OBJECTIVE: To characterize clinical management of deliveries resulting in neonatal hypoxic ischemic encephalopathy. DESIGN: Retrospective case series SETTING: Three academic referral medical centers in the United States POPULATION: All neonates ≥35 weeks’ gestation with HIE based on cord blood pH<7.0, base deficit of ≥12.0mmol/L, along with relevant radiological, laboratory, and clinical findings. METHODS: Clinical management was characterized based on whether (i)delivery occurred within 120 minutes of presentation, (ii)delivery occurred due to a sentinel event such as cord prolapse or uterine rupture, and (iii)the fetal heart rate tracing(FHR) demonstrated variability, accelerations, or both upon presentation and in the half hour before delivery. MAIN OUTCOME MEASURES: Relationship of mode of delivery to FHR tracing characteristics at delivery. Obstetric outcomes, labour course and management were analysed. RESULTS: Of 144,904 deliveries, 102 maternal-newborn dyads met criteria. Of these, 19 delivered within 120 of minutes of presentation and four further women experienced a sentinel event. Of the remaining 79, 66(84%) had a FHR tracing on presentation that demonstrated variability, accelerations or both. Of these 66 cases, 27 had a fetal heart tracing that demonstrated variability, accelerations or both in the 30 minutes preceding delivery. CONCLUSION: Approximately two-thirds of cases of HIE occurred in cases where the FHR tracing initially demonstrated variability, accelerations, or both, without a sentinel event and without a condition requiring delivery within 120 minutes of presentation. Of these >40% had variability, accelerations, or both in the half hour before delivery. This suggests additional insights are required to prevent some cases of HIE.

Objective: Studies have examined the impact of race on infertility, but few have compared ethnic differences in infertility within a given race. We sought to determine whether infertility etiologies differ between Black ethnic subgroups. Design/Setting: Retrospective study in an urban safety net hospital. Population: Women seeking infertility care between 2005-2015. Methods: Charts of women with infertility and PCOS ICD-9 diagnoses were reviewed to confirm diagnoses. Data was stratified by race and subsequently by ethnicity to evaluate differences in infertility etiologies between Black American, Haitian, and African women. White American women were used as the comparison group. Main outcome measures: Infertility diagnoses between ethnic groups. Results: A total of 358 women met inclusion criteria including 99 Black American, 110 Black Haitian, 61 Black African, and 88 White American women. Anovulation/polycystic ovarian syndrome (PCOS) was the most common diagnosis in each ethnic group, accounting for 40% of infertility among White American, 57% among Black American, 25% among Haitian, and 21% among African women. There were no significant differences in individual infertility diagnoses between Black and White women. Between ethnic subgroups, multivariate analysis showed significantly higher odds of infertility due to anovulation/PCOS in Black American women compared to African women (odds ratio [OR]=4.9; 95% CI=1.4-17.0). Compared to African women, higher odds of tubal factor infertility were observed in Black American (OR=4.7; 95% CI=1.16-18.7) and Haitian women (OR=4.0; 95% CI=1.1-14.0). Conclusions: Causes of infertility weren’t homogeneous across Black ethnic groups. Studies examining infertility should specify ethnic subgroups within race as this may affect results.

Objective. This study examined the predictive ability of established Maternal Early Warning systems (MEWS) for different types of maternal morbidity, in order to discern an optimal early warning system. Design. Retrospective cohort study. Setting. Four-hospital urban academic system. Population. All patients admitted to the obstetric services of this hospital system in 2018. Methods. All patient vital signs were collected and three sets of published MEWS criteria were evaluated in relation to maternal morbidity. The test characteristics of each MEWS, as well as for heart rate, blood pressure, and oxygen saturation individually and in different combinations were compared. Main Outcome Measures. Maternal morbidity, defined as a composite of hemorrhage, infection, acute cardiac disease, and acute respiratory disease, ascertained from informatics and administrative data. Results. Of 14,597 obstetric admissions, 2,451 patients experienced composite morbidity (16.8%). The sensitivities (15.3% - 64.8%), specificities (56.8% - 96.1%), and positive predictive values (22.3% - 44.5%) of the three MEWS criteria ranged. Of patients with any morbidity, 28% met criteria for the most liberal vital sign combination, while only 2% met criteria for the most restrictive parameters, compared to 14% and 1% of patients without morbidity, respectively. Sensitivity of all vital sign combinations was low (maximum 28.2%), while specificity ranged from 86.1 – 99.3%. Conclusions. Though all MEWS criteria demonstrated poor sensitivity for maternal morbidity, permutations of the most abnormal vital signs have high specificity, suggesting that MEWS may be better implemented as a trigger tool to target more sensitive screening techniques for maternal morbidity.