Objective Goals of the study are to estimate the pharmacokinetic(PK) parameters of standard dose betamethasone in a large obstetrical population and evaluate the effect of maternal body size and multiple gestation on the PK parameters and their observed variability. Study Design Prospective PK study. Liquid chromatography mass spectrometry was used to measure betamethasone plasma concentrations. PK parameters and significant clinical covariates were estimated using mixed effect modeling. Bootstrap analysis confirmed validity of the model. Results Two hundred and seventy four blood samples from 77 patients were obtained. Greatest effect on PK variability was observed with maternal lean body weight(LBW). The relationship between the PK parameters and LBW remained linear over a wide range of maternal body sizes. Multiple gestations did not affect the PK parameters. Conclusion Individualization of betamethasone dosing by maternal LBWreduces variability in drug exposure. Mutiple gestations do not require betamethasone dosing adjustment, because PK are the same as singleton gestations.

We sought to determine preventability for cases of obstetric hemorrhage, identify preventable factors, and compare differences between levels of hospital. We retrospectively reviewed a 1-year cohort of severe and near-miss obstetric hemorrhage in an urban perinatal network. An expert panel, using a validated preventability model, reviewed all cases. Preventability and distribution of preventability factors were compared between levels of hospital care. Sixty-three severe and near-miss obstetric hemorrhage cases were identified from 11 hospitals; 54% were deemed potentially preventable. Overall preventability was not statistically different by level of hospital, and 88% were provider related. The only treatment-related preventability factors were significantly different between levels of hospital and significantly less common in level III hospitals (p < 0.01). The majority of obstetric hemorrhage was preventable. The most common potentially preventable factor was provider treatment error, and this was significantly more common in level II hospitals. New interventions should be focused on decreasing providers' treatment errors.

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Actinomyces israelii is a gram-positive, filamentous anaerobic bacteria colonizing the oral and gastrointestinal tracts. Retroperitoneal actinomycotic abscess is uncommon and its rare presentation as a hemorrhagic mass may be confused with malignancy. We present a case of this unusual infection complicating pregnancy. Increased awareness of actinomycotic abscess in the differential diagnosis of renal mass concerning for malignancy is critical to early recognition and treatment of this rare infection and most importantly, avoidance of unnecessary surgical intervention.

Vacuum manufacturers recommend against utilizing their devices beyond three pop-offs, however there is a paucity of evidence to support this recommendation. Our objective was to examine whether the number of pop-offs in a vacuum-assisted delivery was associated with adverse neonatal outcomes. STUDY DESIGN: This is a retrospective cohort of women who underwent a trial of a vacuum-assisted vaginal delivery at a single tertiary care institution between October 2005 and June 2014. Maternal and fetal factors associated with the number of pop-offs were examined in bivariable analyses. Multivariable analyses were performed to determine the independent association of the number of pop-offs with adverse neonatal outcomes. RESULTS: Of the 1838 women who met inclusion criteria, 1296 (70.5%) had no pop-offs, 241 (13.1%) had one pop-off, 129 (7.0%) had two pop-offs, and 74 (4.0%) had three or more pop-offs. Neonatal scalp/facial lacerations, intracranial hemorrhage, seizures, central nervous system depression, and NICU admission were all associated with the number of pop-offs in bivariable analyses. In multivariable analyses, compared to no pop-offs, having vacuum pop-offs was associated with an increased risk of adverse outcomes, however there was not a consistent increase in adverse events associated with three or more pop-offs (with aOR and 95% CI after adjusting for nulliparity, chorioamnionitis, arrest/exhaustion indication for operative delivery, and occiput posterior presentation presented in the Table). CONCLUSION: While having vacuum pop-offs in a vacuum-assisted delivery was associated with an increased risk of adverse neonatal outcomes, there did not appear to be a dose dependent association with the number of pop-offs, thereby calling the three pop-off convention into question.