The recommendations of the American Institute of Medicine (IOM) for normal and underweight women to reduce the risk of low birth weight.

OBJECTIVE: The recommendations of the American Institute of Medicine (IOM) were revised recently in order to enhance maternal and neonatal health. The aim of our study was to investigate the risk of low birth weight (LBW) among women who follow the IOM recommendations. MATERIALS AND METHODS: Gestational weight gain (GWG) and rate of weight gain (RWG) across the different periods of pregnancy among women who delivered LBW fetuses were analyzed retrospectively. The logistic regression was used to analyze the risk of LBW and to identify recommendations. RESULTS: From January 2008 to December 2009, 117 out of 4924 (2.4%) women delivered term LBW fetuses. After exclusions, 88 LBW and 91 control subjects were enrolled into the study. There was increased risk of cesarean delivery [odds ratio (OR) with 95% confidence interval (CI): 2.53 (1.33-4.83)] and neonatal asphyxia within 7 days of birth [OR 95% CI: 5.71 (1.21-26.83)] for the LBW group compared with the control group. Normal weight women [body mass index (BMI): 18.5-24.9 kg/m(2)] who followed the GWG and RWG recommendations of the IOM had no increased risk of LBW. However, there was a two-to three-fold increased LBW risk among normal weight women who followed the IOM guidelines when, during the 2(nd) trimester, their GWG was ≤7 kg [OR 95% CI: 2.21 (1.28-6.49)] or their RWG was ≤0.45 kg/week [OR 95% CI: 3.14 (1.32-7.47)]. Among underweight women (BMI < 18.5 kg/m(2)), if, during the 2(nd) and 3(rd) trimesters, they followed the lower range of the GWG and RWG recommendations of the IOM there was a five-fold increased risk of LBW if the GWG was ≤13 kg [OR 95% CI: 5.29 (1.61-25.51)]; or the RWG was ≤0.45 kg/week [OR 95% CI: 5.35 (1.61-24.66)]. CONCLUSION: For underweight women, it is suggested that they follow the upper range of the IOM recommendation in order to avoid LBW. For normal weight women, although the IOM guidelines provide a good basis, it is suggested that they carefully follow the recommended GWG and the RWG values during the 2(nd) trimester, which is a very important period for fetal growth.

Following the 2009 American Institute of Medicine recommendations for normal body mass index and overweight women led to an increased risk of fetal macrosomia among Taiwanese women.

OBJECTIVE: This study aimed to investigate the risk of birth weights over 4000 g (macrosomia) in association with following the 2009 American Institute of Medicine (AIOM) recommendations. MATERIALS AND METHODS: Seventy-six nondiabetic women who delivered a singleton, term macrosomic fetus and 82 women who delivered a singleton, term fetus weighing <4000 g were analyzed retrospectively. The relationship between the risk of macrosomia and gestational weight gain in different periods of pregnancy was investigated using logistic regression. RESULTS: The incidence of macrosomia from January 2008 to December 2009 was 1.8% among the Taiwanese women. The incidences of cesarean delivery (54.5% vs. 18.2%, p < 0.001) and blood loss >1000 mL at delivery (35.5% vs. 6.1%, p < 0.0001) were associated with macrosomia. The risk of macrosomia among normal weight women with gestational weight gain greater than 13 kg increased four-fold [odds ratio (OR) = 4.88; 95% confidence interval (CI) 1.84-12.90]. For overweight women with total gestational weight gain >11.5 kg, the risk of macrosomia increased nine-fold (OR = 9.63; 95% CI 1.76-52.74). CONCLUSION: Macrosomia resulted in more cesarean deliveries and greater maternal blood loss at birth. In Taiwan, to prevent macrosomia, we suggest that the total gestational weight gain should be <11.5 kg among normal weight women and within 10 kg for overweight women.

Effectiveness of double cervical cerclage in women with at least one previous pregnancy loss in the second trimester: a randomized controlled trial.

AIM: To evaluate the effect of double cervical cerclage on the prevention of preterm delivery, and perinatal and maternal outcomes in women with previous fetal loss in the second trimester. METHODS: Between January 2001 and December 2006 we conducted a prospective study in which patients with a previous preterm delivery at the second trimester who met clinical criteria for the diagnosis of cervical incompetence were randomly allocated to receive double cervical cerclage or traditional single cervical cerclage at a ratio of 1:2. RESULTS: The perinatal and maternal outcomes of the two groups were compared. A total of 17 women were allocated to the double cervical cerclage group, and 34 to the traditional single cervical cerclage group. The single cervical cerclage group had a higher incidence of preterm delivery at <28 weeks than the double cerclage group (29.4 vs 5.9%, respectively, P = 0.0528). The mean gestational age and birth weight in the double cervical cerclage group were significantly higher than in the traditional single cervical cerclage group (35.9 +/- 5.4 vs 32.9 +/- 7.5 weeks, respectively for gestational age, P = 0.045; 2696 +/- 911 vs 2242 +/- 1119 g, respectively for birth weight, P = 0.048). No significant differences in rates of neonatal survival (P = 0.241) and neonatal admission to the intensive care unit were found between the two groups. CONCLUSION: Our results demonstrated that double cervical cerclage may significantly improve perinatal outcome in women with at least one previous pregnancy loss in the second trimester.

Comparative study of conservative and surgical management for symptomatic moderate and severe hydronephrosis in pregnancy: a prospective randomized study.

BACKGROUND: To analyze the role of different measures in the treatment of acute moderate or severe symptomatic hydronephrosis in pregnancy. METHODS: Of the 18,130 women delivering at our institution between January 2000 and December 2004, 93 patients were admitted due to symptomatic hydronephrosis. Among these, 50 patients were diagnosed with moderate or severe hydronephrosis, and were randomly treated with conservative measures (25 patients) or double pigtail stent insertion (25 patients). Renal sonography, urinalysis, serum creatinine levels, white blood cell counts, and urine culture were done in all patients at first visit. The clinical and perinatal outcomes of the two groups were compared. RESULTS: The incidence of symptomatic hydronephrosis in pregnancy was 0.5% in our institution (93/18,130). The majority of the moderate or severe hydronephrosis (88%) cases were diagnosed after the first trimester. There were no statistically significant differences in the fetal body weight, Apgar score, preterm labor, and hospitalization day between the two groups. Among those receiving conservative treatment, five patients (5/25, 20%) failed to respond and were subsequently treated by double pigtail stent insertion successfully, compared with the surgical group, in which all patients were successfully relieved by double pigtail stent (p=0.018). Four patients receiving double pigtail stent insertion complained of stent discomfort and flank pain after the procedure (16%). CONCLUSION: Double pigtail stent insertion is effective for the treatment of moderate or severe symptomatic hydronephrosis in pregnancy, and showed a lower failure rate than the conservative treatment. However, due to the complications and discomfort with surgical treatment, conservative treatment should still be the first choice.

Thyroid cancer in pregnancy: a report of 3 cases.

BACKGROUND: Thyroid cancer in pregnancy presents a unique challenge to the thyroid specialist and the obstetrician. We report 3 cases of thyroid cancer diagnosed during pregnancy. CASES: Three cases of papillary thyroid carcinoma were diagnosed during pregnancy, at the 14th, 19th and 40th weeks of gestation. The first 2 cases underwent thyroidectomy immediately after the diagnosis, while in the third the operation was deferred until the postpartum period. All 3 women delivered healthy infants, who were 2 months to 8 years of age at the last follow-up visit. CONCLUSION: If well-differentiated thyroid cancer is diagnosed prior to the midtrimester, it is possible to carry out the surgical intervention in the midtrimester. During late pregnancy, resection after delivery is the option of choice. There is no indication for termination of pregnancy.

Vaginal cuff endometriosis resulting in a fistula between the vagina and abdominal cavity and presenting as peritonitis: a case report.

BACKGROUND: The specimen from a vaginal cuff fistula between the vagina and abdominal cavity revealed endometriosis. Culture of the fluid revealed Streptococcus viridans. CASE: A 44-year-old woman presented with lower abdominal pain for 1 week. She also had cyclic vaginal spotting that had started 1 month after she underwent laparoscopically assisted vaginal hysterectomy for a myoma 2 years earlier. One year prior to this admission, she was noted to have a right endometrioma on a sonographic examination; monthly follow-up revealed that the cyst was enlarging. The patient was admitted for surgery. On laparotomy, severe adhesions were noted. After adhesiolysis, a right adnexal cyst with chocolatelike contents mixed with malodorous, yellowish, mucoid fluid was noted. A vaginal cuff fistula between the vagina and abdominal cavity was also noted. The specimen from this area revealed endometriosis. Culture of the fluid showed Streptococcus viridans. CONCLUSION: Various laparoscopic complications are cited in the literature. Although rare, the risk of infection after laparoscopy can occur. In our case the infection may have been caused by the presence of vaginal cuff fistula in the presence of endometriosis.

A rapidly growing paraurethral myoma with profuse bleeding from a mucosal vessel: report of a case.

Paraurethral leiomyoma is rare. This is the first reported case of a woman with a 6 x 7 x 5 cm urethral leiomyoma with profuse vaginal bleeding. The site of bleeding was identified as the anterior vaginal mucosal vein, which we subsequently electrocauterized. Enucleation of the mass was performed smoothly with a Foley catheter to avoid damage to the urethra. Profuse bleeding from a paraurethral myoma is possibly due to increased vascularity and the prolapsed nature of the tumor in this area.

Persistent megalocystic ovary following in vitro fertilization in a postpartum patient with polycystic ovarian syndrome.

OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is more severe when pregnancy occurs, as the developing pregnancy produces human chorionic gonadotropin, which stimulates the ovary's persistent growth. If no pregnancy occurs, the syndrome will typically resolve within 1 week. In a maintained pregnancy, slow resolution of symptoms usually occurs over 1-2 months. CASE REPORT: A 31-year-old woman, gravida 2, para 1, aborta 1, with polycystic ovary syndrome underwent in vitro fertilization (IVF) with clomiphene citrate and follicle-stimulating hormone/gonadotropin releasing hormone-antagonist stimulation. During transvaginal oocyte retrieval, enlarged bilateral ovaries were noted. She had an episode of OHSS after IVF/embryo transfer, for which paracentesis was performed three times. Pregnancy was achieved. Throughout antenatal examinations, bilateral ovaries were enlarged. She delivered a healthy baby by cesarean section at term. However, 1 month after delivery, the bilateral ovary had not shrunk, and levels of tumor markers CA125 and CA199 were 50.84 and 41.34 U/mL, respectively. At laparotomy for suspected malignancy, both adnexae formed "kissing ovaries", which were multinodulated with yellow serous fluid. Specimens from wedge resection submitted for frozen section showed a benign ovarian cyst. The final pathology report showed bilateral follicle cysts. CONCLUSION: With the increasing use of gonadotropins in the management of infertility, ovarian enlargement secondary to hyperstimulation is common. Generally, symptoms appear between the 6th and 13th weeks of pregnancy and disappear thereafter. The hyperstimulated ovary often subsides after the first trimester. This case is unusual as the megalocystic ovary persisted after delivery. To the best of our knowledge, we report the first case of enlarged bilateral ovaries persisting 2 months after delivery.