Sangeeta Jain

Progesterone, but not 17-alpha-hydroxyprogesterone caproate, inhibits human myometrial contractions

OBJECTIVE The aim was to determine whether progesterone (P4) or 17-alpha-hydroxyprogesterone caproate (17P) directly inhibit human uterine contractility in vitro and thereby clarify their mechanisms of action. STUDY DESIGN Myometrial tissues were suspended in organ chambers and exposed for 2 to 20 hours to varying concentrations of P4 or 17P or solvent. Contractile activity was registered, stored, and analyzed. Dose response curves were then generated for P4 or 17P at various times. RESULTS P4 significantly inhibited spontaneous contractility dose dependently. The inhibition was not blocked by RU486 but was reversible after washing. Surprisingly, 17P dose dependently stimulated contractility. HPLC and GC-MS methods were used to determine the detectable concentrations of progestins in the baths. CONCLUSION P4, at concentrations equivalent to those present in the placenta and uterus, inhibit spontaneous myometrial contractility in vitro by nongenomic mechanisms.

Preterm Premature Rupture of Membranes: Clinical Outcomes of Late-Preterm Infants

Objective: To determine gestational age-specific neonatal outcomes of late preterm infants delivered as a consequence of premature rupture of membranes (PROM). Methods: Retrospective cohort study of infants born to women delivered electively due to preterm PROM between 340/7 and 366/7 weeks of gestation. Neonatal outcomes were compared between those delivered at 340/7 to 34 6/7 weeks, at 350/7 to 356/7 weeks, and at 36 0/7 to 366/7 weeks. Results: 192 infants were identified. The 340/7 to 346/7 week infants had significantly higher neonatal intensive care admission rate (72.5%) compared to those at 35 0/7 to 356/7 weeks (22.8%) and at 36 to 366/7 weeks (17.8%) (P < .05). Neonatal respiratory distress syndrome was significantly higher at 340/7 to 346/7 weeks (35.4%) compared with 350/7 to 356/7 week and 360/7 to 36 6/7 week infants (10.5% and 4.1%; P < .05). The longest hospitalization occurred in the 340/7 to 346/7 week infants (248.5 ± 20.0 hours). Conclusion: Substantial short-term morbidity occurred in late preterm infants. The greatest number of complications affected infants born at 340/7 to 346/7 weeks.

Glyburide metabolism by placentas of healthy and gestational diabetics.

The aim of this investigation was to determine the metabolism of glyburide (GL) by microsomes prepared from placentas obtained from uncomplicated pregnancies (UP), women with gestational diabetics (GD) on a diabetic diet, and those on a diet and GL. Term placentas were obtained from UP and GD. Crude microsomal fractions were prepared by differential centrifugation and stored at -80 degrees C. The activity of the microsomes in metabolizing glyburide to the trans-4-hydroxycyclohexyl glyburide (THCGL) and cis-3-hydroxycyclohexyl glyburide (CHCGL) was determined and quantified using high-performance liquid chromatography-mass spectrometer (HPLC-MS). The activity of the placental microsomes varied widely between individual placentas in each group. The median values (pmol.mg (-1) P.min (-1)) for the rates of THCGL formation were 0.34, 0.3, and 0.23 for placentas of UP, GD on diet, and GD on GL and a diet, respectively. The median values for CHCGL formation were 0.13 for UP, 0.11 for GD on a diet, and 0.10 (pmol.mg (-1) P.min (-1)) for GD on GL and a diet. A pool of individual microsomal fractions from each group was prepared and its activity revealed the following: greater formation of THCGL in the UP (0.36 +/- 0.10) than GD (0.22 +/- 0.03) ( P = 0.058 for GD on a diet, 0.04 for GD on GL). There was greater formation of CHCGL in UP (0.26 +/- 0.04) than GD (0.12 +/- 0.003) ( P < 0.006). There was no difference in GD on a diet and GD on GL plus diet. We concluded that the apparent differences in the formation of metabolites may be statistically significant, but it is unlikely to be of physiological importance, given the sample size and other experimental factors. Therefore, a more comprehensive investigation is underway.

Can an Evidence-Based Video of Cesarean Delivery Improve Intern Numbers?

METHODS: An evidence-based video of a primary cesarean delivery was made. All faculty agreed it to be the standard method. After institutional review board approval, baseline data were obtained from 2013 to 2014 interns who learned how to perform cesarean delivery by the traditional method. They were evaluated by filling out a cesarean delivery surgical competency operating room evaluation (CS-SCORE). The interns starting July 2014 were shown the cesarean delivery video along with the traditional methods.

The Pattern of Indeterminate Human Immunodeficiency Virus Test and Follow-Up Evaluation in Pregnant Women

We studied the pattern of indeterminate HIV serological tests among pregnant women with follow-up testing in the postpartum period. Medical records of pregnant women were reviewed over a 2-year period. Of 16,596 pregnant women, 127 (0.8%) had positive HIV enzyme-linked immunoassay (ELISA) result. With Western blot (WB) test, 54 (0.33%) were positive, 43 (0.26%) were negative, and 30 (0.18%) were indeterminate. One of the 30 women (3.3%) with indeterminate WB converted to positive WB during pregnancy. White and black women were more likely to have an unconfirmed positive ELISA (indeterminate or negative WB) than Hispanics ( P = 0.021). The positive WB rate for black women was significantly higher ( P < 0.001) than other racial/ethnic groups. The postpartum follow-up testing of 14 women with indeterminate WB varied between 4 to 20 weeks; 16 did not have any postpartum follow-up test. The common bands in indeterminate WB were P24, P18, and nonviral proteins. The pattern of indeterminate WB result and its follow-up was variable during pregnancy and postpartum period. There is a need for development of national standards of care for indeterminate WB mothers and their infants in the postpartum period. Additional studies are needed to determine the cause of indeterminate tests, reducing their occurrence in the testing process, and the optimum time for testing in the postpartum period.