Women's Health and Education Center (WHEC)


List of Articles

  • Non-Invasive Prenatal Genetic Testing for Fetal Anomalies
    Non-invasive prenatal testing that uses cell-free fetal DNA (cfDNA) from the plasma of pregnant women offers tremendous potential as a screening tool for fetal aneuploidy. Recently, a number of groups have validated a technology known as massively parallel genomic sequencing, which uses a highly sensitive assay to quantify millions of DNA fragments in biological samples in a span of days and has been reported to accurately detect trisomy 13, trisomy 18 and trisomy 21 as early as the 10th week of pregnancy with results available approximately 1 week after maternal sampling. cfDNA has a very high detection rate for trisomy 21: 99% or 100%. It does not replace the precision obtained with diagnostic tests, such as chorionic villus sampling (CVS) or amniocentesis, and currently does not offer other genetic information. Given that the fetus is the source of perhaps 5% of cfDNA in maternal plasma, blood from a mother carrying a trisomy 21 pregnancy should have 2.5% more chromosome 21 sequences than if her fetus were not trisomic. cfDNA analysis will remain a screen, not a test requiring no additional assays before a management decision. Expert patient counseling may be important before and after testing. Metabolomic analysis could lead to the development of additional biochemical markers to improve Down syndrome screening. Metabolomics provide insights into the cellular dysfunction in Down syndrome. Clinical management guidelines and education are essential. As with all new screening tests and technologies, the expanded panel should be appropriately studied before it replaces current standard of care and changes clinical practice.

  • Postpartum Hemorrhage
    The purpose of this document is to review the etiology, evaluation, and management of postpartum hemorrhage. Although many risk factors have been associated with postpartum hemorrhage, it often occurs without warning. Attention to improving the hospital systems necessary for the care of women at risk for major obstetric hemorrhage is important in the effort to decrease maternal mortality from hemorrhage. The creation of a patient safety team that works to improve the hospital systems for caring for women at risk for major obstetric hemorrhage can help to identify and manage these situations and save lives. Development of clinical pathways, guidelines and protocols designed to provide early diagnosis of patients at risk for major obstetric hemorrhage and for streamlined care in emergency situations are essential. A multidisciplinary patient safety team that includes individuals from the Division of Obstetric Anesthesiology, Maternal Fetal Medicine, Neonatology, and the Blood Bank as well as Departments of Nursing, Communication, and Administration and quarterly mock drills of rapid response team, helps to respond to these situations effectively.

  • Nausea and Vomiting in Pregnancy
    Without a doubt, nausea and vomiting are common side effects of pregnancy. Hyperemesis gravidarum is a rare and severe complication of pregnancy that requires appropriate diagnosis and management to improve the patient’s quality of life and provide best possible maternal and neonatal outcomes. Physicians must appreciate the magnitude of the condition given its widespread implications – economic costs, decreased quality of life, maternal psychological effects, and risks to mother and fetus. Common maternal complications include dehydration, weight loss, and nutrient deficiencies. Current strategies include dietary modification, antiemetic therapy, and in certain situations, alimentary support. Use caution when prescribing phenothiazines because dystonia and extrapyramidal symptoms can occur with prolonged use and high dose. Future strategies should include more randomized controlled trials therapies that are safe for both mother and fetus, and effective treatment to prevent hospitalization and offer alternatives for nutritional support.

  • Stillbirth: Evaluation and Management
    Despite improvements in antenatal and intrapartum care, stillbirth, defined as in utero fetal death at 20 weeks of gestation or greater, remains and important, largely unstudied, and poignant problem in obstetrics. This review discusses known and suspected causes of stillbirth including genetic abnormalities, infection, fetal-maternal hemorrhage, and a variety of medical conditions in the mother. The proportion of stillbirths that have a diagnostic explanation is higher in centers that conduct a defined and systemic evaluation. The most important test in the evaluation of a stillbirth is fetal autopsy; examination of the placenta, cord and membranes; and karyotype evaluation. Patient support should include emotional support and clear communication of test results. Referral to a bereavement counselor, religious leader, peer support group, or mental health professional may be advisable for management of grief and depression.

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