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PubMed1979

The bacterial pathogenesis of infection following cesarean section.

To further define the bacterial pathogenesis of infections following cesarean section, amnionic fluid was obtained transabdominally at the time of surgery from 56 women whose membranes were ruptured for more than 6 hours. In all specimens, bacterial growth was demonstrated, and 53 of these women developed postoperative myometritis. A mean of 2.5 pathogenic bacteria was isolated from each specimen. More than 90% of the amnionic fluid specimens had polymicrobial anaerobic/aerobic growth (63%) or anaerobes only (30%). Aerobic and anaerobic streptococci accounted for 72% of all bacterial isolates; Bacteroides and Escherichia coli were the next most commonly recovered species. In women treated for myometritis and who subsequently developed a wound or pelvic abscess, cultures from these wounds or abscesses were positive for 1-3 organisms present in amnionic fluid. These data indicate that ascending colonization of flora from the lower genital tract and inoculation into surgically traumatized tissues usually result in polymicrobial pelvic infection with a predominance of anaerobic pathogens. Moreover, abscess development in these women is probably associated with organisms identified in amnionic fluid. Bacterial isolates from these women are remarkably similar to those from women with other pelvic infections.

Adolescent↗
PubMed1987

Diagnosis and treatment of rhinitis during pregnancy and lactation.

Many women develop rhinitis during pregnancy. However, to call this "rhinitis of pregnancy" may be misleading. Many of these women who seem to have "developed" rhinitis during pregnancy turn out, on careful questioning, to have had similar preexisting symptoms. Furthermore, these women and those who truly appear to have developed their symptoms for the first time during pregnancy are often found to have common causes for their rhinitis. Certain factors have been cited to account for the frequent appearance (or reappearance) of rhinitis during pregnancy (Table 1). Nasal vascular pooling from the increased circulating blood volume and possibly from progesterone induced vascular smooth muscle relaxation will enhance nasal stuffiness. Stress associated with even a normal pregnancy may have a similar effect. Hormonally induced increased nasal mucous gland activity also has been suggested. The peak age of onset of classical inhalant allergic disease falls within the child bearing time of life, and hence could be coincidental with a pregnancy. Even routine episodes of bacterial rhinosinusitis are increased up to 6-fold during pregnancy. This report will review the clinical approach to rhinitis in the pregnant patient with reference to pathophysiology, differential diagnosis, and treatment during this complex time in a woman's life.

Female↗
PubMed1992

Asymptomatic thrombocytopenia developing during pregnancy (gestational thrombocytopenia)--a clinical study.

During pregnancy some women develop unexplained thrombocytopenia (gestational thrombocytopenia). Previous studies have detected abnormal platelet antibodies, suggesting an autoimmune aetiology. To determine whether gestational thrombocytopenia is associated with increased maternal bleeding or adversely affects the fetus, 31 pregnant women with asymptomatic thrombocytopenia were compared with 12 women with thrombocytopenia associated with pre-eclampsia and 34 normal pregnant controls. There was no increase in maternal bleeding in those with asymptomatic thrombocytopenia compared with the normal controls, but pre-eclamptic women experienced more bleeding (mean difference 181 ml, 95 per cent confidence limits 50-312 ml, p < 0.01). There was no difference in the mean weights of the babies or placenta, nor in the APGAR scores between infants born to controls and those with asymptomatic thrombocytopenia. Cord blood platelet levels were measured in 26 women with asymptomatic thrombocytopenia and were normal in 25 and mildly reduced in one. Thus measures used for the treatment and delivery of pregnancies complicated by autoimmune thrombocytopenia are not indicated in gestational thrombocytopenia. Pregnant women should not be considered thrombocytopenic unless the platelet count has fallen below 120 x 10(9)/l.

Adult↗
PubMed1997

Transvaginal uterine and umbilical artery Doppler examination of 12-16 weeks and the subsequent development of pre-eclampsia and intrauterine growth retardation.

We aimed to determine whether Doppler measurements obtained from the uterine and umbilical arteries in early pregnancy correlate with the subsequent development of pre-eclampsia, or the delivery of a small-for-gestational-age (SGA) baby. A follow-up study was carried out in 652 women with singleton pregnancies who had transvaginal uterine and umbilical artery Doppler examinations performed at 12-16 weeks' gestation. Measurements included: the presence or absence of an early diastolic notch, vessel diameter, resistance index (RI), pulsatility index (PI), time-averaged mean velocity (TAV), maximum systolic velocity and volume flow in the right and left uterine arteries and RI and PI in the umbilical arteries. The main outcome measures were: intrauterine death, birth weight, pre-eclampsia (proteinuric pregnancy-induced hypertension, PPIH) and antepartum hemorrhage. Twelve pregnancies terminated in the second trimester, and in 14 the outcome is unknown. In the remaining 626 women, 44 (7.0%) pregnancies ended in a premature delivery, 30 (4.7%) women developed PPIH, 60 (9.6%) infants were SGA (< 10th centile), of which 19 were < 5th centile and five were < 3rd centile, and 23 (3.7%) women suffered an antepartum hemorrhage. At 12-16 weeks, 205 (32.7%) women had bilateral (right and left) notching of the uterine artery waveforms. When compared to values from women with a normal pregnancy outcome, women who subsequently developed PPIH demonstrated a significant difference in mean uterine artery TAV (24.6 cm/s for PPIH vs. 33.25 cm/s for normal outcome, p < 0.003), volume flow (120.5 ml/min vs. 184.5 ml/min, p < 0.001) and elevated resistance (mean RI = 0.80 vs. 0.695, p < 0.001). In women with bilateral notching, there were significant differences between values for pregnancies with PPIH (odds ratio (OR) 42.02, 95% confidence interval (CI) 5.66, 311.99), being SGA at birth (OR 8.61, 95% CI 4.0, 20.0) or delivering prematurely (OR 2.38, 95% CI 1.19, 4.75), compared with pregnancies with a normal outcome. We conclude that abnormal Doppler values, indicative of a failure to modify the uterine circulation in early pregnancy, are associated with premature delivery, the development of PPIH and the delivery of an SGA baby. This information may be of value in increasing our understanding of the pathophysiological events that lead to the subsequent development of uteroplacental complications such as pre-eclampsia.

Female↗
PubMed2005

Biological underpinnings of health alterations in women with PTSD: a sex disparity.

Women develop posttraumatic stress disorder (PTSD) at twice the rate of men, even though fewer women than men experience traumatic events over their lifetimes. Current studies of individuals with PTSD provide evidence of alterations in the neuroendocrine system that involve levels and activity of cortisol and DHEA and changes in immune function that predispose these individuals toward an innate (Th1) immune response. Yet few studies have addressed the possible role of these biologic alterations in women's increased vulnerability to developing PTSD. In addition, current studies are limited in their ability to link biologic alterations to the observed fourfold increase in medical conditions in women with PTSD as compared to women without PTSD. And finally, few studies have addressed the biologic impact of co-occurring major depressive disorder (MDD) in individuals with PTSD. This critical review provides an update on neuroendocrine and immune perturbations associated with PTSD with and without co-occurring MDD to suggest links to health and possible mechanisms underlying the observed sex disparity in the development of PTSD.

Adaptation, Physiological↗
PubMed2005

A cross-sectional and a prospective study of thyroid disorders in lithium-treated patients.

BACKGROUND: The effects of lithium treatment on the thyroid gland have been demonstrated in a number of studies. Most of this research is based on cross-sectional studies and prospective studies are required to confirm these observations. METHOD: During our genetic association studies, we recruited 115 males and 159 females suffering with affective disorders who had received lithium treatment. We observed longitudinally 57 of these patients, who attended our clinic for between 1 and 7 years and had no thyroid abnormalities at baseline. We performed regular checks of thyroid antibodies, thyroid function tests and lithium levels. RESULTS: Hypo- and hyperthyroidism, including cases that developed prior to lithium treatment, were more common in women (25.8%) than in men (8.7%) and increased with age. By the age of 65, the risk in women increased to 50%. Hypothyroidism was induced by lithium in 17% women. In the prospective study, 4 out of 33 women developed hypothyroidism (an incidence of 27.4 cases per 1000 years). One woman developed thyrotoxicosis. CONCLUSIONS: The risk for hypothyroidism induced by lithium is especially increased in women over the age of 50. Women should be warned of the risks involved when offered lithium treatment. The frequency of lithium-induced thyrotoxicosis is very low.

Antipsychotic Agents↗
PubMed2002

Predictors of sustained amenorrhea from pulsed intravenous cyclophosphamide in premenopausal women with systemic lupus erythematosus.

OBJECTIVE: To identify predictors of intravenous cyclophosphamide (IC) induced sustained amenorrhea, especially in young premenopausal women with systemic lupus erythematosus (SLE). METHODS: The cumulative dose resulting in sustained amenorrhea in 50 and 90% of the treated women (D50 and D90) and predictors of sustained amenorrhea at various ages were determined with Kaplan-Meier plots and Cox regressions in a consecutively enrolled cohort of 67 premenopausal women with SLE who received a pulsed IC regimen (monthly doses of 0.75-1.00 g/m2) for nephritis (n = 59) or other indications (n = 8). RESULTS: Twenty-one of 67 women developed sustained amenorrhea of > 12 months' duration. Age was the strongest determinant of this adverse event. For women in the upper age tertile (>or= 32 years old), D50 was 8 g/m2 and D90 was 12 g/m2, and no strong protective or predisposing factors were identified. Conversely, only 5 of 44 women <or= 31 years old at initiation of IC developed sustained amenorrhea. In these young women the risk was modulated by the prior SLE disease duration (risk increased 1.28-fold per year; p = 0.002), the presence of anti-U1RNP antibodies (relative risk 9.5; p = 0.016), and the presence of anti-Ro antibodies (relative risk 13.5; p = 0.021). In multivariate modeling, anti-U1RNP and disease duration were still significant (p < 0.05). CONCLUSION: Sustained amenorrhea is difficult to avoid in women 32 years or older, even with very short IC courses, and alternative regimens should be considered. In younger women treated with a monthly IC regimen, sustained amenorrhea may occur predominantly in those with the recognized adverse predictors of this complication.

Adult↗
PubMed2005

Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study.

BACKGROUND: Data are limited with regard to the relations of low-grade albuminuria (below the microalbuminuria threshold) and incidence of cardiovascular disease (CVD) events in nondiabetic, nonhypertensive individuals. METHODS AND RESULTS: We examined the association of urinary albumin excretion (spot urine albumin indexed to creatinine [UACR]) and the incidence of CVD events and all-cause mortality in 1568 nonhypertensive, nondiabetic Framingham Offspring Study participants (mean age, 55 years; 58% women) free of CVD. On follow-up (median, 6 years), 54 participants (20 women) developed a first CVD event, and 49 (19 women) died. After adjustment for established risk factors, increasing UACR was associated with greater risk of CVD (hazards ratio [HR] per SD increment in log UACR, 1.36; 95% CI, 1.00 to 1.87) and death (HR per SD increment in log UACR, 1.55; 95% CI, 1.10 to 2.20). Participants with UACR greater than or equal to the sex-specific median (> or =3.9 microg/mg for men, > or =7.5 microg/mg for women) experienced a nearly 3-fold risk of CVD (adjusted HR, 2.92; 95% CI, 1.57 to 5.44; P<0.001) and a borderline significantly increased risk of death (adjusted HR, 1.75; 95% CI, 0.95 to 3.22; P=0.08) compared with those with UACR below the median. The increased CVD risk associated with UACR at or above the median remained robust in analyses restricted to individuals without microalbuminuria (n=1470) and in subgroups with intermediate (n=1469) and low (n=1186) pretest probabilities of CVD. CONCLUSIONS: In our community-based sample of middle-aged nonhypertensive, nondiabetic individuals, low levels of urinary albumin excretion well below the current microalbuminuria threshold predicted the development of CVD. Our observations add to the growing body of evidence that challenges the notion that UACR <30 microg/mg indicates "normal" albumin excretion.

Albuminuria↗
PubMed1992

Postpartum thyroid dysfunction.

Postpartum thyroid dysfunction (PPTD) refers to the syndromes of transient hyperthyroidism, transient hypothyroidism, or both, occurring sequentially in the first 12 months postpartum. Approximately 5 to 9% of women develop the disorder in this period. PPTD is most often subclinical but some women will experience symptoms such as lack of energy and depression in the hypothyroid phase. The thyroid gland, which normally enlarges during pregnancy, will remain enlarged or enlarge further in the postpartum period in a significant number of affected women, instead of returning to the prepregnancy size as in unaffected women. The gland is painless and histologically demonstrates lymphocytic infiltration. PPTD is strongly associated with the presence of antimicrosomal and/or antithyroglobulin antibodies, which occur in up to 76% of cases. Antibody activity tends to increase in the postpartum period and to peak at the time of onset of the disorder. TSH receptor antibodies are not seen and the gland has low radioiodine uptake, distinguishing PPTD from Graves' disease. The HLA associations are controversial, as is the role of dietary iodine. The etiology of PPTD is almost certainly immunological, reflecting the phenomenon of rebound from the relative immune tolerance of pregnancy. Detection of the disorder is important in order to reassure or treat those who are symptomatic and because PPTD may recur in subsequent pregnancies. In addition, up to one third of affected women will go on to develop permanent hypothyroidism 2 to 4 years later. The role of screening for PPTD remains to be clarified.

Autoantibodies↗
PubMed2006

Maternal hepatotoxicity with nevirapine as part of combination antiretroviral therapy in pregnancy.

OBJECTIVES: To describe the maternal tolerability of nevirapine as part of combination antiretroviral therapy in pregnancy at three HIV centres in Dublin, Ireland and to determine risk factors for development of significant hepatotoxicity. METHODS: A retrospective study was carried out of all women prescribed nevirapine as part of combination antiretroviral therapy in pregnancy at three HIV centres in Dublin, Ireland (October 2000 to February 2003). Toxicities experienced were graded according to the Division of AIDS toxicity guidelines for adults. Statistical analysis was performed to determine whether there were differences between those that did and those that did not experience significant hepatotoxicity. RESULTS: A total of 123 women initiated nevirapine as part of combination antiretroviral therapy in the study period. Eight women developed significant hepatotoxicity, including two women who died from fulminant hepatitis. Women who experienced more severe hepatotoxicity had higher pretreatment CD4 counts (P=0.01). CONCLUSIONS: In this cohort, women who experienced more severe hepatotoxicity had higher pretreatment CD4 counts, lending additional weight to the need for caution in using nevirapine as part of combination antiretroviral therapy in women not requiring antiretroviral therapy for their own health.

Adolescent↗
PubMed2005

Childhood nocturnal enuresis in vulvar vestibulitis syndrome.

OBJECTIVE: To define correlations between vulvar vestibulitis syndrome (VVS) and childhood nocturnal enuresis and the effect of biofeedback therapy. STUDY DESIGN: Of 104 women diagnosed with VVS, 54 (30 with primary vulvar vestibulitis syndrome [PVVS] and 24 with secondary vulvar vestibulitis syndrome [SVVS], mean age 24.5 years) chose Glazer biofeedback therapy. Information on lower urinary tract symptoms was recorded at the initial and final visits. RESULTS: Eight of the 30 women with PVVS (26.6%) had a history of childhood enuresis as compared to none of the women with SVVS (p < 0.01). The 8 women developed lower urinary tract symptoms following biofeedback treatment. None of the women with SVVS had urinary symptoms before or following biofeedback therapy. The high, unstable baseline muscle tone revealed by the Glazer technique to be present in all VVS patients underwent substantial reduction and stabilization at the end of biofeedback therapy. CONCLUSION: Childhood nocturnal enuresis is apparently common among women with PVVS. New urinary symptoms may develop following biofeedback therapy for PVVS.

Adult↗
PubMed1991

[Contraception with cyclic administration of buserelin and gestagens: increase in testosterone and free testosterone serum concentration].

During contraception with the LH-RH analogue buserelin, some women developed mild androgenic symptoms. Therefore, we investigated in 10 women various hormonal serum parameters during one cycle of treatment with daily 300 micrograms buserelin intranasally (day 1-22) and 5 mg medroxyprogesterone acetate (MPA) orally (day 16-22), and, after a washout cycle, during another cycle of treatment with daily 300 micrograms buserelin intranasally (day 1-15) and 5 mg norethisterone acetate (NETA) orally (day 16-22). The serum parameters were investigated on day 1, 15 and 21 during the 4 hours after administration of the drugs. During the treatment, LH release was significantly reduced, whereby additional MPA had no effect whatsoever, while NETA profoundly suppressed LH. During treatment with buserelin and MPA, the average oestradiol levels remained unaltered, but were significantly suppressed by 65% during intake of NETA. Contrary to 17 alpha-hydroxyprogesterone, which did not change, serum testosterone was significantly increased by 30% when buserelin was given with or without MPA, while NETA had no effect. During both regimens, the serum concentrations of SHBG were reduced by 15 to 25%, and those of free testosterone were increased by 30 to 50%. These alterations in hormonal parameters may have contributed to the development of seborrhoeic symptoms and acne of the facial skin which were observed in 6 of the 10 women treated with intranasal buserelin for contraception.

Administration, Intranasal↗
PubMed2005

Expectant management of postdural puncture headache increases hospital length of stay and emergency room visits.

PURPOSE: This retrospective cohort study examined hospital length of stay (LOS) and emergency room (ER) visits in parturients diagnosed with postdural puncture headache (PDPH) following recognized dural puncture (DP). All cases were managed expectantly. Outcomes were compared with matched controls with uneventful labour epidurals. METHODS: After Ethics Committee approval, the hospital perinatal database was used to identify healthy parturients with recognized DP during labour epidural placement from 1996-2001. Women developing PDPH after expectant management were matched with women with uneventful epidurals and no evidence of PDPH, as well as by parity, delivery mode and admission date. All women delivered term singletons. The primary outcome was LOS (hours) from delivery to discharge. Secondary outcomes included: number (#) nights in hospital, #ER visits for PDPH, epidural blood patch (EBP) timing (pre vs post discharge), EBP location (ward vs ER) and blood volumes used. RESULTS: 26 cases and 26 controls were identified. Precise discharge times were found for 23 cases and 23 controls. In cases, the LOS was increased by a mean of 17 +/- 23.8 (SD) hours; [95% conficence interval (CI) = 8, 26; P = 0.0012] and # nights in hospital was increased by a mean of 0.62 +/- 0.94 nights (95% CI, 0.26, 0.98, P = 0.0027). Nineteen cases (73% 19/26) received at least one EBP. Sixteen cases received at least one EBP prior to discharge with 38% (6/16) returning to ER for re-assessment/repeat EBP. Forty-four percent (4/9) of cases without an EBP prior to discharge returned to ER for further assessment/EBP. CONCLUSION: PDPH leads to a significant increase in hospital LOS and ER visits. Studies of preventive therapy are warranted.

Adult↗
PubMed2005

Assessment of menstrual blood loss in Belgian users of a new T-shaped levonorgestrel-releasing intrauterine system.

OBJECTIVE: This study was conducted to evaluate the effect of a T-shaped levonorgestrel-releasing intrauterine system (Femilis, LNG IUS) on the amount of menstrual blood loss (MBL) in women with and without menorrhagia. The daily release of the LNG IUS was approximately 20 mug. MATERIALS AND METHODS: In 60 Belgian women, less than 48 years of age at study enrollment, using the Femilis LNG IUS for 4 to more than 30 months, MBL was assessed with the visual assessment technique. Twenty-eight women had normal menstrual periods at baseline (menstrual score <185) and 32 women had idiopathic menorrhagia (menstrual score > or =185). RESULTS: Menstrual blood loss scores dropped significantly during the observation period in all women except one. The median menstrual score at baseline in women with normal menstrual bleeding was 140 (range 80-160) and dropped to a median score of 5 (range 0-150) at follow-up, a decrease of 96%. In the 32 women with menorrhagic bleeding at baseline, menstrual flow dropped from a median score of 232 (range 185-450) at baseline to a median score of 3 (range 0-50) at follow-up, a decrease of 99%. Twenty women developed amenorrhea (33%): 10 in the group of women with normal menstruation and 10 in those women with menorrhagia. Most of the remaining women had oligomenorrhea requiring the use of a few panty-liners only. In one woman, MBL did not decrease, thus requiring further evaluation. CONCLUSION: The impact on MBL of this new 20 mug/day LNG-releasing IUS confirms other studies with devices releasing the same or lower amounts of LNG. The strong endometrial suppression is the principal mechanism explaining the effect on MBL. The strong effect on MBL of this contraceptive method offers an important health benefit and improvement in quality of life, particularly in women with heavy bleeding and anemia, as other treatment modalities are less effective, more costly, more invasive or not readily available.

Adult↗
PubMed2000

Cervical cancer risk: is there a genetic component?

Human papilloma virus (HPV) is a major risk factor for the development of cervical cancer. As only some infected women develop cancer, other factors must be important for disease development. Genetic epidemiological studies show that genetic factors contribute significantly to disease risk. Genetic susceptibility to HPV exposure and/or infection appears to be important in determining the individual risk to develop this virally induced cancer.

Carcinoma in Situ↗
PubMed1999

Early onset of breast carcinoma in African American women with poor prognostic factors.

The purpose of this study was to determine prognostic significance of age and race as independent variables and to see role of age at the onset of breast carcinoma. A retrospective study was conducted of African American and white women with breast cancer treated at SUNY-Health Science Center Brooklyn and Kings County Hospital Center from 1983 to 1993. The objective was to analyze the differences in patterns of disease onset, as related to age and prognostic factors. A total of 738 patients were analyzed for race-adjusted comparison of stage, grade, disease-free survival, and median survival. Age at the time of diagnosis was analyzed to conduct age-specific comparisons of African American (AA) and white patients. The multivariate analysis indicated that AA women develop breast cancer 10 years earlier than white women (p = 0.00001). Corrected by stage and grade, i.e., chi2 test for stage-by-stage and grade-by-grade analysis has revealed that the AA women present with higher stage (p = 0.009), increased number of positive nodes (p = 0.00007), and more estrogen receptor/ progesterone receptor-negative tumors (p = 0.005). Further studies are required to probe into the etiologic possibilities of this significant difference. The important contributing factors could be hormonal, genetic, environmental, and socioeconomic. Obesity and dietary factors also need to be evaluated. Further studies to explore genetic susceptibility by ploidy is recommended to explain this significant difference. We conclude that the onset of breast cancer among AA women occurs at a significantly younger age than in white women, and their prognostic factors are poorer.

Adult↗
PubMed1983

Beta-hemolytic activity of Trichomonas vaginalis correlates with virulence.

The reasons that some women develop symptomatic trichomonal vaginitis, whereas many other infected women remain asymptomatic, are unclear, but it has been suggested that Trichomonas vaginalis strains vary in their intrinsic virulence. We describe beta-hemolytic activity in T. vaginalis which correlates with virulence in patients as well as in an animal model and in tissue culture. Fresh T. vaginalis isolates from four women with severe, symptomatic trichomoniasis had high-level (86.3 +/- 6.6%) hemolytic activity, whereas isolates from three completely asymptomatic women had low-level (45.3 +/- 8.4%) hemolytic activity (P less than 0.001). Hemolytic activity also correlated with the production of subcutaneous abscesses in mice (r = 0.74) and with destruction of CHO cell monolayers (r = 0.94). All of the 20 clinical isolates of T. vaginalis tested possessed hemolytic activity. The beta-hemolysin may be a virulence factor for T. vaginalis.

Animals↗