Updates on the Recognition, Prevention and Management of Hypertension in Pregnancy.

Systematic reviews with meta-analysis represent the highest level of evidence used to guide clinical practice. The defining criteria used to diagnose preeclampsia have evolved, and will likely continue to evolve. Proteinuria is sufficient but not necessary when defining preeclampsia. Hypertension without proteinuria but with severe features is diagnostic. The methods used to measure urinary protein have changed. The gold standard remains the 24-hour urine test. The efficacy of low-dose aspirin in preventing preeclampsia is a function of baseline risk. Data suggest that treating mild to moderate blood pressure has clear maternal benefits with little fetal or neonatal risk.

Interconception Care Opportunities for Mom and Baby.

IMPORTANCE: Interconception care provides an irreplaceable opportunity to address existing chronic disease and correct maladaptive health behaviors. OBJECTIVE: Utilizing the postpartum visit as an opportunity to improve interconception health and provide education to patients will not only improve the patient's life, but also impact any future offspring. EVIDENCE ACQUISITION/RESULTS: Optimization of interconception health has the potential to improve population wellbeing and reduce the societal burden poor birth outcomes. Evidence-based recommendations are described.

Multidisciplinary OBGYN morbidity and mortality conference.

BACKGROUND AND PURPOSE: Obstetrics and gynecology (OB-GYN) morbidity and mortality conferences allow for review of cases with poor or avoidable outcomes. Little data exist on standardized formats for presentation and evaluation. We designed a multidisciplinary morbidity and mortality conference. We formally evaluated resident performance using the milestones format, and evaluated resident understanding of case concepts with a pre- and post-conference survey. METHODOLOGY: Our monthly conference was redesigned to incorporate the entire, residency program, OBGYN department members, nurses, midlevel providers, risk management, quality nurse director, and any additional staff who were involved in the case. Residents functioned as reviewers and presenters, and were then evaluated with a standard milestones-based evaluation by faculty members. Residents were also evaluated with a 10-point Likert scale for understanding of key case concepts, pre- and post-conference. RESULTS: Using a standardized format for presentation and evaluation improved resident presentation skills and ability to organize a vast amount of information from a chart into a valuable learning experience. Over a 6-month period, six cases were presented, and six actions were initiated for quality improvement. Resident understanding of concepts statistically improved after conference. CONCLUSION: M&M plays a crucial role not only in patient care, but also in resident education.

Centering Pregnancy: practical tips for your practice.

IMPORTANCE: With increased access to care, current health delivery systems will need expansion to meet higher demands and needs. PURPOSE: To define Centering Pregnancy and practical tips for implementation into both private and academic practices. METHODS/EVIDENCE ACQUISITION: Evidence was gathered through literature reviews. RESULTS: It was found that Centering Pregnancy offers a patient-centered, evidence-based approach to helping with access issues, as well as improving outcomes. CONCLUSIONS: This article describes the benefits of Centering Pregnancy to the practice, the provider, and the patient. RELEVANCE: Practical implementation tips will be offered, with suggestions for negating common implementation barriers.

Intra-amniotic fluconazole therapy for Candida albicans intra-amniotic infection.

BACKGROUND: The consequences of intra-amniotic Candida infection can be devastating. Currently, standard management includes delivery. We identified only one previous case reporting intrauterine antifungal therapy, which used transcervical amphotericin B. We present two cases of intra-amniotic Candida infection treated with intra-amniotic fluconazole instilled before membrane rupture. CASES: Two patients presented with intra-amniotic Candida albicans infection that was diagnosed during previability. Both underwent cerclage placement before culture results were available. Aggressive antifungal therapy was instituted using oral, vaginal, and intra-amniotic fluconazole instilled through serial amniocenteses. Both fetuses survived without sequelae. CONCLUSION: Intra-amniotic Candida infection is associated with preterm rupture of membranes, preterm labor, severe neonatal infection, and fetal death. Early diagnosis and treatment is essential.

Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity.

Celiac Disease (CD) is an immune-mediated disease dependent on gluten (a protein present in wheat, rye or barley) that occurs in about 1% of the population and is generally characterized by gastrointestinal complaints. More recently the understanding and knowledge of gluten sensitivity (GS), has emerged as an illness distinct from celiac disease with an estimated prevalence 6 times that of CD. Gluten sensitive people do not have villous atrophy or antibodies that are present in celiac disease, but rather they can test positive for antibodies to gliadin. Both CD and GS may present with a variety of neurologic and psychiatric co-morbidities, however, extraintestinal symptoms may be the prime presentation in those with GS. However, gluten sensitivity remains undertreated and underrecognized as a contributing factor to psychiatric and neurologic manifestations. This review focuses on neurologic and psychiatric manifestations implicated with gluten sensitivity, reviews the emergence of gluten sensitivity distinct from celiac disease, and summarizes the potential mechanisms related to this immune reaction.