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Pancuronium bromide was used in 49 patients undergoing repeat elective Caesarean section. In 26 patients who received only pancuronium 0.1 mg kg-1, pancuronium was detected in all umbilical venous or arterial samples (0.12 micrograms ml-1). In 23 other patiets who received suxamethonium 1.0 mg kg-1 followed by pancuronium 0.05 mg kg-1, pancuronium was detected in fetal blood 2 min after injection; the concentration of pancuronium in umbilical venous or arterial samples in 14 subjects was 0.08 micrograms ml-1, and less than 0.05 micrograms ml-1 in nine subjects. There was no evidence that such concentrations of pancuronium were detrimental to the fetus. The use of suxamethonium before pancuronium resulted in reduction of pancuronium dosage, induction-delivery time, and fetal concentrations of pancuronium, and was associated with better condition of the neonate.

During the period November 1972 through October 1974, 118 epidural blood patch procedures were performed for severe postlumbar-puncture cephalgia. Subsequently, in a period varying from 105 to 380 days, three patients, two of whom had twice undergone epidural blood patch, were readmitted for either surgical operation or delivery. Either epidural, caudal, or spinal block was successfully accomplished. During the epidural block, the epidural block the epidural space was easily identified and no resistance was felt either to injection of the local anesthetic or to advancement of the epidural catheter. During the spinal block, ligmentum flavum was distinctly felt from the dura. The extent of the blocks, the onset and duration of action ofpivacaine, mepivacaine, and lidocaine were within normal limits. It is, therefore, concluded that epidural blood patch does not obliterate the epidural space and should not preclude the use of regional block for later surgical or obstetric procedures.

Objectives: Data regarding the longitudinal relationship of global longitudinal strain (GLS) and echocardiographic parameters are lacking in peripartum cardiomyopathy (PPCM). We evaluated GLS and its correlation with change (∆) in left ventricular ejection fraction (LVEF). Methods: We retrospectively identified women age ≥16 years hospitalized at Montefiore Medical Center in Bronx, NY from 1999-2015 with International Statistical Classification of Diseases and Related Health Problems, 9th revision codes for PPCM or an occurrence of unexplained heart failure during or up to 5 months postpartum. N = 195 charts were reviewed for inclusion/exclusion criteria, n = 53 patients met criteria for PPCM, and of those, n = 13 had a baseline and follow-up echocardiogram suitable for GLS analysis.Results: Of those eligible for strain analysis, the mean age was 30 ± 6 years, 46.2% identified as Black and 38.5% as Hispanic/Latina. Baseline LVEF was 30 (25, 35)%, GLS was −13.2 (−14, −7.6)%. At a mean follow-up time of 1.2 ± 0.7 years, 11/13 had persistently mild −15.6 (−16.3, −12.7)%, and 2/13 severely abnormal GLS −7.05

Peripartum cardiomyopathy (PPCM) is idiopathic systolic congestive heart failure around pregnancy. Comparisons with matched controls are lacking. We investigated maternal characteristics and outcomes up to 12 months in a cohort admitted to Montefiore Health System in Bronx, New York 1999–2015 (n = 53 cases and n = 92 age and race-matched controls, >80% Black or Hispanic/Latina). Compared to peers, women with PPCM had more chronic hypertension (24.5% vs. 8.8%, p = 0.001), prior gestational hypertension (20.8% vs. 5.4%, p = 0.001), prior preeclampsia (17.0% vs. 3.3%, p = 0.001), familial dilated cardiomyopathy (5.7% vs. 0.0%, p = 0.04), smoking (15.1% vs. 2.2%, p = 0.001), lower summary socioeconomic scores (−4.12 (IQR −6.81, −2.13) vs. −1.62 (IQR −4.20, −0.74), p < 0.001), public insurance (67.9% vs. 29.3% p = 0.001), and frequent depressive symptoms. Women with PPCM were often admitted antepartum (34.0% vs. 18.5%, p = 0.001) and underwent Cesarean section (65.4% vs. 30.4%, p = 0.001), but had less preterm labor (27.3% vs. 51.1%, p = 0.001). Women were rarely treated with bromocriptine (3.8%), frequently underwent left ventricular assist device placement (9.4% and n = 2 with menorrhagia requiring transfusion and progesterone) or heart transplantation (3.8%), but there were no in-hospital deaths. In sum, women with PPCM had worse socioeconomic disadvantage and baseline health than matched peers. Programs addressing social determinants of health may be important for women at high risk of PPCM.

This RCT will add to our understanding of the roles of different imaging modalities in triaging patients with suspected angina. It will increase the CER evidence base comparing SE and CTA and provide insight into potential benefits and limitations of appropriate use of treadmill SE in the ED.

INTRODUCTION:Testosterone-induced vaginal atrophy is hypothesized to increase the risk of vaginal cuff dehiscence (VCD); however, current studies are limited and conflicting. This study compares risk of VCD among gender-diverse people on testosterone (GDT) and ciswomen (CW) and evaluates factors associated with VCD.METHODS:An IRB-approved retrospective cohort study was conducted among adults who underwent total hysterectomy (June 1, 2014 to December 31, 2019) for benign indications at Kaiser Permanente Northern California. Patients had 6 months postoperative follow-up, and GDT had greater than 6 months testosterone use prior to hysterectomy. Differences between GDT and CW were evaluated using Wald χ2, Fisher’s exact, Student’s t test, or Kruskal–Wallis tests. Unadjusted logistic regression was conducted to estimate odds ratios (OR) for VCD.RESULTS:The cohort (n=22,109) included 154 (0.7%) GDT and 21,995 (99.3%) CW. GDT were younger (median 27 [interquartile range (IQR) 22–36] versus 47 [IQR 42–52] years, P<.001) and had lower proportion with Charlson Comorbidity Index (CCI) greater than or equal to 1 (18.2% versus 27.1%, P=.013) than CW. A greater proportion of GDT experienced VCD (5.8% versus 2.5%, P<.016; OR 2.42, 95% CI 1.23–4.77, P=.011). Patients with CCI greater than or equal to 1 or had hypertension were associated with 25% (95% CI 4–50%, P=.015) and 41% (95% CI 18–68%, P<.001) higher odds of VCD, respectively.CONCLUSION:The odds of VCD was 2.4 times higher in GDT despite being younger and healthier than CW. Charlson Comorbidity Index of 1 or higher and hypertension were also associated with higher risk of VCD. These findings support the theory of testosterone-induced vaginal atrophy as a risk factor for VCD. Additional studies are needed to better understand the pathophysiology of VCD among GDT and prevent this morbid complication.