Hemoptysis in pregnancy is rare and can be life-threatening. This case describes management of hemoptysis in pregnancy requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO). The patient presented with massive hemoptysis in respiratory failure at 26 weeks gestation. VV-ECMO was utilized for maternal stability due to severe hypoxia from lung parenchymal damage. An extensive work-up for hemoptysis returned negative except for an elevated Bordetella pertussis IgG antibody. The patient was delivered via cesarean section with a complicated post-partum course. She and the infant were discharged in stable condition after long hospital stays. Prior publications describing VV-ECMO use in pregnancy are limited to treatment of respiratory infections such as influenza or pneumonia. This case is the first in the literature to describe VV-ECMO utilization for hemoptysis in pregnancy, specifically, and demonstrates its significant benefit in cases of respiratory failure due to hemoptysis.

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Background: Complete uterine rupture (UR) is a rare, catastrophic event.Case: We present a rare case of fetal demise with delayed presentation of complete UR in a hemodynamically stable, asymptomatic 32-year-old woman with a history of one low transverse cesarean section and two subsequent uncomplicated vaginal births after cesarean delivery (VBAC). Conclusion:Complete prelabor ruptures in women with a previous uterine scar are rare but are associated with catastrophic outcomes. Intrauterine fetal demise should be recognized as a sign, not necessarily a sole diagnosis, until other etiologies are excluded.

Complete outcome data were available on 3831 (92.4%) women. A positive screen detected 61.8% of all FGR (n¼396 (10.3%); +LR 2.76,-LR 0.49). Test performance was not significantly different without placental biometry (+LR 3.35,-LR 0.54). Detection of preterm FGR (n¼98, 2.6%) was excellent (sens. 90.8% & NPV 99.7%), but was also not significantly improved by inclusion of placental biometry (89.8% & 99.7%). Inclusion of placental measurements as continuous data in a logistic regression model yielded minor improvements in screening performance, but did not increase the PPV over the predefined UtAD/EFW thresholds (10.7 vs 11.3%). Sensitivity analyses by FGR risk factor did not identify any significant differences in the test performance (sens. 88-92%, PPV 9.2-12.4%). CONCLUSION: This is largest study to date of 2D placental biometry measurement for the prediction of FGR. It demonstrates that placental assessment marginally improves predictive ability, but that the majority of pregnancies at risk can be identified by EFW/UtAD measurement.