Prenatal selective serotonin reuptake inhibitor (SSRI) exposure increases the risk for adverse neonatal behavioral outcomes; although it is unknown whether altered brain function is present before birth. We investigated fetal vascular and heart rate changes at 36-wk gestation in SSRI-treated women with mood disorders (n ϭ 29) [exposed (EXP)] and controls (n ϭ 45) [non-EXP (NEXP)]. Fetal middle cerebral artery (MCA) flow parameters and heart rate characteristics were obtained during pre-SSRI dose morning and postdose afternoon sessions. Maternal mood and cord Hb and hematocrit were measured. Basal fetal heart rate (fHR) did not differ between groups or across the day. The fHR short-and long-term variations, accelerations, and duration of high variability episodes remained lower and did not change across the day in EXP, whereas all increased significantly in NEXP. In both groups, MCA flow velocity and volume flow increased significantly across the day. EXP MCA pulsatility index was significantly lower, as was MCA cross-sectional area. EXP cord Hb and hematocrit were significantly increased. Prenatal SSRI exposure reduced fetal MCA flow resistance and fHR variability, before and after an SSRI dose, controlling for maternal mood. These changes and the SSRI-related increased red cell indices suggest possible fetal hypoxia. (Pediatr Res 70: 96-101, 2011) I ncreasing use of selective serotonin reuptake inhibitor (SSRI) antidepressants to manage maternal mood disturbance during pregnancy has raised concerns about the longterm effects of increased central serotonergic tone during fetal development (1-3). Widespread observations of neonatal neurobehavioral disturbances (4,5), altered infant stress regulation (6,7), and increased risk for neonatal persistent pulmonary hypertension (8) have been reported. Although persistent pulmonary hypertension in neonates has been supported by findings of increased pulmonary arterial wall thickness, associated with lower oxygen saturation and a higher mortality in fluoxetine-exposed (EXP) newborn rats (9), a subsequent human report did not replicate the earlier human reports (10). Such adverse consequences may reflect the effects of SSRI-related increased levels of the neurotransmitter serotonin during fetal development (3,11). SSRIs primarily act by blocking the serotonin transporter thereby increasing extracellular serotonin levels, and because SSRIs readily cross the placenta and the blood-brain barrier, it is conceivable that they alter early brain development via increased central serotonin levels (12). It remains unclear, however, what mechanisms underlie these disturbances and whether the effects of prenatal SSRI exposure are apparent before birth, long before ongoing antenatal medication exposure ends.To date, very little is known about SSRI effects on the human fetal physiologic functions (13). In a single report, fetal middle cerebral artery (MCA) Doppler blood flow velocities increased by 18.5% over an expected clinical level in two fetuses of depressed SSRI-treated...

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Objective: To systematically review and meta-analyze evidence on surgical outcomes after uterine artery occlusion (UAO) at myomectomy. Design: Systematic review and meta-analysis. Setting: Not applicable. Patient(s): Twenty-six studies involving 2,871 patients located via database searches of MEDLINE, Embase, Web of Science, PubMed, clinicaltrials.gov, and cited references. Intervention(s): Intervention groups undergoing UAO at laparoscopic or abdominal myomectomy (UAOþM) (1,569 patients), and control groups undergoing myomectomy alone (1,302 patients). Main Outcome Measure(s): Primary outcome of surgical blood loss (estimated blood loss, transfusion rate, and change in hemoglobin values), and secondary outcomes including operative time, length of stay, conversion and complications rates, fibroid recurrence, and changes in fibroid-related symptoms. Result(s): The patients undergoing UAOþM had a statistically significant reduction in estimated blood loss (mean difference [MD] À103.7 mL; 95% confidence interval [CI], À126.5 to À80.8), blood transfusion (relative risk [RR] 0.24; 95% CI, 0.15-0.39), and change in hemoglobin values (MD À0.60 g/dL; 95% CI, À0.79 to À0.40) compared with controls. Using UAOþM prolonged operative times (MD 10.9 minutes; 95% CI, 3.5-18.2) but shortened the length of stay (MD À0.37 days; 95% CI, À0.62-0.11). Using UAOþM lowered the complication rates (RR 0.73; 95% CI, 0.52-1.00) to the threshold of statistical significance and reduced the risk of fibroid recurrence (RR 0.36; 95% CI, 0.16-0.83) compared with controls. Conclusion(s):Uterine artery occlusion at myomectomy is associated with decreased surgical blood loss and transfusion rate compared with control patients. However, further research is required on reproductive outcomes and the effect on ovarian reserve before routine use can be recommended in women desiring future fertility. (Fertil Steril Ò 2019;111:816-27. Ó2018 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.