American journal of obstetrics and gynecology
-
Am. J. Obstet. Gynecol. · Mar 2017
ReviewTesting for Zika Virus (ZIKV) Infection in Pregnancy: Key Concepts to Deal with an Emerging Epidemic.
Zika virus is an emerging mosquito-borne (Aedes genus) arbovirus of the Flaviviridae family. Following epidemics in Micronesia and French Polynesia during the past decade, more recent Zika virus infection outbreaks were first reported in South America as early as May 2013 and spread to now 50 countries throughout the Americas. Although no other flavivirus has previously been known to cause major fetal malformations following perinatal infection, reports of a causal link between Zika virus and microcephaly, brain and ocular malformations, and fetal loss emerged from hard-hit regions of Brazil by October 2015. ⋯ We review recent epidemiological data pertaining to the risk of congenital Zika virus malformations based on trimester of exposure and consider side by side with emerging data demonstrating replication of Zika virus in placental and fetal tissue throughout gestation. We discuss limitations to ultrasound based strategies that rely largely or solely on the detection of microcephaly and provide alternative neurosonographic approaches for the detection of malformations that may precede or occur independent of a small head circumference. This expert review provides information that is of value for the following: (1) obstetrician, maternal-fetal medicine specialist, midwife, patient, and family in cases of suspected Zika virus infection; (2) review of the methodology for laboratory testing to explore the presence of the virus and the immune response; (3) ultrasound-based assessment of the fetus suspected to be exposed to Zika virus with particular emphasis on the central nervous system; and (4) identification of areas ready for development.
-
Am. J. Obstet. Gynecol. · Mar 2017
Multicenter StudyReduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative.
Obstetric hemorrhage is the leading cause of severe maternal morbidity and of preventable maternal mortality in the United States. The California Maternal Quality Care Collaborative developed a comprehensive quality improvement tool kit for hemorrhage based on the national patient safety bundle for obstetric hemorrhage and noted promising results in pilot implementation projects. ⋯ We used an innovative collaborative quality improvement approach (mentor model) to scale up implementation of the national hemorrhage bundle. Participation in the collaborative was strongly associated with reductions in severe maternal morbidity among hemorrhage patients. Women in hospitals in their second collaborative had an even greater reduction in morbidity than those approaching the bundle for the first time, reinforcing the concept that quality improvement is a long-term and cumulative process.
-
Am. J. Obstet. Gynecol. · Mar 2017
Fertility treatments and pediatric neoplasms of the offspring: results of a population-based cohort with a median follow-up of 10 years.
Studies have questioned the long-term health effects of offspring conceived after fertility treatments. ⋯ Children conceived after fertility treatments are at an increased risk for pediatric neoplasms.
-
Am. J. Obstet. Gynecol. · Mar 2017
Comparative Study Observational StudyInfant outcomes among women with Zika virus infection during pregnancy: results of a large prenatal Zika screening program.
Zika virus infection during pregnancy is a known cause of congenital microcephaly and other neurologic morbidities. ⋯ Based on a large-scale prenatal Zika screening program in an area with a predominantly Hispanic population, we identified that 4% were at risk from reported travel with only 2/1000 infected. Women traveling from heavily affected areas were most at risk for infection. Neonatal head circumference percentiles among infants born to women with evidence of possible Zika virus infection during pregnancy were not reduced when compared to infants born to women without infection.
-
Am. J. Obstet. Gynecol. · Mar 2017
The performance and safety of bilateral salpingectomy for ovarian cancer prevention in the United States.
Ovarian cancer is the leading cause of death due to gynecologic malignancy and the fifth most common cause of cancer deaths in developed countries. Recent evidence has indicated that the most common and lethal form of ovarian cancer originates in the distal fallopian tube, and recommendations for surgical removal of the fallopian tube (bilateral salpingectomy) at the time of other gynecologic surgeries (particularly hysterectomy and tubal sterilization) have been made, most recently by the American Congress of Obstetricians and Gynecologists. ⋯ Our results suggest that hysterectomy with bilateral salpingectomy is significantly increasing in the United States and is not associated with increased risks of postoperative complications.