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Ondersma SJ, Chang G, Blake-Lamb T, Gilstad-Hayden K, Orav J, Beatty JR, Goyert GL, Yonkers KA. Accuracy of five self-report screening instruments for substance use in pregnancy. Addiction 2019; 114:1683-1693. [PMID: 31216102 PMCID: PMC8407406 DOI: 10.1111/add.14651] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/27/2019] [Accepted: 05/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The accuracy of current screening instruments for identification of substance use in pregnancy is unclear, particularly given methodological shortcomings in existing research. This diagnostic accuracy study compared five existing instruments for ability to identify illicit drug, opioid and alcohol use, under privacy expectations consistent with applied practice and using a gold standard incorporating toxicological analysis. DESIGN Prospective cross-sectional screening accuracy study. SETTING Three sites encompassing four prenatal care clinics in the United States. PARTICIPANTS Convenience sample of 1220 racially, ethnically and socio-economically diverse pregnant women aged 18 years and over. MEASUREMENTS In Phase I, participants completed the five screening instruments in counterbalanced order. Instruments included the Substance Use Risk Profile-Pregnancy (SURP-P), CRAFFT (acronym for five-item screener with items related to car, relax, alone, forget, friends and trouble), 5Ps (parents, peers, partner, pregnancy, past), Wayne Indirect Drug Use Screener (WIDUS) and the National Institute on Drug Abuse (NIDA) Quick Screen. In Phase II, participants provided a urine sample and completed a calendar recall-based interview regarding substance use. These screeners were tested, using receiver operating characteristic (ROC) analysis and accuracy statistics, against a reference standard consisting of substance use in three classes (illicit drugs, opioids and alcohol), considered positive if use was evident via 30-day calendar recall or urine analysis. FINDINGS Three hundred and fifteen of 1220 participants (26.3%) met reference standard criteria for positivity. The single-item screening questions from the NIDA Quick Screen showed high specificity (0.99) for all substances, but very poor sensitivity (0.10-0.27). The 5Ps showed high sensitivity (0.80-0.88) but low specificity (0.35-0.37). The CRAFFT, SURP-P and 5Ps had the highest area under the curve (AUC) for alcohol (0.67, 0.66 and 0.62, respectively), and the WIDUS had the highest AUC for illicit drugs and opioids (0.70 and 0.69, respectively). Performance of all instruments varied significantly with race, site and economic status. CONCLUSIONS Of five screening instruments for substance use in pregnancy tested (Substance Use Risk Profile-Pregnancy (SURP-P), CRAFFT, 5Ps, Wayne Indirect Drug Use Screener (WIDUS) and the National Institute on Drug Abuse (Quick Screen), none showed both high sensitivity and high specificity, and area under the curve was low for nearly all measures.
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Affiliation(s)
- Steven J. Ondersma
- Merrill Palmer Skillman Institute and Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Grace Chang
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Tiffany Blake-Lamb
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - John Orav
- Department of Medicine (Biostatistics) and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica R. Beatty
- Merrill Palmer Skillman Institute and Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Gregory L. Goyert
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI, USA
| | - Kimberly A. Yonkers
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,,Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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Brenot K, Goyert GL. Impact of robotic surgery on obstetric-gynecologic resident training. J Reprod Med 2009; 54:675-677. [PMID: 20120900] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To compare the volume and type of surgical techniques for hysterectomies performed prior to and after the introduction of robotic surgery at our institution and to assess the potential impact on obstetric-gynecologic resident training. STUDY DESIGN A retrospective study examined the number and types of hysterectomies performed at our institution during the 18 months prior to, and the 18 months after, the introduction of a robotic surgical system. Procedures performed during both time periods were compared by number and percentage using the chi2 or Fisher's exact test for counts < 5. RESULTS A total of 903 hysterectomies were performed from July 1, 2005, to July 1, 2008. There were 444 hysterectomies in the prerobotic surgical system group and 459 hysterectomies in the postrobotic surgical system group. There was a statistically significant decrease in the number of laparoscopically assisted vaginal hysterectomies (94 vs. 36; p < 0.001) and total abdominal hysterectomies (249 vs. 203; p < 0.001) performed. CONCLUSION This study demonstrated a significant impact on the volume and type of surgical techniques for hysterectomies performed prior to and after the introduction of robotic surgery at our institution. This observation may have direct consequences for obstetric-gynecologic resident surgical experience.
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Affiliation(s)
- Karen Brenot
- Department of Obstetrics and Gynecology, Henry Ford Wyandotte Hospital, Wyandotte, Michigan, USA
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Abstract
OBJECTIVE We sought to determine the impact of harmonic tissue imaging on image resolution and visualization of fetal structures during obstetric ultrasonography. STUDY DESIGN Patients with singleton second- or third-trimester fetuses were recruited. Prospective comparisons of conventional fundamental imaging and harmonic tissue imaging were made. Visualization rates and frequencies of improvement in resolution were calculated. Discriminate function analysis evaluated determinants of improved visualization. RESULTS Harmonic tissue imaging improved resolution of at least one fetal structure in 51.4% of patients studied. Differences were most marked for 4-chamber views of the heart with improvement in resolution in 30.5% of patients and change in ability to visualize in 9.5%. Maternal weight and gestational age had a significant influence on whether improvements were noted with harmonic tissue imaging, accounting for 27% of the variance. CONCLUSIONS Harmonic tissue imaging offers significant improvements over fundamental imaging in image resolution and structure visualization in obese patients during the second trimester of pregnancy.
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Affiliation(s)
- M C Treadwell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hutzel Hospital/Wayne State University, Detroit, MI 48201, USA.
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Barrionuevo MJ, Bronsteen RA, Eilender LM, Wright DJ, Goyert GL. Idiopathic granulomatous angiitis of the central nervous system in pregnancy: the first case report. J Matern Fetal Med 1997; 6:58-60. [PMID: 9029388 DOI: 10.1002/(sici)1520-6661(199701/02)6:1<58::aid-mfm12>3.0.co;2-i] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Idiopathic granulomatous angiitis of the central nervous system (IGANS) is a rare vasculitis primarily affecting the spinal cord and brain not related to any underlying systemic disease. Clinical manifestations range from simple headache to cerebral vascular accidents secondary to vascular occlusion. The management of a pregnancy complicated by multiple risk factors including underlying IGANS is reported. An expectant, empiric approach was adopted and resulted in excellent maternal and neonatal outcomes. The first report of the management of a pregnancy complicated by IGANS is presented. Underlying maternal IGANS may not necessarily represent an indication for pregnancy termination.
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Affiliation(s)
- M J Barrionuevo
- Department of Obstetrics and Gynecology, Sinai Hospital, Wayne State University School of Medicine, Detroit, Michigan, USA
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Barrionuevo MJ, Bronsteen RA, Eilender LM, Wright DJ, Goyert GL. Idiopathic Granulomatous Angiitis of the Central Nervous System in Pregnancy. J Matern Fetal Neonatal Med 1997. [DOI: 10.3109/14767059709161954] [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: 11/13/2022]
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Puder KS, Humes RA, Gold RL, Bawle EV, Goyert GL. The genetic implication for preceding generations of the prenatal diagnosis of interrupted aortic arch in association with unsuspected DiGeorge anomaly. Am J Obstet Gynecol 1995; 173:239-41. [PMID: 7631695 DOI: 10.1016/0002-9378(95)90204-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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
We present a case of prenatally diagnosed interrupted aortic arch with a ventricular septal defect in the presence of maternal congenital heart disease, which led to the detection of segmental monosomy of chromosome 22q11.2 in both patients. The implications of detecting a microdeletion and the importance of a multidisciplinary approach to prenatal diagnosis and counseling are discussed.
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Affiliation(s)
- K S Puder
- Department of Obstetrics and Gynecology, Children's Hospital of Michigan, Hutzel Hospital, Detroit, USA
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Goyert GL, Gold RB, Mandell SH, Bronsteen RA, Wright DJ, Ward BE. Prenatal Identification of a Tetraploid Fetus with fish. J Matern Fetal Neonatal Med 1995. [DOI: 10.3109/14767059509017305] [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: 11/13/2022]
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Katz LE, Goyert GL, Bloom RE, Rivera E, Wright DJ, Schwartz DB. Essential Thrombocytosis in Pregnancy: Is Pharmacologic Therapy Indicated? J Matern Fetal Neonatal Med 1994. [DOI: 10.3109/14767059409017274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Blessed WB, Coughlin JP, Johnson MP, Evans MI, Jewell MR, Goyert GL, Schwartz DB, Klein MD. Immediate delivery room repair of fetal abdominal wall defects. Fetal Diagn Ther 1993; 8:203-8. [PMID: 8240695 DOI: 10.1159/000263826] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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
Eighteen patients with a prenatal diagnosis of fetal abdominal wall defect were delivered by cesarean section and repaired either immediately (begun within 15 min, n = 9), or by the traditional (delayed) method (n = 9, average delay = 4.4 h). Neonates repaired immediately had comparable gestational ages and birthweight, however, subjectively had less edematous bowel with less fibrous peel. These fetuses were more likely to be closed primarily (7/9 vs. 4/9), spent less time on a ventilator (8.1 vs. 17.9 days), seemed to be fed sooner (7.6 vs. 17.9 days), and discharged home earlier (14.3 vs. 24.0 days). Our results suggest that for fetuses delivered by cesarean section, early defect repair may reduce bowel edema and fibrous peel formation thus facilitating primary closure, with earlier ventilator weaning, feeding and discharge home.
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Affiliation(s)
- W B Blessed
- Department of Obstetrics and Gynecology, Hutzel and Sinai Hospital, Detroit, Mich
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Lacoste H, Goyert GL, Goldman LS, Wright DJ, Schwartz DB. Acute iron intoxication in pregnancy: case report and review of the literature. Obstet Gynecol 1992; 80:500-1. [PMID: 1495721] [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: 12/27/2022]
Abstract
Limited reports exist regarding acute iron intoxication during pregnancy. The maternal and fetal effects of accidental or deliberate ingestion of large amounts of iron may be catastrophic. A case report of acute iron intoxication, management strategies, and a review of the literature are presented. The cornerstones of effective therapy are aggressive management with emesis induction or gastric lavage, bicarbonate instillation, vigorous intravenous hydration, and chelation therapy with deferoxamine.
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Affiliation(s)
- H Lacoste
- Department of Obstetrics and Gynecology, Sinai Hospital, Wayne State University School of Medicine, Detroit, Michigan
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Williams MA, Schmidt AR, Carleton CL, Darien BJ, Goyert GL, Sokol RJ, Derksen FJ. Amniotic fluid analysis for ante-partum foetal assessment in the horse. Equine Vet J 1992; 24:236-8. [PMID: 1606938 DOI: 10.1111/j.2042-3306.1992.tb02821.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M A Williams
- Michigan State University, College of Veterinary Medicine, Department of Large Animal Clinical Sciences, East Lansing 48824
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Abstract
The first description of the antenatal appearance of a duplication cyst of the pylorus is presented. Prior to the infant's delivery, the possibility that this intra-abdominal cystic mass represented a choledochal cyst was also strongly considered. The antenatal detection of this cystic mass allowed close neonatal surveillance and timely surgical intervention prior to the onset of serious neonatal complications. The embryogenesis of duplication cysts of the gastrointestinal tract and bronchopulmonary foregut malformations is reviewed. The clinical utility of the prenatal diagnosis of such fetal gastrointestinal anomalies is also discussed.
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Affiliation(s)
- G L Goyert
- Department of Obstetrics and Gynecology, Sinai Hospital, Detroit, MI 48235
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Abstract
Fetal heart rate reactivity was evaluated following acoustic stimulation testing (AST). The AST and NST (non-stress test) were compared with regards to certain adverse perinatal outcome criteria, and in a selected sample of cases, to other surveillance tests. These tests were the oxytocin challenge test (OCT) and biophysical profile (BPP). 479 tests were performed on 240 high-risk patients. The AST significantly increased fetal heart rate reactivity. With regards adverse perinatal outcome criteria, there was no significant difference between the AST and NST in relation to sensitivity, specificity or predictive values. In the 38 patients with both non-reactive NSTs and reactive ASTs, 5 (13.5%) had immediate follow-up surveillance tests (OCTs and/or BPPs) that were non-reassuring and necessitated delivery. In four of the five cases, there was evidence of potential fetal compromise. These preliminary observations suggest that the AST may have evoked reactivity in fetuses with early compromise, and raise concerns about replacing the NST with the AST as a primary screening test of fetal well-being.
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Affiliation(s)
- D B Schwartz
- Department of Obstetrics and Gynecology, Sinai Hospital, Detroit, MI 48235
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Gold RB, Goyert GL, Schwartz DB, Evans MI, Seabolt LA. Conservative management of second-trimester post-amniocentesis fluid leakage. Int J Gynaecol Obstet 1990. [DOI: 10.1016/0020-7292(90)90498-a] [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: 11/26/2022]
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15
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Elman KD, Welch RA, Frank RN, Goyert GL, Sokol RJ. Diabetic retinopathy in pregnancy: a review. Obstet Gynecol 1990; 75:119-27. [PMID: 2404223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Diabetic retinopathy is the leading cause of blindness between the ages of 24-64 years. The first half of this period corresponds to peak fertility and the childbearing years. The effects of pregnancy on diabetic retinopathy are unclear, but recent studies suggest that pregnancy may be less harmful to the retina of the diabetic subject than was thought previously. Nevertheless, there is reason to believe that at least some women experience a worsening of their retinopathy as a result of pregnancy. Thus, careful ophthalmic evaluation and follow-up are essential for the pregnant woman with diabetes. This should include a minimum of one complete eye examination every trimester and within 3 months postpartum. Color fundus photography and laser treatment are safe, whereas fluorescein angiography, although commonly used to evaluate retinal vascular disease, can usually be avoided during pregnancy.
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Affiliation(s)
- K D Elman
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
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Gold RB, Goyert GL, Schwartz DB, Evans MI, Seabolt LA. Conservative management of second-trimester post-amniocentesis fluid leakage. Obstet Gynecol 1989; 74:745-7. [PMID: 2812651] [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: 01/02/2023]
Abstract
During a 32-month period, 603 genetic amniocenteses were performed in our institution, and seven patients (1.2%) experienced fluid leakage within 24 hours of the procedure. All seven patients were hospitalized for strict bed rest and expectant management. Cessation of amniotic fluid leakage and reaccumulation of normal amniotic fluid occurred within 7 days in all cases. Six patients were delivered at term of appropriately grown infants without complication. One patient experienced an intrauterine death at 25 weeks' gestation (6 weeks after the occurrence of fluid leakage secondary to genetic amniocentesis). Although limited by the small number of patients, our experience suggests the following: 1) Appropriate respect for potential complications of genetic amniocentesis is still warranted; 2) expectant management of patients who experience membrane rupture after genetic amniocentesis may be associated with a good perinatal outcome; and 3) membrane rupture after genetic amniocentesis may represent a fundamentally different etiologic entity than spontaneous rupture of the membranes in the second trimester not associated with genetic amniocentesis.
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Affiliation(s)
- R B Gold
- Department of Obstetrics and Gynecology, Sinai Hospital, Detroit, Michigan
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Abstract
To investigate the influence of physicians' practice styles on the rate of deliveries by cesarean section, we studied 1533 affluent women at low risk of obstetrical complications who were cared for by 11 obstetricians in a single community hospital. The mean rate of delivery by cesarean section was 26.9 percent, but the rate ranged from 19.1 to 42.3 percent, according to the physician. The mean rate of primary cesarean section (i.e., the rate for women without previous cesarean deliveries) was 17.2, with a range of 9.6 to 31.8 percent. A stepwise logistic-regression model of the determinants of primary cesarean section, including the individual physician, parity, birth weight, and maternal age and excluding specific medical indications, showed that only nulliparity (P less than 0.0001) was more important than the identity of the physician (P less than 0.001) in its influence on the rate of cesarean section. Variation in cesarean-section rates among physicians was not attributable to the practice setting, the patient population, the degree of obstetrical risk, or the physician's recent medicolegal experience, and it was not accompanied by corresponding differences in neonatal outcome. We conclude that individual practice style may be an important determinant of the wide variations in the rates of cesarean delivery among obstetricians. Our data do not permit us to say with certainty whether the procedure is overused by some obstetricians or underused by others, but we found no obvious differences in neonatal outcome associated with differences in the cesarean-section rate.
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Affiliation(s)
- G L Goyert
- Department of Obstetrics and Gynecology, Wayne State University-Hutzel Hospital, Detroit
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Williams MA, Goyert NA, Goyert GL, Sokol RJ. Preliminary report of transabdominal amniocentesis for the determination of pulmonary maturity in an equine population. Equine Vet J 1988; 20:457-8. [PMID: 3063523 DOI: 10.1111/j.2042-3306.1988.tb01574.x] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- M A Williams
- College of Veterinary Medicine, Department of Large Animal Clinical Sciences, Michigan State University, E. Lansing
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Goyert GL, Mariona FG. Management of uterine hyperstimulation after prostaglandin E2 administration. Obstet Gynecol 1987; 70:468-70. [PMID: 3476877] [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
Recent literature suggests that intravaginal or intracervical application of prostaglandin E2 gel may be an effective agent for cervical ripening. One potentially disastrous reported side effect is uterine hyperstimulation. This case report represents the first description of the successful management of uterine hyperstimulation with intravenous ritodrine therapy after the intravaginal administration of prostaglandin E2.
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Goyert GL, Bottoms SF, Sokol RJ. Anicteric presentation of fatal herpetic hepatitis in pregnancy. Obstet Gynecol 1985; 65:585-8. [PMID: 4039045] [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: 01/08/2023]
Abstract
Herpes simplex virus hepatitis in pregnancy was first reported in 1969. Seven other cases have since been reported, and this communication describes two additional cases. The clinical presentation and laboratory profiles of these two cases parallel those described. Unreported, however, is the sharp contrast between the presentation of pregnant patients with herpes simplex virus hepatitis and the presentation of pregnant patients with other life-threatening forms of hepatitis. Nine of ten patients reported to date have been anicteric with peak total bilirubin levels of less than 1.3 mg/dL before cesarean section or laparotomy. That this presentation may not be unique to pregnancy is suggested by three case reports of fatal, anicteric herpes simplex virus hepatitis in previously healthy, nonpregnant adults. The cause of this phenomenon is unknown.
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