1
|
Tang JW, Pumarino J, Cameron KA, Peaceman AM, Ackermann RT. Perceptions of misdiagnosis among women diagnosed with gestational diabetes. Diabet Med 2016; 33:1451-2. [PMID: 26535796 DOI: 10.1111/dme.13028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J W Tang
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - J Pumarino
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - K A Cameron
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - A M Peaceman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - R T Ackermann
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
2
|
Abramovici A, Gandley RE, Clifton RG, Leveno KJ, Myatt L, Wapner RJ, Thorp JM, Mercer BM, Peaceman AM, Samuels P, Sciscione A, Harper M, Saade G, Sorokin Y. Prenatal vitamin C and E supplementation in smokers is associated with reduced placental abruption and preterm birth: a secondary analysis. BJOG 2014. [PMID: 25516497 DOI: 10.1111/1471‐0528.13201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Smoking and pre-eclampsia (PE) are associated with increases in preterm birth, placental abruption and low birthweight. We evaluated the relationship between prenatal vitamin C and E (C/E) supplementation and perinatal outcomes by maternal self-reported smoking status focusing on outcomes known to be impacted by maternal smoking. DESIGN/SETTING/POPULATION A secondary analysis of a multi-centre trial of vitamin C/E supplementation starting at 9-16 weeks in low-risk nulliparous women with singleton gestations. METHODS We examined the effect of vitamin C/E by smoking status at randomisation using the Breslow-Day test for interaction. MAIN OUTCOME MEASURES The trial's primary outcomes were PE and a composite outcome of pregnancy-associated hypertension (PAH) with serious adverse outcomes. Perinatal outcomes included preterm birth and abruption. RESULTS There were no differences in baseline characteristics within subgroups (smokers versus nonsmokers) by vitamin supplementation status. The effect of prenatal vitamin C/E on the risk of PE (P = 0.66) or PAH composite outcome (P = 0.86) did not differ by smoking status. Vitamin C/E was protective for placental abruption in smokers (relative risk [RR] 0.09; 95% CI 0.00-0.87], but not in nonsmokers (RR 0.92; 95% CI 0.52-1.62) (P = 0.01), and for preterm birth in smokers (RR 0.76; 95% CI 0.58-0.99) but not in nonsmokers (RR 1.03; 95% CI 0.90-1.17) (P = 0.046). CONCLUSION In this cohort of women, smoking was not associated with a reduction in PE or the composite outcome of PAH. Vitamin C/E supplementation appears to be associated with a reduction in placental abruption and preterm birth among smokers.
Collapse
Affiliation(s)
- A Abramovici
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R E Gandley
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - R G Clifton
- Department of Obstetrics and Gynecology, The George Washington University Biostatistics Center, Washington, DC, USA
| | - K J Leveno
- Department of Obstetrics and Gynecology, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - L Myatt
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
| | - R J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - J M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - B M Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, USA
| | - A M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - P Samuels
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - A Sciscione
- Department of Obstetrics and Gynecology, Drexel University, Philadelphia, PA, USA
| | - M Harper
- Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - G Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Y Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | | |
Collapse
|
3
|
Abramovici A, Gandley RE, Clifton RG, Leveno KJ, Myatt L, Wapner RJ, Thorp JM, Mercer BM, Peaceman AM, Samuels P, Sciscione A, Harper M, Saade G, Sorokin Y. Prenatal vitamin C and E supplementation in smokers is associated with reduced placental abruption and preterm birth: a secondary analysis. BJOG 2014; 122:1740-7. [PMID: 25516497 DOI: 10.1111/1471-0528.13201] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Smoking and pre-eclampsia (PE) are associated with increases in preterm birth, placental abruption and low birthweight. We evaluated the relationship between prenatal vitamin C and E (C/E) supplementation and perinatal outcomes by maternal self-reported smoking status focusing on outcomes known to be impacted by maternal smoking. DESIGN/SETTING/POPULATION A secondary analysis of a multi-centre trial of vitamin C/E supplementation starting at 9-16 weeks in low-risk nulliparous women with singleton gestations. METHODS We examined the effect of vitamin C/E by smoking status at randomisation using the Breslow-Day test for interaction. MAIN OUTCOME MEASURES The trial's primary outcomes were PE and a composite outcome of pregnancy-associated hypertension (PAH) with serious adverse outcomes. Perinatal outcomes included preterm birth and abruption. RESULTS There were no differences in baseline characteristics within subgroups (smokers versus nonsmokers) by vitamin supplementation status. The effect of prenatal vitamin C/E on the risk of PE (P = 0.66) or PAH composite outcome (P = 0.86) did not differ by smoking status. Vitamin C/E was protective for placental abruption in smokers (relative risk [RR] 0.09; 95% CI 0.00-0.87], but not in nonsmokers (RR 0.92; 95% CI 0.52-1.62) (P = 0.01), and for preterm birth in smokers (RR 0.76; 95% CI 0.58-0.99) but not in nonsmokers (RR 1.03; 95% CI 0.90-1.17) (P = 0.046). CONCLUSION In this cohort of women, smoking was not associated with a reduction in PE or the composite outcome of PAH. Vitamin C/E supplementation appears to be associated with a reduction in placental abruption and preterm birth among smokers.
Collapse
Affiliation(s)
- A Abramovici
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R E Gandley
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - R G Clifton
- Department of Obstetrics and Gynecology, The George Washington University Biostatistics Center, Washington, DC, USA
| | - K J Leveno
- Department of Obstetrics and Gynecology, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - L Myatt
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
| | - R J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - J M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - B M Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, USA
| | - A M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - P Samuels
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - A Sciscione
- Department of Obstetrics and Gynecology, Drexel University, Philadelphia, PA, USA
| | - M Harper
- Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - G Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Y Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | | |
Collapse
|
4
|
Myatt L, Clifton RG, Roberts JM, Spong CY, Wapner RJ, Thorp JM, Mercer BM, Peaceman AM, Ramin SM, Carpenter MW, Sciscione A, Tolosa JE, Saade G, Sorokin Y, Anderson GD. Can changes in angiogenic biomarkers between the first and second trimesters of pregnancy predict development of pre-eclampsia in a low-risk nulliparous patient population? BJOG 2013; 120:1183-91. [PMID: 23331974 DOI: 10.1111/1471-0528.12128] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine if change in maternal angiogenic biomarkers between the first and second trimesters predicts pre-eclampsia in low-risk nulliparous women. DESIGN A nested case-control study of change in maternal plasma soluble Flt-1 (sFlt-1), soluble endoglin (sEng) and placenta growth factor (PlGF). We studied 158 pregnancies complicated by pre-eclampsia and 468 normotensive nonproteinuric controls. SETTING A multicentre study in 16 academic medical centres in the USA. POPULATION Low-risk nulliparous women. METHODS Luminex assays for PlGF, sFlt-1 and sEng performed on maternal EDTA plasma collected at 9-12, 15-18 and 23-26 weeks of gestation. Rate of change of analyte between first and either early or late second trimester was calculated with and without adjustment for baseline clinical characteristics. MAIN OUTCOME MEASURES Change in PlGF, sFlt-1 and sEng. RESULTS Rates of change of PlGF, sEng and sFlt-1 between first and either early or late second trimesters were significantly different in women who developed pre-eclampsia, severe pre-eclampsia or early-onset pre-eclampsia compared with women who remained normotensive. Inclusion of clinical characteristics (race, body mass index and blood pressure at entry) increased sensitivity for detecting severe and particularly early-onset pre-eclampsia but not pre-eclampsia overall. Receiver operating characteristics curves for change from first to early second trimester in sEng, PlGF and sFlt-1 with clinical characteristics had areas under the curve of 0.88, 0.84 and 0.86, respectively, and for early-onset pre-eclampsia with sensitivities of 88% (95% CI 64-99), 77% (95% CI 50-93) and 77% (95% CI 50-93) for 80% specificity, respectively. Similar results were seen in the change from first to late second trimester. CONCLUSION Change in angiogenic biomarkers between first and early second trimester combined with clinical characteristics has strong utility for predicting early-onset pre-eclampsia.
Collapse
Affiliation(s)
- L Myatt
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Thorp JM, Camargo CA, McGee PL, Harper M, Klebanoff MA, Sorokin Y, Varner MW, Wapner RJ, Caritis SN, Iams JD, Carpenter MW, Peaceman AM, Mercer BM, Sciscione A, Rouse DJ, Ramin SM, Anderson GB. Vitamin D status and recurrent preterm birth: a nested case-control study in high-risk women. BJOG 2012; 119:1617-23. [PMID: 23078336 PMCID: PMC3546544 DOI: 10.1111/j.1471-0528.2012.03495.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether vitamin D status is associated with recurrent preterm birth, and any interactions between vitamin D levels and fish consumption. DESIGN A nested case-control study, using data from a randomised trial of omega-3 fatty acid supplementation to prevent recurrent preterm birth. SETTING Fourteen academic health centres in the USA. POPULATION Women with prior spontaneous preterm birth. METHODS In 131 cases (preterm delivery at <35 weeks of gestation) and 134 term controls, we measured serum 25-hydroxyvitamin D [25(OH)D] concentrations by liquid chromatography-tandem mass spectrometry (LC-MS) from samples collected at baseline (16-22 weeks of gestation). Logistic regression models controlled for study centre, maternal age, race/ethnicity, number of prior preterm deliveries, smoking status, body mass index, and treatment. MAIN OUTCOME MEASURES Recurrent preterm birth at <37 and <32 weeks of gestation. RESULTS The median mid-gestation serum 25(OH)D concentration was 67 nmol/l, and 27% had concentrations of <50 nmol/l. Serum 25(OH)D concentration was not significantly associated with preterm birth (OR 1.33; 95% CI 0.48-3.70 for lowest versus highest quartiles). Likewise, comparing women with 25(OH)D concentrations of 50 nmol/l, or higher, with those with <50 nmol/l generated an odds ratio of 0.80 (95% CI 0.38-1.69). Contrary to our expectation, a negative correlation was observed between fish consumption and serum 25(OH)D concentration (-0.18, P < 0.01). CONCLUSIONS In a cohort of women with a prior preterm birth, vitamin D status at mid-pregnancy was not associated with recurrent preterm birth.
Collapse
Affiliation(s)
- J M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7570, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Wong CA, Scavone BM, Slavenas JP, Vidovich MI, Peaceman AM, Ganchiff JN, Strauss-Hoder T, McCarthy RJ. Efficacy and side effect profile of varying doses of intrathecal fentanyl added to bupivacaine for labor analgesia. Int J Obstet Anesth 2004; 13:19-24. [PMID: 15321435 DOI: 10.1016/s0959-289x(03)00106-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2003] [Indexed: 10/26/2022]
Abstract
The purpose of this randomized, double blinded and controlled study was to determine the optimal dose of intrathecal fentanyl when combined with bupivacaine 2.5 mg for initiation of labor analgesia. Parous parturients with cervical dilation between 3 and 5 cm were randomized to receive intrathecal fentanyl 0 (control), 5, 10, 15, 20 or 25 micrograms, combined with bupivacaine 2.5 mg, followed by a lidocaine/epinephrine epidural test dose. Visual analog pain scores (VAPS) and the presence of side effects were determined every 15 min until the parturient requested additional analgesia. Fetal heart rate (FHR) tracings were compared between groups. All parturients who received fentanyl >/= 15 micrograms had VAPS < 20 mm and duration of analgesia > 15 min, but this was not true for all parturients with fentanyl doses < 15 micrograms. Duration of analgesia was shorter for fentanyl groups 0, 5 and 10 micrograms, compared to groups 15, 20 and 25 micrograms, but there was no difference between the 15, 20 and 25 micrograms groups. There was no difference in the incidence of nausea and vomiting, or in FHR tracing changes. The incidence of pruritus was greater in all fentanyl groups compared to control. These data suggest that, when combined with intrathecal bupivacaine 2.5 mg, fentanyl 15 micrograms provides satisfactory analgesia to all parturients. Higher fentanyl doses produced no additional benefit in duration or quality of analgesia.
Collapse
Affiliation(s)
- C A Wong
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Abstract
BACKGROUND Regional analgesia for labor often is initiated with an intrathecal injection of a local anesthetic and opioid. The purpose of this prospective, randomized, blinded study was to determine the optimal dose of intrathecal sufentanil when combined with 2.5 mg bupivacaine for labor analgesia. METHODS One hundred seventy parous parturients with cervical dilation between 3-5 cm were randomized to receive intrathecal 0 (control), 2.5, 5.0, 7.5, or 10.0 microg sufentanil combined with 2.5 mg bupivacaine, followed by a lidocaine epidural test dose, for initiation of analgesia (34 patients in each group). Visual analog scores and the presence of nausea, vomiting, and pruritus were determined every 15 min until the patient requested additional analgesia. Fetal heart rate tracings were compared between groups. RESULTS Groups were similar for age, height, weight, oxytocin dose, duration of labor, and baseline visual analog scores. Duration of action was significantly shorter for control patients (39 +/- 25 min [mean +/- SD]) compared with those administered sufentanil, all doses (93 +/- 32, 93 +/- 47, 94 +/- 33, 97 +/- 39 min), but was not different among groups administered 2.5, 5.0, 7.5, or 10.0 microg sufentanil. More patients who received 10 microg sufentanil reported nausea and vomiting than did control patients. The severity of pruritus increased with administration of 7.5 and 10.0 microg sufentanil. There was no difference in fetal heart rate changes among groups. CONCLUSIONS Intrathecal bupivacaine (2.5 mg) without sufentanil did not provide satisfactory analgesia for parous patients. However, bupivacaine combined with 2.5 microg sufentanil provided analgesia comparable to higher doses, with a lower incidence of nausea and vomiting and less severe pruritus.
Collapse
Affiliation(s)
- C A Wong
- Department of Anesthesiology, Section of Obstetric Anesthesiology, Section of Maternal-Fetal Medicine, Northwestern University Medical School, Chicago, Illinois 60611, USA.
| | | | | | | | | | | |
Collapse
|
8
|
Abstract
OBJECTIVE This analysis was undertaken to better understand the costs and health consequences of a trial of labor after cesarean when compared with a policy of routine elective repeat cesarean delivery. METHODS A decision-tree model incorporating a Markov analysis was used to examine the reproductive life of a hypothetical cohort of 100,000 pregnant women whose only prior pregnancy was delivered through a low transverse cesarean incision. Using this model, the policy of performing routine elective cesarean delivery was compared with a policy of allowing a trial of labor. Main outcome measures were maternal and neonatal morbidity and mortality, total costs to the health care system, and cost per major neonatal complication avoided (death or permanent neurologic sequelae). RESULTS The consequences of routine elective cesarean delivery for a second birth are significant, with an additional 117,748 cesarean deliveries, 5500 maternal morbid events, and $179 million incurred during the reproductive life of 100,000 women. The prevention of one major adverse neonatal outcome requires 1591 cesarean deliveries and $2.4 million. Sensitivity analysis confirms the robustness of the analysis. CONCLUSION Routine elective cesarean for a second delivery for women with a prior low transverse cesarean incision results in an excess of maternal morbidity and mortality and a high cost to the medical system.
Collapse
Affiliation(s)
- W A Grobman
- Section of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, Northwestern Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60640, USA.
| | | | | |
Collapse
|
9
|
Branch DW, Peaceman AM, Druzin M, Silver RK, El-Sayed Y, Silver RM, Esplin MS, Spinnato J, Harger J. A multicenter, placebo-controlled pilot study of intravenous immune globulin treatment of antiphospholipid syndrome during pregnancy. The Pregnancy Loss Study Group. Am J Obstet Gynecol 2000; 182:122-7. [PMID: 10649166 DOI: 10.1016/s0002-9378(00)70500-x] [Citation(s) in RCA: 240] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Treatment with heparin and low-dose aspirin improves fetal survival among women with antiphospholipid syndrome. Despite treatment, however, these pregnancies are frequently complicated by preeclampsia, fetal growth restriction, and placental insufficiency, often with the result of preterm birth. Small case series suggest that intravenous immune globulin may reduce the rates of these obstetric complications, but the efficacy of this treatment remains unproven. This pilot study was undertaken to determine the feasibility of a multicenter trial of intravenous immune globulin and to assess the impact on obstetric and neonatal outcomes among women with antiphospholipid syndrome of the addition of intravenous immune globulin to a heparin and low-dose aspirin regimen. STUDY DESIGN This multicenter, randomized, double-blind pilot study compared treatment with heparin and low-dose aspirin plus intravenous immune globulin with heparin and low-dose aspirin plus placebo in a group of women who met strict criteria for antiphospholipid syndrome. All patients had lupus anticoagulant, medium to high levels of immunoglobulin G anticardiolipin antibodies, or both. Patients with a single live intrauterine fetus at </=12 weeks' gestation were randomly assigned to receive either intravenous immune globulin (1 g/kg body weight) or an identical-appearing placebo for 2 consecutive days each month until 36 weeks' gestation in addition to a heparin and low-dose aspirin regimen. Maternal characteristics, obstetric complications, and neonatal outcomes were compared with the Student t test and the Fisher exact test as appropriate. RESULTS Sixteen women were enrolled during a 2-year period; 7 received intravenous immune globulin and 9 were given placebo. The groups were similar with respect to age, gravidity, number of previous pregnancy losses, and gestational age at the initiation of treatment. Obstetric outcomes were excellent in both groups, with all women being delivered of live-born infants after 32 weeks' gestation. The rates of antepartum complications such as preeclampsia, fetal growth restriction, and placental insufficiency (as manifested by fetal growth restriction or fetal distress) were similar between the 2 groups. Gestational age at delivery (intravenous immune globulin group, 34.6 +/- 1.1 weeks; placebo group, 36.7 +/- 2.1 weeks) and birth weights (intravenous immune globulin group, 2249.7 +/- 186.1 g; placebo group; 2604.4 +/- 868.9 g) were similar between the 2 groups. There were fewer cases of fetal growth restriction (intravenous immune globulin group, 0%; placebo group, 33%) and neonatal intensive care unit admission (intravenous immune globulin group, 20%; placebo group, 44%) among the infants in the intravenous immune globulin group than those in the placebo group, but these differences were not significant. CONCLUSION A multicenter treatment trial of intravenous immune globulin is feasible. In this pilot study intravenous immune globulin did not improve obstetric or neonatal outcomes beyond those achieved with a heparin and low-dose aspirin regimen. Although not statistically significant, the findings of fewer cases of fetal growth restriction and neonatal intensive care unit admissions among the intravenous immune globulin-treated pregnancies may warrant expansion of the study.
Collapse
Affiliation(s)
- D W Branch
- University of Utah Health Sciences Center, Salt Lake City 84132, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
We investigated the role of the fetal immune system in pregnancies complicated by preeclampsia by assessing umbilical cord plasma levels of the cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta). Nineteen nulliparous patients with severe preeclampsia composed the study group (group A). A comparison group was comprised of 19 healthy nulliparous patients with uneventful pregnancies (group B). Mixed umbilical cord blood was collected immediately after delivery. Plasma was prepared and all samples were assayed for TNF-alpha and IL-1beta by specific enzyme-linked immunoassays (ELISAs). Data are presented as the median with range of values. The length of labor was similar in both groups. TNF-alpha was detected less frequently in the umbilical cord plasma of preeclamptic patients than in the umbilical cord plasma of control patients (57.9 vs. 89.5%, p < 0.05), and the concentrations of TNF-alpha were significantly lower in the umbilical cord plasma of the preeclamptic patients [20 pg/ml (0-80 pg/mL) vs. 50 pg/mL (0-310 pg/mL), p < 0.05]. Umbilical cord plasma IL-1beta detection rates and concentrations from the preeclamptic and control patients were similar, [15.8 vs. 5.3%, 0 pg/mL (0-40 pg/mL) vs 0 pg/mL (0-10 pg/mL)]. The lower concentrations of TNF-alpha in umbilical cord plasma of patients with severe preeclampsia suggest that release of TNF-alpha by the fetus and mother are independent and may reflect adaptation of the fetus to reduced placental perfusion in preeclampsia.
Collapse
Affiliation(s)
- M J Kupferminc
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | | | | |
Collapse
|
11
|
Abstract
The active management of labor may be one approach to achieving lower rates of intervention. Numerous institutions have reported lower CS rates since initiating this labor management scheme, and concurrent decreases in the length of labor and infectious morbidity have been demonstrated. Sufficient data now exist to conclude that such programs can be instituted without deleterious effects on neonatal outcomes. Nevertheless, success in decreasing CS rates has not been uniform and may be confined to certain settings. Other approaches to labor management may be as good or better at achieving low rates of intervention with minimum morbidity. Any approach that emphasizes advocacy for vaginal birth is likely to produce some success and should receive support.
Collapse
Affiliation(s)
- M L Socol
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois, USA
| | | |
Collapse
|
12
|
Abstract
OBJECTIVE To expand on prior investigations and further evaluate the fetal risk associated with vaginal birth after cesarean (VBAC) by examining the incidence not only of a depressed Apgar score at 5 minutes but also of fetal acidemia. METHODS Between January 1, 1991, and December 31, 1996, the following groups of patients who delivered a singleton fetus with birth weight greater than 750 g were identified: 2082 patients with one or more prior cesarean deliveries who were allowed a trial of labor, 1677 of whom delivered vaginally and 405 of whom delivered by repeat cesarean; 920 patients delivered by elective repeat cesarean; 22,863 patients without a prior cesarean who delivered vaginally; and 2432 patients delivered by primary cesarean after laboring. Umbilical cord arterial blood gases were obtained in 88.3% of these deliveries. Comparisons of Apgar scores at 5 minutes and umbilical cord arterial pH measurements were made between groups with chi2 or Fisher exact test, and odds ratios (ORs) were calculated. RESULTS The only significant differences were noted between those patients who delivered vaginally after a prior cesarean and those patients who delivered vaginally without a prior cesarean. Neonates in the successful VBAC group were more likely to have an Apgar score at 5 minutes less than 7 (OR 1.52) or an umbilical arterial pH less than 7.1 (OR 1.69). Those neonates, however, were not at greater risk for an Apgar score less than 4 or a pH less than 7.0. CONCLUSION Our experience suggests that VBAC poses a low level of fetal risk, although a much larger sample size would be required to exclude a two-fold increase in potentially damaging fetal acidemia.
Collapse
Affiliation(s)
- M L Socol
- Department of Obstetrics and Gynecology, Northwestern University Medical School, and Northwestern Memorial Hospital, Chicago, Illinois, USA.
| | | |
Collapse
|
13
|
Abstract
OBJECTIVE We evaluated the risk factors associated with cesarean delivery in laboring twin gestations at least 36 completed weeks. METHODS We reviewed the records of 134 women with twin gestations who underwent a trial of labor between 1993 and 1995. Women who delivered by cesarean were compared with women who delivered vaginally. The factors associated with an increased risk for cesarean were determined using univariate analysis. Logistic regression was used to determine which of those factors was most strongly associated with cesarean delivery. RESULTS Of 134 laboring twin gestations, 25 (18.7%) delivered by cesarean and 109 (81.3%) delivered vaginally. Univariate analysis revealed that women who delivered by cesarean were more likely to be nulliparous, have a less advanced cervix at both admission and epidural placement, a higher mean oxytocin infusion rate for induction or augmentation of labor, a combined fetal weight greater than 5500 g, and received magnesium for seizure prophylaxis. Multivariate analysis identified that nulliparity and timing of epidural administration were the factors most strongly associated with cesarean delivery. CONCLUSION The timing of epidural analgesia is a modifiable risk factor strongly associated with cesarean delivery in term and near-term laboring twin gestations.
Collapse
Affiliation(s)
- W A Grobman
- Department of Obstetrics and Gynecology, Northwestern Memorial Hospital, Northwestern University Medical School, Chicago, Illinois, USA.
| | | | | |
Collapse
|
14
|
Abstract
OBJECTIVE This study aimed to compare neonatal outcomes in a cohort of triplet gestations undergoing a trial of labor with those of a similar cohort delivered by elective cesarean delivery. STUDY DESIGN Thirty-three women with triplet gestations who underwent a trial of labor were compared with a matched cohort of 33 women with triplet gestations who were delivered of their infants by elective cesarean delivery. Neonatal outcomes assessed included respiratory distress syndrome, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage, Apgar scores, and birth trauma. RESULTS Twenty-nine of 33 women (87.9%) who underwent a trial of labor had a successful vaginal delivery of all 3 neonates. One patient was delivered of her first triplet vaginally but then required a cesarean delivery for abruptio placentae; 3 other patients were delivered of their infants by cesarean section for active-phase arrest of labor. There were no differences in neonatal outcomes between the 2 groups, although triplet neonates delivered by elective cesarean section demonstrated a trend toward a greater incidence of respiratory distress syndrome (P = .09). CONCLUSION Our experience suggests that offering vaginal delivery is an acceptable management plan for triplet gestations.
Collapse
Affiliation(s)
- W A Grobman
- Department of Obstetrics and Gynecology, Northwestern University Medical School, and Northwestern Memorial Hospital, Chicago, Illinois, USA
| | | | | | | | | |
Collapse
|
15
|
Abstract
BACKGROUND Although cesarean section is known to be associated with higher hospital charges than vaginal delivery, cost comparisons require further investigation. This study compared maternal hospital charges of women with one previous cesarean section undergoing a trial of labor with the charges of women who underwent an elective repeat cesarean section. Hospital charges for the trial of labor group were also compared with charges of women with a previous vaginal delivery but no previous cesarean section. METHODS A retrospective analysis of three primiparous privately insured patient groups who gave birth from July 1992 to October 1993 was conducted. Hospital charges for 50 primiparas with previous cesarean births who underwent a trial of labor were compared with those of 50 contemporaneous primiparas who underwent elective repeat cesarean section, and with those of 50 primiparas without a past history of cesarean birth. RESULTS Trial of labor was associated with a mean maternal hospital charge of $5820 +/- $1609 compared with $6785 +/- $771 for elective repeat cesarean section (p < 0.001). Trial of labor was also associated with a decreased length of stay when compared with elective cesarean section (2.48 +/- 0.88 days vs 3.62 +/- 0.57 days, p < 0.001). The difference in charges between these two groups was primarily due to charges associated with length of stay and the operating room, but was partly offset by charges associated with labor. The group of women without a past history of cesarean birth had a mean maternal hospital charge of $4685 +/- $966 and a mean length of stay of 1.96 +/- 0.63 days. CONCLUSIONS Trial of labor is associated with an overall 14 percent reduction in maternal hospital charges and a 31 percent reduction in length of stay compared with elective repeat cesarean section.
Collapse
Affiliation(s)
- J D Traynor
- Department of Obstetrics and Gynecology at Northwestern University Medical School, Northwestern Memorial Hospital, Chicago, Illinois 60611, USA
| | | |
Collapse
|
16
|
Affiliation(s)
- W A Grobman
- Northwestern University Medical School, Chicago, Illinois, USA
| | | |
Collapse
|
17
|
Peaceman AM, Andrews WW, Thorp JM, Cliver SP, Lukes A, Iams JD, Coultrip L, Eriksen N, Holbrook RH, Elliott J, Ingardia C, Pietrantoni M. Fetal fibronectin as a predictor of preterm birth in patients with symptoms: a multicenter trial. Am J Obstet Gynecol 1997; 177:13-8. [PMID: 9240576 DOI: 10.1016/s0002-9378(97)70431-9] [Citation(s) in RCA: 229] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Our aim was to determine whether the presence of fetal fibronectin in vaginal secretions of patients with symptoms suggestive of preterm labor predicts preterm delivery. STUDY DESIGN Patients who were examined at the hospital between 24 weeks' and 34 weeks 6 days' gestation with intact membranes, no prior tocolysis, symptoms suggestive of preterm labor, and cervical dilation < 3 cm were recruited at 10 sites. Swabs of the posterior fornix were assayed for the presence of fetal fibronectin by monoclonal antibody assay, with a positive result defined as > or = 50 ng/ml. Results were not available to the managing physicians. Tocolysis was used when clinically indicated after specimen collection. RESULTS A total of 763 patients had fetal fibronectin results and pregnancy outcome data available for analysis. Fetal fibronectin was detected in specimens from 150 (20%) patients. Compared with patients who had negative results, patients who had positive results for fetal fibronectin were more likely to be delivered within 7 days (relative risk 25.9 [95% confidence interval 7.8 to 86]), within 14 days (relative risk 20.4 [95% confidence interval 8.0 to 53]), and before 37 completed weeks (relative risk 2.9 [95% confidence interval 2.2 to 3.7]). The negative predictive values for delivery within 7 days, within 14 days, and at < 37 weeks were 99.5%, 99.2%, and 84.5%, respectively. When we used multiple logistic regression analysis to control for potential confounding variables among singleton pregnancies, only the presence of fetal fibronectin (odds ratio 48.8, 95% confidence interval 7.4 to 320), prior preterm birth (odds ratio 8.3, 95% confidence interval 1.5 to 46.6), and tocolysis (odds ratio 4.1, 95% confidence interval 1.0 to 16.0) were associated with birth within 7 days; fetal fibronectin (odds ratio 3.6, 95% confidence interval 2.2 to 5.9), prior preterm birth (odds ratio 2.5, 95% confidence interval 1.4 to 4.4), cervical dilatation > 1 cm (odds ratio 2.9, 95% confidence interval 1.6 to 5.2), and tocolysis (odds ratio 4.5, 95% confidence interval 2.8 to 7.2) were all independently associated with delivery before 37 weeks. CONCLUSION In a population of patients with symptoms, the presence of fetal fibronectin in vaginal secretions best defines a subgroup at increased risk for delivery within 7 days; the high negative predictive value of fetal fibronectin sampling supports less intervention for patients with this result.
Collapse
Affiliation(s)
- A M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Brody SC, Grobman WA, Peaceman AM. The impact on labor of delaying epidural analgesia in nulliparous patients: A randomized trial. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80120-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
19
|
Kupferminc MJ, Peaceman AM, Aderka D, Wallach D, Socol ML. Soluble tumor necrosis factor receptors and interleukin-6 levels in patients with severe preeclampsia. Obstet Gynecol 1996; 88:420-7. [PMID: 8752252 DOI: 10.1016/0029-7844(96)00179-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether serum and amniotic fluid (AF) levels of soluble tumor necrosis factor receptors and interleukin-6, markers of immune activation and endothelial dysfunction, are altered in patients with severe preeclampsia. METHODS Plasma was collected before induction of labor, at delivery, and postpartum from 19 patients with severe preeclampsia. Amniotic fluid was also obtained in early labor from these patients. Similar samples were obtained from an antepartum control group matched for gestational age and a term control group without preeclampsia. All plasma and AF samples were assayed for p55 and p75 soluble tumor necrosis factor receptors and for interleukin-6 by specific enzyme-linked immunoassays. Levels in preeclamptic patients and the control groups were compared. RESULTS Levels of both receptors were significantly elevated in AF and all maternal plasma samples except those collected 24 hours postpartum for patients with preeclampsia relative to levels in controls. Interleukin-6 was detected more frequently and in higher concentrations in the plasma collected before labor for preeclamptic patients compared with controls, but no difference was noted in interleukin-6 detection rates or plasma concentrations at delivery. Conversely, AF concentrations of interleukin-6 were significantly reduced in patients with preeclampsia. CONCLUSION The increased levels of soluble tumor necrosis factor receptors found in patients with severe preeclampsia may represent a protective response to increased tumor necrosis factor activity and be a marker for immune activation. Increased interleukin-6 concentrations in maternal plasma before labor suggest the involvement of this cytokine as well in the altered immune response and its contribution to endothelial cell dysfunction.
Collapse
Affiliation(s)
- M J Kupferminc
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois, USA
| | | | | | | | | |
Collapse
|
20
|
Abstract
Active management of labor was first instituted as a program to shorten the length of nulliparous labor. Numerous institutions have found that implementation of this program decreased rates of cesarean section. Two randomized trials have evaluated this program, with both showing that labor was shortened by approximately 2 hours and maternal infectious morbidity was decreased by approximately 50%. Although one trial demonstrated a significant reduction in the rate of cesarean birth, the other did not. No users have reported any increase in neonatal morbidity. For some institutions implementation of active management of labor principles may be one approach to decrease operative deliveries for dystocia.
Collapse
Affiliation(s)
- A M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois, USA
| | | |
Collapse
|
21
|
Peaceman AM, Socol ML, López-Zeno JA. A clinical trial of active management of labor. N Engl J Med 1996; 334:797-8; author reply 798-9. [PMID: 8592559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
22
|
Affiliation(s)
- A M Peaceman
- Northwestern University Medical School, Chicago, Illinois, USA
| | | |
Collapse
|
23
|
Peaceman AM, Rehnberg KA. The effect of aspirin and indomethacin on prostacyclin and thromboxane production by placental tissue incubated with immunoglobulin G fractions from patients with lupus anticoagulant. Am J Obstet Gynecol 1995; 173:1391-6. [PMID: 7503174 DOI: 10.1016/0002-9378(95)90622-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE We investigated the hypothesis that nonsteroidal antiinflammatory agents can influence the abnormal prostanoid production associated with antiphospholipid antibodies. We specifically assessed whether aspirin or indomethacin could eliminate the increased placental thromboxane production previously observed with immunoglobulin G fractions from patients with lupus anticoagulant without adversely affecting prostacyclin production. STUDY DESIGN Immunoglobulin G fractions were prepared from the plasma of eight nonpregnant patients with antiphospholipid antibody syndrome and demonstrable lupus anticoagulant. Samples from each patient were then placed in incubation wells containing explants from normal term pregnancies and 10(-4) mol/L aspirin, 10(-7) mol/L indomethacin, or no added drug. Aliquots were removed at intervals up to 48 hours of incubation and assessed for placental prostacyclin and thromboxane production by radioimmunoassay of the stable metabolites prostaglandin F1 alpha and thromboxane B2. RESULTS The addition of aspirin to wells containing immunoglobulin G from patients with lupus anticoagulant was associated with a significant decrease in thromboxane production compared with wells without added drug, but prostacyclin production was unaffected. In contrast, the addition of indomethacin also decreased thromboxane production significantly, but prostacyclin production was also diminished, so the ratio of thromboxane to prostacyclin was unaffected. CONCLUSION These results support a role for the use of aspirin for antiphospholipid antibody-related pregnancy loss through a mechanism similar to that postulated for preeclampsia, namely, selective inhibition of thromboxane production.
Collapse
Affiliation(s)
- A M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Northwestern Memorial Hospital, Chicago, IL 60611, USA
| | | |
Collapse
|
24
|
Kupferminc MJ, Peaceman AM, Aderka D, Wallach D, Peyser MR, Lessing JB, Socol ML. Soluble tumor necrosis factor receptors in maternal plasma and second-trimester amniotic fluid. Am J Obstet Gynecol 1995; 173:900-5. [PMID: 7573266 DOI: 10.1016/0002-9378(95)90363-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES We assessed maternal plasma and second-trimester amniotic fluid for levels of the p55 and p75 soluble tumor necrosis factor receptors. STUDY DESIGN Blood was drawn from 61 healthy pregnant women (group A) before second-trimester genetic amniocentesis, and an aliquot of amniotic fluid was also obtained for this study. An additional blood sample was obtained from 13 of these patients at 36 to 40 weeks' gestation. Twenty-three healthy, nonpregnant women of reproductive age donated blood as a control group (group B). All plasma and amniotic fluid specimens were collectively assayed for the p55 and p75 soluble tumor necrosis factor receptors by specific enzyme-linked immunoassays. Additionally, tumor necrosis factor-alpha concentrations were measured in second-trimester plasma and amniotic fluid of 22 patients in group A and in all 23 of the nonpregnant women. RESULTS The p55 and p75 soluble tumor necrosis factor receptors were detectable in all plasma samples from both groups of patients. The concentrations of both soluble receptors were significantly higher in second-trimester plasma compared with nonpregnant measurements (p < 0.01), and the plasma concentrations of both soluble receptors increased significantly from the second to third trimester (p < 0.01). The p55 and p75 soluble tumor necrosis factor receptors were also detectable in all amniotic fluid samples. Tumor necrosis factor-alpha was detected in the plasma of 15 of 22 patients in the second trimester but in none of the amniotic fluid samples and in none of the plasma samples from the nonpregnant cohort. CONCLUSIONS Both the p55 and p75 soluble tumor necrosis factor receptors are physiologic constituents of second-trimester maternal plasma and amniotic fluid. Concentrations are elevated in pregnancy and further increase from the second to third trimester.
Collapse
Affiliation(s)
- M J Kupferminc
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois, USA
| | | | | | | | | | | | | |
Collapse
|
25
|
Silver RK, Peaceman AM, Adams DM. Understanding prostaglandin metabolites and platelet-activating factor in the pathophysiology and treatment of the antiphospholipid syndrome. Clin Perinatol 1995; 22:357-73. [PMID: 7671542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
As clinicians include an immunologic evaluation in their assessment of recurrent fetal loss among otherwise asymptomatic women, the diagnosis of PAPS will be uncovered with greater frequency. Our understanding of the underlying pathophysiology of PAPS is critical if we are to propose safe and rational therapies for these patients. It appears as though prostaglandin metabolites are implicated directly in the processes that culminate in this unique, localized vasculopathy; and research is actively progressing with this focus in mind. For the present, we should look critically at the available treatments to be sure that the rationale for use is consistent with current evidence and that the margin of fetal and maternal safety justifies their use. To date, only low-dose aspirin appears to alter prostaglandin metabolites favorably and is thus, emerging as our safest and most efficacious treatment.
Collapse
Affiliation(s)
- R K Silver
- Division of Maternal-Fetal Medicine, Evanston Hospital, Illinois, USA
| | | | | |
Collapse
|
26
|
Kupferminc MJ, Peaceman AM, Wigton TR, Rehnberg KA, Socol ML. Fetal fibronectin levels are elevated in maternal plasma and amniotic fluid of patients with severe preeclampsia. Am J Obstet Gynecol 1995; 172:649-53. [PMID: 7856700 DOI: 10.1016/0002-9378(95)90587-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Our purpose was to investigate levels of fetal fibronectin in maternal plasma, amniotic fluid, and umbilical cord plasma from patients with severe preeclampsia. STUDY DESIGN The study group comprised 20 patients with severe preeclampsia (group A). An antepartum comparison group was composed of 20 healthy patients matched for gestational age (group B). An intrapartum control group consisted of 20 term normotensive patients (group C). Maternal plasma samples were collected before labor (groups A and B), then immediately after delivery, and again at 20 to 24 hours post partum (groups A and C). Amniotic fluid was also collected in early labor, and umbilical cord blood was collected at delivery (groups A and C). Samples were assayed for fetal fibronectin by a specific enzyme-linked immunoassay. RESULTS Before labor maternal plasma levels of fetal fibronectin were significantly elevated in preeclamptic patients compared with patients in group B (p < 0.0001). Plasma levels of fetal fibronectin were also increased in preeclamptic patients compared with patients in group C at delivery (p < 0.0001) and post partum (p < 0.05). Additionally, amniotic fluid levels of fetal fibronectin in the preeclamptic patients were significantly increased (p < 0.05). In contrast, umbilical cord plasma fetal fibronectin concentrations from the preeclamptic and control patients were similar. CONCLUSIONS Fetal fibronectin is elevated in the maternal plasma and amniotic fluid, but not umbilical cord plasma, of patients with severe preeclampsia. These findings suggest an increase in production of fetal fibronectin from chorionic trophoblast in patients with preeclampsia or an abnormal interaction between chorionic trophoblast and decidua with resultant increased leakage into the maternal circulation and amniotic fluid.
Collapse
Affiliation(s)
- M J Kupferminc
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois
| | | | | | | | | |
Collapse
|
27
|
Kupferminc MJ, Peaceman AM, Wigton TR, Tamura RK, Rehnberg KA, Socol ML. Immunoreactive tumor necrosis factor-alpha is elevated in maternal plasma but undetected in amniotic fluid in the second trimester. Am J Obstet Gynecol 1994; 171:976-9. [PMID: 7943112 DOI: 10.1016/0002-9378(94)90017-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE We investigated the participation of the cellular arm of the immune system in adaptation to pregnancy by assessing plasma and amniotic fluid levels of the cytokine tumor necrosis factor-alpha. STUDY DESIGN Fifty-five healthy pregnant women who underwent second-trimester genetic amniocentesis at a mean gestational age of 17.0 +/- 1.4 weeks composed study group A. Blood was drawn from each patient before amniocentesis, and an aliquot of amniotic fluid was obtained for this study. Twenty-one healthy patients at a mean gestational age of 35.5 +/- 4.8 weeks composed study group B, and blood was obtained from each patient at an outpatient prenatal visit. Twenty-two healthy, nonpregnant women of reproductive age composed the control group (C). All specimens were stored at -70 degrees C and collectively assayed for tumor necrosis factor-alpha by a specific enzyme-linked immunoassay. RESULTS All patients in group A had a normal karyotype and all patients in groups A and B had uneventful pregnancies. Tumor necrosis factor-alpha was detected in the plasma of 43 of 55 (78.2%) patients in group A compared with 7 of 21 (33.3%) patients in group B (p < 0.001); tumor necrosis factor-alpha was not detected in any of the 22 women in group C. The median plasma tumor necrosis factor-alpha level for group A was 135 pg/ml (range 0 to 625 pg/ml) compared with 0 pg/ml (range 0 to 110 pg/ml) in group B (p < 0.001). Tumor necrosis factor-alpha was not detected in any of the amniotic fluid specimens studied. CONCLUSIONS Levels of tumor necrosis factor-alpha were elevated in the plasma but not detected in the amniotic fluid of normal pregnant patients in the second trimester. These findings suggest involvement of the cellular branch of the immune system and its products, the cytokines, in the normal adaptation of the mother to the fetal allograft, with a possible role in regulating trophoblast growth and invasion.
Collapse
Affiliation(s)
- M J Kupferminc
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois
| | | | | | | | | | | |
Collapse
|
28
|
Kupferminc MJ, Peaceman AM, Wigton TR, Rehnberg KA, Socol ML. Tumor necrosis factor-alpha is elevated in plasma and amniotic fluid of patients with severe preeclampsia. Am J Obstet Gynecol 1994; 170:1752-7; discussion 1757-9. [PMID: 8203436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our purpose was to investigate whether markers for activation of the immune system are present in patients with preeclampsia by assessing maternal plasma and amniotic fluid for tumor necrosis factor-alpha and interleukin-1 beta. STUDY DESIGN Twenty-one patients with severe preeclampsia composed the study group (group A). An antepartum comparison group was composed of healthy nulliparous patients not in labor and matched for gestational age (group B). Another control group consisted of term nulliparous patients in labor with uneventful pregnancies (group C). Maternal plasma samples were collected from all patients at recruitment and from patients in groups A and C immediately after delivery and again 20 to 24 hours post partum. Amniotic fluid was also collected from patients in groups A and C during labor. All samples were collectively assayed for tumor necrosis factor-alpha and interleukin-1 beta by specific enzyme-linked immunoassays. RESULTS Before labor tumor necrosis factor-alpha was detected more frequently in the plasma of preeclamptic patients than in the plasma of patients in group B (12/16 vs 5/16, p < 0.05) and in higher concentrations (median 35 pg/ml vs median 0 pg/ml, p < 0.05). Although tumor necrosis factor-alpha was frequently detected in the plasma of patients in group C in early labor (16/20), concentrations were higher in the four preeclamptic patients first sampled in early labor (210 pg/ml vs 65 pg/ml, p < 0.05). Similarly, amniotic fluid levels of tumor necrosis factor-alpha were increased in preeclamptic patients compared with control patients. At delivery tumor necrosis factor-alpha was more likely to be identified in the plasma of preeclamptic patients and was found in higher concentrations, but by 20 to 24 hours post partum measurements in the preeclamptic and control patients were similar. There were no differences in the frequency with which interleukin-1 beta was detected or the concentration of interleukin-1 beta in any of the samples. CONCLUSIONS Tumor necrosis factor-alpha is increased in the plasma and amniotic fluid of patients with severe preeclampsia. These data are suggestive of a role for abnormal immune activation in the pathophysiologic mechanisms of preeclampsia.
Collapse
Affiliation(s)
- M J Kupferminc
- Department of Obstetrics and Gynecology, Northwestern University Medical School
| | | | | | | | | |
Collapse
|
29
|
Kupferminc MJ, Lee MJ, Green D, Peaceman AM. Severe postpartum pulmonary, cardiac, and renal syndrome associated with antiphospholipid antibodies. Obstet Gynecol 1994; 83:806-7. [PMID: 8159356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The antiphospholipid antibody syndrome has been associated with thromboembolic events, thrombocytopenia, fetal death, fetal growth retardation, and early-onset severe preeclampsia. CASE A postpartum woman developed fever, pulmonary infiltrates, cardiac conduction defects, and renal insufficiency following severe preeclampsia. She tested positive for lupus anticoagulant and anticardiolipin antibody, and responded to steroid therapy and plasmapheresis. CONCLUSION The postpartum multi-system involvement suggests that a variety of clinical presentations may be associated with antiphospholipid antibodies. Treatment with plasmapheresis or corticosteroids may be of value in similar cases.
Collapse
Affiliation(s)
- M J Kupferminc
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois
| | | | | | | |
Collapse
|
30
|
Peaceman AM, Rehnberg KA. The effect of immunoglobulin G fractions from patients with lupus anticoagulant on placental prostacyclin and thromboxane production. Am J Obstet Gynecol 1993; 169:1403-6. [PMID: 8267036 DOI: 10.1016/0002-9378(93)90408-b] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE We evaluated whether the production of prostacyclin and thromboxane by normal human placental tissue is consistently altered by incubation with immunoglobulin G fractions prepared from plasma of patients with lupus anticoagulant. STUDY DESIGN The immunoglobulin G fractions were prepared from eight patients with lupus anticoagulant and eight control patients. Doses of these fractions (3 mg, 7.5 mg, and 12 mg) were incubated with placental explants obtained from normal pregnancies, and prostacyclin and thromboxane production was assessed over 48 hours. RESULTS Prostacyclin production was similar for placental tissue incubated with immunoglobulin fractions from control and lupus anticoagulant patients at all of the doses tested. Placental production of thromboxane was significantly increased with immunoglobulin fractions from lupus anticoagulant patients for all three doses (p = 0.02). CONCLUSIONS The immunoglobulin G fraction from patients with lupus anticoagulant consistently alters placental thromboxane production without affecting prostacyclin production. Increases in placental thromboxane production may contribute to antiphospholipid antibody-mediated pregnancy loss.
Collapse
Affiliation(s)
- A M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, IL
| | | |
Collapse
|
31
|
Abstract
OBJECTIVE Our purpose was to compare maternal and fetal factors that influence the route of delivery with active management of labor and a traditional labor management protocol. STUDY DESIGN Data were collected prospectively on 346 consecutive patients receiving active management of labor and 354 patients who were managed traditionally. Within each group demographic and labor characteristics of patients undergoing cesarean section were compared with those of patients having vaginal deliveries by means of the Student t test, chi 2 analysis, and stepwise logistic regression. RESULTS With both active management of labor and traditional labor management success in achieving vaginal delivery was related to the station of the fetal vertex at admission, the need for oxytocin augmentation of labor, the uterine response to oxytocin, the use of epidural anesthesia, and the development of chorioamnionitis. By means of multiple logistic regression analysis maternal age, height, payor status, and birth weight were also identified as risk factors for cesarean section with traditional labor management but not with active management of labor. CONCLUSIONS Differences were identified in risk factors for cesarean section between active management and traditional labor management. Active management of labor may diminish or eliminate some patient characteristics as risk factors for cesarean birth.
Collapse
Affiliation(s)
- A M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, IL 60611
| | | | | | | |
Collapse
|
32
|
Adashek JA, Peaceman AM, Lopez-Zeno JA, Minogue JP, Socol ML. Factors contributing to the increased cesarean birth rate in older parturient women. Am J Obstet Gynecol 1993; 169:936-40. [PMID: 8238152 DOI: 10.1016/0002-9378(93)90030-m] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our purpose was to determine factors contributing to the increased use of cesarean section in patients > or = 35 years old. STUDY DESIGN Data were collected prospectively on nulliparous patients in spontaneous labor with term, singleton pregnancies and vertex presentations. Criteria for the diagnosis of labor were standardized: regular, painful uterine contractions at least once every 5 minutes in the presence of either complete cervical effacement or spontaneous rupture of membranes. The labors of women > or = 35 years old (n = 74) were compared with those of women 20 to 29 years old (n = 275). RESULTS The cesarean section rate was significantly greater for patients > or = 35 years old (21.6% vs 10.2%, odds ratio 2.4, 95% confidence interval 1.2 to 5.1). Mean birth weights were similar in the two groups, but when birth weight was > or = 3600 gm patients > or = 35 years old were more likely to be delivered by cesarean section (36.7% vs 12.2%, odds ratio 4.0, 95% confidence interval 1.4 to 11.9). There were no differences between the two age groups in physician factors that could explain the disparate rates of cesarean delivery. Indeed, of patients delivered vaginally the older parturients received oxytocin for longer duration (6.4 +/- 2.6 vs 5.0 +/- 3.1 hours, p < 0.05) and at higher maximum doses (12.4 +/- 6.1 vs 9.8 +/- 6.2 mU, p < 0.05). After controlling for potentially confounding variables with multiple logistic regression analysis, maternal age (R = 0.125, p < 0.005), birth weight (R = 0.196, p < 0.001), the need for oxytocin (R = 0.210, p < 0.001), and epidural anesthesia (R = 0.195, p < 0.001) were found to be independently associated with the increased rate of cesarean section. CONCLUSION We could not identify any controllable physician factors affecting the rate of cesarean section in patients > or = 35 years old. The increased oxytocin requirements and the incidence of dystocia with birth weight > or = 3600 gm suggest that maternal and fetal characteristics contribute to the increased frequency of cesarean section in older parturients.
Collapse
Affiliation(s)
- J A Adashek
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois
| | | | | | | | | |
Collapse
|
33
|
Abstract
OBJECTIVE The rise in cesarean birth at Northwestern Memorial Hospital in 1986 to 27.3% prompted implementation of three initiatives to reverse the escalating cesarean section rate. STUDY DESIGN First, vaginal birth after cesarean section was more strongly encouraged. Second, after the 1988 calendar year the cesarean section rate of every obstetrician was circulated annually to each attending physician. Third, on completion of a prospective, randomized trial of the active management of labor in early 1991, this protocol was recommended as the preferred method of labor management for term nulliparous patients. RESULTS The total, primary, and repeat cesarean section rates declined from 27.3%, 18.2%, and 9.1% in 1986 to 16.9%, 10.6%, and 6.4%, respectively, in 1991. At the same time the perinatal mortality dropped from 19.5 to 10.3. Significant reductions in abdominal deliveries occurred for both private patients (30.3% to 19.1%, p < 0.0001) and clinic patients (20.8% to 11.5%, p < 0.0001). A decline in operative deliveries for dystocia and an increase in vaginal birth after prior cesarean section were the principal factors contributing to the lower cesarean section rates. However, in 1991 individual private physicians still had wide variations in primary cesarean section rates (4.6% to 21.1%) and use of vaginal birth after prior cesarean section (5.3% to 90%). CONCLUSION The cesarean section rate has been significantly reduced for both private and clinic patients. Differences in population demographics and individual physician practice patterns contributed to a higher incidence of cesarean birth on the private service.
Collapse
Affiliation(s)
- M L Socol
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois
| | | | | | | |
Collapse
|
34
|
Peaceman AM, Rehnberg KA. The immunoglobulin G fraction from plasma containing antiphospholipid antibodies causes increased placental thromboxane production. Am J Obstet Gynecol 1992; 167:1543-7. [PMID: 1471662 DOI: 10.1016/0002-9378(92)91736-t] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Our objective was to evaluate whether the immunoglobulin G fraction from plasma containing high levels of antiphospholipid antibodies alters the production of prostacyclin or thromboxane when incubated with normal human placental tissue. STUDY DESIGN The immunoglobulin G fraction was prepared from the pooled plasma of five volunteers with normal obstetric histories and no antiphospholipid antibodies. The immunoglobulin G fraction was prepared similarly from a patient with the antiphospholipid antibody syndrome. Doses of these immunoglobulin G fractions ranging from 0.3 to 3.0 mg were incubated with placental explants obtained from eight normal pregnancies, and prostacyclin and thromboxane production was assessed over 48 hours. RESULTS Placental prostacyclin production was unaltered by incubation with either immunoglobulin G fraction at any of the doses tested. Placental thromboxane production tripled by 32 hours with the addition of 0.6, 1.5, and 3.0 mg of the antiphospholipid antibody fraction (p < 0.05) compared with baseline production but was unaltered by the addition of the normal pooled plasma fraction at any dose. The increase in thromboxane production with antiphospholipid antibody immunoglobulin G appeared to be dose related. CONCLUSION The immunoglobulin G fraction prepared from plasma containing antiphospholipid antibodies caused increased placental thromboxane production without altering prostacyclin production.
Collapse
Affiliation(s)
- A M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Northwestern Memorial Hospital, Chicago, IL 60611
| | | |
Collapse
|
35
|
Abstract
OBJECTIVE We evaluated an alternative approach to the management of triplet gestations that did not include home uterine monitoring, prophylactic tocolysis, or routine antepartum hospitalization. STUDY DESIGN Fifteen patients were managed over a 42-month period by an antepartum protocol that emphasized patient education regarding signs and symptoms of preterm labor, weekly prenatal visits after 24 weeks' gestation with cervical examination, and increased rest in an outpatient setting. Tocolytic therapy was only used for regular uterine contractions when cervical change was documented. RESULTS Nine of 15 (60%) patients with management in this uniform manner were delivered at > or = 35 weeks' gestation, and six patients (40%) completed 37 weeks of pregnancy. Only five patients (33%) received tocolytic therapy. The mean birth weight was 1957 +/- 488 gm, and only 19 of 45 neonates (42%) were admitted to the intensive care nursery. CONCLUSION This management scheme was effective in reducing preterm delivery and thereby optimizing perinatal outcome.
Collapse
Affiliation(s)
- A M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, IL 60611
| | | | | | | |
Collapse
|
36
|
Abstract
OBJECTIVE Because of the widespread use of antiphospholipid antibody testing in the evaluation of patients with recurrent pregnancy loss, we evaluated the consistency of results among laboratories testing for anticardiolipin antibody and the lupus anticoagulant. STUDY DESIGN A questionnaire regarding methods used and samples of blood from 20 patients were sent to five university-based and five commercial facilities for antiphospholipid antibody testing. RESULTS The responses of the participating laboratories to the questionnaires revealed significant differences in methods, standardization, and units of reporting. For anticardiolipin antibody, the number of specimens found to be positive for any isotype (immunoglobulin G, M, or A) varied considerably among laboratories, with a range of 5 to 13. All laboratories were in agreement (i.e., at least one isotype was present or all were absent) for only 5 of 20 specimens (25%). In contrast, lupus anticoagulant results were more reproducible, although one facility reported results markedly discordant from the other four laboratories. CONCLUSION These observations suggest that significant interlaboratory variation exists in antiphospholipid antibody, and particularly anticardiolipin antibody, testing and might lead to unnecessary therapeutic interventions.
Collapse
Affiliation(s)
- A M Peaceman
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, IL 60611
| | | | | | | |
Collapse
|
37
|
Abstract
BACKGROUND Over the past two decades, the rate of cesarean section in the United States has risen from 5 percent to 25 percent of deliveries, primarily because of the increased frequency of dystocia (arrest of labor). One strategy that has been proposed for increasing the rate of vaginal delivery is a program of active management of labor that encourages early amniotomy, early diagnosis of slow progress in labor, and the use of higher than usual doses of oxytocin; the efficacy and safety of this approach are uncertain, however. METHODS We conducted a randomized trial in which nulliparous women in spontaneous labor at term were randomly assigned to either active management of labor or traditional management. With active management, amniotomy was performed within one hour of the diagnosis of labor, and when the rate of cervical dilation was less than 1 cm per hour, oxytocin was infused at an initial rate of 6 mU per minute. The dose was increased by 6 mU per minute every 15 minutes (to a maximum of 36 mU per minute) until there were seven contractions every 15 minutes. RESULTS For the women assigned to active management (n = 351), the cesarean-section rate was 10.5 percent, as compared with 14.1 percent for those assigned to traditional management (n = 354, P = 0.18). The 26 percent reduction in the cesarean-section rate was due primarily to a decrease in dystocia. After we controlled for potential confounding variables, the reduction in the rate of delivery by cesarean section was statistically significant (odds ratio for women given active as compared with traditional management, 0.57; 95 percent confidence interval, 0.36 to 0.95). With active management, the average length of labor was shortened by 1.66 hours, principally because of earlier amniotomy and earlier use of oxytocin. There was no increase in maternal or neonatal morbidity, and there were significantly fewer infectious complications in the mothers. CONCLUSIONS The program we studied for the active management of labor reduces the incidence of dystocia and increases the rate of vaginal delivery without increasing maternal or neonatal morbidity.
Collapse
Affiliation(s)
- J A López-Zeno
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Northwestern Memorial Hospital, Chicago, IL 60611
| | | | | | | |
Collapse
|
38
|
Abstract
A retrospective study assessing the effect of epidural analgesia in labor on the incidence of cesarean section was performed. The first 500 consecutive nulliparas meeting the following criteria were included in this study: term (37 weeks or longer) and singleton gestation, cephalic presentation, spontaneous onset of labor, and 5 cm or less of cervical dilation on admission. Patients were grouped according to their rate of cervical dilation in early labor (greater than or equal to 1 cm/hr, and less than 1 cm/hr) and the timing of epidural placement (none, early, or late). There was no effect of epidural analgesia on the incidence of cesarean section for fetal distress. The incidence of cesarean section for dystocia was significantly greater (p greater than 0.000001) in the epidural group (15.6%) than in the nonepidural group (2.4%). The greatest effect of epidural analgesia on the incidence of cesarean section for dystocia was observed in nulliparas who dilated at slower rates (less than 1 cm/hr) in early labor and who had epidural analgesia placed at 5 cm or less of cervical dilation (20.6% versus 3.4%, relative risk of 6, p less than 0.0005). The increase of cesarean section for dystocia associated with epidural analgesia could not be accounted for when other possibly confounding variables were studied. Both the dilation rate prior to epidural placement and the cervical dilation at epidural placement were significantly correlated to frequency of cesarean section for dystocia (p less than 0.01). This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparas.
Collapse
Affiliation(s)
- J A Thorp
- Department of Obstetrics, Gynecology, University of Texas Medical School, Houston
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
During the past decade, the incidence of sexually transmitted viral diseases has increased dramatically. In many cases, diagnosis is difficult, consequences are severe, and curative therapy is not available at present. In this article, Drs Peaceman and Gonik review current evidence about sexual transmission of viruses and discuss the latest methods of diagnosis, management, and prevention.
Collapse
Affiliation(s)
- A M Peaceman
- Department of Obstetrics and gynecology, Northwestern University Medical School, Chicago
| | | |
Collapse
|
40
|
Franger AL, Buchsbaum HJ, Peaceman AM. Abdominal gunshot wounds in pregnancy. Int J Gynaecol Obstet 1990. [DOI: 10.1016/0020-7292(90)90204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
41
|
Abstract
The biophysical profile has proved to be a valuable tool for the assessment of fetal well-being, independent of gestational age. Magnesium sulfate is commonly used as a tocolytic agent, yet relatively little is known about its effects on the biophysical activities of the fetus. To investigate the effects of magnesium sulfate on the biophysical profile, we performed serial studies on patients who received tocolytic therapy with this agent because of preterm labor. A total of 16 women with 22 fetuses at 26 to 34 weeks' gestation in spontaneous preterm labor were studied. An initial biophysical profile was performed at the time of admission, and a second examination was performed when maternal serum magnesium levels reached 6 to 8 mg/dl. On admission all fetuses had reactive nonstress test results and 21 of 22 (95%) demonstrated sustained fetal breathing movements. With magnesium sulfate tocolysis, 50% of fetuses had nonreactive nonstress test results, and only 4 of 22 (18%) demonstrated sustained fetal breathing movements. Fetal tone, gross body movements, and amniotic fluid volume were found to be unaffected by magnesium sulfate tocolysis.
Collapse
Affiliation(s)
- A M Peaceman
- Department of Obstetrics and Gynecology and Reproductive Sciences, University of Texas Medical School 77030
| | | | | | | | | |
Collapse
|
42
|
Abstract
The incidence of gunshot wounds in the civilian population is increasing. Likewise, pregnant women are more frequently sustaining wounds of the abdomen. We report on three women who sustained abdominal gunshot wounds during pregnancy. Guidelines for management are suggested. Select patients may be observed if the following conditions are present: mother's condition is stable, the entrance wound is below the fundus of the uterus, the missile can be radiographically demonstrated to be in the uterine cavity, there is a negative abdominal examination, and there is no blood in the urine or gastrointestinal tract.
Collapse
Affiliation(s)
- A L Franger
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee 53226
| | | | | |
Collapse
|
43
|
Peaceman AM, Katz AR, Laville M. Bernard-Soulier syndrome complicating pregnancy: a case report. Obstet Gynecol 1989; 73:457-9. [PMID: 2915873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The pregnancy of a patient with Bernard-Soulier syndrome is described. Coagulation abnormalities were encountered, as well as isoimmunization from previous transfusions. Immune suppression was achieved with steroids and intravenous gamma globulin, and plasmapheresis was performed to allow platelet transfusion.
Collapse
Affiliation(s)
- A M Peaceman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Medical School, Houston
| | | | | |
Collapse
|
44
|
Iams JD, Peaceman AM, Creasy RK. Prevention of prematurity. Semin Perinatol 1988; 12:280-91. [PMID: 3065941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- J D Iams
- Ohio State University, Department of Obstetrics and Gynecology, Columbus 43210
| | | | | |
Collapse
|
45
|
Peaceman AM, Cruikshank DP. Ehlers-Danlos syndrome and pregnancy: association of type IV disease with maternal death. Obstet Gynecol 1987; 69:428-31. [PMID: 3492694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Ehlers-Danlos syndrome (EDS) is a rare connective tissue disorder known to be associated with complications during pregnancy. Recently, the syndrome has been subdivided into a number of types with different clinical manifestations. We report a maternal death with type IV, and review the literature for obstetric complications of the syndrome by type. A very high risk of maternal death with type IV is identified. Recommendations for managing pregnancies complicated by EDS are given.
Collapse
|