Objective  To evaluate the relationship between maternal fever at the time of hospital admission and subsequent maternal morbidity in pregnant patients with pyelonephritis. Study Design  In this retrospective cohort study, inpatient records were reviewed for all obstetric patients discharged from a single tertiary care hospital between June 1, 2011, and May 30, 2017, with the diagnosis of pyelonephritis. Patients were stratified into two groups, those with and without fever at the time of admission. Descriptive statistics were utilized to evaluate the association of fever at the time of presentation with subsequent morbidity. Using admission vital signs, maternal early warning criteria (MEWC) were applied and odds ratios calculated to predict intensive care unit (ICU) admission. Results  A total of 110 patients were admitted with pyelonephritis in pregnancy; 24 patients were febrile and 86 patients were afebrile on admission. There was no difference in rates of maternal ICU admission between both groups. Positive MEWC was predictive of ICU admission with an adjusted odds ratio of 16.54 (95% confidence interval: 1.29–212.5; p  = 0.03). Conclusion  Afebrile pregnant patients with pyelonephritis remain at risk of significant maternal morbidity. Application of the MEWC on admission identifies patients at higher risk of ICU admission.

Objective To determine the optimal sonographic dating of dichorionic gestations. Materials and Methods We reviewed dichorionic pregnancies conceived with assisted reproductive technologies (ART) at 2 institutions between 2006–2016, excluding fetuses with major anomalies. Gestational age was calculated with smaller, larger, and mean of the crown‐rump lengths (CRL) and biometry midgestation and compared to the ART age. The mean and mean absolute deviation of the observed gestational age from the ART age was calculated to assess accuracy, precision, and presence of bias. The incidence of small for gestational age using the smaller and larger CRLs was compared to the ART age via McNemar's test. Results Based on 140 ultrasounds, the CRL from the smaller twin best approximates the true gestational age with least bias compared to the larger twin or average (mean absolute deviation: 2.8, mean deviation: –0.1 [95% CI: −0.4, 0.2] versus 2.7, −0.9 [−1.1, −0.6] and 2.9, −1.5 [−1.8, −1.3], in days, respectively). Based on 165 ultrasounds, biometry from the smaller fetus is least accurate compared to the larger or mean (11.8, 2.5 [1.5, 3.6] versus 11.7, 0.8 [−0.3, 1.8] and 11.9, −1.0 [−2.0, 0.04], respectively). The incidence of small for gestational age neonates did not differ from the true rate using either the CRL from the larger or smaller twin (p > .05). Conclusion In ART dichorionic gestations, ultrasound of the smaller fetus is most accurate in establishing gestational age in the first trimester but least accurate in the second, though all methods performed well with little clinical difference.

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INTRODUCTION: We evaluate the effect of a selective early postpartum magnesium cessation protocol in patients diagnosed with preeclampsia with severe features. METHODS: A standardized protocol was implemented in March 2017 identifying patients at lower risk of postpartum eclampsia, and thus eligible for early discontinuation of magnesium sulfate at 12 hours postpartum. An IRB approved, retrospective cohort study was performed of all patients with preeclampsia with severe features 25 months before and after protocol implementation. The primary outcome assessed was the incidence of postpartum readministration of magnesium sulfate after completion of the initial course. RESULTS: Preeclampsia with severe features was identified in 737 patients with exclusion of 58 patients due to postpartum preeclampsia diagnosis or eclampsia prior to initial magnesium cessation. While the rate of preeclampsia with severe features increased (3.9% vs 7.0%, p<.001) in the pre and post-implementation groups, there was no difference in the rate of eclampsia (0.03% vs 0.05%, P=.59). Analysis included 272 patients pre and 407 patients post protocol implementation. Rates of early magnesium cessation, less than 23 hours of postpartum magnesium, were 11.1% vs 55.5% pre and post protocol implementation. In patients who underwent early magnesium cessation (n=226), there was no significant difference in postpartum readministration of magnesium (1.5% vs 3%, P=.25). There was no difference in readmission for hypertensive disorders of pregnancy (1.1% vs 2.5%, P=.20). CONCLUSION: In patients with preeclampsia with severe features who underwent selective early magnesium cessation there was no difference in postpartum readministration of magnesium sulfate or readmission for hypertensive disorders of pregnancy.