Validation of a novel mobile phone application for type 2 diabetes screening following gestational diabetes mellitus.

Background: We sought to determine if using fasting blood glucose (FBG) through text-based care is an effective screening tool for type 2 diabetes in the postpartum period compared to in-person, 2-hour oral glucose tolerance testing (2hr OGTT). Methods: This was a single-center interventional study that included individuals diagnosed with gestational diabetes. Patients were enrolled in standard, office-based 2hr OGTT in combination with text-based remote diabetes screening. Study participants were instructed to record FBG for 3 consecutive days using a mobile application. We assessed agreement with 2hr OGTT using sensitivity, specificity, positive and negative predictive value with exact binomial 95% confidence intervals. Results: A total of 446 individuals diagnosed with gestational diabetes met inclusion criteria, 239 of which were enrolled in standard office-based screening and 207 were enrolled in dual screening using standard 2hr OGTT testing combined with text-based remote FBG screening. A FBG value less than 100 mg/dL had 100% sensitivity (86-100%), 86% specificity (77-93%) with a 100% (94-100%) negative predictive value and 71% (54-85%) positive predictive value. Follow-up was significantly higher among individuals enrolled in remote text-based screening compared to standard in-office screening (48% vs. 25%, respectively; P<0.001). Conclusions: Text-based screening may be a feasible alternative to in-office screening. A mobile-based system using FBG successfully screened all patients with type 2 diabetes in the postpartum period with 100% sensitivity and negative predictive value. Remote telehealth screening significantly increased follow-up with type 2 diabetes screening.

Fetal adrenal gland size and the ability to predict spontaneous term labor.

OBJECTIVE: The objective of this study was to evaluate whether ultrasound measured fetal adrenal gland size can be a predictor of spontaneous term labor. STUDY DESIGN: This study was a diagnostic test accuracy study using a prospective cohort design evaluating the ability of 2-dimensional ultrasound measurement of fetal adrenal gland total length, total width, fetal zone length and fetal zone width in women in the third trimester to predict the primary outcome of spontaneous term labor. Secondary outcomes were vaginal delivery, length of labor, and maternal and neonatal morbidities. RESULTS: Of 43 patients recruited, 3 were excluded. 11 (25.6%) presented in spontaneous labor and 29 (67.4%) underwent induction of labor. Patient demographics were similar for all included except for admission cervical exam and oxytocin use. A receiver operative curve was created to assess test predictability. Weighted width of fetal adrenal gland was the best predictor of spontaneous labor amongst variables measured with an area under the curve of 0.674, p = 0.93. w/W ≥ 0.41 had a sensitivity of 91.0%, specificity of 44.8%, positive predictive value of 38.5% and a negative predictive value of 92.3%. Maternal and neonatal morbidities were not different between the spontaneous labor group and the induction of labor group. CONCLUSION: Ultrasound measured fetal w/W was moderately predictive of spontaneous labor.

Intrapartum fetal heart rate characteristics of nonanomalous fetuses with trisomy 21.

OBJECTIVE: To compare the intrapartum fetal heart rate (FHR) characteristics and selected birth outcomes of nonanomalous trisomy 21 (T21) fetuses to matched controls. STUDY DESIGN: Nonanomalous, non-growth-restricted T21 infants were identified and matched by gestational age to presumed euploid controls. We excluded women with scheduled cesarean deliveries and multiple gestations. The incidence of abnormal FHR patterns within 3 hours of delivery and birth outcomes were compared between T21 fetuses and controls. The presence of any abnormal FHR pattern was the primary outcome. Birth outcomes included 5-minute Apgar <7, neonatal intensive care unit admission, and cesarean delivery for fetal indications. RESULTS: Forty-four T21 infants and 44 controls were compared. Of the T21 infants, 83% were postnatally diagnosed. No significant differences were noted in the primary outcome (68% versus 59%, p = 0.37) or birth outcomes. CONCLUSION: T21 is not associated with an increased incidence of abnormal FHR patterns or adverse birth outcomes compared with presumed euploid fetuses.

Internal carotid artery dissection as a cause of headache in the second trimester.

OBJECTIVE: Carotid dissection is a rare cause of headache in pregnancy. STUDY DESIGN: A 38-year-old woman gravida 5 para 3-0-1-3 presented at 21 weeks with a headache. Imaging revealed carotid artery dissection. CONCLUSION: Carotid artery dissection may cause refractory headache in pregnancy. Prompt anticoagulation is required due to the potential for stroke.

Acute pulmonary edema in pregnancy.

OBJECTIVE: To describe the incidence, predisposing conditions, and inciting factors culminating in pulmonary edema in the pregnant patient. METHODS: A review of 62,917 consecutive pregnancies delivered at our institution from January 1, 1989 to June 1, 1999 was undertaken for the diagnosis of pulmonary edema. Each chart was reviewed for maternal demographics, admission diagnoses, medication use, gestational age at diagnosis, fluid balance, coexisting maternal illness, tocolytic use, evidence of preeclampsia, and diagnostic criteria. After careful review of the records, the most likely cause of pulmonary edema was assigned. RESULTS: Fifty-one women (0.08%) were diagnosed with acute pulmonary edema during pregnancy or in the postpartum period. The mean patient age at the time of diagnosis was 27.6 +/- 6.4 years. The mean gestational age at the time of diagnosis was 31.5 +/- 6.8 weeks. The diagnosis of pulmonary edema was made during the antepartum period in 24 patients (47%), the intrapartum period in seven (14%), and the postpartum period in 20 (39%). The most common attributable causes were tocolytic use (13 patients [25.5%]), cardiac disease (13 patients [25.5%]), fluid overload (11 patients [21.5%]), and preeclampsia (nine patients [18%]). Those with fluid overload identified as the likely etiology had a significantly greater mean positive fluid balance (6022 +/- 3340 mL). All patients whose pulmonary edema was secondary to tocolytic use received multiple simultaneous tocolytic agents; the most common combination was intravenous magnesium sulfate and subcutaneous terbutaline. Six of the 13 women with cardiac disease were found to have previously undiagnosed structural heart disease. CONCLUSION: The most common causes of pulmonary edema are the use of tocolytic agents, underlying cardiac disease, fluid overload, and preeclampsia.