Acute hyperlipidemic pancreatitis in pregnancy.

Background: Pancreatitis in pregnancy remains a rare event and is most often associated with gallstone disease. Hyperlipidemic gestational pancreatitis usually occurs in women with a preexisting abnormality of the lipid metabolism and poses particular problems in diagnosis and clinical management.

Cases: We describe 5 patients with acute episodes of pancreatitis during pregnancy caused by hyperlipidemia.

Management of ectopic pregnancy in the military during deployment to Southwest Asia.

Background: Expeditionary military facilities care for deployed military personnel. They deploy with limited equipment and personnel to austere environments. Female military personnel are deployed forward in a support capacity.

Commitment, confirmation, and clearance: new techniques for nonradiation ERCP during pregnancy (with videos).

Background: Symptomatic choledocholithiasis during pregnancy can be treated with ERCP, but fluoroscopy may pose a risk to the fetus. Nonradiation ERCP may be a safer form of treatment, but its performance has not been optimized.

Objectives: The purpose of this study was to evaluate new methods of nonradiation ERCP during pregnancy, including wire-guided cannulation techniques to achieve bile-duct access without the use of fluoroscopy, and the use of peroral choledochoscopy to confirm ductal clearance.

Maternal mortality in the U.S. Department of Defense, 1993-1998.

Objective: To determine the maternal mortality ratio (MMR) in Department of Defense medical facilities from 1993 to 1998.

Study Design: We conducted a retrospective review of birth data from military medical facilities using the Standard Inpatient Data Records from 1993 through 1998. The total number of live births and dispositions due to maternal death were obtained.

Endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy without the use of radiation.

Background: Biliary disease in pregnancy is a relatively uncommon condition; the diagnosis of this condition is not standardized. Furthermore, the use of radiographic imaging studies and therapeutic approaches in pregnancy is limited because of the possibility of fetal exposure.

Study Design: During a 2-year interval of 2001 to 2002, we successfully performed endoscopic retrograde cholangiopancreatography (ERCP) studies in 6 pregnant women between 6 and 30 weeks of gestation with symptomatic acute cholangitis or pancreatitis without irradiation exposure or major maternal complications.

Comparing ambulatory spot urine protein/creatinine ratios and 24-h urine protein measurements in normal pregnancies.

Objective: To determine whether a single specimen protein/creatinine ratio correlated with a 24-h urine protein measurement in ambulatory women with normal pregnancies.

Methods: A prospective cohort was evaluated of healthy women performing a 24-h urine collection and spot urine measurement for protein and creatinine in each trimester and the postpartum period. Data were analyzed to establish the correlation of values and the reliability of cut-off values.

Voluntary screening program for HIV in pregnancy. Cost effectiveness.

Objective: To determine the effectiveness of a voluntary human immunodeficiency virus (HIV) screening program in pregnancy.

Study Design: Using a business decision theory analysis model, we estimated the outcomes and costs of the two possible decisions by our patients (test/no test). Patients with a positive HIV screen would undergo evaluation and possible prophylactic antiviral therapy.

Bilateral ovarian thecosis and virilization in pregnancy. A case report.

Virilization is usually associated with amenorrhea, infertility and ovarian stromal lesions. Paradoxically, however, it may also be seen in pregnancy; this type of virilization is rare and accompanies ovarian thecosis. Thecosis, also known as thecomatosis and stromal thecosis, is a complex assortment of types of ovarian stromal proliferation associated with various types and amounts of hormonal activity.

Complications of the Ehlers-Danlos syndrome in pregnancy. A case report.

The Ehlers-Danlos syndrome (EDS) is a disorder of the connective tissue characterized by hyperextensible skin, loose jointedness, fragile tissues, bruising and bleeding diathesis. At least eight subtypes of EDS are recognized, each one with different clinical manifestations. On rare occasions EDS is associated with pregnancy.

Potassium and glucose concentrations in patients treated with oral tocolytic agents: a preliminary report.

Fifteen patients referred to the Division of Maternal-Fetal Medicine with the diagnosis of cervical incompetence were placed in a study protocol where prophylactic oral beta mimetic agents were used in an attempt to prevent cervical dilatation between 20 and 36 weeks of gestation. Our study suggest that after the first week of therapy prolonged maternal oral tocolytic therapy has no significant effect on glucose or serum potassium levels and no deleterious effects on the immediate neonatal course.

Fetal growth sustained by parenteral nutrition in pregnancy.

Severe maternal nutritional deprivation has been associated with intrauterine growth retardation, premature labor, and increased perinatal mortality and morbidity. The authors present four cases in which total parenteral nutrition was used successfully to support fetal growth in such diverse complications as twin pregnancy with maternal jejunoileal bypass, regional enteritis, and acute pancreatitis. Maintenance of fetal growth as evidenced by serial sonographic examination allows achievement of fetal lung maturation before delivery.

Needle and catheter colonization in pregnant diabetic patients using the continuous subcutaneous insulin infusion pump.

The incidence of bacterial colonization and risk of infection associated with the use of continuous insulin infusion pump (CIIP) was examined in 11 pregnant diabetic patients. All patients received instruction on specific aspects of CIIP and needle insertion technique according to the protocol used in our institution. A total of 220 cultures was performed on the subcutaneous needle and connective tubing.

Sinusoidal fetal heart rate pattern in hydranencephaly. A case report.

A sinusoidal fetal heart rate pattern developed immediately after a meperidine/promethazine injection in a fetus with hydranencephaly. Various etiologies of sinusoidal fetal heart rate pattern, as well as possible mechanisms leading to this entity, have been proposed.

The use of ultrasound in the expectant management of abruptio placentae.

The use of real-time ultrasound and antepartum nonstress testing in the management of abruptio placentae is discussed. In one patient, fetal distress developed when the retroplacental clot volume reached 480 ml. Two cases in which retroplacental clot was less than 480 ml were managed expectantly with the use of ultrasound and antepartum fetal testing, with excellent results.

Listeria monocytogenes. An important pathogen in premature labor and intrauterine fetal sepsis.

Listeria monocytogenes is a rare complication of pregnancy. Maternal listeriosis often causes premature labor and congenital infections. High perinatal morbidity and mortality rates are associated with this disease.

Home birth: negative implications derived from a hospital-based birthing suite.

Our study of 390 patients enrolled in a birthing suite program revealed that antepartum or intrapartum problems allowed only 160 (41%) to actually give birth in the birthing suite. Antepartum complications included premature labor in ten (2.5%), premature ruptured membranes in 31 (8%), postdatism in 50 (13%), preeclampsia in 27 (7%), and diabetes mellitus in five (1.

Fetal heart rate acceleration: fetal movement ratio in the management of high-risk pregnancy.

The nonstress test (NST) was used as the primary tool in the management of 318 high-risk pregnancies. A simple and reliable method for interpreting the NST is obtained by dividing the total number of fetal heart rate accelerations associated with fetal movements by the total number of fetal movements. This is expressed as a percentage called the acceleration:fetal movement ratio.