(Obstet Gynecol. 2019;134:1105–1108) Recently, maternal-fetal medicine (MFM) specialists have been asked to advocate for safer abortion access. This is particularly true in the case of pregnant women with potentially life-threatening comorbidities. As the maternal mortality rate in the United States rises and maternal mortality review committees are increasingly developed, there has not been attention given to the option of pregnancy termination to reduce mortality.

Obesity in pregnancy bears unique maternal and fetal risks, including an increased risk for gestational diabetes and metabolic perturbations in the offspring. Obesity has also been associated with chronic inflammation, including elevated levels of IL-6 and TNF-alpha. Levels of serum lipopolysaccharides (LPS) rise with increased gut permeability, and have been implicated in driving this inflammation, a phenomenon called metabolic endotoxemia (ME). GLP-2, a proglucagon-derived peptide believed to be integral in maintaining the integrity of the intestine in the face of LPS-mediated endotoxemia. However, variations in these likely molecular mediators in pregnancies among normal, obese, and women with excess weight gain have not yet been explored. We hypothesized that obesity and/or excess weight gain in pregnancy would be associated with an increase in maternal and neonatal markers of ME, as well as GLP-2. STUDY DESIGN: Paired maternal and neonatal (cord blood) serum samples (n¼161) were obtained from our pregnancy biobank repository. Serum levels of LPS, endotoxin core antibody (EndoCAb-IgM), and GLP-2 were measured by ELISA. IL-6 and TNF-alpha were measured using a Milliplex assay. Results were stratified by maternal body mass index (BMI), diabetes, and gestational weight gain (GWG). RESULTS: Maternal IL-6 is significantly decreased in the obese, diabetic cohort compared with the non-obese, non-diabetics (95.28 vs. 99.48 pg/mL, p¼0.047) while GLP-2 is significantly increased (1.92 vs. 2.89 ng/mL, p¼0.026). Neonatal TNF-alpha is significantly decreased in the obese cohort compared to the non-obese (12.43 vs. 13.93 pg/mL, p¼0.044). Maternal GLP-2 is significantly increased in women with excess GWG compared with those with normal GWG (2.27 vs. 1.48 ng/mL, p¼0.014, Figure). We further found that neonatal IL-6 and TNF-alpha are negatively correlated with maternal BMI (-0.186, p¼0.036 and-0.179, p¼0.044 respectively), and that maternal and neonatal IL-6 showed a positive correlation (0.348, p<0.001). CONCLUSION: While we observed altered levels of markers of inflammation (IL-6 and TNF-alpha) with maternal obesity and diabetes, no changes in LPS or endoCAb-IgM were observed. We hypothesize that the increased GLP-2 levels in maternal serum in association with excess GWG may protect against ME in pregnancy.

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abnormal vaginal bleeding requiring intervention had no statistical difference between VP and WVP patients group (p=0.3074) as other complications as well (table 1). Median of related days of vaginal bleeding after the procedure were 7.4 days (SD 8.75) in VP group and 7.34days (SD 8.52) in WVP group, with no statistical difference (p=0.912). Conclusions Insert a vaginal pack or not, after LEEP, do not affect the number of postoperative gynecologic intervention due to vaginal bleeding or the amount of postoperative bleeding days. Previous pregnancies, hormonal status, cytology or LEEP specimen characteristics did not affect the disclosure. We also could not find any risk factor associated to abnormal bleeding. Based on that, the use of vaginal pack can be omitted with no further complications.

Using an easily accessible pharmacy and a standard preoperative template improves utilization of prophylactic antibiotics for patients undergoing abortions in the operating room.