Obstetrics and Gynecology Commons^™

Severe Propylthiouracil-Induced Hepatotoxicity In Pregnancy Managed Successfully By Liver Transplantation: A Case Report, Evan Sequeira, Sikolia Wanyonyi, Raj Dodia

Obstetrics and Gynaecology, East Africa

Introduction: Propylthiouracil-induced severe hepatotoxicity is a relatively rare occurrence, with very few cases reported in the literature. The management of this complication in pregnancy can be a challenge because of the effects of the various treatment options on the fetus.

Case presentation: We report a rare case of fulminant hepatic failure in a 36-year-old gravida 2 black woman of African descent that occurred at 17 weeks gestation following propylthiouracil treatment for Graves’ disease. Her liver failure was managed by liver transplantation and thyroidectomy. Her pregnancy was continued to term, though with not so favorable early childhood sequelae.

Conclusion: This case …

Domestic Violence And Pregnancy: The Challenge Of Framing A European-Wide Research Question., Caroline Andries, Nicola Buckley, Kristien Roelens, Ingunn Studsrød, Marleen Temmerman, An-Sofie Van Parys, Elisabeth Willumsen

Obstetrics and Gynaecology, East Africa

No abstract provided.

Primary Hyperparathyrodism In Pregnancy And Review Of Literature, Tahira Naru, Rozilla Sadia Khan, Mohammed Ataullah Khan

Department of Obstetrics & Gynaecology

hyperparathyroidism (PHPT) is rare condition during pregnancy; however, it can carry significant risks to both mother and foetus during and after the pregnancy. The definitive treatment is parathyroidectomy undertaken preferably in the second or early third trimester. A case of asymptomatic PHPT diagnosed and treated by parathyroidectomy in the third trimester is described.

Ouabain Stimulates A Na+/K+-Atpase-Mediated Sfk-Activated Signalling Pathway That Regulates Tight Junction Function In The Mouse Blastocyst., Holly Giannatselis, Michele Calder, Andrew J Watson

Obstetrics & Gynaecology Publications

The Na(+)/K(+)-ATPase plays a pivotal role during preimplantation development; it establishes a trans-epithelial ionic gradient that facilitates the formation of the fluid-filled blastocyst cavity, crucial for implantation and successful pregnancy. The Na(+)/K(+)-ATPase is also implicated in regulating tight junctions and cardiotonic steroid (CTS)-induced signal transduction via SRC. We investigated the expression of SRC family kinase (SFK) members, Src and Yes, during preimplantation development and determined whether SFK activity is required for blastocyst formation. Embryos were collected following super-ovulation of CD1 or MF1 female mice. RT-PCR was used to detect SFK mRNAs encoding Src and Yes throughout preimplantation development. SRC and …

The Effects Of Smoking On Pregnant Women, Meir Cohen

The Science Journal of the Lander College of Arts and Sciences

Smoking during pregnancy is accepted as the most significant avoidable risk factor for an unsuccessful pregnancy result. Smoking is linked with fetal growth restriction, and increasing evidence also suggests that smoking can cause stillbirth, preterm birth, placental abruption, and possibly sudden infant death syndrome. Smoking during pregnancy is also associated with enhanced risks of spontaneous abortions, ectopic pregnancies, and placenta previa, and it might increase risks of behavioral disorders in childhood. Studies have shown with randomized controlled trials, that smoking intervention during pregnancy has had limited success. Smoking during pregnancy continues to be an important risk factor for maternal and …

Prenatal Maternal Stress Programs Infant Stress Regulation, Elyssia Poggi Davis, Laura M. Glynn, Feizal Waffarn, Curt A. Sandman

Psychology Faculty Articles and Research

Objective: Prenatal exposure to inappropriate levels of glucocorticoids (GCs) and maternal stress are putative mechanisms for the fetal programming of later health outcomes. The current investigation examined the influence of prenatal maternal cortisol and maternal psychosocial stress on infant physiological and behavioral responses to stress.

Methods: The study sample comprised 116 women and their full term infants. Maternal plasma cortisol and report of stress, anxiety and depression were assessed at 15, 19, 25, 31 and 36 + weeks' gestational age. Infant cortisol and behavioral responses to the painful stress of a heel-stick blood draw were evaluated at 24 hours after …

Prenatal Programming Of Human Neurological Function, Curt A. Sandman, Elyssia Poggi Davis, Claudia Buss, Laura M. Glynn

Psychology Faculty Articles and Research

The human placenta expresses the genes for proopiomelanocortin and the major stress hormone, corticotropin-releasing hormone (CRH), profoundly altering the "fight or flight" stress system in mother and fetus. As pregnancy progresses, the levels of these stress hormones, including maternal cortisol, increase dramatically. These endocrine changes are important for fetal maturation, but if the levels are altered (e.g., in response to stress), they influence (program) the fetal nervous system with long-term consequences. The evidence indicates that fetal exposure to elevated levels of stress hormones (i) delays fetal nervous system maturation, (ii) restricts the neuromuscular development and alters the stress response of …

Development Of Fetal Movement Between 26 And 36 Weeks’ Gestation In Response To Vibroacoustic Stimulation, Marybeth Grant-Beuttler, Laura M. Glynn, Amy L. Salisbury, Elyssia Poggi Davis, Carol Holliday, Curt A. Sandman

Psychology Faculty Articles and Research

BACKGROUND: Ultrasound observation of fetal movement has documented general trends in motor development and fetal age when motor response to stimulation is observed. Evaluation of fetal movement quality, in addition to specific motor activity, may improve documentation of motor development and highlight specific motor responses to stimulation.

AIM: The aim of this investigation was to assess fetal movement at 26 and 36-weeks gestation during three conditions (baseline, immediate response to vibro-acoustic stimulation (VAS), and post-response).

DESIGN: A prospective, longitudinal design was utilized.

SUBJECTS: Twelve normally developing fetuses, eight females and four males, were examined with continuous ultrasound imaging.

OUTCOME MEASURES: …

Factor Vii Deficiency And Pregnancy: A Case Report And Review Of Literature, Syed Mohammad Asad Zaidi, Rahat Qureshi, Salman Naseem Adil

Department of Obstetrics & Gynaecology

Factor VII deficiency is one of the 'rare inherited disorders of coagulation.' Few cases of Factor VII deficiency have been reported during pregnancy, a state which could potentially cause fatal haemorrhage. Here we report a case of a pregnant lady with a history of heavy menorrhagia and multiple first pregnancy failures. Delivery was carried out via Caesarean section due to non-reassuring foetal heart monitoring. Patient was treated with Fresh Frozen Plasma (FFPs) and Factor VII concentrates, however, the patient developed bleeding postoperatively. Literature indicates that whilst Factor VII levels rise during pregnancy in normal women, no increase is seen in …

Pregnancy Associated Breast Cancer: An Analysis Of Fetal Treatment Risk, Melissa Barnett

The Science Journal of the Lander College of Arts and Sciences

There are several viable treatment options for patients with PABC considered un-harmful to fetal development. Trastusumab, or Herceptin, targets HER2 protein and successfully combats aggressive breast cancer. In standard doses, it appears to be safe to the fetus even when administered during the first trimester. A likely side effect of Herceptin is anhydramnios, which can be monitored for throughout the stages of a pregnancy (Shrim et al. 2008). Anthracyclines, commonly used in chemotherapy, appear to be non-toxic, and have been used to successfully cure PABC patients in their second and third trimester. However, first trimester spontaneous abortions are documented to …

Prenatal Beta-Endorphin As An Early Predictor Of Postpartum Depressive Symptoms In Euthymic Women, Ilona S. Yim, Laura M. Glynn, Christine Dunkel Schetter, Calvin J. Hobel, Aleksandra Chicz-Demet, Curt A. Sandman

Psychology Faculty Articles and Research

After delivery, many women experience symptoms of postpartum depression (PPD), and early identification of women at risk is therefore important. The opioid peptide [beta]-endorphin has been implicated in non-puerperal depression but its role in the development of PPD is unknown.

Communalism Predicts Prenatal Affect, Stress, And Physiology Better Than Ethnicity And Socioeconomic Status, Cleopatra M. Abdou, Christine Dunkel Schetter, Belinda Campos, Clayton J. Hilmert, Tyan Parker Dominguez, Calvin J. Hobel, Laura M. Glynn, Curt A. Sandman

Psychology Faculty Articles and Research

The authors examined the relevance of communalism, operationalized as a cultural orientation emphasizing interdependence, to maternal prenatal emotional health and physiology and distinguished its effects from those of ethnicity and childhood and adult socioeconomic status (SES). African American and European American women (N = 297) were recruited early in pregnancy and followed through 32 weeks gestation using interviews and medical chart review. Overall, African American women and women of lower socioeconomic backgrounds had higher levels of negative affect, stress, and blood pressure, but these ethnic and socioeconomic disparities were not observed among women higher in communalism. Hierarchical multivariate regression analyses …

Hiv/Aids And Pregnancy-Related Deaths In Blantyre, Malawi, V. M. Lema, C. Kanyighe, J. Changole, E. V. Malunga

Obstetrics and Gynaecology, East Africa

Background: HIV/AIDS epidemic is one of the major factors affecting women’s health and impeding national efforts to improve it especially in sub-Saharan Africa. Current evidence indicates that HIV/ AIDS is increasingly becoming a major cause or contributing factor to pregnancy-related deaths, almost overtaking the “traditional” causes and factors.

Objectives: To survey the contribution of HIV infection and AIDS to pregnancy-related deaths in Blantyre, Malawi.

Design: A retrospective, descriptive, facility-based survey.

Setting: The Queen Elizabeth Central Teaching Hospital, Blantyre, Malawi.

Subjects: All women recorded to have had pregnancy-related deaths between January 1, 1999 and December 31, 2000.

Results: There were …

Mitogen-Activated Protein Kinase (Mapk) Pathways Mediate Embryonic Responses To Culture Medium Osmolarity By Regulating Aquaporin 3 And 9 Expression And Localization, As Well As Embryonic Apoptosis., Christine E Bell, Nathalie M K Larivière, Patricia H Watson, Andrew J Watson

Obstetrics & Gynaecology Publications

BACKGROUND: In order to advance the development of culture conditions and increase the potential for supporting normal preimplantation embryo development in vitro, it is critical to define the mechanisms that early embryos utilize to survive in culture. We investigated the mechanisms that embryos employ in response to culture medium osmolarity. We hypothesized that mitogen-activated protein kinase (MAPK) pathways mediate responses to hyperosmotic stress by regulating Aquaporin (AQP) 3 and 9 expression as well as embryonic apoptosis.

METHODS: Real-time reverse transcription and polymerase chain reaction and whole-mount immunofluorescence were used to determine the relative mRNA levels and protein localization patterns of …

Elevated Corticotropin-Releasing Hormone In Human Pregnancy Increases The Risk Of Postpartum Depressive Symptoms, Ilona S. Yim, Laura M. Glynn, Christine Dunkel Schetter, Calvin J. Hobel, Aleksandra Chicz-Demet, Curt A. Sandman

Psychology Faculty Articles and Research

Postpartum depression (PPD) is common and has serious implications for the mother and her newborn. A possible link between placental corticotropin-releasing hormone (pCRH) and PPD incidence has been discussed, but there is a lack of empirical evidence.

Perinatal Outcomes In Pregnancy With Asthma, Rashid Zaheer Syed, Ali Bin Sarwar Zubairi, Muhammad Ahsan Zafar, Rahat Qureshi

Department of Obstetrics & Gynaecology

Objective: To examine the relationship between asthmatic pregnancies and selected maternal and neonatal outcomes in a representative cohort.

Methods: A retrospective cohort study was conducted at the Aga Khan University Hospital during the year 2004. A random selection was made of 65 asthmatic and 63 non-asthmatic singleton births. The neonatal outcomes studied were birth weight, premature birth and Apgar scores at 1 and 5 minutes. The maternal outcomes studied were number of hospital admissions, and number of documented UTI during the studied pregnancy and past history of abortions and stillbirths.

Resluts: The mean age of asthmatics and nonasthmatics were 28.0 …

Drug-Prescribing Patterns During Pregnancy In The Tertiary Care Hospitals Of Pakistan: A Cross Sectional Study., Dileep K Rohra, Nirmal Das, Syed I Azam, Nazir A Solangi, Zahida Memon, Abdul M Shaikh, Nusrat H Khan

Department of Biological & Biomedical Sciences

Background: The rationale for use of drugs during pregnancy requires a careful assessment as in addition to the mother, the health and life of her unborn child is also at stake. Information on the use of drugs during pregnancy is not available in Pakistan. The aim of this study was to evaluate the patterns of drug prescriptions to pregnant women in tertiary care hospitals of Pakistan. Methods: This was a cross-sectional study conducted at five tertiary care hospitals of Pakistan. Copies of outPatient medicinal prescriptions given to pregnant Patients attending the antenatal clinics were collected. The drugs were classified according …

Connexin Expression And Gap Junctional Coupling In Human Cumulus Cells: Contribution To Embryo Quality, Hong-Xing Wang, Dan Tong, Faraj El-Gehani, Francis R. Tekpetey, Gerald M. Kidder

Physiology and Pharmacology Publications

Gap junctional coupling among cumulus cells is important for oogenesis since its deficiency in mice leads to impaired folliculogenesis. Multiple connexins (Cx), the subunits of gap junction channels, have been found within ovarian follicles in several species but little is known about the connexins in human follicles. The aim of this study was to determine which connexins contribute to gap junctions in human cumulus cells and to explore the possible relationship between connexin expression and pregnancy outcome from in vitro fertilization (IVF). Cumulus cells were obtained from IVF patients undergoing intracytoplasmic sperm injection (ICSI). Connexin expression was examined by RT-PCR …

Preimplantation Embryo Programming: Transcription, Epigenetics, And Culture Environment., Veronique Duranthon, Andrew J Watson, Patrick Lonergan

Obstetrics & Gynaecology Publications

Preimplantation development directs the formation of an implantation- or attachment-competent embryo so that metabolic interactions with the uterus can occur, pregnancy can be initiated, and fetal development can be sustained. The preimplantation embryo exhibits a form of autonomous development fueled by products provided by the oocyte and also from activation of the embryo's genome. Despite this autonomy, the preimplantation embryo is highly influenced by factors in the external environment and in extreme situations, such as those presented by embryo culture or nuclear transfer, the ability of the embryo to adapt to the changing environmental conditions or chromatin to become reprogrammed …

Successful Pregnancy Outcome Following Laparoscopic Myomectomy: Case Report, R. B. Parkar, Sikolia Wanyonyi, W. J. Kamau, D. Otieno

Obstetrics and Gynaecology, East Africa

Laparoscopic myomectomy is now widely used as an alternative to laparotomy in the management of symptomatic uterine fibroids. The advantages of this minimal access approach outweigh those of the open techniques. The pregnancy outcomes between the two methods have been studied and are comparable, but there still exists a lot of scepticism locally concerning this. It is against this background that we present a 31 year old nulliparous lady who had a two year history of primary infertility secondary to multiple uterine fibroids, the largest being fundal and measuring 6.6cm. She underwent a successful laparoscopic myomectomy in November, 2006 and …

Timing Of Fetal Exposure To Stress Hormones: Effects On Newborn Physical And Neuromuscular Maturation, Lauren M. Ellman, Christine Dunkel Schetter, Calvin J. Hobel, Aleksandra Chicz-Demet, Laura M. Glynn, Curt A. Sandman

Psychology Faculty Articles and Research

The purpose of the study was to determine the specific periods during pregnancy in which human fetal exposure to stress hormones affects newborn physical and neuromuscular maturation. Blood was collected from 158 women at 15, 19, 25, and 31 weeks' gestation. Levels of placental corticotropin-releasing hormone (CRH) and maternal cortisol were determined from plasma. Newborns were evaluated with the New Ballard Maturation Score. Results indicated that increases in maternal cortisol at 15, 19, and 25 weeks and increases in placental CRH at 31 weeks were significantly associated with decreases in infant maturation among mates (even after con trolling for length …

Racial Differences In Birth Outcomes: The Role Of General, Pregnancy, And Racism Stress, Tyan Parker Dominguez, Christine Dunkel Schetter, Laura M. Glynn, Calvin J. Hobel, Curt A. Sandman

Psychology Faculty Articles and Research

Objective: This study examined the role of psychosocial stress in racial differences in birth outcomes.

Design: Maternal health, sociodemographic factors, and 3 forms of stress (general stress, pregnancy stress, and perceived racism) were assessed prospectively in a sample of 51 African American and 73 non-Hispanic White pregnant women.

Main Outcome Measures: The outcomes of interest were birth weight and gestational age at delivery. Only predictive models of birth weight were tested as the groups did not differ significantly in gestational age.

Results: Perceived racism and indicators of general stress were correlated with birth weight and tested in regression analyses. In …

Factors Associated With Teenage Pregnancy In The European Union Countries: A Systematic Review, Mari Imamura, Janet Tucker, Phil Hannaford, Miguel Oliveira Da Silva, Margaret Astin, Laura Wyness, Kitty Wm Bloemenkamp, Albrecht Jahn, Helle Karro, Jørn Olsen, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: As part of the REPROSTAT2 project, this systematic review aimed to identify factors associated with teenage pregnancy in 25 European Union countries.

Methods: The search strategy included electronic bibliographic databases (1995 to May 2005), bibliographies of selected articles and requests to all country representatives of the research team for relevant reports and publications. Primary outcome measure was conception. Inclusion criteria were quantitative studies of individual-level factors associated with teenage (13–19 years) pregnancy in EU countries.

Results: Of 4444 studies identified and screened, 20 met the inclusion criteria. Most of the included studies took place in UK and Nordic countries. …

Mouse Preimplantation Embryo Responses To Culture Medium Osmolarity Include Increased Expression Of Ccm2 And P38 Mapk Activation., Barry Fong, Patricia H Watson, Andrew J Watson

Obstetrics & Gynaecology Publications

BACKGROUND: Mechanisms that confer an ability to respond positively to environmental osmolarity are fundamental to ensuring embryo survival during the preimplantation period. Activation of p38 mitogen-activated protein kinase (MAPK) occurs following exposure to hyperosmotic treatment. Recently, a novel scaffolding protein called Osmosensing Scaffold for MEKK3 (OSM) was linked to p38 MAPK activation in response to sorbitol-induced hypertonicity. The human ortholog of OSM is cerebral cavernous malformation 2 (CCM2). The present study was conducted to investigate whether CCM2 is expressed during mouse preimplantation development and to determine whether this scaffolding protein is associated with p38 MAPK activation following exposure of preimplantation …

Guide To A Successful Pregnancy: A Resource Manual For Pregnant And Parenting Young Women In Las Vegas, Nevada Institute For Children's Research And Policy Reports

Nevada Institute for Children's Research and Policy Reports

A Guide to a Successful Pregnancy.

• Are you Pregnant? Taking a pregnancy test
• First steps of Pregnancy: Options of pregnancy, health plans, obtaining medical care such as a doctor
• Months 1, 2, 3: Maintaining a healthy diet, what you should stay away from, exercise, symptoms of danger, and normal symptoms of pregnancy
• Months 4, 5, 6: Following a routine, classes available during pregnancy, normal pregnancy symptoms
• Months 7, 8, 9: Following a routine, normal pregnancy symptoms
• Labor and Delivery: Symptoms of labor, symptoms of danger
• Parenting: Normal symptoms after birth, Routine to follow to return to normal state, Breast feeding …

P38 Mitogen-Activated Protein Kinase (Mapk) First Regulates Filamentous Actin At The 8-16-Cell Stage During Preimplantation Development., Andrew J M Paliga, David R Natale, Andrew J Watson

Obstetrics & Gynaecology Publications

BACKGROUND INFORMATION: The MAPK (mitogen-activated protein kinase) superfamily of proteins consists of four separate signalling cascades: the c-Jun N-terminal kinase or stress-activated protein kinases (JNK/SAPK); the ERKs (extracellular-signal-regulated kinases); the ERK5 or big MAPK1; and the p38 MAPK group of protein kinases, all of which are highly conserved. To date, our studies have focused on defining the role of the p38 MAPK pathway during preimplantation development. p38 MAPK regulates actin filament formation through the downstream kinases MAPKAPK2/3 (MAPK-activated protein kinase 2/3) or MAPKAPK5 [PRAK (p38 regulated/activated kinase)] and subsequently through HSP25/27 (heat-shock protein 25/27). We recently reported that 2-cell-stage murine …

P38 Mapk Signaling During Murine Preimplantation Development., David R Natale, Andrew J M Paliga, Frank Beier, S J A D'Souza, Andrew J Watson

Obstetrics & Gynaecology Publications

Mitogen-activated protein kinase (MAPK) pathways mediate some important cellular processes and are likely to also regulate preimplantation development. The role of p38 MAP kinase signaling during murine preimplantation development was investigated in the present study. p38 MAPK, p38-regulated or -activated kinase (PRAK; MK5), map kinase-activated protein kinase 2 (MK2), and heat shock protein 25 (hsp25) mRNAs and proteins were detected throughout preimplantation development. Two-cell stage embryos cultured in the presence of SB220025 and SB203580 (specific inhibitors of p38 MAPK alpha/beta), progressed to the eight-cell stage with the same frequency as controls; however, treated embryos halted their development at the 8- …

The Gamma-Subunit Of The Na-K-Atpase As A Potential Regulator Of Apical And Basolateral Na+-Pump Isozymes During Development Of Bovine Pre-Attachment Embryos., L C Barcroft, S E Gill, A J Watson

Obstetrics & Gynaecology Publications

Expression and activity of the Na-K-ATPase within the basolateral membrane domains of the trophectoderm epithelium provide the driving force for accumulation of Na(+) and Cl(-) across the nascent epithelium, mediating fluid movement into the forming blastocoel. Within the trophectoderm of the bovine blastocyst, multiple isozymes of the Na-K-ATPase are expressed. Immunolocalization has demonstrated that the alpha1-isozyme localizes within the basolateral membrane, whereas the alpha 3-isozyme localizes to the apical cell margins. Gene-specific RT-PCR and wholemount indirect immunofluorescence confocal laser scanning microscopy were used to examine expression of the Na-K-ATPase gamma-subunit (a regulatory subunit of the Na-K-ATPase) throughout development of bovine …

Comparative Study--Efficacy, Safety And Compliance Of Intravenous Iron Sucrose And Intramuscular Iron Sorbitol In Iron Deficiency Anemia Of Pregnancy, A Wali, A Mushtaq, Nilofer

Department of Obstetrics & Gynaecology

Objective: (1) To determine an alternative iron supplementation with better efficacy, compliance & safety in treatment of iron deficiency anemia during pregnancy, (2) to reduce blood transfusion during pregnancy, labor and puerperium.
Material and Method: A prospective comparative study. A total number of 60 pregnant women with the gestational age of 12 - 34 weeks were included in the study who were suffering from iron deficiency anemia. They were divided in 3 groups (A, B and C). Group A (n15) received intravenous iron sucrose according to recommended dose containing 500 mg of iron sucrose for storage, in group B (n=20) …

Sensitivity Of Bovine Blastocyst Gene Expression Patterns To Culture Environments Assessed By Differential Display Rt-Pcr., D R Natale, P A De Sousa, M E Westhusin, A J Watson

Obstetrics & Gynaecology Publications

The use of culture media to support the development of preimplantation embryos to the blastocyst stage is often associated with detrimental effects on normal development. These effects have been uncovered largely by investigating the phenotypic abnormalities displayed by fetuses and newborns derived from cultured preimplantation embryos. Research to understand the impact of culture on the embryonic developmental programme has focused on embryo metabolism, gene expression and genomic imprinting. We have used differential display RT-PCR to examine culture influences on global transcript pools in bovine embryos. Others have examined culture influences on candidate "marker genes" in cultured murine, ovine and bovine …