Pregnancy Termination in Patients With Rheumatic Diseases.

Rheumatic diseases affect women during their reproductive years. Many women with rheumatic diseases become pregnant; some undergo pregnancy termination. However, there are no official guidelines on pregnancy termination in patients with rheumatic diseases. This work provides an overview of factors that health care professionals must consider. We highlight areas that require further studies and the importance of pregnancy planning and contraception counseling. Patients with rheumatic diseases need to be informed of adverse maternal and fetal outcomes of pregnancy to make informed reproductive decisions and reduce the need for pregnancy terminations.

Prevalence of Chlamydia and Gonorrhea Among Pregnant Adolescents Screened in the Third Trimester Using a Urine PCR Test: A Retrospective Review.

OBJECTIVE: Our study assessed the rate of new and recurrent Chlamydia trachomatis and Neisseria gonorrhoeae infections in the third trimester at an adolescent obstetrics clinic. METHOD: Between October 2016 and June 2020, routine third-trimester screening for C. trachomatis and N. gonorrhoeae was implemented according to new Canadian recommendations. Urine nucleic acid amplification was performed. Patient records were reviewed retrospectively, and demographic data; pregnancy and delivery characteristics; and information on screening at presentation to care, third-trimester screening (33-38 weeks), and other STI testing was recorded. RESULTS: A total of 115 adolescents (mean age 17.90 ± 1.43 y) with 125 pregnancies presented for care. Twenty-three pregnancies were excluded (12 transferred out and 11 experienced a pregnancy loss). At presentation, screening was performed in 100 of 102 pregnancies: 64 of 100 at <13 weeks, 32 of 100 at 13-27 weeks, and 4 of 100 at 28-30 weeks. Nine tested positive for C. trachomatis and none tested positive for N. gonorrhoeae. In the third trimester, there were 3 positive C. trachomatis tests, but all were indicated: test of cure was due for 1 patient, 1 patient had a new sexual partner, and 1 patient presented with symptoms. The remaining 89 of 102 pregnancies were screened (with no other indication) and none were positive for C. trachomatis or N. gonorrhoeae. Ten patients could not be sampled (5 missed, 4 pre-term deliveries, and 1 non-compliant with testing). CONCLUSION: No cases of C. trachomatis or N. gonorrhoeae infection were identified on third-trimester screening in our study. Adolescent obstetrics providers implementing Canadian screening guidelines may want to monitor their screening results to determine whether their yield warrants universal implementation.

A comparative study of neonatal outcomes in placenta previa versus cesarean for other indication at term.

OBJECTIVE: Currently, no ACOG guidelines address the issue of the optimal timing of delivery in placenta previa. Though there is an increased risk of neonatal morbidity and mortality when electively delivered preterm, it is unclear whether adverse neonatal outcomes exist when these pregnancies make it beyond term. By comparing neonatal outcomes amongst pregnancies with placenta previa versus those from cesarean for another indication at term, the objective of this study was to determine whether placenta previa is an independent risk factor for adverse neonatal outcomes at term. METHODS: We conducted a population-based cohort-study using the CDC's Linked Birth-Infant Death data from the United States. The effect of placenta previa on the risk of adverse neonatal outcomes was estimated using unconditional logistic regression analysis, adjusting for relevant confounders. RESULTS: Our cohort consisted of 3,550,842 deliveries meeting inclusion criteria. The incidence of placenta previa at term was 1.3/1000 (n = 4,492), accounting for 40.6% of all previa cases. Relative to cesareans for other indications, pregnancies with placenta previa had an increased risk of IUGR 3.20 [2.50-4.10], SGA 2.70 [2.45-2.97], respiratory distress 3.82 [2.91-5.00], prolonged ventilation 3.41 [2.70-4.32] and neonatal anemia 6.87 [4.43-10.65]. Rates of meconium aspiration syndrome, seizures, birth injury and overall infant mortality do not appear to be affected by this condition. CONCLUSION: Relative to cesareans for other indications, placenta previa is associated with increased morbidity, but not mortality, at term. This information might be helpful in the development of future guidelines, which are currently needed to guide and standardize clinical practice regarding the optimal timing of delivery in placenta previa.

Combined effects of feature-based working memory and feature-based attention on the perception of visual motion direction.

We investigated whether human subjects' ability to identify the direction of a brief pulse of coherent motion in a random-dot pattern (RDP) was influenced by: (a) maintaining in working memory the direction of motion of an RDP previously presented far from the pulse (feature-based working memory or FBWM, Experiment 1), (b) attending to the direction of an RDP co-occurring with but far from the pulse (feature-based attention or FBA, Experiment 2), and (c) both FBWM and FBA acting simultaneously (Experiment 3). In the first two experiments, pulse direction identification performance was higher when the remembered direction (FBWM) or the direction of the concurrently attended RDP (FBA) matched the pulse direction than when it was opposite. In Experiment 3, performance was highest when both the remembered and the attended directions matched the pulse direction (combined effects of FBWM and FBA), it was intermediate when only one of them matched the pulse direction, and it was lowest when neither matched the pulse direction. Our results demonstrate that both feature-based working memory and feature-based attention can individually modulate the perception of motion direction and that when acting together they produce an even larger modulation.