Ethical challenges of pregnancy prevention programs.

Certain useful pharmaceutical agents carry a high risk of embryopathy. The US Food and Drug Administration (FDA), in cooperation with drug manufacturers, has established pregnancy prevention programs (PPPs) to reduce the incidence of birth defects for thalidomide (STEPS [System for Thalidomide Education and Prescribing Safety]) and isotretinoin (iPLEDGE) but not for other teratogenic drugs in clinical use. These programs are complex and raise important concerns regarding privacy, the clinician-patient relationship, and convenience of medical care.

Tuberculosis in pregnancy: current recommendations for screening and treatment in the USA.

The main focus of this review is the management of active and latent tuberculosis in pregnancy in industrialized countries. The review is geared towards the healthcare professional taking care of the obstetric patient. The epidemiology of active and latent tuberculosis in the USA and recommendations for the screening of tuberculosis in pregnancy are considered.

Severe preeclampsia presenting as third nerve palsy.

Preeclampsia is a common complication of pregnancy and often manifests in severe cases with neurological symptoms. We present the first documented case of preeclampsia associated with third nerve palsy. A 19-year-old primigravida presented at 31 2/7 weeks' gestation with preeclampsia.

Pregnancy and economic outcomes in patients treated for recurrent preterm labor.

Objective: To compare clinical and cost-effectiveness of treating recurrent preterm labor (RPTL) with oral nifedipine versus continuous subcutaneous terbutaline infusion (SQT).

Study Design: Women with singleton gestations prescribed nifedipine for tocolysis following first diagnosis of preterm labor were identified. Women hospitalized with RPTL at <34 weeks were matched by gestational age (GA) after resuming nifedipine (NIF group) with women prescribed SQT (SQT group) after stabilization.

Obstetrics and gynecology--to be or not to be? Factors influencing one's decision.

Objective: The study was undertaken to determine factors influencing a medical student's decision to choose obstetrics and gynecology (OB/GYN) versus another specialty.

Study Design: Medical school graduates from 1991 to 2001 were surveyed about factors influencing their specialty choice. Data were analyzed with chi(2), logistic regression, and odds ratio where appropriate.

Latent tuberculosis in pregnancy: screening and treatment.

Currently, most cases of active tuberculosis in the United States are a result of activation of latent tuberculosis infection. In this article, the history of the epidemiology of tuberculosis and latent tuberculosis infection is reviewed. Previous and current recommendations for screening and treatment for latent tuberculosis during pregnancy and the postpartum period are discussed.

Outcomes of extremely low-birth-weight infants between 500 and 750 g.

Objective: The purpose of this study was to describe morbidity, mortality, and developmental outcomes among extremely low-birth-weight infants (500-750 g).

Study Design: This retrospective cohort study included 167 live-born infants born at Long Beach Memorial Medical Center between January 1990 and December 1995.

Results: Mortality rates were 86% among infants <600 g and 44% among those > or =600 g, and the rate decreased with increasing gestational age.

The effect of transport on the rate of severe intraventricular hemorrhage in very low birth weight infants.

Objective: To determine the incidence of grade III or IV intraventricular hemorrhage in very low birth weight (VLBW) infants born at level I hospitals and transported to one tertiary center compared with those delivered at the same level III facility.

Methods: We evaluated all newborns admitted to a large tertiary neonatal intensive care unit from June 1, 1992, through December 31, 1995. All live born infants with birth weights of 500-1200 g and at least 24 weeks' gestation were included.

Flare during drug withdrawal as a method to support efficacy in rheumatoid arthritis: amiprilose hydrochloride as an example in a double blind, randomized study.

Objective: To evaluate the use of a randomized, double blind, drug withdrawal design as a means to test the efficacy of longterm therapy with antirheumatic drugs.

Methods: We evaluated 286 patients with rheumatoid arthritis (RA) treated with amiprilose hydrochloride for 1-3 years, with response, with or without other antirheumatic therapy, in a double blind, 12 week withdrawal study that compared patients randomized to continue amiprilose therapy vs patients randomized to placebo. The primary efficacy variable was preventing a predefined degree of clinical reactivation, or flare; the statistical tests of success were a difference in the proportion of flares and in the mean time to flare.

Is fluorescence polarization reliable and cost efficient in a fetal lung maturity cascade?

Objective: The objective of the study was to compare the accuracy of the TDxFLM test (Abbott Laboratories) with the fetal lung maturity cascade (shake, foam stability index, lecithin/sphingomyelin tests) and to determine whether the TDxFLM test could increase the efficiency and reduce the cost without decreasing the reliability of a cascade.

Study Design: A prospective, single-blinded study was conducted. Uncontaminated amniotic fluid obtained by transabdominal amniocentesis for fetal lung maturity assessment was evaluated with use of the fetal lung maturity cascade and the TDxFLM test.

The efficacy and safety of auranofin compared to placebo in rheumatoid arthritis.

This double-blind multicenter study compares the effect of adding auranofin (AF) 3 mg bid or placebo to patients already taking nonsteroidal antiinflammatory drugs for rheumatoid arthritis. The 242 patients who completed 3 months of therapy demonstrated that the group receiving AF responded better than those receiving placebo. Of the 144 patients who completed 6 months coded medication, the efficacy in the AF group was superior to the placebo group in several parameters including a reduction in the number of painful or swollen joints, grip strength, dropout rate, and global efficacy as judged by the evaluating physician.