Hypertensive Disorders of Pregnancy.

According to the American College of Obstetricians and Gynecologists (ACOG), women who have a systolic blood pressure ≥ 140 mm Hg and/or a diastolic pressure ≥ 90 mm Hg before pregnancy or before 20 weeks of gestation have chronic hypertension. Up to 1.5% of women in their childbearing years have a diagnosis of chronic hypertension, and 16% of pregnant women develop hypertension during their pregnancy. Physiological cardiovascular changes from pregnancy may mask or exacerbate hypertensive diseases during gestation, which is why prepregnancy counseling is emphasized for all patients to optimize comorbidities and establish a patient's baseline blood pressure. This review provides an overview of the diagnoses and treatments of hypertensive diseases that can occur in pregnancy, including definitions of key terms and types of hypertension as well as ACOG recommendations.

Safety and efficacy of ketamine-augmented electroconvulsive therapy in third trimester pregnancy complicated by COVID-19.

Major depressive disorder during pregnancy can be detrimental to the fetus and patient. Treatments can include electroconvulsive therapy (ECT) for severe cases. The use of ketamine in ECT can provide symptomatic relief as well as induce anesthesia. Here, we describe the case of a 35-year-old gravid woman with a long-standing history of major depressive disorder who presented with treatment-resistant depression with suicidal ideation after an alteration in her antidepressant medication. After psychiatric evaluation, she was deemed to be a good candidate for ECT augmented with ketamine for symptomatic relief. This was complicated by an positive but asymptomatic COVID-19 status. Despite these factors, the patient experienced significant relief after an eight-treatment course of ECT, with a reduction of her PHQ-9 score from 22/27 to 4/27 points.

Non-16/18 high-risk HPV infection predicts disease persistence and progression in women with an initial interpretation of LSIL.

BACKGROUND: The current management strategy for women with low-grade squamous intraepithelial lesions (LSILs) is inefficient and expensive because of the inability to identify patients at high risk for disease progression. The current study was designed to determine the genotypic patterns of human papillomavirus (HPV) associated with the persistence and progression of cervical lesions in women with an initial interpretation of LSIL. METHODS: One hundred sixty-seven women with LSIL on Papanicolaou tests collected between December 1, 2009 and March 30, 2011 were studied. HPV DNA was extracted from residual SurePath specimens, genotypes were determined with a DNA microarray containing 40 HPV genotype probes, and microarray data were confirmed by sequencing. Follow-up Papanicolaou tests and/or biopsies were performed within a 20- to 46-month period after the initial diagnosis. RESULTS: Ninety-seven of the 167 cases with follow-up results were included in the study. Compared with the women with a regressed cervical lesion, those with a persistent cervical lesion (PCL) were significantly more commonly infected with high-risk human papillomavirus (HR-HPV) genotypes (P < .01) and particularly with non-16/18 HR-HPV genotypes (P < .05). The PCL group also had a significantly higher average number of HR-HPV genotypes and non-16/18 HPV genotypes per specimen (P < .01). Infection with HPV-16/18 genotypes was not significantly associated with the persistence or progression of cervical lesions. CONCLUSIONS: Infection with non-16/18 HR-HPV genotypes but not with HPV-16/18 genotypes was a strong predictor of the persistence and progression of cervical disease upon follow-up. Genotyping solely for HPV-16/18 would miss the majority of patients with LSIL who progress to high-grade squamous intraepithelial lesions. Pooled HR-HPV tests provide a better predictive value than HPV-16/18 genotyping alone in guiding the clinical management of patients with LSIL.

Factors associated with a lack of pap smear utilization in women exposed in utero to diethylstilbestrol.

BACKGROUND: Women in the 1940s-1960s were prescribed diethylstilbestrol (DES), a nonsteroidal estrogen, to prevent miscarriages, but the practice was terminated after it was discovered that the daughters so exposed in utero were at increased risk for developing clear cell adenocarcinoma (CCA) of the vagina or cervix at early ages. Pap smear screening is one of the principal methods used to identify tumor development and is necessary in this group of women to maintain their health. Currently, little is known about the factors associated with nonutilization of this screening tool in this high-risk population of women. METHODS: National cohort data from the National Cancer Institute (NCI) DES Combined Cohort Follow-up Study during 1994, 1997, 2001, and 2006 were used to determine which factors were associated with Pap smear screening nonutilization in 2006 among DES-exposed and unexposed women. Self-reported questionnaire data from 2,861 DES-exposed and 1,027 unexposed women were analyzed using binary logistic regression models. RESULTS: DES exposure, not having a previous gynecologic dysplasia diagnosis, lack of insurance, originating cohort, increasing age, and previous screening behavior were all factors associated with not reporting a Pap smear examination in the 2006 questionnaire, although college education reduced nonutilization. CONCLUSIONS: Understanding which factors are associated with not acquiring a screening exam can help clinicians better identify which DES-exposed women are at risk for nonutilization and possibly tailor their standard of care to aid in the early detection of cervical and vaginal adenocarcinomas in this high-risk group.

Genotype-specific prevalence and distribution of human papillomavirus genotypes in underserved Latino women with abnormal Papanicolaou tests.

INTRODUCTION: Knowledge about the prevalence and distribution of human papillomavirus (HPV) genotypes in cervical premalignant and malignant lesions is crucial to guide development of clinical management strategies and prophylactic vaccines. The aim of this study was to determine HPV genotype-specific prevalence and distribution in an underserved cohort of Latino women. MATERIALS AND METHODS: From December 2009 to April 2011, 808 SurePath cervicovaginal specimens were collected from women who were referred from charity clinics for abnormal Papanicolaou tests. The patients' average age was 36.5 years (range 19-85 years). The specimens were tested for HPV genotypes by DNA microarray and sequencing assays. RESULTS: The HPV infection rate was extremely high (93% for any HPV and 64% for high-risk [HR]-HPV), with frequent multiple-strain infection (39%). Younger age (<30 years) was associated with frequent HR-HPV infection, multiple strain infections, and cytologic abnormalities. When compared with previous reports, HPV 16 remained the most common genotype (44.6%) in women with high-grade squamous intraepithelial lesion; however, a significant increase in HPV 31 (17.9%) and 45 (10.7%) and a decrease in HPV 35, 52, 33, and 66 were observed. CONCLUSIONS: The HPV genotype-specific prevalence and distribution pattern in this cohort of underserved Latino women differed significantly from previously published data in the United States. Understanding the potentially changing trends in HPV distribution pattern will help guide the development of appropriate preventive and therapeutic strategies for both underserved and general populations.

Postoperative small bowel obstruction associated with use of hemostatic agents.

A case of early postoperative small bowel obstruction (SBO) after intraoperative use of hemostatic agents during laparoscopic staging for endometrial cancer is reported. A 46-year-old woman underwent a laparoscopic staging procedure for endometrial cancer during which hemostatic agents were used in the management of an iatrogenic injury to the inferior vena cava. The patient returned on postoperative day 6 with SBO and was taken to the operating department. She required a small bowel resection in the specific area where the hemostatic agents were used. Pathology showed extensive fibrotic changes caused by a foreign material that was suggestive of a thrombin-related product. Use of hemostatic agents should be considered as a cause in the differential diagnosis of patients with early postoperative SBO.