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Stiff person syndrome may be successfully managed in pregnancy. Patients can deliver vaginally with adequate pain control to avoid muscle spasms.

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Objective To evaluate the impact of an immediate ultrasound feedback intervention on trainee accuracy in vaginal‐examination‐based assessment of fetal head position. Methods This was a prospective cohort study conducted at a single tertiary care center. Six third‐year and six fourth‐year residents in an obstetrics and gynecology residency training program were the study subjects. The third‐year residents underwent a training intervention in which they assessed fetal head position by transvaginal digital examination and then received immediate feedback through ultrasound demonstration of the actual position. All examinations were performed in women with a singleton gestation ≥ 35 weeks and cervical dilation ≥ 8 cm, following rupture of membranes. The comparison groups were third‐year residents before, during and after training and fourth‐year residents who were not exposed to the training intervention. The primary outcome was the difference in accuracy of fetal‐head‐position assessment on vaginal examination by third‐year residents before and after ultrasound feedback training. Univariate and multivariate analyses were performed to identify factors associated with digital examination accuracy. Results Overall, 390 examinations were performed. The accuracy of fetal‐head‐position assessments of third‐year residents was 55% (53/96) before training, 65% (74/114) during training and 70% (63/90) after training, while that of fourth‐year residents who did not undergo training was 52% (47/90) (P = 0.04). Fourth‐year residents who did not undergo ultrasound training demonstrated similar baseline accuracy to that of third‐year residents pretraining (52% (47/90) vs 55% (53/96), P = 0.68), but had significantly lower accuracy than had the third‐year residents post‐training (52% (47/90) vs 70% (63/90); P = 0.01). Multivariable analysis revealed a positive association between ultrasound feedback training and the ability to assess accurately fetal head position. After adjusting for the variables included in the final model, examinations performed by third‐year residents pretraining and those performed by fourth‐year residents who did not undergo training were less likely to be accurate than those performed by third‐year residents post‐training (adjusted odds ratio, 0.48 (95% CI, 0.26–0.91) and 0.42 (95% CI, 0.22–0.80), respectively). Conclusion Immediate ultrasound feedback training increased trainee accuracy in vaginal assessment of fetal head position in labor. Its integration into obstetric training programs should be considered. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

INTRODUCTION: Our objective was to determine if birth weight of infants of women with chronic hypertension is affected by range of antepartum blood pressure. METHODS: A retrospective chart review of patients with chronic hypertension at a single tertiary care center was completed. The difference in birth weight between women with mean antenatal blood pressures in the systolic range of <140 mmHg verses >140mmHg was assessed. A second analysis to assess mean antenatal diastolic blood pressure of <90mmHg versus >90 mmHg was completed. Chi squared analysis was utilized, with a P-value of <.05 used to indicate statistical significance. RESULTS: Data from 148 women with a diagnosis of chronic hypertension was analyzed. This analysis included both those taking antihypertensive medications and those who were not medicated. There was a significant difference in birth weight in normotensive (<140mmHg systolic or <90 mmHg diastolic) versus hypertensive pregnancies, with normotensive women bearing larger children. Median birth weight for those who had normotensive systolic blood pressures was 3,005g versus 2,450g for those who had hypertensive average systolic blood pressures (P=.008). Median birth weight was 2,997.5g for those with normotensive diastolic pressure averages versus 1,857.5g who were hypertensive (P<.001). CONCLUSION: Women with chronic hypertension in pregnancy deliver larger babies when blood pressures are in the normotensive range during the antepartum period.