Cardiovascular disease and maternal mortality: perceptions in a Midwest birthing population.

BACKGROUND: Missouri has one of the highest rates of maternal mortality in the United States. To date, there are currently no studies describing birthing peoples' knowledge or perceptions of contributing causes of maternal mortality. An improved understanding of population-specific knowledge can help to define how best to design targeted interventions to reduce disease-specific causes of maternal mortality. OBJECTIVE: This study aimed to examine the knowledge and understanding of maternal mortality in a Missouri birthing population. STUDY DESIGN: A 46-question, cross-sectional survey to assess the familiarity with local maternal mortality rates, groups affected, and causality was developed by the Missouri Perinatal Quality Collaborative and the Maternal-Child Learning and Action Network and emailed to a random sample of birthing people across Missouri. Those who identified as someone with birthing potential with a Missouri zip code and who were ≥18 years of age were eligible for inclusion. Unadjusted descriptive statistics were generated and stratified by age, race, and region. RESULTS: Among 2196 surveys sent, 1738 people completed the survey. Of those who responded, 78.2% were aware of the risk of pregnancy-related death with 14.7% reporting that they intimately knew someone who died. When asked if a certain group is affected disproportionately more, 66.4% responded affirmatively. Black (58.7%), uninsured (61.8%), poor (71.0%), those with substance abuse disorders (57.4%), and Native American (28.8%) birthing people were identified as groups that were perceived as suffering higher rates of maternal death. When polled on etiology, severe bleeding (56.9%) was believed to be the leading cause of death, and the second stage of labor was thought to be the period of highest risk (42.3%). Beliefs about the timing of death differed by age (P=.042) but not race (P=.81) or region (P=.191). CONCLUSION: Missouri birthing people are cognizant of the social factors associated with increased maternal mortality but are unaware of the leading causes of death, namely cardiovascular disease and mental health conditions. Future Perinatal Quality Collaborative work should focus on campaigns that raise public awareness about cardiovascular disease and mental health-related birthing risks and the importance of monitoring early warning signs after delivery.

Triple confusion: An interesting case of proteinuria in pregnancy.

Pregnancy-related renal diseases are unique and need special attention, both for diagnosis and management. The major confounding factors for diagnosis are the physiological multiorgan changes that occur throughout the gestational period. Proper diagnosis of the renal disease is also important, given the impact of varied management options both on the maternal and fetal health. A young middle-aged female with a long-standing history of diabetes presented to the hospital with worsening proteinuria in her second trimester of pregnancy. Clinical history, examinations, and laboratory analysis did not give any clues for diagnosis of a specific disease entity. This led us to take the risk of renal biopsy for a tissue diagnosis. The odds of renal biopsy favored the management decision in her case, thereby avoiding the confusions prior to biopsy. The pathological diagnosis is a surprise though not a unique entity on its own (minimal change disease in pregnancy). The case illustrates the disparity of clinical presentations and the pathology in patients, and the importance of renal biopsy in pregnant patients in particular.

Sonographic cervical length, vaginal bleeding, and the risk of preterm birth.

OBJECTIVE: We sought to evaluate the contributions of vaginal bleeding and cervical length to the risk of preterm birth. STUDY DESIGN: This was a secondary analysis of a cohort study designed to study predictors of preterm birth. The study included 2988 women with singleton gestations. Women underwent midtrimester transvaginal ultrasound assessment of cervical length and were queried regarding first- and second-trimester vaginal bleeding. RESULTS: There was a significant second-order relation between cervical length and preterm birth (P < .001, P = .005). Women with vaginal bleeding were at higher risk of preterm birth (odds ratio, 1.5; 95% confidence interval, 1.3-2.0). There was a significant interaction between cervical length and vaginal bleeding (P = .015). After accounting for cervical length and interaction, the adjusted odds ratio for vaginal bleeding and preterm birth was 4.8 (95% confidence interval, 1.89-12.4; P = .001). CONCLUSION: The magnitude of risk of preterm birth associated with sonographic cervical length depends on a woman's history of first- and second-trimester vaginal bleeding.

Optimal interval for ultrasound surveillance in monochorionic twin gestations.

OBJECTIVE: To examine the association between interval from previous ultrasonogram to diagnosis of twin-twin transfusion syndrome and stage at diagnosis. METHODS: We reviewed all monochorionic twins undergoing evaluation for twin-twin transfusion syndrome in our ultrasound department from 2001 to 2008. Cases of twin-twin transfusion syndrome were categorized as early (Quintero stages I and II) or late (Quintero stages III-V). The gestational age at diagnosis and the interval from the last ultrasonogram were recorded. The interval was categorized as 14 days or less or greater than 14 days. Pregnancies diagnosed with twin-twin transfusion syndrome at the initial ultrasonogram were categorized as greater than 14 days. The univariable association between interval from last scan and twin-twin transfusion syndrome stage was determined by χ2. P<.05 was considered significant. RESULTS: One-hundred eight monochorionic twin pregnancies were identified, and 42 met criteria for twin-twin transfusion syndrome: 24 with early stage and 18 with late stage. The median gestational age at diagnosis was 19 6/7 (15 3/7-36 3/7) weeks. Twin-twin transfusion syndrome was more likely to be diagnosed at a later stage with an ultrasound interval greater than 14 days (P=.004). Two cases (11.8%) of late twin-twin transfusion syndrome were diagnosed in pregnancies with an ultrasound interval of 14 days or less. CONCLUSION: An interval of greater than 14 days from previous ultrasonogram was strongly associated with detection of higher-stage twin-twin transfusion syndrome. These data suggest that a maximum surveillance interval of 14 days for monochorionic twins may lead to earlier stage at diagnosis, earlier intervention, and better outcomes. LEVEL OF EVIDENCE: III.

When is elevated testosterone not testosterone? When it is an immunoassay interfering antibody.

A discrepancy between clinical findings and a markedly elevated testosterone (T) level stimulated search to explain this inconsistency. The cause of the falsely elevated T level was determined to be heterophile antibodies from a polyclonal gammopathy in a subject with acute myelogenous leukemia.