Robert J. Stiller

Ursodeoxycholic acid for the treatment of intrahepatic cholestasis of pregnancy

Objective : To report our experience in managing intrahepatic cholestasis of pregnancy with ursodeoxycholic acid. Methods : All cases of intrahepatic cholestasis of pregnancy that were diagnosed at Bridgeport Hospital from January 1997 to August 1999 were identified. Information was abstracted on demographics, medical and obstetric history, symptoms, laboratory data, therapy and pregnancy outcome. Statistical analysis was primarily descriptive; continuous variables were analyzed with t tests. Results : A total of 20 cases of intrahepatic cholestasis of pregnancy were identified (0.32% of live births). All patients presented with pruritus. The mean gestational age at onset of symptoms was 31.1 weeks (range 13-38.4, median 32.4). Bile acids were measured in 18 cases and were elevated in all. The mean gestational age at delivery was 36.4 weeks (32.3-39.9). Eight patients were treated with ursodeoxycholic acid (600-1200 mg). All eight patients experienced subjective improvement in pruritus after initiation of treatment with ursodeoxycholic acid. Ursodeoxycholic acid was associated with a decrease in bile acids in most patients ( p = 0.16) and with a significant decrease in serum transaminases ( p = 0.03). Conclusions : Ursodeoxycholic acid is an effective therapy for relief of pruritus and improvement of the liver dysfunction that occurs with intrahepatic cholestasis of pregnancy.

Reasons Why Women Accept or Reject the Trivalent Inactivated Influenza Vaccine (TIV) During Pregnancy

The aim of the study was to gain an in-depth understanding of the reasons why pregnant women accept or reject the seasonal influenza vaccine. The qualitative descriptive design used a face-to-face semi-structured interview format. Sixty pregnant and postpartum women at two hospitals in the Northeastern United States participated. Content analysis was the inductive method used to code the data and identify emergent themes. Six themes emerged from the data: differing degrees of influence affect action to vaccinate; two-for-one benefit is a pivotal piece of knowledge that influences future vaccination; fear if I do (vaccinate), fear if I don’t; women who verbalize ‘no need’ for the vaccine also fear the vaccine; a conveniently located venue for vaccination reduces barriers to uptake; H1N1—a benefit and barrier to the seasonal vaccine. Our study supports previous findings and reveals a deeper understanding and interpretation of the behavior and decision-making to accept or reject the influenza vaccine. Understanding the reasons behind the behavior of vaccine rejection gives us the chance to change it.

Transvaginal ultrasonography in patients at risk for ectopic pregnancy

Transvaginal ultrasonography was performed in 139 patients at risk for ectopic pregnancy. Among these patients, 22 ectopic pregnancies and 117 intrauterine pregnancies were eventually confirmed. Transvaginal ultrasonography definitively identified 18 of 22 (82%) ectopic pregnancies at initial evaluation by either direct visualization of an ectopically placed gestational sac (N = 14) or failure to visualize an intrauterine gestational sac combined with a level of the beta-subunit of human chorionic gonadotropin greater than 1300 mIU/ml (First International Reference Preparation) (N = 4). Transvaginal ultrasonography definitively diagnosed 103 of 117 (88%) intrauterine pregnancies at initial evaluation. Eighteen patients could not be definitively diagnosed by transvaginal ultrasonography at initial evaluation because nonvisualization of a gestational sac and a beta-subunit of human chorionic gonadotropin value less than 1300 mIU/ml. Evaluation of this group with serial measurements of beta-subunit of human chorionic gonadotropin, repeat ultrasonography, or both, revealed ectopic gestation (N = 4), early intrauterine pregnancy (N = 4), and complete abortion (N = 10).

The association of increased fetal nuchal translucency and spinal muscular atrophy type I

We report a fetus with spinal muscular atrophy type I, who presented with an increased nuchal translucency at 13 weeks gestation. A review of the literature reveals additional cases of spinal muscular atrophy type I associated with increased nuchal translucency and suggests increased nuchal translucency may be an early finding in this disorder. Copyright

Pregnancy outcome after successful external cephalic version

OBJECTIVEnRecent studies have suggested that the rate of cesarean delivery in patients who have undergone a successful external cephalic version is higher than expected. This study compares the incidence of cesarean delivery in patients who underwent successful external cephalic version and patients with primary cephalic presentations.nnnSTUDY DESIGNnWe identified and reviewed the charts of 92 patients who underwent a successful external cephalic version. We identified a control population of 184 patients from the delivery room logs. We collected outcome data and information on additional risk factors that may affect cesarean delivery rates.nnnRESULTSnThere were no significant differences between study and control populations. There was no significant difference in the cesarean delivery rate between study patients (22.8%) and control patients (23.4%).nnnCONCLUSIONSnWe could not demonstrate a significant increase in the cesarean delivery rate for women who underwent successful external cephalic version in comparison with patients in labor with primary cephalic presentations.

Single Ventricle in Pregnancy: Case Report and Review of the Literature

&NA; A pregnancy complicated by cyanotic heart disease due to single ventricle was recently managed at the authorss institution. Review of the literature showed only five previous case reports. The management of this uncommon disorder is presented along with a review of the literature. The presence of pulmonary hypertension appears to be a major determinant in assessing maternal risk. (Obstet Gynecol 64:18S, 1984)

Maternal Influenza Vaccination: Evaluation of a Patient-Centered Pamphlet Designed to Increase Uptake in Pregnancy

We developed and tested a theoretically-based pamphlet entitled ‘Influenza in Pregnancy,’ specifically designed to increase pregnant women’s knowledge, reduce barriers to maternal vaccination, and subsequently improve vaccine uptake. A randomized control trial was conducted on pregnant women (nxa0=xa0135) at three locations in Connecticut during the 2011–2012 season to evaluate the impact of the patient-centered pamphlet. The women were randomized to one of three groups: the pamphlet; pamphlet/benefit statement (vaccinating the pregnant woman also benefits the young infant); or control. A Chi square analysis compared the intervention with control using the primary outcome of vaccination. A secondary outcome of the perceptions of health beliefs of maternal vaccination were measured through General Linear Model/ANOVA model for repeated measures. Overall 66.9xa0% (89/133) were vaccinated. Both the pamphlet group 72.9xa0% (35/48) (χ²xa0=xa06.81, dfxa0=xa01 pxa0=xa0.009), and the pamphlet/benefit statement group 86.1xa0% (31/36) (χ²xa0=xa013.74, dfxa0=xa01, pxa0<xa0.001), had significantly higher vaccine uptake than the control group 46.9xa0% (23/49). The potential barrier, perception of vaccine safety (Fxa0=xa04.973, dfxa0=xa02, pxa0<xa0.01), and benefit of vaccination to mother and infant (Fxa0=xa06.690, dfxa0=xa02, pxa0<xa0.01) significantly improved for the intervention groups compared to control group. The pamphlet significantly increased the pregnant women’s perceptions of the safety and benefit of the vaccine, and the overall uptake.

Postpartum pulmonary embolus as an unusual cause of cortical blindness.

A pregnant patient was delivered by cesarean section with blindness occurring in the postoperative period. Diagnostic evaluation revealed the presence of massive pulmonary embolus associated with cardiogenic shock. The differential diagnosis of blindness during pregnancy is discussed.

Primary atony of the lower uterine segment as a distinct cause of early postpartum haemorrhage: A case series and management recommendations

Summary Primary atony of the lower uterine segment appears to be a distinct cause of postpartum haemorrhage. We report a case series of women with postpartum haemorrhage where ultrasound and clinical findings revealed a well contracted fundus and upper uterine segment and a ballooned out lower uterine segment, a condition we have called primary atony of the lower uterine segment. We hope that this case series will lead to increased recognition of this condition, stimulate others to report their experience and lead to additional studies to better characterise this entity, and develop more effective therapies.

Rapid detection of vaginal colonization with group B streptococci by means of latex agglutination

Latex agglutination testing for colonization of the vagina with group B streptococci was carried out in 1100 patients. Samples underwent latex testing after 8 to 12 hours of preincubation in selective growth medium. This technique allowed a sensitivity of 91.8% and specificity of 97.6%. This study demonstrates the usefulness of latex agglutination testing in the detection of vaginal colonization with group B streptococci.