Manju Monga

Seizure disorders in pregnancy.

This article discusses seizure disorders in pregnancy. Seizure disorder affects 1.1 million women of reproductive age in the United States. In 1995, the annual cost of treatment of patients who had epilepsy was estimated to be 12.5 billion dollars. Seizures are disorganized firing of neural cells. Epilepsy is the presence of two or more seizures in the absence of an identifiable cause for the seizures (ie, no intracranial or metabolic abnormality). Epilepsy has an impact on many aspects of womens health, particularly with respect to reproduction. The management of women who have epilepsy during pregnancy is the focus of this article.

Burnout in residency: a statewide study.

Objective: To determine the prevalence of burnout in residents in obstetrics and gynecology through the use of a validated tool. Methods: The Maslach Burnout Inventory Human Services questionnaire is a previously validated tool that measures burnout. Obstetrics and gynecology residents from Texas were invited to participate in this study in 2002. The Maslach Burnout Inventory Human Services questionnaire and a demographic survey were distributed to each resident. Responses were anonymous and returned by mail. Contingency coefficient and χ2 tests were used for analysis; values of P < 0.05 were significant. Results: Residents (n = 368) from 17 programs in Texas were surveyed. Responses were received from 14 programs (82.4%), with 136 surveys (37%) returned. Overall, 38.2% reported high emotional exhaustion, 47.1% reported high depersonalization, and 19.1% reported reduced personal accomplishment. The number of residents experiencing true burnout (high emotional exhaustion, high depersonalization, and low personal accomplishment) was 17.6% (n = 24). Conclusions: High levels of emotional exhaustion and depersonalization occur in some residents. Burnout in residents included in this study was approximately 18%.

Oxytocin-stimulated capacitative calcium entry in human myometrial cells

OBJECTIVE Our purpose was to investigate the relative contribution of extracellular calcium recruitment and release of calcium from intracellular stores in an immortalized myometrial cell line derived from a pregnant woman (PHM1-41) and to determine the importance of capacitative calcium entry in the oxytocin-stimulated rise in intracellular free calcium. STUDY DESIGN The PHM1-41 immortalized myometrial cell line, which retains smooth muscle phenotype, estrogen, and oxytocin receptors and responds to oxytocin with an increase in intracellular free calcium, was used for this study. Intracellular free calcium was measured directly in cells loaded with Fura 2-AM. RESULTS The oxytocin-stimulated rise in intracellular free calcium decreased in the absence of extracellular calcium or in the presence of phospholipase C inhibitors, suggesting mobilization of calcium from both extracellular and intracellular sources to increase intracellular free calcium. Phospholipase C inhibitors resulted in greater inhibition of the oxytocin-stimulated rise in intracellular free calcium than expected on the basis of experiments performed in the absence of extracellular calcium. This implies interdependence of the intracellular and extracellular pathways for elevation of intracellular free calcium and suggests some capacitative entry of calcium as a consequence of depletion of intracellular stores. The oxytocin-stimulated intracellular free calcium increase resulting from calcium entry was blocked by store depletion by thapsigargin or cyclopiazonic acid, consistent with a capacitative calcium entry mechanism. CONCLUSION Oxytocin stimulates both capacitative and noncapacitative calcium entry in a pregnant human myometrium cell line.

Quality of life assessment in pregnant women with the human immunodeficiency virus.

Objective To describe the perceived quality of life and functional status of women with human immunodeficiency virus (HIV) during the antenatal, perinatal, and postpartum periods. Methods Medical Outcome Survey—Short Form questionnaires were completed during antenatal visits, 24 hours after delivery, and 6 months postpartum by 21 HIV-positive women and 21 HIV-negative controls matched for age, race, parity, and education. The Medical Outcome Survey—Short Form measures subject perceptions of overall health, pain, physical role, social and cognitive function, mental health, energy/fatigue, health distress, quality of life, and health transition. Median scores between 0 and 100 (with 0 indicating poorest health) were compared using the Wilcoxon signed-rank and Kruskal Wallis/Dunn tests. Results All HIV-positive patients were asymptomatic; the median CD4 count was 386 on entry into the study. Seropositive patients reported increased health distress (50.0 versus 87.5; P < .001) and worse health transition (60.0 versus 80.0; P = .01) during antenatal visits. During the perinatal period, HIV-negative patients had a decreased sense of overall health (40 versus 80; P < .001) and worse health transition (40.0 versus 60.0; P = .04). Six months postpartum, the HIV-positive women reported decreased cognitive function (41.7 versus 62.5; P < .005) and worse social function (33.3 versus 66.7; P = .02). In general, HIV-negative women reported better quality of life in the antepartum as compared with the perinatal or postpartum period. This overall trend was also seen in the HIV-positive population. Conclusions This is the first longitudinal evaluation of perceived quality of life in HIV-positive pregnant subjects. We conclude that perceived quality of life differs between HIV-positive and HIV-negative pregnant women. These differences may not be manifest during initial antenatal visits but may develop as pregnancy, the disease process, and other life events specific to delivery and the postpartum period interact and affect overall perceived quality of life. Longitudinal evaluation of quality-of-life issues may be important in the comprehensive care of HIV-positive women during pregnancy.

Work hours for practicing obstetrician-gynecologists: The reality of life after residency

Abstract Objective Recently the Accreditation Council for Graduate Medical Education placed restrictions on all residency programs that limited work hours to 80 hours per week. The objective of this study was to determine the work hours for practicing obstetrician-gynecologists in an urban center. Study design A questionnaire about physician demographics and work hours was mailed to all obstetrician-gynecologists in Houston in June 2002. χ 2 testing was used for statistical analysis. Results One hundred eighty-nine surveys were mailed. One hundred surveys (56%) were returned complete and analyzed. Sixty-two physicians reported working >80 hours per week. Physicians were more likely to work >80 hours per week if they were men or if they were >50 years old. Marital status and having children living at home did not affect work hours. Conclusion Most obstetrician-gynecologists in Houston work longer hours than the number of hours that is imposed by the Accreditation Council for Graduate Medical Education resident work hour guidelines.

Racial-Ethnic Differences in Genetic Amniocentesis Uptake

The objective of this study was to determine the role of health beliefs in genetic amniocentesis acceptance in a diverse racial-ethnic population. Participants completed a previously-validated questionnaire consisting of three sections: (1) demographics, (2) amniocentesis knowledge, and (3) health beliefs, which assessed perceived susceptibility, seriousness of potential impact, benefits of testing, and barriers to testing. The results showed that Hispanic women were less likely to accept amniocentesis (51.5% vs. Caucasian 82.8%, African American 82.9%, Asian 82.8%). Education level was the only demographic factor higher among acceptors. Women who accepted amniocentesis had higher perceived seriousness, susceptibility, and benefits HBM scores and higher knowledge scores than women who declined. HBM scores and knowledge predicted the amniocentesis decision correctly 91.5% of the time. Individual health beliefs and knowledge play a greater role in genetic amniocentesis acceptance than do demographic factors such as race-ethnicity.

Endotoxin, interleukin-1β, interleukin-6, or tumor necrosis factor-α do not acutely stimulate isolated murine myometrial contractile activity

Objectives: Endotoxin, interleukin-1 β, interleukin-6, and tumor necrosis factor-α have been implicated in the pathogenesis of preterm labor, but their acute effect on myometrial contractile activity is unknown. The objective of this study was to determine their effect on isolated pregnant murine myometrial contractile activity. Study Design: Isometric contractions were measured in myometrium isolated from pregnancy day 18 Swiss-Webster mice. Frequency, duration, amplitude, and integrated area were compared before and after the addition of endotoxin (10 3 and 10 4 ng/ml) ( n = 6), interleukin-1β (10 and 10 ng/ml) ( n = 6), interleukin-6 (1 and 10 ng/ml) ( n = 6), and tumor necrosis factor-α (1 and 10 ng/ml) ( n = 6). Results were analyzed with the Wilcoxon rank-sum test. Results: The addition of endotoxin, interleukin-1β, interleukin-6, or tumor necrosis factor-α did not result in a change in the contractile activity of isolated pregnant murine myometrium compared with control. Conclusion: Endotoxin, interleukin-1 β, interleukin-6, and tumor necrosis factor-α do not acutely increase isolated murine myometrial contractile activity.

Expression of Transient Receptor Channel Proteins in Human Fundal Myometrium in Pregnancy

Objective: Cation channels comprised of transient receptor potential (TrpC) proteins may play a role in signal-regulated calcium entry and calcium homeostasis in myometrium. The objective of this study was to determine the relative abundance of specific TrpC mRNAs expressed in human myometrium and determine if TrpC mRNA and protein concentrations differ in fundal myometrium before and after the onset of labor. Methods: A quantitative real-time polymerase chain reaction (Q-RT-PCR) procedure was developed for determining the concentration of TrpC mRNA expression in immortalized and primary human myometrial cells and myometrial fundus tissues from patients before and after the onset of labor. The corresponding TrpC proteins were detected by Western blot analysis and immunohistochemistry. Results: hTrpC1, 3, 4, 5, 6, and 7 mRNAs were expressed in two lines of immortalized human myometrial cells and in primary human myocytes. In all of these cells, hTrpC1 and hTrpC4 mRNAs were the most abundant, followed by hTrpC6. A similar distribution was observed in fundal myometrium samples from patients before and after the onset of labor. hTrpC4 and mRNA was significantly lower after the onset of labor; there were no significant changes in the concentrations of other TrpC mRNAs. Immunohistochemistry identified hTrpC1, 3, 4, and 6 proteins in myometrial smooth muscle cells. Western blot analysis of myometrial membranes demonstrated no statistically significant changes in hTrpC1, 3, 4, and 6 proteins between samples collected before and after the onset of labor. Conclusions: We have demonstrated that hTrpC1 and hTrpC4 are the most abundant TrpC mRNAs in human myometrium, with TrpC6 being the next most abundant. There was no increase in TrpC mRNA or protein in fundal myometrium with the onset of labor. Nonetheless, these isoforms may play significant roles in signal regulated calcium entry in human myometrium.

Cocaine alters placental production of thromboxane and prostacyclin

OBJECTIVE The objective of this study was to test the hypothesis that cocaine alters placental prostaglandin production in vitro. STUDY DESIGN Placentas were obtained from healthy women (n = 6) after normal vaginal delivery at term. Placental explants (300 mg) were incubated in duplicate at 37 degrees C in the presence of 0, 30, 300, or 3000 ng/ml cocaine. Thromboxane and prostacyclin production was measured by radioimmunoassay of their stable metabolites (thromboxane B2 and 6-keto-prostaglandin F1 alpha) at 0, 0.5, 1.0, 1.5, 2, 4, 8, and 12 hours. Analysis of variance with Newman-Keuls test was used for statistical analysis. RESULTS Cocaine increased thromboxane production in a dose-dependent manner (p < 0.001) and decreased prostacyclin production (p < 0.05). Cocaine increased the ratio of thromboxane/prostacyclin production (p < 0.05). CONCLUSION Cocaine alters the placental production of prostaglandins in vitro, favoring thromboxane production, which may cause vasoconstriction and decrease uteroplacental blood flow.

The acute effect of cocaine exposure on pregnant human myometrial contractile activity

OBJECTIVE The objective of this study was to test the hypothesis that cocaine acutely increases contractile activity in isolated pregnant human myometrium. STUDY DESIGN Myometrial samples were obtained from the lower uterine segment at elective cesarean section from five women at term who were not in labor and who had no perinatal risk factors. Myometrial strips were suspended in contractile buffer, and isometric contractions were measured. Frequency, amplitude, duration, and integrated area (mean +/- SE) were compared before and after the addition of cocaine (10(-6) to 10(-4) mol/L) by means of analysis of variance and Duncans multiple range test. RESULTS Contraction duration, expressed relative to control, increased acutely after addition of cocaine (10(-5) mol/L, 2.0 +/- 0.29; 10(-4) mol/L, 2.8 +/- 0.64) (p < 0.001). Integrated area of contractions also increased relative to control (10(-6) mol/L, 1.6 +/- 0.18, p < 0.05; 10(-5) mol/L, 2.4 +/- 0.16 and 10(-4) mol/L, 3.5 +/- 0.23, p < 0.001). These effects were dose dependent. CONCLUSION Cocaine acutely increases contractile activity in myometrium isolated from pregnant women.