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PubMed1987

The developmental toxicity of triethylene glycol dimethyl ether in mice.

Triethylene glycol dimethyl ether (triEGdiME) is structurally related to several compounds which produce reproductive and developmental toxicity, including teratogenicity in laboratory animals. In the present study, triEGdiME (0, 250, 500, or 1000 mg/kg/day) was administered by gavage to timed-pregnant CD-1 mice during major organogenesis (Gestational Days (gd) 6-15). Maternal clinical status was monitored daily during treatment. At sacrifice (gd 17), confirmed-pregnant females (26-28 per group) were evaluated for clinical status and gestational outcome; each live fetus was examined for external, visceral, and skeletal malformations. No maternal death or morbidity was observed. Clinical signs of toxicity including piloerection were minor. Maternal weight gain during treatment, gestation, and maternal weight gain during gestation corrected for gravid uterine weight were not affected. Gravid uterine weight decreased in a dose-related manner, indicating compromised pregnancy status. Relative maternal liver weight (% body wt) was significantly increased over controls at doses greater than or equal to 500 and 1000 mg/kg/day. Average fetal body weight per litter was significantly reduced at doses greater than or equal to 500 mg/kg/day. The percentage malformed live fetuses per litter (0.3, 0, 0.8, and 11.1%) was significantly increased at 1000 mg/kg/day. Major malformations affected primarily the development of the neural tube, craniofacial structures, and the axial skeleton. In summary, oral administration of triEGdiME during major organogenesis produced only marginal signs of altered maternal status, as evidenced by an increase in maternal liver weight, and caused selective adverse effects upon fetal growth and morphological development at doses greater than or equal to 500 mg/kg/day.

Abnormalities, Drug-Induced↗
PubMed1995

Intra-uterine infection in women with preterm premature rupture of membranes: maternal and neonatal characteristics.

OBJECTIVE: Our purpose was to determine the prevalence of intra-uterine infection in patients with preterm premature rupture of membranes and to evaluate the clinical characteristics of women and neonates according to the presence or absence of intrauterine infection. STUDY DESIGN: Trans-abdominal amniocentesis was performed in 90 consecutive patients admitted with preterm premature rupture of membranes. Maternal clinical parameters evaluated included maternal age, origin, gravidity, parity, habitual abortion, previous perinatal death, previous preterm birth, urinary tract infection, fetal distress, abruptio placentae, gestational diabetes, admission-delivery interval and cesarean rate. Neonatal clinical parameters evaluated were gestational age at delivery, birth weight, Apgar score, neonatal gender, perinatal death and neonatal sepsis. RESULTS: The prevalence of intra-uterine infection was 66.6% (60/90). No differences between patients with intra-uterine infection and those without intra-uterine infection were observed in maternal age, origin, gravidity, parity, habitual abortion, previous perinatal death, fetal distress, abruptio placentae, gestational diabetes, admission-delivery interval, cesarean section, neonate's gender, Apgar score at 5 min and neonatal sepsis. On the other hand, gestational age at delivery, birth weight and Apgar score at 1 min were significantly different between the groups. CONCLUSION: An intra-uterine infection was found in two thirds of women presenting with preterm premature rupture of membranes. Women presenting with preterm premature rupture of membranes and intra-uterine infection had a lower gestational age at delivery and consequently had a lower neonatal birth weight than those without intra-uterine infection.

Amniotic Fluid↗
PubMed1989

Rad-2-dependent repair of radiation-induced chromosomal aberrations in Caenorhabditis elegans.

A method involving light microscopy was developed and utilized for the observation of gamma- or ultraviolet-induced aberrations of the chromosomes of Caenorhabditis elegans var. Bristol (N2). Gravid worms were irradiated and the chromosomes were examined in the early embryos derived from eggs fertilized after the irradiation. The frequency of gamma-induced aberrations in the early embryonic cells of C. elegans increased proportionally with the dosage of gamma-rays. It decreased greatly following incubation of the irradiated gravid worms for 2 days. This decrease was blocked by the rad-2 mutation but not by the rad-1 mutation of the same epistasis group. Both mutations make worms sensitive to radiation and chemicals. In addition, the hatchability of eggs laid by the rad-2 mutant after irradiation was restored very quickly as was that of the wild-type strain. Ultraviolet irradiation, on the other hand, induced few aberrations in both the wild-type and rad-1 strains, but it caused an elevated frequency of aberrations in the rad-2 strain. Ultraviolet irradiation strongly blocked the separation of chromosomes of the rad-2 strain. Furthermore, hatchability was very low in eggs laid by ultraviolet-irradiated rad-2 worms. These results suggest the existence of a rad-2-dependent mechanism for gonadal repair of chromosomal aberrations, including chromosomal non-separation, and indicate that gamma-induced chromosome aberrations are not fatal to the hatching of Caenorhabditis elegans which has holocentric chromosomes.

Animals↗
PubMed2004

Preinduction cervical ripening with the Foley catheter and the risk of subsequent preterm birth.

OBJECTIVE: The Foley catheter is a safe and effective form of preinduction cervical ripening and is quickly growing in popularity. Its major effect appears to be through mechanical dilation, which has raised the concern that the use of the Foley catheter for cervical ripening may damage the cervix and result in a higher rate of subsequent preterm birth. STUDY DESIGN: We conducted a review of all induction of labor at our institution from July 1998 to July 2001 that required preinduction cervical ripening and had a subsequent birth. The primary outcome variable was preterm birth at <35 weeks of gestation. Demographic and potential confounding variables were analyzed. A probability value of <.05 was considered significant. RESULTS: The cases of 126 women (63 women in the Foley group and 63 women in the prostaglandin group) were studied. Women in the prostaglandin group had a prostaglandin agent used. There was no difference in maternal age, gravidity, parity, Bishop score, total time of induction, gestational age, oxytocin use, maximum oxytocin level, tobacco or drug use, or type of delivery in the index pregnancy between the groups. In the subsequent pregnancies, there were no differences in maternal age, gravidity, parity, spontaneous abortions, terminations, cone or Loop Electrosurgical Excision Procedure (LEEP) procedures, history of cervical manipulation, tobacco or drug use, stillbirth, need for induction, mode of delivery, episiotomy, gestational age at delivery, Apgar scores, labor duration, use of oxytocin, or birth weight. There were no differences in preterm birth at 37, 35, or 32 weeks of gestation between the groups. CONCLUSION: The use of the Foley catheter for preinduction cervical ripening does not appear to increase the risk of preterm birth in a subsequent pregnancy.

Adult↗
PubMed2004

Number and gestational age of prior preterm births does not modify the predictive value of a short cervix.

OBJECTIVE: This study was undertaken to determine whether the number and gestational age of prior preterm deliveries modifies the significance of endovaginal sonographic cervical length less than 25 mm for the prediction of recurrent preterm birth less than 35 weeks' gestation. STUDY DESIGN: Secondary analysis of a multicenter, blinded, observational study. Endovaginal ultrasonographic examinations were scheduled at 2-week intervals between 16 and 23 weeks' gestation in singleton pregnancies of 181 gravid women with at least 1 prior spontaneous preterm birth between 16 and 32 weeks' gestation. RESULTS: The earliest prior preterm birth occurred before 23 weeks in 61 women and at 23.0 to 31 weeks in 115; 5 had missing gestational age data. Cervical length was not different between these 2 groups both at the initial scan (median 38 vs 37 mm, P=.54) and considering the shortest ever observed cervical length over the entire study period (median 30 vs 30 mm, P=.97). Cervical length less than 25 mm was associated with spontaneous preterm birth less than 35 weeks for both groups (positive predictive value 80% vs 71%, P>.99). There were 134 women with 1 prior preterm delivery (74%) and 47 with 2 or more. Cervical lengths were not different between these 2 groups at the initial scan (median 36.5 vs 37 mm, P=.52) or over the entire study period (median 30 vs 32 mm, P=.31). The positive predictive value of cervical length less than 25 mm for subsequent spontaneous premature birth was not significantly higher in gravid women with multiple prior preterm births (100% vs 73%, P>.99). CONCLUSION: Neither the number nor the gestational age of prior preterm births modify the predictive value of a cervical length less than 25 mm at 16 to 19 weeks for recurrent spontaneous preterm birth.

Adult↗
PubMed2006

A novel amniocentesis model for learning stereotactic skills.

OBJECTIVE: This study developed a lifelike amniocentesis model to allow effective acquisition of the stereotactic skills necessary and comfort level with this procedure. STUDY DESIGN: An amniocentesis model is constructed using a formalin preserved gravid pig uterus. A large Ziploc freezer bag (Dow, Indianapolis, Ind) filled with ultrasound gel is placed on the uterus to simulate the skin and subcutaneous layer. RESULTS: Amniocentesis can be performed in the usual fashion using this lifelike model. No leak was observed in the Ziploc bag (Dow) or gravid uterus despite more than 50 needle insertions. The cost of 4 to 5 learning stations is approximately $50.00. This model enjoys the advantages of being changeable to reproduce a variety of real-life situations, including poly/oligo/anhydramnios, varied fetal positions and different thickness of subcutaneous tissue. CONCLUSION: This low-cost novel model provides realistic tissue resistance and yields a sonographically accurate amniocentesis-training tool. The use of this model permits resident instruction in a nonthreatening environment.

Amniocentesis↗
PubMed2004

Effect of intrauterine administration of oestradiol on postpartum uterine bacterial infection in cattle.

After parturition fewer first dominant follicles are selected in the ovary ipsilateral to the previously gravid uterine horn in cattle. However, the presence of a large oestradiol-secreting follicle in the ipsilateral ovary is a predictor of fertility, possibly due to a localised effect of oestradiol which increases the rate of elimination of the ubiquitous uterine bacterial contamination that occurs after calving. The present study tested the hypothesis that oestradiol reduces uterine bacterial contamination when administered into the uterine lumen around the expected time for selection of the first postpartum dominant follicle. Animals were infused with saline (n=15) or 10mg oestradiol benzoate (n=15) into the previously gravid uterine horn on Days 7 and 10 postpartum. Peripheral coccygeal blood samples were collected daily and oestradiol concentrations measured by radioimmunoassay (RIA). Uterine lumen swabs were collected 7, 14 and 21 days postpartum for aerobic and anaerobic culture, bacteria were identified and growth scored semi-quantitatively. Plasma oestradiol concentrations were higher for treated animals between Days 7 and 14 (1.4+/-0.1 versus 2.0+/-0.2 pg/ml, P<0.05). Control animals had a similar bacterial growth score on Days 7 and 14, with a lower value on Day 21 (5.7+/-1.0 and 6.1+/-0.7 versus 0.3+/-0.1, P<0.05). However, treated animals had a surprising higher bacterial load on Day 14, than on Days 7 or 21 (7.1+/-0.9 versus 4.0+/-0.6 or 3.6+/-0.6, P<0.05). The increased score was attributable to more pathogens associated with endometritis on Day 14 than Day 7 (5.1+/-1.0 versus 2.5+/-0.5, P<0.05), in particular Prevotella melaninogenicus (1.5+/-0.5 versus 0.7+/-0.2, P<0.05) and Fusobacterium necrophorum (1.5+/-0.4 versus 0.3+/-0.2, P<0.05). In conclusion, administration of oestradiol into the uterine lumen surprisingly increased uterine pathogenic anaerobic bacterial contamination. Thus, it is unlikely that increased fertility associated with a first dominant follicle in the ipsilateral ovary is a consequence of the elimination of bacterial contamination by ovarian oestradiol.

Animals↗
PubMed2004

Active induction management of labor for diabetic pregnancies at term; mode of delivery and fetal outcome--a single center experience.

OBJECTIVES: To evaluate the mode of delivery in diabetic pregnancies at term following induction of labor with vaginal application of prostaglandin E2 (PGE2), and to identify possible predictors of successful vaginal delivery. PATIENTS AND METHODS: The study group consisted of 105 women with diabetic pregnancies at term admitted for induction of labor; 84 (80%) had gestational diabetes (GDM) and 21 (20%) type 1 diabetes. Findings were compared with women who underwent elective induction of labor (n=115), and women with normal spontaneous onset of labor (n=510). Women with previous cesarean section (CS) were excluded from both study and control groups. RESULTS: Maternal age and gravidity were significantly higher in the study group than the control groups (age: 31.4+/-5, 28+/-5.0 and 28.1+/-4.8 years, respectively; gravidity: 3.0+/-1.9, 2.5+/-1.6, and 2.1+/-1.4, respectively; P<0.001 for both) and gestational age and nulliparity rate were significantly lower (gestational age: 38.6+/-1.1, 40.2+/-1.3 and 39.3+/-2.7 weeks, respectively; nulliparity: 34.6, 45.2, 51.6%, respectively; P<0.002 for both). There were no between-group differences in the incidence of oligohydramnios, number of PGE2 applications used, birth weight, rate of non-reassuring fetal heart rate pattern leading to CS, and rate of low 5 min Apgar score (<7). The rate of CS in the study group (18.2%) was significantly higher than in the spontaneous labor group (9%) but similar to the elective induction group (14.8%). On stepwise analysis, only nulliparity (OR 4.56, 95% CI 1.11-18.67, P=0.035) was independently and significantly associated with increased risk of CS. Within the study group (R2=0.257, P=0.002), type 1 diabetes (OR 2.4, 95% CI 1.04-5.51) was independently and significantly associated with increased risk of CS. CONCLUSION: In diabetic pregnancies, induction of labor at term with vaginal PGE2 is successful in approximately 82% of patients, but yields a significantly higher CS rate compared to uncomplicated pregnancies. Nulliparity and diagnosis of type 1 diabetes are independently and significantly associated with increased risk of CS. CONDENSATION: In diabetic pregnancies, induction of labor at term is successful in 82% of patients, but yields higher CS rates compared to uncomplicated pregnancies.

Adult↗
PubMed2006

Anaesthesia for uterine rupture in a Nigerian teaching hospital: maternal and fetal outcome.

BACKGROUND: An observational retrospective study was conducted at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria to determine the outcome for patients with rupture of the gravid uterus who had anaesthesia for laparotomy over a four-year period, July 2000 to June 2004. METHODS: The hospital records (case files, labour ward and theatre records) of patients over a four-year period with rupture of the uterus were reviewed. RESULTS: A total of 2707 deliveries took place at UNTH, Enugu, Nigeria. There were 2556 live births (94.8% of deliveries) and 714 (26.4%) caesarean deliveries. Twenty-three cases of uterine rupture occurred, giving a prevalence of 8.5/1000 deliveries. In nine patents (39.1%) the uterus was already scarred. The patients' mean age was 30.2 years. No nulliparous patients suffered ruptured uterus. General anaesthesia with muscle relaxants was administered to all patients. Twenty-two patients (95.6%) received blood transfusions. All the patients received normal saline and one patient also received Haemacel. Five (21.7%) patients had preoperative hypotension and two (8.6%) had intraoperative hypotension. There was one maternal death which occurred three days after the cesarean section. Twenty-three (96.3%) fetal deaths, including the loss of a set of twins, were recorded. Fetal deaths from ruptured uterus represented 32.4% of all fetal loss following caesarean section during the study period. There were no neonatal deaths. CONCLUSION: Rupture of the gravid uterus presents the anaesthetist with the unique challenge of maintaining haemodynamic status before haemostasis is secured, often with the patient in shock. Choice of anaesthetic drugs and availability of blood are important, as well as the skill and experience of the anaesthetist. The maternal mortality rates in other West African studies reviewed were generally higher than those in this series. The maternal outcome re-emphasises the vital role of prompt intervention and availability of blood in reducing maternal mortality following rupture of the uterus.

Adult↗
PubMed2005

Postpartum ovarian follicular dynamics in primiparous and pluriparous Mediterranean Italian buffaloes (Bubalus bubalis).

The objective of this study was to monitor ovarian function in postpartum primiparous and pluriparous Mediterranean Italian buffaloes (Bubalus bubalis) during months of increasing daylength. Ovarian ultrasound monitoring was carried out for a total of 60 days from calving in 10 primiparous and 10 pluriparous buffaloes. Progesterone was determined from calving until a week after first postpartum ovulation. The study was undertaken during months of increasing day length. Time required for complete postpartum uterine involution was 31 +/- 1.0 and 33 +/- 1.3 days in primiparous and pluriparous buffaloes respectively (P = 0.1). The first postpartum ovulation was recorded on 4 primiparous and 8 pluriparous buffaloes (P = 0.16). Time for first postpartum ovulation to occur was 25.5 +/- 6.9 and 15.5 +/- 1.3 days in primiparous and pluriparous buffaloes, respectively (P = 0.07). Overall, 8 of the 12 first postpartum ovulations (66.6%) occurred in the ovary contra-lateral to the one bearing the gravidic CL, one out of 4 in primiparous and 3 out of 8 in pluriparous buffaloes (P = 1.0). Following a first postpartum ovulation, 3 primiparous and 4 pluriparous buffaloes displayed a complete wave of follicular development leading to a new ovulation. Ovulation following parturition was not recorded in 6 primiparous and two pluriparous buffaloes for the 60 days of ultrasound monitoring. Growth rate (mm/d) and largest size (mm) of first postpartum ovulating follicle was 0.95 +/- 0.18 and 1.07 +/- 0.07 (P = 0.4), and 13.5 +/- 0.8 and 14.1 +/- 0.4 (P = 0.4) in primiparous and pluriparous buffaloes, respectively. Following calving, the total number of available antral follicles (> or =2 mm) declined gradually towards the end of the study period. Follicles greater or equal to 3 mm in diameter on the contrary showed a prominent increase in the first 2 weeks from calving. The number of follicles greater or equal to 3 mm in diameter was significantly higher in the ovary contra-lateral to the one bearing the gravidic CL. A balance in the number of such follicles was reached toward the end of the first month. In conclusion, although some follicular activity was recorded in the ovaries of all buffaloes, true postpartum resumption of cyclicity in the months of increasing daylight hours was delayed in the majority of animals.

Animals↗
PubMed2006

Effects of storage treatment on fecal steroid hormone concentrations of a rodent, the Cape ground squirrel (Xerus inauris).

Fecal steroid analysis is an increasingly common non-invasive technique used in both captive and field studies to measure an animal's approximate hormonal levels and corresponding physiological state. Fecal collection in the field necessitates storage and transportation methods that will prevent the degradation of hormonal metabolites by fecal bacteria. To determine the most stable and therefore preferred method of storage, 48 fecal samples were collected from six captive female Cape ground squirrels (Xerus inauris). Each sample was randomly divided into three sub-samples to be processed for storage through freezing, drying, or preservation in ethanol. Frozen samples were stored at -20 degrees C, dried-treated samples were desiccated in a conventional oven at 40 degrees C for 4 h, and alcohol-treated samples were preserved in 3 ml of 95% ethanol. Samples were stored for 330 days followed by enzyme immunoassay analysis (EIA) to determine their progestogen and estrone conjugate (E(1)C) concentrations. Validations were performed to establish that the progestogen and E(1)C assays accurately measure fecal progestogen and estrone conjugate concentrations and were sensitive enough to detect biologically meaningful differences in these steroid metabolite concentrations in female X. inauris. Validation results showed a significant difference in progestogen concentrations of gravid females compared to sub-adults and non-gravid females. There was also a significant difference in estrone conjugates between sub-adult and adult females. Duration of storage time did not affect progestogen or estrone metabolite concentrations after being frozen for 3 months. Storage treatment results showed no significant difference between frozen and dried samples, but a significant difference was found between frozen and ethanol samples in both progestogen and estrone conjugate concentrations demonstrating that drying feces provides a reliable method for long-term preservation of fecal steroid concentrations and is the better alternative when freezing is not a viable option.

Age Factors↗
PubMed1984

Low-dose prostaglandin E2 analogue for cervical dilatation prior to pregnancy termination.

The trauma of mechanical cervical dilatation preceding abortion is directly related to the degree of cervical resistance. Prostaglandins may reduce cervical rigidity but are accompanied by undesirable side effects. Our aims were to ascertain if a low-dose (10 mg) analogue (9-deoxo-16, 16 dimethyl-9-methylene PGE2) is effective and well tolerated and, if so, to try to determine the possible mechanism by which it works. To this end, we studied 39 women with gestational ages ranging from 7 to 19 weeks who were given a single vaginal suppository 1 to 4 hours before suction curettage. In addition to demographic data on age, gravidity, parity, and previous abortions, we determined progesterone, human chorionic gonadotropin and prostaglandin plasma levels. This low-dose prostaglandin E2 analogue was found to be effective in achieving cervical dilatation and softening with minimal side effects (mild nausea in one patient only). Mean cervical dilatation achieved was 7.8 +/- 2.3 mm. Softening was apparent and facilitated additional instrumental dilatation when required. No correlation was found between drug effectiveness and gravidity, gestational age, or duration of action. There was no detectable trend with regard to baseline progesterone or human chorionic gonadotropin levels. This suggested a specific sensitivity to the local effect by the drug, apparently unrelated to dosage.

16,16-Dimethylprostaglandin E2↗
PubMed1985

Maternal weight and pregnancy complications.

The effect of obesity alone was investigated among 16,858 women who were delivered of their infants within a 12-month period. Complete analysis was possible for 9667 patients who were divided into four weight categories and separated into two groups, with and without complications. Perinatal mortality, infant size, and the primary cesarean delivery rate were calculated for each group. Among 2597 women with antenatal complications, there was a significant increase in perinatal mortality (p less than 0.001), primary cesarean delivery (p less than 0.02), and mean infant birth weight (p less than 0.01) in the obese and the morbidly obese gravid women. Among 7070 women without antenatal complications there was a significant increase in primary cesarean delivery (p less than 0.001) and mean infant birth weight (p less than 0.01) but not perinatal mortality in the obese and the morbidly obese gravid women. Obesity alone does not appear to affect the perinatal mortality rate but it increases the likelihood of cesarean delivery in the morbidly obese patient.

Birth Weight↗
PubMed1986

Myosin detection in human myometrium with a monoclonal antibody.

A monoclonal antibody was prepared from a mouse immunized with human gravid uterine myosin. This monoclonal antibody is specific for the myosin heavy chains of human smooth muscle as determined by radioimmunoassay and immunoblotting experiments. Frozen cryostat sections isolated from different uterine regions were studied by immunofluorescence in order to detect myosin distribution within cells of nongravid, gravid, and pathologic human uteri. Myosin was detectable in the cytoplasm of all uterine muscle cells. No fiber heterogeneity with regard to myosin distribution was detected among or within the different uterine regions, regardless of which physiologic or pathophysiologic situation was studied. A large increase in the cell size was observed during pregnancy. These preliminary observations suggest the value of further production of monoclonal antibodies specific for the different putative molecular variants of uterine myosin and their potential use in identifying individual cells containing different myosin variants.

Antibodies, Monoclonal↗
PubMed1987

A hypothesis concerning the general basis of organogenetic congenital anomalies.

Evidence supports the idea that it is the degree of metabolic imbalance present in diabetic gravid women during the period of organogenesis that accounts for organogenetic congenital defects. In light of the proved and inferred metabolic instability occurring during early pregnancy, we propose that metabolic imbalances may occur that result in organogenetic congenital defects in offspring of apparently normal gravid women.

Abnormalities, Multiple↗
PubMed1996

The prevalence of urinary incontinence or prolapse among white and Hispanic women.

OBJECTIVE: Our purpose was to study the distribution of symptoms and disorders of urinary incontinence or prolapse among white and Hispanic women. STUDY DESIGN: Data were collected for all new patients referred to the urogynecology clinic over a 2-year period. One hundred twenty-one Hispanic and 50 white women consecutively referred to the urogynecology clinic as new patients over 2 years were included in the study. All patients underwent a detailed history and physical examination and multichannel urodynamic studies. Differences between the two groups were analyzed for significant differences by use of demographic data, presenting symptoms, urodynamic profiles, and final diagnosis or disorder. RESULTS: The symptoms of stress, urge, or mixed incontinence and prolapse were noted in 26%, 18%, 30%, and 14% of white women, respectively, compared with 41%, 9%, 21%, and 26% of Hispanic women (p=0.019). The diagnosis of genuine stress incontinence, motor urge incontinence, mixed incontinence, and pelvic organ prolapse without incontinence was made, respectively, in 16%, 44%, 6%, and 18% of white women versus 30%, 27%, 5%, and 18% of Hispanic women (p=0.33). The nondiagnostic rate after a complete evaluation for both groups was 10%. Hispanic women were of significantly higher gravidity (5.6 vs 3.8, p=0.001) and parity (4.7 vs 3.0, p=0.0006) than white women but were of comparable age. Medical problems and medications were too infrequent to allow meaningful comparison. White women were much more likely to have undergone a hysterectomy (36% vs 11.5%, p=0.0004, 95% confidence interval 1.8 to 10.3). CONCLUSION: Although the distribution of presenting symptoms of incontinence differs between Hispanic and white women, the final diagnosis after a complete urogynecologic evaluation was similar. Therefore presenting complaints in patients of different ethnic groups appears to be a poor predictor of the type of incontinence. Hispanic women were of higher gravidity and parity than white women were, but white women were more likely to have undergone a hysterectomy. Because the power of this study was limited by the 50 white women, larger prospective and longitudinal studies are needed to determine the significance of possible difference in etiologic factors.

Adult↗
PubMed1997

Hyperemesis gravidarum: is serotonin implicated?

Serotonin excretion was investigated in the nausea and vomiting associated with hyperemesis gravidarum. Urinary hydroxyindoleacetic acid was measured in 13 gravid women with hyperemesis gravidarum, 10 gravid women without nausea and vomiting, and 10 nongravid women of similar age not taking contraceptive pills. No significant difference in the urinary excretion of hydroxyindoleacetic acid was found among the groups. Hyperemesis gravidarum is not associated with an increase of serotonin secretion.

Female↗
PubMed1998

Transvaginal versus transperineal ultrasonography: a blinded comparison in the assessment of cervical length at midgestation.

OBJECTIVE: The study's objective was to determine the correlation and agreement between transperineal ultrasonography and transvaginal ultrasonography in the assessment of cervical length in gravid patients. STUDY DESIGN: After a pilot, unblinded series of transperineal and transvaginal cervical length measurements in 200 gravid patients, 206 study patients between 14 and 34 weeks' gestation with intact membranes and cervical dilatation of < or = 2 cm underwent transperineal and transvaginal cervical length assessment under a blinded, 2-sonographer protocol. The Pearson correlation coefficient, Lin concordance coefficient, and Bland-Altman plot were used. Acceptable concordance was defined as > 0.82, with an acceptable correlation of > 0.9 and an acceptable difference between the means of < 3 mm. The power of the study to detect this degree of concordance was estimated to be 95% at this sample size. RESULTS: Paired ultrasonographic measurements were obtained for all 206 study patients. Transperineal mean cervical length was 35 +/- 8.6 mm. Transvaginal mean cervical length was 35.9 +/- 8.8 mm. The Pearson correlation coefficient was 0.959, and the Lin concordance coefficient was 0.955, with a 95% confidence lower bound of 0.949. Close agreement between transperineal and transvaginal measurements was observed across the full range of cervical lengths (1-5 cm). The estimated difference between the paired means was 1 mm. The 95% tolerance interval for any given paired observation (Transperineal length - Transvaginal length) was -5.7 to +4 mm. CONCLUSIONS: Cervical length measured by transperineal ultrasonography demonstrates close correlation and agreement with transvaginal measurements. With sonographer experience and optimal technique, approximately 95% of transperineal cervical length observations can be expected to be within 5 mm of a given paired transvaginal measurement. Transperineal ultrasonography may be a preferred method of cervical length assessment for situations in which vaginal placement of instruments should be minimized.

Cervix Uteri↗