BackgroundIdentifying pregnancy‐associated risk factors before the development of major cardiovascular disease events could provide opportunities for prevention. The objective of this study was to determine the association between outcomes in first pregnancies and subsequent cardiovascular health.Methods and ResultsThe Nulliparous Pregnancy Outcomes Study Monitoring Mothers‐to‐be Heart Health Study is a prospective observational cohort that followed 4484 women 2 to 7 years (mean 3.2 years) after their first pregnancy. Adverse pregnancy outcomes (defined as hypertensive disorders of pregnancy, small‐for‐gestational‐age birth, preterm birth, and stillbirth) were identified prospectively in 1017 of the women (22.7%) during this pregnancy. The primary outcome was incident hypertension (HTN). Women without adverse pregnancy outcomes served as controls. Risk ratios (RR) and 95% CIs were adjusted for age, smoking, body mass index, insurance type, and race/ethnicity at enrollment during pregnancy. The overall incidence of HTN was 5.4% (95% CI 4.7% to 6.1%). Women with adverse pregnancy outcomes had higher adjusted risk of HTN at follow‐up compared with controls (RR 2.4, 95% CI 1.8‐3.1). The association held for individual adverse pregnancy outcomes: any hypertensive disorders of pregnancy (RR 2.7, 95% CI 2.0‐3.6), preeclampsia (RR 2.8, 95% CI 2.0‐4.0), and preterm birth (RR 2.7, 95% CI 1.9‐3.8). Women who had an indicated preterm birth and hypertensive disorders of pregnancy had the highest risk of HTN (RR 4.3, 95% CI 2.7‐6.7).ConclusionsSeveral pregnancy complications in the first pregnancy are associated with development of HTN 2 to 7 years later. Preventive care for women should include a detailed pregnancy history to aid in counseling about HTN risk.Clinical Trial Registration URL: http://www.clinicaltrials.gov Unique identifier: NCT02231398.

Objective We compare validation characteristics of four early warning systems for maternal morbidity. Study Design We used a retrospective cohort of severe maternal morbidity cases between January 2016 and December 2016 compared with a cohort of controls. We determined if the modified early obstetric warning score (MEOWS), maternal early recognition criteria (MERC), modified early warning system (MEWS), or maternal early warning trigger (MEWT) would have alerted. We developed criteria to determine which of these alerts was considered clinically “relevant.” Results We reviewed 79 morbidity cases and 123 controls. MEOWS and MERC were more sensitive than MEWS or MEWT (67.1 and 67.1% vs. 19% and 40.5%, p < 0.001); however, MEWT and MEWS were more specific (88.6% MEWT and 93.5% MEWS vs. 51.2% MEOWS and 60.2% MERC, p < 0.001). In the control population, 70% of MEWT alerts still appeared “relevant” to the clinical scenario in contrast to the MEOWS (32%) or MERC systems (31%). Conclusion There are limited comparative data regarding how early warning systems perform in an American population for maternal morbidity. None of the systems performs with high sensitivity and specificity. High-volume, high-acuity units may decide that the lower sensitivity of the MEWT is relatively acceptable when considering the high false trigger rate of the other more sensitive systems. In addition, triggers in the MEWT system were more likely to be clinically relevant even in cases that did not have severe morbidity.

Objective  We study whether using an intra-aortic balloon (IAB) during cesarean hysterectomy decreases delivery morbidity in patients with suspected morbidly adherent placentation. Study Design  This is a retrospective cohort study of deliveries complicated by suspected abnormal placentation between 2009 and 2016 comparing maternal and neonatal outcomes with an IAB placed prior to cesarean hysterectomy versus no IAB. The primary outcome included quantified blood loss (QBL). Results  Thirty-five cases were reviewed, 16 with IAB and 19 without IAB. No difference was seen in median QBL between the two groups (1,351 vs. 1,397 mL; p  = 0.90). There were no significant differences in overall surgical complications (19% IAB, 21% no IAB; p  = 0.86), bladder complications (12 vs. 21%; p  = 0.66), intensive care unit admissions (12 vs. 26%; p  = 0.41), surgical duration (2.9 vs. 2.8 hour; p  = 0.83), or blood transfusions (median 2 vs. 2; p  = 0.27) between the two groups. There was one groin hematoma at the balloon site that was managed conservatively. There were no complications involving thrombosis or limb ischemia in the IAB group. Conclusion  While we did not detect statistically significant differences, larger studies may be warranted given the potential for extreme morbidity in these cases. This study highlights the potential use of an IAB in the management of these cases.

This study was designed to test the benefit of acetyl-1-carnitine in patients with dementia. Seventy-one patients of 65 years and over, living in their own homes or in residential care, took part in a 24-week randomized, double-blind, placebo-controlled, parallel-group clinical trial. The outcome was measured by comparing psychometric tests at 24 weeks to baseline measures. The active treatment group improved in mean scores in seven out ofeight psychometric tests, the placebo treatment group in only two out of eight tests. The improvements were statistically significant in one test, recognition memory (p <0.01). Linear discriminant function analysis indicated that active and placebo therapy could be distinguished according to the pattern of responses to the eight psychological tests (p< 0.01). In this small trial, acetyl-I-carnitine was shown to be non-toxic and possibly beneficial. Further large-scale trials are needed over long periods of time.

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