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Plasminogen Activator Inhibitor-1 (PAI-1): Role in Adverse Pregnancy Outcome? - 3 - Association with Recurrent Pregnancy Loss
In our last post, we reviewed several studies that would lend support to the hypothesis that women with elevated levels of plasminogen activator inhibitor-1 (PAI-1), and a genetic predisposition for the same, are at increased risk for adverse preg...
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Diabetes in Pregnancy - 2 - Glucose Metabolism and Insulin Action
To continue the discussion of diabetes in pregnancy, let’s first start with a very simplified review of glucose metabolism and the role of insulin so that we understand what the furor is all about….Glucose is one of the primary substrates for the ...
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Indications for Doppler Flow Velocimetry During Pregnancy
Recently, I received a phone call from our billing office reporting that an insurance company had declined to reimburse us for a claim that included charges for Doppler flow velocimetry for the indication of intrauterine growth restriction (IUGR)....
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Recurrent Early Pregnancy Loss: To Treat or Not to Treat...
The readers who sent in the comments below related to recurrent early pregnancy loss (RPL) have what we could consider to be 'borderline' indications for 'treatment' and several questions related to their therapy. But, the fact remains, they have ...
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The Human Value of Knowledge
Since we have been on the subject of aneuploidy screening, let me tell you about a situation that we had on Friday that epitomizes the importance of knowing as much as you can about a baby, including its karyotype (chromosomal status), before deli...
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Late Preterm Birth - Patient and Provider Education is Still Needed
I have spent much of the last year preaching the gospel of “Thou shalt not deliver before 39 weeks, unless thou hast a good indication.” In general, the “word” has been well-received by providers, although many have voiced skepticism of its divine...
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Preterm Labor or Cervical Incompetence?: Unclear Diagnoses Complicate Choices for Therapy
Below are three comments from readers that appeared under my recent post on the safety of 17-hydroxyprogesterone caproate (17P) in the treatment of premature labor. They give us pause to reflect on the fact that the distinction between preterm lab...
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Cytomegalovirus (CMV): Common and Confusing
Let's take a break from the PTB saga which I promise to continue soon. The other day I got a call from a physician in Louisiana who had tracked me down to where I currently live in South Carolina. The call was regarding a woman who had lost a baby...
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Obstetrical Ultrasound - A Sinister Cause for Concern?
A few weeks ago, a patient was sent to me for consultation with the new diagnosis of gestational diabetes detected at the time of routine screening at 26 weeks. After reviewing her history and performing a limited physical exam, I proceeded with ...
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Amniotic Fluid - 4 - Consequences of Decreased Amniotic Fluid
In the last three posts, we have reviewed basic aspects of amniotic fluid production and measurement and common causes of decreased amniotic fluid, or oligohydramnios. Now let’s look at reasons decreased amniotic fluid increases the risk for feta...
