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Author Moaddab, A.; Dildy, G.A.; Brown, H.L.; Bateni, Z.H.; Belfort, M.A.; Sangi-Haghpeykar, H.; Clark, S.L. file  url
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Title Health Care Disparity and State-Specific Pregnancy-Related Mortality in the United States, 2005-2014 Type
Year 2016 Publication Obstetrics and Gynecology Abbreviated Journal Obstet Gynecol  
Volume 128 Issue 4 Pages 869-875  
Keywords Centers for Disease Control and Prevention (U.S.); Ethnic Groups/statistics & numerical data; Female; *Healthcare Disparities; Humans; Infant; Infant Mortality; Maternal Mortality; *Maternal-Child Health Services; *Perinatal Care; Pregnancy; United States/epidemiology  
Abstract OBJECTIVE: To investigate factors associated with differential state maternal mortality ratios and to quantitate the contribution of various demographic factors to such variation. METHODS: In a population-level analysis study, we analyzed data from the Centers for Disease Control and Prevention National Center for Health Statistics database and the Detailed Mortality Underlying Cause of Death database (CDC WONDER) that contains mortality and population counts for all U.S. counties. Bivariate correlations between maternal mortality ratio and all maternal demographic, lifestyle, health, and medical service utilization characteristics were calculated. We performed a maximum likelihood factor analysis with varimax rotation retaining variables that were significant (P<.05) in the univariate analysis to deal with multicollinearity among the existing variables. RESULTS: The United States has experienced a continued increase in maternal mortality ratio since 2007 with rates of 21-22 per 100,000 live births in 2013 and 2014. This increase in mortality was most dramatic in non-Hispanic black women. There was a significant correlation between state mortality ranking and the percentage of non-Hispanic black women in the delivery population. Cesarean deliveries, unintended births, unmarried status, percentage of non-Hispanic black deliveries, and four or less prenatal visits were significantly (P<.05) associated with increased maternal mortality ratio. CONCLUSION: Interstate differences in maternal mortality ratios largely reflect a different proportion of non-Hispanic black or unmarried patients with unplanned pregnancies. Racial disparities in health care availability, access, or utilization by underserved populations are an important issue faced by states in seeking to decrease maternal mortality.  
Call Number Serial 2252  
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Author Oyelese, Y.; Smulian, J.C. file  url
openurl 
Title Placenta previa, placenta accreta, and vasa previa Type Journal Article
Year 2006 Publication Obstetrics and Gynecology Abbreviated Journal Obstet Gynecol  
Volume 107 Issue 4 Pages 927-941  
Keywords Balloon Occlusion/methods; Cesarean Section; Female; Follow-Up Studies; Humans; Hysterectomy/*methods; Magnetic Resonance Imaging; Methotrexate/therapeutic use; Physical Examination/methods; Placenta Accreta/diagnosis/*therapy; Placenta Diseases/diagnostic imaging/surgery; Placenta Previa/diagnosis/*therapy; Postpartum Hemorrhage/diagnosis/*therapy; Pregnancy; Risk Assessment; Severity of Illness Index; Treatment Outcome; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal  
Abstract Placenta previa, placenta accreta, and vasa previa are important causes of bleeding in the second half of pregnancy and in labor. Risk factors for placenta previa include prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, and maternal age. The diagnostic modality of choice for placenta previa is transvaginal ultrasonography, and women with a complete placenta previa should be delivered by cesarean. Small studies suggest that, when the placenta to cervical os distance is greater than 2 cm, women may safely have a vaginal delivery. Regional anesthesia for cesarean delivery in women with placenta previa is safe. Delivery should take place at an institution with adequate blood banking facilities. The incidence of placenta accreta is rising, primarily because of the rise in cesarean delivery rates. This condition can be associated with massive blood loss at delivery. Prenatal diagnosis by imaging, followed by planning of peripartum management by a multidisciplinary team, may help reduce morbidity and mortality. Women known to have placenta accreta should be delivered by cesarean, and no attempt should be made to separate the placenta at the time of delivery. The majority of women with significant degrees of placenta accreta will require a hysterectomy. Although successful conservative management has been described, there are currently insufficient data to recommend this approach to management routinely. Vasa previa carries a risk of fetal exsanguination and death when the membranes rupture. The condition can be diagnosed prenatally by ultrasound examination. Good outcomes depend on prenatal diagnosis and cesarean delivery before the membranes rupture.  
Call Number Serial 2166  
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Author Walker, R.W.; Clemente, J.C.; Peter, I.; Loos, R.J.F. file  url
openurl 
Title The prenatal gut microbiome: are we colonized with bacteria in utero? Type Journal Article
Year 2017 Publication Pediatric Obesity Abbreviated Journal Pediatr Obes  
Volume 12 Suppl 1 Issue Pages 3-17  
Keywords Animals; Bacteria; Delivery, Obstetric; Female; Fetus/*microbiology; *Gastrointestinal Microbiome; Humans; Infant; Infant, Newborn; Mothers; Pregnancy; Bacteria; foetal development; gut microbiome; pregnancy  
Abstract The colonization of the gut with microbes in early life is critical to the developing newborn immune system, metabolic function and potentially future health. Maternal microbes are transmitted to offspring during childbirth, representing a key step in the colonization of the infant gut. Studies of infant meconium suggest that bacteria are present in the foetal gut prior to birth, meaning that colonization could occur prenatally. Animal studies have shown that prenatal transmission of microbes to the foetus is possible, and physiological changes observed in pregnant mothers indicate that in utero transfer is likely in humans as well. However, direct evidence of in utero transfer of bacteria in humans is lacking. Understanding the timing and mechanisms involved in the first colonization of the human gut is critical to a comprehensive understanding of the early life gut microbiome. This review will discuss the evidence supporting in utero transmission of microbes from mother to infants. We also review sources of transferred bacteria, physiological mechanisms of transfer and modifiers of maternal microbiomes and their potential role in early life infant health. Well-designed longitudinal birth studies that account for established modifiers of the gut microbiome are challenging, but will be necessary to confirm in utero transfer and further our knowledge of the prenatal microbiome.  
Call Number Serial 2081  
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Author Gohir, W.; Ratcliffe, E.M.; Sloboda, D.M. file  url
openurl 
Title Of the bugs that shape us: maternal obesity, the gut microbiome, and long-term disease risk Type Journal Article
Year 2015 Publication Pediatric Research Abbreviated Journal Pediatr Res  
Volume 77 Issue 1-2 Pages 196-204  
Keywords Female; Gastrointestinal Tract/growth & development/*microbiology; Humans; *Maternal Nutritional Physiological Phenomena; *Maternal-Fetal Exchange; *Microbiota; Obesity/*complications/microbiology; Pregnancy; Prenatal Exposure Delayed Effects/immunology/*microbiology; Microbiome  
Abstract Chronic disease risk is inextricably linked to our early-life environment, where maternal, fetal, and childhood factors predict disease risk later in life. Currently, maternal obesity is a key predictor of childhood obesity and metabolic complications in adulthood. Although the mechanisms are unclear, new and emerging evidence points to our microbiome, where the bacterial composition of the gut modulates the weight gain and altered metabolism that drives obesity. Over the course of pregnancy, maternal bacterial load increases, and gut bacterial diversity changes and is influenced by pre-pregnancy- and pregnancy-related obesity. Alterations in the bacterial composition of the mother have been shown to affect the development and function of the gastrointestinal tract of her offspring. How these microbial shifts influence the maternal-fetal-infant relationship is a topic of hot debate. This paper will review the evidence linking nutrition, maternal obesity, the maternal gut microbiome, and fetal gut development, bringing together clinical observations in humans and experimental data from targeted animal models.  
Call Number Serial 2080  
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Author Solt, I. file  url
openurl 
Title The human microbiome and the great obstetrical syndromes: a new frontier in maternal-fetal medicine Type Journal Article
Year 2015 Publication Best Practice & Research. Clinical Obstetrics & Gynaecology Abbreviated Journal Best Pract Res Clin Obstet Gynaecol  
Volume 29 Issue 2 Pages 165-175  
Keywords Chorioamnionitis/microbiology; Diabetes, Gestational/microbiology; Female; Fetal Growth Retardation/microbiology; Humans; Maternal-Fetal Exchange; *Microbiota; Placenta/microbiology; Pre-Eclampsia/microbiology; Pregnancy; Pregnancy Complications/*microbiology; Premature Birth/microbiology; Syndrome; Uterus/*microbiology; Vagina/*microbiology; bacteria; infection; inflammation; maternal-fetal medicine; microbiome; pregnancy  
Abstract The emergence of the concept of the microbiome, together with the development of molecular-based techniques, particularly polymerase chain reaction (PCR) amplification using the 16S ribosomal RNA (rRNA) gene, has dramatically increased the detection of microorganisms, the number of known species, and the understanding of bacterial communities that are relevant to maternal-fetal medicine in health and disease. Culture-independent methods enable characterization of the microbiomes of the reproductive tract of pregnant and nonpregnant women, and have increased our understanding of the role of the uterine microbiome in adverse obstetric outcomes. While bacterial ascent from the vaginal tract is recognized as the primary cause of intrauterine infection, the microbiomes of the gastrointestinal, oral, and respiratory tracts are shown to be involved by means of hematogenous spread. The transmission of maternal microbiomes to the neonate, by vaginal delivery or cesarean section, is shown to affect health from birth to adulthood.  
Call Number Serial 2079  
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