BACKGROUND Obesity has been identified as a risk factor for spontaneous miscarriage although the mechanism is unclear. The purpose of this study is to better understand the effect of obesity on early ...pregnancy success by examining the cytogenetic results of miscarriages in women with normal and elevated body mass index (BMI). METHODS We conducted a retrospective case–control study in an academic infertility practice. Medical records of women ages <40 years with first trimester missed abortion (n = 204), who underwent dilatation and curettage between 1999 and 2008, were reviewed for demographics, BMI, diagnosis of polycystic ovary syndrome (PCOS) and karyotype analysis. χ2 and Student's t-test analysis were used for statistical analysis, with P < 0.05 considered significant. RESULTS A total of 204 miscarriages were included, from women with a mean age of 34.5 years. The overall rate of aneuploidy was 59%. Women with BMI ≥ 25 kg/m2 had a significant increase in euploid miscarriages compared with women with lower BMI (P = 0.04), despite a similar mean age (34.4 years for both). CONCLUSIONS We found a significant increase in normal embryonic karyotypes in the miscarriages of overweight and obese women (BMI ≥ 25). These results suggest that the excess risk of miscarriages in the overweight and obese population is independent of embryonic aneuploidy. Further studies are needed to assess the impact of lifestyle modification, insulin resistance and PCOS on pregnancy outcomes in the overweight and obese population.
There is limited data on the effectiveness of training interventions to improve the delivery of bad news.
This preliminary research included pre-post assessments and an open-ended survey to evaluate ...the effectiveness and perceived value of training on delivering bad news for 26 first- and second-year fellows from five adult and pediatric fellowship programs.
There was a significant increase in faculty assessment scores (34.5 vs. 41.0, respectively, Z = -3.661,
< 0.001) and Standardized Patient (SP) assessment scores (37.5 vs .44.5, respectively, Z = -2.244,
= 0.025). Fellows valued having a standard framework to aid in the delivery of bad news; receiving targeted feedback and having the opportunity to apply their skills in a subsequent case.
A one-hour, four-phase lesson plan that includes an individualized training approach and simulation do-overs can be effective and valuable for preparing fellows to deliver bad news.
Objectives
The purpose of this study was to evaluate whether the use of customized fetal reference standards improves the prenatal detection of intrauterine growth restriction.
Methods
We conducted a ...retrospective cohort study. Singleton pregnancies with a diagnosis of a small‐for‐gestational‐age (SGA) fetus based on the in utero reference standard of Hadlock et al (Am J Obstet Gynecol 1985; 151:333–337; Radiology 1991; 181:129–133) were identified from our ultrasound database, and customized percentiles were calculated by adjusting for maternal height, weight, ethnicity, parity, and sex.
Results
A total of 300 pregnancies were identified as SGA by both the Hadlock and customized standards, and 60 were identified as SGA by the Hadlock standard only. Small‐for‐gestational age pregnancies identified by the Hadlock standard only were significantly less likely to have any abnormal sonographic findings, including an elevated head to abdominal circumference ratio (8.3% versus 21.7%; P = .019), oligohydramnios (3.3% versus 13%; P = .027), abnormal umbilical artery Doppler findings (3.4% versus 14.7%; P = .017), maternal hypertensive disease (3.3% versus 12.7%; P = .041), and preterm delivery (6.7% versus 27.7%; P < .001). There was no difference in neonatal intensive care unit admission rates; however, neonates identified as SGA by the Hadlock standard only were less likely to have a postnatal diagnosis of SGA (9.1% versus 78.3%; P < .001) and had a shorter neonatal intensive care unit stay (median, 2 versus 8 days; P < .001).
Conclusions
Using a customized standard, we have identified a population of pregnancies with low rates of antenatal complications and sonographic findings associated with pathologic growth. Adoption of customized standards to improve our antenatal detection rate of intrauterine growth restriction may decrease the need for intervention in healthy but constitutionally small fetuses.
Redo tricuspid valve replacement has high surgical operative mortality. Transcatheter valve-in-valve provides a viable option for valve replacement. We discuss the decision-making process involved in ...performing transcatheter tricuspid valve-in-valve replacement in a 23-week pregnant woman with multiple comorbidities and symptomatic severe bioprosthetic stenosis. (Level of Difficulty: Intermediate.)
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