Maternal arrhythmia and perinatal outcomes.

OBJECTIVE: The objective of this study was to determine whether arrhythmia in the setting of maternal cardiac disease (MCD) affects perinatal outcomes. STUDY DESIGN: This is a retrospective cohort study of pregnant women with MCD who delivered during 2008 to 2013. Perinatal outcomes among women with an arrhythmia were compared with those without. RESULTS: Among 143 women, 36 (25%) had an arrhythmia. Those with an arrhythmia were more likely to have a spontaneous vaginal delivery (64 vs 43%, P<0.05) and required fewer operative vaginal births (8 vs 27%, P=0.02). Pregnancies were more likely to be complicated by intrauterine growth restriction (IUGR) (17 vs 5%, P<0.05), although there were no differences in the rate of small for gestational age. The risk of IUGR remained increased after controlling for confounding (adjusted odds ratio 6.98, 95% confidence interval 1.59 to 30.79, P=0.01). Two cases of placental abruption were identified among mothers with arrhythmia while none were identified in the controls (P<0.05). CONCLUSION: Patients with arrhythmias were more likely to have a spontaneous vaginal delivery. Our data suggest that these pregnancies were an increased risk for IUGR.

Coagulopathy secondary to vitamin K deficiency in hyperemesis gravidarum.

BACKGROUND: Hyperemesis gravidarum is a condition of pregnancy characterized by excessive nausea and vomiting, which can be associated with malnutrition. Vitamin K deficiency is a known complication of malnutrition as well as a known cause of coagulopathy. To date, there is no reported case in the literature of vitamin K deficiency in hyperemesis gravidarum. CASE: A woman at 15 weeks' gestation presented with hyperemesis gravidarum complicated by an episode of severe epistaxis. Investigation revealed coagulopathy secondary to vitamin K deficiency. The coagulopathy resolved after vitamin K replacement, with complete correction of all clotting factors. CONCLUSION: Vitamin K deficiency and coagulopathy should be considered in women with hyperemesis gravidarum who present with a bleeding diathesis. Prophylactic vitamin K replacement should be considered in cases in which hyperemesis is severe and protracted.

Apoptosis in human term placenta. A morphological and gene expression study.

The objective of this study was to examine placentas after delivery from normal, healthy patients at term gestation. The placentas were from elective cesarean sections (n = 10, prior to the onset of labor) and spontaneous vaginal delivery (n = 10, after labor). We found that deoxyribonucleic acid laddering was present in all placentas and consistent with the pattern found in tissues that undergo apoptosis. Paraffin-embedded sections of placental villi stained by the in situ terminal deoxynucleotidyl transferase mediated biotinylated dUTP nick end labeling method revealed positive apoptotic nuclei in the placental villi. Reverse-transcriptase polymerase chain reaction demonstrated expression of messenger RNA for testosterone-repressed prostate message 2 and B cell lymphoma/leukemia-2 in the placenta. Our data demonstrate that apoptosis occurs in human term placenta.

Localization and timing of appearance of insulin, insulin-like growth factor-I, and their receptors in the human fetal müllerian tract.

OBJECTIVE: The factors that regulate fetal müllerian tract development are still unknown. Insulin and insulin-like growth factor-I are peptides postulated to serve as autocrine or paracrine regulators of cell activity. We have previously demonstrated that messenger ribonucleic acid for insulin and insulin-like growth factor-I receptors are expressed in fetal uterine tissues. We undertook this study to determine by immunohistochemical techniques the exact location of these two growth factors and their receptors in the human fetal uterus. STUDY DESIGN: We obtained freshly discarded human fetal uteri (n = 12) between 15 and 22 weeks of gestation from elective pregnancy terminations. Frozen-section specimens were incubated with antibodies against insulin, insulin-like growth factor-I, insulin receptor, and insulin-like growth factor-I receptor. These sections were then incubated with a second antibody conjugated to fluorescein isothiocyanate and examined under phase and fluorescent microscopy. RESULTS: The fetal endometrium at 19 and 22 weeks of gestation contained insulin, insulin-like growth factor-I, insulin receptor, and insulin-like growth factor-I receptor. The distribution of immunofluorescence in the endometrium is similar for both insulin and its receptor. The same pattern of immunostaining was likewise demonstrated for insulin-like growth factor-I and its receptor. CONCLUSION: The localization of these growth factors and their receptors, combined with our previous messenger ribonucleic acid data, suggest an autocrine or paracrine role for insulin and insulin-like growth factor-I in the developing human fetal müllerian tract.

Inhaled nitric oxide therapy in pregnancy complicated by pulmonary hypertension.

The use of nitric oxide as an agent to reduce pulmonary artery pressure in a pregnancy complicated by pulmonary hypertension is reported for the first time. This therapy can reduce pulmonary vascular resistance and therefore potentially enable the right ventricle to better compensate for the physiologic changes of pregnancy.