Preterm Prelabor Rupture of Membranes: Outcomes with Expectant Management until 34 versus 35 Weeks.

OBJECTIVE: To evaluate outcomes with expectant management of preterm prelabor rupture of membranes (PROM) until 35 weeks versus immediate delivery at ≥34 weeks. STUDY DESIGN: This was a multicenter retrospective cohort study of singletons with preterm PROM at >20 weeks from 2011 through 2017. Groups were defined as expectant management until 35 weeks versus immediate delivery at ≥34 weeks. Primary outcome was composite neonatal morbidity: need for respiratory support, culture positive neonatal sepsis, or antibiotic administration for >72 hours. Univariate and general estimating equation models were used with p < 0.05 considered significant. RESULTS: A total of 280 mother-infant dyads were included. There was no difference in composite neonatal outcome in pregnancies managed with expectant management compared with immediate delivery (43.4 vs. 37.5%; p = 0.32). Those with expectant management had shorter length of neonatal intensive care unit (NICU) admission but higher rates of neonatal antibiotics for > 72 hours, endometritis, and histological chorioamnionitis. There were no cases of fetal demise, neonatal death, or maternal sepsis, and only three cases of neonatal sepsis. CONCLUSION: There is no difference in composite neonatal morbidity in pregnancies with preterm PROM managed with expectant management until 35 weeks as compared with immediate delivery at 34 weeks. Expectant management is associated with a decreased length of NICU admission but increased short-term infectious morbidity.

Alcoholic Pancreatitis Masquerading as Preeclampsia.

BACKGROUND: Coexisting medical complications in pregnancy can present in a fashion similar to preeclampsia and can be challenging to differentiate. CASE: We present a patient who, at 27 3/7 weeks of gestation, fulfilled diagnostic criteria for severe preeclampsia, including hypertension, proteinuria, headache, abnormal serum creatinine levels, thrombocytopenia, and liver function abnormalities, but who nevertheless did not have preeclampsia. Instead, she was diagnosed with alcoholic pancreatitis based on a history of heavy alcohol use and elevated amylase and lipase. Abnormal laboratory values resolved with supportive therapy, and she continued to term without subsequent recurrence of proteinuria or hypertension. CONCLUSION: Alcoholic pancreatitis can be mistaken for preeclampsia.

Computer science security research and human subjects: emerging considerations for research ethics boards.

This paper explores the growing concerns with computer science research, and in particular, computer security research and its relationship with the committees that review human subjects research. It offers cases that review boards are likely to confront, and provides a context for appropriate consideration of such research, as issues of bots, clouds, and worms enter the discourse of human subjects review.

The Ronald McDonald House as an alternative to antepartum hospitalization.

OBJECTIVE: We sought to evaluate the use of the Ronald McDonald House (RMH) for selected high-risk pregnant women. METHODS: Beginning in November of 1999, women on the Maternal Fetal Medicine service at Albany Medical Center Hospital (AMCH) were candidates for antepartum lodging at the Ronald McDonald House (RMH). Women whose only indication for antepartum hospitalization was to maintain proximity to a tertiary care center were offered stays at the RMH. Antenatal and neonatal outcomes were reviewed. RESULTS: A total of 41 antepartum subjects stayed at the RMH during the study period. No adverse perinatal outcomes were identified due to utilization of the RMH. Patients stayed at the RMH instead of staying at AMCH as inpatients for a total of 586 days during the study period. CONCLUSIONS: Outpatient management at the RMH is a cost-effective alternative for selected high-risk pregnancies. No adverse outcomes in the study population were attributable to the utilization of the RMH.

The timing of elective delivery in preterm premature rupture of the membranes: a survey of members of the Society of Maternal-Fetal Medicine.

OBJECTIVE: We sought to assess the gestational age at which elective delivery is considered in an otherwise uncomplicated patient with preterm premature rupture of the membranes (PROM) by members of the Society of Maternal Fetal-Medicine (SMFM). STUDY DESIGN: A 3-page survey was mailed to members of the SMFM for this observational study. Information solicited included demographic data and practice patterns for the timing of delivery in patients with preterm PROM. RESULTS: Seven hundred seventeen questionnaires (40%) were completed. The majority (81%) did not believe there is a consensus regarding the gestational age for elective delivery in patients with preterm PROM. With confirmed fetal lung maturity, the greatest number of respondents selected 32 and 34 weeks as the earliest gestational age for elective delivery. In the absence of fetal pulmonary maturity testing, the majority of respondents chose 34 weeks. CONCLUSION: Most SMFM respondents electively deliver uncomplicated patients with preterm PROM by 34 weeks' gestation.