Second trimester placenta percreta presenting as acute abdomen.

Diagnosing placenta percreta can be difficult. We describe a 41-year-old woman presenting at 21 weeks' gestation with intraabdominal bleeding and no signs of placental abnormality on ultrasound. The disagreement between results of the ultrasound and magnetic resonance imaging made definitive diagnosis difficult.

Hemostatic dysfunction with acute fatty liver of pregnancy.

Objective: To estimate the frequency of disseminated intravascular coagulation (DIC); elucidate the genesis of hemostatic dysfunction; and characterize associated hemolysis in women with acute fatty liver of pregnancy.

Methods: Hemostatic function was measured in 51 women. Disseminated intravascular coagulation was assessed using the International Society of Thrombosis and Haemostasis DIC score.

Acute fatty liver of pregnancy: clinical outcomes and expected duration of recovery.

Objective: Our aim was to provide a description of clinical and laboratory finding: pregnancy outcomes in women with acute fatty liver of pregnancy (AFLP). We also characterize the duration of recovery of multiorgan system dysfunction that begins after delivery.

Study Design: All women who were admitted to Parkland Hospital with AFLP were identified; their clinical and laboratory findings, pregnancy outcomes, and postpartum resolution of AFLP were reviewed.

Postpartum contraceptive preferences of HIV-infected women in the era of highly active antiretroviral therapy (HAART) and scheduled cesarean deliveries.

Background: We sought to determine if postpartum tubal ligation among HIV-infected women changed with the introduction of highly active antiretroviral therapy (HAART) and scheduled cesarean delivery.

Methods: Retrospective cohort study of HIV-infected women delivered before (Pre-HAART) and after (Post-HAART) the introduction of HAART and scheduled cesarean delivery. Rates of the primary outcome, postpartum tubal ligation (PPTL), were compared by univariable and multivariable analyses.

Estrogen and progesterone metabolism in the cervix during pregnancy and parturition.

Context: Experimental and clinical studies in a variety of nonprimate species demonstrate that progesterone withdrawal leads to changes in gene expression that initiate parturition at term. Mice deficient in 5alpha-reductase type I fail to undergo cervical ripening at term despite the timely onset of luteolysis and progesterone withdrawal in blood.

Objective: Our objective was to test the hypothesis that estrogen and progesterone metabolism is regulated in cervical tissues during pregnancy, even in species in which parturition is not characterized by progesterone withdrawal in blood.

Magnetic resonance signal characteristics of the cervix as pregnancy advances.

The objective of this study is to describe magnetic resonance (MR) signal intensity (SI) changes in the cervix during pregnancy. This is an observational cohort study of women with a history of preterm delivery. MR imaging sequences were performed every 3 to 4 weeks.

Natural history of cervical funneling in women at high risk for spontaneous preterm birth.

Objective: To estimate the natural history of funneling in the second trimester by transvaginal ultrasonograms and whether funneling increases the risk of spontaneous birth.

Methods: Secondary analysis of a blinded, multi-center observational study of women with at least one prior spontaneous preterm birth at 16.0-31.

Effect of coitus on recurrent preterm birth.

Objective: To estimate the impact of sexual behavior on the risk of recurrent spontaneous preterm birth at less than 37 weeks of gestation.

Methods: This is a secondary analysis of a multicenter, blinded observational study of endovaginal sonographic examinations performed at 16-18 weeks of gestation on 187 women with singleton gestations who were at high risk for recurrent spontaneous preterm birth (prior spontaneous preterm birth at < 32 weeks of gestation). At the time of enrollment, each woman was interviewed by a research nurse with regard to her sexual history.

A prospective observational study of domestic violence during pregnancy.

Objective: To assess whether women reporting domestic violence are at increased risk for adverse pregnancy outcomes.

Methods: A screening questionnaire, previously validated for the identification of female victims of domestic violence, was offered to women presenting to our Labor and Delivery Unit. The survey prompted women to indicate whether her partner or family member physically hurt her, insulted or talked down to her, threatened her with harm, or screamed or cursed at her.

Hospitalization for women with arrested preterm labor: a randomized trial.

Objective: To determine whether hospitalization of women with arrested preterm labor has an effect on delivery at 36 weeks or greater when compared with women discharged home.

Methods: All women with a singleton gestation and a diagnosis of arrested preterm labor with intact membranes between 24 and 33 weeks, 4 days of gestation were randomly assigned to home or hospital management. Upon completion of a dexamethasone course, women assigned to outpatient management were promptly discharged, and women in the inpatient group were advised to continue hospitalization until 34 weeks.

Can shortened midtrimester cervical length predict very early spontaneous preterm birth?

Objective: The study was undertaken to test the hypothesis that shortened midtrimester cervical length is more predictive of early (<26 weeks) than later (26-34 weeks) spontaneous preterm birth.

Study Design: This is a secondary analysis of a blinded, multicenter observational study of 183 women with a prior preterm birth. Vaginal sonography was begun at 16 to18 weeks' gestation and scheduled every 2 weeks (maximum 4 scans per patient).

Number and gestational age of prior preterm births does not modify the predictive value of a short cervix.

Objective: This study was undertaken to determine whether the number and gestational age of prior preterm deliveries modifies the significance of endovaginal sonographic cervical length less than 25 mm for the prediction of recurrent preterm birth less than 35 weeks' gestation.

Study Design: Secondary analysis of a multicenter, blinded, observational study. Endovaginal ultrasonographic examinations were scheduled at 2-week intervals between 16 and 23 weeks' gestation in singleton pregnancies of 181 gravid women with at least 1 prior spontaneous preterm birth between 16 and 32 weeks' gestation.

A hospital-sponsored quality improvement study of pain management after cesarean delivery.

Objective: We undertook this study to systematically assess prevailing pain management regimes used at our hospital in women after cesarean delivery.

Study Design: Between August 1999 and July 2000, all women delivered by cesarean section at Parkland Hospital were assigned to 1 of 4 different pain management strategies: (1). intramuscular (IM) meperidine, (2).

Second-trimester cervical sonography: features other than cervical length to predict spontaneous preterm birth.

Objective: To estimate whether cervical and lower uterine segment characteristics other than cervical length and funneling predict recurrent preterm birth.

Methods: We conducted a secondary analysis of a multicenter, blinded observational study of 181 women with singletons and prior spontaneous preterm births. Endovaginal ultrasonic examinations were performed at 2-week intervals between 16 0/7 weeks and 23 6/7 weeks of gestation.

Critical care infectious disease.

Septic shock, toxic shock syndrome, acute respiratory distress syndrome, and catheter-related infections are conditions in which intensive care management of the patient may be necessary. Toxic shock syndrome is a toxin-mediated illness that is not limited to young menstruating women and should be considered in women and men who present with fever, hypotension, rash, and multiorgan dysfunction. Sepsis is the leading cause of death in critically ill patients in the United States and is the most common predisposing factor for acute lung injury or acute respiratory distress syndrome.

A randomized, placebo-controlled trial of corticosteroids for hyperemesis due to pregnancy.

Objective: Hyperemesis gravidarum, a severe form of nausea and vomiting due to pregnancy for which there is no proven pharmacological treatment, is the third leading cause for hospitalization during pregnancy. Corticosteroids are commonly used for the treatment of nausea and vomiting due to cancer chemotherapy-induced emesis and might prove useful in hyperemesis gravidarum.

Methods: A randomized, double-blind, placebo-controlled trial was conducted in 126 women who previously had not responded to outpatient therapy for hyperemesis gravidarum during the first half of pregnancy.

Acute renal failure in association with severe hyperemesis gravidarum.

Background: Severe hyperemesis gravidarum is a rare but potentially devastating complication of pregnancy. Among its many potential complications are dehydration, electrolyte imbalance, malnutrition, Wernicke encephalopathy, and compromised renal function.

Case: We report the case of a 21-year-old woman at 15 weeks' gestation presenting to the emergency department with severe hyperemesis gravidarum associated with acute renal failure.

Absence of the G1528C (E474Q) mutation in the alpha-subunit of the mitochondrial trifunctional protein in women with acute fatty liver of pregnancy.

Acute fatty liver of pregnancy (AFLP) is a rare and dreaded complication of pregnancy, almost exclusively seen in the third trimester. The histopathologic features of AFLP closely resemble those seen in metabolic disorders characterized by deficiency of fatty acid oxidative enzymes. Several reports have established a strong association between AFLP in the mother and fetal deficiency of the enzyme long-chain L-3-hydroxyacyl-CoA dehydrogenase (LCHAD).