Serum levels of the ovarian cancer biomarker HE4 are decreased in pregnancy and increase with age.
Am J Obstet Gynecol. 2011 Dec 30;
Authors: Moore RG, Miller MC, Eklund EE, Lu KH, Bast RC, Lambert-Messerlian G
Abstract
OBJECTIVE: The purpose of this study was to establish normal ranges for human epididymis protein 4 (HE4) serum levels in healthy women. STUDY DESIGN: HE4 levels were measured in healthy women and analyzed by age, menopausal status, and pregnancy status. Upper 95th percentiles were determined for normal ranges. RESULTS: Serum samples from 1101 healthy women and 67 pregnant women were analyzed. Above the age of 40 years significant elevations in HE4 concentrations emerged with advancing age. The upper 95th percentile for HE4 levels was 89 pmol/L for premenopausal women, 128 pmol/L for postmenopausal women, and 115 pmol/L for all women. There was a significant difference in the median serum HE4 levels in premenopausal women (46.6 pmol/L) compared with postmenopausal women (57.6 pmol/L; P < .001). In pregnant women, median HE4 concentrations were significantly lower than their premenopausal counterparts (P < .001). CONCLUSION: HE4 serum concentrations vary significantly on the basis of age. These variations must be considered when the upper limit of normal for HE4 is determined.
PMID: 22301440 [PubMed - as supplied by publisher]
OBJECTIVE: We investigated self-reported occupational exposure to antineoplastic drugs, anesthetic gases, antiviral drugs, sterilizing agents (disinfectants), and X-rays and the risk of spontaneous abortion in US nurses. STUDY DESIGN: Pregnancy outcome and occupational exposures were collected retrospectively from 8461 participants of the Nurses’ Health Study II. Of these, 7482 were eligible for analysis using logistic regression. RESULTS: Participants reported 6707 live births, and 775 (10%) spontaneous abortions (<20 weeks). After adjusting for age, parity, shift work, and hours worked, antineoplastic drug exposure was associated with a 2-fold increased risk of spontaneous abortion, particularly with early spontaneous abortion before the 12th week, and 3.5-fold increased risk among nulliparous women. Exposure to sterilizing agents was associated with a 2-fold increased risk of late spontaneous abortion (12-20 weeks), but not with early spontaneous abortion. CONCLUSION: This study suggests that certain occupational exposures common to nurses are related to risks of spontaneous abortion.
PMID: 22304790 [PubMed - as supplied by publisher]
Early detection of placental inflammation by MRI enabling protection by clinically relevant IL-1Ra administration.
Am J Obstet Gynecol. 2012 Jan 13;
Authors: Girard S, Tremblay L, Lepage M, Sebire G
Abstract
OBJECTIVE: We studied whether magnetic resonance imaging (MRI) could be used to detect placental inflammation before the detection of irreversible tissue damage. Next, we tested whether this early detection would enable the administration of treatment (ie, interleukin-1 receptor antagonist [IL-1Ra]) in a realistic clinical time after diagnosis. STUDY DESIGN: Pregnant rats were injected intraperitoneally with lipopolysaccharide with/without delayed IL-1Ra. MRI was performed at different time after the injection, and placentas were collected for comparison. Placental inflammation was assessed by determination of the levels of inflammatory cytokines. RESULTS: Placental inflammation was detected by MRI as early as 3 hours after maternal administration of lipopolysaccharide, concomitantly to IL-1β up-regulation. This was observed before any tissue damage, which appeared only at 24 hours after the administration of lipopolysaccharide. Delayed IL-1Ra administration (after MRI diagnosis) protected the placenta, as seen by the preserved tissue integrity and limited macrophages infiltration in the placental parenchyma. CONCLUSION: These findings established a noninvasive diagnostic method for early in utero detection of placental inflammation that would allow the administration of placentoprotective intervention within a clinically relevant delay after diagnosis.
PMID: 22304959 [PubMed - as supplied by publisher]
2009 H1N1 vaccination by pregnant women during the 2009-10 H1N1 influenza pandemic.
Am J Obstet Gynecol. 2011 Dec 30;
Authors: Dlugacz Y, Fleischer A, Carney MT, Copperman N, Ahmed I, Ross Z, Buchman T, Fried AM, Cabello C, De Geronimo M, Sweetapple C, Besthoff CM, Silverman RA
Abstract
OBJECTIVE: Pregnant women were identified at greater risk and given priority for 2009 H1N1 vaccination during the 2009 through 2010 H1N1 pandemic. We identified factors associated with acceptance or refusal of 2009 H1N1 vaccination during pregnancy. STUDY DESIGN: We conducted an in-person survey of postpartum women on the labor and delivery service from June 17 through Aug. 13, 2010, at 4 New York hospitals. RESULTS: Of 1325 survey respondents, 34.2% received 2009 H1N1 vaccination during pregnancy. A provider recommendation was most strongly associated with vaccine acceptance (odds ratio [OR], 19.4; 95% confidence interval [CI], 12.7-31.1). Also more likely to take vaccine were women indicating the vaccine was safe for the fetus (OR, 12.4; 95% CI, 8.3-19.0) and those who previously took seasonal flu vaccination (OR, 7.9; 95% CI, 5.8-10.7). Race, education, income, and age were less important in accepting vaccine. CONCLUSION: Greater emphasis on vaccine safety and provider recommendation is needed to increase the number of women vaccinated during pregnancy.
PMID: 22306303 [PubMed - as supplied by publisher]
Authors: Cahill AG, Roehl KA, Odibo AO, Zhao Q, Macones GA
Abstract
OBJECTIVE: We sought to estimate the association between fetal gender and first-stage labor curve at term. STUDY DESIGN: Within a large, retrospective cohort study of consecutive, singleton term labor patients who delivered in the second stage, we compared the active phase of first-stage labor by fetal gender. The primary outcome was length of active stage 1. Interval-censored regression was used to estimate the effect of fetal gender on the duration of active first stage (4-10 cm) and was adjusted for relevant covariates. RESULTS: Of 2400 women, 2373 women had complete labor information and were available for this analysis. Male gender was associated with both a statistically significantly longer active first stage of labor (4.6 vs 4.0 hours; P = .002) and stratified analyses by parity and labor type. CONCLUSION: Male fetuses are associated with longer active phase of the first stage of labor and, specifically, may need to be considered in the setting of arrest diagnoses.
PMID: 22306304 [PubMed - as supplied by publisher]
Fear of the unknown: ionizing radiation exposure during pregnancy.
Am J Obstet Gynecol. 2011 Dec 11;
Authors: Groen RS, Bae JY, Lim KJ
Abstract
Ionizing radiation during pregnancy can negatively impact a fetus. In light of the Fukushima nuclear plant disaster in Japan, we discuss existing knowledge on the health effects of radiation and preventive measures for pregnant women. Overall, the risk of exposure to radiation is limited but severe defects can result from fetal radiation exposure >100 mGy equivalent to 10 rad (>1000 chest x-rays). While such high-level exposure rarely occurs during single medical diagnostic procedures, caution should be exercised for pregnant women. As a protective public health measure in light of a disaster, evacuation, shielding, and elimination of ingested radioactive isotopes should all be considered. Detailed radiation reports with health effects and precautionary measures should be available for a population exposed to more than background radiation.
PMID: 22244469 [PubMed - as supplied by publisher]
Inhibition of uterine contractility with various tocolytics with and without progesterone: in vitro studies.
Am J Obstet Gynecol. 2011 Dec 16;
Authors: Baumbach J, Shi SQ, Shi L, Balducci J, Coonrod DV, Garfield RE
Abstract
OBJECTIVE: Various tocolytics are used to suppress uterine contractility in patients in preterm labor. Progesterone (P4) is used in patients at high risk for preterm delivery. In this study, we evaluated the effects of various tocolytics with and without P4 to examine effects on uterine contractility. STUDY DESIGN: Uterine tissues (n = 280) from women undergoing cesarean at term were exposed in vitro to various agents (vehicle, magnesium sulfate [MgSO(4)], nifedipine, indomethacin, or pinacidil-all with and without P4). Contractility was measured before and after addition of the various agents. RESULTS: P4 alone at 10(-5) mol/L concentration has little effect to inhibit contractility (P ≥ .05). MgSO(4) (2-8 × 10(-3) mol/L) inhibits uterine contractility (P < .05) but there is no change when combined with P4 (P > .05). Nifedipine (10(-8) mol/L) and indomethacin (10(-5) mol/L) inhibit contractions alone (P < .05) and to a greater extent when combined with P4 (P < .05). P4 significantly (P < .05) reduced the effects of pinacidil (10(-6.5) mol/L). CONCLUSION:: Combinations of P4 with nifedipine or indomethacin, but not MgSO(4), might be used to effectively suppress preterm labor.
PMID: 22244470 [PubMed - as supplied by publisher]
Timing of delivery and pregnancy outcomes among laboring nulliparous women.
Am J Obstet Gynecol. 2011 Dec 16;
Authors: Tita AT, Lai Y, Bloom SL, Spong CY, Varner MW, Ramin SM, Caritis SN, Grobman WA, Sorokin Y, Sciscione A, Carpenter MW, Mercer BM, Thorp JM, Malone FD, Harper M, Iams JD
Abstract
OBJECTIVE: The objective of the study was to compare pregnancy outcomes by completed week of gestation after 39 weeks with outcomes at 39 weeks. STUDY DESIGN: Secondary analysis of a multicenter trial of fetal pulse oximetry in spontaneously laboring or induced nulliparous women at a gestation of 36 weeks or longer. Maternal outcomes included a composite (treated uterine atony, blood transfusion, and peripartum infections) and cesarean delivery. Neonatal outcomes included a composite of death, neonatal respiratory and other morbidities, and neonatal intensive care unit admission. RESULTS: Among the 4086 women studied, the risks of the composite maternal outcome (P value for trend < .001), cesarean delivery (P < .001), and composite neonatal outcome (P = .047) increased with increasing gestational age from 39 to 41 or more completed weeks. Adjusted odds ratios (95% confidence interval) for 40 and 41 or more weeks, respectively, compared with 39 weeks were 1.29 (1.03-1.64) and 2.05 (1.60-2.64) for composite maternal outcome, 1.28 (1.05-1.57) and 1.75 (1.41-2.16) for cesarean delivery, and 1.25 (0.86-1.83) and 1.37 (0.90-2.09) for composite neonatal outcome. CONCLUSION: Risks of maternal morbidity and cesarean delivery but not neonatal morbidity increased significantly beyond 39 weeks.
PMID: 22244471 [PubMed - as supplied by publisher]
The estimated annual cost of uterine leiomyomata in the United States.
Am J Obstet Gynecol. 2011 Dec 11;
Authors: Cardozo ER, Clark AD, Banks NK, Henne MB, Stegmann BJ, Segars JH
Abstract
OBJECTIVE: The purpose of this study was to estimate the total annual societal cost of uterine fibroid tumors in the United States, based on direct and indirect costs that include associated obstetric complications. STUDY DESIGN: A systematic review of the literature was conducted to estimate the number of women who seek treatment for symptomatic fibroid tumors annually, the costs of medical and surgical treatment, the amount of work time lost, and obstetric complications that are attributable to fibroid tumors. Total annual costs were converted to 2010 US dollars. A sensitivity analysis was performed. RESULTS: The estimated annual direct costs (surgery, hospital admissions, outpatient visits, and medications) were $4.1-9.4 billion. Estimated lost work-hour costs ranged from $1.55-17.2 billion annually. Obstetric outcomes that were attributed to fibroid tumors resulted in a cost of $238 million to $7.76 billion annually. Uterine fibroid tumors were estimated to cost the United States $5.9-34.4 billion annually. CONCLUSION: Obstetric complications that are associated with fibroid tumors contributed significantly to their economic burden. Lost work-hour costs may account for the largest proportion of societal costs because of fibroid tumors.
PMID: 22244472 [PubMed - as supplied by publisher]
The 5-tier system of assessing fetal heart rate tracings is superior to the 3-tier system in identifying fetal acidemia.
Am J Obstet Gynecol. 2011 Dec 22;
Authors: Coletta J, Murphy E, Rubeo Z, Gyamfi-Bannerman C
Abstract
OBJECTIVE: Electronic fetal heart rate monitoring was developed to identify fetuses at risk of acidemia for intervention before adverse outcomes. Our objective was to compare the 3-tier system with a 5-tier system in evaluation of fetal acidemia. STUDY DESIGN: Retrospective case-control study of patients with a fetal arterial pH <7 matched to the next birth that resulted in a pH >7.2. Tracings were categorized into 3- and 5-tier systems by a single reviewer. Sensitivities and specificities were calculated for each. RESULTS: Twenty-four cases and 24 controls were identified. The sensitivity for an orange or red tracing was higher than for category III, with more of these in the pH <7 group compared with controls (P ≤ .001). There were significantly more green, blue, and yellow tracings in the normal pH group compared with the pH <7 group (P = .033, P = .008, P = .023), respectively. CONCLUSION: The 5-tier system had a better sensitivity than the 3-tier system.
PMID: 22244473 [PubMed - as supplied by publisher]
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