Effect of endogenous steroid hormones on 17-alpha-hydroxyprogesterone caproate metabolism.

Objective: Plasma concentrations of 17-alpha-hydroxyprogesterone caproate (17-OHPC) vary substantially in pregnant patients who receive an identical dose. Endogenous steroid hormones may alter 17-OHPC metabolism, which contributes to this large variability.

Study Design: Pooled human liver microsomes were incubated with 17-OHPC alone or in combination with progesterone, hydroxyprogesterone, estrone, estradiol, or estriol.

Unruptured 32-week rudimentary horn pregnancy presenting as right upper quadrant pain.

Background: An unruptured third trimester rudimentary horn pregnancy is rare, life threatening, and can go undetected until the onset of symptoms. Given the high risk of uterine rupture, conservative management after viability is controversial.

Case: A 21 year-old with a 32-week rudimentary horn pregnancy, diagnosed via exploratory laparotomy five days earlier, presented with acute right upper quadrant pain.

Diagnosis and management of a monochorionic/monoamniotic twin gestation discordant for fetal anomalies.

Monoamniotic twinning is rare and associated with fetal mortality as high as 13-32% (1). In pregnancies discordant for fetal anomalies, mortality is as high as 43% (2.3).