Maternal and neonatal outcomes of repeat cesarean delivery in women with a prior classical versus low transverse uterine incision.

We compared maternal and neonatal outcomes following repeat cesarean delivery (CD) of women with a prior classical CD with those with a prior low transverse CD. The Maternal Fetal Medicine Units Network Cesarean Delivery Registry was used to identify women with one previous CD who underwent an elective repeat CD prior to the onset of labor at ≥36 weeks. Outcomes were compared between women with a previous classical CD and those with a prior low transverse CD. Of the 7936 women who met study criteria, 122 had a prior classical CD. Women with a prior classical CD had a higher rate of classical uterine incision at repeat CD (12.73% versus 0.59%; P < 0.001), had longer total operative time and hospital stay, and had higher intensive care unit admission. Uterine dehiscence was more frequent in women with a prior classical CD (2.46% versus 0.27%, odds ratio 9.35, 95% confidence interval 1.76 to 31.93). After adjusting for confounding factors, there were no statistical differences in major maternal or neonatal morbidities between groups. Uterine dehiscence was present at repeat CD in 2.46% of women with a prior classical CD. However, major maternal morbidities were similar to those with a prior low transverse CD.

Mesenchymal stem cells from the Wharton's jelly of umbilical cord segments provide stromal support for the maintenance of cord blood hematopoietic stem cells during long-term ex vivo culture.

BACKGROUND: Hematopoietic stem cells (HSCs) are routinely obtained from marrow, mobilized peripheral blood, and umbilical cord blood. Mesenchymal stem cells (MSCs) are traditionally isolated from marrow. Bone marrow-derived MSCs (BM-MSCs) have previously demonstrated their ability to act as a feeder layer in support of ex vivo cord blood expansion. However, the use of BM-MSCs to support the growth, differentiation, and engraftment of cord blood may not be ideal for transplant purposes. Therefore, the potential of MSCs from a novel source, the Wharton's jelly of umbilical cords, to act as stromal support for the long-term culture of cord blood HSC was evaluated. STUDY DESIGN AND METHODS: Umbilical cord-derived MSCs (UC-MSCs) were cultured from the Wharton's jelly of umbilical cord segments. The UC-MSCs were then profiled for expression of 12 cell surface receptors and tested for their ability to support cord blood HSCs in a long-term culture-initiating cell (LTC-IC) assay. RESULTS: Upon culture, UC-MSCs express a defined set of cell surface markers (CD29, CD44, CD73, CD90, CD105, CD166, and HLA-A) and lack other markers (CD45, CD34, CD38, CD117, and HLA-DR) similar to BM-MSCs. Like BM-MSCs, UC-MSCs effectively support the growth of CD34+ cord blood cells in LTC-IC assays. CONCLUSION: These data suggest the potential therapeutic application of Wharton's jelly-derived UC-MSCs to provide stromal support structure for the long-term culture of cord blood HSCs as well as the possibility of cotransplantation of genetically identical, HLA-matched, or unmatched cord blood HSCs and UC-MSCs in the setting of HSC transplantation.

Pelvic varicosities and inferior vena cava.

BACKGROUND: Large pelvic varicosities and an absence of the inferior vena cava below the renal veins were identified in pregnancy. CASE: A young woman with a history of hemitruncus repair in infancy was noted to have large pelvic varicosities on a transvaginal ultrasonogram in early pregnancy. Magnetic resonance imaging confirmed these findings. Her protein S activity was mildly depressed, and an methylene tetrahydrofolate reductase mutation was present with normal fasting homocysteine levels. Despite concerns regarding the presence of these varicosities and potential thrombotic and hemorrhagic complications, a spontaneous vaginal delivery was achieved. CONCLUSION: Large pelvic varicosities may be present in women with congenital heart disease. Although these women are at risk for complications, vaginal delivery may be safely achieved.

Chorioamniotic Membrane Separation Found on Routine Testing in an Otherwise Asymptomatic Woman With Late Preterm Twin Gestation.

BACKGROUND: Chorioamniotic membrane separation (CMS) is a rare finding that is commonly preceded by invasive fetal procedures. The presence of CMS can also be associated with uncommon maternal or fetal conditions as well as preterm delivery, amniotic band syndrome, umbilical cord complications, and fetal and neonatal death. It is classified as a high-risk antepartum condition due to the significant fetal morbidity and mortality that may ensue. CASE REPORT: A 40-year-old gravida 5 para 1212 at 35 weeks presented for antepartum fetal testing. Her antepartum course was complicated by di-di twin gestation, chronic hypertension, and advanced maternal age. A routine ultrasound (as part of the antepartum fetal testing) identified an incidental finding of CMS. The patient's only reported symptom was that of preterm contractions, without evidence of active labor, and other fetal testing was reassuring. She had a repeat cesarean section that day and the suspected etiology was preterm, premature rupture of membranes of Twin B that was seen on entry into the uterine cavity. DISCUSSION: Chorioamniotic separation is a rare occurrence associated with significant adverse fetal outcomes. This is the first reported case of incidental diagnosis in a twin pregnancy during antepartum fetal surveillance testing. Our detection resulted in the delivery of late preterm, but otherwise healthy, twin neonates.