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The purpose of this study was to evaluate the efficacy of adding laminaria tents to sequential intravaginal prostaglandin E2 (PGE2) gel for cervical ripening. A prospective, randomized study was conducted from October 1994 to May 1995. Pregnant women with maternal or fetal indications for induction of labor at > or = 37 weeks gestation and a Bishop score of or = 5 was achieved. The groups were comparable with respect to maternal age, parity, gestational age, reason for induction, and initial Bishop score. The addition of laminaria tents to sequential PGE2 gel did not statistically improve the time to a favorable cervix (control group 12.7 +/- 8.5 hr (95% CI, 9.1-16.3) and study group 10.9 +/- 7.1 hr (95% CI, 7.5-14.3) (P = 0.59). The 6-hr difference from the time of the initial PGE2 gel placement to delivery was not detected (control group 22.4 +/- 11.2 hr, 95% CI 17-27 and study group 23.4 +/- 13.1 hr, 95% CI 17-29.6 (P = 0.79). The combination approach of laminaria tents and PGE2 gel did not have a significant impact on the vaginal delivery rate, with 28.0% of patients in the control group and 26.3% of patients in the study group undergoing cesarean section (P = 0.90). Maternal and neonatal complications were rare in both groups. We had insufficient evidence to show that the addition of laminaria tents to PGE2 gel improved cervical ripening, the induction to delivery interval, or the cesarean section rate in patients at term undergoing induction of labor.

The inner perivitelline layer, separated from laid chicken eggs, was investigated as readily available material for studying the spermatozoa-egg interaction in vitro. This layer was found to have a similar response to hydrolysis by spermatozoa as the inner perivitelline layer from ovulated and follicular ova, in terms of the numbers of points of hydrolysis made by spermatozoa during a 5 min incubation at 40 degrees C. Initiation of hydrolysis of the inner perivitelline layer was found to occur within 2.5 min, after which the size, but not the number of holes, increased with time. The frequency of the points of hydrolysis per unit area of the inner perivitelline layer was positively correlated with the concentration of spermatozoa in the incubation medium. The perivitelline hydrolysis assay was able to detect more damaged spermatozoa in samples that had been either stored at 5 degrees C or cryopreserved in liquid N2 than did other tests of sperm quality, which are known to overestimate the fertilizing ability of stored avian semen.

OBJECTIVE The "Hispanic paradox" refers to the epidemiological finding that Hispanics in the US have better health outcomes than the average population despite what their aggregate socioeconomic determinants would predict. The aim of this study was to evaluate obstetric outcomes for a multiethnic population with hypertensive diseases. METHODS We performed a retrospective review of parturients with hypertensive disease delivering at Duke University Medical Center. We analyzed maternal sociodemographic characteristics and ethnic differences in hypertensive disease types using Chi Square tests. RESULTS A total of 3,124 women delivered during a period of one year; 9% of them had hypertensive diseases in pregnancy. Gestational hypertension was more commonly diagnosed in Whites, whereas chronic hypertension and mild preeclampsia were more frequently encountered in Blacks and Hispanics respectively (Chi-square = 39.11, p < 0.001). The overall incidence of preeclampsia was less in Hispanics. However, severe preeclampsia rates were equal across groups. Hispanics were more likely to be uninsured and younger, enter prenatal care later, and least likely to complete high school. There was no significant difference in smoking or parity. Stratified analyses by ethnicity showed that the relationship between severe preeclampsia and comorbidities (intrauterine growth restriction, low birth weight, and need for admission to intensive care nursery) were least pronounced in Hispanics and strongest in Black women. CONCLUSION Despite similar rates of severe preeclampsia and adverse sociodemographic characteristics, Hispanic women with severe preeclampsia had better pregnancy outcomes than Black or White women with the disease.

Smoking in pregnancy reduces preeclampsia risk, but the mechanism of this effect is unknown. Prior studies have demonstrated that women with preeclampsia have lower placental adrenomedullin (AM) expression, and cigarette smoke extract (CSE) treatment of placental trophoblast cells in culture increases AM cellular production. We hypothesized that CSE alters trophoblast invasion through an AM-mediated mechanism, and that placental AM expression is greater among smokers. HTR-8/SVneo trophoblast cells were incubated for 24 hours in Matrigel-invasion chambers with 6 treatment groups: nonstimulated (NS), AM, AM inhibitor (AM22-52), 1% CSE, AM + AM22-52, and 1% CSE + AM22-52. Cells that penetrated the lower surface of the chambers were quantified, invasion indices were calculated, and compared using a 1-way analysis of variance with Bonferroni corrections for multiple comparisons. Trophoblast cells treated with both AM and 1% CSE demonstrated increased cellular invasion compared to NS controls (1.5-fold [P < .01] and 1.45-fold [P < .01], respectively). Cotreatment with the AM inhibitor significantly attenuated the increased invasion seen with both AM and CSE alone. Next, the placental tissue was obtained from 11 smokers and 11 nonsmokers at term and processed for immunohistochemistry (IHC) and real-time quantitative polymerase chain reaction (PCR) for AM. Placentas from smokers demonstrated more intense AM staining and increased AM gene (ADM) expression compared to placentas from nonsmokers (P = .004 for IHC, P = .022 for PCR). The CSE increases trophoblast cell invasion through an AM-mediated process, and placental AM expression is increased among term smokers compared to nonsmokers. These findings provide evidence that the AM pathway may play a role in the protection from preeclampsia seen in smokers.

The obstetrical, neonatal, and childhood risk associated with prenatal smoking are well known. Prenatal smoking has been implicated in up to 25% of low birth weight infants primarily from preterm birth and fetal growth restriction and up to 10% of all infant mortality. The relationship between prenatal marijuana smoking and obstetrical and infant outcomes is less clear. Marijuana is the most commonly used illicit drug during pregnancy. Neither exposure to cigarette nor marijuana smoke has evidence for teratogenicity, but both have been implicated in developmental and hyperactivity disorders in children. Pregnant women should be counseled on the risk of both cigarette and marijuana smoking.

Education of patients and the community should begin with an acknowledgment of the increase in primary and secondary morbidity and mortality associated with the initial cesarean delivery. Women with cesarean birth have a higher rate of rehospitalization for various indications, including surgical site infections. The direct cost for cesarean-related surgical site infection alone is in the tens of millions of dollars. It is important for patients to appreciate risk factors that lead to an increase the risk for primary cesarean, such as obesity, and medical comorbidities. Education on these factors allows in some instances for preconception interventions that can potentially lower the risk for primary cesarean. The obstetrician and the maternal fetal medicine subspecialist have an obligation to focus on evidence-based obstetrical practices that can lead to a more acceptable primary cesarean rate for the obstetrical population. Patient and community awareness can contribute to the promotion of this expectation in obstetrical practice.

Purpose To evaluate the impact of prenatal education by case managers on 2 social determinants of health behaviors—breast feeding and smoking cessation—among participants enrolled in Indianapolis Healthy Start (IHS). Method Birth and death data up to 1 year for IHS clients were collected from Marion County vital records for births 20 weeks or greater. Case managers provide education on the health benefits for mothers and infants on breast feeding and smoking cessation to all clients. Data were analyzed for differences between the IHS participants and other Marion County births. Results Most participants (63%) were non-Hispanic blacks aged less than 25 years (56%), without a high school diploma or general education development (53%), and enrolled in Medicaid (91%). Program participants were more likely to initiate breast feeding than nonparticipants (OR, 1.33; 95% CI, 1.10-1.61), and 22% continued to breast feed for 6 months. Hispanic women were more likely to breast feed for at least 6 months (OR, 4.71; 95% CI, 2.32-9.58). Women with advanced education were more likely to have quit smoking, as were women who were breast feeding at hospital discharge. After controlling for education, IHS clients tended to be less likely to continue to smoke during the third trimester (OR, 0.76, 95% CI, 0.49-1.16), as were those with a first pregnancy (OR, 0.32; 95% CI, 0.10, 0.98) and no other smokers in the home (OR, 0.25; 95% CI, 0.08, 0.74). Conclusion Breast feeding and smoking cessation are modifiable risk factors that were impacted by behavioral interventions through case management education.

To determine whether cervical dilation at the time of physical examination indicated cerclage placement can predicts latency and gestational age at delivery.A retrospective cohort study of all women who underwent physical examination indicated cerclage placement from 1996 to 2011 at Duke University Hospital (DUH) was performed. Physical examination indicated cerclage was defined as cerclage placement after 16 weeks in women with a cervical length of less than 2.5 cm and/or cervical dilation greater than or equal to 1 cm at time of procedure. Subjects were divided into two groups depending on cervical dilation at time of procedure (2 cm,2 cm) for comparison. A multivariate linear regression model for the outcome gestational age of delivery was constructed, controlling for confounding variables.A total of 110 women with complete data were available for analysis. Median gestational age at cerclage placement was similar between the two groups (20.3 vs. 20.3 weeks, p = 0.8). Women with cervical dilatation ≥ 2 cm dilation delivered at an earlier median gestational age than women with cervical dilation2 cm (27.0 vs. 35.6 weeks, p0.001). Cervical dilation at the time of cerclage placement independently predicted gestational age at delivery while controlling for use of intracervical Foley balloon catheter for membrane reduction, cerclage suture type, history of prior preterm birth, race, insurance status, and tobacco use.Women who receive a rescue cerclage are more likely to deliver at an earlier gestational age when cervical dilation is ≥ 2 cm at the time of procedure.

We tested the hypothesis that cigarette smoke extract (CSE) leads to differences in expression of genes involved in angiogenesis and affects cell viability and migration in a first-trimester cytotrophoblast cell line (HTR-8/SVneo). HTR-8/SVneo cells were treated with 1% CSE, and gene expression for adrenomedullin (ADM), placental growth factor (PlGF), soluble fms-like tyrosine kinase 1 (sFLT-1), and vascular endothelia growth factor (VEGF) and protein content for ADM, PlGF, and sFlt-1 determined. A cell viability assay and a cell migration scratch assay were utilized following treatment with CSE with and without ADM inhibitor. Adrenomedullin, PlGF, and VEGF gene transcripts were significantly upregulated by 1% CSE treatment compared with unstimulated cells or cells treated with nicotine alone. Neither 1% CSE nor nicotine treatment alone affected sFlt-1 gene expression. There was a significant increase in secreted ADM protein from cells treated with 1% CSE detected by enzyme-linked immunosorbant assay, though no differences in PlGF or sFlt-1 production were seen. Treatment with 1% CSE increased cell viability and cell migration compared with unstimulated cells and was inhibited by co-treatment with ADM inhibitor. Treatment of a first-trimester trophoblast cell line with CSE increases cell viability and cell migration that are reversed by co-treatment with ADM inhibitor, suggesting that ADM at least partially mediates cell growth and viability following CSE treatment.

Patients with the variant form of xeroderma pigmentosum (XP) have clinical XP including a high frequency of skin cancer but, in contrast to the other forms of XP, have normal post-ultraviolet (UV) DNA excision repair and nearly normal post-UV survival. However, like excision repair-deficient XP cells, the XP variant cells are UV hypermutable. We used a UV-treated plasmid shuttle vector, pZ189, to examine the DNA repair defect in lymphoblastoid cells from an XP variant patient, XPPHBE, and a normal control. Plasmid repair, mutagenesis, and replication occur within transfected cells in a process dependent on the cells' repair capacity. With the XP variant cells post-UV, plasmid survival was normal with but there was an abnormally increased post-UV plasmid mutation frequency. Sequence analysis of the mutated plasmids revealed an increased frequency of plasmids with single base substitution mutations with the XP variant cells. As in earlier studies with UV mutagenesis, there was a predominance of G:C-->A:T base substitution mutations with plasmids recovered from both cell lines. The frequency of G:C-->C:G transversions was significantly higher with plasmids recovered from the XP variant cells than from normal cells. The location of mutations in the marker gene was non-random with different mutagenic hotspots found in plasmids recovered from the XP variant cells and from the normal cells. This study suggests that plasmid UV hypermutability in the presence of normal UV survival may be related to the increased UV skin cancer susceptibility of XP variant patients.

The objective of this study was to measure the performance of the Affirm Ambient Temperature Transport System (ATTS) over time and to estimate the length of time the system can preserve a vaginal specimen containing the three common organisms causing vaginitis: Trichomonas vaginalis , Candida species, and Gardnerella vaginalis (one of the causative agents of bacterial vaginosis). Women with symptoms of vaginitis presenting to one of three clinical centers were evaluated over a 4- to 8-week period. Four simultaneously obtained swabs were collected and tested by the Affirm VPIII assay at time zero with and without a preservative reagent, at 24 h with reagent, and at either 48 or 72 h with reagent. For each of the three organisms, Trichomonas , Gardnerella , and Candida , positivity at each time point was evaluated and compared to that at reference time zero with and without the ATTS. A total of 940 specimens were obtained from the three clinical sites. Eight hundred three were positive for one or more of the three organisms. Gardnerella had the highest overall positive rate (62%), followed by Candida with 18% and Trichomonas at 9%. The percent sensitivity versus control for Trichomonas ranged from 100% at time zero with and without reagent to 91% by 72 h. Gardnerella and Candida sensitivity remained at 100% for each time period. The Affirm VPIII ATTS system performed within 10% of the control swab (no transport reagent) at all four time points (0, 24, 48, and 72 h) for Trichomonas , Gardnerella , and Candida .

Purpose To determine the impact of ethnicity on "near miss"/severe obstetric morbidity in a multi-ethnic, tertiary care population. Methods We carried out a cross-sectional analysis using birth data for 12,774 women with Medicaid who gave birth between January 1994 and January 2005 at Duke University. Univariate and multivariate analyses were carried out to compare ethnic groups and risk factors for severe obstetric morbidity and mortality using codes for conditions corresponding to the WHO definitions of near miss maternal morbidities. Results African-American women experienced significantly more pregnancy complications (25.4%) compared to White (21.7%) and Hispanic (18.8%) women. The presence of medical comorbidities was highest among African-Americans (9.1%) compared to Whites (8.1%) and Hispanics (2.6%). Near miss mortality, however, was significantly higher in Hispanic women (5.9%) compared to African-Americans (4.6%), and Whites (4.1%). Hispanic women had 45% greater risk of near miss mortality compared to Whites (relative risk [RR] = 1.45, 95% confidence interval [CI]: 1.14-1.84) whereas differences were non-significant for African-American women. In multivariate regression, near misses remained highest for Hispanic women (RR = 1.66; 95% CI: 1.27-2.17). Conclusions The increase in near miss maternal mortality for Hispanic women suggests a more complex interaction between ethnicity, socioeconomic status and health than traditional birth outcome measures capture.

Venous thromboembolism is a leading cause for maternal mortality. Because of the increase risk for thromboembolism in pregnancy and the postpartum period, the clinician must be on high alert for the signs and symptoms and use appropriate diagnostics in a timely manner so that prompt anticoagulation therapy can be initiated. A diagnostic and management approach for both deep vein thrombosis and pulmonary embolism and for prophylaxis against thromboembolism in the obstetric patient are crucial to decreasing morbidity, mortality, and long-term sequelae.

Excessive gestational weight gain and obesity have been recognized as independent risk factors for maternal and fetal complications of pregnancy with significant lifelong consequences. These associations call into question the recently released Institute of Medicine (IOM) gestational weight gain recommendations, particularly for obese women. The IOM recommendation of a single standard of weight gain for all obesity classes is also of concern, because higher body mass index levels are associated with more severe pregnancy complications, such as preeclampsia and gestational diabetes. The IOM recommendations retained the 1990 focus on the theoretical association between poor gestational weight gain and low birth weight (LBW). Low gestational weight gain may often be a consequence and not the cause of LBW, and there is a lack of evidence in developed countries that dietary supplementation increases birth weight. Current obstetric practice allows for accurate and timely diagnosis of and intervention for LBW. We submit that gestational weight gain recommendations should be more individualized especially for obese women. Obese pregnant women should not be precluded from partaking in healthy lifestyle modifications in pregnancy that include physical activities, modified, judicious diets, and limited weight gain.

Women with antiphospholipid antibodies have a significant risk of reproductive failure and adverse pregnancy outcomes. The incidence of recurrent abortion, fetal death, and intrauterine fetal growth retardation is significant. Women with a history of recurrent abortion and unexplained fetal death or a history of recurrent thrombotic episodes should be screened for the presence of antiphospholipid antibodies. The benefit of routine screening of pregnant women for the presence of these antibodies has not been established, and the yield from such screening studies has been found to be low. No treatment regimen has eliminated fetal loss and adverse pregnancy events completely in women with the antiphospholipid antibody syndrome. Even when treatment is instituted, maternal and fetal status must be monitored closely. Management of such patients has not been standardized, and various treatment regimens have been found to be efficacious. Multicenter randomized treatment trials are currently underway, and standardization of therapy in these patients may be achieved.

In order to examine possible cell-type specificity in mutagenic events, a shuttle-vector plasmid, pZ18, carrying a bacterial suppressor tRNA marker gene, was treated with ultraviolet radiation and propagated in Epstein-Barr virus transformed lymphoblastoid cell lines from a patient, XP12BE, with xeroderma pigmentosum (XP), group A, and a normal control. XP is a skin-cancer-prone disorder with UV hypersensitivity and defective DNA repair. Plasmid survival and mutations inactivating the marker gene were scored by transforming an indicator strain of E. coli . An earlier report on this data [Seetharam et al., (1990) J. Mol. Biol., 212, 433] indicated lower survival and higher mutation frequency with the UV-treated plasmid passed through the XP12Be(EBV) line. In the present report, sequence analysis of 198 mutant plasmids revealed a predominance of G:C → A:T transitions with both lymphoblastoid cell lines. This finding is consistent with the bias of polymerases toward insertion of an adenine opposite non-coding photoproducts (dinucleotides or other lesions). Transversion mutagenesis, non-adjacent double mutations, and triple-base mutations may involve other mechanisms. These results were compared to similar data from a fibroblast line from the same patient [Bredberg et al., (1986) Proc. Natl. Acad. Sci. (U.S.A.), 83, 8273]. The frequency of G:C → A:T transitions was higher, and there were fewer plasmids with multiple-base substitutions and with transversion mutations with both XP lymphoblasts and fibroblasts than with the normal lymphoblasts and fibroblasts. There were no significant differences in classes or types of mutations in the UV-treated plasmid replicated in the XP lymphoblasts and the XP fibroblasts. This suggests that the major features of UV mutagenesis in different cell types from the same individual are similar.

Objective: Transabdominal cerclage is now evolving as an alternative to transvaginal cerclage in patients with cervical incompetence. The purpose of our study was to evaluate and describe our experience in patients selected to undergo transabdominal cerclage placement.Methods: Outcome data for all patients who underwent transabdominal cerclage from January, 1990, through December, 1994, was collected. Indications for transabdominal cerclage included patients with prior failed vaginal cerclage, extremely shortened cervix, or anatomical defects judged unsuitable for transvaginal cerclage.Results: Eleven patients underwent 12 transabdominal cerclage procedures. The mean gestational age at the time of cerclage placement was 12.5 weeks (range 10-14 weeks). The mean gestational age at delivery was 34 weeks. There were two neonatal deaths, which were related to extreme prematurity. The mean birthweight was 2,622 g. The fetal salvage rate was 83%.Conclusions: These findings suggest that in a highly select group o...

Fifteen to 25% of thromboembolic events in pregnancy are recurrent events. Women with a history of thrombosis have a three- to fourfold increased risk of recurrence when they are pregnant compared with when they are not. The risks are even higher postpartum. The rate of recurrent venous thromboembolic events without anticoagulation is 2.4% to 12.2%, whereas the rate with anticoagulation is 0% to 2.4%. Because the rates of recurrent thromboembolism can be reduced with anticoagulation, women with a history of thrombosis who are not on lifelong anticoagulation will likely require anticoagulation during pregnancy, or at least during the postpartum period. Women who are already on lifelong warfarin for the prevention of recurrent venous thromboembolism should be counseled about the teratogenic effects of warfarin and offered the opportunity to be converted to heparin before conception. During pregnancy, low-molecular-weight heparin, with fewer side effects and a longer half-life, is generally preferred over unfractionated heparin. Unfractionated heparin with its shorter half-life is generally preferred around the time of delivery. Women on antiplatelet medication for prevention of arterial thromboembolism may be converted to low-dose aspirin after conception and supplemented with low-dose heparin or low-molecular-weight heparin during pregnancy. Because current recommendations rely on case series and expert opinion, additional studies including randomized trials might enhance our ability to prevent recurrent thromboembolism in pregnancy.

Objective The purpose of this study was to examine racial disparities and the "Hispanic paradox" in pregnancy outcomes at a tertiary-care medical center. Study Design A cross-sectional study of pregnancy events was performed with information from the Duke University birth database. The latter includes data on birth outcomes, cost, and health services factors. The final sample included 10,755 women with Medicaid insurance, who gave birth during calendar years 1994-2004. Pregnancy comorbidities and outcome measures were identified by International Classification of Diseases, 9th revision, and Current Procedural Terminology (CPT) codes. Univariate and multivariate analyses were performed to compare racial/ethnic groups. Results African-American women were younger and more likely to be employed, to have a medical comorbidity, to remain in the hospital for >4 days, and to have hospital charges of >$7500. African-American women had higher rates of preterm birth, small-for-gestational-age infants, preeclampsia, and stillbirths. There were no differences by race for gestational diabetes mellitus. With the use of white women as the reference group, Hispanic women had lower odds for preterm birth (odds ratio, 0.66; 95% CI, 0.54-0.80), and African-American women had greater odds for preeclampsia (odds ratio, 1.30; 95% CI, 1.07-1.58) and small-for-gestational-age infants (odds ratio, 1.74; 95% CI, 1.29-2.36). With the use of African-American women as the reference, Hispanic women were less likely than African-American women to experience any adverse pregnancy event, with the exception of gestational diabetes mellitus. Conclusion Poverty and insurance status does not explain differences in adverse pregnancy outcomes between African-American women and Hispanic women with Medicaid insurance.

Although the risk of death from complications of pregnancy in the 20th century has decreased dramatically, several lines of evidence suggest that it has not reached an irreducible minimum. To further reduce pregnancy-related mortality, we must understand which deaths are potentially preventable and the changes needed to prevent them. We sought to identify all pregnancy-related deaths in North Carolina and conduct a comprehensive review examining ways in which the number of these deaths could potentially be reduced.The North Carolina Pregnancy-Related Mortality Review Committee reviewed all of the 108 pregnancy-related deaths (women who died during or within 1 year of the end of pregnancy from a complication of pregnancy or its treatment) that occurred in the state in 1995-1999. For each death, the committee determined the cause of death, whether it could have been prevented, and if so, the means by which it might have been prevented.Although overall, 40% of pregnancy-related deaths were potentially preventable, this varied by the cause of death. Almost all deaths due to hemorrhage and complications of chronic diseases were believed to be potentially preventable, whereas none of the deaths due to amniotic fluid embolus, microangiopathic hemolytic syndrome, and cerebrovascular accident were considered preventable. Improved quality of medical care was considered to be the most important factor in preventing these deaths. Among African-American women, 46% of deaths were potentially preventable, compared with 33% of the deaths among white women.Despite the decline in pregnancy-related mortality rates, almost one half of these deaths could potentially be prevented, mainly through improved quality of medical care. In-depth review of pregnancy-related deaths can help determine strategies needed to continue making pregnancy safer.

Background and aims: Transfer of CD4 + CD45RB Hi T cells into semi syngeneic immunodeficient mice represents a model of inflammatory bowel disease (IBD). As patients with IBD often suffer from osteopenia, we studied if this T cell transfer in mice results in osteopenia in addition to colitis, and if treatment with osteoprotegerin (OPG) has effects on the bone mineral density of T cell transferred mice. We also investigated whether osteopenia was due to malabsorption as a result of a dysregulated digestive tract or as a consequence of the inflammatory process. Methods: CD4 + CD45RB Hi or CD4 + CD45RB Lo T cells (4×10 5 ) were sorted from CB6F1 and transferred into C.B.17 scid/scid mice. Recipient mice were treated with human IgG1 Fc (control) or Fc-OPG three times per week in a prophylactic regimen as well as a therapeutic regimen (after 10% body weight loss) and were evaluated for osteopenia and colitis. Results: Mice that received CD4 + CD45RB Hi T cells developed osteopenia (as indicated by decreased bone density accompanied by decreased osteoblasts and increased osteoclasts) and colitis (as indicated by histological changes in the large intestine). Mice that received CD4 + CD45RB Lo T cells developed neither osteopenia nor colitis. All animals consumed, on average, the same amount of food and water over the course of the study. Prophylactic treatment with Fc-OPG increased bone density in mice that received either CD4 + CD45RB Hi or CD4 + CD45RB Lo T cells but had no effects on the gastrointestinal tract. Fc-OPG treatment of osteopenic mice with established IBD caused the normalisation of bone density. Osteopenia in CD4 + CD45RB Hi T cell recipients was accompanied by hypoparathyroidism that was partially normalised by treatment with Fc-OPG. CD4 + CD45RB Hi T cell recipients also had a bone marrow inflammatory cell infiltrate expressing tumour necrosis factor α which was unaffected by treatment with Fc-OPG. Conclusions: CD4 + CD45RB Hi T cell transfer results in osteopenia in addition to colitis. Evidence suggests that this osteopenia was induced by inflammatory cell infiltration and not by malabsorption of calcium. Recombinant human osteoprotegerin effectively treated the osteopenia. OPG may be a useful therapeutic option for treating osteopenia in patients with IBD.

INTRODUCTION:Recently, oxytocin has been classified as a high-alert medication. Opinion statements have recommended more conservative oxytocin protocols and our labor and delivery unit changed its protocol by decreasing maximal infusion rates, lengthening time between dose changes, and adjusting inf

The objective of this study was to measure the performance of the Affirm Ambient Temperature Transport System (ATTS) over time and to estimate the length of time the system can preserve a vaginal specimen containing the three common organisms causing vaginitis: Trichomonas vaginalis, Candida species, and Gardnerella vaginalis (one of the causative agents of bacterial vaginosis). Women with symptoms of vaginitis presenting to one of three clinical centers were evaluated over a 4- to 8-week period. Four simultaneously obtained swabs were collected and tested by the Affirm VPIII assay at time zero with and without a preservative reagent, at 24 h with reagent, and at either 48 or 72 h with reagent. For each of the three organisms, Trichomonas, Gardnerella, and Candida, positivity at each time point was evaluated and compared to that at reference time zero with and without the ATTS. A total of 940 specimens were obtained from the three clinical sites. Eight hundred three were positive for one or more of the three organisms. Gardnerella had the highest overall positive rate (62%), followed by Candida with 18% and Trichomonas at 9%. The percent sensitivity versus control for Trichomonas ranged from 100% at time zero with and without reagent to 91% by 72 h. Gardnerella and Candida sensitivity remained at 100% for each time period. The Affirm VPIII ATTS system performed within 10% of the control swab (no transport reagent) at all four time points (0, 24, 48, and 72 h) for Trichomonas, Gardnerella, and Candida.

The vasculature of the normal and arthritic knee is described. The joint contains a number of different tissues, many of which are heterogeneous and each with varying degrees of vascularization. In the normal joint the vasculature is highly organised, some tissues are highly vascular with well defined vascular organisation, whilst other tissues are avascular. During arthritis vascular turnover is increased. This vascular plasticity leads to redistribution of the vascular bed and may compromise its functional ability. The normal joint is able to regulate its blood flow, but this ability may be compromised by the inflammation and increased synovial fluid volume that are associated with joint disease. Growth of the subchondral vasculature into the articular cartilage may also occur, leading to ossification of the articular cartilage.

Acute traumatic injury during pregnancy is a significant contributor to maternal and fetal morbidity and mortality in the United States. Motor vehicle accidents are the leading cause of injury-related maternal death, followed by violence and assault. Lack of seat belts or other restraints increases the risks of both maternal and fetal morbidity and mortality. The American College of Obstetricians and Gynecologists recommends proper seat belt use by all pregnant women and screening for domestic abuse. Maternal injury and death from physical abuse is prevalent, and in some communities, homicide is a major cause of pregnancy-associated maternal death. Blunt trauma most often occurs as a result of motor vehicle accidents, whereas penetrating trauma results from gunshots or stabbings. Blunt trauma to the abdomen increases the risk for placental abruption, and direct fetal injury is more likely with penetrating trauma. Management strategies in acute maternal trauma must focus on a thorough assessment of the mother. A coordinated team effort that includes the obstetrician is essential to ensure optimal maternal and fetal outcomes. Imaging studies should not be delayed because of concerns of fetal radiation exposure, because the risk is minimal with usual imaging procedures, especially in mid-to-late pregnancy. The obstetrician should serve in a consultative role if nonobstetric surgical care is required and must also be prepared to intervene on behalf of the mother and the fetus if trauma care is compromised by the pregnancy. Perimortem cesarean delivery should be considered early in the resuscitation of a pregnant trauma victim, especially when fetal viability is a concern. Once the mother is stabilized in the emergency setting, she should be transported for appropriate maternal and fetal observation until both mother and fetus are clear of danger. It is essential that the clinician and staff maintain thorough and accurate documentation and recording of the chronology of events, the maternal and fetal assessment, and the management and outcome of the pregnancy.

Objective: The aim of this study was to compare the distributions of protein kinase C isozymes in human nonpregnant and pregnant myometrial tissues and primary cell cultures. Study Design: Myometrial tissues were obtained at hysterectomy from nonpregnant women and at cesarean delivery from women both before and during early labor at term. Western immunoblot analysis was performed on homogenates of myometrial tissues and primary cell cultures with monoclonal antibodies specific for protein kinase C isozymes. Redistribution and translocation of protein kinase C were examined by means of immunocytochemical methods. Results: Nonpregnant myometrial tissues contained protein kinase C isozymes α, γ, δ, μ, ι, and ζ but not β 1 , β 2 , θ, or ϵ. Pregnant myometrial tissues both before and during early labor contained the same protein kinase C isozymes and also β 1 and β 2 . The protein kinase C isozyme distribution in primary myometrial cell cultures was identical to that in the myometrial tissues. Protein kinase C redistribution and translocation were demonstrated in these cultured myometrial cells. Conclusion: Both human myometrial tissues and primary cell cultures expressed a broad range of protein kinase C isozymes. Protein kinase C isozymes β 1 and β 2 were absent in nonpregnant myometrium but were induced during pregnancy. Labor at term did not alter protein kinase C isozyme expression. (Am J Obstet Gynecol 2000;183:1525-31.)

Objective: Care coordination is a Medicaid benefit program designed to assist low-income women in gaining access to pregnancy related services. This study examines the relationship between prenatal care coordination and its impact on access to prenatal services and birth outcome. Methods: Ninety-four women who received prenatal care coordination and gave birth at Wishard Memorial Hospital in 1996 comprised the study population. A control group of 190 non care coordination participants was obtained from women who gave birth immediately before and after the women who was a care coordination participant. The prenatal and birth records from both groups were retrospectively reviewed. Data collected included information on birth weight, gestational age at delivery, WIC participation, number of prenatal visits, smoking and substance abuse. Perinatal complications were also recorded. Statistics was by t test and χ2 with significance at .05. Results: Women enrolled in care coordination received 10 prenatal visits versus 8 for controls (P = .0005). Preterm labor occurred in 1.1% of women in care coordination compared to 5.8% of controls (P = .063). There was no difference in birth weight or the incidence of birth weight

In the human pregnant state a high molecular weight form of angiotensinogen (HMrA) is present in significant quantities in addition to the usual low molecular weight angiotensinogen (LMrA). In a previous study involving a small number of white women, it was found that women who had developed pregnancy-induced hypertension (PIH) had significantly higher levels of plasma HMrA. It has been determined that there are five isoforms of HMrA. The objectives of this study were to expand the previous study with the inclusion of black women and to determine which isoform(s) of plasma HMrA are elevated in PIH. Plasma LMrA and HMrA were quantitated in 24 normotensive pregnant women and 65 women with PIH. The PIH group had higher levels of HMrA and somewhat lower levels of LMrA than the normotensive group. The HMrA/LMrA ratio was elevated in 47% of the PIH group. The five isoforms of HMrA were quantitated in plasma from 10 white women with PIH, 10 black women with PIH, and 6 normotensive pregnant white women. Half of both the white and black women with PIH had an elevated HMrA/LMrA ratio. The relative proportion of the HMrA isomers was similar in all groups. These studies show that half the women with PIH have a distinct abnormality in their renin angiotensin system. Both white and black women show this abnormality. In those women who have an elevated total HMrA, all five isoforms of HMrA are equally elevated.