Novel Approach to Reduction of an Incarcerated Uterus.

Background: Incarceration of the pregnant uterus is a rare condition and can lead to bladder obstruction, renal failure, or uterine rupture. We present a novel, noninvasive technique to reduce an incarcerated uterus.

Method: With conscious sedation, the patient was placed in all-fours position.

Effectiveness of Vaginal Delivery Simulation in Novice Trainees.

Objective: Simulation training has been demonstrated to increase medical student confidence with vaginal deliveries; however, effect on skill performance is still lacking. To determine if integration of simulation training into the OB/GYN clerkship improves performance of vaginal deliveries, we assessed the effectiveness of simulation in third-year medical students.

Methods: During the OB/GYN clerkship, third-year students were assigned to receive vaginal delivery simulation (n=54) or cervical exam simulation (n=56), with each group serving as a simulation naïve control for the other skill.

Efficacy of a Nurse-Delivered Intervention to Prevent and Delay Postpartum Return to Smoking: The Quit for Two Trial.

Introduction: Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among pregnant women who quit smoking that was tailored on their high risk of relapse (eg, had strong intentions to return).

Effectiveness of Labor Cervical Examination Simulation in Medical Student Education.

Objective: To estimate whether simulation training improves medical students' cervical examination accuracy.

Background: The training paradigm for the labor cervical examination exposes patients to additional examinations, lacks a gold standard, and does not objectively assess trainee competence. To address these issues and optimize training, we assessed the effectiveness of cervical examination simulation in third-year medical students.

Isolated unilateral pulmonary agenesis and other fetal thoracic anomalies.

Importance: Although the diagnostic workup and management regimens for many of the common fetal thoracic lesions have been well described, the understanding of pulmonary agenesis is more limited. A better understanding of the published reports of this condition is essential to provide proper care for these complicated pregnancies.

Objective: The aims of this study were to provide a better understanding of the difficulties in the diagnosis and management of fetal thoracic lesions and to consolidate what is known about unilateral pulmonary agenesis.

Rupture of an unscarred uterus in a quadruplet pregnancy.

Background: Uterine rupture of an unscarred uterus is a rare complication in a quadruplet pregnancy.

Case: A 30-year-old woman, gravida 4 para 0030, with a quadruplet pregnancy and no previous uterine surgeries presented with moderate vaginal bleeding at 32 4/7 weeks of gestation. Fetal testing was reassuring, and the cervix showed no signs of preterm labor.

Successful outcome of a triplet gestation in a patient with a history of an open maternal-fetal surgery.

Reproductive outcomes in women after pregnancy complicated by an open maternal-fetal surgery (OMFS) are limited. A review of the medical literature reveals only isolated cases of successful multiple pregnancies, and there are no prior documented cases of successful triplet gestations following OMFS. We report the delivery of a triplet gestation at 34-week gestation in a patient with a history of previous OMFS.

Predictors of adverse events among pregnant smokers exposed in a nicotine replacement therapy trial.

Objective: The purpose of this study was to determine the contribution of randomization to nicotine replacement therapy (NRT), sociodemographic and psychosocial factors, and pregnancy and medical history to serious perinatal adverse events among pregnant smokers.

Study Design: We performed a retrospective review of all medical records for participants in the Baby Steps Trial. Data that were abstracted from 157 records were combined with baseline characteristics for logistic regression modeling of serious adverse events and adjusted for covariates.

The prevalence of childhood trauma among those seeking buprenorphine treatment.

In this study, the authors examined the prevalence of five types of childhood trauma among a sample of adult patients who were addicted to opioids and seeking treatment with buprenorphine. Using a survey methodology, the authors examined a consecutive sample of 113 participants and found that 20.4% reported having experienced sexual abuse, 39.

Psychophysiological disorders among buprenorphine patients.

In this study, we examined the prevalence of 14 psychophysiological disorders among 114 opioid-dependent individuals (a sample that previously evidenced high rates of borderline personality) as well as the relationship between these disorders and borderline personality. In the aftermath of analyses, only migraine headaches (28.9%) and chronic pain (33.

The prevalence of borderline personality among buprenorphine patients.

Objective: In this study, we examined the prevalence of borderline personality disorder (BPD) in a sample of patients seeking outpatient treatment with buprenorphine for opioid addiction.

Method: To assess for BPD, we used three self-report surveys in a consecutive study sample.

Results: Of the 111 participants who completed all three measures of BPD, 49 (44.

Implementation of a process-oriented cultural proficiency curriculum.

The authors implemented a process-oriented cultural proficiency curriculum in their family medicine residency program, emphasizing the understanding of each individual patient through skilled interviewing rather than promoting the acquisition of knowledge about specific cultural groups.

Anomalies associated with failed methotrexate and misoprostol termination.

Background: Methotrexate and misoprostol are frequently used in combination for medical termination of pregnancy. Despite their frequent use, published information about low-dose exposures to these known teratogens is sparse and neonatal follow-up data are limited. We present neonatal outcomes in three infants from two different women who had failed medical terminations with methotrexate and misoprostol.

Differential expression of TcR-CD3 zeta as evidence for altered immunoregulation in preeclamptic versus normotensive women.

Objective: The study was undertaken to exhibit and quantify the difference in modulation of CD3-zeta protein (an integral component of the T-cell receptor) in preeclamptic and normotensive women.

Study Design: Serum was collected from 10 preeclamptic and 10 normotensive women at >or=37 weeks' gestation on admission. Jurkat E-61 cells were incubated with the sera (20% volume to volume) and analyzed with Western immunoblot using mouse monoclonal CD3-zeta antibody.

Paternal leukocyte alloimmunization as a treatment for hemolytic disease of the newborn in a rabbit model.

Objective: The purpose of this study was to evaluate maternal alloimmunization to paternal leukocytes as a treatment for hemolytic disease of the fetus/newborn in a rabbit model.

Study Design: Twelve does and paired red blood cell-incompatible bucks underwent the experimental protocol. Fetal hematologic parameters that were obtained by ultrasound-guided intracardiac sampling were compared from unaffected, compatible litters; from affected, incompatible litters (after alloimmunization to red blood cell antigens); and from affected, incompatible litters after alloimmunization to paternal leukocytes.

Altered expression of TCR-CD3zeta induced by sera from women with preeclampsia.

Objective: To investigate TCR-CD3zeta expression by cultured T lymphocytes exposed to midtrimester sera from pregnant women in whom preeclampsia developed at term compared with normotensive pregnant control subjects.

Study Design: Sera obtained at 24 to 28 weeks' gestation from 16 nulliparous women in whom preeclampsia developed at term and from 32 gestational age-matched control subjects without preeclampsia were evaluated for TCR-CD3zeta chain expression with use of Jurkat cells. Subsets of serum samples from 6 women with preeclampsia and 6 control subjects were then evaluated for their ability to induce apoptosis and to suppress interleukin-2 production.

The prevalence of borderline personality among primary care patients with chronic pain.

This study was designed to explore the prevalence of borderline personality disorder among primary care patients (N=17) with various pain syndromes. All participants completed two self-report measures [Personality Diagnostic Questionnaire-Revised (PDQ-R); Self-Harm Inventory (SHI)] and a semi-structured interview [Diagnostic Interview for Borderlines (DIB)] for the assessment of borderline personality disorder. According to study measures, 8 (47.

Fetal splenic rupture following transfusion.

Background: Splenic rupture in the newborn is a rare complication in erythroblastosis fetalis. There are no reports of splenic rupture in the fetus affected by hemolytic disease of the newborn.

Case: A 41-year-old gravida 3, para 2-0-0-2 with severe rhesus alloimmunization was managed with serial intrauterine transfusions resulting in fetal death after the fourth procedure.

A questionnaire survey of family practice physicians' perceptions of bereavement care.

Survey responses were obtained from 113 family physicians in an exploratory investigation of bereavement care by family physicians. Respondents generally indicated that they believed that bereavement presented significant health risks to their patients and that the identification and treatment of bereaved patients was an important part of their role. However, physicians were highly variable in how they reported identifying and responding to bereaved patients in terms of counseling, addressing spiritual concerns, and medically treating symptoms.

Second-trimester presentation of placenta percreta.

Placenta percreta is diagnosed usually in the third trimester as massive postpartum hemorrhage when an attempt to remove the placenta reveals lack of a cleavage plane. However, placenta percreta may present in the second trimester with signs and symptoms of uterine rupture. The diagnosis of this event may be difficult because of mild abdominal discomfort often associated with normal pregnancy.

Sonographic methods to detect fetal anemia in red blood cell alloimmunization.

Published reports, case studies, and articles from the English language regarding ultrasonographic detection of fetal anemia in red blood cell alloimmunization were obtained from a MEDLINE search from 1966 to November 1999 using the keywords Rh disease, hemolytic disease of the newborn, ultrasound, and Doppler flow studies and combinations thereof. All articles were cross-referenced. Ultrasound techniques including early findings associated with immune hydrops fetalis, multiple morphologic ultrasound markers, and Doppler flow studies that have been used to detect fetal anemia are reviewed and critically evaluated.

Managing pain in the dying patient.

End-of-life care can be a challenge requiring the full range of a family physician's skills. Significant pain is common but is often undertreated despite available medications and technology. Starting with an appropriate assessment and following recommended guidelines on the use of analgesics, family physicians can achieve successful pain relief in nearly 90 percent of dying patients.