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Objective To evaluate trends of emergency peripartum hysterectomy over two decades. Study Design This was a retrospective cohort study of peripartum hysterectomies at one institution from 1988 to 2009. Medical records were reviewed and data from the first 11 years were compared with data from the second 11 years. Results During the study period, 558 emergent peripartum hysterectomies were performed with full records available for 553 to review: 280 in the first period, 273 in the second (p = 0.19). In the second period, prior cesarean deliveries, length of surgery, estimated blood loss, blood transfusions, and the number of units transfused were all increased (p < 0.001). Also in the second period, there were twice as many hysterectomies for suspected placental invasion, and an almost threefold increase in pathologically confirmed placental invasion (both p < 0.001). Conclusion Although emergent peripartum hysterectomies are not increasing in frequency, the risk factors and morbidities have changed. [ABSTRACT FROM AUTHOR]

Compounds that are systemically absorbed during the course of cigarette smoking, and their metabolites, affect the coagulation system and cause endothelial dysfunction, dyslipidemia, and platelet activation leading to a prothrombotic state. In addition, smoking increases the activity of fibrinogen, homocysteine, and C-reactive protein. We hypothesize that smoking may affect functional coagulation testing during pregnancy. A secondary analysis of 371 women pregnant with a singleton pregnancy and enrolled in a multicenter, prospective observational study of complications of factor V Leiden mutation subsequently underwent functional coagulation testing for antithrombin III, protein C antigen and activity, and protein S antigen and activity. Smoking was assessed by self-report at time of enrollment (<14 weeks). None of the functional coagulation testing results was altered by maternal smoking during pregnancy. Smoking does not affect the aforementioned functional coagulation testing results during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the prevalence of hepatitis B and hepatitis C virus co-infection among pregnant women who are infected by human immunodeficiency virus and who attend an obstetric complications prenatal clinic. Study design: A de-identified research obstetric human immunodeficiency virus database was reviewed regarding patient demographic characteristics, risk factors for infection, history of sexually transmitted diseases, and initial CD4 count. Results: Four hundred fifty-five women who are infected with human immunodeficiency virus with 572 pregnancies were delivered over 11 years. The overall prevalence of human immunodeficiency virus and hepatitis B or C virus co-infection in our population was 6.3%. More specifically, 1.5% was co-infected with hepatitis B virus, and 4.9% was co-infected with hepatitis C virus. Patients with hepatitis virus were more likely to use intravenous drugs (52% vs 18%; P < .01) and alcohol (38% vs 5%; P < .01). Co-infected patients were older (28 vs 25.6 years; P = .04), but there were no racial differences. Median baseline CD4 counts in hepatitis B virus co-infected patients were significantly lower (310 cells/mm³) than those in either hepatitis C virus co-infected patients (453 cells/mm³) or patients who were not co-infected with human immunodeficiency virus (414 cells/mm³). Conclusion: One of 16 pregnant women who were infected with human immunodeficiency virus was co-infected with hepatitis B or hepatitis C virus. Hepatitis B co-infections appear to be associated with more compromised immune status in our cohort. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine whether serologic testing for herpes simplex virus type 2 (HSV-2) in pregnant women and their partners is cost-effective. Study design: A decision analysis model was developed to investigate the cost-effectiveness of providing type-specific serologic testing at week 15 of pregnancy for all women unaware of their HSV-2 status, and offering antiviral suppressive therapy from week 36 until delivery to all seropositive women. This scenario was compared with current care, in which only a minority of women diagnosed with genital herpes (GH) receives antiviral suppressive therapy (AST), In a third scenario, testing is offered to partners of pregnant women who test seronegative, and antiviral suppressive therapy is offered to the partners who test seropositive. Results: Compared with current care, offering testing and antiviral suppressive therapy to 100,000 pregnant women resulted in an incremental cost of $3.1 million, 15.7 fewer cases of neonatal herpes, 186 fewer cesarean deliveries, and an incremental cost per quality-adjusted life- year gained (QALY) of $18,680. Offering testing and suppressive therapy to both the pregnant women and their partners resulted in an increased cost of $8.6 million, 16.8 fewer cases of neonatal herpes, 192 fewer cesarean deliveries, and an incremental cost per QALY of $48,946 compared with no testing. Conclusion: Compared with commonly accepted benchmarks for cost-effectiveness (<$50,000/QALY), type-specific HSV-2 serologic testing of pregnant women may be a cost-effective strategy. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the morbidity that is associated with curettage for the management of abortions in women who were infected with human immunodeficiency virus compared with women who were not infected with human immunodeficiency virus. Study design: Women who were infected with human immunodeficiency virus (cases) and who underwent curettage for the management of scheduled and unscheduled abortions in the first half of pregnancy between January 1, 1993, and December 31, 2002, were identified. Women who were not infected with human immunodeficiency virus (control subjects) were matched 3:1 to cases for gestational age, type of abortion, and year of procedure. Medical records were reviewed to obtain demographic characteristics, gestational age, abortion characteristics, and procedure-related complications. Chi-squared test, Student t test, and Wilcoxon rank-sum test were used to determine statistical significance. Results: Seventy-one women who were infected with human immunodeficiency virus (cases) and 213 women who were not infected with human immunodeficiency virus (control subjects) who underwent curettage during the study period were evaluated. Forty-eight cases (68%) and 146 control subjects (69%) underwent a scheduled curettage. Twenty-three cases (32%) and 66 control subjects (31%) underwent an unscheduled curettage for spontaneous or incomplete abortion. No significant differences were seen in age, gravidity, or parity. There were significantly more black women in the HIV-infected cohort (P < .001), which was representative of our human immunodeficiency virus population. The mean gestational age in the cases was greater than in the control subjects (10.9 + 4.2 weeks of gestation vs 9.2 + 3.1 weeks of gestation; P = .004). Procedure-related complications occurred in 10 of the women (14%) who were infected with human immunodeficiency virus who underwent curettage, compared with 9 of the women (4%) who were not infected with human immunodeficiency virus (P = .004). With the use of logistic regression, complication rates were unaffected by the difference in gestational age. Infectious complications did not differ between the 2 groups (P = .435). Conclusion: There was a higher rate of procedure-related complications among women who were infected with human immunodeficiency virus and who underwent curettage for management of spontaneous and induced abortions. There was no increase in infectious morbidity in the women who were infected with human immunodeficiency virus. [ABSTRACT FROM AUTHOR]

Objectives: To determine maternal-fetal transplacental passage of vancomycin in the ex vivo human placental perfusion model. Methods: Six term placentas were collected immediately after delivery and perfused with physiologic medium using the single cotyledon perfusion system. Vancomycin was added to the maternal medium and perfused through the maternal circulation of the cotyledon. Over a 1-h period in an open system, samples of the perfusate were collected at defined intervals from the fetal venous catheter and from the maternal effluence to assess vancomycin transfer. Thereafter, the system was closed for 1-5 h to establish accumulation. Transport fraction and clearance indexes were calculated by perfusing antipyrine 14 C (positive control). Vancomycin was estimated by high pressure liquid chromatography and antipyrine 14 C concentration was determined by liquid scintillation. Results: Mean vancomycin maternal peak and trough concentrations ranged from 30.0 to 51.5 μg/ml and 7.7 to 16.4 μg/ml, respectively. Clearance indexes were minimal with a mean peak range of 0.000-0.080 and a mean trough range of 0.00-0.17. For each placenta, transport fraction for antipyrine 14 C was > 1.85 with a single pass of > 40%. No accumulation of vancomycin was noted when the system was closed for 1-5 h. The mean peak clearance index was zero after perfusing the placenta for up to 5 h with 35.8 μg/ml of vancomycin. Conclusion: Transplacental passage of vancomycin was minimal in the ex vivo human placental perfusion model, with no detectable accumulation. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the frequency and pattern of state laws or regulations regarding prenatal syphilis serologic screening in the United States in 2001.Study Design: We surveyed the United States for existing laws and regulations regarding serologic screening for syphilis during pregnancy. Testing was compared with 2000 state rates of syphilis in women and newborn infants, with states that had syphilis high morbidity areas, and with national 2000 and 2010 objectives for rates of syphilis.Results: Forty-six of the 50 states (90%) and the District of Columbia have laws regarding antenatal syphilis screening. Thirty-four of the 46 statutes (76%) mandate one prenatal test, usually at the first prenatal visit or early in pregnancy. Twelve laws (26%) include third-trimester testing for all or high-risk women. The presence of high morbidity areas, incidence of early syphilis in women, and rates of congenital syphilis are associated with increasing frequency of legislated antepartum screening.Conclusion: Only 90% of states have statutes that require antepartum syphilis screening, and there is variation in the content of the statutes about the number and timing of tests. States with a heavy burden of infectious syphilis in women tend to require more prenatal testing. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to describe our 2-year experience with 483 critically ill peripartum women and to propose a blueprint for obstetric critical care. STUDY DESIGN: This was a prospective study to evaluate all admissions to the Obstetric Intermediate Care Unit and obstetric admissions to medical/surgical intensive care units. Our findings are followed by general recommendations for the organization of obstetric critical care. RESULTS: Almost two thirds of the women had obstetric complications that included pregnancy-associated hypertension and obstetric hemorrhage. Medical disorders were most common in the other one third of the women. CONCLUSION: An Obstetric Intermediate Care Unit allows for the continuation of care by obstetricians and results in fewer transfers to medical/surgical intensive care units. Patient treatment depends on hospital size and available resources, in most tertiary centers, the critically ill pregnant woman is best cared for by obstetricians in an Obstetric Intermediate Care Unit. In smaller hospitals, transfer to a medical or surgical intensive care unit may be preferable. [ABSTRACT FROM AUTHOR]

Objective: We sought to assess the efficacy of a clinical protocol to reduce the incidence of early-onset neonatal group B Streptococcus (GBS) infection.Study Design: We assessed neonatal sepsis from GBS and other organisms with use of a before-after study design to evaluate the effects of implementation of combined intrapartum antimicrobial prophylaxis given selectively to mothers with GBS risks and penicillin G given to all neonates.Results: In 1994, early-onset GBS infection developed in 31 of 13,887 live births (2.2/1000), 13 preterm and 18 term cases. After implementation of the prophylaxis protocol (1995), 6 of 13,527 live births had early-onset GBS (0.4/1000) (P <.001). There were no preterm (P =.0004) and 6 term GBS cases (P =.02). The efficacy continued through 1999 (0.5/1000) without an increase in neonatal infections from other bacteria.Conclusion: Combined maternal and infant antimicrobial prophylaxis can significantly and safely reduce rates of early-onset GBS infection in both preterm and term infants. [ABSTRACT FROM AUTHOR]

Examines the complication of congenital syphilis after maternal treatment for syphilis during pregnancy. Identification of infants with congenital syphilis by clinical or laboratory criteria; Analysis of antepartum factors; Number of women receiving antepartum therapy for syphilis with infants with congenital syphilis.

Evaluates the United States Centers for Disease Control & Prevention's recommendations for the treatment of gonococcal infection in pregnancy. Comparison of the efficacy of ceftriaxone with that of cefixime; Drug dosage and administration; Factors contributing to treatment failures.