Valerie E. Whiteman

Morbidity associated with nonemergent hysterectomy for placenta accreta

OBJECTIVE The purpose of this study was to report the morbidity of nonemergent hysterectomy for suspected placenta accreta. STUDY DESIGN This was a retrospective study of all patients who underwent nonemergent hysterectomy for placenta accreta at Tampa General Hospital from June 1, 2003 to May 31, 2009. RESULTS Twenty-nine patients were identified. Diagnosis was suspected on ultrasound scanning in 26 women (6 women also underwent magnetic resonance imaging) and on direct vision at repeat cesarean section delivery in 3 women. All of the women were multiparous, and 18 women had undergone > or =2 cesarean section deliveries. Twenty-one women had a placenta previa, and 8 women had a low anterior placenta. Final pathologic findings revealed accreta (20 specimens), increta (6 women), and percreta (3 women). Mean total operative time was 216 minutes; blood loss was 4061 mL. Two women had ureteral transection (1 was bilateral); 3 women had cystotomy, and 3 women had partial cystectomy. Postoperative hemorrhage occurred in 5 women; 1 hemorrhage resolved after catheter embolization, and the other 4 hemorrhage required reoperation. CONCLUSION Nonemergent hysterectomy for placenta accreta is associated with significant morbidity in the forms of hemorrhage and urinary tract insult.

Association between HIV-specific T helper responses and CTL activities in pediatric AIDS

We examined the relationship between the profile of HIV‐specific T helper (Th) cell responses, cytotoxic T lymphocyte (CTL) activity, HIV viral load, and CD4+ T cell counts during longitudinal studies in children with perinatal HIV infection. Patients with AIDS demonstrated undetectable or low levels of HIV‐specific Th and CTL activities, and exhibited almost exclusively Th0 type of responses with low IFN‐γ and IL‐4 production. The levels of IL‐2 expression in the envelope (env) peptide‐stimulated peripheral blood mononuclear cells were increased in children with a slowly progressive disease, concomitant with higher numbers of CD45RO+ memory T cells and increased proportions of Th1 clones. In these patients, high levels of env peptide‐specific IL‐2 expression correlated with increases in HIV‐specific CTL responses, whereas a delay in the generation of HIV‐specific CTL activity was associated with lower IL‐2 production and elevated Th2 responses. Patients with slow disease progression produced higher levels of β‐chemokines than those detected in children with AIDS. These results suggest that an impaired development of HIV‐specific cellular responses and inhibition of T cell differentiation during infancy are associated with fast disease progression. They also point to a protective role of noncytotoxic antiviral activity that might complement HIV‐specific CTL responses in children with a slowly progressive disease.

Maternal Opioid Drug Use during Pregnancy and Its Impact on Perinatal Morbidity, Mortality, and the Costs of Medical Care in the United States

Objective. To identify factors associated with opioid use during pregnancy and to compare perinatal morbidity, mortality, and healthcare costs between opioid users and nonusers. Methods. We conducted a cross-sectional analysis of pregnancy-related discharges from 1998 to 2009 using the largest publicly available all-payer inpatient database in the United States. We scanned ICD-9-CM codes for opioid use and perinatal outcomes. Costs of care were estimated from hospital charges. Survey logistic regression was used to assess the association between maternal opioid use and each outcome; generalized linear modeling was used to compare hospitalization costs by opioid use status. Results. Women who used opioids during pregnancy experienced higher rates of depression, anxiety, and chronic medical conditions. After adjusting for confounders, opioid use was associated with increased odds of threatened preterm labor, early onset delivery, poor fetal growth, and stillbirth. Users were four times as likely to have a prolonged hospital stay and were almost four times more likely to die before discharge. The mean per-hospitalization cost of a woman who used opioids during pregnancy was

Impact of intrauterine tobacco exposure on fetal telomere length

5,616 (95% CI:

Perinatal outcomes and hospital costs in gastroschisis based on gestational age at delivery.

5,166–

Interpregnancy Body Mass Index Changes and Risk of Stillbirth

6,067), compared to

The maternal, fetal, and neonatal effects of cocaine exposure in pregnancy.

4,084 (95% CI:

Intensive interventional maternity care reduces infant morbidity and hospital costs.

4,002–

Systematic review on sleep disorders and obstetric outcomes: scope of current knowledge.

4,166) for nonusers. Conclusion. Opioid use during pregnancy is associated with adverse perinatal outcomes and increased healthcare costs.

Maternal hepatitis B and hepatitis C infection and neonatal neurological outcomes

OBJECTIVE We sought to investigate whether maternal smoking during pregnancy affects telomere length of the fetus. STUDY DESIGN Pregnant women were recruited on hospital admission at delivery. A self-report questionnaire and salivary cotinine test were used to confirm tobacco exposure. Neonatal umbilical cord blood samples were collected, and genomic DNA was isolated from cord blood leukocytes and was analyzed for fetal telomere length based on quantitative polymerase chain reaction. A ratio of relative telomere length was determined by telomere repeat copy number and single copy gene copy number (T/S ratio) and used to compare the telomere length of active, passive, and nonsmokers. Bootstrap and analysis of variance statistical methods were used to evaluate the relationship between prenatal smoking status and fetal telomere length. RESULTS Of the 86 women who were included in this study, approximately 69.8% of the participants were covered by Medicaid, and 55.8% of the participants were black or Hispanic. The overall mean T/S ratio was 0.8608 ± 1.0442. We noted an inverse relationship between smoking and fetal telomere length in a dose-response pattern (T/S ratio of nonsmokers that was more than passive smokers that was more than active smokers). Telomere length was significantly different for each pairwise comparison, and the greatest difference was between active and nonsmokers. CONCLUSION Our results provide the first evidence to demonstrate a positive association between shortened fetal telomere length and smoking during pregnancy. Our findings suggest the possibility of early intrauterine programming for accelerated aging that is the result of tobacco exposure.