American Journal of Obstetrics & Gynecology - Articles in Press

Trends in inpatient prolapse procedures in the United States, 1979–2006 - Corrected Proof

2010-03-12

Objective: We sought to describe national trends for inpatient procedures for pelvic organ prolapse from 1979–2006.Study design: The National Hospital Discharge Survey was analyzed for patient and hospital demographics, as were International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedures codes from 1979–2006. Age-adjusted rates (AARs) per 1000 women were calculated using the 1990 US Census data.Results: There was a significantly decreasing trend in the AARs for inpatient prolapse procedures, from 2.93–1.52 per 1000 women from 1979–2006. AARs for hysterectomy decreased from 8.39–4.55 per 1000 women from 1979–2006. Over the study period, AARs remained at about the 1979 level among the women ≥52 years old (2.73–2.86; P = .075). In women <52 years old, AARs declined to less than one-third of the 1979 rate (3.03–0.84; P < .001).Conclusion: AARs for inpatient procedures for prolapse in the United States remained stable for women aged ≥52 years from 1979–2006; rates declined by two-thirds for women aged <52 years.

Nicotine restores endothelial dysfunction caused by excess sFlt1 and sEng in an in vitro model of preeclamptic vascular endothelium: a possible therapeutic role of nicotinic acetylcholine receptor (nAChR) agonists for preeclampsia - Corrected Proof

2010-03-12

Objective: In this study we tested the hypothesis that nicotine restores proangiogenic functions to endothelial cells pretreated with soluble fms-like tyrosine kinase 1 and/or soluble endoglin.Study Design: Wound healing assay and tube formation assay were performed using human umbilical vein endothelial cells treated with nicotine (10−9 to 10−6 M), and with various combinations of soluble fms-like tyrosine kinase 1 (100 ng/mL), soluble endoglin (100 ng/mL), and nicotine (10−7 M). Enzyme-linked immunosorbent assay was performed to measure vascular endothelial growth factor, placental growth factor, and transforming growth factor-β1 concentrations in the conditioned media treated with nicotine (10−9 to 10−6 M).Results: Nicotine significantly facilitated endothelial migration and tube formation. By contrast, soluble fms-like tyrosine kinase 1 and/or soluble endoglin suppressed these endothelial functions. Nicotine restored these soluble fms-like tyrosine kinase 1 and/or soluble endoglin-reduced endothelial functions. Placental growth factor, but not transforming growth factor-β1, production was significantly stimulated by the presence of nicotine. Vascular endothelial growth factor was undetectable.Conclusion: Our results suggest a possible mechanism for the protective effects of cigarette smoking against preeclampsia, thus proposing a therapeutic potential of nicotine or other nicotinic acetylcholine receptor agonists for preeclampsia.

Correlation between levator ani muscle injuries on magnetic resonance imaging and fecal incontinence, pelvic organ prolapse, and urinary incontinence in primiparous women - Corrected Proof

2010-03-11

Objective: The objective of the study was to correlate the presence of major levator ani muscle (LAM) injuries on magnetic resonance imaging (MRI) with fecal incontinence (FI), pelvic organ prolapse (POP), and urinary incontinence (UI) in primiparous women 6-12 months postpartum.Study Design: A published scoring system was used to characterize LAM injuries on MRI dichotomously (MRI negative, no/mild vs MRI positive, major).Results: Major LAM injuries were observed in 17 of 89 (19.1%) women who delivered vaginally with external anal sphincter (EAS) injuries, 3 of 88 (3.5%) who delivered vaginally without EAS injury, and 0 of 29 (0%) who delivered by cesarean section before labor (P = .0005). Among women with EAS injuries, those with major LAM injuries trended toward more FI, 35.3% vs 16.7% (P = .10) and POP, 35.3% vs 15.5% (P = .09), but not UI (P = 1.0).Conclusion: These data support the growing body of literature suggesting that both EAS and LAM are important for fecal continence and that multiple injuries contribute to pelvic floor dysfunction.

Abnormal anal cytology in HIV-infected women - Corrected Proof

2010-03-11

Objective: The purpose of this study was to assess the prevalence of and risk factors for abnormal anal cytology and human papillomavirus (HPV) infections in women who are human immunodeficiency virus (HIV) positive.Study Design: We conducted an observational single center study of 100 HIV-infected women with cervical and anal specimens that were obtained for cytologic and high-risk HPV testing with Hybrid Capture 2.Results: Seventeen women had abnormal anal cytology; 16 women had anal HPV; 21 women had abnormal cervical cytology, and 24 women had cervical HPV. Abnormal anal cytology was associated with cervical HPV infection, abnormal cervical cytology, and anal HPV infection in univariate analysis. In multivariate analysis, abnormal anal cytology was associated with a CD4 count <200 cells/mm3, a history of sexually transmitted disease, and concurrent cervical cytologic abnormality.Conclusion: HIV-infected women are at high risk for abnormal cytology and HPV infections of both the anus and cervix. Risk factors for abnormal anal cytology include abnormal cervical cytology, cervical and anal HPV infections, and low CD4 count.

Placental vascular lesion differences in pregnancy-induced hypertension and normotensive fetal growth restriction - Corrected Proof

2010-03-11

Objective: Pregnancy-induced hypertension/preeclampsia (PIH) and fetal growth restriction (FGR) share a common placental origin. The pathologic classification that divides placental lesions to maternal or fetal origin was compared between these disorders.Study design: Placentas from pregnancies that were complicated by PIH, normotensive FGR, or by both (combined) were analyzed, and lesions were classified as those consistent with maternal under-perfusion and with fetal thromboocclusive disease.Results: Maternal vascular lesions were more common in the PIH group and combined group (61% and 59%, respectively), compared with the FGR group (16.2%; P < .001), and villous lesions were more common in the combined group, compared with the FGR and PIH groups (79.5%, 53.5%, and 46.9%, respectively; P = .004). Fetal villous changes were observed in 16.2% in the FGR group, compared with 3.1% in the PIH group (P = .03), and chronic villitis was 15.2% in the FGR group vs 1.6% in the PIH group (P = .004).Conclusion: Placental lesions correspond with different clinical presentations.

Lower urinary tract injury in women in the United States, 1979–2006 - Corrected Proof

Elizabeth A. Frankman, Li Wang, Clareann H. Bunker, Jerry L. Lowder — 2010-03-11

Objective: We sought to determine age-adjusted rates (AARs) of lower urinary tract injury and incidence in selected inpatient gynecologic and obstetric procedures.Study design: We utilized the National Hospital Discharge Survey, 1979–2006. AARs of nonobstetric bladder and ureteral injuries and incidence of lower urinary tract injury for various hysterectomy types and deliveries were calculated for women >18 years old.Results: Overall AARs of ureteral injury decreased from 0.06–0.03 per 1000 women (1979–2006). AARs of inpatient gynecologic procedures decreased from 24.9–11.8 per 1000 women (1979–2006). By hysterectomy type, bladder injury was highest in laparoscopic-assisted vaginal hysterectomy (VH) (13.8 per 1000) and VH (13.1 per 1000). Ureteral injury recognized during hysterectomy was most common with radical hysterectomy (7.7 per 1000) and least common with laparoscopic-assisted VH (0 per 1000).Conclusion: Ureteral injuries at time of inpatient surgical procedures have decreased from 1979–2006. This corresponds with a sharp decrease in inpatient gynecologic procedures.

Is laminin gamma-1 a candidate gene for advanced pelvic organ prolapse? - Corrected Proof

2010-03-11

Objectives: We sought to determine allele frequencies of 3 LAMC1 single nucleotide polymorphisms (SNPs) in Caucasian and African American (AA) women with stage > II pelvic organ prolapse (POP) (cases) and in ethnicity-matched controls with stage < 2 POP. We also sought to determine if LAMC1 is associated with POP within ethnic groups.Study design: Allelic discrimination was performed for LAMC1 SNPs rs10911193 (C/T), rs20563 (A/G), and rs20558 (T/C). SNP and haplotype-specific tests were used to examine associations among POP, ethnicity, and LAMC1.Results: In all, 411 women were enrolled. Significant differences in allele and haplotype frequencies existed among AAs and Caucasians: rs10911193 “T” (P = .0014); rs20563 “G” (P < .0001); rs20558 “C” (P < .0001); rs20563, rs20558 “GC” (P < .0001); and rs20563, rs20558 “AT” (P < .0001). No significant associations between POP and LAMC1 SNPs or haplotypes were found within ethnicities.Conclusion: While significant differences were identified between AA and Caucasian women, no associations were found between any LAMC1 gene variant and advanced POP.

Fecal incontinence in primary care: prevalence, diagnosis, and health care utilization - Corrected Proof

2010-03-11

Objective: We sought to estimate the frequency of self-reported fecal incontinence (FI), identify what proportion of these patients have a diagnosis of FI in their medical record, and compare health care costs and utilization in patients with different severities of FI to those without FI.Study design: Patients in a health maintenance organization were eligible and 1707 completed a survey. Patients with self-reported FI were assessed for a diagnosis of FI in their medical record for the last 5 years. Health care costs and utilization were obtained from claims data.Results: FI was reported by 36.2% of primary care patients, but only 2.7% of patients with FI had a medical diagnosis. FI adversely affected quality of life and severe FI was associated with 55% higher health care costs (including 77% higher gastrointestinal-related health care costs) compared to continent patients.Conclusion: Increased screening of FI is needed.

Is computed tomography a reliable diagnostic modality in detecting placental injuries in the setting of acute trauma? - Corrected Proof

2010-03-11

Objective: The objective of this study was to determine whether computed tomography (CT) is a reliable method of imaging to assess placental injury after acute trauma during pregnancy.Study Design: This study was a retrospective review of digital CT images and electronically scanned charts of pregnant trauma patients identified from the hospital trauma registry list.Results: Using delivery within 36 hours of trauma as the clinical marker for the occurrence of placental abruption, positive radiologic readings showed 86% sensitivity and 98% specificity. The overall accuracy was 96%.Conclusion: Given that defined patterns on CT can be identified and those can be correlated to actual abruption, CT may be a reliable method for evaluation of placental abruption after maternal trauma, especially in the face of abdominal trauma. Our results show that CT has both good sensitivity and specificity identifying abruption and should be considered for use in the management in the pregnant patient after trauma.

Allelic variations in angiogenic pathway genes are associated with preeclampsia - Corrected Proof

Sindhu K. Srinivas, Alanna C. Morrison, Christina M. Andrela, Michal A. Elovitz — 2010-03-11

Objective: This study investigates the association of allelic variation in angiogenic pathway genes and preeclampsia.Study Design: Data for cases with preeclampsia and term control subjects were collected prospectively. Maternal DNA was extracted, and 124 tagging single nucleotide polymorphisms in 6 genes (vascular endothelial growth factor A, B, and C; fms-like tyrosine kinase 1 and 4; endoglin) were genotyped. Multivariable logistic regression was used to evaluate the association between tagging single nucleotide polymorphisms and preeclampsia; data were controlled for age. All models were evaluated in black women and white women separately. Haplotype analyses were performed.Results: We analyzed data from 606 women (489 black women [184 cases] and 117 white women [32 cases]). In black women, the fms-like tyrosine kinase 1 rs12584067 (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.01–2.36; P = .05) and rs7335588 (OR, 1.61; 95% CI, 1.06–2.43; P = .01) and the vascular endothelial growth factor C rs1485766 (OR, 1.56; 95% CI, 1.05–2.30; P = .03) and rs6838834 (OR, 1.60; 95% CI, 1.05–2.45; P = .03) single nucleotide polymorphisms were associated with preeclampsia. In white women, the fms-like tyrosine kinase 1 rs722503 (OR, 2.12; 95% CI, 1.07–4.19; P = .03), fms-like tyrosine kinase 4 rs307826 (OR, 3.06; 95% CI, 1.18–7.91; P = .01), and vascular endothelial growth factor C rs7664413 (OR, 2.04; 95% CI, 0.99–4.17; P = .04) single nucleotide polymorphisms were associated with preeclampsia.Conclusion: Allelic variations in the fms-like tyrosine kinase 1 and vascular endothelial growth factor C genes are associated with preeclampsia in both ethnic groups.

Racial and ethnic disparities in reproductive endocrinology and infertility - Corrected Proof

2010-03-08

This review examines racial and ethnic disparities in reproductive health focusing on 3 key topical areas: (1) infertility, (2) polycystic ovarian syndrome, and (3) reproductive aging. We report that an increasing body of knowledge points toward reduced infertility access and in vitro fertilization outcomes in Asian, black, and Hispanic women compared with white women. There are differences in the reproductive and metabolic phenotypes of Asian, black, and Hispanic women presenting with the polycystic ovarian syndrome compared with white women. Reproductive aging differences appear to exist in all racial and ethnic groups. Awareness of racial and ethnic disparities is critical to a complete understanding of the health issues facing women of reproductive age.

The use of senna with docusate for postoperative constipation after pelvic reconstructive surgery: a randomized, double-blind, placebo-controlled trial - Corrected Proof

Minita Patel, Megan O. Schimpf, David M. O'Sullivan, Christine A. LaSala — 2010-03-08

Objective: The objective of the study was to compare time to first bowel movement (BM) after surgery in subjects randomized to placebo or senna with docusate.Study Design: Ninety-six subjects completed a baseline 7-day bowel diary before and after surgery. After pelvic reconstructive surgery, the subjects were randomized to either placebo (n = 45) or senna (8.6 mg) with docusate (50 mg) (n = 48). Time to first BM and postoperative use of magnesium citrate were compared.Results: There was a significant difference in the time to first BM in those receiving senna with docusate vs placebo (3.00 ± 1.50 vs 4.05 ± 1.50 days; P < .002). More subjects in the placebo group needed to use magnesium citrate to initiate a bowel movement (43.6% vs 7.0%; P < .001).Conclusion: The use of senna with docusate decreases time to first BM in those undergoing pelvic reconstructive surgery compared with placebo. Subjects using senna with docusate are also significantly less likely to use magnesium citrate.

Congenital anomalies of upper extremities: prenatal ultrasound diagnosis, significance, and outcome - Corrected Proof

2010-02-22

Objective: We sought to assess the role of ultrasound in the prenatal characterization of fetal malformations of the upper extremities (MUE).Study design: Ultrasound findings, associated anomalies, pregnancy, and fetoneonatal outcome were analyzed in 100 fetuses with MUE, categorized after Swanson classification of hand congenital abnormalities. Follow-up information was available in all.Results: Twelve cases had an isolated defect, while 88 showed associated abnormalities involving other organ systems. Fetuses with multiple malformations showed a 76% syndromic risk (32% chromosomal, 41% nonchromosomal), with unfavorable outcome in almost all cases (only 4 survivors, 2 with neurodevelopmental delay). In 27% of syndromic fetuses, the sonographic evidence of the MUE represented the key finding leading to the final diagnosis. The prognosis was usually favorable in cases of isolated defects.Conclusion: A thorough prenatal ultrasound characterization of fetal MUE can assist in the differential diagnosis of many syndromic conditions. When isolated, MUE tend to have a good outcome.

Twin-twin transfusion syndrome: an ethics-based and evidence-based argument for clinical research - Corrected Proof

David M. Stamilio, William D. Fraser, Thomas R. Moore — 2010-02-22

Aspects of twin-twin transfusion syndrome (TTTS) diagnosis, treatment alternatives, and research opportunities were considered during a consensus conference that was held by the North American Fetal Therapy Network in 2009. A 3-member scientific consensus panel gathered data from expert conference presentations, postconference communications, and comprehensive scientific literature database searches to develop recommendations for TTTS diagnosis, therapy, and research. The panel recommends retaining the Quintero staging system until a superior system has been validated appropriately. It concludes that there is normative equipoise to justify the performance of randomized clinical trials to identify the optimal treatment strategy for mild TTTS. Recommendations for the design and conduct of clinical trials and observational studies are also provided.

Prospective trial on obstructive sleep apnea in pregnancy and fetal heart rate monitoring - Corrected Proof

2010-02-22

Objective: Obstructive sleep apnea (OSA) involves episodic nocturnal apneas. Using polysomnography, we examined the predictive capacity of screening questionnaires (Berlin) in pregnancy. Incorporating simultaneous fetal heart rate monitoring (FHM), we examined the association of maternal apnea with FHM abnormalities.Study design: We enrolled 100 pregnant women at 26-39 weeks of gestation with OSA screening and baseline data ascertainment who underwent polysomnography and FHM for ≥3 hours. The relationship between maternal characteristics, OSA, and FHM was explored with multivariate analyses that were controlled for potential confounders.Results: When compared with polysomnography, sensitivity and specificity by Berlin screening was 35% and 63.8%, respectively; the snoring component of the Berlin correlated better with oxygen desaturation <95% (P = .003). Body mass index was a significant confounder (rs = 0.44; P < .0001). No association was observed between FHM abnormalities and OSA parameters.Conclusion: In pregnancy, the Berlin questionnaire poorly predicts OSA. It is unclear whether fetal compromise during maternal apnea is a mechanism in OSA that is related to pregnancy outcome.

Questioning the importance of genetic ancestry as a contributor to preterm delivery and related traits in African American women - Corrected Proof

Amy L. Non, Clarence C. Gravlee, Connie J. Mulligan — 2010-02-22

We read with interest the article by Tsai et al about a significant association between African genetic ancestry in African American women and preterm delivery (PTD). They conclude that “more intensive investigation of genetic admixture in African Americans” is needed to identify novel PTD-related susceptibility genes. Their conclusions, however, rely on inconsistent trends in ancestry levels and the use of potentially biased estimates of ancestry, and they neglect important alternative risk factors for PTD.

Reply - Corrected Proof

Hui-Ju Tsai, Xiaobin Wang — 2010-02-22

We thank Non et al for their comments. First, we observed an increasing trend in preterm delivery (PTD; odds ratio [OR], 1.5 vs 1.7), spontaneous PTD (OR, 1.3 vs 1.7), very PTD (OR, 1.4 vs 2.1), and PTD accompanied by histologic chorioamnionitis (OR, 1.1 vs 1.2), but not in other traits; specifically, medically indicated PTD (OR, 2.1 vs 1.9), near-term PTD (OR, 1.6 vs 1.5), and PTD with maternal hypertensive disorder (OR, 2.4 vs 2.2) were noted. This may be due to at least 2 reasons: (1) PTD has heterogeneous causes. The 7 traits may represent different subphenotypes of PTD, thus, may have different associations with ancestry informative markers; and (2) we may not have adequate statistical power because of a smaller sample size in each subgroup. Because we did not correct for multiple testing, we agree with Non et al that the detected signals may (or may not) be retained after correction for multiple testing.

Amplification of the chromosome 3q26 region shows high negative predictive value for nonmalignant transformation of LSIL cytologic finding - Corrected Proof

2010-02-22

Objective: The chromosome 3q26 region is a biomarker for cervical cancer. Women with low-grade squamous intraepithelial lesions (LSIL) currently are referred for immediate colposcopy. The objective of this study was to determine the negative predictive value of the 3q26 amplification test for the persistence or regression of LSIL.Study design: Archival thin layer cytologic slides of 47 women (14–67 years old) with LSIL were linked to histologic and cytologic end points. To determine 3q status, the slides were hybridized for the chromosome 3q26 region and for the centromere of chromosome 7, as a control, with the use of the standard fluorescent in situ hybridization methods.Results: The negative predictive value of 3q26 gain for the development of cervical intraepithelial neoplasia grade 2/3 within 1 year was 93% (95% confidence interval, 68– 100); after 21 months, its negative predictive value was 100% (95% confidence interval, 29–100).Conclusion: The 3q26 gain might help identify women with LSIL who do not need colposcopy.

The association between obesity and stage II or greater prolapse - Corrected Proof

Blair B. Washington, Elisabeth A. Erekson, Nadine C. Kassis, Deborah L. Myers — 2010-02-22

Objective: We sought to evaluate the association between obesity and vaginal prolapse as well as pelvic organ prolapse symptoms.Study design: This was a cross-sectional study of women referred for urogynecologic care. The exposure was obesity and outcome, stage ≥ II prolapse. Secondary outcomes were symptom bother and disease-specific quality of life.Results: Our study included 721 women. No difference in stage ≥ II prolapse was observed between obese (n/N = 258/721 [35.8%]) and nonobese (n/N = 463/721 [64.2%]) women (50.8% vs 52.7%; P = .62). Obesity was associated with increased distress on the Pelvic Floor Distress Inventory-20 (100 [±57.3] vs 87.4 [±53.1]; P = .003) due to higher scores on the Colorectal-Anal Distress Inventory-8 (22.9 [±21.5] vs 18.3 [±19.7]; P = .003) and the Urinary Distress Inventory-6 (48.8 [±27] vs 42.4 [±26.1]; P = .002).Conclusion: Obesity was not associated with stage ≥ II prolapse but was associated with increased pelvic floor symptoms secondary to urinary and anal incontinence subscales.

Impact of pessary use on prolapse symptoms, quality of life, and body image - Corrected Proof

Minita Patel, Colleen Mellen, David M. O'Sullivan, Christine A. LaSala — 2010-02-22

Objective: We sought to evaluate whether use of a vaginal pessary would change body image, bother symptoms, and quality of life in women with pelvic organ prolapse.Study design: Women presenting for pessary insertion completed the short forms of Pelvic Floor Distress Inventory-20, Pelvic Floor Impact Questionnaire, and Body Image Scale. After successful pessary insertion and use for at least 3 months, subjects completed the surveys again. Scores were compared with a paired t test.Results: A total of 75 subjects were enrolled and follow-up responses were available for 54 subjects for analysis. Body Image Scale scores showed a significant decrease (6.1–3.4; P < .001), indicating an improvement in these women's perception of themselves, as did Pelvic Floor Distress Inventory-20 scores (81.34–45.83; P < .001) and Pelvic Floor Impact Questionnaire scores (50.32–17.98; P = .003).Conclusion: The use of a pessary for 3 months reduces bother symptoms and improves both quality of life and perception of body image in women.

Inhibition of glycolysis enhances cisplatin-induced apoptosis in ovarian cancer cells - Corrected Proof

2010-02-08

Objective: Up-regulation of glycolysis has been demonstrated in multiple tumor types and is believed to originate as an adaptive response to the selective pressure of the tumor microenvironment. We hypothesized that ovarian cancer cells are dependent on the glycolytic pathway for adenosine triphosphate generation and that this phenotype could be exploited for therapeutic intervention.Study Design: Expression of glucose transporter 1 (Glut1), phosphorylated protein kinase B (pPKB/pAkt), and phosphorylated mammalian target of rapamycin (pmTOR) was assessed in ovarian carcinoma tumors and cell lines. Cells were incubated with 2-deoxyglucose and rapamycin; growth inhibition, viability, and mechanism of cell death were determined.Results: Ovarian carcinoma cells overexpress Glut1, pAkt, and pmTOR compared with benign ovarian epithelial cells. 2-Deoxyglucose and rapamycin markedly enhance apoptotic and nonapoptotic cell death in ovarian cancer cells.Conclusion: The glycolytic phenotype of ovarian cancer cells can be targeted for therapeutic intervention. Combined treatment modalities that target multiple cellular pathways hold promise for the treatment of chemoresistant ovarian cancer cells.

Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes - Corrected Proof

Claire E. Margerison Zilko, David Rehkopf, Barbara Abrams — 2010-02-04

Objective: The purpose of this study was to investigate the associations between gestational weight gain (GWG) and small- and large-for-gestational-age (SGA, LGA), cesarean delivery, child overweight, and maternal postpartum weight retention in a diverse sample of women in the Unites States.Study Design: We estimated associations between GWG (continuous and within categories defined by the Institute of Medicine), maternal prepregnancy body mass index, and each outcome in 4496 births in the National Longitudinal Survey of Youth 1979, which was a prospective cohort.Results: GWG (kilograms) was associated with decreased risk of SGA and increased risk of LGA, cesarean delivery, postpartum weight retention, and child overweight independent of maternal demographic and pregnancy characteristics. Gain above the Institute of Medicine guidelines was associated with decreased risk of SGA and increased risk of all other outcomes.Conclusion: Excessive gain may have long-term consequences for maternal and child body size, but the benefits of lower gain must be balanced against risk of SGA.

Recurrence of preterm premature rupture of membranes in relation to interval between pregnancies - Corrected Proof

2010-02-04

Objective: The purpose of this study was to examine whether the recurrence risk of preterm premature rupture of membranes (PPROM) is modified by the interpregnancy interval (IPI).Study design: We used the Missouri 1989–1997 longitudinally linked data to examine the recurrence risk of PPROM in women with first 2 (n = 150,929) and first 3 (n = 30,011) successive pregnancies. Race-specific recurrence risks were examined. Adjusted odds ratios (ORs) were used to estimate risks.Results: Risks of PPROM in the second pregnancy among women with and without previous PPROM were 5.7% and 2.3%, respectively, among white women (OR, 8.7; 95% confidence interval, 6.7–11.4) and 10.3% and 4.3%, respectively, among African American women (OR, 7.2; 95% confidence interval, 5.1–10.1). Short IPI was associated with increased risk for PPROM recurrence, with substantially higher risk for African American women than white women. However, long IPI was associated with increased recurrence among African American women.Conclusion: Women with previous PPROM are at increased risk for recurrence, and a short IPI is associated with increased risk.

Inpatient hospitalization for gynecologic disorders in the United States - Corrected Proof

2010-02-04

Objective: The purpose of this study was to examine trends in hospitalizations for gynecologic disorders in the United States.Study design: Data on hospitalizations from 1998–2005 among women 15–54 years old were from the Nationwide Inpatient Sample, a nationally representative survey of inpatient hospitalizations. Hospitalizations with a principal diagnosis of a gynecologic disorder were used to estimate rates per 10,000 women.Results: Gynecologic disorders accounted for 7% and 14% of all hospitalizations among women 15–44 and 45–54 years old, respectively. The most common diagnoses were uterine leiomyomas (rate = 27.5), menstrual disorders (rate = 12.3), endometriosis (rate = 9.5), genital prolapse (rate = 7.0), benign ovarian cysts (rate = 6.5), and pelvic inflammatory disease (rate = 6.1). The hospitalization rate for menstrual disorders increased from 9.8 in 1998 to 13.3 in 2005 (P-trend < .001). In contrast, rates declined for pelvic inflammatory disease, genital prolapse, benign ovarian cysts, and endometriosis (P-trend < .05) and were unchanged for uterine leiomyoma.Conclusion: Gynecologic disorders are an important contributor to inpatient hospitalization among women in the United States.

Prevalence, incidence, and natural history of simple ovarian cysts among women >55 years old in a large cancer screening trial - Corrected Proof

2010-01-25

Objective: The purpose of this study was to measure the occurrence and natural history of simple ovarian cysts in a cohort of older women.Study Design: Simple cysts were ascertained among a cohort of 15,735 women from the intervention arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial through 4 years of transvaginal ultrasound screening.Results: Simple cysts were seen in 14% of women the first time that their ovaries were visualized. The 1-year incidence of new simple cysts was 8%. Among ovaries with 1 simple cyst at the first screen, 54% retained 1 simple cyst, and 32% had no cyst 1 year later. Simple cysts did not increase risk of subsequent invasive ovarian cancer.Conclusion: Simple ovarian cysts are fairly common among postmenopausal women, and most cysts appear stable or resolve by the next annual examination. These findings support recent recommendations to follow unilocular simple cysts in postmenopausal women without intervention.

Immunoreactivity of oxytocin receptor and transient receptor potential vanilloid type 1 and its correlation with dysmenorrhea in adenomyosis - Corrected Proof

Jichan Nie, Xishi Liu, Sun-Wei Guo — 2010-01-25

Objective: We sought to investigate the expression and localization of oxytocin receptor (OTR) and transient receptor potential vanilloid type 1 (TRPV1) in women with and without adenomyosis.Study design: Ectopic and homologous eutopic endometrium from 50 women with adenomyosis and endometrium from 18 women without adenomyosis were used for immunohistochemical analysis of OTR and TRPV1. Microscopic evaluation assessed the presence and localization of OTR and TRPV1 throughout the menstrual cycle in both eutopic endometrial and endometriotic tissues of women with adenomyosis and compared them with normal endometrium.Results: Compared with normal endometrium, immunoreactivity of OTR and TRPV1 were significantly increased in ectopic endometrium. Both OTR and TRPV1 immunoreactivity were positively correlated with the severity of dysmenorrhea and found to be significant predicators for dysmenorrhea severity.Conclusion: These findings suggest that OTR and TRPV1 may be involved in dysmenorrhea and its severity in adenomyosis and may be potential therapeutic targets.

Laparoscopic ovarian diathermy vs clomiphene citrate plus metformin as second-line strategy for infertile anovulatory patients with polycystic ovary syndrome: a randomized controlled trial - Corrected Proof

2010-01-25

Objective: The purpose of this study was to compare the effectiveness of laparoscopic ovarian diathermy (LOD) vs clomiphene citrate (CC) plus metformin in infertile patients with CC-resistant polycystic ovary syndrome (PCOS).Study Design: Fifty primary infertile patients with CC-resistant PCOS were assigned randomly to receive LOD followed by a 6-month observation (group A) or 6-cycle course of CC plus metformin (group B). Reproductive and safety outcomes were analyzed.Results: No significant difference between 2 groups in pregnancy (15/92 women [16.3%] vs 14/107 women [13.1%]; P = .521) and live-birth (13/92 women [14.1%] vs 12/107 women [11.2%]; P = .536) rates per cycle was observed. With the use of a Cox regression analysis, patients under medical treatment, compared with patients who received surgical treatment, had a relative risk of pregnancy of 1.2 (95% confidence interval, 0.61–2.44; P = .582) and a relative risk of live-birth of 1.4 (95% confidence interval, 0.63–2.96; P = .425).Conclusion: LOD and CC plus metformin seem to be 2 effective approaches to treat infertility in patients with CC-resistant PCOS.

Reduced prevalence of metabolic acidosis at birth: an analysis of established STAN usage in the total population of deliveries in a Swedish district hospital - Corrected Proof

Håkan Norén, Ann Carlsson — 2010-01-18

Objective: The purpose of this study was to investigate quality-of-care improvements after the introduction of ST waveform analysis as an adjunct to standard cardiotocography (CTG).Study design: This was a prospective clinical study that was conducted over 7 years. Four yearly cohorts of 12,832 term pregnancies were part of a detailed analysis. Cord blood metabolic acidosis and neonatal outcome were main outcome measures.Results: The STAN (S31 Fetal Heart Monitor; Neoventa Medical AB, Mölndal, Sweden) usage rate increased from 26 to 69%. The cord metabolic acidosis rate was reduced from 0.72 to 0.06%. This 91.7% improvement was associated with a significant reduction in the number of cases with a prolonged response time, calculated as the time from CTG + ST indications to intervene until delivery and an ability of the staff to identify and act on preterminal and unstable fetal heart rate patterns at the onset of a recording.Conclusion: Our data indicate a paradigm shift in the outcome of delivery related to a high rate of CTG + ST usage and the application of structured CTG analysis.

Toll-like receptor-3 as a target to enhance bioactivity of cancer immunotherapy - Corrected Proof

2010-01-18

Objective: The purpose of this study was to explore the potential of toll-like receptor-3 stimulation, with polyI:C12U (poly[l].poly[C12,U]; rintatolamid [Ampligen; Hemispherx Biopharma, Philadelphia, PA]) to enhance bioactivity of cancer immunotherapies.Study design: Several models of immune activation were assessed with polyI:C12U at concentrations that were achieved clinically. Dendritic cell maturation and antigen-specific immune responses were evaluated in vitro and in a murine model. The potential for polyI:C12U to enhance antibody-dependent cellular cytotoxicity against tumor was also evaluated.Results: Dendritic cells are matured and T-cell stimulation is enhanced in the presence of polyI:C12U. In addition, polyI:C12U induced the release of proinflammatory chemokines and cytokines. Prostate-specific antigen-specific T-cell and antibody responses were enhanced significantly in a BALB/c prostate-specific antigen transgenic mouse model. Finally, rituximab-mediated antibody-dependent cellular cytotoxicity against tumor targets was improved significantly by the addition of polyI:C12U.Conclusion: PolyI:C12U shows promise as a potential agent for selective enhancement of effect with currently available and future cancer immunotherapies.

Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: a decision and economic analysis - Corrected Proof

2010-01-18

Objective: The purpose of this study was to estimate which strategy is the most cost-effective for the prevention of preterm birth and associated morbidity.Study design: We used decision-analytic and cost-effectiveness analyses to estimate which of 4 strategies was superior based on quality-adjusted life-years, cost in US dollars, and number of preterm births prevented.Results: Universal sonographic screening for cervical length and treatment with vaginal progesterone was the most cost-effective strategy and was the dominant choice over the 3 alternatives: cervical length screening for women at increased risk for preterm birth and treatment with vaginal progesterone; risk-based treatment with 17 α-hydroxyprogesterone caproate (17-OHP-C) without screening; no screening or treatment. Universal screening represented savings of $1339 ($8325 vs $9664), when compared with treatment with 17-OHP-C, and led to a reduction of 95,920 preterm births annually in the United States.Conclusion: Universal sonographic screening for short cervical length and treatment with vaginal progesterone appears to be cost-effective and yields the greatest reduction in preterm birth at <34 weeks' gestation.

Can levator avulsion be predicted antenatally? - Corrected Proof

Ka Lai Shek, Hans Peter Dietz — 2010-01-15

Objective: We sought to determine whether antepartum prediction of major levator trauma is feasible.Study design: A prospective longitudinal study was undertaken on 488 pregnant nulliparous women seen between 36-38 weeks and again 4 months after delivery. All underwent an interview and 4-dimensional transperineal ultrasound. Diagnosis of levator trauma (avulsion) on tomographic ultrasound was correlated with predelivery demographic variables and ultrasound parameters.Results: In all, 367 women returned for postpartum assessment after normal vaginal delivery (n = 187), vacuum/forceps (n = 54), and cesarean section (n = 126). Avulsion was diagnosed in 34 vaginally parous women (14%). Maternal age, family history of cesarean section, hiatal dimensions, levator muscle strain, bladder neck descent, and subpubic arch angle were not associated with avulsion. The only predictor identified was a lower body mass index (P = .005).Conclusion: Antepartum prediction of major levator trauma may be difficult or impossible. Future studies should focus on modification of current obstetric practices and antepartum interventions applicable to the general population.

National survey of obstetrician attitudes about timing the subsequent pregnancy after perinatal death - Corrected Proof

Katherine J.. Gold, Irving Leon, Mark C. Chames — 2010-01-15

Objective: After stillbirth or early infant death, parents often query when they can try for another pregnancy. We conducted a national survey of US obstetricians to assess attitudes about optimal timing of next pregnancy and advice given to parents.Study design: The study was an anonymous mail survey of 1500 randomly selected US obstetricians asking about physician experiences with perinatal death.Results: In all, 804 of 1500 obstetricians completed the survey for a 54% usable response rate. Two-thirds of respondents endorsed a waiting time <6 months for parents bereaved by stillbirth who desired another pregnancy.Conclusion: Physicians in this national survey supported very short interpregnancy intervals for parents bereaved by perinatal death. Responses may reflect efforts to support parents emotionally while recognizing individuals vary in coping and clinical circumstances. However, this is a provocative finding since short intervals may confer greater fetal risks for poor outcome.

Route of delivery and neonatal birth trauma - Corrected Proof

2010-01-15

Objective: We sought to examine rates of birth trauma in 2 groupings (all International Classification of Diseases, Ninth Revision codes for birth trauma, and as defined by the Agency for Healthcare Research and Quality Patient Safety Indicator [PSI]) among infants born by vaginal and cesarean delivery.Study design: Data on singleton infants were obtained from the 2004-2005 Healthcare Cost and Utilization Project Nationwide Inpatient Sample.Results: The rates of Agency for Healthcare Research and Quality PSI and all birth trauma were 2.45 and 25.85 per 1000 births, respectively. Compared with vaginal, cesarean delivery was associated with increased odds of PSI birth trauma (odds ratio [OR], 1.71), primarily due to an increased risk for “other specified birth trauma” (OR, 2.61). Conversely, cesarean delivery was associated with decreased odds of all birth trauma (OR, 0.55), due to decreased odds of clavicle fractures (OR, 0.07), brachial plexus (OR, 0.10), and scalp injuries (OR, 0.55).Conclusion: Infants delivered by cesarean are at risk for different types of birth trauma from infants delivered vaginally.

Defining normal and abnormal fetal growth: promises and challenges - Corrected Proof

Jun Zhang, Mario Merialdi, Lawrence D. Platt, Michael S. Kramer — 2010-01-14

Normal fetal growth is a critical component of a healthy pregnancy and influences the long-term health of the offspring. However, defining normal and abnormal fetal growth has been a long-standing challenge in clinical practice and research. We review various references and standards that are used widely to evaluate fetal growth and discuss common pitfalls of current definitions of abnormal fetal growth. Pros and cons of different approaches to customize fetal growth standards are described. We further discuss recent advances toward an integrated definition for fetal growth restriction. Such a definition may incorporate fetal size with the status of placental health that is measured by maternal and fetal Doppler velocimetry and biomarkers, biophysical findings, and genetics. Although the concept of an integrated definition appears promising, further development and testing are required. An improved definition of abnormal fetal growth should benefit both research and clinical practice.

Fetal brain asymmetry: in utero sonographic study of normal fetuses - Corrected Proof

Zvi Kivilevitch, Reuven Achiron, Yaron Zalel — 2010-01-14

Objective: The objective of the study was to evaluate the magnitude of normal fetal brain asymmetry.Study Design: This was a prospective study. Normal fetuses between 19–28 weeks of gestation were studied. The cerebral atria, occipital cortex, and hemispheres in both sides were measured. The difference between each side was evaluated and was correlated with sex, head biometry, and estimated weight.Results: Four hundred six fetuses were studied. Mean atrial width was larger in the males and on the left side (5.2% and 6.5%, respectively). Mean cortical width was 2.6% larger in males but 5.5% thinner on the left side. Mean hemisphere width was larger in males and on the left side (2.3% and 1.5%, respectively). The atria and the cortex presented an inverse relationship regarding fetal growth parameters.Conclusion: Brain asymmetry represents normal fetal brain developmental phenomena. It is sex dependent and lateralized in most cases to the left. Lateralization was more accentuated in males.

Reply - Corrected Proof

Stefano Uccella, Giacomo F. Colombo, Pierfrancesco Bolis — 2010-01-14

We deeply appreciated the interest of Professor Spellacy for our article. As clearly stated in the headings, Table 2 refers to the data about the intrapartum outcomes of only those women who underwent labor (n = 866). On the contrary, Table 5 and the last sentence of the Results refer to the risk of adverse pregnancy outcomes considering the whole population included (n = 1037). Therefore, no conflict exists in these data.

Corrected Proof

William N. Spellacy — 2010-01-14

I read the article by Uccella et al. The authors reported that low plasma pregnancy-associated plasma protein-A (PAPP-A) levels predicted several poor pregnancy outcomes. There seems to be a conflict between the data in the table and that in the text. The table shows a probability value for preterm delivery of less than 37 weeks as 0.22 (not significant), but the last paragraph in the Results section states that preterm delay (<37 and <34 weeks) was higher in the women with low PAPP-A levels. The same statement is also made in the Comment section (paragraph 2 on page 168).

Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants - Corrected Proof

Allison S. Bryant, Ayaba Worjoloh, Aaron B. Caughey, A. Eugene Washington — 2010-01-11

Wide disparities in obstetric outcomes exist between women of different race/ethnicities. The prevalence of preterm birth, fetal growth restriction, fetal demise, maternal mortality, and inadequate receipt of prenatal care all vary by maternal race/ethnicity. These disparities have their roots in maternal health behaviors, genetics, the physical and social environments, and access to and quality of health care. Elimination of the health inequities because of sociocultural differences or access to or quality of health care will require a multidisciplinary approach. We aim to describe these obstetric disparities, with an eye toward potential etiologies, thereby improving our ability to target appropriate solutions.

Vitamin D insufficiency in pregnant and nonpregnant women of childbearing age in the United States - Corrected Proof

Adit A. Ginde, Ashley F. Sullivan, Jonathan M. Mansbach, Carlos A. Camargo — 2010-01-11

Objective: We evaluated vitamin D insufficiency in a nationally representative sample of women and assessed the role of vitamin supplementation.Study design: We conducted secondary analysis of 928 pregnant and 5173 nonpregnant women aged 13-44 years from the National Health and Nutrition Examination Survey 2001-2006.Results: The mean 25-hydroxyvitamin D (25[OH]D) level was 65 nmol/L for pregnant women and 59 nmol/L for nonpregnant women. The prevalence of 25(OH)D <75 nmol/L was 69% and 78%, respectively. Pregnant women in the first trimester had similar 25(OH)D levels as nonpregnant women (55 vs 59 nmol/L), despite a higher proportion taking vitamin D supplementation (61% vs 32%). However, first-trimester women had lower 25(OH)D levels than third-trimester women (80 nmol/L), likely from shorter duration of supplement use.Conclusion: Adolescent and adult women of childbearing age have a high prevalence of vitamin D insufficiency. Current prenatal multivitamins (400 IU vitamin D) helped to raise serum 25(OH)D levels, but higher doses and longer duration may be required.

Prenatal diagnosis and outcome of isolated interrupted inferior vena cava - Corrected Proof

Moshe Bronshtein, Nizar Khatib, Zeev Blumenfeld — 2010-01-08

Objective: Report our experience in prenatal diagnosis of 11 cases of interrupted inferior vena cava, summarize the clinical significance and implications of this variant.Study Design: Retrospective analysis of 11 fetuses diagnosed with interrupted inferior vena cava, of 55,457 pregnant women who underwent extensive fetal anomaly scan during 20 years.Results: Eight of the 11 fetuses with interrupted inferior vena cava had a completely normal outcome. One had also normal outcome but abnormal function of the spleen. One had multiple abnormalities, and 1 case was lost to follow up.Conclusion: The incidence of IIVC is 1:5000. In the vast majority (90%) of the cases, it is an isolated variant not associated with isomerism or fetal anomalies. In all the cases of isolated interrupted inferior vena cava, the outcome is favorable. In 10% of isolated interrupted inferior vena cava, abnormal function of the spleen may be detected after delivery, necessitating antipneumococcal vaccination.

Amniocentesis and chorionic villus sampling in twin gestations: which is the best sampling technique? - Corrected Proof

2010-01-08

Objective: To compare the fetal loss rate <24 weeks and the preterm premature rupture of the membranes <34 weeks' gestation according to type of invasive procedure and to sampling techniques in twins.Study Design: Retrospective cohort study of 204 twin pregnancies, who underwent amniocentesis (100) or chorionic villus sampling (104).Results: Fetal loss rate <4 weeks was 3.85% in chorionic villus sampling group and 4.00% in amniocentesis group (P value not significant). According to sampling technique, fetal loss rate was 4.17% (chorionic villus sampling 1 puncture), 2.70% (amniocentesis 1 puncture), 3.75% (chorionic villus sampling 2 punctures), and 4.76% (amniocentesis 2 punctures), (P values not significant). Preterm premature rupture of the membranes rate <34 weeks was 8.2% chorionic villus sampling group and 10% in amniocentesis group (P value not significant). According to sampling technique, preterm premature rupture of the membranes rate was 12.5% (chorionic villus sampling 1 puncture), 8.1% (amniocentesis 1 puncture), 6.9% (chorionic villus sampling 2 punctures), and 11.1 % (amniocentesis 2 punctures), (P values not significant).Conclusion: Double entry technique does not affect significantly the outcomes evaluated, in both amniocentesis and chorionic villus sampling.

Comparison of adnexal torsion between pregnant and nonpregnant women - Corrected Proof

2010-01-08

Objective: The purpose of this study was to compare clinical manifestations, treatment, and pregnancy outcome of adnexal torsion in pregnant and nonpregnant women.Study design: We conducted a retrospective case-control study in the Departments of Gynecology at 2 tertiary centers between 1999-2008. Forty-one pregnant and 77 nonpregnant women with surgically proved adnexal torsion were assessed.Results: Recurrence rate of torsion was 19.5% in pregnant women and 9.1% in control subjects; 73% of pregnant women conceived through assisted reproductive technologies. Doppler blood flow was falsely normal in 61% of pregnant women and in 45% of nonpregnant women; 83.3% of pregnant women delivered at term. Laparoscopic detorsion was the main surgical procedure.Conclusion: Presentation of adnexal torsion is similar in pregnant and nonpregnant women. Past assisted reproductive technology is an important risk factor in pregnancy. Doppler blood flow has a high false-negative rate and should not outweigh clinical suspicion. Although pregnancy outcome is favorable, the high rate of recurrence raises the issue of surgical fixation at the first episode.

Prophylactic bilateral oophorectomy or removal of remaining ovary at the time of hysterectomy in the United States, 1979-2004 - Corrected Proof

2010-01-08

Objective: The purpose of this study was to describe national rates and trends of prophylactic bilateral oophorectomy or remaining oophorectomy (BO/RO) at hysterectomy in women without specific gynecologic disease.Study Design: Data from the National Hospital Discharge Survey were analyzed for 1979-2004. Hysterectomies were divided into 2 groups: (1) hysterectomy with BO/RO and (2) hysterectomy alone (≥1 ovary remaining). Age-adjusted rates (AARs) were calculated with 2000 US census data.Results: Approximately 3,686,000 hysterectomies with BO/RO were performed from 1979-2004. AARs of hysterectomy with BO/RO decreased during this period; the AARs in women ≥50 years old increased. The number of hysterectomies alone was 5,461,100, and AARs of hysterectomy alone decreased significantly from 2.9 per 1000 women in from 1979-1981 to 1.1 per 1000 women in 2001 (P < .001). The proportion of women who underwent hysterectomy with BO/RO increased from 29% in 1979 to 45% in 2004.Conclusion: Although AARs of prophylactic BO/RO decreased from 1979-2004, the actual proportion of BO/RO at hysterectomy increased.

Health-related quality of life and patient satisfaction after global endometrial ablation for menorrhagia in women with bleeding disorders: a follow-up survey and systematic review - Corrected Proof

2010-01-08

Objective: The purpose of this study was to describe health-related quality of life and satisfaction after global endometrial ablation in women with bleeding disorders and a systematic review of the literature.Study design: A follow-up survey was mailed to 36 patients with bleeding disorders and 110 reference patients (no coagulopathies) who underwent global endometrial ablation for menorrhagia. The survey included a generic (SF-12) and menorrhagia multi-attribute utility scale questionnaires.Results: Ninety-six women (66%) responded. The total menorrhagia multiattribute utility scale score increased from 35-100 in bleeding disorder cohort (P = .03) and from 48-100 in the reference cohort (P < .001). Although postablation SF-12 mental domain scores were comparable in both cohorts (55 vs 55; P = .67), physical domain scores were lower in the bleeding disorder cohort (50 vs 56; P < .001). High satisfaction was reported by both cohorts (95% vs 84%; P = .60).Conclusion: Global endometrial ablation improved health-related quality of life for women with bleeding disorders and had high satisfaction rates.

Tissue tumor marker expression in smokers, including serum cotinine concentrations, in women with cervical intraepithelial neoplasia or normal squamous cervical epithelium - Corrected Proof

Raghad Samir, Anna Asplund, Tibor Tot, Gyula Pekar, Dan Hellberg — 2010-01-08

Objective: The purpose of this study was to investigate correlations between smoking and serum cotinine, respectively, and tumor marker expression in cervical intraepithelial neoplasia (CIN) and normal epithelium.Study design: Women (n = 228) with cervical biopsy specimens that ranged histologically from normal to carcinoma in situ (CIN III) were included. Expression of 11 tumor markers with possible relevance in cervical neoplasms was studied. Smoking habits were recorded, and serum was assessed for cotinine concentrations.Results: No differences were found in tumor marker expression in normal epithelium between smokers and nonsmokers. The tumor suppressors p53 and fragile histidine triad and the immunologic marker interleukin-10 were underexpressed, and the tumor markers cyclooxygenase-2 and Ki-67 were overexpressed in smoking, compared with nonsmoking, women with CIN and particularly in all fertile women.Conclusion: The molecular pattern indicates that smoking exerts unfavorable effects in cervical neoplasia. This provides biologic evidence of smoking being a true cofactor in cervical neoplasia.

Reply - Corrected Proof

Patrizia Vergani, Sara Ornaghi, Alessandro Ghidini — 2010-01-04

We thank Drs Paterson and Wilson for their interest in our study. They request additional information on the subset of women who were admitted to trial of labor (TOL). The aim of our study was to evaluate the incidence of cesarean section delivery (CS) in relation to a standardized way to diagnose placenta praevia using transvaginal ultrasound. Subanalysis of specific groups leads to small sample sizes, which negatively influences statistical significance of the results. The following data should answer their requests: 28 of 53 women (53%) with a placental edge-to-cervical os distance between 1–20 mm were admitted to TOL; 8 cases belonged to group 1 (1–10 mm), and the remaining 20 cases to group 2 (11–20 mm). Among these 28 women, 26 women delivered vaginally, and 2 women underwent CS in labor for nonreassuring fetal testing and intrapartum hemorrhage, respectively (both women belonged to group 1). Estimated blood loss (EBL) for women who were admitted to TOL, compared with those women who underwent prelabor CS, was 812 ± 909 mL vs 492 ± 633 mL (P = .29). Among cases in group 1, EBL in TOL vs prelabor CS was 812 ± 909 mL vs 697 ± 545 mL (P = .70); in group 2, it was 492 ± 633 mL vs 550 ± 306 mL (P = .80).

Placenta previa - Corrected Proof

Nicole D. Paterson, R. Douglas Wilson — 2010-01-04

In the recent article by Dr Vergani et al, we read with interest the information presented regarding placental distance from the cervical os and mode of delivery. However, we had numerous concerns with the data presented in the study.

Prenatal intraabdominal bowel dilation is associated with postnatal gastrointestinal complications in fetuses with gastroschisis - Corrected Proof

Nancy G. Huh, Shinjiro Hirose, Ruth B. Goldstein — 2009-12-31

Objective: The purpose of this study was to determine whether prenatal intraabdominal bowel dilation (IBD) is associated with increased postnatal complications in fetuses with gastroschisis.Study Design: A retrospective review was performed on all maternal-fetus pairs with prenatally diagnosed gastroschisis that was treated at the University of California San Francisco from 2002-2008. Postnatal outcomes were compared between fetuses with and without IBD.Results: Forty-three of 61 maternal-fetal pairs met the criteria for inclusion. Sixteen fetuses (37%) had evidence of IBD. Fetuses with IBD were significantly more likely to have postnatal bowel complications (38% vs 7%; P = .037). The presence of multiple loops of IBD (n = 6) as opposed to a single loop (n = 10) was associated highly with bowel complications and increased time to full enteral feeding and length of hospital stay (100% vs 0% [P = .001]; 44 vs 23 days [P = .034]; 69 vs 27 days [P = .001], respectively).Conclusion: IBD is associated with increased postnatal complications in infants with prenatally diagnosed gastroschisis; however, this association seems to be limited to those with multiple loops of dilated intraabdominal bowel.

Forgotten “Father of Progesterone” - Corrected Proof

Thomas Kerenyi — 2009-12-31

I read with interest your “Editors' Choice” article, a review on ”Progesterone for pre-term birth prevention: an evolving intervention” (Am J Obstet Gynecol 2009;200:219-24). Although the authors state that their concise review was restricted only to more recent data (since 2000), they also state that “there is still considerable uncertainty surrounding how progesterone actually works, indication for its use…” The review then essentially concludes that, empirically, progesterone, when used prophylactically, leads to significant reduction of preterm birth and low birthweight. No attempt was made to advance a theory of a possible mechanism of action of the physiologic evidence of this progesterone effect. In the 1960s and 1970s, Csapo et al published several original research papers and comprehensive reviews on the pathophysiologic effect of preterm labor and the potential of treating it with progesterone. A man, who spent a lifetime and a distinguished career on the very subject that was reviewed here, should have been acknowledged in the bibliography of this otherwise useful retrospective.

Letters to the Editor - Corrected Proof

Daniel A. Tsin — 2009-12-30

I read with interest the work of Candani et al. The authors reported that planned adnexectomies were done in 100% of the laparoscopic procedures vs 73% of the vaginal. The increasing experiences in laparoscopic surgeries had led these and other authors to suggest that laparoscopic hysterectomy should be preferred over vaginal hysterectomy, because difficult transvaginal oophorectomies are among the potential benefits of the laparoscopy approach.