Pessary versus cerclage versus expectant management for cervical dilation with visible membranes in the second trimester.

OBJECTIVE: We evaluated pessary for dilated cervix and exposed membranes for prolonging pregnancy compared to cerclage or expectant management. METHODS: Multicenter retrospective cohort study of women, 15-24 weeks, singleton pregnancies, dilated cervix ≥2 cm and exposed membranes. Women received pessary, cerclage or expectant management. Primary outcome was gestational age (GA) at delivery. Secondary outcomes were time until delivery, preterm premature rupture of membranes (PPROM) and neonatal survival. RESULTS: About 112 women met study criteria; 9 - pessary, 85 - cerclage and 18 - expectant management. Mean GA at delivery was 22.9 ± 4.5 weeks with pessary, 29.2 ± 7.5 weeks with cerclage and 25.6 ± 6.7 weeks with expectant management (p = 0.015). Time until delivery was 16.1 ± 18.9 days in the pessary group, 61.7 ± 48.2 days in the cerclage group and 26.8 ± 33.4 days in the expectant group (p \u3c 0.001). PPROM occurred less frequently and neonatal survival increased in women with cerclage. There was a significant difference in all the perinatal outcomes with cerclage compared with either pessary or expectant management. CONCLUSIONS: Perinatal outcomes with pessary were not superior to expectant management in women with dilated cervix with exposed membranes in the second trimester in this small retrospective cohort

Bacterial Spinal Epidural and Psoas Abscess in Pregnancy Associated with Intravenous Drug Use

Spontaneous spinal epidural abscess (SEA) is a rare infection of the central nervous system. We report a case of a 25-year-old G3 P0020 at 36 weeks of gestational age with history of intravenous drug abuse presenting with acute-onset and severe back pain. Despite antibiotic therapy, pain worsened and she developed lower extremity weakness. Magnetic resonance imaging (MRI) revealed an SEA, and cesarean delivery was performed secondary to increasing weakness, followed by laminectomy (T9-12) and decompression of epidural abscess. Postoperative course was complicated by a psoas muscle abscess and persistent SEA refractory to antibiotic therapy, requiring surgical reexploration and extended treatment with antibiotics. She was discharged home in stable condition and neonate did well with no resulting sequelae. Spinal epidural and psoas abscesses are rare and diagnosis is often delayed. Prompt recognition and treatment are necessary to prevent catastrophic neurologic consequences, and the diagnosis should be considered in pregnant patients presenting with back pain, especially in those with risk factors

Use of External Cephalic Version and Amnioreduction in the Delivery of a Fetal Demise with Macrocephaly Secondary to Massive Intracranial Teratoma

Abstract Introduction Congenital intracranial tumors are rare and often incidentally diagnosed on routine ultrasound. We report a case of a fetal demise with a massive intracranial teratoma at 25 weeks of gestation and the management of her delivery in the setting of macrocephaly, breech presentation, and polyhydramnios. Case A 31-year-old G3P1011 woman at 25 weeks' gestation presented with a recent fetal demise and a fetal intracranial tumor first identified at 16 weeks' gestational age. The patient had declined termination of pregnancy. Biometry was consistent with 24 weeks' gestation, except for a head circumference of 394.4 mm consistent with 39 weeks' gestation. The fetus was in a breech presentation. An external cephalic version (ECV) was successfully performed under epidural anesthesia and an amnioreduction was then performed to stabilize the fetal position. Immediate induction of labor and vaginal delivery followed. Discussion ECV and amnioreduction may help facilitate delivery in cases of fetal demise complicated by macrocephaly, malpresentation, and polyhydramnios

Use of External Cephalic Version and Amnioreduction in the Delivery of a Fetal Demise with Macrocephaly Secondary to Massive Intracranial Teratoma

Abstract Introduction Congenital intracranial tumors are rare and often incidentally diagnosed on routine ultrasound. We report a case of a fetal demise with a massive intracranial teratoma at 25 weeks of gestation and the management of her delivery in the setting of macrocephaly, breech presentation, and polyhydramnios. Case A 31-year-old G3P1011 woman at 25 weeks' gestation presented with a recent fetal demise and a fetal intracranial tumor first identified at 16 weeks' gestational age. The patient had declined termination of pregnancy. Biometry was consistent with 24 weeks' gestation, except for a head circumference of 394.4 mm consistent with 39 weeks' gestation. The fetus was in a breech presentation. An external cephalic version (ECV) was successfully performed under epidural anesthesia and an amnioreduction was then performed to stabilize the fetal position. Immediate induction of labor and vaginal delivery followed. Discussion ECV and amnioreduction may help facilitate delivery in cases of fetal demise complicated by macrocephaly, malpresentation, and polyhydramnios

Maternal activity level in patients with preterm premature rupture of membranes: A Prospective Observational Cohort Study

Objective: To evaluate the level of maternal physical activity effect on the perinatal outcomes of women with preterm premature rupture of membranes (PPROM) Study Design: This is a pilot, prospective, observational multicenter cohort study. We approached patients admitted between 23 0/7 weeks to 32 0/7 weeks gestation with confirmed PPROM between January of 2014 and June of 2017 All patients received corticosteroids and latency antibiotics. Enrollment was done on third day of admission. Delivery occurred at 34 weeks per protocol via induction of labor or cesarean section as obstetrically indicated; or sooner if chorioamnionitis was diagnosed or spontaneous preterm labor occurred. Patients were provided a pedometer to wear for the duration of their antepartum course and they have maternal activity at lib and were encouraged to go to the physical therapy gymnasium. Results: We enrolled 32 women. We stratified them in two groups: low activity as less than 500 step a day and higher maternal activity more than 500 steps a day, There were no significant differences in the demographics. Latency from PPROM to delivery were significantly prolonged in women with maternal activity \u3e 500 steps a day: 11.0 ± 8.42 vs 21.18 ± 4.26 days p = 0.004. No maternal or fetal adverse outcomes were identified. Conclusion: Maternal activity more than 500 steps a day showed a significant association with prolongation of latencyhttps://jdc.jefferson.edu/obgynposters/1001/thumbnail.jp