Biomedical subjects
Publications and source records attributed to J T Repke.
Increased understanding of SLE as it relates to pregnancy has allowed for many women with lupus today to have a successful pregnancy. However, pregnancies are high risk with up to 25 percent ending in miscarriage and with a high frequency of preterm delivery.
Plasma and serum from pregnant women with preeclampsia (N = 35) and normotensive pregnant (N = 71) and nonpregnant (N = 10) controls were screened for fibrin(ogen) degradation products (fibrinogen and cross-linked fibrin degradation products, and fibrin polymers) using three different assay systems (immunoblot, enzyme-linked immunosorbent assay [ELISA], and latex-bead agglutination assay). All tests showed statistically significant differences (P less than .05) between the preeclamptic patients and the other two groups (pregnant and nonpregnant women). The ELISA assay for total fibrin(ogen) degradation products was the most sensitive test, but was less specific than D-dimer latex. Eleven of the 35 preeclamptic women developed HELLP syndrome (hemolysis, elevated liver enzyme, and low platelet counts). Positive tests were as common in the 11 preeclamptic women who developed the syndrome as in the 24 who did not. These results suggest that fibrinolytic disorders are secondary pathophysiologic events in the course of preeclampsia, but further studies with a larger number of patients are needed.
It would appear from the above that Pritchard agrees with the use of some agents other than magnesium sulfate that have known anticonvulsant properties. We believe that the subject at issue is whether magnesium sulfate should be used in treating the seizures of eclampsia. In our "Controversies" article, we do not address the issue of whether magnesium sulfate modifies pathophysiological factors leading to preeclampsia, but restrict ourselves to the treatment of the seizure per se, once seizures supervene, and the avoidance of their recurrence. The pathophysiological mechanisms and optimal treatment of preeclampsia and of eclampsia (excepting seizures) remain to be determined, as does the use of magnesium sulfate in this condition. Eclamptic seizures are clinically and electroencephalographically indistinguishable from generalized tonic-clonic seizures. Whether seizures arise in or out of the setting of preeclampsia, they should be treated as are other seizures, with known anticonvulsants. Controlled clinical trials are needed to address the effectiveness of alternative antiseizure regimens.
Prior to initiating routine fetal cord serum (FCS) supplementation in our in vitro laboratory, the incidence of HIV in 306 random fetal cord samples obtained at the Labor and Delivery Unit of the Johns Hopkins Hospital from July 1985 to January 1988 was determined from a cross-sectional patient sample. Of 306 samples, 3 (0.98%) were positive for HIV, and confirmed by Western blot analysis, enzyme immunoassay (ELISA), a prevalence significantly higher than a national sample (0.012%). The use of FCS in this setting was determined to be an unacceptable risk to patients undergoing in vitro fertilization. The 90-day quarantine period for verification of HIV seronegativity applied to semen donors may not be applicable to FCS sampling. Patient risk may also increase with pooling of FCS samples prior to HIV testing.
Results are presented of a randomized, double-blinded controlled clinical trial of calcium supplementation (2.0 gm of elemental calcium as calcium carbonate) and a placebo. All participants were 17 years of age or less and clinically healthy. Patients were enrolled by the twenty third week of gestation. The mean duration of calcium supplementation or placebo was approximately 14 weeks. Treatment consisted of 2.8 (+/- 1.5) tablets per day in the placebo group (N = 95) and 3.0 (+/- 1.4) tablets per day in the calcium group (N = 94). Dietary calcium intake was similar in both groups at about 1200 mg/day. The calcium group had a lower incidence of preterm delivery (less than 37 weeks; 7.4% vs 21.1%; p = 0.007); spontaneous labor and preterm delivery (6.4% vs 17.9%; p = 0.01); and low birth weight (9.6% vs 21.1%; p = 0.03). This effect was also present after stratified analysis by level of treatment compliance, urinary tract infection, and chlamydial infection. Life-table analysis demonstrated an overall shift to a higher gestational age in the calcium group compared with the placebo group (log-rank test, p = 0.02). As suggested previously, the observed effect could be mediated by a reduction in uterine smooth muscle contractibility. If confirmed by future research, these results could represent an important preventive intervention for prematurity in high-risk populations.
Explore the source record for details and available documents.
The prevalence of human papillomavirus (HPV) infections in the lower genital tracts of pregnant and nonpregnant women was studied. Cervical and vaginal exfoliated cells were obtained during a routine pelvic examination in 45 pregnant women in early labor, and in 44 nonpregnant women. A detailed questionnaire with emphasis on sexual history and sexually transmitted diseases was administered. The two groups of women were comparable with respect to mean age, prior pregnancy experiences, and number of lifetime sexual partners. Compared with pregnant women, the nonpregnant women had a more frequent history of sexually transmitted diseases (61% versus 39%; p = 0.06), and of genital warts (16% versus 0%; p = 0.01). Utilizing Southern transfer and hybridization with 32P-labeled viral DNA probes for HPV types 6, 11, 16, 18, and 31, DNAs extracted from cervicovaginal exfoliated cells were assessed for HPV genomic sequences. HPV genomic sequences were identified in 25% of nonpregnant women compared with 13.5% of term pregnant women. This difference was not statistically significant (p = 0.26). Six HPV isolates identified in pregnant women were distributed as follows: type 6/11, 1; type 16, 1, type 31, 1; and unknown type, 3. Eleven isolates were identified in nonpregnant women and were distributed as follows: type 6/11, 2; type 16, 6; type 18, 2; and type 31, 1. HPV type 6/11, the type responsible for laryngeal papillomatosis of juvenile onset, was identified in 2% of the pregnant population and accounted for only one of six isolates. HPV DNA-positive pregnant and nonpregnant women were predominantly asymptomatic and had normal Papanicolaou smears and normal clinical examinations.
A case of hyperparathyroidism complicating pregnancy is described. An uncommon associated finding of hypokalemia and its possible etiology is discussed. When hypokalemia occurs in the setting of hyperparathyroidism, oral phosphates should be used with caution, since they may worsen hypokalemia.
In a study population that comprised 34 normal black pregnant women, biochemical changes are compared between a group of women who received 1.5 gm of calcium supplementation a day and a group of women who received placebos. The blood pressure-lowering effect of calcium supplementation appears to involve a mechanism that relates parathyroid hormone and plasma renin activity. Other alterations in calcium and magnesium metabolism, as reflected by increased urinary calcium excretion and serum magnesium levels, may also contribute to this effect. Subgroups of study participants with initial (less than 26 weeks' gestation) low levels of serum calcium and plasma renin activity are the ones with the largest reductions in blood pressure. Whether these alterations can produce a reduction in the incidence of pregnancy-induced hypertension is the next question to be answered in this area.
Explore the source record for details and available documents.
A retrospective analysis of computerized data from 11,815 patients with no history of previous cesarean section revealed an increasing primary cesarean section rate with increasing maternal age. This increase occurred over the entire reproductive age span. Fetal distress as an indication for primary cesarean section may account for this increase.
Cervicitis has been associated with several infections of the female genital tract. Criteria have been established for making the diagnosis of cervicitis in gynecologic populations but there are no well-established criteria for diagnosing cervicitis in obstetrical populations. Because of the association of the cervicitis and sexually transmitted diseases, and because of the association of sexually transmitted diseases and adverse pregnancy outcome, the present study was undertaken in an attempt to establish criteria for the diagnosis of cervicitis in pregnancy. We also attempted to determine the reproducibility of that diagnosis with respect to intra- and interobserver variability. We concluded that intraobserver variability is improved after specific training has been completed and that interobserver variability may be reduced to an acceptable level. On a public health scale, this may allow for identification of a population at high risk for adverse pregnancy outcome when sophisticated microbiologic techniques are unavailable.
Cervical rupture and subsequent development of a cervicovaginal fistula is a relatively uncommon but well-documented complication of midtrimester abortion. Patients with cervicovaginal fistula may be at increased risk of subsequent infertility and obstetric complications.
Congenital complete heart block has been associated with collagen vascular disorders. Many etiologies have been proposed for the myocarditis that develops and results in the complete heart block. Transplacental antibody transfer--specifically, antibodies to tissue-soluble ribonuclear protein antigen-A--has been implicated as the etiology of the myocarditis. This case supports the association of this antibody while suggesting that viral infection may serve as an initiator of the autoimmune destruction. Also, fetal viral infection alone must be considered a possible cause of congenital complete heart block.
Explore the source record for details and available documents.
A rare case of renal cell carcinoma occurring during pregnancy is described. The modalities used to make the diagnosis and the antepartum management of the patient are discussed. The case reported herein demonstrates the major diagnostic challenge of the young pregnant patient with a rare disease.
Explore the source record for details and available documents.