Objective To determine if women with severe postpartum hemorrhage (PPH) secondary to uterine atony received greater amounts of oxytocin compared to women without PPH. Study Design Subjects with both severe PPH, defined as having received a blood transfusion, and PPH secondary to uterine atony were compared to matched controls. Total oxytocin exposure was calculated as the area under the concentration curve (mUnits/min*mins). Variables were compared using paired t-test, chi-square and logistic regression. Results Women with severe PPH had a mean oxytocin area under the curve (AUC) of 10,054 mU compared to 3762 mU in controls (p<0.001). After controlling for race, BMI, admission hematocrit, induction status, magnesium therapy, and chorioamnionitis using logistic regression, oxytocin AUC continued to predict severe PPH. Conclusion Women with severe PPH secondary to uterine atony were exposed to significantly more oxytocin compared to matched controls.

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Expanded genetic testing of BRCA mutations has led to identification of more reproductive-aged women who test positive for the mutation which might impact attitudes and decisions about relationships, childbearing and the use of preimplantation genetic diagnosis (PGD) and prenatal diagnosis (PND). A cross-sectional survey was administered to 1081 self-reported BRCA carriers to investigate how knowledge of BRCA status influences these issues. The mean age at BRCA test disclosure was 44 years and 36% reported a personal history of cancer. Of 163 women who were unpartnered, 21.5% felt more pressure to get married. Of 284 women whose families were not complete, 41% reported that carrier status impacted their decision to have biological children. Women with a history of cancer were more likely to report that knowledge of BRCA+ status impacted their decision to have a child (OR 1.8, 95% CI 1–3.2). Fifty-nine percent thought PGD should be offered to mutation carriers and 55.5% thought PND should be offered. In conclusion, knowledge of BRCA status impacts attitudes regarding relationships and childbearing, and most carriers believe that PGD and PND should be offered to other carriers. This study suggests that BRCA carriers desire and would benefit from reproductive counseling after test disclosure.

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Objective To compare Anti-Mullerian Hormone (AMH) levels in women at high risk for hereditary breast and ovarian cancer compared to healthy, low-risk controls. Design Prospective cohort Setting Ambulatory Patient(s) Reproductive age women with a uterus and both ovaries were analyzed in four groups: BRCA1 carriers, BRCA2 carriers, BRCA negative, and low-risk controls Intervention(s) Self-collected dried blood spot (DBS) Main Outcome Measure(s) AMH levels Result(s) One hundred ninety-five women were included: 55 BRCA1 carriers, 50 BRCA2 carriers, 26 BRCA negative, and 64 low-risk controls. After adjusting for confounders, BRCA2 carriers had AMH levels that were 33% lower than controls (Geometric Mean Ratio(GMR)=0.67, 95% CI 0.47–0.94) and an increased odds of having AMH<1 ng/mL (OR 3.69, 95% CI 1.34–10.19). BRCA1 carriers and BRCA negative women had similar AMH levels to controls. When analysis was restricted to regularly menstruating women younger than 40, BRCA2 carriers continued to demonstrate significantly lower AMH levels and increased likelihood of low AMH. Also, in this restricted group, BRCA negative women demonstrated AMH levels that were 42% lower than controls (GMR=0.58; 95%CI 0.35–0.95). No difference in AMH was observed among BRCA1 carriers. Conclusion(s) We observed significantly lower AMH levels among BRCA2 carriers compared to low-risk controls. These results were stable across all models. BRCA negative women also had lower AMH values, but only in models restricted to young, regularly menstruating women. In contrast to previous analyses, BRCA1 carriers had AMH values that were similar to low-risk controls, but this may be due to differences in the population studied.