Human Metapneumovirus Infection and Acute Respiratory Distress Syndrome During Pregnancy
OBSTETRICS AND GYNECOLOGY
2017; 130 (3): 630–32
Fetal proximal humeral epiphysis as an indicator of term gestation in different ethnic groups
JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE
2017; 30 (20): 2505–9
Human metapneumovirus has recently been recognized as an important cause of severe respiratory viral infections and of viral infections in patients admitted to intensive care units. Little is known about the course of this infection in pregnancy.A late-preterm primigravid woman was admitted to the intensive care unit for acute respiratory distress syndrome and subsequently diagnosed with human metapneumovirus. Because of worsening maternal respiratory status, she was intubated and a primary cesarean delivery was performed. The patient's respiratory status continued to decline postpartum, and she ultimately required extracorporeal membrane oxygenation. She was treated supportively until her respiratory status improved, at which time she was extubated and weaned off extracorporeal membrane oxygenation and subsequently discharged home.Human metapneumovirus can lead to severe respiratory illness during pregnancy.
View details for DOI 10.1097/AOG.0000000000002165
View details for Web of Science ID 000408150300027
View details for PubMedID 28796690
Please put on your own oxygen mask before assisting others: a call to arms to battle burnout
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
2016; 215 (6): 731-+
Accurate pregnancy dating is critical for appropriate clinical management. Our aim was to determine the time of appearance of proximal humeral epiphysis (PHE), consistency of its appearance among ethnic groups and whether 3D imaging helps with its visualization.A cross-sectional study was done on 360 patients with 563 scans in different ethnic groups between August 2013 and July 2015. Inclusion criteria were singleton pregnancies (34-40+ weeks of gestation), well dated by <20 weeks sonogram.PHE was not seen at 34 (n = 44) or 35 weeks (n = 36) and was present at gestational ages 36 (n = 3), 37 (n = 126), 38 (n = 96), 39 (n = 100) and 40 weeks (n = 28) in 2%, 12%, 51%, 75% and 100%, respectively. PHE was seen in 20 of 50 (60%) African-Americans, 22 of 61 (64%) south Asians, 41 of 72 (57%) Caucasians, 45 of 86 (48%) Hispanics and 41 of 80 (49%) Asians.Appearance of PHE did increase with gestational age, prior to 40 weeks, it was not uniformly present and was seen as early as 36 weeks independent of ethnic group.
View details for DOI 10.1080/14767058.2016.1254184
View details for Web of Science ID 000406760000022
View details for PubMedID 27819180
Patterns of Internet Use by Pregnant Women, and Reliability of Pregnancy-Related Searches
MATERNAL AND CHILD HEALTH JOURNAL
2016; 20 (12): 2502–9
Burnout among healthcare workers has reached epidemic proportions. Obstetrician/Gynecologists are not exceptions. Burnout is a phenomenon that can be difficult to distinguish from other entities, but one that has far-reaching consequences that can be deleterious both to physicians and to their patients. Most worrisome are its insidious nature, its contagiousness, and its relationship to depression. To date there has been a paucity of solutions proven to effectively fight burnout, and the implementation of those that may be helpful has been fragmented. An aggressive and multi-pronged approach is warranted that focus at the individual, departmental, institutional and national levels. Potential solutions should take into account external and internal factors, as well as issues of feasibility, impact and cost. Interventions that may play a role include cognitive-behavioral therapy, enhanced communication, physician wellbeing programs, improving work conditions, and advocacy efforts.
View details for DOI 10.1016/j.ajog.2016.08.029
View details for Web of Science ID 000389514400007
View details for PubMedID 27567563
Resolution of superimposed pre-eclampsia, and improvement in umbilical artery flow in a surviving twin after intrauterine demise of its co-twin
JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH
2015; 41 (9): 1473–77
Objective To assess patterns of e-health use in pregnancy in an underserved racially diverse inner-city population, and to assess the accuracy of pregnancy-related information obtained from the Internet. Methods A cross sectional study of 503 pregnant/postpartum women belonging to an underserved racially diverse inner-city population who completed a survey regarding e-health use. To assess accuracy, four independent expert-reviewers rated the first 10 webpages on Google searches for each of five questions based upon those in ACOG bulletins. Results 70.8 % of pregnant/postpartum women belonging to an underserved racially diverse inner-city population were e-health users. E-health users were younger (mean age 29.4 vs. 31.2, P = 0.009), more likely to be nulliparous (50.3 vs. 21.3 %, P < 0.001), have English as their primary language (62.3 vs. 49.1 %, P = 0.014) and have a college/graduate education (78 vs. 26.6 %, P < 0.001). While 60 % of these women said e-health influenced decision making, only 71.3 % of them discussed their searches with their provider. Expert reviewers determined that the online information was fairly accurate (mean score: +1.48 to +4.33 on a scale of -5 to +5) but not uniformly accurate, and there was at least one webpage with inaccurate information for every question. Conclusions for practice Pregnant women frequently use e-health resources but do not routinely share their findings with their providers. Most, but not all, information obtained is accurate. Therefore it is important for providers to discuss their patients' use, and help to guide them to reliable information.
View details for DOI 10.1007/s10995-016-2075-0
View details for Web of Science ID 000392301800012
View details for PubMedID 27456311
Pre-eclampsia has a progressive clinical course, and is only cured by delivery of the placenta. We report a 30-year-old G1P0 with dichorionic twins, discordant growth and chronic hypertension who developed superimposed pre-eclampsia in her 21st week of gestation. After intrauterine demise of the severely growth-restricted twin, the superimposed pre-eclampsia resolved. The surviving twin initially had absent end diastolic flow, which resolved after the demise. A healthy 1935-g neonate with Apgar 9/9 was delivered at 34 weeks. Antenatal resolution of pre-eclampsia is extremely rare and resolution of superimposed pre-eclampsia has not, to our knowledge, been reported.
View details for DOI 10.1111/jog.12725
View details for Web of Science ID 000362674400025
View details for PubMedID 26096469