Medicine and Health Sciences Commons^™

Obstetric Outcomes After In Vitro Fertilization In Obese And Morbidly Obese Women., Anuja Dokras, Lindsey Baredziak, Jill Blaine, Craig Syrop, Bradley Van Voorhis, Amy Sparks

Amy E.T. Sparks

OBJECTIVE: In addition to numerous health detriments caused by obesity, fertility and pregnancy success may also be compromised. The aims of this study were to compare the effects of obesity and morbid obesity on in vitro fertilization (IVF) outcomes. We also investigated the effects of obesity on obstetric outcomes after IVF treatment. METHODS: Retrospective study of women less than 38 years of age during their first fresh IVF cycle (January 1995 to April 2005). RESULTS: A total of 1,293 women were included in the study, with 236 obese women (body mass index [BMI] = 30-39.9) and 79 morbidly obese women …

Cyclophosphamide Therapy In A Serious Case Of Lupus Nephritis During Pregnancy., H Kart Köseoglu, A. Yücel, G. Künefeci, F. Ozdemir, E. Duran

Eyup Hakan Duran

Systemic lupus erythematosus (SLE) flare is common, and renal involvement is one of the most serious problems during pregnancy. Aggressive immunosuppressive therapy should be considered for patients with diffuse proliferative lupus nephritis. These individuals are at high risk for progression to end-stage renal disease. Immunosuppressive drugs can cause significant toxic and teratogenetic effects. In this report, we describe the case of a pregnant patient with lupus nephritis who was treated with cyclophosphamide. The patient was in the second trimester of her first pregnancy and did not respond to corticosteroid therapy. She underwent intensive in-hospital care while she was on cyclophosphamide …

Obstetric Outcomes After In Vitro Fertilization In Obese And Morbidly Obese Women., Anuja Dokras, Lindsey Baredziak, Jill Blaine, Craig Syrop, Bradley Van Voorhis, Amy Sparks

Bradley J Van Voorhis

OBJECTIVE: In addition to numerous health detriments caused by obesity, fertility and pregnancy success may also be compromised. The aims of this study were to compare the effects of obesity and morbid obesity on in vitro fertilization (IVF) outcomes. We also investigated the effects of obesity on obstetric outcomes after IVF treatment. METHODS: Retrospective study of women less than 38 years of age during their first fresh IVF cycle (January 1995 to April 2005). RESULTS: A total of 1,293 women were included in the study, with 236 obese women (body mass index [BMI] = 30-39.9) and 79 morbidly obese women …

Experience With An Adolescent Pregnancy Program. A Preliminary Report, D. Youngs, Jennifer Niebyl, D. Blake, D. Shipp, J. Stanley, T. King

Jennifer R Niebyl

A program has been designed to give comprehensive health care services to pregnant adolescents. The program components include community liason, patient education, counseling and social services, a nurse "on call" program for labor and delivery, and pediatric nurse-practitioner followup. In addition, a drug use identification component screens the patients by interview and urinalysis. Hypertensive disorders of pregnancy occurred in 10% of the first 202 patients. Forty-three percent had anemia (hematocrit less than 35%), and screening cervical cultures for gonorrhea were positive in 3.5%. Cigarettes, alcohol, and marijuana constituted the most common nonmedical drugs used, and aspirin the most common medical …

Antibiotics And Other Anti-Infective Agents In Pregnancy And Lactation, Jennifer Niebyl

Jennifer R Niebyl

Serum levels of many drugs are lower in pregnancy compared with the nonpregnant state. Their renal clearance is higher and the maternal intravascular volume is expanded. Most antibiotics are safe for use in pregnancy and lactation. Tetracyclines cause fetal tooth discoloration and inhibition of bone growth if used in the second and third trimesters. Aminoglycosides carry a small risk of fetal ototoxicity. Quinolones may cause arthropathies in children, and so are currently not recommended for use in pregnancy. Most drugs are secreted into breast milk in very small amounts, not enough to have any therapeutic effect. The only antibiotics which …

Prevention Of Perinatal Transmission Of Hepatitis B Virus: The Sensitivity, Specificity, And Predictive Value Of The Recommended Screening Questions To Detect High-Risk Women In An Obstetric Population, G. Mcquillan, T. Townsend, C. Johannes, T. Dillard, R. Molteni, P. Ness, Jennifer Niebyl

Jennifer R Niebyl

The Advisory Committee on Immunization Practices recommends that all pregnant women be questioned concerning risk factors for hepatitis B virus infection and that those giving positive responses be serotested. The sensitivity, specificity, and predictive value of those recommended questions among 692 parturient women were determined. A total of 59 currently or previously infected women (hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), or antibody to hepatitis B core antigen (anti-HBc) seropositive) were compared with the 633 seronegative women. Among nonwhite women, the sensitivity of a positive response to any one of the recommended questions was 60%. …

The Validity Of The Leukocyte Esterase Reagent Test Strip In Detecting Significant Leukocyturia, G. Marquette, T. Dillard, S. Bietla, Jennifer Niebyl

Jennifer R Niebyl

This prospective trial demonstrated that the best possible definition for a positive leukocyte esterase test (Chemstrip 9) is + or ++. With use of this definition, the sensitivity in detecting significant leukocyturia is 83% and the specificity is 70%. The use of this test strip could reduce screening costs in registering obstetric patients.

The Bland-White-Garland Syndrome In Pregnancy, V. Klein, J. Repke, G. Marquette, Jennifer Niebyl

Jennifer R Niebyl

No abstract provided.

The Glycosphingolipid Composition Of The Placenta Of A Blood Group P Fetus Delivered By A Blood Group Pk1 Woman And Analysis Of The Anti-Globoside Antibodies Found In Maternal Serum, G. Hansson, K. Wazniowska, J. Rock, P. Ness, T. Kickler, R. Shirey, Jennifer Niebyl, D. Zopf

Jennifer R Niebyl

To further define the molecules that may mediate spontaneous abortion due to maternal-fetal blood group incompatibility within the P blood group system, we have examined the fine specificities of maternal antibodies and the glycolipid antigens from the placenta of a P infant born to a Pk1 mother. Maternal antibodies obtained during therapeutic plasmapheresis were analyzed to determine their reactivities with placental glycolipid extracts on thin-layer plates. Second antibodies specific for IgM, IgG, and IgA revealed immunoglobulins of all of these classes strongly reactive with one major placental glycolipid that comigrates with globoside. GC/MS analysis confirmed that the major P-active pentaglycosylceramide …

Use Of Antibiotics For Ear, Nose, And Throat Disorders In Pregnancy And Lactation, Jennifer Niebyl

Jennifer R Niebyl

No abstract provided.

Metastatic Adenocarcinoma Of The Lung Complicating Pregnancy. A Case Report, R. Suda, J. Repke, R. Steer, Jennifer Niebyl

Jennifer R Niebyl

A case of large cell undifferentiated adenocarcinoma of the lung was complicated by an aggressive clinical course and documented placental metastases. The management of these neoplasms is complex, requiring one to pay attention to the maternal, as well as fetal and neonatal, prognosis.

Acute Bacterial Endocarditis With Postpartum Aortic Valve Replacement, R. Cavalieri, L. Watkins, R. Abraham, H. Berkay, Jennifer Niebyl

Jennifer R Niebyl

A case of acute bacterial endocarditis with aortic valve abscess, aortic insufficiency, and congestive heart failure at 32 weeks' gestation is described. Prompt valve replacement is indicated due to the risks of embolism to the coronary arteries and brain, and to the high mortality of such patients with medical management only. The infant was delivered prematurely to avoid the intraoperative risks to the fetus of cardiac surgery. General rather than regional anesthesia was chosen because venous pooling from a regional block would necessitate preoperative fluid loading and vasopressor therapy, which would be stressful for an already failing heart. In the …

Management Of Sickle Cell Disease In Pregnant Patients, S. Charache, J. Scott, Jennifer Niebyl, D. Bonds

Jennifer R Niebyl

Data from a total of 74 pregnancies in 42 patients with sickling disorders seen at Johns Hopkins Hospital are compared with similar data from other centers. Although risks are still higher than those for women without sickle cell disease, they have diminished significantly from those reported earlier. Prophylactic transfusion therapy may decrease these risks further, but benefits of transfusion are unproved at present. Patients with sickling disorders should receive meticulous individualized treatment until further data are made available.

Pregnancy In Sickle Cell Disease, S. Charache, Jennifer Niebyl

Jennifer R Niebyl

No abstract provided.

Marijuana Use In Pregnancy And Pregnancy Outcome, F. Witter, Jennifer Niebyl

Jennifer R Niebyl

A retrospective analysis utilizing historical data collected as part of our computerized data base was performed to assess the impact of marijuana use in pregnancy on pregnancy outcome. Records of 8350 patients were reviewed and 417 patients gave a history of only marijuana use for a prevalence of 5%. There was no association between marijuana use and prematurity or congenital anomalies. Marijuana use was strongly associated with the use of alcoholic beverages and smoking. Previously reported associations may represent the concomitant use of these other drugs.

Cervical Cancer Diagnosed Shortly After Pregnancy: Prognostic Variables And Delivery Routes, A. Sood, J. Sorosky, N. Mayr, B. Anderson, R. Buller, Jennifer Niebyl

Jennifer R Niebyl

No abstract provided.

Perinatal Management Of Women With Immune Thrombocytopenic Purpura: Survey Of United States Perinatologists, D. Peleg, Stephen Hunter

Stephen K. Hunter

OBJECTIVE: The aim of the study was to determine how perinatologists in the United States manage the care of women with immune thrombocytopenic purpura with respect to mode of delivery. Study Design: US members of the Society of Perinatal Obstetricians were surveyed with a 4-question questionnaire. Two mailings were sent. Questions 1 and 2 asked for a response regarding the perinatal management of delivery for women with chronic immune thrombocytopenic purpura and new-onset disease. The options were cordocentesis or fetal scalp blood sampling and cesarean delivery if the platelet count was <50,000 cells/microL, cesarean delivery if the maternal platelet count …

Periodontal Disease In Pregnancy Complicated By Type 1 Diabetes Mellitus, J. Guthmiller, J. Hassebroek-Johnson, D. Weenig, G. Johnson, H. Kirchner, F. Kohout, Stephen Hunter

Stephen K. Hunter

BACKGROUND: Systemic disease and hormonal changes have been implicated as complicating factors for periodontal disease. Diabetes has been identified as a risk factor for periodontal disease, and diabetics can experience periodontal destruction at an earlier age than non-diabetic individuals. Increased hormone levels during pregnancy can contribute to increased gingival inflammation. The purpose of this study was to examine the association of type 1 diabetes mellitus (DM) on the periodontal status of pregnant women. METHODS: Thirty-three (13 diabetic and 20 non-diabetic) subjects, 20 to 39 weeks gestation, participated in this study. The mean age of the diabetics and non-diabetics was 28.5 …

Cell Encapsulation As A Potential Nondietary Therapy For Maternal Phenylketonuria., Donna Santillan, Mark Santillan, Stephen Hunter

Stephen K. Hunter

OBJECTIVE: The objective of this work was to determine whether cells overexpressing phenylalanine (Phe) hydroxylase (PAH) can significantly reduce Phe in vitro for potential use as a therapy for preventing maternal phenylketonuria.

STUDY DESIGN: Human 293T and WRL68 cell lines were transiently and stably transfected to overexpress PAH. Cells were encapsulated within microspheres of sodium alginate. Timed measurements of Phe in media were performed using tandem mass spectrometry.

RESULTS: Both nonencapsulated and encapsulated transiently transfected cells overexpressing PAH significantly reduced the Phe concentration in media by approximately 50% in comparison to mock-transfected cells. Cell line clones stably expressing PAH significantly …

Leukemia In Pregnancy And Fetal Response To Multiagent Chemotherapy, W. Hansen, P. Fretz, Stephen Hunter, J. Yankowitz

Stephen K. Hunter

BACKGROUND: Leukemia is rare in pregnancy and treatment with intensive, multiagent chemotherapy produces complete remission in most adults, but might have deleterious effects on fetuses. CASE: A 24-year-old gravida 3 para 2 presented at 24 weeks with pruritus, rash, pancytopenia, and hepatitis. A bone marrow biopsy found acute lymphocytic leukemia. She completed three cycles of intensive multiagent chemotherapy with transient oligohydramnios in each cycle. Although there was decreased fetal growth rate, umbilical artery Doppler scans were normal. She delivered a normal 2150-g male infant at 36 weeks. CONCLUSION: Pregnant women with newly diagnosed leukemia should not delay treatment, but multiagent …

Asthma In Pregnancy: Pathophysiology, Diagnosis And Management., Abbey Hardy-Fairbanks, Emily Baker

Abbey J Hardy-Fairbanks

Asthma is a common, potentially serious, even life-threatening, chronic medical condition seen amongst nearly all groups of patients, regardless of ethnicity and socioeconomic circumstances. This article addresses the group of pregnant women with symptomatic asthma as well as those whose asthma is asymptomatic as a result of good control. The incidence, the pathophysiologic changes of pregnancy, and the interplay between these changes and asthma are reviewed in this article. The classification of these patients and appropriate management strategies are discussed.

Acute Intrauterine Infection Results In An Imbalance Between Pro- And Anti-Inflammatory Cytokines In The Pregnant Rabbit., Kimberly Leslie, S. Lee, S. Woodcock, J. Davies, R. Mcduffie, E. Hirsch, M. Sherman, J. Eskens, R. Gibbs

Kimberly K. Leslie

PROBLEM: Intrauterine infection results in an increase in cytokines. This study compared the time courses for the pro- and anti-inflammatory cytokine responses in 33 pregnant rabbits at 70% gestation. Pro-inflammatory markers were activated nuclear factor-kappa B (NF-kappaB) in placenta and tumor necrosis factor-alpha (TNF-alpha) in amniotic fluid. These were compared to the anti-inflammatory cytokine, interleukin-1 receptor antagonist (IL-1ra), in placenta and uterus. METHOD OF STUDY: Does were endoscopically inoculated with Escherichia coli through their cervices and sacrificed at six intervals between 0 and 30 hr post-inoculation. RESULTS: Activated NF-kappaB, determined by electromobility gel shift assay, increased significantly 16 hr after …

Histologic Inflammation In The Maternal And Fetal Compartments In A Rabbit Model Of Acute Intra-Amniotic Infection., J. Davies, R. Shikes, C. Sze, Kimberly Leslie, R. Mcduffie, R. Romero, R. Gibbs

Kimberly K. Leslie

OBJECTIVE: This study was undertaken to determine the course of acute inflammation in the maternal and fetal compartments during experimentally induced ascending intra-amniotic infection. STUDY DESIGN: Forty pregnant rabbits at 70% gestation were inoculated endocervically with 10(5) colony-forming units of Escherichia coli. Does were killed at 0, 4, 8, 16, 24, and 30 hours after inoculation. At necropsy, blood, peritoneal fluid, amniotic fluid, and uterine tissue were cultured. Fetal brain, lung, heart, gut, and kidney were collected for histologic examination. Necrosis, infiltrates, congestion, and edema were each assessed semiquantitatively, and mean composite histologic-inflammation scores were compared with analysis of variance. …

Estrogens In Intrahepatic Cholestasis Of Pregnancy., Kimberly Leslie, L. Reznikov, F. Simon, P. Fennessey, H. Reyes, J. Ribalta

Kimberly K. Leslie

OBJECTIVE: To determine whether estrogen production and excretion are impaired in gravidas with intrahepatic cholestasis. METHODS: Plasma and urine samples were collected from 13 women from the United States and Chile at 35-38 weeks' gestation with mild (n = 9) or severe (n = 4) intrahepatic cholestasis of pregnancy. Urinary and plasma steroid levels from women with cholestasis were compared with levels from 27 normal pregnant women within the same gestational age range. Urinary concentrations of dehydroepiandrosterone (DHEA), estrone (E1), estradiol (E2), estriol (E3), estetrol, progesterone, and 16-hydroxy-pregnenolone were measured by gas chromatography mass spectrometry, and plasma concentrations of DHEA …

A Randomized Controlled Trial Of Interleukin-1 Receptor Antagonist In A Rabbit Model Of Ascending Infection In Pregnancy., R. Mcduffie, J. Davies, Kimberly Leslie, S. Lee, M. Sherman, R. Gibbs

Kimberly K. Leslie

OBJECTIVE: To determine whether treatment with interleukin-1 receptor antagonist (IL1-ra) would affect amniotic fluid concentrations of tumor necrosis factor alpha (TNF-alpha) and prostaglandins or clinical or microbiological outcomes in a model of ascending bacterial infection in pregnancy. METHODS: Timed pregnant New Zealand white rabbits at 70% of gestation underwent endoscopic inoculation of the cervices with 10(6) - 10(7) cfu Escherichia coli. Animals were randomly assigned in a blinded manner to a 5-h intravenous infusion of human IL1-ra (10 mg/kg) or placebo beginning 1-2 h after inoculation. Blood was drawn from the does for assay of serum IL1-ra concentration before inoculation, …

Targeted Treatment Using Monoclonal Antibodies And Tyrosine-Kinase Inhibitors In Pregnancy, A. Robinson, W. Watson, Kimberly Leslie

Kimberly K. Leslie

An expanding knowledge of the signalling pathways involved in the cell cycle has led to great improvements in the understanding of the molecular events involved in carcinogenesis. The past decade has seen substantial advances with the introduction of several classes of targeted therapeutics for the treatment of various cancers and autoimmune disorders. However, the question arises as to whether pregnant women can take advantage of these new treatments in view of the potential risks to the fetus. Published work suggests that biological agents, like traditional treatments, have the potential to affect the fetus, and should, therefore, be used with caution …

Chronic Intrauterine Infection And Inflammation In The Preterm Rabbit, Despite Antibiotic Therapy, R. Gibbs, J. Davies, R. Mcduffie, Kimberly Leslie, M. Sherman, C. Centretto, D. Wolf

Kimberly K. Leslie

OBJECTIVE: In a pregnant rabbit model using intracervical inoculation of Escherichia coli with delayed antibiotic therapy, we investigated the rate of positive cultures and histologic inflammation of maternal and fetal compartments and the concentration of tumor necrosis factor-alpha in the amniotic fluid for up to 5 days. STUDY DESIGN: New Zealand White rabbits at 70% gestation were inoculated intracervically with 10(3) - 10(4) colony-forming units of E coli per uterine horn. At varying intervals after inoculation (0.5 - 4.0 hours), antibiotic therapy was initiated with ampicillin-sulbactam. Primary outcomes were positive cultures and histologic inflammation score. Tumor necrosis factor-alpha levels in …

Breast Cancer And Pregnancy, Kimberly Leslie, C. Lange

Kimberly K. Leslie

This article addresses a challenging diagnostic and treatment dilemma encountered in the care of pregnant women-breast cancer. The treatment of a breast cancer is significantly affected by an ongoing pregnancy and may result in an increased risk for a poor outcome in the mother. The definition, incidence, mechanism, diagnosis, and treatment of breast cancer associated with pregnancy and the normal physiologic and endocrine changes in the breast during pregnancy that contribute to the difficulty encountered by practitioners in diagnosing and treating the disorder are reviewed. The risks associated with pregnancy after breast cancer treatment and the effect of pregnancy on …

Chemotherapeutic Drugs In Pregnancy, Kimberly Leslie, C. Koil, W. Rayburn

Kimberly K. Leslie

Chemotherapy may be indicated for the treatment of cancer during pregnancy. The decision to use chemotherapy significantly impacts the pregnancy, and in turn the pregnancy may affect the treatment options available to patients with cancer. This review provides information about the effects of chemotherapeutic agents in pregnancy, taking into account both the mother and the fetus. For convenience, the agents are divided into categories based upon class and mechanism of action. These include alkylating agents, antimetabolites, nucleoside analogs, topoisomerase I inhibitors, topisomerase II inhibitors, vinca alkaloids, taxanes, and biologics such as signaling and growth factor blocking agents.

Chronic Hepatitis C In Pregnancy, E. Berkley, Kimberly Leslie, S. Arora, C. Qualls, J. Dunkelberg

Kimberly K. Leslie

OBJECTIVE: To estimate outcomes, to determine whether appropriate follow-up was performed for pregnant patients with hepatitis C virus (HCV), and to show that maternal and neonatal complications would be higher in the HCV-positive group. METHODS: We compared pregnant women from a drug dependence and treatment program who were HCV antibody-positive with those who were HCV antibody-negative using the University of New Mexico Perinatal Database. Maternal and neonatal outcomes were evaluated, including cholestasis of pregnancy, preterm birth, low birth weight, neonatal intensive care unit admissions, and neonatal methadone withdrawal. Variables were compared using Student t, Fisher exact, and chi(2) tests. RESULTS: …