Ray Mercado

Prevalence and predictors of positive screening for postpartum depression in minority parturients in the South Bronx.

It is reported that the rates of perinatal depressive disorders are high in ethnic minority groups from non-English speaking countries. However, very few studies have compared the prevalence of positive screening for postpartum depression (PPD) in minority communities living in an inner city. The goal of this study is to determine the prevalence and the predictors of positive screening for postpartum depression in minority parturients in the South Bronx. The study is a chart review of 314 minority parturients, Black or Hispanic, screened for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) tool. The overall prevalence of a positive EPDS screen among Black and Hispanic women was similar, 24.04 and 18.75%, respectively. The Black immigrant cohort had comparable positive screens with 23.81 as African Americans. Hispanic women born in the USA had the least prevalence of positive screens, 7.14%, and those who moved from the Dominican Republic and Puerto Rico had a prevalence of 17.24% of positive screens. The women who immigrated from Mexico, Central America, or South America had the highest prevalence of positive screens for PPD, 32.26%. As to the socioeconomic status (SES), there was a significant increase of 27.04 vs. 13.95% (P < 0.019) in positive screens for PPD for the unemployed mothers. Overall, Black and Hispanic parturients had similar rates of positive screens for PPD. Among the Hispanic women, immigrants had higher rates of positive screens, with those from Mexico, Central, and South America as the highest. The hospital experience did not affect the rates of positive screens. Neither did the SES with one exception; those unemployed had the higher rates of positive screens.

Serum inhibin A concentration in women with polycystic ovarian syndrome and the correlation to ethnicity, androgens and insulin resistance

A prospective case-series in an academic hospital clinic was performed to determine whether there is a relationship between polycystic ovarian syndrome (PCOS) and ethnicity. Also, serum inhibin A concentrations were compared between PCOS and normal-ovulatory women. The possibility of a correlation between inhibin A, androgens and insulin resistance in PCOS women was evaluated. Serum inhibin A concentrations were measured in anovulatory PCOS patients (n=32) and in control women of reproductive age (n=16). Statistical analysis was performed using the Mann-Whitney U-test. Serum concentrations of inhibin A, follicle-stimulating hormone, LH, prolactin, thyroid-stimulating hormone, fasting glucose, insulin, testosterone, 17-hydroxyprogesterone (17-OHP) and dehydroepiandrosterone sulphate (DHEAS) were measured. Inhibin A concentrations were significantly lower (4.5+/-4.8 pg/ml) when compared with the control group (13.2+/-14.4 pg/ml; P=0.003) and were not significantly different between Hispanic and Caucasian women diagnosed with PCOS. There was no correlation between inhibin A concentrations and insulin, testosterone, free testosterone, 17-OHP, or DHEAS concentrations. In PCOS women, inhibin A concentrations are similar between Hispanic and Caucasian women; however, women with PCOS, regardless of ethnicity, have a lower inhibin A concentration compared with normal-ovulatory women. No correlation was observed between inhibin A androgens and insulin resistance in women diagnosed with PCOS.

The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age

TO THE EDITORS:We readwith great anticipation the report by Puljic et al. The authors presented data in support of a positive correlation between advancing gestational age in intrahepatic cholestasis of pregnancy (ICP)-affected pregnancies and risk of fetal demise. The authors controlled for the large number of disparities and confounding maternal variables, such as older age, member of ethnic minority, and the presence of cardiovascular disease, between the 2 study groups. However, we suggest the higher stillbirth rates identified in the study group are directly related to the prevalence of the confounders known to be risks for fetal demise. The authors should have provided characteristics of women in the study who experienced a stillbirth, along with a data plot permitting review of the correlation and adjustments used for their analysis. Puljic et al provided a citation indicating that active management of ICP-affected pregnancies is not associated with increased rates of cesarean deliveries. This cited randomized delivery trial enrolled 30 and 32 women in the active and expectant management group, respectively. While 100% (30/ 30) of women assigned to early term delivery were actively managed and delivered early, only 37% (12/32) of women assigned to receive expectant management had no intervention before the onset of spontaneous labor. Therefore, we suggest the small sample size and intent-to-treat analysis of this randomized trial would call into question its use as evidence that activemanagement of ICP-affected pregnancies is not a risk for a cesarean delivery. The early impetus for evaluating the association between ICP and adverse perinatal outcome was that ICP was a cause of unexplained stillbirth. In their analysis, Puljic et al. have inappropriately treated accepted independent explanations for stillbirths as irrelevant confounding information. -

Cesarean delivery under local anesthesia: A literature review

Pregnancy and childbirth management have been modernized with advances in medicine, often diverging from the natural birthing process. Today many more women around the world are opting for elective caesarean sections (CD). In March 2017, the Centers for Disease Control (CDC) reported 32.0% of pregnancies were delivered via cesarean delivery in the U.S.1 Because cesarean delivery is effective at reducing the mental, physical (pelvic damage), and the painful burden of giving birth, many women prefer cesarean delivery.

Preconceptional and postconception cerclage placement, dual case reports with review of literatures

Cervical incompetence is defined as cervical insufficiently during the second trimester.1 This process is characterized by painless cervical dilation with subsequent prolapse of membranes into the vagina resulting in the expulsion of an immature fetus; with an increased risk for future pregnancies.2 Individuals with exposure to diethylstilbestrol (DES), insufficient collagen and elastin, surgical trauma, mechanical dilation, and post-delivery trauma of the cervix are also at an increased risk for cervical incompetence.3

Reaffirming the Importance of Retroviral Therapy to Prevent Vertical Transmission of HIV: A Case Report [8F]

INTRODUCTION: HAART is an undisputed essential tool to preventing vertical transmission of human immunodeficiency virus (HIV). However, there remain missed opportunities to perinatal HIV transmission. We present a case demonstrating perinatal outcome associated the clinical evolution of HIV screening and treatment. METHODS: Case Report. RESULTS: Case: A 19-year-old female with congenital HIV infection presented to our institution at 36 wks gestation having received no prenatal care. On presentation, the HIV viral load was 21,000 copies/mL and CD4 cell count was 132. At 38 weeks of gestation, after intrapartum administration of Azidothymidine, a primary cesarean was performed. At no time during the antenatal period did the patient use any antiretroviral therapy. Vertical transmission occurred, for which the neonate was treated with, AZT and lamivudine. Upon discharge, the mother discontinued the infants antiretroviral therapy. The babys death at age 1 month was attributed to sudden infant death syndrome. During the second pregnancy the patient got adequate prenatal care services that included treatment with Truvada, Abacavir, Mepron, and Kaletra. At 38-weeks of gestation, preoperative and intraoperative AZT was administered for a repeat cesarean that resulted in delivery a neonate with a negative HIV screen. After 3 negative HIV tests, HAART therapy for this patients second child was discontinued. The patient died 2 years after her second delivery as a consequence of HIV related pneumonia and respiratory failure. CONCLUSION: This case serves to illustrate for patients and health care providers the significant advances in our knowledge regarding HIV vertical transmission and the value of perinatal administration of antiretroviral therapy.

Anencephaly in Mexican Population: A Case Report and Review of Literature [16M]

INTRODUCTION: Anencephaly is the absence of major malformation of the brain, scalp and cranial vault. Neural tube defect occurs between 23rd to 26th days after conception resulting from failed closure of frontal end of the neural tube. Numerous risk factors have been associated with development of Neural Tube Defects (NTD). These risk factors are multifactorials that combine an interaction between genetic, environmental, low socioeconomic status, member of racial or ethnic minority group or folic acid deficiency. METHODS: Case Report. We present a case of a 32 year old Mexican female, G4P2022 with history of two pregnancies that resulted both in anencephalic fetuses. We reviewed the risk factors for the index case and present a systematic literature review of anencephaly. RESULTS: DISCUSSION: Folic acid deficiency, maternal low socioeconomic status, genetics, hereditary predispositions, Hispanic origin, especially Mexicans are some of the risk factors for development of anencephaly. Mexico has one of the highest incidence of anencephaly in the world with a rate of 13.34 per 10,000 births. Our patient was originally from Puebla, one of the most affected regions of the Mexico, supporting the genetic predisposition of this condition when other risk factors are not present. CONCLUSION: This case is an example of a vulnerable population for development of anencephaly. It highlights the importance of primary and secondary preventive strategies that can be targeted to these groups, including preconceptional counseling and adoption of measures to prevent NTD and the need of additional research to evaluate the genetic, socioeconomic and environmental factors predisposing NTD.

Are There Economic Influences on Choice for Sterilization by Minority Women in an Inner-City Hospital? [187]

INTRODUCTION: Female sterilization is one of the most widely used methods of family planning by women in general and minorities in particular. Few articles have looked at the effect of economic changes on the decision to undergo sterilization by minority women. METHODS: This is a retrospective study of women admitted to our service from January 1, 2007, to December 31, 2012, who received permanent sterilization in the postpartum period. Rates of tubal sterilization were compared with unemployment rates obtained from the Bureau of Labor Statistics. RESULTS: Approximately 2 years into the recession, deliveries continued to rise but dropped off as the recession deepened before its peak in 2010 and continued to do so for another year before rising again as the economy recovered employment. However, the rate of tubal ligations fell early on, declining steadily from 7.75% in 2007 to 2.81% in 2010. This mirrored inversely the steady rise of unemployment of 4.6–9.7% in those years. From then on, as unemployment improved, the number of tubal ligations increased (7.37% in 2011, and 5.60% in 2012). CONCLUSION AND IMPLICATION: Although it has been reported that in periods of economic declines fertility rates trend down, the findings of this study that permanent sterilizations are reduced in economic depression is interesting. We would speculate that in a population with a limited number of wage earners, the loss of wages is significant enough to postpone the choice for sterilizations. This study is limited to one institution, and further work should expand these findings.