An overview of available drugs for management of opioid abuse during pregnancy.

The prevalence of opioid abuse in the United States has been steadily increasing over the last several years among many major demographics, including pregnant women. Rise in prenatal opioid abuse has resulted in subsequent escalation of neonatal abstinence syndrome incidence, prompting the US Congress to pass the Protecting Our Infants Act of 2015. This act specifically calls for a critical review of current treatment options for prenatal opioid abuse which may ultimately lead to the development of better therapies and a decreased incidence of neonatal abstinence syndrome. Currently, the American College of Obstetricians and Gynecologists recommends methadone, buprenorphine, or buprenorphine/naloxone in the treatment of prenatal opioid abuse. In this review, each maintenance therapy treatment option is discussed and compared revealing inconsistencies in postpartum retention rates, effects on fetal development, and availability to patients due to restrictions in health care coverage. Although each of these treatment options reduces opioid abuse and potential negative outcomes for the fetus, the shortcomings of these drugs highlight the overarching need for an improved standard of care. Drug developers and lawmakers should consider that affordability, coverage by health insurance, and success in retention rates substantially impacts the decision of the patient and healthcare provider regarding utilization of a particular opioid maintenance therapy.

Circularity, Solidity, Axes of a Best Fit Ellipse, Aspect Ratio, and Roundness of the Foramen Ovale: A Morphometric Analysis With Neurosurgical Considerations.

The structure of the foramen ovale of the sphenoid bone is clinically important, particularly with regard to surgical procedures that cannulate the foramen such as percutaneous trigeminal rhizotomy for the treatment of trigeminal neuralgia, percutaneous biopsy of parasellar lesions, and electroencephalographic analysis of the temporal lobe among patients undergoing selective amygdalohippocampectomy. Differences in the morphology of the foramen ovale (FO) have been reported to contribute to difficulties in the cannulation of the FO. Reports regarding the structure of the FO, however, use subjective and ambiguous descriptions of morphology, including "oval," "truly oval," "elongated oval," "elongated," "semicircular," "almond," "round," "rounded," "slit," "irregular," "D shape," and "pear." Therefore, it is necessary to describe the structure of the FO with reproducible objective morphometric data. This study analyzed 169 foramina to determine normative morphometric shape descriptions of the following: area, perimeter, circularity, solidity, axes of a best fit ellipse, aspect ratio, and roundness. The shape descriptors reported herein may aid in identification and description of structural variation in FO including bony projections encroaching upon the foramina and may improve surgical approaches to transovale cannulation.

Orientation of the Foramen Ovale: An Anatomic Study With Neurosurgical Considerations.

Unsuccessful cannulation of the foramen ovale (FO) continues to occur with both fluoroscopic technique and technique using computed tomography paired with navigational technology. Despite advances in stereotactic neurosurgical imaging and technique, anatomic variation of the FO occasionally prevents successful cannulation. Morphometric study of the FO has been limited to length, width, and area parameters; therefore, this report analyzed the orientation of the FO. A total of 139 crania (235 foramina ovalae) were photographed and assessed digitally by ImageJ software (NIH). Foramina were fit with a best fit ellipse. For orientation, the midsagittal plane was located by bisecting the basilar process of the occiput; the coronal plane was identified as perpendicular to the midsagittal plane. The angles between the major axis of the best fit ellipse of the FO and the midsagittal and coronal planes were measured. The angle formed between the major axis of the best fit ellipse of the FO and the coronal plane averaged 35.43° ± 9.74° (mean ± SD) on the left and 36.47° ± 7.60° on the right. The angle formed between the major axis of the best fit ellipse of the FO and the sagittal plane averaged 54.57° ± 9.74° on the left and 53.53° ± 7.60° on the right. No significant difference was found between FO orientation among the sexes. Understanding the orientation of the FO may aid in stereotactic neurosurgical planning and successful cannulation of the FO.