Background: Iodine is necessary for fetal thyroid development. Excess maternal intake of iodine can cause fetal hypothyroidism due to the inability to escape from the Wolff-Chaikoff effect in utero. Case Report: We report a case of fetal hypothyroid goiter secondary to inadvertent excess maternal iodine ingestion from infertility supplements. The fetus was successfully treated with intra-amniotic levothyroxine injections. Serial fetal blood sampling confirmed fetal escape from the Wolff-Chaikoff effect in the mid third trimester. Early hearing test and neurodevelopmental milestones were normal. Conclusion: Intra-amniotic treatment of fetal hypothyroidism may decrease the rate of impaired neurodevelopment and sensorineural hearing loss.

Introduction Abundant research has reported twin‐twin transfusion syndrome (TTTS) outcomes following fetal therapy. Our research describes TTTS patients who did not undergo fetal therapy. Methods Records from TTTS pregnancies evaluated at 16 to 26 gestational weeks were reviewed between January 2006 and March 2017. The study population comprised subjects who did not undergo fetal therapy. Based on initial consultation, patients were grouped as nonsurgical vs surgical candidates. TTTS progression and perinatal outcomes were assessed. Results Of 734 TTTS patients evaluated, 68 (9.3%) did not undergo intervention. Of these, 62% were nonsurgical candidates and 38% were surgical candidates. Nonsurgical candidates were ineligible for treatment because of fetal demise or maternal factors (placental abruption, severe membrane separation, and preterm labor). Of surgical candidates, 11 underwent expectant management, eight elected pregnancy termination, and seven planned fetal intervention but had a complication before the procedure. TTTS progression occurred in 10 (15.2%) of 66 cases. Neonatal survival in 64 cases was as follows: in 41 (64%), no survivors; in 11 (17.2%), one survivor; and in 12 (18.8%), two survivors. Conclusion Nine percent of referred TTTS patients did not undergo fetal therapy, with many ineligible because of morbidity between referral and consultation. Studies of TTTS should acknowledge this subgroup and circumstances leading to lack of treatment.

INTRODUCTION: The incidence of STIs, specifically gonorrhea, chlamydia, and trichomoniasis among Los Angeles County residents is on the rise. One possible explanation is inadequate treatment, especially of sexual partners. Expedited partner therapy (EPT) is a method of treating patients' partners without a separate healthcare visit, which has been shown to decrease persistent and/or recurrent infections. We report on quality improvement outcomes following interventions to help increase the rates of EPT provision. METHODS: Interventions included creating a protocol with the pharmacy, arranging for Cefixime to be on formulary, and conducting resident training sessions. Data collection was performed on all positive gonorrhea (GC), chlamydia (CT) and trichomoniasis lab results seen from January 1, 2017 to February 27, 2019 across all departments, inclusive of Ob/Gyn. EPT rates before and after interventions are presented. RESULTS: The rates of EPT prescriptions provided by OB/GYN providers for STI treatment increased following the interventions. EPT for GC/CT increased from 40% to 55% of cases; EPT for Trichomonas increased from 38% to 85%. Interestingly, patients were often counseled on the need for partner treatment, but were not given prescriptions. This study includes only female patients seen by Ob/Gyn providers, though the majority of results were detected in the emergency department by non Ob/Gyn providers. CONCLUSION: Following interventions aimed at establishing agreements with the pharmacy as well as increasing awareness among residents, the EPT rates of gonorrhea, chlamydia, and trichomoniasis did increase significantly. This may assist with decreasing the rate of STI reinfection among County hospitals and hospitals supported by medical trainees.

INTRODUCTION: Abundant research has been conducted regarding patients with TTTS who underwent fetal therapy, i.e., laser surgery, amnioreduction, and umbilical cord occlusion. Here, we describe patients referred for TTTS who did not undergo fetal therapy. METHODS: TTTS gestations at 16-26 weeks referred between 1/2006 and 3/2017 were reviewed. Those who did not undergo fetal therapy comprised the final study population. Based on initial consultation data, patients were grouped as non-surgical vs. surgical candidates. TTTS progression and perinatal outcomes were assessed. RESULTS: 734 TTTS patients were evaluated. Of these, 68 (9.3%) did not undergo intervention; 42 non-surgical candidates (62%) and 26 surgical candidates (38%). Of the non-surgical candidates, 21 were ineligible because of fetal demise and 21 were ineligible because of maternal factors (12: preterm labor or preterm premature rupture of membranes, 7: placental abruption, 2: severe membrane separation). Of the surgical candidates, 11 underwent expectant management without subsequent intervention, 8 elected pregnancy termination, and 7 planned fetal intervention but had a complication before the procedure. Of 66 untreated cases, 10 (15.2%) had TTTS disease progression. Neonatal outcomes were available in 64 untreated cases: 41 (64%) had no survivors, 11 (17.2%) had one survivor and 12 (18.8%) had two survivors. CONCLUSION: 9% of referred TTTS patients did not undergo fetal therapy, with many ineligible because of the development of fetal demise or labor onset between referral and consultation. To avoid bias, studies tracking outcomes of TTTS should routinely acknowledge this subgroup and the circumstances leading to lack of treatment.