Department of Obstetrics and Gynecology Publications Copyright (c) 2013 University of Iowa All rights reserved. http://ir.uiowa.edu/obgyn_pubs Recent documents in Department of Obstetrics and Gynecology Publications en-us Tue, 21 May 2013 01:40:10 PDT 3600 Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study http://ir.uiowa.edu/obgyn_pubs/614 http://ir.uiowa.edu/obgyn_pubs/614 Mon, 20 May 2013 14:36:51 PDT Fifty-nine women completed a randomized, double-blind placebo-controlled study of pyridoxine hydrochloride (vitamin B6) for the treatment of nausea and vomiting of pregnancy. Thirty-one patients received vitamin B6, 25-mg tablets orally every 8 hours for 72 hours, and 28 patients received placebo in the same regimen. Patients were categorized according to the presence of vomiting: severe nausea (score greater than 7) or mild to moderate nausea (score of 7 or less). The severity of nausea (as graded on a visual analogue scale of 1-10 cm) and the number of patients with vomiting over a 72-hour period were used to evaluate response to therapy. Twelve of 31 patients in the vitamin B6 group had a pre-treatment nausea score greater than 7 (severe) (mean 8.2 +/- 0.8), as did ten of 28 patients in the placebo group (mean 8.7 +/- 0.9) (not significant). Following therapy, there was a significant difference in the mean "difference in nausea" score (ie, baseline - post-therapy nausea) between patients with severe nausea receiving vitamin B6 (mean 4.3 +/- 2.1) and placebo (mean 1.8 +/- 2.2) (P less than .01). In patients with mild to moderate nausea and in the group as a whole, no significant difference between treatment and placebo was observed. Fifteen of 31 vitamin B6-treated patients had vomiting before therapy, compared with ten of 28 in the placebo group (not significant). At the completion of 3 days of therapy, only eight of 31 patients in the vitamin B6 group had any vomiting, compared with 15 of 28 patients in the placebo group (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

]]> V. Sahakian et al. Use of antibiotics for ear, nose, and throat disorders in pregnancy and lactation http://ir.uiowa.edu/obgyn_pubs/613 http://ir.uiowa.edu/obgyn_pubs/613 Mon, 20 May 2013 14:36:50 PDT Jennifer R. Niebyl Unilateral ovarian abscess associated with the intrauterine device http://ir.uiowa.edu/obgyn_pubs/612 http://ir.uiowa.edu/obgyn_pubs/612 Mon, 20 May 2013 14:36:50 PDT Four cases of primary ovarian abscess associated with intrauterine contraceptive devices are presented. It is proposed that both their unilaterality and the fact that they were primary in the ovary rather than tuboovarian are due to the fact that bacteria from the intrauterine device are shed continuously through the fallopian tubes, resulting in the inoculation of the corpus luteum, a unilateral structure. Removal of the ovarian abscess without additional surgical therapy is sufficient for a patient with this type of pelvic infection.

]]> Jennifer R. Niebyl et al. Ultrasonic aspiration transducer for management of Rh incompatibility http://ir.uiowa.edu/obgyn_pubs/611 http://ir.uiowa.edu/obgyn_pubs/611 Mon, 20 May 2013 14:36:49 PDT J. F. Rampone et al. Therapeutic drugs in pregnancy. Caution is the watchword http://ir.uiowa.edu/obgyn_pubs/609 http://ir.uiowa.edu/obgyn_pubs/609 Mon, 20 May 2013 14:36:48 PDT Many medical conditions during pregnancy are best treated initially with nonpharmacologic remedies. Before a drug is used during pregnancy, the indications should be clear and the risk-benefit ratio should justify its use. Then, the minimum effective dose should be employed. If possible, therapy should be postponed until after the first trimester.

]]> Jennifer R. Niebyl Treatment of premature labor with indomethacin http://ir.uiowa.edu/obgyn_pubs/610 http://ir.uiowa.edu/obgyn_pubs/610 Mon, 20 May 2013 14:36:48 PDT D. A. Blake et al. The validity of the leukocyte esterase reagent test strip in detecting significant leukocyturia http://ir.uiowa.edu/obgyn_pubs/608 http://ir.uiowa.edu/obgyn_pubs/608 Mon, 20 May 2013 14:36:47 PDT This prospective trial demonstrated that the best possible definition for a positive leukocyte esterase test (Chemstrip 9) is + or ++. With use of this definition, the sensitivity in detecting significant leukocyturia is 83% and the specificity is 70%. The use of this test strip could reduce screening costs in registering obstetric patients.

]]> G. P. Marquette et al. The safety and efficacy of tocolytic agents for the treatment of preterm labor http://ir.uiowa.edu/obgyn_pubs/607 http://ir.uiowa.edu/obgyn_pubs/607 Mon, 20 May 2013 14:36:46 PDT Pharmacologic inhibition of uterine contractions remains the mainstay of treatment for preterm labor despite the ongoing controversy regarding its effectiveness. A diverse variety of tocolytic medications have been proposed for clinical use, with betamimetics and magnesium sulfate being the common therapeutic agents of choice in the United States today. The clinician using these agents should be aware of the significant maternal and fetal side-effects associated with these particular medications. New classes of pharmacologic agents, including prostaglandin synthetase inhibitors, calcium channel blockers and phosphodiesterase inhibitors, have been proposed as tocolytic agents and are currently undergoing critical clinical evaluation. The purpose of this review is to provide a compilation of the available clinical studies that document the safety and efficacy of these various tocolytic agents.

]]> R. E. Besinger et al. The pharmaceutical industry: friend or foe? http://ir.uiowa.edu/obgyn_pubs/605 http://ir.uiowa.edu/obgyn_pubs/605 Mon, 20 May 2013 14:36:45 PDT Jennifer R. Niebyl The pharmacologic inhibition of premature labor http://ir.uiowa.edu/obgyn_pubs/606 http://ir.uiowa.edu/obgyn_pubs/606 Mon, 20 May 2013 14:36:45 PDT Oxytocin, elevated estrogen-progesterone ratio, fetal corticosteroids, prostaglandins, catecholamines, and changes in uterine blood flow have all been implicated as triggers of labor. In approximately one-third of cases of threatened premature labor contractions stop spontaneously. Thus placebo-controlled randomized trials of any new drug for inhibition of premature labor are necessary, as the spontaneous cessation of contractions always favors the claimed therapeutic efficacy. Alcohol inhibits the release of endogenous oxytocin and has an additional direct effect on the myometrium. In one study alcohol was more effective than placebo in the postponement of delivery. Isoxsuprine, ritodrine, and terbutaline have also been shown to be better than placebo in the inhibition of premature labor, and the beta adrenergic agents appear to be more effective than alcohol. Prostaglandin inhibitors such as indomethacin are currently under investigation. Success is correlated with early administration of the therapy, which requires treating some patients whose contractions might have stopped spontaneoulsy. As different factors may be involved in triggering premature labor, if one therapeutic approach fails another should be initiated promptly.

]]> Jennifer R. Niebyl et al. The inhibition of premature labor with indomethacin http://ir.uiowa.edu/obgyn_pubs/604 http://ir.uiowa.edu/obgyn_pubs/604 Mon, 20 May 2013 14:36:44 PDT We administered indomethacin orally for the treatment of premature labor in a prospective, randomized, double-blind fashion, and all infants were followed up. Indomethacin was significantly more effective than placebo in inhibition of premature labor during a 24-hour course of therapy, with treatment failure during therapy occurring in only one of 15 indomethacin-treated patients compared to nine of 15 placebo-treated patients (p less than 0.01). Mean plasma concentrations of indomethacin were approximately 0.8 micrograms/ml at both 4 and 12 hours after administration. Mean plasma levels of 15-oxo-13,14-dihydroprostaglandin F2 alpha (PGFM) were similar in the two groups before treatment, decreased markedly in the indomethacin group by 4 hours, and were not detected at 12 hours in all but the one indomethacin-treated patient who was delivered within 24 hours. Patients in the placebo group who were delivered prematurely had higher pretreatment PGFM levels (mean +/- SE, 83 +/- 18 pg/ml, n = 9) than the patients who responded to placebo (25 +/- 6 pg/ml, n = 6) (p less than 0.05). There was no difference between the indomethacin and placebo groups with respect to gestational age at delivery, birth weight, and neonatal morbidity and deaths. In particular, we found no evidence of premature closure of the ductus arteriosus, pulmonary hypertension, or increase in bleeding problems among the infants exposed to indomethacin in utero. Although no difference in neonatal outcome was observed in this small number of patients, it would seem prudent still to consider indomethacin as an experimental therapy.

]]> Jennifer R. Niebyl et al. The influence of aspirin on the course of induced midtrimester abortion http://ir.uiowa.edu/obgyn_pubs/603 http://ir.uiowa.edu/obgyn_pubs/603 Mon, 20 May 2013 14:36:43 PDT Prostaglandins appear to mediate the uterine contractions of abortion and labor, and aspirin has been shown to be an inhibitor of prostaglandin synthesis. In this double-blind, placebo-controlled, prospective, and randomized study, aspirin was administered orally in doses of 600 mg. every 6 hours to patients undergoing induced midtrimester abortions with hyperosmolar urea and oxytocin augmentation. The mean injection-abortion interval was significantly prolonged by aspirin in nulliparous patients (aspirin 32.3 +/- 3.3 hr. vs. placebo 21.5 +/- 3.5 hr.) and no aspirin-treated nullipara aborted in less than 18 hours. There was no significant difference between treatment groups in the mean injection-abortion interval in the multiparous patients at the dose of aspirin used. The effectiveness of aspirin in the prolongation of the injection-abortion interval has potential therapeutic implications for the treatment of premature labor.

]]> Jennifer R. Niebyl et al. The effect of maternal age on primary cesarean section rate http://ir.uiowa.edu/obgyn_pubs/601 http://ir.uiowa.edu/obgyn_pubs/601 Mon, 20 May 2013 14:36:42 PDT A retrospective analysis of computerized data from 11,815 patients with no history of previous cesarean section revealed an increasing primary cesarean section rate with increasing maternal age. This increase occurred over the entire reproductive age span. Fetal distress as an indication for primary cesarean section may account for this increase.

]]> F. R. Witter et al. The glycosphingolipid composition of the placenta of a blood group P fetus delivered by a blood group Pk1 woman and analysis of the anti-globoside antibodies found in maternal serum http://ir.uiowa.edu/obgyn_pubs/602 http://ir.uiowa.edu/obgyn_pubs/602 Mon, 20 May 2013 14:36:42 PDT To further define the molecules that may mediate spontaneous abortion due to maternal-fetal blood group incompatibility within the P blood group system, we have examined the fine specificities of maternal antibodies and the glycolipid antigens from the placenta of a P infant born to a Pk1 mother. Maternal antibodies obtained during therapeutic plasmapheresis were analyzed to determine their reactivities with placental glycolipid extracts on thin-layer plates. Second antibodies specific for IgM, IgG, and IgA revealed immunoglobulins of all of these classes strongly reactive with one major placental glycolipid that comigrates with globoside. GC/MS analysis confirmed that the major P-active pentaglycosylceramide of placenta has the same structure as that previously shown for the P antigen of red blood cells: GalNAc beta 1-3Gal alpha 1-4Gal beta 1-4Glc-Cer. Serum antibodies partially purified by affinity chromatography on globoside-octyl-Sepharose specifically recognize glycolipids that contain terminal GalNAc beta 1-3Gal . . . residues and also recognize the same sequence as an internal determinant in some, but not all, glycolipids with extended globoside core regions. Thus, in the blood group P incompatible fetus, the major P antigen present in placenta has the same carbohydrate structure as the P antigen present in fetal and adult erythrocytes and might be a target for the maternal immune system.

]]> G. C. Hansson et al. The effect of magnesium sulfate on fetal heart rate baseline variability http://ir.uiowa.edu/obgyn_pubs/600 http://ir.uiowa.edu/obgyn_pubs/600 Mon, 20 May 2013 14:36:41 PDT Variability of the baseline fetal heart rate is correlated with good fetal outcome, and loss of baseline variability has been observed as a sign of fetal distress. Central nervous system depressing drugs may also decrease fetal heart rate variability, and thus recognition of the effect of medication on the baseline fetal heart rate is important for accurate interpretation of fetal monitor tracings. In the cases reported, marked decrease in fetal heart rate variability was observed within 4 minutes of intravenous administration of magnesium sulfate, and fetal outcome was good in all cases.

]]> A. Babaknia et al. The Bland-White-Garland syndrome in pregnancy http://ir.uiowa.edu/obgyn_pubs/598 http://ir.uiowa.edu/obgyn_pubs/598 Mon, 20 May 2013 14:36:40 PDT V. R. Klein et al. The effect of chlorotrianisene as postpartum lactation suppression on blood coagulation factors http://ir.uiowa.edu/obgyn_pubs/599 http://ir.uiowa.edu/obgyn_pubs/599 Mon, 20 May 2013 14:36:40 PDT Coagulation changes and increased risk of thromboembolic disease may occur in association with estrogen administration. The puerperium is also a high-risk period for thromboembolism, and estrogen administration at this time may increase this risk. Patients with congenital deficiency of antithrombin III have recurrent venous thromboembolic disease, suggesting that low levels of this factor may be associated with "hypercoagulability" states. We studied 50 postpartum patients who received chlorotrianisene (Tace) or placebo for lactation suppression in a prospective, double-blind, randomized fashion. Antithrombin III values were significantly lower on the third day post partum in the treated group compared to the placebo group (p less than 0.05). In addition, our clinical data from a total of 99 patients support the previous evidence that estrogens delay rather than prevent breast engorgement. Thus, with questionable benefit and a possible increased thromboembolic risk, it would appear prudent to discontinue the practice of estrogen administration for lactation suppression.

]]> Jennifer R. Niebyl et al. The association of anti-P and early abortion http://ir.uiowa.edu/obgyn_pubs/597 http://ir.uiowa.edu/obgyn_pubs/597 Mon, 20 May 2013 14:36:39 PDT The current report details the serologic findings in a case reported previously of a P1k woman, para 0 gravida 13, who was treated during her fourteenth pregnancy with plasmapheresis to reduce the anti-P titer. These studies suggest that anti-P can induce early abortion in Pk women and that the abortions are immunologically mediated. Further, this case supports the disputed proposal that the anti-P component of anti-PP1Pk is responsible for pregnancy loss in p women.

]]> R. S. Shirey et al. The accuracy of visual and meter determinations of blood glucose with the use of Chemstrip bG http://ir.uiowa.edu/obgyn_pubs/596 http://ir.uiowa.edu/obgyn_pubs/596 Mon, 20 May 2013 14:36:38 PDT The 95% confidence intervals for the blood glucose determinations with use of the Chemstrip bG were +/- 28 mg/dl by visual reading and +/- 18 mg/dl by means of the Accu-Chek photometer. These rapid methods continue to be an important aid in the home care of pregnant diabetic women.

]]> G. P. Marquette et al. Teenage pregnancy http://ir.uiowa.edu/obgyn_pubs/595 http://ir.uiowa.edu/obgyn_pubs/595 Mon, 20 May 2013 14:36:38 PDT D. D. Youngs et al. Sporadic (nonepidemic) puerperal mastitis http://ir.uiowa.edu/obgyn_pubs/594 http://ir.uiowa.edu/obgyn_pubs/594 Mon, 20 May 2013 14:36:37 PDT Sporadic puerperal mastitis is an acute cellulitis, characterized by fever and segmental erythema in the breast. Staphylococcus aureus can be cultured in approximately one-half of the cases. With early antibiotic therapy, the infection can be cleared and abscess formation prevented. Breast engorgement may also contribute to abscess formation, and so nursing should not be discontinued. No ill effects are observed in infants who continue to nurse. Twenty women with acute puerperal mastitis had breast milk cultures, and Staphylococcus aureus was recovered in seven cases. All patients were treated with antibiotics and continued nursing. No abscesses developed, and no ill effects were observed in any infants.

]]> Jennifer R. Niebyl et al. Situational and financial barriers to prenatal care in a sample of low-income, inner-city women http://ir.uiowa.edu/obgyn_pubs/593 http://ir.uiowa.edu/obgyn_pubs/593 Mon, 20 May 2013 14:36:36 PDT The relationship between the use of prenatal care and factors that may impede access to care was examined in a sample of low-income, inner-city women. Situational and financial barriers to care were not important correlates of utilization. In unadjusted analyses, only insurance status and employment status were associated with utilization. Of the sociodemographic characteristics studied, only parity was strongly associated with the use of prenatal care. When the apparent associations between utilization and insurance status and utilization and employment were analyzed controlling for parity, the estimated strength and statistical significance of these relationships diminished considerably. Multiparous women who were more likely than primiparous women to be underutilizers were also more likely to be on medical assistance and to be unemployed. These findings suggest that situational and financial barriers are not important correlates of utilization for low-income, adult women living in urban areas where there are accessible clinic facilities and public transportation. Efforts to identify and surmount other kinds of barriers may prove to be a more effective approach to prenatal outreach for women in these circumstances.

]]> P. A. St Clair et al. Severe lead poisoning caused by use of health supplements presenting as acute abdominal pain during pregnancy http://ir.uiowa.edu/obgyn_pubs/592 http://ir.uiowa.edu/obgyn_pubs/592 Mon, 20 May 2013 14:36:35 PDT BACKGROUND: The public and some health care providers regard complementary and alternative medications as safe. There is no scientific basis for that belief, but there is evidence of poor quality control and toxicity of some remedies. CASE: A white pregnant woman presented with diffuse, acute abdominal pain ultimately diagnosed as lead poisoning due to the use of traditional Asian Indian health supplements. CONCLUSION: Use of traditional medicines may extend beyond the ethnic group in which the traditional medicine originated. When symptoms warrant, poisoning with lead or other heavy metals should be considered in the differential diagnosis.

]]> A. A. Shamshirsaz et al. Serum carbamazepine levels during pregnancy and post partum http://ir.uiowa.edu/obgyn_pubs/591 http://ir.uiowa.edu/obgyn_pubs/591 Mon, 20 May 2013 14:36:35 PDT G. Abbasi et al. Research and professional briefs. Folate, zinc, and vitamin B-12 intake during pregnancy and postpartum http://ir.uiowa.edu/obgyn_pubs/590 http://ir.uiowa.edu/obgyn_pubs/590 Mon, 20 May 2013 14:36:34 PDT M. J. Berg et al. Randomized comparative trial of indomethacin and ritodrine for the long-term treatment of preterm labor http://ir.uiowa.edu/obgyn_pubs/588 http://ir.uiowa.edu/obgyn_pubs/588 Mon, 20 May 2013 14:36:33 PDT A randomized prospective trial was performed to compare the efficacy and safety of ritodrine and indomethacin in the long-term treatment of preterm labor. Forty patients with intact membranes in preterm labor at 23 to 34 weeks' gestation were randomized to receive either intravenous ritodrine or oral indomethacin as the first-line tocolytic agent. Successful intravenous ritodrine therapy was followed by oral terbutaline therapy, and indomethacin-treated patients continued to receive oral indomethacin. Treatment failures were defined as progressive preterm labor or patient intolerance, and these patients were treated with intravenous magnesium sulfate. Ritodrine and indomethacin were equally successful in delaying preterm birth as defined by interval to delivery, gestational age at delivery, delivery delayed greater than 7 days, attainment of 35 weeks of gestation, percentage of patients who required magnesium sulfate therapy, percentage of patients who were readmitted with premature rupture of membranes, absence of recurrent preterm labor, and infant birth weight. More than 80% of mothers who received ritodrine voiced complaints of beta-sympathomimetic side effects, and one patient discontinued treatment as the result of intolerance. There were minimal patient complaints with indomethacin use. No statistically significant differences were noted in neonatal outcome as defined by Apgar scores, umbilical cord pH, intensive care days, ventilator days, or neonatal deaths. However, three cases of primary pulmonary hypertension were observed in the indomethacin group. We had not previously observed this problem with short-term (24 to 48 hours) indomethacin therapy.

]]> R. E. Besinger et al. Reproducibility of the diagnosis of cervicitis in pregnancy http://ir.uiowa.edu/obgyn_pubs/589 http://ir.uiowa.edu/obgyn_pubs/589 Mon, 20 May 2013 14:36:33 PDT Cervicitis has been associated with several infections of the female genital tract. Criteria have been established for making the diagnosis of cervicitis in gynecologic populations but there are no well-established criteria for diagnosing cervicitis in obstetrical populations. Because of the association of the cervicitis and sexually transmitted diseases, and because of the association of sexually transmitted diseases and adverse pregnancy outcome, the present study was undertaken in an attempt to establish criteria for the diagnosis of cervicitis in pregnancy. We also attempted to determine the reproducibility of that diagnosis with respect to intra- and interobserver variability. We concluded that intraobserver variability is improved after specific training has been completed and that interobserver variability may be reduced to an acceptable level. On a public health scale, this may allow for identification of a population at high risk for adverse pregnancy outcome when sophisticated microbiologic techniques are unavailable.

]]> J. T. Repke et al. Quantitative and qualitative relationships between fetal heart rate accelerations and fetal movement http://ir.uiowa.edu/obgyn_pubs/587 http://ir.uiowa.edu/obgyn_pubs/587 Mon, 20 May 2013 14:36:32 PDT TRB Johnson et al. Prolactin and plasma prostaglandin metabolite levels in patients undergoing nipple stimulation contraction stress tests http://ir.uiowa.edu/obgyn_pubs/585 http://ir.uiowa.edu/obgyn_pubs/585 Mon, 20 May 2013 14:36:31 PDT Twenty-five patients undergoing nipple stimulation contraction stress tests were enrolled in this study. Plasma 13,14-dihydro, 15-keto prostaglandin F2 alpha and plasma prolactin concentrations were analyzed before and during the contraction stress tests. Prolactin concentrations were significantly higher (p less than 0.01) in patients who responded with a successful stress test versus those who did not. No significant changes were observed in the mean concentration of plasma 13,14-dihydro, 15-keto prostaglandin F2 alpha levels between the two groups.

]]> A. G. Rijhsinghani et al. Prostaglandin F metabolite concentration as a prognostic factor in preterm labor http://ir.uiowa.edu/obgyn_pubs/586 http://ir.uiowa.edu/obgyn_pubs/586 Mon, 20 May 2013 14:36:31 PDT Concentration of the 13,14-dihydro,15 keto-metabolite of prostaglandin F2 alpha (PGFM) was measured in women being observed for preterm labor. The mean initial PGFM level was significantly higher in patients who delivered preterm (65.9 +/- 9.7 pg/mL; N = 14) than in patients not in preterm labor (32.1 +/- 4.3 pg/mL; N = 11; P less than .01). Plasma PGFM concentrations decreased significantly during ritodrine therapy only in successfully treated patients (P less than .05). All patients with initial PGFM concentrations greater than or equal to 55 pg/mL delivered preterm. Two of four patients not considered to be in preterm labor but who delivered prematurely (within five days of initial evaluation) had initial PGFM concentrations of greater than 55 pg/mL. Concentration determinations of PGFM might be a useful adjunct in identifying early preterm labor and in predicting success of tocolytic therapy.

]]> C. M. Weitz et al. Prevention of perinatal transmission of hepatitis B virus: the sensitivity, specificity, and predictive value of the recommended screening questions to detect high-risk women in an obstetric population http://ir.uiowa.edu/obgyn_pubs/584 http://ir.uiowa.edu/obgyn_pubs/584 Mon, 20 May 2013 14:36:30 PDT The Advisory Committee on Immunization Practices recommends that all pregnant women be questioned concerning risk factors for hepatitis B virus infection and that those giving positive responses be serotested. The sensitivity, specificity, and predictive value of those recommended questions among 692 parturient women were determined. A total of 59 currently or previously infected women (hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), or antibody to hepatitis B core antigen (anti-HBc) seropositive) were compared with the 633 seronegative women. Among nonwhite women, the sensitivity of a positive response to any one of the recommended questions was 60%. Specificity and positive predictive value were 71% and 19%, respectively. Among white women, the sensitivity, specificity, and positive predictive value were 56%, 75%, and 11%, respectively. To increase such unacceptably low sensitivity, the authors included two additional questions: single marital status and Medicaid/medical assistance payer status. Sensitivity increased to 96% among nonwhite women and 84% among white women. However, a positive response to at least one of the recommended questions or to additional questions was elicited from 78% of all women (92% nonwhite and 64% white). The authors conclude that to prevent perinatal transmission of hepatitis B, we must serotest all women in our obstetric population.

]]> G. M. McQuillan et al. Preterm parturition. Prostaglandin synthetase inhibitors http://ir.uiowa.edu/obgyn_pubs/583 http://ir.uiowa.edu/obgyn_pubs/583 Mon, 20 May 2013 14:36:29 PDT Jennifer R. Niebyl President's page http://ir.uiowa.edu/obgyn_pubs/581 http://ir.uiowa.edu/obgyn_pubs/581 Mon, 20 May 2013 14:36:28 PDT Jennifer R. Niebyl President's page http://ir.uiowa.edu/obgyn_pubs/582 http://ir.uiowa.edu/obgyn_pubs/582 Mon, 20 May 2013 14:36:28 PDT Jennifer R. Niebyl Prescribing antiemetic therapy during pregnancy http://ir.uiowa.edu/obgyn_pubs/580 http://ir.uiowa.edu/obgyn_pubs/580 Mon, 20 May 2013 14:36:27 PDT Although the exact percentage is unknown, most women in early pregnancy are affected by nausea and vomiting, which often causes them to change their lifestyle.

]]> D. Peleg et al. Premature rupture of the membranes and prolonged latency http://ir.uiowa.edu/obgyn_pubs/579 http://ir.uiowa.edu/obgyn_pubs/579 Mon, 20 May 2013 14:36:27 PDT The aim of this retrospective study in 8320 patients with premature rupture of the membranes (PROM) was to determine the consequences of prolongation of the latent period. Among patients with pregnancies of more than 37 weeks' duration, those with PROM and latent periods of more than 1 day demonstrated an increased incidence of intrapartum fever (IPF), whereas those with latent periods of more than 3 days demonstrated a marked increase in fetal (but not neonatal) deaths. Although IPF and perinatal mortality were more common in preterm pregnancies, neither was found to increase or decrease with prolonged latency, provided differences in gestational ages and race were taken into account. In the absence of chorioamnionitis, there appears to be no benefit to delivery before 37 weeks' gestation.

]]> J. W. Johnson et al. Pregnancy in sickle cell disease http://ir.uiowa.edu/obgyn_pubs/578 http://ir.uiowa.edu/obgyn_pubs/578 Mon, 20 May 2013 14:36:26 PDT S. Charache et al. Pregnancy following total hysterectomy http://ir.uiowa.edu/obgyn_pubs/577 http://ir.uiowa.edu/obgyn_pubs/577 Mon, 20 May 2013 14:36:25 PDT Jennifer R. Niebyl Pharmacogenetic screening for susceptibility to fetal malformations in women http://ir.uiowa.edu/obgyn_pubs/575 http://ir.uiowa.edu/obgyn_pubs/575 Mon, 20 May 2013 14:36:24 PDT OBJECTIVE: To present a review of the literature and research on the pharmacogenetics of congenital defects, with a focus on the need for predictive maternal genotype assays. DATA SOURCE: MEDLINE searches (January 1985-January 1999), past reference reviews, and unpublished research. STUDY SELECTION: Review of relevant human, animal, and basic science studies. DATA EXTRACTION: Data on research on polymorphisms, genotyping, cytochrome P450 enzyme systems, epoxide hydrolase, folate metabolism, metabolism of anticonvulsant medications, molecular genetics of neural tube defects, variations in drug metabolism, and environmental exposures were evaluated. DATA SYNTHESIS: Data synthesis includes not only a review of the literature but suggests ways such data might be used to facilitate the development of maternal genotype assays, with the goal of preventing birth defects. CONCLUSIONS: Individuals vary in how they metabolize drugs and handle toxic environmental exposures. In an ideal pregnancy, there is no or limited exposure to medications and environmental agents. However, in women with chronic medical conditions such as heart disease and seizures, this is often not possible. Unfortunately, no techniques have been available to identify those at risk in this population. Gene polymorphisms for a specific enzyme may result in an absence or reduction in the level of enzyme activity or in no change at all, with little effect on the structure/function of the gene product(s); they are not associated with clinical phenotypes in either the mother or the fetus. Other polymorphisms may be only markers. Thus, developing genotyping assays for women that are predictive of phenotype expression in the fetus is the key to screening for polymorphisms. As more mutations are identified and clinical, pharmacologic, biologic, and pharmacokinetic relationships are established, using these polymorphisms to develop a genotyping assay for women may become a clinical reality, possibly leading to preventive prepregnancy or prenatal treatment that may play an increasingly effective role in maternal care.

]]> D. C. Van Dyke et al. Plasmapheresis for the treatment of repeated early pregnancy wastage associated with anti-P http://ir.uiowa.edu/obgyn_pubs/576 http://ir.uiowa.edu/obgyn_pubs/576 Mon, 20 May 2013 14:36:24 PDT It has been proposed that the blood group antibody, anti-P, produced by p or Pk individuals may cause abortion early in pregnancy. The authors have studied and successfully treated a Pk woman with anti-P who had 13 consecutive first-trimester miscarriages. Anti-P was implicated as the cause of repeated pregnancy loss after extensive clinical, endocrinologic, immunologic, and chromosomal evaluations. To remove P blood group antibodies, plasmapheresis was begun at five weeks' gestation during the 14th pregnancy with one plasma volume exchange two to three times per week. This therapy resulted in a reduction in the titer of anti-P, and the patient was delivered of a viable female infant after 33 weeks' gestation. The management and outcome indicate that habitual abortion presumably due to anti-P can be successfully treated with plasmapheresis. This case provides additional evidence that anti-P is responsible for abortions in p or Pk women, and that these abortions are immunologically mediated.

]]> J. A. Rock et al. Penile nerve block for newborn circumcision http://ir.uiowa.edu/obgyn_pubs/574 http://ir.uiowa.edu/obgyn_pubs/574 Mon, 20 May 2013 14:36:23 PDT Circumcision in neonates is performed, almost universally, without anesthesia or analgesia. It is associated with pain, crying, agitation, and physiologic stress. Twenty infants receiving penile nerve block for circumcision were compared with ten infants having circumcision without anesthesia. Heart rate and blood pressure rose 34 and 15%, respectively, in unblocked infants, and were unchanged in infants receiving local anesthesia. Oxygen saturation declined 16% in unanesthetized infants compared with 6% in blocked infants (P less than .03). Anesthetized infants were less agitated and cried less. Peak plasma concentrations of the local anesthetic lidocaine averaged 0.51 +/- 0.17 microgram/mL (range 0.1-1.6), well below accepted toxic levels. There were no local or systemic complications.

]]> L. G. Maxwell et al. Overview of nausea and vomiting of pregnancy with an emphasis on vitamins and ginger http://ir.uiowa.edu/obgyn_pubs/573 http://ir.uiowa.edu/obgyn_pubs/573 Mon, 20 May 2013 14:36:22 PDT Patients suffering from nausea and vomiting of pregnancy (NVP) frequently do not receive therapy, in part because of fears of adverse effects of medications on the fetus. Several vitamin-based and herbal therapies have been shown to be effective and safe. Two randomized trials of vitamin B(6) have shown a benefit in reducing NVP. Women taking periconceptional multivitamins are less likely to have severe NVP. The combination of vitamin B(6) and doxylamine (previously marketed in the United States as Bendectin) has been shown to be safe for the fetus and effective in reducing NVP. Ginger was shown, in 2 studies, to reduce NVP. Vitamin B(1) (thiamine) deficiency can lead to Wernicke's encephalopathy in women with severe NVP. Replacement is needed for all women with vomiting of more than 3 weeks' duration. Prophylaxis with multivitamins and therapy with B(6), with or without doxylamine, are safe and effective therapies for NVP.

]]> Jennifer R. Niebyl et al. Neonatal outcome after indomethacin treatment for preterm labor http://ir.uiowa.edu/obgyn_pubs/572 http://ir.uiowa.edu/obgyn_pubs/572 Mon, 20 May 2013 14:36:22 PDT Forty-six infants exposed to indomethacin in utero for treatment for preterm labor were compared with infants from two control groups. In one control group the next consecutive patient treated with a tocolytic agent was used, and the other control group was formed by picking the next consecutive patient matched by gestational age who did not receive any tocolytic agent. There was no significant difference in Apgar scores, birth weight, or gestational age in the three groups. The incidence of neonatal complications including hypocalcemia, hypoglycemia, respiratory distress syndrome, patient ductus arteriosus, sepsis, and neonatal mortality were not significantly different in the three groups. No cases of premature closure of the ductus arteriosus or persistent fetal circulation were seen.

]]> Jennifer R. Niebyl et al. Nausea and Vomiting in Pregnancy http://ir.uiowa.edu/obgyn_pubs/571 http://ir.uiowa.edu/obgyn_pubs/571 Mon, 20 May 2013 14:36:21 PDT Jennifer R. Niebyl Nature of migraine attacks during pregnancy http://ir.uiowa.edu/obgyn_pubs/570 http://ir.uiowa.edu/obgyn_pubs/570 Mon, 20 May 2013 14:36:20 PDT Although management of the disorder is conservative, exposing the fetus to nonheadache symptoms of nausea, vomiting, and possible dehydration may be riskier than using drugs.

]]> S. D. Silberstein et al. Multiple pregnancy with late death of one fetus http://ir.uiowa.edu/obgyn_pubs/569 http://ir.uiowa.edu/obgyn_pubs/569 Mon, 20 May 2013 14:36:20 PDT Twenty cases of fetal death complicating a multiple pregnancy after 20 weeks' gestation are reviewed. We evaluated gestational age at diagnosis and delivery (29.3 +/- 0.7 and 31.8 +/- 0.9 weeks, respectively), interval from diagnosis to delivery (2.6 +/- 0.6 weeks), and cause of fetal death as a group and by type of placentation (76.5% monochorionic). Eighty-five percent of the surviving fetuses were delivered preterm, and the four neonatal deaths were all due to extreme prematurity, with a mean (+/- SEM) birth weight of 794 +/- 237 g. Perinatal mortality was 585 per 1000, 450 for twin A and 750 for twin B. The causes of fetal death varied. Maternal disseminated intravascular coagulation was not diagnosed in any pregnancy in the present series. The high risk of complications related to preterm birth, compared with the low risk of problems related to continuation of a multiple pregnancy after diagnosis of a fetal death, argues in favor of conservative management in this setting.

]]> P. H. Cherouny et al. Morphologic and immunologic characterization of human basophils developed in cultures of cord blood mononuclear cells http://ir.uiowa.edu/obgyn_pubs/568 http://ir.uiowa.edu/obgyn_pubs/568 Mon, 20 May 2013 14:36:19 PDT Selective growth of human basophilic granulocytes was obtained in suspension cultures of mononuclear cells from umbilical cord blood. Approximately 50 to 80% of nonadherent cells recovered from 2- to 3-wk-old cultures contained metachromatic granules, and these cells were identified as human basophilic granulocytes by electron microscopy. Histamine content of cultured human basophils was comparable to that in peripheral blood basophils. Cultured basophils bear 2.7 to 3.7 X 10(5) IgE receptors per cell that bind both human IgE and rodent IgE with comparable affinity. Average equilibrium constants of the receptors for human IgE and mouse IgE were 2.56 +/- 0.88 X 10(9) M-1 and 1.85 +/- 0.86 X 10(9) M-1, respectively. The cell-surface component of the IgE receptors on cultured basophils has a m.w. of 64,000. Cultured basophils could be passively sensitized with human IgE and mouse IgE monoclonal antibody, and sensitized basophils released characteristic cytoplasmic granules and both histamine and arachidonate upon challenge with either anti-human IgE or antigen. Incubation of cultured basophils with ionophore A23187 or F-Met-Leu-Phe resulted in histamine release. However, compound 48/80 failed to induce histamine release from the cells.

]]> T. Ishizaka et al. Methotrexate and misoprostol to terminate early pregnancy http://ir.uiowa.edu/obgyn_pubs/567 http://ir.uiowa.edu/obgyn_pubs/567 Mon, 20 May 2013 14:36:18 PDT J. Yankowitz et al. Maternal serum alpha-fetoprotein screening: effects of weight adjustment http://ir.uiowa.edu/obgyn_pubs/565 http://ir.uiowa.edu/obgyn_pubs/565 Mon, 20 May 2013 14:36:17 PDT L. C. Kazazian et al. Metastatic adenocarcinoma of the lung complicating pregnancy. A case report http://ir.uiowa.edu/obgyn_pubs/566 http://ir.uiowa.edu/obgyn_pubs/566 Mon, 20 May 2013 14:36:17 PDT A case of large cell undifferentiated adenocarcinoma of the lung was complicated by an aggressive clinical course and documented placental metastases. The management of these neoplasms is complex, requiring one to pay attention to the maternal, as well as fetal and neonatal, prognosis.

]]> R. Suda et al. Marijuana use in pregnancy and pregnancy outcome http://ir.uiowa.edu/obgyn_pubs/564 http://ir.uiowa.edu/obgyn_pubs/564 Mon, 20 May 2013 14:36:16 PDT A retrospective analysis utilizing historical data collected as part of our computerized data base was performed to assess the impact of marijuana use in pregnancy on pregnancy outcome. Records of 8350 patients were reviewed and 417 patients gave a history of only marijuana use for a prevalence of 5%. There was no association between marijuana use and prematurity or congenital anomalies. Marijuana use was strongly associated with the use of alcoholic beverages and smoking. Previously reported associations may represent the concomitant use of these other drugs.

]]> F. R. Witter et al. Management of sickle cell disease in pregnant patients http://ir.uiowa.edu/obgyn_pubs/563 http://ir.uiowa.edu/obgyn_pubs/563 Mon, 20 May 2013 14:36:15 PDT Data from a total of 74 pregnancies in 42 patients with sickling disorders seen at Johns Hopkins Hospital are compared with similar data from other centers. Although risks are still higher than those for women without sickle cell disease, they have diminished significantly from those reported earlier. Prophylactic transfusion therapy may decrease these risks further, but benefits of transfusion are unproved at present. Patients with sickling disorders should receive meticulous individualized treatment until further data are made available.

]]> S. Charache et al. Letter: Pneumoperitoneum secondary to cunnilingus http://ir.uiowa.edu/obgyn_pubs/562 http://ir.uiowa.edu/obgyn_pubs/562 Mon, 20 May 2013 14:36:15 PDT S. Ashai et al. Lack of maternal metabolic, endocrine, and environmental influences in the etiology of cleft lip with or without cleft palate http://ir.uiowa.edu/obgyn_pubs/561 http://ir.uiowa.edu/obgyn_pubs/561 Mon, 20 May 2013 14:36:14 PDT We studied metabolic, endocrine, and environmental factors in 59 women who had delivered a child with cleft lip with or without cleft palate (CL +/- CP) and compared these values with those of 56 mothers of unaffected children. There was no significant difference between the two groups with respect to race, age, weight, height, education, parity, menstrual history, medical illnesses, or the use of contraceptives, tobacco, alcohol, or caffeine. All patients had a normal XX karyotype confirmed by the fluorescent banding technique. The two groups demonstrated no significant difference in test results of serum chemistries, glucose tolerance, serum or erythrocyte folate, vitamin A, carotene, corticoids, prolactin T4, free T4, urine 17-ketosteroids, 17-hydroxysteroids, total estrogens, or pregnanediol. Urinalyses revealed no group differences in the presence of barbiturates, amphetamines, salicylates, or benzodiazepines. The percentage of immunologic studies reflecting susceptibility to toxoplasmosis, rubella, cytomegalic inclusion disease, and herpes was not different between the two groups. The only statistically significant metabolic differences between the two groups were serum alkaline phosphatase, creatinine, creatinine clearance, and creatinine clearance/m2. Phenytoin pharmacokinetics and urinary metabolic patterns were compared in a subgroup of ten mothers of affected children and ten mothers from the control group. No significant differences were observed. However, a brief course of phenytoin treatment induced a greater inhibition of the folate tolerance test in controls than in mothers of children with clefts.

]]> Jennifer R. Niebyl et al. Iron therapy in pregnancy http://ir.uiowa.edu/obgyn_pubs/560 http://ir.uiowa.edu/obgyn_pubs/560 Mon, 20 May 2013 14:36:13 PDT Iron is the only nutrient for which requirements during pregnancy cannot be met by diet alone. A supplement is usually recommended so that the patient's iron stores do not become depleted.

]]> Jennifer R. Niebyl Inhibition of arachidonic acid metabolism in the perinatal period: pharmacology, clinical application, and potential adverse effects http://ir.uiowa.edu/obgyn_pubs/558 http://ir.uiowa.edu/obgyn_pubs/558 Mon, 20 May 2013 14:36:12 PDT F. R. Witter et al. Inhibition of preterm labor http://ir.uiowa.edu/obgyn_pubs/559 http://ir.uiowa.edu/obgyn_pubs/559 Mon, 20 May 2013 14:36:12 PDT Jennifer R. Niebyl et al. Human plasma prekallikrein and high molecular weight kininogen decrease during parturition http://ir.uiowa.edu/obgyn_pubs/557 http://ir.uiowa.edu/obgyn_pubs/557 Mon, 20 May 2013 14:36:11 PDT Prekallikrein and high molecular weight kininogen were measured in plasma taken from nine women during parturition. Prekallikrein decreased significantly (p less than 0.01) from 1.49 +/- 0.15 S-2302 U/ml (mean +/- SEM) in early labor to 1.26 +/- 0.13 S-2302 U/ml in the immediate postpartum period. Immunoreactive high molecular weight kininogen also significantly decreased from 76 +/- 5 micrograms/ml to 68 +/- 5 micrograms/ml one day postpartum (p less than 0.01). Both proteins rose to normal levels within two days. The data suggest that the kallikrein-kinin system is utilized during parturition.

]]> B. M. Alving et al. Folic acid supplementation to prevent birth defects http://ir.uiowa.edu/obgyn_pubs/555 http://ir.uiowa.edu/obgyn_pubs/555 Mon, 20 May 2013 14:36:10 PDT The Centers for Disease Control and Prevention recommends the following: women who have had an infant with a neural tube defect should take 4 mg a day from at least 4 weeks before conception through the first 3 months of pregnancy; all women capable of becoming pregnant should consume 0.4 mg a day.

]]> Jennifer R. Niebyl Gonococcal salpingitis in pregnancy http://ir.uiowa.edu/obgyn_pubs/556 http://ir.uiowa.edu/obgyn_pubs/556 Mon, 20 May 2013 14:36:10 PDT R. R. Genadry et al. Folic acid and prevention of birth defects http://ir.uiowa.edu/obgyn_pubs/554 http://ir.uiowa.edu/obgyn_pubs/554 Mon, 20 May 2013 14:36:09 PDT D. C. Van Dyke et al. Folate, zinc, and vitamin B-12 intake during pregnancy and postpartum http://ir.uiowa.edu/obgyn_pubs/553 http://ir.uiowa.edu/obgyn_pubs/553 Mon, 20 May 2013 14:36:08 PDT M. J. Berg et al. Folate, carotene, and smoking http://ir.uiowa.edu/obgyn_pubs/552 http://ir.uiowa.edu/obgyn_pubs/552 Mon, 20 May 2013 14:36:07 PDT F. R. Witter et al. Folate levels during pregnancy and post partum http://ir.uiowa.edu/obgyn_pubs/551 http://ir.uiowa.edu/obgyn_pubs/551 Mon, 20 May 2013 14:36:06 PDT G. Abbasi et al. Fetal distress during a maternal systemic allergic reaction http://ir.uiowa.edu/obgyn_pubs/550 http://ir.uiowa.edu/obgyn_pubs/550 Mon, 20 May 2013 14:36:06 PDT Systemic allergic reactions to food ingestion rarely result in life-threatening situations. When these reactions occur during pregnancy, however, the accompanying physiologic changes may result in fetal distress. A case of repetitive late decelerations in the fetal heart rate during a maternal allergic reaction is presented. Prompt and aggressive medical management brought about total resolution of maternal and fetal compromise.

]]> V. R. Klein et al. Experience with an adolescent pregnancy program. A preliminary report http://ir.uiowa.edu/obgyn_pubs/549 http://ir.uiowa.edu/obgyn_pubs/549 Mon, 20 May 2013 14:36:05 PDT A program has been designed to give comprehensive health care services to pregnant adolescents. The program components include community liason, patient education, counseling and social services, a nurse "on call" program for labor and delivery, and pediatric nurse-practitioner followup. In addition, a drug use identification component screens the patients by interview and urinalysis. Hypertensive disorders of pregnancy occurred in 10% of the first 202 patients. Forty-three percent had anemia (hematocrit less than 35%), and screening cervical cultures for gonorrhea were positive in 3.5%. Cigarettes, alcohol, and marijuana constituted the most common nonmedical drugs used, and aspirin the most common medical drug. Eighty-one percent of the patients attended 7 or more antenatal visits, one-half did not miss a single clinic appointment, and 95% completed a post-partum visit, indicating that the program was well accepted by the adolescents.

]]> D. D. Youngs et al. Efficacy of screening for gestational diabetes http://ir.uiowa.edu/obgyn_pubs/548 http://ir.uiowa.edu/obgyn_pubs/548 Mon, 20 May 2013 14:36:04 PDT A cost analysis of glucose screening was studied prospectively in 434 patients. All patients underwent a 50-gm oral glucose load followed by a 1-hour plasma glucose screen test at 28 weeks (+/- 2 weeks). Patients with a screen test greater than or equal to 130 mg/dl plasma glucose were further tested with an oral glucose tolerance test. Also, previously described clinical risk factors for diabetes were documented on all patients. A 3.3% prevalence of gestational diabetes was found in 178 patients with risk factors, compared with 2.4% of 256 patients without risk factors, not a significant difference. Ten of the 12 gestational diabetics were at least 24 years old, so that screening only this subgroup would still retain a good sensitivity (83%) but at half the cost of universal screening. Screening on the basis of risk factors other than age is inefficient. Though testing only patients who are 24 years of age or older is more cost effective than universal screening, an individual decision must be made regarding its reduced sensitivity.

]]> G. P. Marquette et al. Effect of hydrogen peroxide on prostaglandin production and contractions of the pregnant rat uterus http://ir.uiowa.edu/obgyn_pubs/546 http://ir.uiowa.edu/obgyn_pubs/546 Mon, 20 May 2013 14:36:03 PDT Although evidence for a role for prostaglandins in parturition is abundant, less is known about how prostaglandin levels are regulated at term. Conditions occurring peripartum in the uteroplacental unit can result in reactive oxygen production. We investigated the effect of one reactive oxygen product, hydrogen peroxide, on in vitro activity of uterine segments from the 18-day-pregnant rat. H2O2 (0.3 mmol/L) was found to elicit rhythmic contractions and increase prostaglandins F2 alpha and E2 release by uterine tissue. Indomethacin blocked both of these effects. We conclude that H2O2 stimulates uterine contractions through a prostaglandin release mechanism. A speculative hypothesis of peripartum regulation of prostaglandin production by reactive oxygen is discussed.

]]> P. H. Cherouny et al. Effect of proteolipid protein on central nervous system myelin membrane fluidity http://ir.uiowa.edu/obgyn_pubs/547 http://ir.uiowa.edu/obgyn_pubs/547 Mon, 20 May 2013 14:36:03 PDT The effect which intrinsic (proteolipid) protein has on fluidity of central nervous system myelin membrane was measured through differences in temperature-dependent anisotropy of the lipid-soluble fluorescence probe, 1,6-diphenyl-1,3,5-hexatriene (DPH), in multilamellar vesicles (MLV) prepared from total myelin lipids in the presence and absence of proteolipid protein. Very little difference was observed in the anisotropies of DPH incorporated into intact myelin membrane vesicles compared with MLV reconstituted from total myelin lipid plus proteolipid protein but excluding myelin basic protein. In contrast, a significant decrease (P less than 0.01) in anisotropy was observed when MLV prepared from total myelin lipids depleted of proteolipid protein were compared with vesicles containing proteolipid protein. Given the different distributions of myelin basic protein and proteolipid protein suggested by freeze-fracture, neutron and X-ray diffraction studies, and the fact that the hydrophobic DPH probe is known to distribute in the non-polar regions of lipid bilayers, we interpret the marked decrease in anisotropy when proteolipid protein is excluded from MLV to suggest that at least part of the proteolipid is distributed in the hydrocarbon region of the MLV. These findings are consistent with the earlier physical studies and recent postulations that extensive hydrophobic segments exist in proteolipid protein and that these hydrophobic segments are buried in the myelin lipid bilayer and alternate with hydrophilic extra-membrane segments.

]]> F. R.,3rd Brown et al. Drugs in pregnancy: epilepsy, cancer, and more http://ir.uiowa.edu/obgyn_pubs/545 http://ir.uiowa.edu/obgyn_pubs/545 Mon, 20 May 2013 14:36:02 PDT You can't shun anticonvulsants, antineoplastics, immunosuppressants, anticoagulants, or thyroid agents in pregnancy. This roundup can keep the benefit-risk balance in your favor. Second of three parts.

]]> PM,,III Gazaway et al. Drugs in pregnancy http://ir.uiowa.edu/obgyn_pubs/544 http://ir.uiowa.edu/obgyn_pubs/544 Mon, 20 May 2013 14:36:01 PDT Jennifer R. Niebyl Drugs for inhibition of premature labor http://ir.uiowa.edu/obgyn_pubs/543 http://ir.uiowa.edu/obgyn_pubs/543 Mon, 20 May 2013 14:36:01 PDT Effective inhibition of premature labor depends on prompt initiation of treatment. The author discusses factors initiating parturition, and the benefits and risks for mother and child of administration of alcohol, beta adrenergic agents, magnesium sulfate, and other agents that may counteract them.

]]> Jennifer R. Niebyl Drugs for acute infection during pregnancy need careful selection http://ir.uiowa.edu/obgyn_pubs/542 http://ir.uiowa.edu/obgyn_pubs/542 Mon, 20 May 2013 14:36:00 PDT Jennifer R. Niebyl Drug therapy during pregnancy http://ir.uiowa.edu/obgyn_pubs/540 http://ir.uiowa.edu/obgyn_pubs/540 Mon, 20 May 2013 14:35:59 PDT A randomized prospective trial has shown that folic acid started before conception and continued for the first trimester reduces the risk of recurrence of neural tube defects by 72% in women with a previously affected child. Carbamazepine exposure in utero is associated with a 1% risk of spina bifida. Long-term follow-up of antenatal exposure to phenobarbital and carbamazepine in two groups of infants shows no neurologic differences between the two groups. Magnesium sulfate is more effective in prevention of recurrent eclamptic seizures than phenytoin. During pregnancy, the need for thyroxine increases in many women. Vitamin B6 and ginger are both effective for nausea and vomiting in early pregnancy. Low-dose aspirin does not change the course of preeclampsia when it is started after the diagnosis is made. Angiotensin-converting enzyme inhibitors cause significant disturbances of fetal and neonatal renal function. Prophylactic beta-adrenergic agents fail to prevent prematurity in twins. Oral tocolysis with magnesium chloride or ritodrine is no more effective than observation alone. The risk of primary pulmonary hypertension in the newborn after indomethacin tocolysis is increased with prolonged therapy. Lithium causes polyhydramnios from fetal diabetes insipidus in utero. Treatment of Ureaplasma urealyticum infection with erythromycin during pregnancy does not eliminate the organism from the lower genital tract and does not improve perinatal outcome.

]]> Jennifer R. Niebyl Drugs and related areas in pregnancy http://ir.uiowa.edu/obgyn_pubs/541 http://ir.uiowa.edu/obgyn_pubs/541 Mon, 20 May 2013 14:35:59 PDT Jennifer R. Niebyl Doppler ultrasound and maternal erythrocyte fragility http://ir.uiowa.edu/obgyn_pubs/539 http://ir.uiowa.edu/obgyn_pubs/539 Mon, 20 May 2013 14:35:58 PDT Maternal erythrocyte fragility was studied in eight controls and in 16 women exposed to Doppler ultrasound monitoring during labor. Blood samples were taken before and after Doppler monitoring and no significant change in erythrocyte fragility was seen, although there was a trend toward increased fragility in patients exposed continuously for more than seven hours.

]]> G. S. Bause et al. Cost-effective criteria for glucose screening http://ir.uiowa.edu/obgyn_pubs/538 http://ir.uiowa.edu/obgyn_pubs/538 Mon, 20 May 2013 14:35:57 PDT To study cost-effective screening criteria for gestational diabetes, a prospective study of 1012 patients was completed. All patients underwent a glucose screen between 26 and 30 weeks of gestation, consisting of a 50-g oral glucose load followed by a one-hour plasma glucose determination. Patients with a glucose screen greater than or equal to 130 mg/dL were studied with a standard three-hour oral glucose tolerance test. The incidence of gestational diabetes was 2.4% (24 of 1012). Only one gestational diabetic was identified with a glucose screen below 150 mg/dL. Twenty-two of the 24 cases were at least 24 years old. Twenty-one of the 24 (88%) gestational diabetes had a glucose screen greater than or equal to 150 mg/dL and were 24 years old or greater. The cost of the diagnosis in these latter patients was 40% of the cost of diagnosis of universal screening with a threshold of 130 mg/dL. It is concluded that screening with a threshold of 150 mg/dL only patients who are at least 24 years old should be considered an alternative to universal screening.

]]> G. P. Marquette et al. Cornual contraction ring with retained placenta in midtrimester abortion http://ir.uiowa.edu/obgyn_pubs/537 http://ir.uiowa.edu/obgyn_pubs/537 Mon, 20 May 2013 14:35:57 PDT Jennifer R. Niebyl et al. Consultations & comments: reader reaction and timely answers from experts. Balancing maternal need for pain control and fetal risk http://ir.uiowa.edu/obgyn_pubs/536 http://ir.uiowa.edu/obgyn_pubs/536 Mon, 20 May 2013 14:35:56 PDT Jennifer R. Niebyl Consultations & comments. SSRIs and pregnancy: what risk to the fetus? http://ir.uiowa.edu/obgyn_pubs/535 http://ir.uiowa.edu/obgyn_pubs/535 Mon, 20 May 2013 14:35:55 PDT Jennifer R. Niebyl Cocaine abuse in a high risk obstetrical population http://ir.uiowa.edu/obgyn_pubs/534 http://ir.uiowa.edu/obgyn_pubs/534 Mon, 20 May 2013 14:35:55 PDT S. Keller et al. Clinical practice. Nausea and vomiting in pregnancy http://ir.uiowa.edu/obgyn_pubs/533 http://ir.uiowa.edu/obgyn_pubs/533 Mon, 20 May 2013 14:35:54 PDT Jennifer R. Niebyl Clinical high-risk designation does not predict excess fetal-maternal hemorrhage http://ir.uiowa.edu/obgyn_pubs/532 http://ir.uiowa.edu/obgyn_pubs/532 Mon, 20 May 2013 14:35:53 PDT During a 5-year period, an enzyme-linked antiglobulin test was used to screen and quantitate fetal-maternal hemorrhage in 789 consecutive D-negative mothers who were delivered of D-positive babies. Six hundred seventy-two patients (85.2%) had no detectable fetal-maternal hemorrhage, and 117 patients (14.8%) had a detectable fetal-maternal hemorrhage. Eight of the 789 (1%) had a fetal-maternal hemorrhage greater than 30 ml and required more than one vial of Rh immune globulin. Two patients with fetal-maternal hemorrhage of 29 and 30 ml also received additional Rh immune globulin. Each case was reviewed for the presence of high-risk features that are thought to predict patients at risk for fetal-maternal hemorrhage. Patients having a cesarean section or complicated vaginal delivery were considered to be in a group at high risk for fetal-maternal hemorrhage, while those with a spontaneous vaginal delivery were considered not to be at risk for fetal-maternal hemorrhage. Thirty-two of 237 patients (13.5%) in the risk group and 82 of 552 patients (15.3%) in the group not at risk had detectable fetal-maternal hemorrhage. The incidence of fetal-maternal hemorrhage for these two groups was not statistically different (p greater than 0.50 by chi 2 analysis). If only patients in the risk group had been screened for fetal-maternal hemorrhage, then five of 10 (50%) who required more than one vial of Rh immune globulin would have been undertreated and at risk for developing anti-D antibodies. In addition, newborn birth weight, Apgar scores, and hematocrits were examined for 13 cases of fetal-maternal hemorrhage of greater than or equal to 21 ml, and none of these characteristics could be used to predict patients at risk for fetal-maternal hemorrhage. Therefore, no maternal or newborn characteristics could be identified that would reliably predict patients at risk for fetal-maternal hemorrhage. We conclude that all D-negative patients with D-positive babies should continue to be screened for fetal-maternal hemorrhage to identify those patients requiring more than one vial of Rh immune globulin.

]]> P. M. Ness et al. Changes in the diagnostic process during 40 years of clinicopathologic conferences http://ir.uiowa.edu/obgyn_pubs/531 http://ir.uiowa.edu/obgyn_pubs/531 Mon, 20 May 2013 14:35:53 PDT A. R. Feinstein et al. Cervical cancer diagnosed shortly after pregnancy: prognostic variables and delivery routes http://ir.uiowa.edu/obgyn_pubs/530 http://ir.uiowa.edu/obgyn_pubs/530 Mon, 20 May 2013 14:35:52 PDT A. K. Sood et al. Cardiac and respiratory drugs in pregnancy http://ir.uiowa.edu/obgyn_pubs/529 http://ir.uiowa.edu/obgyn_pubs/529 Mon, 20 May 2013 14:35:51 PDT Medical advances have led to safer pregnancies, but fetal toxicity of drugs remains enigmatic. For many, the jury is still out. Use these guidelines to treat pregnant patients safely. First of three articles.

]]> PM,,III Gazaway et al. Carbamazepine levels in pregnancy and lactation http://ir.uiowa.edu/obgyn_pubs/528 http://ir.uiowa.edu/obgyn_pubs/528 Mon, 20 May 2013 14:35:51 PDT An epileptic patient whose seizures were controlled with carbamazepine and primidone was followed throughout pregnancy and lactation. Blood levels of primidone decreased during pregnancy and rose postpartum requiring dosage adjustments. Pharmacologically insignificant amounts of the drug were detected in breast milk. A review of the literature revealed 94 infants exposed to carbamazepine in utero and no evidence to date that this drug carries a teratogenic risk.

]]> Jennifer R. Niebyl et al. Biological properties of a recombinant human immunoglobulin epsilon-chain fragment http://ir.uiowa.edu/obgyn_pubs/527 http://ir.uiowa.edu/obgyn_pubs/527 Mon, 20 May 2013 14:35:50 PDT A recombinant human immunoglobulin epsilon-chain gene expression product (rFc epsilon) was compared with a human E myeloma protein in the affinity for epsilon-chain Fc fragment receptors (Fc epsilon R) on cultured human basophils. The association-dissociation kinetics of the rFc epsilon-Fc epsilon R interaction are indistinguishable from that of E myeloma protein, indicating that rFc epsilon and IgE have identical affinity for the receptors. The recombinant gene product sensitizes cultured basophils for anti-IgE-induced histamine release. A dose-response curve of histamine release indicates that the gene product is equally efficient in transducing the signal for degranulation as the natural IgE. Both the rFc epsilon and IgE lost the affinity for Fc epsilon R by heating at 56 degrees C. Upon renaturation by passage through a solution of 6 M guanidine hydrochloride, rFc epsilon recovered both the affinity for Fc epsilon R and the original CD spectra. On the other hand, renaturation of heat-denatured IgE largely restored optical activity above 250 nm but restored neither the affinity for Fc epsilon R nor the CD spectrum below 220 nm. The results suggest that either the amino acid sequence or the carbohydrate present in the myeloma protein, but not the rFc epsilon, may interfere with refolding of the receptor-binding structures.

]]> T. Ishizaka et al. Antidepressant drug use in pregnancy http://ir.uiowa.edu/obgyn_pubs/526 http://ir.uiowa.edu/obgyn_pubs/526 Mon, 20 May 2013 14:35:49 PDT Jennifer R. Niebyl Antibiotics and other anti-infective agents in pregnancy and lactation http://ir.uiowa.edu/obgyn_pubs/524 http://ir.uiowa.edu/obgyn_pubs/524 Mon, 20 May 2013 14:35:48 PDT Serum levels of many drugs are lower in pregnancy compared with the nonpregnant state. Their renal clearance is higher and the maternal intravascular volume is expanded. Most antibiotics are safe for use in pregnancy and lactation. Tetracyclines cause fetal tooth discoloration and inhibition of bone growth if used in the second and third trimesters. Aminoglycosides carry a small risk of fetal ototoxicity. Quinolones may cause arthropathies in children, and so are currently not recommended for use in pregnancy. Most drugs are secreted into breast milk in very small amounts, not enough to have any therapeutic effect. The only antibiotics which may be of concern in nursing infants are sulfonamides and quinolones, and possibly metronidazole.

]]> Jennifer R. Niebyl Antibiotics, analgesics, arthritis drugs in pregnancy http://ir.uiowa.edu/obgyn_pubs/525 http://ir.uiowa.edu/obgyn_pubs/525 Mon, 20 May 2013 14:35:48 PDT PM,,III Gazaway et al. Adolescent pregnancy and abortion http://ir.uiowa.edu/obgyn_pubs/523 http://ir.uiowa.edu/obgyn_pubs/523 Mon, 20 May 2013 14:35:47 PDT D. D. Youngs et al. Abnormal glucose screening in pregnancy in patients with normal oral glucose tolerance tests as a screening test for fetal macrosomia http://ir.uiowa.edu/obgyn_pubs/521 http://ir.uiowa.edu/obgyn_pubs/521 Mon, 20 May 2013 14:35:46 PDT Minor abnormalities of carbohydrate metabolism in pregnancy are a risk factor for delivery of a macrosomic infant. However, the 50-g 1-h oral glucose screen at 28 weeks is not a useful screening test for macrosomia in pregnant patients with normal glucose tolerance tests, because a positive screen does not raise the probability of delivering a macrosomic infant sufficiently to warrant intervention.

]]> F. R. Witter et al. Acute bacterial endocarditis with postpartum aortic valve replacement http://ir.uiowa.edu/obgyn_pubs/522 http://ir.uiowa.edu/obgyn_pubs/522 Mon, 20 May 2013 14:35:46 PDT A case of acute bacterial endocarditis with aortic valve abscess, aortic insufficiency, and congestive heart failure at 32 weeks' gestation is described. Prompt valve replacement is indicated due to the risks of embolism to the coronary arteries and brain, and to the high mortality of such patients with medical management only. The infant was delivered prematurely to avoid the intraoperative risks to the fetus of cardiac surgery. General rather than regional anesthesia was chosen because venous pooling from a regional block would necessitate preoperative fluid loading and vasopressor therapy, which would be stressful for an already failing heart. In the presence of severe congestive heart failure, the patient underwent cesarean section and delivered a health 2020-g male infant; 36 hours later the aortic valve was successfully replaced with a no. 21 Byork-Shiley prosthesis. The infecting organism was Streptococcus viridans.

]]> R. L. Cavalieri et al. A placebo-controlled randomized trial of the terbutaline pump for prevention of preterm delivery http://ir.uiowa.edu/obgyn_pubs/520 http://ir.uiowa.edu/obgyn_pubs/520 Mon, 20 May 2013 14:35:45 PDT To determine the efficacy of the terbutaline pump for the prevention of preterm delivery, patients in preterm labor defined by progressive cervical change underwent intravenous magnesium sulfate tocolysis (with or without oral indomethacin, as necessary), and once labor was arrested, were randomized to one of three treatment arms: terbutaline by pump, saline by pump (blinded), or oral terbutaline. If recurrent preterm labor occurred despite maximization of therapy, the treatment arm was determined and therapy was changed; saline pump and oral terbutaline were switched to terbutaline pump, terbutaline pump was switched to oral terbutaline. Patients who continued to labor were readmitted for aggressive intravenous therapy. Women randomized to the terbutaline pump (n = 15), saline pump (n = 12), and oral terbutaline (n = 15) groups were similar in terms of gravidity, parity, days of tocolysis before study entry, gestational age at entry, and cervical dilatation at entry. The mean gestational age at delivery was the same in all three groups (35 weeks), as were neonatal outcomes. Terbutaline by pump, saline by pump, and oral terbutaline appear equivalent for the prevention of preterm delivery. The terbutaline pump should remain experimental.

]]> K. D. Wenstrom et al. A false negative oxytocin challenge test http://ir.uiowa.edu/obgyn_pubs/519 http://ir.uiowa.edu/obgyn_pubs/519 Mon, 20 May 2013 14:35:44 PDT A negative oxytocin challenge test has been considered a very reassuring finding in managing pregnancies in which the fetus is at risk from uteroplacental insufficency. In the case described here a fetal death in utero occurred 4 days after a negative oxytocin challenge test in a Class D diabetic patient, but in that period of time the patient's metabolic status deteriorated. A negative oxytocin challenge test does not protect the fetus from a subsequent acute event such as abruptio placentae, a cord accident, or diabetic ketoacidosis.

]]> W. M. McCranie et al. Degradation of MONOCULM 1 by APC/C-TAD1 regulates rice tillering http://ir.uiowa.edu/obgyn_pubs/518 http://ir.uiowa.edu/obgyn_pubs/518 Thu, 16 May 2013 13:06:40 PDT A rice tiller is a specialized grain-bearing branch that contributes greatly to grain yield. The MONOCULM 1 (MOC1) gene is the first identified key regulator controlling rice tiller number; however, the underlying mechanism remains to be elucidated. Here we report a novel rice gene, Tillering and Dwarf 1 (TAD1), which encodes a co-activator of the anaphase-promoting complex (APC/C), a multi-subunit E3 ligase. Although the elucidation of co-activators and individual subunits of plant APC/C involved in regulating plant development have emerged recently, the understanding of whether and how this large cell-cycle machinery controls plant development is still very limited. Our study demonstrates that TAD1 interacts with MOC1, forms a complex with OsAPC10 and functions as a co-activator of APC/C to target MOC1 for degradation in a cell-cycle-dependent manner. Our findings uncovered a new mechanism underlying shoot branching and shed light on the understanding of how the cell-cycle machinery regulates plant architecture.

]]> Cao Xu et al. Differential Expression of Ikaros Isoforms in Monozygotic Twins With MLL-rearranged Precursor-B Acute Lymphoblastic Leukemia http://ir.uiowa.edu/obgyn_pubs/517 http://ir.uiowa.edu/obgyn_pubs/517 Thu, 16 May 2013 13:06:38 PDT Infant leukemia associated with rearrangement of the MLL gene typically presents with high-risk clinical features. Relapse is common despite aggressive therapy and perturbations in signaling pathways may contribute to disease resistance. We evaluated twin 4-month-old monozygotic baby boys who presented with MLL-rearranged precursor-B acute lymphoblastic leukemia. Two different MLL/AF4 variants were found in both the twins, the first involving MLL intron 8 and AF4 intron 3 and the second stemming from translocations of MLL exon 10 and AF4 exon 4. We detected expression of the DNA-binding Ikaros isoforms, Ik1, Ikx +, Ik2 and the dominant-negative 114 Ikaros isoform in both patients. However, the dominant-negative Ik8 isoform was detected in only I boy, suggesting a common genetic ontogeny that was modulated by leukemic evolution. Further exploration of Ikaros expression in the background of MLL rearrangements may provide new insights into disease pathogenesis and could offer targets for novel chemotherapeutic agents.

]]> Thomas Russell et al. Association of human RAD52 protein with transcription factors http://ir.uiowa.edu/obgyn_pubs/516 http://ir.uiowa.edu/obgyn_pubs/516 Thu, 16 May 2013 13:06:35 PDT The human RAD52 protein has been implicated in DNA homologous recombination. Four major functional domains have been identified: a DNA binding domain (amino acids 1-85), a self-association and UBC9-interacting domain (amino acids 85-159), an RPA-interacting domain (amino acids 221-280), and a RAD51-interacting domain (amino acids 287-330). However, it is uncertain about the functional roles of the C-terminal region of RAD52 protein. In this report, we demonstrate an association of a C-terminal domain of human RAD52 (amino acids 302-418) with the XPB and XPD subunits of transcription factor TFIIH and RNA polymerase II (RNAPII). Using a Gal-4 binding based transcription assay, we further show that this C-terminal domain activates transcription. However, the RAD52 self-association domain suppresses transcription, resulting in an overall activity of transcriptional suppression by the full-length RAD52 protein. These results suggest a novel activity of RAD52 in transcription regulation and may further imply a functional role of RAD52 in targeting DNA damage on transcription active loci to recombinational repair. (C) 2002 Elsevier Science (USA). All rights reserved.

]]> J. M. Liu et al. BCCIP Functions through p53 to regulate the expression of p21(Waf1/Cip1) http://ir.uiowa.edu/obgyn_pubs/515 http://ir.uiowa.edu/obgyn_pubs/515 Thu, 16 May 2013 13:06:32 PDT The BCCIP protein is a BRCA2 and CDKN1A (p21(Waf1/Cip1)) Interacting Protein, which binds to a highly conserved domain of BRCA2, and a C-terminal domain of the CDK-inhibitor p21. We have previously reported that overexpression of BCCIP increases p21 mRNA and protein levels, and inhibits G(1) to S progression. In this report, we show that a partial shutdown of BCCIP expression by RNA interference reduces p21 levels and impairs G(1)/S checkpoint activation in response to ionizing radiation in HT1080 cells. We further show that the regulation of p21 expression by BCCIP is dependent on p53, and BCCIP regulates p53 transcription activity. These data provide a new mechanism by which BCCIP regulates p21 functions.

]]> Xiangbing Meng et al. Inhibition of G(1) to S cell cycle progression by BCCI beta http://ir.uiowa.edu/obgyn_pubs/514 http://ir.uiowa.edu/obgyn_pubs/514 Thu, 16 May 2013 13:06:29 PDT The BCCIPalpha protein was identified as a BRCA2 and CDKN1A (p21, or p21(Waf1/Cip1)) Interacting Protein. It binds to a highly conserved domain proximate to the C-terminus of BRCA2 protein and the C-terminal domain of the CDK-inhibitor p21. Previous reports showed that BCCIPa enhances the inhibitory activity of p21 toward CDK2 and that BCCIPalpha inhibits the growth of certain tumor cells. Here we show that a second isoform, BCCIbeta, also binds to p21 and inhibits cell growth. The growth inhibition by BCCIPbeta can be partially abrogated in p21 deficient cells. Overexpression of BCCIPbeta delays the G1 to S progression and results in an elevated p21 expression. These data suggest BCCIPbeta as a new regulator for the G(1)-S cell cycle progression and cell growth control.

]]> Xiangbing Meng et al. Genomic structure of the human BCCIP gene and its expression in cancer http://ir.uiowa.edu/obgyn_pubs/513 http://ir.uiowa.edu/obgyn_pubs/513 Thu, 16 May 2013 13:06:27 PDT Human BCCIPalpha (Tok-1alpha) is a BRCA2 and CDKN1A (Cip1, p21) interacting protein. Our previous studies have showed that overexpression of BCCIPalpha inhibits the growth of certain tumor cells [Oncogene 20 (2001) 336]. In this study, we report the genomic structure of the human BCCIP gene, which contains nine exons. Alternative splicing of the 3-terminal exons produces two isoforms of BCCIP transcripts, BCCIPalpha and BCCIPbeta. The BCCIP gene is flanked by two genes that are transcribed in the opposite orientation of the BCCIP gene. It lies head-to-head and shares a bi-directional promoter with the uroporphyrinogen III synthase (UROS) gene. The last three exons of BCCIP gene overlap the 3'-terminal seven exons of a DEAD/H helicase-like gene (DDX32). Using a matched normal/tumor cDNA array, we identified a reduced expression of BCCIP in kidney tumor, suggesting a role of BCCIP in cancer etiology. (C) 2002 Published by Elsevier Science B.V.

]]> Xiangbing Meng et al. IKK inhibitor bay 11-7082 induces necroptotic cell death in precursor-B acute lymphoblastic leukaemic blasts http://ir.uiowa.edu/obgyn_pubs/512 http://ir.uiowa.edu/obgyn_pubs/512 Thu, 16 May 2013 13:06:25 PDT Xiangbing Meng et al. DWARF27, an Iron-Containing Protein Required for the Biosynthesis of Strigolactones, Regulates Rice Tiller Bud Outgrowth http://ir.uiowa.edu/obgyn_pubs/511 http://ir.uiowa.edu/obgyn_pubs/511 Thu, 16 May 2013 13:06:22 PDT Tillering in rice (Oryza sativa) is one of the most important agronomic traits that determine grain yields. Previous studies on rice tillering mutants have shown that the outgrowth of tiller buds in rice is regulated by a carotenoid-derived MAX/RMS/D (more axillary branching) pathway, which may be conserved in higher plants. Strigolactones, a group of terpenoid lactones, have been recently identified as products of the MAX/RMS/D pathway that inhibits axillary bud outgrowth. We report here the molecular genetic characterization of d27, a classic rice mutant exhibiting increased tillers and reduced plant height. D27 encodes a novel iron-containing protein that localizes in chloroplasts and is expressed mainly in vascular cells of shoots and roots. The phenotype of d27 is correlated with enhanced polar auxin transport. The phenotypes of the d27 d10 double mutant are similar to those of d10, a mutant defective in the ortholog of MAX4/RMS1 in rice. In addition, 2'-epi-5-deoxystrigol, an identified strigolactone in root exudates of rice seedlings, was undetectable in d27, and the phenotypes of d27 could be rescued by supplementation with GR24, a synthetic strigolactone analog. Our results demonstrate that D27 is involved in the MAX/RMS/D pathway, in which D27 acts as a new member participating in the biosynthesis of strigolactones.

]]> Hao Lin et al. Rice gene OsNAC19 encodes a novel NAC-domain transcription factor and responds to infection by Magnaporthe grisea http://ir.uiowa.edu/obgyn_pubs/510 http://ir.uiowa.edu/obgyn_pubs/510 Thu, 16 May 2013 13:06:19 PDT The plant-specific NAC-domain proteins have been identified to play important roles in plant responses to stresses or in plant development regulation. In this research, a full-length cDNA clone OsNAC19 (Oryza sativa NAC19), encoding a novel NAC-domain protein, was isolated from a cDNA library prepared with rice leaves infected by incompatible race 131 of blast fungus (Magnaporthe grisea). The similarity between OsNAC 19 and the members of OsNAC3 subgroup is from 65.87 to 51.53%. One plant-specific NAC domain is located in the N-terminus of OsNAC19. The protein OsNAC19 was localized in the nucleus of onion epidemical cells. The fusion protein of OsNAC19 with GAL4 DNA-binding domain (BD) activated the reporter genes LacZ and HIS3 in a yeast assay system, and the activation domain was located within amino acid 181-240 of its C-terminal region. The expression of gene OsNAC19 was high in rice seedling roots, culms and blade sheathes, but its expression in rice leaves was low. The expression of OsNAC19 in rice leaves could be induced by the infection of blast fungus, and by application of exogenous methyl jasmonate (MeJA), ABA and ethylene but ethylene had a relatively weak induction effect. These data suggest that OsNAC19 protein is a transcriptional activator involved in rice response to infection by M. grisea and may play a role in the MeJA-mediated signaling pathway. (c) 2006 Elsevier Ireland Ltd. All rights reserved.

]]> Ruiming Lin et al. Molecular cloning and characterization of a rice gene encoding AP2/EREBP-type transcription factor and its expression in response to infection with blast fungus and abiotic stresses http://ir.uiowa.edu/obgyn_pubs/509 http://ir.uiowa.edu/obgyn_pubs/509 Thu, 16 May 2013 13:06:17 PDT The AP2/EREBP domain-containing transcription factors play various functions in developmental processes and stress-related responses in plants. In present study, a full-length cDNA OsEBP2 (Oryza sativa ethylene-responsive-element binding protein2), encoding a 396-amino-acid protein containing one AP2/EREBP domain, was isolated from a cDNA library prepared with japonica rice leaves infected by blast fungus Magnaporthe grisea, which is identity to the locus OsO9g26420 and has been isolated from the japonica variety before. OsEBP2 is a member of Group VII of ERF family and is orthologous to OsBIERF1 in indica variety. OsEBP2 transcripts were detected at a similar level in the leaf, sheath and root of young Aichiasahi plants and in stem of 10-week-old plants. OsEBP2 expression was induced to increase more strongly in the compatible interaction between rice variety Aichiasahi and race 220 of M. grisea than in the incompatible one. OsEBP2 responded transiently to the treatments with MeJA, ABA and ethophen. In its promoter region several ciselements involved in stress responses are present. Based on these results, we propose that the transcription factor encoded by gene OsEBP2 may be involved in rice defense response to infection by blast fungus and in stress response. (C) 2007 Elsevier Ltd. All rights reserved.

]]> Running Lin et al. BCCIP regulates homologous recombination by distinct domains and suppresses spontaneous DNA damage http://ir.uiowa.edu/obgyn_pubs/508 http://ir.uiowa.edu/obgyn_pubs/508 Thu, 16 May 2013 13:06:15 PDT Homologous recombination (HR) is critical for maintaining genome stability through precise repair of DNA double-strand breaks (DSBs) and restarting stalled or collapsed DNA replication forks. HR is regulated by many proteins through distinct mechanisms. Some proteins have direct enzymatic roles in HR reactions, while others act as accessory factors that regulate HR enzymatic activity or coordinate HR with other cellular processes such as the cell cycle. The breast cancer susceptibility gene BRCA2 encodes a critical accessory protein that interacts with the RAD51 recombinase and this interaction fluctuates during the cell cycle. We previously showed that a BRCA2- and p21-interacting protein, BCCIP, regulates BRCA2 and RAD51 nuclear focus formation, DSB-induced HR and cell cycle progression. However, it has not been clear whether BCCIP acts exclusively through BRCA2 to regulate HR and whether BCCIP also regulates the alternative DSB repair pathway, non-homologous end joining. In this study, we found that BCCIP fragments that interact with BRCA2 or with p21 each inhibit DSB repair by HR. We further show that transient down-regulation of BCCIP in human cells does not affect non-specific integration of transfected DNA, but significantly inhibits homology-directed gene targeting. Furthermore, human HT1080 cells with constitutive down-regulation of BCCIP display increased levels of spontaneous single-stranded DNA (ssDNA) and DSBs. These data indicate that multiple BCCIP domains are important for HR regulation, that BCCIP is unlikely to regulate non-homologous end joining, and that BCCIP plays a critical role in resolving spontaneous DNA damage.

]]> Huimei Lu et al. BCCIP is required for the nuclear localization of the p21 protein http://ir.uiowa.edu/obgyn_pubs/507 http://ir.uiowa.edu/obgyn_pubs/507 Thu, 16 May 2013 13:06:13 PDT The p21 (CDKN1A, Waf1 or Cip1) protein is widely known as an inhibitor of cyclin-dependent kinase (CDK), which plays a critical role in regulation of the G(1)-S transition during the cell cycle progression. The inhibition of G(1)-S transition by p21 is mainly mediated in the nucleus. However, the cytoplasmic p21 has been shown to play a pro-proliferation and anti-apoptosis role. Thus, the regulation of p21's intracellular distribution has a significant implication for cell fate determination. BCCIP is a BRCA2 and CDKN1A Interacting Protein. Previous reports showed that BCCIP enhances the p21 suppression activity towards CDK2, and BCCIP downregulation reduces p21 expression by abrogating p53 transcription activity. In this report, we demonstrate that the BCCIP-p21 interaction is enhanced in response to DNA damage using Fluorescent Resonance Energy Transfer (FRET) technique. We found that the downregulation of BCCIP reduces nuclear p21 and increases cytoplasmic p21. This p21 redistribution is not caused by the reduced expression of endogenous p21 resulting from BCCIP downregulation, because exogenously expressed p21 also preferably distributes in the cytoplasm. The BCCIP regulation of p21 distribution is not related to the status of Thr-145 phosphorylation that is known to cause cytoplasmic distribution. These data suggest that regulation of p21 intracellular distribution as a new mechanism for BCCIP to modulate p21 functions.

]]> Jinjiang Fan et al. Cloning and Characterization of the DHDPS Gene Encoding the Lysine Biosynthetic Enzyme Dihydrodipocolinate Synthase from Zizania latifolia (Griseb) http://ir.uiowa.edu/obgyn_pubs/506 http://ir.uiowa.edu/obgyn_pubs/506 Thu, 16 May 2013 13:06:11 PDT Dihydrodipicolinate synthase (DHDPS) is the main enzyme of a specific branch of the aspartate pathway leading to lysine biosynthesis in higher plants. We have cloned and characterized the DHDPS gene from Zizania latifolia Griseb, which was named ZlDHDPS. Sequence analysis indicates that it contains an ORF of 954 bp interrupted by two exons and one intron encoding a polypeptide of 317 amino acids lacking a plastid transit peptide and a stop codon. The sequence of ZlDHDPS has high identity with known plant DHDPS in GenBank. Southern blotting analysis indicates that there are two copies of Z. latifolia DHDPS (ZlDHDPS) gene in the Z. latifolia nuclear genome. RT-PCR analysis shows the expression of ZlDHDPS is tissue specific and high level expression is present in fast-growing tissue and reproductive tissue. The 5'-regulatory sequence of ZlDHDPS contains a GT-1 box and a (CA)n element, which may play a role in regulating the expression of ZlDHDPS. The fusion construct of the ZlDHDPS sequence with the reporter gene GUS was transiently expressed in the onion epidermal cells by particle gun-mediated bombardment suggesting that ZlDHDPS was located in the cytoplasm, different from DHDPS gene of other species. Functional complementary analysis showed that ZlDHDPS can recover the DHDPS-deleted mutant of Escherichia coli.

]]> Fanna Kong et al. The BRCA2-interacting protein BCCIP functions in RAD51 and BRCA2 focus formation and homologous recombinational repair http://ir.uiowa.edu/obgyn_pubs/505 http://ir.uiowa.edu/obgyn_pubs/505 Thu, 16 May 2013 13:06:09 PDT Homologous recombinational repair (HRR) of DNA damage is critical for maintaining genome stability and tumor suppression. RAD51 and BRCA2 colocalization in nuclear foci is a hallmark of HRR. BRCA2 has important roles in RAD51 focus formation and HRR of DNA double-strand breaks (DSBs). We previously reported that 13CCIPalpha interacts with BRCA2. We show that a second isoform, BCCIPP, also interacts with BRCA2 and that this interaction occurs in a region shared by BCCIPot and BCCIPP. We further show that chromatin-bound BRCA2 colocalizes with BCCIP nuclear foci and that most radiation-induced RAD51 foci colocalize with BCCIP. Reducing BCCIPalpha by 90% or BCCIPbeta by 50% by RNA interference markedly reduces RAD51 and BRCA2 foci and reduces HRR of DSBs by 20- to 100-fold. Similarly, reducing BRCA2 by 50% reduces RAD51 and BCCIP foci. These data indicate that BCCIP is critical for BRCA2- and RAD51-dependent responses to DNA damage and HRR.

]]> H. M. Lu et al. Select gamma-Secretase Inhibitors Induce Apoptosis in Pre-B ALL Cells and Disrupt the Balance Between Constitutive Notch Signaling and Repression. http://ir.uiowa.edu/obgyn_pubs/504 http://ir.uiowa.edu/obgyn_pubs/504 Thu, 16 May 2013 13:06:08 PDT Bridget S. Wilson et al. Recovery from DNA damage-induced G(2) arrest requires actin-binding protein filamin-A/actin-binding protein 280 http://ir.uiowa.edu/obgyn_pubs/503 http://ir.uiowa.edu/obgyn_pubs/503 Thu, 16 May 2013 13:06:06 PDT Filamin-A (filamin-1) is an actin-binding protein involved in the organization of actin networks. Our previous study shows that filamin-A interacts with BRCA2, and lack of filamin-A expression results in increased cellular sensitivity to several DNA damaging agents in melanoma cells (Yuan, Y., and Shen, Z. (2001) J. Biol. Chem. 276, 48318-48324), suggesting a role of filamin-A in DNA damage response. In this report, we demonstrated that deficiency of filamin-A results in an 8-h delay in the recovery from G(2) arrest in response to ionizing radiation. However, filamin-A deficiency does not affect the initial activation of the G(2)/M checkpoint. We also found that filamin-A deficiency results in sustained activation of Chk1 and Chk2 after irradiation. This in turn causes a delay in the dephosphorylation of phospho-Cdc2, which is inhibitory to the G(2)/M transition. In addition, filamin-A-deficient M2 cells undergo mitotic catastrophe-related nuclear fragmentation after they are released from the G(2) arrest. Together, these data suggest a functional role of filamin-A in the recovery from G(2) arrest and subsequent mitotic cell death after DNA damage.

]]> Xiangbing Meng et al. Abrogation of the transactivation activity of p53 by BCCIP down-regulation http://ir.uiowa.edu/obgyn_pubs/502 http://ir.uiowa.edu/obgyn_pubs/502 Thu, 16 May 2013 13:06:01 PDT The tumor suppression function of p53 is mostly conferred by its transactivation activity, which is inactivated by p53 mutations in similar to 50% of human cancers. In cancers harboring wild type p53, the p53 transactivation activity may be compromised by other mechanisms. Identifying the mechanisms by which wild type p53 transactivation activity can be abrogated may provide insights into the molecular etiology of cancers harboring wild type p53. In this report, we show that BCCIP, a BRCA2 and CDKN1A- interacting protein, is required for the transactivation activity of wild type p53. In p53 wild type cells, BCCIP knock down by RNA interference diminishes the transactivation activity of p53 without reducing the p53 protein level, inhibits the binding of p53 to the promoters of p53 target genes p21 and HDM2, and reduces the tetrameric formation of p53. These data demonstrate a critical role of BCCIP in maintaining the transactivation activity of wild type p53 and further suggest down-regulation of BCCIP as a novel mechanism to impair the p53 function in cells harboring wild type p53.

]]> Xiangbing Meng et al. Short panicle1 encodes a putative PTR family transporter and determines rice panicle size http://ir.uiowa.edu/obgyn_pubs/501 http://ir.uiowa.edu/obgyn_pubs/501 Thu, 16 May 2013 13:05:57 PDT The architecture of the rice inflorescence, which is determined mainly by the number and length of primary and secondary inflorescence branches, is of importance in both agronomy and developmental biology. The position and number of primary branches are established during the phase transition from vegetative to reproductive growth, and several of the genes identified as participating in this process do so by regulating the meristemic activities of inflorescence. However, little is known about the molecular mechanism that controls inflorescence branch elongation. Here, we report on a novel rice mutant, short panicle1 (sp1), which is defective in rice panicle elongation, and thus leads to the short-panicle phenotype. Gene cloning and characterization indicate that SP1 encodes a putative transporter that belongs to the peptide transporter (PTR) family. This conclusion is based on the findings that SP1 contains a conserved PTR2 domain consisting of 12 transmembrane domains, and that the SP1-GFP fusion protein is localized in the plasma membrane. The SP1 gene is highly expressed in the phloem of the branches of young panicles, which is consistent with the predicted function of SP1 and the sp1 phenotype. Phylogenetic analysis implies that SP1 might be a nitrate transporter. However, neither nitrate transporter activity nor any other compounds transported by known PTR proteins could be detected in either a Xenopus oocyte or yeast system, in our study, suggesting that SP1 may need other component(s) to be able to function as a transporter, or that it transports unknown substrates in the monocotyledonous rice plant.

]]> Shengben Li et al. Present and future perspectives on the use of free or encapsulated pancreatic islet cell transplantation as a treatment of pregnancy complicated by type 1 diabetes http://ir.uiowa.edu/obgyn_pubs/500 http://ir.uiowa.edu/obgyn_pubs/500 Wed, 15 May 2013 13:06:20 PDT Pregnancies complicated by insulin-dependent diabetes mellitus (IDDM) pose significant health risks to both the mother and her developing fetus. Congenital malformations in the offspring of diabetic mothers have an incidence which is 2-5 times that seen in the background. Euglycemia in the first trimester of pregnancy can reduce this incidence, but achieving euglycemia with conventional exogenous insulin therapy is both costly and difficult. Even with intense insulin dosage adjustments, the blood glucose profile of the diabetic pregnant patient does not mimic that seen in nondiabetic patients. Both the difficulties and inadequacies of conventional therapy for IDDM-complicated pregnancy provide a stimulus for research to develop improved therapeutic modalities. Islet transplantation holds great promise as a treatment for pregnancies complicated by IDDM. This article reviews the current status of islet transplantation including the use of immunomodulation and immunoisolation techniques and their potential use for the treatment of IDDM pregnancies.

]]> Stephen K. Hunter Perinatal management of women with immune thrombocytopenic purpura: survey of United States perinatologists http://ir.uiowa.edu/obgyn_pubs/499 http://ir.uiowa.edu/obgyn_pubs/499 Wed, 15 May 2013 13:06:18 PDT OBJECTIVE: The aim of the study was to determine how perinatologists in the United States manage the care of women with immune thrombocytopenic purpura with respect to mode of delivery. Study Design: US members of the Society of Perinatal Obstetricians were surveyed with a 4-question questionnaire. Two mailings were sent. Questions 1 and 2 asked for a response regarding the perinatal management of delivery for women with chronic immune thrombocytopenic purpura and new-onset disease. The options were cordocentesis or fetal scalp blood sampling and cesarean delivery if the platelet count was <50,000 cells/microL, cesarean delivery if the maternal platelet count was <50,000 cells/microL, cesarean delivery of all women with immune thrombocytopenic purpura, and trial of labor without determining fetal platelet count. The third question asked for an opinion on whether cesarean delivery was protective against intracranial hemorrhage in cases of immune thrombocytopenic purpura. The fourth question asked whether the practitioner was in academic or private practice or both. RESULTS: Among the 1596 perinatologists surveyed, there were 940 informative responses (58.9%). Most would allow a trial of labor for women with chronic (59.0%) or new-onset (66.6%) immune thrombocytopenic purpura. In cases of chronic immune thrombocytopenic purpura, 31.0% of those responding would perform an invasive procedure to determine fetal platelet count, followed by cesarean delivery if this count was <50, 000 cells/microL. In cases of new-onset immune thrombocytopenic purpura, 25.4% would do so. Of the respondents, 11.8% reportedly considered cesarean delivery protective against intracranial hemorrhage, whereas 56.6% did not and 31.6% were unsure. CONCLUSIONS: The management of women with immune thrombocytopenic purpura remains controversial in the United States. Approximately two thirds of perinatologists would allow a trial of labor without a procedure to determine fetal platelet count. Most physicians surveyed did not consider cesarean delivery to be protective against intracranial hemorrhage.

]]> D. Peleg et al. Oral hypoglycemic agents in pregnancy http://ir.uiowa.edu/obgyn_pubs/498 http://ir.uiowa.edu/obgyn_pubs/498 Wed, 15 May 2013 13:06:16 PDT Pregnancies in diabetic women are associated with increased risk of spontaneous abortion, congenital malformations, preeclampsia, preterm labor, macrosomia, shoulder dystocia, and cesarean section. Advances in antepartum cares and strict adherence to dietary and insulin regimens have been shown to significantly reduce the rate of maternal morbidity as well as perinatal morbidity and mortality. Historically, reports of potential fetal teratogenicity and hypoglycemic effects on the fetus contraindicated the use of oral hypoglycemic agents in pregnancies complicated with either type II diabetes mellitus (DM) or gestational diabetes mellitus (GDM). Recently, physicians increasingly prescribe newer generations of oral hypoglycemic agents to treat GDM and type II DM to pregnant patients. This review addresses the safety, current recommendations, and controversies surrounding use of the available oral hypoglycemic agents during pregnancy. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the mechanisms of actions of the various oral hypoglycemic agents, to list the known side effects of these agents, and to summarize the data on the use of these agents during pregnancy.

]]> N. D. Tran et al. Bioartificial pancreas use in diabetic pregnancy http://ir.uiowa.edu/obgyn_pubs/497 http://ir.uiowa.edu/obgyn_pubs/497 Wed, 15 May 2013 13:06:14 PDT The purpose of this study was to evaluate the feasibility and effectiveness of Bioartificial Pancreas (BAP) technology use during diabetic pregnancy. In particular, the study asked 1) can microencapsulated islet cells effectively correct carbohydrate metabolism during diabetic pregnancy and 2) will such therapy, if initiated before conception, eliminate diabetes-induced congenital malformations in the fetus? Streptozotocin-induced diabetic female mice (ICR) received transplants of rat islets encapsulated within alginate microbeads. Animals were placed with male mice and bred. Random, nonfasting blood glucose (BG) determinations were made posttransplantation and throughout pregnancy. Pups were delivered by cesarean section on day 19 of gestation. Outcome parameters from transplanted animals (Tx) were compared to nondiabetic control animals and to untreated diabetic (DM) animals. Transplanted animals had significantly lower BG levels throughout pregnancy, compared with DM animals, but also had levels that were often lower than those seen in control nondiabetic animals, and had increased episodes of documented hypoglycemia. The malformation and fetal loss rate in the Tx group was significantly lower than the untreated group (ICR: 5.4% vs. 40%). Only 3 of 84 pups from the Tx group had major malformations, but all had anencephaly, a malformation not seen in any other study group. Both maternal BG levels and fetal malformation rates are significantly reduced using BAP technology in our animal models. However, the possible role these encapsulated islets may play in producing increased episodes of hypoglycemia or specific congenital malformations in pregnancy must be thoroughly investigated before any clinical studies.

]]> Stephen K. Hunter et al. Theoretical prediction of induction period from transient pore evolvement in polyester-based microparticles http://ir.uiowa.edu/obgyn_pubs/496 http://ir.uiowa.edu/obgyn_pubs/496 Wed, 15 May 2013 13:06:10 PDT A model was developed and compared to experimental results for prediction of the induction period during drug delivery from various compositions of biodegradable copolymer PLGA microparticles. The uniqueness of this model is that it considers transient pore evolvement and uses the kinetic parameters of polymer degradation, which are independent of experimental measurements of microparticle erosion, in its analysis. Delivery data from PLGA microparticles (50:50, 75:25, and 85:15) releasing ovalbumin (OVA, 46 kDa) and bovine serum albumin (BSA, 66 kDa) were determined and used as the model systems. Experimental measurements were carried out from 85 to 150 days depending on the PLGA characteristics. The predicted induction periods were approximately 45, 70, and 105 days for the release of both OVA and BSA from 50:50, 75:25, and 85:15 PLGA microparticles, respectively. Overall, these values were in very good agreement with experimentally estimated results.

]]> A. Zhao et al. Mathematical modeling of myoglobin facilitated transport of oxygen in devices containing myoglobin-expressing cells http://ir.uiowa.edu/obgyn_pubs/495 http://ir.uiowa.edu/obgyn_pubs/495 Wed, 15 May 2013 13:06:08 PDT Low pO(2) is perhaps the most significant factor in artificial pancreas failure. In these environments, not only is the beta cell production of insulin reduced, but the cell death rate is also significantly higher. Mathematical models are developed to test the feasibility of facilitated oxygen transport in enhancing O(2) flux to genetically engineered cells in a bioartificial device such as a pancreas. For this device, it is proposed that beta cells be genetically engineered to express myoglobin throughout the cell. In addition, the significance of including myoglobin throughout the alginate matrix present to provide immuno-protection for the transplanted cells is considered. The mathematical analysis predicts that myoglobin facilitated oxygen transport has the potential of increasing the oxygen concentration at the centre of a cluster of cells (islet) with an effective radius of 100 microm by 50%. These theoretical models for myoglobin facilitated oxygen transport with homogeneous Michaelis-Menten consumption also indicate that including myoglobin in the alginate gel would beneficially improve the flux of oxygen to the transplanted cells.

]]> H. K. Tilakaratne et al. Biodegradable microspheres containing group B Streptococcus vaccine: immune response in mice http://ir.uiowa.edu/obgyn_pubs/494 http://ir.uiowa.edu/obgyn_pubs/494 Wed, 15 May 2013 13:06:06 PDT OBJECTIVE: This study seeks to show the feasibility of producing a group B Streptococcus (GBS) vaccine, which is capable of producing both a local IgA immune response at the mucosal surface where GBS is colonized and a humoral IgG response, which is capable of transplacental passive immunization. STUDY DESIGN: Inactivated GBS antigen was microencapsulated in poly (D, L-lactic-co-glycolic acid) (PLG) with a water-in-oil-in-water double emulsion technique. Immunostimulatory synthetic oligodeoxynucleotides containing cytidine-phosphate-guanosine (CpG) motifs were coencapsulated as a potent adjuvant. The ICR strain of mouse was used in these studies. Female mice with normal immune systems were immunized with the PLG microparticles containing GBS type III polysaccharide (GBS PS) vaccine and CpG adjuvant (PLG/GBS/CpG) via the oral, vaginal, or nasal routes or by the intramuscular or intraperitoneal routes. Booster doses were administered 4 weeks after the initial immunization. Vaginal washings and blood samples were obtained 3 weeks after the booster dose and examined for both IgG and secretory IgA (sIgA) GBS antibodies with the use of an enzyme-linked immunoabsorbent assay method. RESULTS: PLG/GBS/CpG microparticles elicited a significantly higher GBS antibody response when compared with nonencapsulated GBS antigen or PLG-encapsulated GBS PS vaccine without the addition of the CpG adjuvant. IgG and secretory IgA (sIgA) antibodies to GBS antigen were documented in both the vaginal washings and blood samples. CONCLUSION: Preliminary findings indicate that this novel PLG/GBS/CpG vaccine elicited both IgA and IgG antibody responses to the GBS PS antigen studied. This antibody response may provide both protection against maternal GBS colonization and passive transplacental immunization for the fetus and neonate.

]]> Stephen K. Hunter et al. Intrauterine growth restriction: identification and management http://ir.uiowa.edu/obgyn_pubs/493 http://ir.uiowa.edu/obgyn_pubs/493 Wed, 15 May 2013 13:06:04 PDT Intrauterine growth restriction (IUGR) is a common diagnosis in obstetrics and carries an increased risk of perinatal mortality and morbidity. Identification of IUGR is crucial because proper evaluation and management can result in a favorable outcome. Certain pregnancies are at high risk for growth restriction, although a substantial percentage of cases occur in the general obstetric population. Accurate dating early in pregnancy is essential for a diagnosis of IUGR. Ultrasound biometry is the gold standard for assessment of fetal size and the amount of amniotic fluid. Growth restriction is classified as symmetric and asymmetric. A lag in fundal height of 4 cm or more suggests IUGR. Serial ultrasonograms are important for monitoring growth restriction, and management must be individualized. General management measures include treatment of maternal disease, good nutrition and institution of bed rest. Preterm delivery is indicated if the fetus shows evidence of abnormal function on biophysical profile testing. The fetus should be monitored continuously during labor to minimize fetal hypoxia.

]]> D. Peleg et al. Information from your family doctor. Intrauterine growth restriction: when your baby stops growing before birth http://ir.uiowa.edu/obgyn_pubs/492 http://ir.uiowa.edu/obgyn_pubs/492 Wed, 15 May 2013 13:06:03 PDT D. Peleg et al. Protective immunization in mice against group B streptococci using encapsulated C5a peptidase http://ir.uiowa.edu/obgyn_pubs/491 http://ir.uiowa.edu/obgyn_pubs/491 Wed, 15 May 2013 13:06:00 PDT OBJECTIVE: The purpose of the study was to test whether C5a peptidase encapsulated within a biodegradable polymer can act as a vaccine and elicit an immune response to prevent group B streptococci (GBS) infection in mice and provide protection to pups. STUDY DESIGN: C5a peptidase was encapsulated in semipermeable microspheres of poly(lactide-co-glycolide). Female ICR mice were immunized with encapsulated C5a peptidase, free C5a peptidase, or empty microparticles. Booster doses were given at days 21 and 42. Antibody responses were measured by enzyme-linked immunosorbent assay. Challenge with GBS type III was performed 4 days after the final booster in the vaginal vault of adult mice and intraperitoneally 48 hours after the birth for pups. RESULTS: Encapsulated C5a peptidase elicited a systemic immunoglobulin (Ig) G antibody response after intramuscular and intranasal administration. Unencapsulated C5a peptidase elicited a smaller systemic response. In addition to the strong IgG response, a secretory IgA response was observed in the vaginal mucosa after intranasal vaccination. No evidence of GBS colonization was found in vaccinated mice. Eighty-seven percent and 81% of the pups from intramuscularly and intranasally vaccinated dams survived a 90% lethal dose (LD90) GBS challenge vs 9% born to nonvaccinated dams. CONCLUSION: Encapsulated C5a peptidase elicited significant immune responses and protection against GBS challenge. C5a peptidase microsphere encapsulation has potential as a GBS vaccine.

]]> D. A. Santillan et al. Liver transplant after massive spontaneous hepatic rupture in pregnancy complicated by preeclampsia http://ir.uiowa.edu/obgyn_pubs/490 http://ir.uiowa.edu/obgyn_pubs/490 Wed, 15 May 2013 13:05:55 PDT BACKGROUND: Spontaneous hepatic rupture associated with preeclampsia is a rare but life-threatening situation. Several different surgical treatments have been described, depending on the severity of the rupture. Liver transplantation has become the mainstay for patients with end-stage liver disease. Transplantation in the setting of liver trauma or massive parenchymal disruption is not well defined. To our knowledge, this treatment has not been reported for spontaneous hepatic rupture in pregnancy. CASE: Massive, spontaneous hepatic rupture occurred in a patient at 36 weeks' gestation as a result of severe preeclampsia. Conventional surgical therapies were unsuccessful in controlling the massive hemorrhage. As a life-saving measure, the patient underwent total hepatectomy with the creation of an end-to-side portcaval shunt, thereby rendering the patient anhepatic. The patient was listed as urgently needing a liver for transplantation through the United Network for Organ Sharing. A suitable donor liver was located approximately 8 hours after the emergency hepatectomy. The patient underwent orthotopic liver transplantation after being maintained in an anhepatic state for almost 13 hours. The patient was discharged on postoperative day 41, suffering only from some ischemic lower extremity neuropathy secondary to hypovolemic hypotension occurring during the hepatectomy procedure. CONCLUSION: In the reported case, spontaneous hepatic rupture resulted in a massive hemorrhage that could not be controlled by previously reported techniques and required total hepatectomy followed by liver transplantation.

]]> Stephen K. Hunter et al. Antidepressants may mitigate the effects of prenatal maternal anxiety on infant auditory sensory gating http://ir.uiowa.edu/obgyn_pubs/489 http://ir.uiowa.edu/obgyn_pubs/489 Wed, 15 May 2013 13:05:54 PDT OBJECTIVE: Prenatal maternal anxiety has detrimental effects on the offspring's neurocognitive development, including impaired attentional function. Antidepressants are commonly used during pregnancy, yet their impact on offspring attention and their interaction with maternal anxiety has not been assessed. The authors used P50 auditory sensory gating, a putative marker of early attentional processes measurable in young infants, to assess the impact of maternal anxiety and antidepressant use. METHOD: A total of 242 mother-infant dyads were classified relative to maternal history of anxiety and maternal prenatal antidepressant use. Infant P50 auditory sensory gating was recorded during active sleep at a mean age of 76 days (SD=38). RESULTS: In the absence of prenatal antidepressant exposure, infants whose mothers had a history of anxiety diagnoses had diminished P50 sensory gating. Prenatal antidepressant exposure mitigated the effect of anxiety. The effect of maternal anxiety was limited to amplitude of response to the second stimulus, while antidepressant exposure had an impact on the amplitude of response to both the first and second stimulus. CONCLUSIONS: Maternal anxiety disorders are associated with less inhibition during infant sensory gating, a performance deficit mitigated by prenatal antidepressant exposure. This effect may be important in considering the risks and benefits of antidepressant use during pregnancy. Cholinergic mechanisms are hypothesized for both anxiety and antidepressant effects, although the cholinergic receptors involved are likely different for anxiety and antidepressant effects.

]]> Stephen K. Hunter et al. Leukemia in pregnancy and fetal response to multiagent chemotherapy http://ir.uiowa.edu/obgyn_pubs/488 http://ir.uiowa.edu/obgyn_pubs/488 Wed, 15 May 2013 13:05:52 PDT BACKGROUND: Leukemia is rare in pregnancy and treatment with intensive, multiagent chemotherapy produces complete remission in most adults, but might have deleterious effects on fetuses. CASE: A 24-year-old gravida 3 para 2 presented at 24 weeks with pruritus, rash, pancytopenia, and hepatitis. A bone marrow biopsy found acute lymphocytic leukemia. She completed three cycles of intensive multiagent chemotherapy with transient oligohydramnios in each cycle. Although there was decreased fetal growth rate, umbilical artery Doppler scans were normal. She delivered a normal 2150-g male infant at 36 weeks. CONCLUSION: Pregnant women with newly diagnosed leukemia should not delay treatment, but multiagent chemotherapy might have transient effects on fetuses, most notably oligohydramnios. However, if fetal testing is normal, delivery might not be indicated.

]]> W. F. Hansen et al. Indoleamine 2,3 Dioxygenase (IDO) Deficiency Results: in Vascular Dysfunction and Proteinuria in Pregnancy http://ir.uiowa.edu/obgyn_pubs/487 http://ir.uiowa.edu/obgyn_pubs/487 Wed, 15 May 2013 13:05:50 PDT Mark K. Santillan et al. Group B streptococci causing neonatal bloodstream infection: antimicrobial susceptibility and serotyping results from SENTRY centers in the Western Hemisphere http://ir.uiowa.edu/obgyn_pubs/486 http://ir.uiowa.edu/obgyn_pubs/486 Wed, 15 May 2013 13:05:45 PDT OBJECTIVE: Group B streptococcal infection is a common cause of neonatal sepsis. Surveillance of antimicrobial susceptibility and serotype frequencies of invasive group B streptococci is important to ensure the effectiveness of therapeutic regimens and to guide vaccine development. STUDY DESIGN: Prospective surveillance of neonatal bloodstream infection was performed at all Western Hemisphere sites participating in the SENTRY Program. From January 1997 through December 1999, a total of 122 isolates of bloodstream infections with group B streptococci were collected and sent to the University of Iowa for antimicrobial susceptibility testing and serotyping. RESULTS: No isolates were resistant to penicillin. More than 25% of isolates from US hospitals and 14% of isolates from Canadian hospitals were erythromycin resistant. Seven percent of isolates from the United States and Canada were resistant to clindamycin. No clindamycin or erythromycin resistance was found among isolates from Latin America. Clindamycin and erythromycin resistance was most frequent among serotype V strains. CONCLUSIONS: No emerging resistance to penicillin was noted among bloodstream infection isolates of group B streptococci from a broad geographic area; erythromycin and clindamycin resistance was found in the United States and Canada and appeared most frequently among serotype V strains.

]]> J. I. Andrews et al. Encapsulated beta-islet cells as a bioartificial pancreas to treat insulin-dependent diabetes during pregnancy http://ir.uiowa.edu/obgyn_pubs/485 http://ir.uiowa.edu/obgyn_pubs/485 Wed, 15 May 2013 13:05:42 PDT OBJECTIVE: Our purpose was to determine the effectiveness of the bioartificial pancreas technique in correcting (1) maternal carbohydrate metabolism and (2) fetal malformation rates in a pregnant diabetic animal model. STUDY DESIGN: Insulin secretion from encapsulated rat islets cultured in the presence of homologous rat prolactin was determined and compared with that of controls. Streptozotocin-induced diabetic Balb/c mice were then transplanted with rat islet cells encapsulated within alginate microbeads and were then bred. Blood glucose determinations were made after transplantation and throughout gestation. Pups were delivered by cesarean section on day 19 of gestation. Outcome parameters from the transplanted study animals were compared with those of nondiabetic controls and untreated diabetic animals. RESULTS: Insulin secretion was increased twofold in encapsulated rat islets exposed to prolactin compared with control values. Throughout gestation maternal weights and blood, glucose levels of transplanted animals were similar to those of nondiabetic controls. A fetal malformation rate of only 1.4% was observed in the pups from transplanted animals. CONCLUSIONS: Transplanted encapsulated islets are capable of normalizing maternal carbohydrate metabolism in a pregnant diabetic animal model. This therapy, if instituted before conception, also appears to eliminate the increase in fetal malformations seen in diabetic pregnancies.

]]> Stephen K. Hunter et al. Maternal parenting stress and mothers' reports of their infants' mastery motivation http://ir.uiowa.edu/obgyn_pubs/484 http://ir.uiowa.edu/obgyn_pubs/484 Wed, 15 May 2013 13:05:40 PDT T. A. Sparks et al. Rotary culture enhances pre-osteoblast aggregation and mineralization http://ir.uiowa.edu/obgyn_pubs/483 http://ir.uiowa.edu/obgyn_pubs/483 Wed, 15 May 2013 13:05:38 PDT Three-dimensional environments have been shown to enhance cell aggregation and osteoblast differentiation. Thus, we hypothesized that three-dimensional (3D) growth environments would enhance the mineralization rate of human embryonic palatal mesenchymal (HEPM) pre-osteoblasts. The objective of this study was to investigate the potential use of rotary cell culture systems (RCCS) as a means to enhance the osteogenic potential of pre-osteoblast cells. HEPM cells were cultured in a RCCS to create 3D enviroments. Tissue culture plastic (2D) cultures served as our control. 3D environments promoted three-dimensional aggregate formations. Increased calcium and phosphorus deposition was significantly enhanced three- to 18-fold (P < 0.001) in 3D cultures as compared with 2D environments. 3D cultures mineralized in 1 wk as compared with the 2D cultures, which took 4 wks, a decrease in time of nearly 75%. In conclusion, our studies demonstrated that 3D environments enhanced osteoblast cell aggregation and mineralization.

]]> S. R. Facer et al. Periodontal disease in pregnancy complicated by type 1 diabetes mellitus http://ir.uiowa.edu/obgyn_pubs/482 http://ir.uiowa.edu/obgyn_pubs/482 Wed, 15 May 2013 13:05:36 PDT BACKGROUND: Systemic disease and hormonal changes have been implicated as complicating factors for periodontal disease. Diabetes has been identified as a risk factor for periodontal disease, and diabetics can experience periodontal destruction at an earlier age than non-diabetic individuals. Increased hormone levels during pregnancy can contribute to increased gingival inflammation. The purpose of this study was to examine the association of type 1 diabetes mellitus (DM) on the periodontal status of pregnant women. METHODS: Thirty-three (13 diabetic and 20 non-diabetic) subjects, 20 to 39 weeks gestation, participated in this study. The mean age of the diabetics and non-diabetics was 28.5 +/- 7.1 (SD) and 27.0 +/- 7.3 years, respectively. The following parameters were assessed at Ramfjord's reference teeth: plaque index (PI), gingival inflammation (GI), probing depth (PD), gingival margin (GM) location, and clinical attachment level (CAL). RESULTS: Diabetic subjects had significantly (P<0.001) higher PI (1.48 +/- 0.69) and GI (1.77 +/- 0.44) scores than non-diabetics (PI = 0.63 +/- 0.38; GI = 0.93 +/- 0.48). Mean PD for diabetics (2.95 +/- 0.69 mm) was significantly different (P<0.024) from that of non-diabetics (2.44 +/- 0.32 mm). Although mean GM location was coronal to the cemento-enamel junction (CEJ) in both groups, gingival margins were at a more apical position (P<0.001) in the diabetics (-0.20 +/- 1.24 mm) compared to non-diabetics (-1.76 +/- 0.53 mm). Mean CAL values also varied significantly (P<0.001) between diabetics (2.60 +/- 1.54 mm) and non-diabetics (0.68 +/- 0.65 mm). Significant differences were seen for GI (P<0.001), PD (P=0.005), GM location (P<0.001), and CAL (P<0.001) when assessing the effect of diabetes and controlling for plaque. When assessing the effect of plaque and controlling for diabetes, the only significant difference was GI (P=0.001). CONCLUSIONS: The results of this study demonstrate that periodontal inflammation and destruction are increased in pregnant diabetics as compared to non-diabetic pregnant patients. These findings may have implications for diabetic control and, hence, maternal and fetal outcomes in pregnant diabetic patients.

]]> J. M. Guthmiller et al. In vivo biocompatibility evaluation of Cibacron blue-agarose http://ir.uiowa.edu/obgyn_pubs/481 http://ir.uiowa.edu/obgyn_pubs/481 Wed, 15 May 2013 13:05:33 PDT This study investigated the biocompatibility of Cibacron blue-agarose as a biomaterial for microencapsulation. Cibacron blue-agarose is known to have an affinity for albumin under certain pH conditions and in the proper steric environment. Thus it was postulated that the material's high affinity for host albumin might reduce a secondary immune response and reduce the fibrotic overgrowth that often accompanies transplanted foreign materials. In vivo tests were performed using the Lewis rat model. Both Cibacron blue-agarose and plain agarose disks were prepared, with some disks from each group being pre-exposed to sera from Lewis rats. The disks were transplanted into the peritoneal cavities of Lewis rats. After 115 days the disks were excised. Fibrotic overgrowth was analyzed using light microscopy, and a blind study was used to measure the average growth thickness on each disk. The results demonstrated that all disks developed some fibrotic encapsulation and that the presence of Cibacron blue was not significant in reducing fibrotic overgrowth (p = 0.62). Agarose disks pre-exposed to sera had significantly less average overgrowth than any other group (p = 0. 06).

]]> J. M. Kao et al. Cyclic changes in glycemia assessed by continuous glucose monitoring system during multiple complete menstrual cycles in women with type 1 diabetes http://ir.uiowa.edu/obgyn_pubs/480 http://ir.uiowa.edu/obgyn_pubs/480 Wed, 15 May 2013 13:05:30 PDT Many women with diabetes notice changes in glucose control perimenstrually. To describe the pattern of changes in glucose control throughout the complete menstrual cycle, and the reproducibility of these changes, we performed a pilot study evaluating glycemic profiles continuously for three cycles in four women with type 1 diabetes. All participants had hemoglobin A1c <7.5% and regular menstrual periods off oral contraceptives. They used Medtronic MiniMed (Northridge, CA) Continuous Glucose Monitoring System (CGMS) devices continuously for three complete menstrual cycles, checked capillary glucose measurements six times daily, changed their own sensors every 3 days, and were seen seven times per menstrual cycle to download data and draw blood. Prolonged monitoring was safely carried out over three consecutive menstrual cycles. We observed two different patterns of glycemic control in relation to the menstrual cycle in these women. The first pattern, seen in two women, was characterized by increased frequency of hyperglycemia in the luteal phase. One of these women also had a hyperglycemic peak in the follicular phase. In the other two women, no characteristic cycle-related pattern was noted. The glucose profiles appeared reproducible between cycles in all women, but varied between women. Thus the menstrual cycle has a reproducible effect on glucose control in a subset of women with type 1 diabetes. Prolonged use of continuous glucose monitoring was safe in the subjects studied, and is the first method clinically available to monitor glucose control over prolonged periods in individuals with diabetes.

]]> W. S. Goldner et al. Promotion of neovascularization around hollow fiber bioartificial organs using biologically active substances http://ir.uiowa.edu/obgyn_pubs/479 http://ir.uiowa.edu/obgyn_pubs/479 Wed, 15 May 2013 13:05:28 PDT A limiting factor of the long-term function of bioartificial organs is oxygen delivery to the encapsulated tissue. This study determined whether incorporation of endothelial cell growth factor (ECGF) into the alginate core of a hollow fiber bioartificial organ will induce neovascularization around the hollow fiber. Polyethersulfone (PES) and polyvinylidine difluoride (PVDF) hollow fibers were examined. Endothelial cell growth factor was incorporated into sodium alginate, extruded into the lumen of hollow fibers, and cured in calcium chloride. Samples without ECGF were fabricated and used as controls. Hollow fibers were implanted into 16 rats. For each rat, two implants were placed subcutaneously and two intraperitoneally, one with and one without ECGF at each site. Implants were placed on opposite sides of each animal. Implants were removed 65 days later and examined using immunohistochemical methods and light microscopy to determine the extent of neovascularization. A total of 64 implants were used. Most intraperitoneal implants were found free floating but were encased within a 100-microm thick avascular fibrotic reaction. This finding was independent from the presence of ECGF. Hollow fibers without ECGF, implanted subcutaneously, also had an avascular fibrotic reaction surrounding each implant. Subcutaneous implants with incorporation of ECGF within the alginate core had marked neovascularization within the fibrotic overgrowth that surrounded these implants. This was most prevalent in hollow fibers, with the thin separation layer facing the fiber lumen irrespective of limiting pore size. Potent angiogenic factors, such as ECGF, incorporated into diffusion chamber bioartificial organs can promote neovascularization around the subcutaneously implanted hollow fiber and may improve oxygen delivery to the tissue encapsulated within devices based on this technology.

]]> Stephen K. Hunter et al. Characterizing short-term release and neovascularization potential of multi-protein growth supplement delivered via alginate hollow fiber devices http://ir.uiowa.edu/obgyn_pubs/478 http://ir.uiowa.edu/obgyn_pubs/478 Wed, 15 May 2013 13:05:26 PDT H. K. Tilakaratne et al. Can myoglobin expression in pancreatic beta cells improve insulin secretion under hypoxia? An exploratory study with transgenic porcine islets http://ir.uiowa.edu/obgyn_pubs/477 http://ir.uiowa.edu/obgyn_pubs/477 Wed, 15 May 2013 13:05:24 PDT Himantha Kushanie Tilakaratne et al. The Intramolecular Friedel-Crafts Ketone Synthesis - a Student Experiment Including Chromatographic-Separation of Products http://ir.uiowa.edu/obgyn_pubs/476 http://ir.uiowa.edu/obgyn_pubs/476 Tue, 14 May 2013 14:26:56 PDT S. G. Levine et al. BRCA1 and BRCA2 alterations in ovarian MMMT http://ir.uiowa.edu/obgyn_pubs/475 http://ir.uiowa.edu/obgyn_pubs/475 Tue, 14 May 2013 14:26:52 PDT J. P. Geisler et al. Small Cell Carcinoma of the Uterine Cervix: A Single-Center Experience http://ir.uiowa.edu/obgyn_pubs/474 http://ir.uiowa.edu/obgyn_pubs/474 Tue, 14 May 2013 14:26:49 PDT Boris G. Naraev et al. Incidence and Management of Gastrointestinal Perforation from Bevacizumab in Advanced Cancers http://ir.uiowa.edu/obgyn_pubs/473 http://ir.uiowa.edu/obgyn_pubs/473 Tue, 14 May 2013 14:26:47 PDT Taher Abu-Hejleh et al. Thromboembolic events in patients treated with definitive chemotherapy and radiation therapy for invasive cervical cancer http://ir.uiowa.edu/obgyn_pubs/472 http://ir.uiowa.edu/obgyn_pubs/472 Tue, 14 May 2013 14:26:45 PDT G. M. Jacobson et al. High Grade Neuroendocrine Carcinoma of the Uterine Cervix: Outcomes and the Role of Radiation and Chemotherapy - The University of Iowa Experience http://ir.uiowa.edu/obgyn_pubs/471 http://ir.uiowa.edu/obgyn_pubs/471 Tue, 14 May 2013 14:26:43 PDT Boris G. Naraev et al. Thromboembolic events in patients with cervical carcinoma: Incidence and effect on survival http://ir.uiowa.edu/obgyn_pubs/470 http://ir.uiowa.edu/obgyn_pubs/470 Tue, 14 May 2013 14:26:41 PDT Geraldine Jacobson et al. Malignant pericardial effusion with cardiac tamponade in ovarian adenocarcinoma http://ir.uiowa.edu/obgyn_pubs/469 http://ir.uiowa.edu/obgyn_pubs/469 Tue, 14 May 2013 14:26:35 PDT Emily E. Petersen et al. P21 expression predicts outcome in p53-null ovarian carcinoma http://ir.uiowa.edu/obgyn_pubs/468 http://ir.uiowa.edu/obgyn_pubs/468 Tue, 14 May 2013 14:26:34 PDT S. L. Rose et al. Ovarian cancer p53 mutation is associated with tumor microvessel density http://ir.uiowa.edu/obgyn_pubs/467 http://ir.uiowa.edu/obgyn_pubs/467 Tue, 14 May 2013 14:26:31 PDT Michael J. Goodheart et al. Selective suppression of cervical cancer Hela cells by 2-O-beta-d-glucopyranosyl-l-ascorbic acid isolated from the fruit of Lycium barbarum L. http://ir.uiowa.edu/obgyn_pubs/466 http://ir.uiowa.edu/obgyn_pubs/466 Tue, 14 May 2013 14:26:29 PDT Zhiping Zhang et al. Progress toward Generating a Transgenic CRE-Reporter Ferret Model To Study Stem/Progenitor Cell Lineage Relationships in the Lung http://ir.uiowa.edu/obgyn_pubs/465 http://ir.uiowa.edu/obgyn_pubs/465 Tue, 14 May 2013 14:26:12 PDT Xiaoming Liu et al. Compensatory Induction of Cgrp in Cystic Fibrosis Airways Alters the Biologic Properties of the Submucosal Gland Progenitor Cell Niche http://ir.uiowa.edu/obgyn_pubs/464 http://ir.uiowa.edu/obgyn_pubs/464 Tue, 14 May 2013 14:26:11 PDT W. Xie et al. CGRP induction in cystic fibrosis airways alters the submucosal gland progenitor cell niche in mice http://ir.uiowa.edu/obgyn_pubs/463 http://ir.uiowa.edu/obgyn_pubs/463 Tue, 14 May 2013 14:26:09 PDT Weiliang Xie et al. Comparative Study of DNA Repair and Cell Proliferation Markers in High Grade Neuroendocrine Carcinoma of the Uterine Cervix and Small Cell Carcinoma of the Lung http://ir.uiowa.edu/obgyn_pubs/462 http://ir.uiowa.edu/obgyn_pubs/462 Tue, 14 May 2013 14:26:07 PDT Boris G. Naraev et al. Cftr Defects in Airway Submucosal Glands Alter Properties of the Glandular Stem/progenitor Cell Niche http://ir.uiowa.edu/obgyn_pubs/461 http://ir.uiowa.edu/obgyn_pubs/461 Tue, 14 May 2013 14:26:05 PDT W. Xie et al. Sox17 modulates Wnt3A/beta-catenin-mediated transcriptional activation of the Lef-1 promoter http://ir.uiowa.edu/obgyn_pubs/460 http://ir.uiowa.edu/obgyn_pubs/460 Tue, 14 May 2013 14:26:03 PDT Xiaoming Liu et al. The Role of LEF1 in Endometrial Gland Formation and Carcinogenesis http://ir.uiowa.edu/obgyn_pubs/459 http://ir.uiowa.edu/obgyn_pubs/459 Tue, 14 May 2013 14:26:01 PDT Dawne N. Shelton et al. Mismatch repair gene expression defects contribute to microsatellite instability in ovarian carcinoma http://ir.uiowa.edu/obgyn_pubs/458 http://ir.uiowa.edu/obgyn_pubs/458 Tue, 14 May 2013 14:26:00 PDT J. P. Geisler et al. The influence of microvessel density on ovarian carcinogenesis http://ir.uiowa.edu/obgyn_pubs/457 http://ir.uiowa.edu/obgyn_pubs/457 Tue, 14 May 2013 14:25:58 PDT P. J. B. Stone et al. The impact of p53 protein core domain structural alteration on ovarian cancer survival http://ir.uiowa.edu/obgyn_pubs/456 http://ir.uiowa.edu/obgyn_pubs/456 Tue, 14 May 2013 14:25:55 PDT S. L. Rose et al. BRCA2 alteration is important in clear cell carcinoma of the ovary http://ir.uiowa.edu/obgyn_pubs/455 http://ir.uiowa.edu/obgyn_pubs/455 Tue, 14 May 2013 14:25:53 PDT Michael J. Goodheart et al. The relationship of molecular markers of p53 function and angiogenesis to prognosis of stage I epithelial ovarian cancer http://ir.uiowa.edu/obgyn_pubs/454 http://ir.uiowa.edu/obgyn_pubs/454 Tue, 14 May 2013 14:25:51 PDT Michael J. Goodheart et al. An anatomic classification of rectovaginal septal defects http://ir.uiowa.edu/obgyn_pubs/453 http://ir.uiowa.edu/obgyn_pubs/453 Tue, 14 May 2013 12:25:48 PDT N B. Rosensheim et al. Benign Lesions of the Endometrium http://ir.uiowa.edu/obgyn_pubs/452 http://ir.uiowa.edu/obgyn_pubs/452 Tue, 14 May 2013 12:25:45 PDT Rene R. Genadry Imaging the female urethra with ultrasound http://ir.uiowa.edu/obgyn_pubs/451 http://ir.uiowa.edu/obgyn_pubs/451 Tue, 14 May 2013 12:25:41 PDT R Sanders et al. Recurrent Anal Incontinence http://ir.uiowa.edu/obgyn_pubs/450 http://ir.uiowa.edu/obgyn_pubs/450 Tue, 14 May 2013 12:25:40 PDT Rene R. Genadry et al. Normal gross and histologic anatomy of the human female urethra: a basis for understanding urinary incontinence http://ir.uiowa.edu/obgyn_pubs/449 http://ir.uiowa.edu/obgyn_pubs/449 Tue, 14 May 2013 12:25:38 PDT J Haderer et al. Miscellaneous diseases http://ir.uiowa.edu/obgyn_pubs/448 http://ir.uiowa.edu/obgyn_pubs/448 Tue, 14 May 2013 12:25:35 PDT Rene R. Genadry et al. Anatomy and Embryology http://ir.uiowa.edu/obgyn_pubs/447 http://ir.uiowa.edu/obgyn_pubs/447 Tue, 14 May 2013 12:25:33 PDT J Anderson et al. Anatomy and Embryology http://ir.uiowa.edu/obgyn_pubs/446 http://ir.uiowa.edu/obgyn_pubs/446 Tue, 14 May 2013 12:25:30 PDT J Anderson et al. Imaging of the Pelvic Floor http://ir.uiowa.edu/obgyn_pubs/445 http://ir.uiowa.edu/obgyn_pubs/445 Tue, 14 May 2013 12:25:21 PDT H Pannu et al. Obstetric vesico-vaginal fistulas at the National Hospital of Niamey, Niger. http://ir.uiowa.edu/obgyn_pubs/444 http://ir.uiowa.edu/obgyn_pubs/444 Tue, 14 May 2013 12:25:18 PDT OBJECTIVE: To determine the epidemiologic and therapeutic characteristics of obstetric vesico-vaginal fistulas at the National Hospital of Niamey, Niger.

METHODS: From December 2003 to February 2005, 111 consecutive patients with vesico-vaginal fistulas presenting for treatment were included and prospectively followed up. Demographic and clinical data were collected. The patients were re-evaluated 3 months after surgery.

RESULTS: Among the 104 patients treated surgically 87% were aged between 15 and 36 years; 84% were married before they were 19 years old; 51% were divorced; and 80% did not live with their husbands. The fistula was caused by the first delivery in 43% of the patients; 93% were in labor for more than 24 hours; 35% were delivered at home; and perinatal death was 100%. The overall cure rate was 73%.

CONCLUSION: These epidemiologic characteristics provide data towards the development of an obstetric fistula prevention program in Niger.

]]> I Nafiou et al. Adolescent Adult Female Humans Incidence Niger Obstetric Labor Complications Poverty Pregnancy Prospective Studies Treatment Outcome Vesicovaginal Fistula