery, or mean birthweight between the 2 groups. There were significantly lower rates of respiratory distress syndrome and bronchopulmonary dysplasia in the betamethasone group, compared with the dexamethasone group. Other neonatal outcomes were similar in both groups. CONCLUSION: Antenatal betamethasone was associated with a significantly lower rate of pulmonary complications caused by prematurity, when compared with dexamethasone.

Resident education and training in urogynecology and pelvic reconstructive surgery: a survey.

The aim of the study is to assess satisfaction with urogynecology education among obstetrics and gynecology residents. An Internet-based survey was designed to obtain a cross-sectional sample of third- and fourth-year residents. Didactic and surgical training as well as perceived surgical competency were assessed. Responses were received from 205 residents for this convenience sample. Nearly half (46%) of the respondents were unsatisfied with urogynecology resident education. There was no significant difference between respondents from academic programs and community programs with regard to overall satisfaction, the opportunity to work with the presence of a fellowship-trained urogynecologist or having a dedicated urogynecology rotation. Respondents were more satisfied with their education if they did a urogynecology rotation or worked with a fellowship-trained urogynecologist. Female pelvic medicine and reconstructive surgery fellows were involved in the education of 23.9% of the respondents. Most respondents indicated comfort performing cystoscopy, anterior and posterior repairs, and McCall's culdoplasty following graduation. Overall, respondents indicated that residency training in urogynecology is less and later than desired, although they did feel competent at some urogynecologic surgeries.

A randomized comparison of two regimens of misoprostol for second-trimester pregnancy termination.

OBJECTIVE: The purpose of this study was to compare the efficacy and side effects of two different misoprostol regimens for second-trimester pregnancy termination. STUDY DESIGN: We performed a randomized clinical trial in patients who were at 14 to 23 weeks of gestation and who were admitted for medical termination of pregnancy. All patients received 800 microg of vaginal misoprostol and were assigned randomly to 400 microg of oral misoprostol or 400 microg of vaginal misoprostol every 8 hours. Efficacy and side effects were compared. The mean induction time of the study group was compared with that of an historic control group that had received 400 microg vaginally every 12 hours. RESULTS: Forty-three women were assigned randomly, 22 women to vaginal misoprostol and 21 women to oral misoprostol. Induction time and hospital stay were slightly shorter for the oral group; however, the differences were not significant. Side effects were similar for both groups. CONCLUSION: After an initial 800 microg dose of vaginal misoprostol, a regimen of 400 microg of oral misoprostol every 8 hours is as effective as the same dose of vaginal misoprostol with no additional side effects, which provides a convenient alternative for midtrimester pregnancy termination.

Clinical implications of velamentous cord insertion in triplet gestations.

OBJECTIVE: The purpose of this study was to determine the incidence of velamentous cord insertion and to evaluate the association between velamentous cord insertion and small-for-gestational age infants in triplet gestations. STUDY DESIGN: We reviewed our computerized database to identify all cases of velamentous cord insertion in triplet gestations who were delivered at our institution from January 1995 through December 1999. Triplet gestations without velamentous cord insertion who were delivered during this period were used as control subjects. Birth weights and pregnancy outcomes were obtained from medical records. Data were analyzed with descriptive statistics, analysis of variance, and chi(2) with Fisher exact test, where appropriate. RESULTS: Thirty-nine sets of triplets (117 infants) were delivered during the study period. Of these, 11 sets of triplets (28.2%) had a velamentous insertion of at least one umbilical cord. Infants with velamentous cord insertion were more likely to be small-for-gestational age than infants without velamentous cord insertion (33% vs 8%, P =.02). There were no significant differences in the rates of pregnancy complications between the two groups. CONCLUSION: Velamentous cord insertion is found frequently in triplet gestations and is significantly associated with small-for-gestational age in triplet neonates.