BackgroundMyomectomy at time of cesarean delivery is traditionally discouraged because of the risk of hemorrhage. A retrospective cohort study was performed to determine whether myomectomy at time of cesarean delivery leads to an increased incidence of intrapartum and short-term postpartum complications.MethodsA computer search of medical records from May 1991 to April 2001 identified a total of 111 women who underwent myomectomy at time of cesarean delivery and 257 women with documented fibroids during the index pregnancy who underwent cesarean delivery alone. Charts were reviewed for the following outcome variables: change in hematocrit from preoperative to postoperative period, length of operation, length of postpartum stay, incidence of postpartum fever, and incidence of hemorrhage. Hemorrhage was defined as a change in hematocrit of 10 points or the need for intraoperative blood transfusion.ResultsThe incidence of hemorrhage in the study group was 12.6% as compared with 12.8% in the control group (p = 0.95). There was also no statistically significant increase in the incidence of postpartum fever, operating time, and length of postpartum stay. No patient in either group required hysterectomy or embolization. Size of fibroid did not appear to affect the incidence of hemorrhage. After stratifying the procedures by type of fibroid removed, intramural myomectomy was found to be associated with a 21.2% incidence of hemorrhage compared with 12.8% in the control group, but this difference was not statistically significant (p = 0.08). This study had 80% power to detect a two-fold increase in the overall incidence of hemorrhage.ConclusionIn selected patients, myomectomy during cesarean delivery does not appear to result in an increased risk of intrapartum or short-term postpartum morbidity.

No abstract

No abstract

Objective The purpose of this study is to determine the frequency of adverse perinatal outcome in women with hyperemesis gravidarum and identify prognostic factors. Study design This is a case-control study in which outcomes of first pregnancies were compared between 254 women with hyperemesis gravidarum treated with intravenous fluids and 308 controls. Prognostic factors were identified by comparing the clinical profile of patients with hyperemesis gravidarum with a normal and an adverse pregnancy outcome. Binary responses were analyzed using either a Chi-square or Fisher exact test and continuous responses were analyzed using a t-test. Results Women with hyperemesis gravidarum have over a 4-fold increased risk of poor outcome including preterm birth and lower birth weight (p < 0.0001). Among maternal characteristics, only gestational hypertension had an influence on outcome (p < 0.0001). Treatment as an outpatient and/or by alternative medicine (acupuncture/acupressure/Bowen massage) was associated with a positive outcome (p < 0.0089). Poor outcomes were associated with early start of symptoms (p < 0.019), and treatment with methylprednisolone (p < 0.0217), promethazine (p < 0.0386), and other antihistamines [diphenhy- dramine (Benadryl), dimenhydrinate (Gravol), doxylamine (Unisom), hydroxyzine (Vistaril/Atarax), doxylamine and pyridoxine (Diclectin/Bendectin)] (p < 0.0151) independent of effectiveness. Among these medications, only the other antihistamines were prescribed independent of severity: they were effective in less than 20% of cases and were taken by almost 50% of patients with an adverse outcome. Conclusion Poor outcomes are significantly greater in women with HG and are associated with gestational hypertension, early symptoms, and antihistamine use. Given these results, there is an urgent need to address the safety and effectiveness of medications containing antihistamines in women with severe nausea of pregnancy.

Cerclage in twin pregnancies significantly decreased the rate of spontaneous preterm birth <32 weeks compared to expectant management. However, when stratified by cerclage indication, this decrease in primary outcome only remained significant in the group with cervical dilation.

We studied 693 consecutive early amniocenteses (prior to 15 weeks) and found a spontaneous abortion rate to 28 weeks' gestation of 1.5 per cent. A control group of women having standard amniocentesis (15-20 weeks) experienced a 0.6 per cent fetal loss in the same period. There were no other apparent differences between the two groups. Early amniocentesis results are generally available 4-6 weeks before standard amniocentesis and 1-3 weeks after chorionic villus sampling (CVS). Alpha-fetoprotein (AFP) can be accurately assayed in 11- to 15-week amniotic fluid samples but additional studies are necessary to determine the accuracy of neural tube defect (NTD) detection. Including the present study, over 5800 early amniocenteses have been reported and the results suggest that this is a relatively safe prenatal diagnostic test and an alternative to CVS and later amniocentesis.

This study is the first to analyze the relationship of psychiatric factors to risk of recurrence of HG. No factors were identified that increase the risk of recurrence including stress symptoms following a HG pregnancy. Psychological sequelae associated with HG are probably a result of the physical symptoms of prolonged severe nausea and vomiting, medication and/or hospitalization, and likely play no role in disease etiology.

ABSTRACT. L-selectin is a leukocyte adhesion molecule important in the initial stages of the interaction of neutrophils with endothelium during neutrophil emigration from the bloodstream. Neutrophils and eosinophils from newborn infants express significantly less L-selectin than do neutrophils and eosinophils from adults. It is not known whether I.-selectin expression on fetal granulocytes is similarly decreased. We studied fetal blood specimens obtained for a variety of clinical indications by percutaneous umbilical cord sampling at 23 to 34 wk of gestation and measured L-selectin expression by flow cytometry. Eosinophils constituted a large proportion of the granulocytes in these fetal specimens (42 & 26%, n = 8), with eosinophil counts ranging from 180 to 690/mm"mean ? SD: 350 f 220). There was no difference in L-selectin expression of unstimulated fetal and adult neutrophils (mean f S D specific fluorescence: 53.0 f 6.8 versus 56.6 2 4.3, n = 6), and no difference between unstimulated fetal and adult eosinophils (16.0 f 6.5 versus 18.7 f 3.2, n = 6). Thus, neutrophils and eosinophils from fetuses a s early a s 23 wk express L-selectin a t adult levels. Furthermore, fetal neutrophils and eosinophils shed the receptor normally in response to stimulation in vitro. We conclude that the reduction of L-selectin expression on neonatal neutrophils and eosinophils is not due to an inherent developmental limitation, but instead must be caused by changes occurring in the neonatal period. Elucidation of the etiology of these changes may aid in the development of therapeutic measures to correct the L-selectin-related defects of neonatal neutrophil adherence. (Pediatr Res 34: 253-257, 1993) Abbreviations FMLP, N-formyl-methionyl-leucyl-phenylalanine HBSS, Hanks' balanced salt solution PE, phycoerythrin L-selectin, a member of the selectin family of cell adhesion molecules, plays a critical role in the initial rolling interaction of neutrophils with activated endothelium (1-4). The rolling interaction greatly reduces the speed of neutrophils in small venules and is a prerequisite for the P2-integrin-mediated interactions that produce firm adhesion of neutrophils and subsequently their