Preterm Premature Rupture of Membranes in Twins: Comparison of Rupture in the Presenting Versus Non-presenting Sac.

OBJECTIVE: This study sought to compare the latency from membrane rupture to delivery and subsequent neonatal outcomes in twin gestations complicated by preterm premature rupture of membranes (PPROM) of the presenting versus non-presenting sac. METHODS: This was a retrospective study of twin pregnancies over a 7-year period diagnosed with PPROM between 12 and 37 weeks gestation with a latency period to delivery of >24 hours. The ruptured sac was identified by ultrasound scan. The study compared the latency period from PPROM to delivery and subsequent neonatal morbidity and mortality resulting from rupture of the presenting versus non-presenting sac. Obstetric and neonatal outcomes were evaluated using a matched-cohort subset analysis (Canadian Task Force Classification II-2). RESULTS: During the study period, 77 twin pregnancies diagnosed with PPROM satisfied the inclusion criteria. The mean latency periods from PPROM to delivery were 10.1 days (n = 7) when the presenting sac ruptured and 41.3 days (n = 10) when the non-presenting sac ruptured (P < 0.05). Neonatal death was higher with PPROM of the presenting than the non-presenting sac (21.4% vs. 0%, respectively; P = 0.05). Neonates were more likely to be affected by retinopathy of prematurity (57% vs. 19%; P < 0.05) but less likely to have persistent pulmonary hypertension of the newborn (0% vs. 25%; P < 0.05) when the rupture occurred in the presenting sac. The rates of other neonatal adverse outcomes were similar between the two groups. CONCLUSIONS: In twin gestations there is a longer latency from PPROM to delivery and fewer neonatal complications when rupture occurs in the non-presenting rather than the presenting sac.

Relaxation properties of human umbilical cord blood at 1.5 Tesla.

PURPOSE: To characterize the MRI relaxation properties of human umbilical cord blood at 1.5 Tesla. METHODS: Relaxometry measurements were performed on cord blood specimens (N = 88, derived from six caesarean deliveries) spanning a broad range of hematocrits (Hct = 0.19-0.76) and oxygen saturations (sO2 = 4-100%), to characterize the dependence of T1 and T2 on these blood properties. Adult blood data (N = 31 specimens, derived from two volunteers) were similarly studied to validate our experimental methods by comparison with existing literature. Using biophysical models previously developed for adult blood, new model parameters were estimated, which relate Hct and sO2 to the observed cord blood relaxation times. RESULTS: Fitted biophysical models explained more than 90% of the variation in T1 and T2 . In general, T2 relaxation times of cord blood were longer (by up to 35%) than those of adult blood, whereas T1 relaxation times were slightly shorter (by up to 10%). CONCLUSIONS: The models and fitted parameters presented here can be used for calibration of future MRI investigations of fetal and neonatal blood physiology. This study is an important step in facilitating accurate, noninvasive assessments of fetal blood oxygen content, a valuable diagnostic parameter in the identification and treatment of fetal hypoxia. Magn Reson Med 77:1678-1690, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Severe Staphylococcus aureus Endocarditis Presenting as Peripartum Thrombotic Thrombocytopenic Purpura.

BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening illness that occurs in both pregnant and non-pregnant women. Several other conditions can mimic the disease, which makes the diagnosis challenging. CASE: We describe a case of severe Staphylococcus aureus endocarditis that initially presented as peripartum TTP in a 39-year-old woman at 29+6 weeks' gestation. We give an overview of the diagnostic considerations and management of thrombocytopenia in pregnancy and review the literature related to TTP and peripartum infective endocarditis. CONCLUSION: Given the significant differences in definitive therapies for the spectrum of thrombocytopenic conditions that occur in pregnancy, timely and accurate diagnosis of TTP is critical for optimal management.

The use of chaperones for intimate examinations: the patient perspective based on an anonymous questionnaire.

The objective of the study was to identify genitourinary (GU) medicine patients' opinions concerning the offer and provision of chaperones and to audit adherence to clinic policy. An anonymous questionnaire was completed by patients after their examination in two GU medicine clinics in central and north London. In total, 750 patients were given questionnaires, of which 627 (84%) were completed and returned. Less than half (45%) reported that they had been offered a chaperone. There was an association between patient gender/orientation and examiner gender/role for both offer and acceptance. Those likely to be offered (75%, 18/24) and accept (93%, 14/15) were women being examined by a man. Those least likely to be offered (27%, 32/120) or accept (3%, 1/31) were men who have sex with men. The offer of a chaperone was significantly greater for younger patients and those from Asian or black ethnic groups. Acceptance was highest among Asian patients. Most patients (88%, 530/602) did not want a chaperone for future examinations. Our conclusion was that most patients do not want a chaperone in the GU medicine clinic. Those who do would prefer for one to be offered, rather than for it to be routine. This supports the recommendation that all patients should be offered a chaperone for intimate examinations.