Stephanie Winsor

An international trial of antioxidants in the prevention of preeclampsia (INTAPP).

OBJECTIVE We sought to investigate whether prenatal vitamin C and E supplementation reduces the incidence of gestational hypertension (GH) and its adverse conditions among high- and low-risk women. STUDY DESIGN In a multicenter randomized controlled trial, women were stratified by the risk status and assigned to daily treatment (1 g vitamin C and 400 IU vitamin E) or placebo. The primary outcome was GH and its adverse conditions. RESULTS Of the 2647 women randomized, 2363 were included in the analysis. There was no difference in the risk of GH and its adverse conditions between groups (relative risk, 0.99; 95% confidence interval, 0.78-1.26). However, vitamins C and E increased the risk of fetal loss or perinatal death (nonprespecified) as well as preterm prelabor rupture of membranes. CONCLUSION Vitamin C and E supplementation did not reduce the rate of preeclampsia or GH, but increased the risk of fetal loss or perinatal death and preterm prelabor rupture of membranes.

Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity : a metaanalysis

OBJECTIVE We conducted a metaanalysis to determine whether antibiotics prolong pregnancy and reduce neonatal morbidity in preterm premature rupture of membranes (PPROM) and preterm labor (PTL) at 34 weeks or less. STUDY DESIGN Randomized trials comparing antibiotic therapy with placebo in PPROM or PTL at a gestation of 34 weeks or less were retrieved. The primary outcome was time to delivery (latency). Infant outcomes included mortality, infection, neurological abnormality, respiratory disease, and neonatal stay. RESULTS Antibiotics were associated with prolongation of pregnancy in PPROM (P < .01) but not PTL. Clinically diagnosed neonatal infections were reduced in both groups; there was a trend toward reduced culture-positive sepsis in PPROM. Intraventricular hemorrhage (all grades) was reduced in PPROM. Other neonatal outcomes were unaffected by antenatal antibiotics. CONCLUSION Antibiotics prolong pregnancy and reduce neonatal morbidity in women with PPROM at a gestation of 34 weeks or less. In PTL at a gestation of 34 weeks or less, there is little evidence of benefit from administration of antibiotics.

A report of recurrent anencephaly with trisomy 2p23-2pter: Additional evidence for the involvement of 2p24 in neural tube development and evaluation of the role for cytogenetic analysis

A woman carrying a balanced reciprocal translocation, 46,XX,t(2;5)(p23;p15)pat, was ascertained following the delivery of an anencephalic fetus whose karyotype was 46,XY,5p+. She subsequently had two pregnancies with a similar unbalanced karyotype (trisomy 2p23‐2pter and monosomy 5p15‐5pter), one of which was also anencephalic. She has three living children, two of whom are balanced translocation carriers. This history raises questions regarding the necessity of cytogenetic assessment of cases identified by ultrasound with ‘isolated’ neural tube defects. The observation of duplication of the 2p23‐2pter region in conjunction with anencephaly also adds to the growing body of evidence suggesting an association of this region and neural tube development.

Preferences for prenatal tests for Down syndrome: an international comparison of the views of pregnant women and health professionals

Non-invasive prenatal testing is increasingly available worldwide and stakeholder viewpoints are essential to guide implementation. Here we compare the preferences of women and health professionals from nine different countries towards attributes of non-invasive and invasive prenatal tests for Down syndrome. A discrete choice experiment was used to obtain participants’ stated preference for prenatal tests that varied according to four attributes: accuracy, time of test, risk of miscarriage, and type of information. Pregnant women and health professionals were recruited from Canada, Denmark, Iceland, Israel, Italy, the Netherlands, Portugal, Singapore, and the United Kingdom. A total of 2666 women’s and 1245 health professionals’ questionnaires were included in the analysis. Differences in preferences were seen between women and health professionals within and between countries. Overall, women placed greater emphasis on test safety and comprehensive information than health professionals, who emphasised accuracy and early testing. Differences between women’s and health professionals’ preferences are marked between countries. Varied approaches to implementation and service delivery are therefore needed and individual countries should develop guidelines appropriate for their own social and screening contexts.

Retrospective Evaluation of the Long-Term Outcomes Following Conservative Management of Menorrhagia in Ovulatory Women

Abstract Objective: to evaluate the long-term outcomes of the conservative management of ovulatory women who were referred for the treatment of menorrhagia. Setting: Tertiary Care Centre, Kingston General Hospital, Queens University. Design: retrospective review of all of the patient charts in the division of Reproductive Endocrinology over a 10-year period. Patients: 127 ovulatory women referred with the primary diagnosis of mmenorrhagia or dysfunctional uterine bleeding who had completed childbearing. Main Outcome Measure: number of treatment trials, hysterectomy rates, time to surgery, current status of bleeding, comparison of younger and older cohorts. Results: data about 105 patients were analysed with a mean follow-up of 7.7 years (range 4-15). Associated features included pain in 79 percent of women and anaemia in 35 percent. The mean number (± SD) of mnedical therapeutic trials was 1.8 ± 1.5 (range 0–8). These primarily involved the use of non-steroidal anti-inflammatories (NSAIDs), the oral contraceptive pill (OCP) and medroxyprogesterone acetate. Sixty-six patients underwent hysterectomy (63 %). Of these, 82 percent had identifiable pathologic lesions. Of the 39 patients who were treated conservatively, 14 have since become menopausal. Of the 25 still menstruating, nine have had spontaneous resolution of mmenorrhagia and 16 require ongoing medical therapy. Four of these women still have problematic bleeding and are considering a surgical option. Conclusions: prior to 1990, the medical options for the treatment of mnenorrhagia were largely unsatisfactory. Even in the hands of reproductive endocrinologists, a group likely to exhaust available medical options, the hysterectomy rate was surprisingly high.

Acute Intrapartum Rupture of the Pubic Symphysis Requiring Resuscitation and Surgical Intervention: A Case Report

BACKGROUND Pubic symphysis rupture significant enough to cause serious complications or require surgical intervention is exceedingly rare. Here we review the literature and examine the details of a unique presentation. CASE A 27-year-old woman presented in labour at 34+6 weeks gestation after an uncomplicated monochorionic-diamniotic twin pregnancy. After vaginal delivery, she developed a substantial labial hematoma. Hours later, she became hemodynamically unstable. Imaging revealed a 4.7-cm pubic diastasis and a small arterial tear. One week later, the diastasis had expanded to 6 cm on X-ray. As a result, the patient underwent surgical intervention. She was discharged home on postpartum day 21 and remained non-weight-bearing for 8 weeks. CONCLUSION Pubic symphysis rupture is a potentially life-threatening obstetrical complication that requires early recognition and effective multidisciplinary care.