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With the emergence of H1N1 pandemic (pH1N1) influenza, the CDC recommended that pregnant women be one of five initial target groups to receive the 2009 monovalent H1N1 vaccine, regardless of prior infection with this influenza strain. We sought to compare the immune response of pregnant women to H1N1 infection versus vaccination and to determine the extent of passive immunity conferred to the newborn. During the 2009-2010 influenza season, we enrolled a cohort of women who either had confirmed pH1N1 infection during pregnancy, did not have pH1N1 during pregnancy but were vaccinated against pH1N1, or did not have illness or vaccination. Maternal and umbilical cord venous blood samples were collected at delivery. Hemagglutination inhibition assays (HAI) for pH1N1 were performed. Data were analyzed using linear regression analyses. HAIs were performed for matched maternal/cord blood pairs for 16 women with confirmed pH1N1 infection, 14 women vaccinated against pH1N1, and 10 women without infection or vaccination. We found that pH1N1 vaccination and wild-type infection during pregnancy did not differ with respect to (1) HAI titers at delivery, (2) HAI antibody decay slopes over time, and (3) HAI titers in the cord blood. Vaccination against pH1N1 confers a similar HAI antibody response as compared to pH1N1 infection during pregnancy, both in quantity and quality. Illness or vaccination during pregnancy confers passive immunity to the newborn.

In this multicenter, randomized trial involving women at high risk for late preterm delivery, administration of betamethasone significantly reduced the rate of neonatal respiratory complications. Antenatal glucocorticoids are widely used in obstetrics for pregnancies at risk for early preterm delivery. Their use increased especially after a consensus conference held by the National Institutes of Health in 1994, which concluded that there was strong evidence that glucocorticoids reduce adverse neonatal outcomes, including death, the respiratory distress syndrome, and other complications, when administered to women who are likely to deliver before 34 weeks of gestation. 1 – 3 The recommendation was not extended to women at risk for preterm delivery after 34 weeks because of both a lack of data 4 , 5 and the belief that at a threshold of . . .

Preterm delivery, low birth weight, and neonatal mortality are the most important problems in obstetrics. From 1970 to 1985, the incidence of low birth weight in the United States declined steadily. From 1986 to 1991, however, the incidence of premature birth of low-birth-weight infants (those born at less than 37 weeks' gestation, weighing less than 2500 g) increased from 6.8 percent to 7.1 percent. 1 Black race, low socioeconomic status, older maternal age, and previous preterm delivery have been consistently related to the preterm delivery of low-birth-weight infants. 2 In 1991, disorders related to preterm delivery and low birth weight were the . . .

In this multicenter randomized trial, the use of fetal electrocardiographic ST-segment analysis as an adjunct to conventional intrapartum electronic fetal heart-rate monitoring did not improve perinatal outcomes or decrease operative-delivery rates. Continuous intrapartum fetal heart-rate monitoring has caused considerable controversy in obstetrics. Despite decades of use and an associated rise in cesarean-delivery rates based at least in part on nonreassuring fetal heart-rate patterns, evidence that such monitoring has reduced the rate of hypoxia-induced neonatal encephalopathy is lacking. In 2005, the Food and Drug Administration (FDA) granted conditional approval of the STAN S31 device (Neoventa Medical) for use as an adjunct to conventional electronic fetal heart-rate monitoring. 1 This technology was designed to provide fetal electrocardiographic (ECG) information reflective of myocardial metabolism and acid–base balance. The rationale is that fetal acidemia is associated . . .

Objective To determine the rate, maternal characteristics, timing, and indicators of severe maternal morbidity (SMM) that occurs at postpartum readmission. Study design Women with a birth in California during 2008–2012 were included in the analysis. Readmissions up to 42 days after delivery were investigated. SMM was defined as presence of any of the 21 indicators defined by ICD-9 codes. Results Among 2,413,943 women with a birth, SMM at readmission occurred in 4229 women. Of all SMM, 12.1% occurred at readmission. Over half (53.5%) of the readmissions with SMM occurred within the first week after delivery hospitalization. The most common indicators of SMM were blood transfusion, sepsis, and pulmonary edema/acute heart failure. Conclusion Twelve percent of SMM was identified at readmission with the majority occurring within 1 week after discharge from delivery hospitalization. Because early readmission may reflect lack of discharge readiness, there may be opportunities to improve care.

This full-color atlas is the ideal quick consult for clinicians treating gynecologic and obstetric infections. It contains over 200 images to help clinicians recognize, diagnose, and treat a wide range of infectious diseases. Coverage begins with specific organisms-including Streptococci, Chlamydial infections, herpes simplex virus, and sexually transmitted diseases-and proceeds to specific diagnostic guidance for all common gynecologic and obstetric infections. Full-color illustrations aid in identifying definitive visual manifestations of infectious diseases. Abundant tables and graphs summarize essential facts on diagnosis and treatment. Cross-references to the textbook Infectious Diseases of the Female Genital Tract, Fourth Edition direct readers to additional information.

Based upon our recent insights into the determinants of preterm birth, which is the leading cause of death in children under five years of age worldwide, we describe potential analytic frameworks that provides both a common understanding and, ultimately the basis for effective, ameliorative action. Our research on preterm birth serves as an example that the framing of any human health condition is a result of complex interactions between the genome and the exposome. New discoveries of the basic biology of pregnancy, such as the complex immunological and signaling processes that dictate the health and length of gestation, have revealed a complexity in the interactions (current and ancestral) between genetic and environmental forces. Understanding of these relationships may help reduce disparities in preterm birth and guide productive research endeavors and ultimately, effective clinical and public health interventions.

A primigravida delivered a stillborn infant at 39.7 weeks' gestation. Testing was positive for group B streptococcus; she was immune to rubella, and the blood type was B Rh-positive. The pregnancy had been uneventful except for costochondritis 14 weeks before delivery and an oval-shaped red rash with central clearing on the thigh 6 weeks before delivery. On the day of admission, fetal movements ceased and contractions began. An external fetal monitor and ultrasonographic examination confirmed intrauterine fetal death. A primigravida delivered a stillborn infant at 39.7 weeks' gestation. Testing was positive for group B streptococcus. The pregnancy had been uneventful except for costochondritis and an oval-shaped red rash. Presentation of Case A 30-year-old primigravida was admitted to the hospital in active spontaneous labor at 39.7 weeks' gestation. The patient had received prenatal care at this hospital since 11.1 weeks' gestation. She had been well. She had had varicella and had received bacille Calmette–Guérin (BCG) vaccine as a child. Four years earlier, a tuberculin skin test had been positive, and a chest radiograph had been negative; she had received antituberculosis medication for 6 months. There was no history of sexually transmitted diseases, and she did not smoke cigarettes, drink alcohol, or use intravenous drugs. She was born and raised . . .

Congenital cytomegalovirus infection is a cause of serious perinatal complications. In this randomized trial involving 399 pregnant women, CMV hyperimmune globulin was found to provide no benefit with respect to congenital CMV infection or perinatal death.