The Advice We Give to Pregnant Women

Abstract

Pregnant women are often advised to sleep on their left side. However, this recommendation lacks supporting evidence, and can be very difficult for pregnant women to do. In this editorial, Dr. Fox and noted author of “Expecting Better”, Professor Emily Oster, discuss a recent article about sleep position in pregnancy goes against this recommendation, as well as their own opinions on this topic.

Listen to Emily Oster on the Podcast

“Pregnancy in the Land of Corona!” -with Emily Oster

“Ending the Quarantine: If, When, and How?” – with Emily Oster

The Association Between Shirodkar Cerclage and Preterm Premature Rupture of Membranes in Singleton Pregnancies

Certain women with high-risk pregnancies undergo a cerclage placement, which is a surgical procedure intended to keep the cervix closed, prolong pregnancy, and prevent pregnancy loss or preterm birth. One of the classis risks of cerclage is the risk of membrane rupture (the “water breaking”) while the cerclage is in place. In this study, we found that the risk of this happening is only approximately 10%, and appears to be mostly due to the risk factors for preterm birth, and not actually the cerclage itself.

The Effect of Microbiome Exposure at Birth on Pediatric Outcomes Using a Twin Cohort Discordant for Microbiome Exposure at Birth

Abstract

The microbiome refers to the normal bacteria that live on our skin and in our bodies. There has been much written about the effect of differing microbiome exposures at birth and outcomes later in childhood and adulthood. In this study, we examined twins with differing microbiome exposure and found no differences at ages 2-10 years old, suggesting the importance of this variable may be overstated.

Listen to More on Healthful Woman

“The Microbiome” – with Dr. Shari Gelber

Serial Cervical Length Evaluation in Low-Risk Women with Shortened Cervical Lengths in the Midtrimester: How Many Will Dilate Prior to 24 Weeks?

For women diagnosed with a short cervix, there is controversy regarding the proper management and follow-up. In this study, we demonstrate that a significant proportion of women with a short cervix in the second trimester will ultimately have a dilated cervix, which is a more concerning situation and often requires different management. These results indicate that one should continue surveillance after the diagnosis of a short cervix.

Induction of Labor versus Cesarean Delivery in Twin Pregnancies

Abstract

For women with twin pregnancies, we have previously shown that outcomes are similar for attempted vaginal delivery as compared to cesarean delivery.  In this study, we demonstrate that this remains true even for women with twin pregnancies who require induction of labor.

Listen to More On Healthful Woman

“Delivery of Twins – Double the Fun!” – with Dr. Stephanie Melka

Subchorionic Hematomas and Adverse Pregnancy Outcomes among Twin Pregnancies

Abstract

Subchorionic hematomas, or subchorionic hemorrhages, are common ultrasound findings in early pregnancy.   However, their significance is uncertain.  Some believe they increase the risk of many pregnancy complications, including pregnancy loss / miscarriage.  In prior studies we demonstrated that subchorionic hematoma does not appear to increase the risk adverse outcomes in singleton pregnancies.

In this study, we present similar results regarding twin pregnancies – subchorionic hematoma does not appear to increase the risk of adverse outcomes in twin pregnancies.

Prior Studies

Association Between First-Trimester Subchorionic Hematomas and Adverse Pregnancy Outcomes After 20 Weeks of Gestation in Singleton Pregnancies

Association Between First-Trimester Subchorionic Hematomas and Pregnancy Loss in Singleton Pregnancies

Association Between First-Trimester Subchorionic Hematomas and Adverse Pregnancy Outcomes After 20 Weeks of Gestation in Singleton Pregnancies

Subchorionic hematomas, or subchorionic hemorrhages, are common ultrasound findings in early pregnancy. However, their significance is uncertain. Some believe they increase the risk of many pregnancy complications, including pregnancy loss / miscarriage. In a prior study we demonstrated that subchorionic hematoma does not appear to increase the risk of miscarriage in singleton pregnancies.

In this study, we present similar results regarding other adverse pregnancy outcomes – subchorionic hematoma does not appear to increase the risk of adverse outcomes later in pregnancy.

COVID-19 in Pregnant Women: Case Series from One Large New York City Obstetrical Practice

Abstract

COVID-19 changed the world in 2020.  One of the questions we get a lot is how it affects pregnant women.  However, most studies only include hospitalized patients, making it seem like outcomes are worse than they might be.  In this study, we report our experience with 92 pregnant women (approximately 12% of our pregnant patients) who had known or suspected COVID-19 infection. Fortunately, outcomes were very reassuring.

Learn More on the Healthful Woman Podcast

“Pregnancy in the Land of Corona!” -with Emily Oster

“We’re Still Open 24/7: Labor and Delivery During Corona” – with Dr. Angela Bianco

“Lockdown: Everyone’s at Home!” – with Dr. Michal Agus Fox

“Newborn Babies and Corona” – with Dr. Annemarie Stroustrup

“The Search for the Cure to Corona” – with Dr. Eldad Hod

“Corona: An Inside Report from the Front Lines” – with Dr. Zevy Hamburger

“The Ethics of Fertility Treatments During Corona” – with Dr. Alan Copperman

“PPE, Yeah You Know Me” – with Dr. Sarp Aksel

“Ending the Quarantine: If, When, and How?” – with Emily Oster

Pregnancy Outcomes in Patients With Prior Uterine Rupture or Dehiscence

Uterine rupture is a serious pregnancy complication associated with significant maternal and neonatal morbidity and mortality. For women with a history of uterine rupture, there is a risk of recurrence, ranging in the literature from 0-33%. Owing to this, some women with a prior uterine rupture are advised not to have more pregnancies. In 2014, we reported outcomes for 14 women (20 pregnancies) with a history of uterine rupture (clinically apparent, complete scar separation in labor or before labor) and 30 women (40 pregnancies) with a history of uterine dehiscence (incomplete uterine scar separation with intact serosa, sometimes referred to as a uterine window). In these 60 pregnancies, there was 0% severe morbidity and 6.7% of pregnancies had uterine dehiscence seen at the time of delivery. Subsequent to the 2014 publication, we have seen an increase in patients with a history of uterine rupture or dehiscence, and the objective of this Research Letter is to update our results with a larger sample size.

Dr. Fox was featured on “The Green Journal” discussing this topic. Listen in!

Frequency of spontaneous resolution of vasa previa with advancing gestational age

Vasa previa, defined as unprotected fetal vessels running through the membranes over the cervix, often ruptures when the membranes rupture, frequently leading to sudden fetal death. This used to be a feared condition among obstetricians, first because of its devastating consequences, but also because, until recently, it was rarely diagnosed prior to the rupture and hence was considered unpreventable. There are now several studies that have documented universally excellent outcomes when vasa previa is diagnosed prenatally, and planned cesarean delivery is undertaken before the membranes rupture. Risk factors for vasa previa include a second-trimester low lying placenta/placenta previa (regardless of resolution), pregnancies with bilobed or succenturiate-lobed placentas, pregnancies resulting from in vitro fertilization, and multifetal pregnancies. Based upon our prior publication from 2014 (Rebarber A, et al JUM) we have recommended targeted screening in pregnancies in which these risk factors are present. Most recently, our current publication (Klahr et al AJOG 2019) found an absence of risk factors in 6% of cases of vasa previa, so we routinely advocate the region over the cervix should also be examined carefully and judicious evaluation with Color Doppler is advised. Additonally, in our  most recent publication on this topic we noted that a proportion of cases diagnosed in early pregnancy will resolve prior to delivery.  Our findings mean that women with vasa previa diagnosed early in pregnancy may not necessarily need hospitalization and early delivery and serial evaluation is important to properly diagnose patients that require cesarean section and early intervention. More specifically, we found that 39% of vasa previas diagnosed patients in our population (at Carnegie Imaging for Women , NYC) resolved over the course of pregnancy. Earlier gestational age at diagnosis, vasa previa not covering the internal os, and not having a resolved placenta previa all are associated independently with an increased likelihood of vasa previa resolution.

We also proudly note that our paper was highlighted in the December 2019 American Journal of Obstetrics and Gynecology Editorial titled “Vasa previa: time to make a difference” providing evidence that standard screening for this condition should be implemented nationwide as we have done since 2005 in our ultrasound units. A unique opportunity exists to prevent perinatal mortality from this condition. Prenatal diagnosis accompanied by timely cesarean delivery will prevent deaths from vasa previa.