JoVE Visualize What is visualize?
Stop Reading. Start Watching.
Advanced Search
Stop Reading. Start Watching.
Regular Search
Find video protocols related to scientific articles indexed in Pubmed.
Customized versus Population Fetal Growth Norms and Adverse Outcomes Associated with Small for Gestational Age Infants in a High-Risk Cohort.
Am J Perinatol
PUBLISHED: 09-28-2014
Show Abstract
Hide Abstract
Objective?To compare population versus customized fetal growth norms in identifying neonates at risk for adverse perinatal and neonatal outcomes (AOs) associated with small for gestational age (SGA) in high-risk women. Design?Secondary analysis to a multicenter treatment trial of pregnant women at high risk for preeclampsia using low-dose aspirin versus placebo. The associations between SGA by population (SGApop) and customized (SGAcust) norms and AOs were evaluated. Results?A total of 2,289 mother/infant pairs were included in the analysis. The rates of SGA in the aspirin and placebo groups were similar by the customized (22.8% vs 23.9%; p?=?0.55) or population (8.7% vs 7.5%; p?=?0.54) norms; however, they were lower using population norms compared with customized norms (p?
Related JoVE Video
Randomized, Controlled Pilot Trial of Bupropion for Pregnant Smokers: Challenges and Future Directions.
Am J Perinatol
PUBLISHED: 08-11-2014
Show Abstract
Hide Abstract
Objective?The aim of the study is to conduct an initial pilot trial evaluating the feasibility, safety, and efficacy of bupropion for smoking cessation in pregnancy. Study Design?A randomized, double-blind, parallel-group pilot study of bupropion versus placebo with 50 pregnant smokers was planned. Eligibility criteria were restrictive (e.g., 14-26 weeks' gestation; no psychiatric conditions or medications) due to the unknown safety, tolerability, and side effect profile of bupropion in pregnancy. Bayesian analyses were planned to provide probability of benefit. Results?Significant challenges were encountered with regard to trial feasibility. Of 820 women screened, 112 were current smokers, but only 11 women were eligible and consented to participate in the study. Excluded women most often had a psychiatric disorder (23%); were outside the gestational range (14%); or declined to participate (11%). Conclusions?This initial attempt to evaluate bupropion for smoking cessation during pregnancy will inform future trial methodology. Because of the unknown safety profile, conservative eligibility criteria were used and resulted in a large portion of this high-risk, low-income smoker population being excluded from the trial, raising questions regarding broad applicability, and highlighting the need to balance patient safety and trial feasibility. Large multisite studies will likely be needed to conduct definitive pharmacotherapy studies.
Related JoVE Video
Neonatal and infant outcomes in twin gestations with preterm premature rupture of membranes at 24-31 weeks of gestation.
Obstet Gynecol
PUBLISHED: 07-09-2014
Show Abstract
Hide Abstract
To describe the perinatal and infant and early childhood morbidity associated with preterm premature rupture of membranes (PROM) in a cohort of twin pregnancies evaluated prospectively with neonatal follow-up to 2 years of age.
Related JoVE Video
A Pilot Randomized, Controlled Trial of Metformin versus Insulin in Women with Type 2 Diabetes Mellitus during Pregnancy.
Am J Perinatol
PUBLISHED: 06-04-2014
Show Abstract
Hide Abstract
Objective?Few studies support oral diabetic treatment in pregnant women with type 2 diabetes mellitus (T2DM). The objective of this study was to compare the effects of metformin versus insulin on achieving glycemic control and improving maternal and neonatal outcomes in pregnant women with T2DM. Study Design?A pilot randomized, controlled trial was conducted of metformin versus insulin for the treatment of T2DM during pregnancy. The primary outcome was glycemic control measured with hemoglobin A1c?
Related JoVE Video
Neonatal brachial plexus palsy: Incidence, prevalence, and temporal trends.
Semin. Perinatol.
PUBLISHED: 05-28-2014
Show Abstract
Hide Abstract
Epidemiological knowledge of the incidence, prevalence, and temporal changes of neonatal brachial plexuses palsy (NBPP) should assist the clinician, avert unnecessary interventions, and help formulate evidence-based health policies. A summary of 63 publications in the English language with over 17 million births and 24,000 NBPPs is notable for six things. First, the rate of NBPP in the US and other countries is comparable: 1.5 vs. 1.3 per 1000 total births, respectively. Second, the rate of NBPP may be decreasing: 0.9, 1.0 and 0.5 per 1,000 births for publications before 1990, 1990-2000, and after 2000, respectively. Third, the likelihood of not having concomitant shoulder dystocia with NBPP was 76% overall, though it varied by whether the publication was from the US (78%) vs. other countries (47%). Fourth, the likelihood of NBPP being permanent (lasting at least 12 months) was 10-18% in the US-based reports and 19-23% in other countries. Fifth, in studies from the US, the rate of permanent NBPP is 1.1-2.2 per 10,000 births and 2.9-3.7 per 10,000 births in other nations. Sixth, we estimate that approximately 5000 NBPPs occur every year in the US, of which over 580-1050 are permanent, and that since birth, 63,000 adults have been afflicted with persistent paresis of their brachial plexus. The exceedingly infrequent nature of permanent NBPP necessitates a multi-center study to improve our understanding of the antecedent factors and to abate the long-term sequela.
Related JoVE Video
Frequency of and factors associated with severe maternal morbidity.
Obstet Gynecol
PUBLISHED: 05-03-2014
Show Abstract
Hide Abstract
To estimate the frequency of severe maternal morbidity, assess its underlying etiologies, and develop a scoring system to predict its occurrence.Supplemental Digital Content is Available in the Text.
Related JoVE Video
Nonmedically indicated induction vs expectant treatment in term nulliparous women.
Am. J. Obstet. Gynecol.
PUBLISHED: 04-08-2014
Show Abstract
Hide Abstract
The purpose of this study was to compare maternal and neonatal outcomes in nulliparous women with nonmedically indicated inductions at term vs those expectantly treated.
Related JoVE Video
Families at risk: home and car smoking among pregnant women attending a low-income, urban prenatal clinic.
Nicotine Tob. Res.
PUBLISHED: 04-01-2014
Show Abstract
Hide Abstract
Secondhand smoke exposure (SHSe) has been identified as a distinct risk factor for adverse obstetric and gynecological outcomes. This study examined the prevalence of SHSe reduction practices (i.e., home and car smoking bans) among pregnant women in a large U.S. prenatal clinic serving low-income women.
Related JoVE Video
The relationship between primary cesarean delivery skin incision type and wound complications in women with morbid obesity.
Am. J. Obstet. Gynecol.
PUBLISHED: 01-10-2014
Show Abstract
Hide Abstract
We sought to evaluate the relationship between skin incision, transverse or vertical, and the development of wound complications in women with morbid obesity requiring primary cesarean delivery (CD).
Related JoVE Video
Excess LIGHT Contributes to Placental Impairment, Increased Secretion of Vasoactive Factors, Hypertension, and Proteinuria in Preeclampsia.
Hypertension
PUBLISHED: 12-09-2013
Show Abstract
Hide Abstract
Preeclampsia, a prevalent hypertensive disorder of pregnancy, is believed to be secondary to uteroplacental ischemia. Accumulating evidence indicates that hypoxia-independent mediators, including inflammatory cytokines and growth factors, are associated with preeclampsia, but it is unclear whether these signals directly contribute to placental damage and disease development in vivo. We report that LIGHT, a novel tumor necrosis factor superfamily member, is significantly elevated in the circulation and placentas of preeclamptic women compared with normotensive pregnant women. Injection of LIGHT into pregnant mice induced placental apoptosis, small fetuses, and key features of preeclampsia, hypertension and proteinuria. Mechanistically, using neutralizing antibodies specific for LIGHT receptors, we found that LIGHT receptors herpes virus entry mediator and lymphotoxin ? receptor are required for LIGHT-induced placental impairment, small fetuses, and preeclampsia features in pregnant mice. Accordingly, we further revealed that LIGHT functions through these 2 receptors to induce secretion of soluble fms-like tyrosine kinase-1 and endothelin-1, 2 well-accepted pathogenic factors in preeclampsia, and thereby plays an important role in hypertension and proteinuria in pregnant mice. Lastly, we extended our animal findings to human studies and demonstrated that activation of LIGHT receptors resulted in increased apoptosis and elevation of soluble fms-like tyrosine kinase-1 secretion in human placental villous explants. Overall, our human and mouse studies show that LIGHT signaling is a previously unrecognized pathway responsible for placental apoptosis, elevated secretion of vasoactive factors, and subsequent maternal features of preeclampsia, and reveal new therapeutic opportunities for the management of the disease.
Related JoVE Video
Tissue Transglutaminase Contributes to the Pathogenesis of Preeclampsia and Stabilizes Placental Angiotensin Receptor Type 1 by Ubiquitination-Preventing Isopeptide Modification.
Hypertension
PUBLISHED: 11-04-2013
Show Abstract
Hide Abstract
Preeclampsia is a life-threatening pregnancy disorder that is widely thought to be triggered by impaired placental development. However, the placenta-related pathogenic factors are not fully identified, and their underlying mechanisms in disease development remain unclear. Here, we report that the protein level and enzyme activity of tissue transglutaminase (TG2 or tTG), the most ubiquitous member of a family of enzymes that conducts post-translational modification of proteins by forming ?-(?-glutamyl)-lysine isopeptide bonds, are significantly elevated in placentas of preeclamptic women. TG2 is localized in the placental syncytiotrophoblasts of patients with preeclampsia where it catalyzes the isopeptide modification of the angiotensin receptor type 1 (AT1). To determine the role of elevated TG2 in preeclampsia, we used a mouse model of preeclampsia based on injection of AT1-agonistic autoantibody. A pathogenic role for TG2 in preeclampsia is suggested by in vivo experiments in which cystamine, a potent transglutaminase inhibitor, or small interfering RNA-mediated TG2 knockdown significantly attenuated autoantibody-induced hypertension and proteinuria in pregnant mice. Cystamine treatment also prevented isopeptide modification of placental AT1 receptors in preeclamptic mice. Mechanistically, we revealed that AT1-agonistic autoantibody stimulation enhances the interaction between AT1 receptor and TG2 and results in increased AT1 receptor stabilization via transglutaminase-mediated isopeptide modification in trophoblasts. Mutagenesis studies further demonstrated that TG2-mediated isopeptide modification of AT1 receptors prevents ubiquitination-dependent receptor degradation. Taken together, our studies not only identify a novel pathogenic involvement of TG2 in preeclampsia but also suggest a previously unrecognized role of TG2 in the regulation of G protein-coupled receptor stabilization by inhibiting ubiquitination-dependent degradation.
Related JoVE Video
A suggested approach for implementing CONSORT guidelines specific to obstetric research.
Obstet Gynecol
PUBLISHED: 10-10-2013
Show Abstract
Hide Abstract
The conduct and reporting of randomized controlled trials (RCTs) are enhanced by being compliant with the CONsolidated Standards of Reporting Trials (CONSORT) statement. The statement was meant to be general and was aimed at most RCTs without any particular focus on specific groups of patients. However, research in pregnancy presents important unique issues and challenges that are not addressed in the CONSORT statement. Thus, we suggest that there is a need to amend the statement to address RCTs enrolling pregnant or postpartum women. We propose CONSORT-OB (OBstetrics), with more than 30 modifications to the current statement. We hope the CONSORT group would consider our proposal, and we respectfully suggest that investigators incorporate these additional data into their reporting of RCTs involving pregnant or postpartum women.
Related JoVE Video
Maternal development experiences of women hospitalized to prevent preterm birth.
Sex Reprod Healthc
PUBLISHED: 09-30-2013
Show Abstract
Hide Abstract
To examine ways that womens experience of hospitalization with bed rest to prevent preterm birth impacts prenatal maternal development.
Related JoVE Video
A History of Prior Preeclampsia As a Risk Factor for Preterm Birth.
Am J Perinatol
PUBLISHED: 08-09-2013
Show Abstract
Hide Abstract
Objective The objectives of this study are to evaluate the frequency and type of preterm birth (PTB) in women with prior preeclampsia and to compare neonatal outcomes between spontaneous PTB (SPTB) and medically indicated PTB (IPTB) groups.Study Design A secondary analysis of data in women with prior preeclampsia enrolled in a multicenter randomized trial for preeclampsia prevention. Delivery indications were categorized as SPTB and IPTB. Primary outcomes were rates of SPTB and IPTB by gestational age (GA). The rates of composite respiratory morbidity and neonatal intensive care unit (NICU) admission were compared between the PTB groups.Results Of the 606 pregnancies studied, 142 (23%) pregnancies were delivered at < 37 weeks: 67 (47%) pregnancies were caused by SPTB and 75 (53%) pregnancies were caused by IPTB. Of those who delivered preterm, 89 (63%) were in the late preterm period. The overall rate of the composite neonatal morbidity was 23%. The rates of composite neonatal morbidity, NICU admission, and perinatal death were not different between the groups. The frequency of small for gestational age (SGA) infants was higher in the IPTB group as compared with the SPTB group (21.3 vs. 1.4%, p = 0.01).Conclusion Women with prior preeclampsia are at high risk for PTB (SPTB and IPTB), particularly late PTB, as well as increased risk for SGA.
Related JoVE Video
Corticosteroids effect on caspase 3 expression in an in-vitro model of hypoxic brain cells.
J. Matern. Fetal. Neonatal. Med.
PUBLISHED: 05-28-2013
Show Abstract
Hide Abstract
Effects of corticosteroids (CS) in the brain of growth-restricted fetus remain largely unstudied. We investigated if dexamethasone (DXM) exposure contributes to neuronal injury in an in-vitro model of neuronal cells under hypoxic conditions (surrogate for fetal growth restriction).
Related JoVE Video
Risk-adjusted models for adverse obstetric outcomes and variation in risk-adjusted outcomes across hospitals.
Am. J. Obstet. Gynecol.
PUBLISHED: 04-19-2013
Show Abstract
Hide Abstract
Regulatory bodies and insurers evaluate hospital quality using obstetrical outcomes, however meaningful comparisons should take preexisting patient characteristics into account. Furthermore, if risk-adjusted outcomes are consistent within a hospital, fewer measures and resources would be needed to assess obstetrical quality. Our objective was to establish risk-adjusted models for 5 obstetric outcomes and assess hospital performance across these outcomes.
Related JoVE Video
Adherence to criteria for transvaginal ultrasound imaging and measurement of cervical length.
Am. J. Obstet. Gynecol.
PUBLISHED: 02-23-2013
Show Abstract
Hide Abstract
Adherence to published criteria for transvaginal imaging and measurement of cervical length is uncertain. We sought to assess adherence by evaluating images submitted to certify research sonographers for participation in a clinical trial.
Related JoVE Video
The impact of medically indicated and spontaneous preterm birth among hypertensive women.
Am J Perinatol
PUBLISHED: 01-28-2013
Show Abstract
Hide Abstract
To (1) describe the frequency of spontaneous preterm birth (SPTB) and medically indicated preterm birth (PTB) among women with chronic hypertension (CHTN) and (2) to evaluate differences in neonatal outcomes according to SPTB or medically indicated PTB.
Related JoVE Video
Angiotensin receptor agonistic autoantibody-mediated soluble fms-like tyrosine kinase-1 induction contributes to impaired adrenal vasculature and decreased aldosterone production in preeclampsia.
Hypertension
PUBLISHED: 01-02-2013
Show Abstract
Hide Abstract
Preeclampsia (PE) is a life-threatening hypertensive disorder during pregnancy associated with decreased circulating aldosterone levels. However, the molecular mechanisms underlying aldosterone reduction in PE remain unidentified. Here we demonstrate that reduced circulating aldosterone levels in preeclamptic women are associated with the presence of angiotensin II type 1 receptor agonistic autoantibody and elevated soluble Fms-like tyrosine kinase-1, 2 prominent pathogenic factors in PE. Using an adoptive transfer animal model of PE, we provide in vivo evidence that the injection of IgG from women with PE, but not IgG from normotensive individuals, resulted in hypertension, proteinuria, and a reduction in aldosterone production from 1377 ± 272 pg/mL to 544 ± 92 pg/mL (P<0.05) in pregnant mice. These features were prevented by coinjection with an epitope peptide that blocks antibody-mediated angiotensin type 1 receptor activation. In contrast, injection of IgG from preeclamptic women into nonpregnant mice induced aldosterone levels from 213 ± 24 pg/mL to 615 ± 48 pg/mL (P<0.05). These results indicate that maternal circulating autoantibody in preeclamptic women is a detrimental factor causing decreased aldosterone production via angiotensin type 1 receptor activation in a pregnancy-dependent manner. Next, we found that circulating soluble Fms-like tyrosine kinase-1 was only induced in autoantibody-injected pregnant mice but not nonpregnant mice. As such, we further observed vascular impairment in adrenal glands of pregnant mice. Finally, we demonstrated that infusion of vascular endothelial growth factor(121) attenuated autoantibody-induced adrenal gland vascular impairment resulting in a recovery in circulating aldosterone (from 544 ± 92 to 1110 ± 269 pg/mL; P<0.05). Overall, we revealed that angiotensin II type 1 receptor agonistic autoantibody-induced soluble Fms-like tyrosine kinase-1 elevation is a novel pathogenic mechanism underlying decreased aldosterone production in PE.
Related JoVE Video
Population standards of birth weight underestimate fetal growth abnormalities in diabetic pregnancies.
Am J Perinatol
PUBLISHED: 11-21-2011
Show Abstract
Hide Abstract
The objective of this study was to compare the frequency of abnormal fetal growth in women with diabetes mellitus (DM) using population-based birth weight (pop BW) percentiles compared with customized birth weight (cust BW) percentiles, which include adjustments for maternal race, parity, height, weight, and fetal sex. The study design comprised a retrospective cohort of singleton DM pregnancies delivered over a 1-year period (June 2007 to May 2008) from a single tertiary care university-based medical center. Inclusion criteria were gestational age >20 weeks at delivery, live birth, and absence of major chromosomal/structural abnormalities. Small for gestational age (SGA), <10th percentile, and large for gestational age (LGA), >90th percentile pregnancies were categorized based on pop BW or cust BW standards. There were significant differences in the rates of SGA (p < 0.004) and LGA (p < 0.001) between cust BW and pop BW methods. When comparing the two methods, pop BW did not identify 13/16 (81%) of SGA and 23/39 (59%) of LGA babies defined by cust BW methods. The use of cust BW calculation in a diabetic population identified a greater percentage of neonates with pathologic fetal growth compared with pop BW standards, suggesting that the population standard may underdiagnose abnormal fetal growth in diabetic pregnancies.
Related JoVE Video
Continuous glucose monitoring in diabetic women following antenatal corticosteroid therapy: a pilot study.
Am J Perinatol
PUBLISHED: 11-17-2011
Show Abstract
Hide Abstract
To compare the timing, duration, and severity of corticosteroid-associated hyperglycemia in pregnant women with and without diabetes mellitus (DM). An observational study was conducted of pregnant women with DM and controls who received corticosteroids. Median glucose levels were calculated over 4-hour intervals after the first dose of corticosteroid with a continuous glucose monitor. A glucose level increase of at least 15% above baseline was considered significant. Nine pregnant women participated in this study (six with DM and three without DM). Elevations of glucose levels occurred at hour 20, 44, and 68 in both groups and lasted for up to 4 hours. In those with DM, glucose levels increased 33 to 48%, whereas in those without DM, glucose levels rose 16 to 33%. Several, relatively short episodes of glucose elevation occur in response to corticosteroids, and are more pronounced in diabetic women.
Related JoVE Video
Timing of delivery for women with stable placenta previa.
Semin. Perinatol.
PUBLISHED: 10-04-2011
Show Abstract
Hide Abstract
Women with placenta previa are at increased risks for complications related to obstetrical hemorrhage and the need for emergent delivery. Some will remain asymptomatic without preterm labor or vaginal bleeding, and thus the clinician must decide when to schedule cesarean delivery in a "stable" patient. Decision-making for the optimal timing of delivery across the late preterm and early-term period requires balancing the probability and severity of maternal hemorrhage at each gestational age versus the probability and severity of neonatal morbidity. On the basis of the limited available data, in women with uncomplicated complete placenta previa, scheduled delivery between 36 and 37 weeks should be considered.
Related JoVE Video
Influenza-like illness in hospitalized pregnant and postpartum women during the 2009-2010 H1N1 pandemic.
Obstet Gynecol
PUBLISHED: 08-24-2011
Show Abstract
Hide Abstract
To estimate characteristics and outcomes of pregnant and immediately postpartum women hospitalized with influenza-like illness during the 2009-2010 influenza pandemic and the factors associated with more severe illness.
Related JoVE Video
Staying with old guidelines.
Am. J. Obstet. Gynecol.
PUBLISHED: 07-27-2011
Show Abstract
Hide Abstract
Gestational diabetes mellitus is associated with increased neonatal morbidities and higher cesarean delivery rates; women with gestational diabetes mellitus are at increased risk for type II diabetes mellitus later in life. The current recommendation for screening includes a glucose tolerance test either early in pregnancy and/or at 24-28 weeks gestation followed by a diagnostic 100-g oral 3-hour glucose tolerance test with a rate of 5%. The results of a large prospective observational study (HAPO study) and 2 randomized trials lead the International Association of Diabetes in Pregnancy Study Group to recommend a 1-stage screening and diagnosis method that includes a 75-g 2-hour glucose tolerance test that will result in an 18% gestational diabetes mellitus rate. However, there is uncertainty about the clinical implications of the adoption of the latter recommendation.
Related JoVE Video
Timing of indicated late-preterm and early-term birth.
Obstet Gynecol
PUBLISHED: 07-22-2011
Show Abstract
Hide Abstract
The growing public health awareness of prematurity and its complications has prompted careful evaluation of the timing of deliveries by clinicians and hospitals. Preterm birth is associated with significant morbidity and mortality, and affects more than half a million births in the United States each year. In some situations, however, a late-preterm or early-term birth is the optimal outcome for the mother, child, or both owing to conditions that can result in worse outcomes if pregnancy is allowed to continue. These conditions may be categorized as placental, maternal, or fetal, including conditions such as placenta previa, preeclampsia, and multiple gestations. Some risks associated with early delivery are common to all conditions, including prematurity-related morbidities (eg, respiratory distress syndrome and intraventricular hemorrhage) as well as maternal intrapartum morbidities such as failed induction and cesarean delivery. However, when continuation of the pregnancy is associated with more risks such as hemorrhage, uterine rupture, and stillbirth, preterm delivery maybe indicated. In February 2011, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Society for Maternal-Fetal Medicine held a workshop titled "Timing of Indicated Late Preterm and Early Term Births." The goal of the workshop was to synthesize the available information regarding conditions that may result in medically indicated late-preterm and early-term births to determine the potential risks and benefits of delivery compared with continued pregnancy, determine the optimal gestational age for delivery of affected pregnancies when possible, and inform future research regarding these issues. Based on available data and expert opinion, optimal timing for delivery for specific conditions was determined by consensus.
Related JoVE Video
The frequency of prior antenatal corticosteroid therapy in late preterm birth pregnancies.
Am J Perinatol
PUBLISHED: 06-30-2011
Show Abstract
Hide Abstract
We sought to quantify how often women with late preterm birth (LPTB) receive antenatal corticosteroid (ACS) therapy prior to 34 weeks and to determine its effects on neonatal respiratory morbidity. LPTBs (34 (0)/ (7) to 36 (6)/ (7) weeks) over a 1-year period at a single tertiary care hospital were studied. A composite neonatal respiratory outcome was defined as mechanical ventilation, continuous positive airway pressure with fraction of inspired oxygen (F IO(2)) >40% for >2 hours or F IO(2) >40% for >4 hours within the first 72 hours of life. Multivariate logistic regression analysis was used to evaluate the association between ACS therapy and neonatal respiratory morbidity. Over the study period, 503 LPTBs met the study criteria and 6.8% ( N?=?34) had ACS therapy <34 weeks. Most had exposure >7 days prior to delivery (64.7%). Almost one-half of those receiving prior ACS therapy delivered between 34 and 35 weeks. There was no difference in the rate of prior ACS therapy based on LPTB indication for delivery. After adjusting for confounding factors, prior ACS therapy was not associated with lower respiratory morbidity (odds ratio [OR] 2.0, 95% confidence interval [CI] 0.2 to 16.3, P?=?0.53). Advancing gestational age was the only variable associated with respiratory morbidity (OR 0.50, 95% CI 0.26 to .94, P?=?0.03). In our population, prior ACS therapy was infrequent and was not associated with improvements in neonatal respiratory morbidity following LPTB.
Related JoVE Video
Excessive gestational weight gain in women with gestational and pregestational diabetes.
Am J Perinatol
PUBLISHED: 06-22-2011
Show Abstract
Hide Abstract
We sought to determine the frequency of excessive gestational weight gain (GWG) and its impact on perinatal outcomes in women with gestational (GDM) and pregestational diabetes mellitus (DM). A retrospective cohort of diabetic women was studied. GWG was categorized by the 2009 Institute of Medicine guidelines. Perinatal outcomes were compared between those women with and without excessive GWG. There were 153 women who met study criteria. There was no difference in excessive GWG between women with GDM and pregestational DM (44.4% versus 38.5%, P?=?0.51) or based on Whites class ( P?=?0.17). After adjusting for confounders, excessive GWG was not associated with an increased rate of adverse perinatal outcomes (odds ratio 1.49, 95% confidence interval 0.56 to 2.35) and had similar associations with both pregestational DM and GDM. Although excessive GWG was common in our diabetic population, it was not associated with an increased rate of adverse perinatal outcomes.
Related JoVE Video
Optimization of gestational weight gain in the obese gravida: a review.
Obstet. Gynecol. Clin. North Am.
PUBLISHED: 05-18-2011
Show Abstract
Hide Abstract
Because of the consistent association between gestational weight gain and birth weight (along with other maternal and child outcomes such as postpartum weight retention and child obesity), helping women avoid excessive weight gain during pregnancy should be an important objective of prenatal and preconceptional care. This article focuses on the updated Institute of Medicine gestational weight gain recommendations and measures directed at maintaining those guidelines and improving pregnancy outcome.
Related JoVE Video
Potential risks and benefits of antenatal corticosteroid therapy prior to preterm birth in pregnancies complicated by severe fetal growth restriction.
Obstet. Gynecol. Clin. North Am.
PUBLISHED: 05-18-2011
Show Abstract
Hide Abstract
The antepartum administration of fluorinated corticosteroids for fetal maturation represents the most important clinical contribution in the battle against prematurity. This treatment reduces the risk of neonatal death and handicap. It is also known that on corticosteroid exposure, fetuses are subjected to transiently increased physiologic and metabolic demands. Healthy fetuses are able to cope, although emerging evidence suggests this may not be the case with severely growth-restricted fetuses. This review presents evidence of efficacy and safety pertaining to corticosteroid administration in fetal growth restriction–affected pregnancies, offers guidance to clinicians, and points out questions that still need answers.
Related JoVE Video
Autoantibody-mediated IL-6-dependent endothelin-1 elevation underlies pathogenesis in a mouse model of preeclampsia.
J. Immunol.
PUBLISHED: 04-11-2011
Show Abstract
Hide Abstract
Preeclampsia (PE) is a life-threatening hypertensive disorder of pregnancy. Elevated circulating endothelin-1 (ET-1) is associated with the disease. However the molecular basis of increased ET-1 production and its role in PE are unknown. This study aimed to investigate the causative factors, pathological role of elevated ET-1 production in PE, and the underlying mechanisms. In this study, we found that IgG from women with PE, in contrast to IgG from normotensive pregnant women, induced preproET-1 mRNA expression via angiotensin II type 1 receptor activation in kidneys and placentas in pregnant mice. The ET-A receptor-specific antagonist BQ123 significantly attenuated autoantibody-induced hypertension, proteinuria, and renal damage in pregnant mice, demonstrating that autoantibody-induced ET-1 production contributes to pathophysiology. Mechanistically, we discovered that IL-6 functioned downstream of TNF-? signaling, contributing to increased ET-1 production in pregnant mice. IL-6 blockade inhibited preeclamptic features in autoantibody-injected pregnant mice. Extending the data to human studies, we found that IL-6 was a key cytokine underlying ET-1 induction mediated by IgG from women with PE in human placental villous explants and that endothelial cells are a key source of ET-1. Overall, we provide human and mouse studies showing that angiotensin II type I receptor-agonistic autoantibody is a novel causative factor responsible for elevated ET-1 production and that increased TNF-?/IL-6 signaling is a key mechanism underlying increased ET-1 production and subsequent maternal features. Significantly, our findings revealed novel factors and signaling cascades involved in ET-1 production, subsequent disease symptom development, and possible therapeutic intervention in the management of PE.
Related JoVE Video
Pregnancy in women with physical disabilities.
Obstet Gynecol
PUBLISHED: 03-23-2011
Show Abstract
Hide Abstract
The Eunice Kennedy Shriver National Institute of Child Health and Human Development sponsored a 2-day workshop to assess the body of evidence on pregnancy in women with physical disabilities, identify gaps in knowledge, and formulate recommendations for further research. A multidisciplinary group of experts discussed available data on pregnancy outcomes among women with varying physically disabling conditions, medical and psychosocial risks for mothers and children, and barriers to prenatal care and parenting for women with physical disabilities. Existing evidence is limited by a preponderance of retrospective single-site studies of small sample sizes. For most women, pregnancy outcomes are favorable. However, increased rates of certain adverse outcomes, such as low birth weight (related to preterm birth or growth restriction) and cesarean delivery, have been reported in women with spinal cord injuries, rheumatoid arthritis, multiple sclerosis, or other conditions. Common morbidities across conditions may include urinary tract infections, decreased mobility and independence, skin ulceration, respiratory compromise, interpersonal abuse, stress, and mood disorders. Socioeconomic, physical, and attitudinal barriers to antenatal care and independent parenting can be problematic. Current evidence, although limited, indicates that most women with physical disabilities will have good pregnancy outcomes; however, some data suggest that rates of a range of complications may be more common among women with physical disabilities, depending on the nature and severity of the underlying condition. Many questions remain unanswered. Establishment of a systematic and comprehensive registry of pregnancy course and outcomes among women with physical disabilities is of high priority for addressing persistent gaps in knowledge.
Related JoVE Video
Assessment of the concordance among 2-tier, 3-tier, and 5-tier fetal heart rate classification systems.
Am. J. Obstet. Gynecol.
PUBLISHED: 03-11-2011
Show Abstract
Hide Abstract
In 2008, a National Institute of Child Health and Human Development/Society for Maternal-Fetal Medicine-sponsored workshop on electronic fetal monitoring recommended a new fetal heart tracing interpretation system. Comparison of this 3-tier system with other systems is lacking. Our purpose was to determine the relationships between fetal heart rate categories for the 3 existing systems.
Related JoVE Video
Interobserver and intraobserver reliability of the NICHD 3-Tier Fetal Heart Rate Interpretation System.
Am. J. Obstet. Gynecol.
PUBLISHED: 03-07-2011
Show Abstract
Hide Abstract
Our purpose was to test the reliability of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) 3-Tier Fetal Heart Rate (FHR) classification system.
Related JoVE Video
Use and misuse of the term "elective" in obstetrics.
Obstet Gynecol
PUBLISHED: 01-22-2011
Show Abstract
Hide Abstract
The term "elective" is commonly used in obstetrics. We performed an electronic search of MEDLINE database using the terms "elective" and "obstetrics," which provided 2,208 publications. We found "elective" was more often used in relation to surgical interventions (eg, cesarean delivery, cerclage) and medical procedures (labor induction) rather than diagnostic procedures. Our review indicates the term lacks the necessary scientific specificity when used to modify procedures such as cerclage, cesarean delivery, timing of delivery, episiotomy, hysterectomy, labor induction, preterm delivery, termination of pregnancy, and ultrasonography. The lack of specificity of the term suggests the most reasonable and prudent course of action is to not use it, but rather to document the specific indication (whether medical or non-medical) for the intervention or procedure (eg, "cesarean delivery on maternal request," "history-indicated cerclage," "induction for preeclampsia"). We propose that the term "elective" should be eliminated from the vocabulary of obstetric practice.
Related JoVE Video
Approximately one-third of medically indicated late preterm births are complicated by fetal growth restriction.
Am. J. Obstet. Gynecol.
PUBLISHED: 01-14-2011
Show Abstract
Hide Abstract
The purpose of this study was to report the frequency of fetal growth restriction (FGR) based on indication for late preterm birth (LPTB).
Related JoVE Video
Recombinant vascular endothelial growth factor 121 attenuates autoantibody-induced features of pre-eclampsia in pregnant mice.
Am. J. Hypertens.
PUBLISHED: 12-23-2010
Show Abstract
Hide Abstract
Pre-eclampsia (PE) is a serious hypertensive disorder of pregnancy characterized by excessive production of a soluble form of the vascular endothelial growth factor (VEGF) receptor-1, termed soluble fms-like tyrosine kinase-1 (sFlt-1). This placental-derived factor is believed to be a key contributor to the clinical features of PE. Women with PE are also characterized by the presence of autoantibodies, termed angiotensin type 1 receptor activating autoantibody (AT(1)-AA), that activate the major angiotensin receptor, AT(1). These autoantibodies cause clinical features of PE and elevated sFlt-1 when injected into pregnant mice. The research reported here used this autoantibody-injection model of PE to assess the therapeutic potential of recombinant VEGF(121), a relatively stable form of the natural ligand.
Related JoVE Video
Computerized physician order entry reduces medication turnaround time of labor induction agents.
Am J Perinatol
PUBLISHED: 11-16-2010
Show Abstract
Hide Abstract
We sought to determine whether computerized physician order entry (CPOE) improves the induction agent turnaround time on the labor and delivery unit (L&D) compared with paper-based order entry (PBOE). We conducted a retrospective study of singleton, term pregnancies admitted to L&D for induction of labor. Outcomes of women who delivered 3 months before or 3 months after universal CPOE implementation were compared including induction agent turnaround time. The induction agent turnaround time was significantly shorter in the CPOE group ( N = 83) compared with PBOE group ( N = 71) [71 (range 8 to 411) versus 100 (2 to 442) minutes, P = 0.004]. There were no differences in cesarean section rate or length of hospital stay. After controlling for time of day of induction, induction agent, and type of order entry, CPOE continued to significantly decrease the induction agent turnaround time by 25 minutes ( P = 0.042). CPOE improved the process of induction of labor and efficiency of care of pregnant women.
Related JoVE Video
Autoantibody-mediated angiotensin receptor activation contributes to preeclampsia through tumor necrosis factor-alpha signaling.
Hypertension
PUBLISHED: 03-29-2010
Show Abstract
Hide Abstract
Preeclampsia is a prevalent life-threatening hypertensive disorder of pregnancy for which the pathophysiology remains largely undefined. Recently, a circulating maternal autoantibody, the angiotensin II type I (AT(1)) receptor agonistic autoantibody (AA), has emerged as a contributor to disease features. Increased circulating maternal tumor necrosis factor alpha (TNF-alpha) is also associated with the disease; however, it is unknown whether this factor directly contributes to preeclamptic symptoms. Here we report that this autoantibody increases the proinflammatory cytokine TNF-alpha in the circulation of AT(1)-AA-injected pregnant mice but not in nonpregnant mice. Coinjection of AT(1)-AA with a TNF-alpha neutralizing antibody reduced cytokine availability in AT(1)-AA-injected pregnant mice. Moreover, TNF-alpha blockade in AT(1)-AA-injected pregnant mice significantly attenuated the key features of preeclampsia. Autoantibody-induced hypertension was reduced from 131+/-4 to 110+/-4 mm Hg, and proteinuria was reduced from 212+/-25 to 155+/-23 microg of albumin per milligram of creatinine (both P<0.05). Injection of AT(1)-AA increased the serum levels of circulating soluble fms-like tyrosine kinase 1 and soluble endoglin (34.1+/-5.1, 2.4+/-0.3 ng/mL, respectively) and coinjection with the TNF-alpha blocker significantly reduced their levels (21.7+/-3.4 and 1.2+/-0.4 ng/mL, respectively). Renal damage and placental abnormalities were also decreased by TNF-alpha blockade. Lastly, the elevated circulating TNF-alpha in preeclamptic patients is significantly correlated with the AT(1)-AA bioactivity in our patient cohort. Similarly, the autoantibody, through AT(1) receptor-mediated TNF-alpha induction, contributed to increased soluble fms-like tyrosine kinase 1, soluble endoglin secretion, and increased apoptosis in cultured human villous explants. Overall, AT(1)-AA is a novel candidate that induces TNF-alpha, a cytokine that may play an important pathogenic role in preeclampsia.
Related JoVE Video
Maternal hypotension during cesarean section: Maayan-Metzger et al.
Am. J. Obstet. Gynecol.
PUBLISHED: 01-28-2010
Show Abstract
Hide Abstract
The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Maayan-Metzger A, Schushan-Eisen I, Todris L, et al. Maternal hypotension during elective cesarean section and short-term neonatal outcome. Am J Obstet Gynecol 2010;202:56.e1-5. The full discussion appears at www.AJOG.org, pages e12-e14.
Related JoVE Video
Discussion: Maternal hypotension during cesarean section by Maayan-Metzger et al.
Am. J. Obstet. Gynecol.
PUBLISHED: 01-26-2010
Show Abstract
Hide Abstract
In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Maayan-Metzger A, Schushan-Eisen I, Todris L, et al. Maternal hypotension during elective cesarean section and short-term neonatal outcome. Am J Obstet Gynecol 2010;202:56.e1-5.
Related JoVE Video
Angiotensin receptor agonistic autoantibody-mediated tumor necrosis factor-alpha induction contributes to increased soluble endoglin production in preeclampsia.
Circulation
PUBLISHED: 01-11-2010
Show Abstract
Hide Abstract
Preeclampsia is a prevalent life-threatening hypertensive disorder of pregnancy. The circulating antiangiogenic factor, soluble endoglin (sEng), is elevated in the blood circulation of women with preeclampsia and contributes to disease pathology; however, the underlying mechanisms responsible for its induction in preeclampsia are unknown.
Related JoVE Video
Whites classification of diabetes in pregnancy in the 21st century: is it still valid?
Am J Perinatol
PUBLISHED: 12-10-2009
Show Abstract
Hide Abstract
Whites classification system (WCS) was created 60 years ago to identify diabetic (DM) pregnancies at increased risk for perinatal morbidity and mortality. Our objective was to assess the association between WCS and adverse pregnancy outcome (APO) in contemporary DM pregnancies. We studied diabetic women with singleton pregnancies who delivered at >20 weeks at a single institution over a 1-year period (2007 to 2008). Perinatal outcomes were compared between WCS groups. APO was defined as any of the following: preterm birth <34 weeks, severe preeclampsia, shoulder dystocia, and neonatal respiratory disease. Presence of vascular disease was defined as presence of chronic hypertension, chronic renal insufficiency, retinopathy, coronary artery disease, or prior cerebrovascular event. One hundred ninety-six DM pregnancies met the criteria. No significant differences in APO existed between Whites class groups among women with pregestational DM (32.7% class B versus 26.9% class C versus 57.1% class D to F; p = 0.46). Logistic regression revealed that vascular disease was associated with APO (odds ratio = 2.7, 95% confidence interval = 1.2 to 6.2). In our population, presence of vascular disease, rather than WCS, was a better predictor of APO in DM women.
Related JoVE Video
Angiotensin receptor agonistic autoantibody is highly prevalent in preeclampsia: correlation with disease severity.
Hypertension
PUBLISHED: 12-07-2009
Show Abstract
Hide Abstract
Preeclampsia (PE), a syndrome affecting 5% of pregnancies, characterized by hypertension and proteinuria, is a leading cause of maternal and fetal morbidity and mortality. The condition is often accompanied by the presence of a circulating maternal autoantibody, the angiotensin II type I receptor agonistic autoantibody (AT(1)-AA). However, the prevalence of AT(1)-AA in PE remains unknown, and the correlation of AT(1)-AA titers with the severity of the disease remains undetermined. We used a sensitive and high-throughput luciferase bioassay to detect AT(1)-AA levels in the serum of 30 normal, 37 preeclamptic (10 mild and 27 severe), and 23 gestational hypertensive individuals. Here we report that AT(1)-AA is highly prevalent in PE ( approximately 95%). Next, by comparing the levels of AT(1)-AA among women with mild and severe PE, we found that the titer of AT(1)-AA is proportional to the severity of the disease. Intriguingly, among severe preeclamptic patients, we discovered that the titer of AT(1)-AA is significantly correlated with the clinical features of PE: systolic blood pressure (r=0.56), proteinuria (r=0.70), and soluble fms-like tyrosine kinase-1 level (r=0.71), respectively. Notably, only AT(1)-AA, and not soluble fms-like tyrosine kinase-1, levels are elevated in gestational hypertensive patients. These data serve as compelling clinical evidence that AT(1)-AA is highly prevalent in PE, and its titer is strongly correlated to the severity of the disease.
Related JoVE Video
The detrimental role of angiotensin receptor agonistic autoantibodies in intrauterine growth restriction seen in preeclampsia.
J. Exp. Med.
PUBLISHED: 11-02-2009
Show Abstract
Hide Abstract
Growth-restricted fetuses are at risk for a variety of lifelong medical conditions. Preeclampsia, a life-threatening hypertensive disorder of pregnancy, is associated with fetuses who suffer from intrauterine growth restriction (IUGR). Recently, emerging evidence indicates that preeclamptic women harbor AT(1) receptor agonistic autoantibodies (AT(1)-AAs) that contribute to the disease features. However, the exact role of AT(1)-AAs in IUGR and the underlying mechanisms have not been identified. We report that these autoantibodies are present in the cord blood of women with preeclampsia and retain the ability to activate AT(1) receptors. Using an autoantibody-induced animal model of preeclampsia, we show that AT(1)-AAs cross the mouse placenta, enter fetal circulation, and lead to small fetuses with organ growth retardation. AT(1)-AAs also induce apoptosis in the placentas of pregnant mice, human villous explants, and human trophoblast cells. Finally, autoantibody-induced IUGR and placental apoptosis are diminished by either losartan or an autoantibody-neutralizing peptide. Thus, these studies identify AT(1)-AA as a novel causative factor of preeclampsia-associated IUGR and offer two possible underlying mechanisms: a direct detrimental effect on fetal development by crossing the placenta and entering fetal circulation, and indirectly through AT(1)-AA-induced placental damage. Our findings highlight AT(1)-AAs as important therapeutic targets.
Related JoVE Video
Validation of the prediction model for success of vaginal birth after cesarean delivery.
Obstet Gynecol
PUBLISHED: 06-11-2009
Show Abstract
Hide Abstract
To validate a previously developed vaginal birth after cesarean (VBAC) prediction model using a patient cohort different than that from which it was derived.
Related JoVE Video
Full publication of clinical trials presented at a national maternal-fetal medicine meeting: is there a publication bias?
Am J Perinatol
PUBLISHED: 04-23-2009
Show Abstract
Hide Abstract
We sought to determine the rate and timing of full publication of clinical trials initially presented as abstracts at a national maternal-fetal medicine (MFM) research meeting and identify factors associated with publication status. All abstracts presented over a 3-year period (2000 to 2002) at the Society of MFM Annual Meeting were reviewed. Abstracts reporting outcomes for prospective, interventional research studies with human subjects were included. Multiple electronic databases were searched for evidence of full publication with a minimum of 5-year follow-up. The reporting characteristics of abstracts that were published as full research reports were compared with those not published. During the study period, 2012 abstracts were presented and 90 met all study criteria (4.5%). Of these, 55.6% (n = 50) were subsequently published as full research reports. There were no differences in the use of placebo, randomization, or blinding. Studies reaching full publication had larger sample size (median 174 [12 to 4165] versus 96 [22 to 1039]; p = 0.02) and were more likely to report treatment differences (60% versus 32.5% p = 0.009). After adjusting for confounding factors, the reporting of treatment differences remained associated with full publication (odds ratio 3.3 [95% confidence interval 1.3 to 8.0]; p = 0.01). Full publication of clinical trials occurred more often if treatment differences were present. Positive publication bias exists in MFM research.
Related JoVE Video
Emerging concepts in antibiotic prophylaxis for cesarean delivery: a systematic review.
Obstet Gynecol
PUBLISHED: 03-21-2009
Show Abstract
Hide Abstract
To review the current status of antibiotic prophylaxis for cesarean delivery, emerging strategies to enhance the effectiveness of antibiotic prophylaxis in reducing postcesarean infection, and the implications of the emerging practices.
Related JoVE Video
Overestimation of fetal weight by ultrasound: does it influence the likelihood of cesarean delivery for labor arrest?
Am. J. Obstet. Gynecol.
PUBLISHED: 03-04-2009
Show Abstract
Hide Abstract
We sought to determine whether the overestimation of ultrasound-derived estimated fetal weight (EFW) is associated with increased diagnosis of labor arrest.
Related JoVE Video
Late preterm birth: how often is it avoidable?
Am. J. Obstet. Gynecol.
PUBLISHED: 02-27-2009
Show Abstract
Hide Abstract
Our objective was to describe indications for late preterm birth (LPTB) and estimate the frequency of potentially avoidable LPTB deliveries.
Related JoVE Video
17 alpha-hydroxyprogesterone caproate to prevent prematurity in nulliparas with cervical length less than 30 mm.
Am. J. Obstet. Gynecol.
Show Abstract
Hide Abstract
We sought to evaluate whether 17 alpha-hydroxyprogesterone caproate (17-OHP) reduces preterm birth (PTB) in nulliparous women with a midtrimester cervical length (CL) <30 mm.
Related JoVE Video
Autoantibody-mediated complement C3a receptor activation contributes to the pathogenesis of preeclampsia.
Hypertension
Show Abstract
Hide Abstract
Preeclampsia (PE) is a prevalent life-threatening hypertensive disorder of pregnancy associated with increased complement activation. However, the causative factors and pathogenic role of increased complement activation in PE are largely unidentified. Here we report that a circulating maternal autoantibody, the angiotensin II type 1 receptor agonistic autoantibody, which emerged recently as a potential pathogenic contributor to PE, stimulates deposition of complement C3 in placentas and kidneys of pregnant mice via angiotensin II type 1 receptor activation. Next, we provide in vivo evidence that selectively interfering with C3a signaling by a complement C3a receptor-specific antagonist significantly reduces hypertension from 167±7 to 143±5 mm Hg and proteinuria from 223.5±7.5 to 78.8±14.0 ?g of albumin per milligram creatinine (both P<0.05) in angiotensin II type 1 receptor agonistic autoantibody-injected pregnant mice. In addition, we demonstrated that complement C3a receptor antagonist significantly inhibited autoantibody-induced circulating soluble fms-like tyrosine kinase 1, a known antiangiogenic protein associated with PE, and reduced small placental size with impaired angiogenesis and intrauterine growth restriction. Similarly, in humans, we demonstrate that C3 deposition is significantly elevated in the placentas of preeclamptic patients compared with normotensive controls. Lastly, we show that complement C3a receptor activation is a key mechanism underlying autoantibody-induced soluble fms-like tyrosine kinase 1 secretion and decreased angiogenesis in cultured human villous explants. Overall, we provide mouse and human evidence that angiotensin II type 1 receptor agonistic autoantibody-mediated activation contributes to elevated C3 and that complement C3a receptor signaling is a key mechanism underlying the pathogenesis of the disease. These studies are the first to link angiotensin II type 1 receptor agonistic autoantibody with complement activation and to provide important new opportunities for therapeutic intervention in PE.
Related JoVE Video
Customized estimated fetal weight: a novel antenatal tool to diagnose abnormal fetal growth.
Am. J. Obstet. Gynecol.
Show Abstract
Hide Abstract
We sought to apply customized standards to ultrasound-derived estimated fetal weight (EFW), and assess the frequency of abnormal growth when compared to population-based standards. We also evaluated association with adverse perinatal outcomes.
Related JoVE Video
simple hit counter

What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.