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BACKGROUND: The umbilical coiling index (UCI) is a measure of the number of coils in the umbilical cord in relation to its length. Hypercoiled cords with a UCI of >0.3 coils/cm have been associated with adverse fetal and neonatal outcomes. AIMS: The primary aim is to determine the accuracy of UCI measured on second trimester ultrasound in predicting UCI at birth. The secondary outcome is to investigate the association between hypercoiling of the umbilical cord on prenatal ultrasound and adverse maternal, fetal and neonatal outcomes. METHODS: This was a prospective cohort study of uncomplicated singleton pregnancies. Seventy two patients were included in the study. UCI was measured in the second trimester ultrasound, and compared to UCI measured postnatally. Outcomes of patients with hypercoiled cords on ultrasound were compared to outcomes of patients with normocoiled cords. RESULTS: Our results failed to show a strong correlation between the UCI determined with ultrasound, and the UCI determined with examination of the umbilical cord after delivery. We also did not demonstrate that measurement of the UCI on second trimester ultrasound is able to predict adverse maternal, fetal or neonatal outcomes. CONCLUSION: This study suggests that measurement of the umbilical coiling index should not be part of routine second trimester sonography in patients with uncomplicated singleton pregnancies, with no other medical or surgical comorbidities.

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OBJECTIVE: The aim of this article is to test the hypothesis that three-dimensional (3D) sonography is correlated to the two-dimensional (2D) sonography for nuchal translucency (NT) measurement during first trimester screening (FTS). METHODS: We performed a prospective observational study on patients presenting for FTS. Three NT measurements were performed using the current standardized 2D method at the midsagittal planes, and NT sonography was then repeated for each case using 3D sagittal and axial plane. The Kruskal-Wallis test and the Spearman rank correlation were used to evaluate the relationship between 2D and 3D NT methods of measurement. A p-value <0.05 was considered significant. RESULTS: The study included 366 patients with singleton pregnancies. Mean maternal age was 31.2 years, and mean gestational age was 12(3/7) weeks. The mean maximal NT measurement for 2D and 3D sagittal and axial planes were 1.65, 1.70, and 1.66 mm, respectively (p = 0.42). The Spearman rank correlation of 2D sagittal plane sonography with 3D sagittal and axial planar sonography was 0.73 and 0.68, respectively (p < 0.001). CONCLUSION: 3D NT measurement appears to be a tool highly correlated to the conventional 2D sonographic approach. This may be useful in selected cases in which there is difficulty in obtaining optimal 2D measurements of the NT space.

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STUDY OBJECTIVE: To determine if prophylactic glycopyrrolate prevents bradycardia after spinal anesthesia. DESIGN: Prospective, randomized, double-blinded, placebo-controlled study. SETTING: Large university-affiliated community hospital. PATIENTS: 81 consecutive term parturients (not in active labor) who were scheduled for elective Cesarean section. INTERVENTIONS: Parturients received 1.0 to 1.5 L of intravenous Ringer's lactate and either glycopyrrolate 0.4 mg or an equal volume of saline, with caregivers blinded to the immediate sequelae of study drug. Each patient received intrathecal bupivacaine (12 to 14 mg) with morphine sulfate (0.1 to 0.2 mg). MEASUREMENTS: Continuous heart rate (HR) and blood pressure monitoring occurred for 20 minutes, with the minimum HR recorded for each 5-minute epoch. Heart rates < 60 beats per minute defined bradycardia. Heart rate variability (HRV) analysis occurred offline. MAIN RESULTS: None of 34 patients administered glycopyrrolate and 6 of 35 (17%) patients receiving saline experienced bradycardia (P = 0.02476). Time domain, frequency domain, and nonlinear and embedded spectrum entropy analyses all reflected the decrease in HRV accompanying administration of glycopyrrolate. CONCLUSION: Bradycardia after spinal anesthesia occurs commonly. Prophylactic glycopyrrolate may prevent the bradycardia, but not necessarily the hypotension.

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This study was performed to determine if cerclage height is associated with spontaneous preterm birth in patients with a history-indicated cerclage. We performed a retrospective cohort study of women with a history-indicated cerclage. Functional cervical length and the cerclage height (distance from cerclage to the external cervical os) were obtained. The cohort was grouped into thirds, based on cerclage height percentile. Our primary outcome was spontaneous preterm birth <35 weeks. There were 21 women in group 1 (cerclage height <10 mm), 53 in group 2 (cerclage height 10 to 19 mm), and 31 in group 3 (cerclage height ≥20 mm). The rates of spontaneous preterm birth <35 weeks were similar between each group: 24, 17, and 10%, respectively ( P = 0.38). Cerclage height is not associated with a reduction in spontaneous preterm birth for women with a history-indicated cerclage. The association between longer cerclage height and decrease in preterm birth was nonsignificant possibly due to the small sample size.

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Placenta percreta with pelvic organ invasion carries a high mortality for mother and fetus. Appropriate multidisciplinary consultation, strategy, and preoperative planning for Cesarean hysterectomy permitted caregivers to provide a maternal-infant bonding experience, surgical hemostasis, preservation of bladder function, and a healthy, vigorous neonate.

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Substance abuse in pregnancy has increased over the past three decades in the United States, resulting in approximately 225,000 infants yearly with prenatal exposure to illicit substances. Routine screening and the education of women of child bearing age remain the most important ways to reduce addiction in pregnancy. Legal and illegal substances and their effect on pregnancy discussed in this review include opiates, cocaine, alcohol, tobacco, marijuana, and amphetamines. Most literature regarding opiate abuse is derived from clinical experience with heroin and methadone. Poor obstetric outcomes can be up to six times higher in patients abusing opiates. Neonatal care must be specialized to treat symptoms of withdrawal. Cocaine use in pregnancy can lead to spontaneous abortion, preterm births, placental abruption, and congenital anomalies. Neonatal issues include poor feeding, lethargy, and seizures. Mothers using cocaine require specialized prenatal care and the neonate may require extra supportive care. More than 50% of women in their reproductive years use alcohol. Alcohol is a teratogen and its effects can include spontaneous abortion, growth restriction, birth defects, and mental retardation. Fetal alcohol spectrum disorder can have long-term sequelae for the infant. Tobacco use is high among pregnant women, but this can be a time of great motivation to begin cessation efforts. Long-term effects of prenatal tobacco exposure include spontaneous abortion, ectopic pregnancy, placental insufficiency, low birth weight, fetal growth restriction, preterm delivery, childhood respiratory disease, and behavioral issues. Marijuana use can lead to fetal growth restriction, as well as withdrawal symptoms in the neonate. Lastly, amphetamines can lead to congenital anomalies and other poor obstetric outcomes. Once recognized, a multidisciplinary approach can lead to improved maternal and neonatal outcomes.

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