Electrical pacemaker as a safe and feasible method for decreasing the uterine contractions of human preterm labor.

AIM: The aim of the study was to test the safety and feasibility of a system designed to decrease the uterine contractions of human preterm labor using a weak electrical current. METHODS: Patients in preterm labor had an electrode catheter placed in the posterior vaginal fornix and attached to an electrical pacemaker. Contraction intervals were determined during the 60-min study, in which minutes 0-20 was the preintervention control period (C1); 21-40 was the electrical intervention (EI), with a 10-s burst of current administered just before each expected contraction; and 41-60 was the postintervention control (C2). Mean intervals were calculated and compared mixed-model ANOVA. RESULTS: Five patients were studied. No maternal or fetal vital sign irregularities were seen. All the babies had a normal neonatal intensive care unit stay for gestational age. The respective mean contraction intervals for C1, EI, and C2 and their within- and between-subject standard deviations were 4.64 (±0.81, ±2.45), 5.71 (±3.03, ±1.62), and 3.83 (±0.83, ±1.31) min. There was a significant difference between EI and C2 (P=0.0078) and no difference between C1 and C2 or between EI and C1 (P=0.1373). CONCLUSIONS: EI appears to be a safe and feasible method for decreasing preterm contractions. To confirm and test effectiveness, longer interventions and additional cases are needed.

Tenofovir disoproxil fumarate for prevention of vertical transmission of hepatitis B virus infection by highly viremic pregnant women: a case series.

BACKGROUND: Despite appropriate immunoprophylaxis, up to 10 % of infants born to highly viremic hepatitis B virus (HBV-DNA ≥ 7 log IU/mL) mothers are infected with HBV. Use of TDF to prevent vertical transmission (VT) by such mothers has not been evaluated. PURPOSE: To evaluate the efficacy and safety of TDF in preventing VT from highly viremic HBV-infected mothers. METHODS: Data were collected retrospectively from HBV mono-infected, hepatitis B e antigen (HBeAg) positive, pregnant women between 6/2008 and 11/2010. Cases enrolled were HBV mono-infected mothers who received TDF (300 mg orally once a day) in the third trimester. Those with pregnancy complications or an abnormal fetus on sonography were excluded from use of TDF. All infants received hepatitis B immunoglobulin and vaccination at birth and subsequently. RESULTS: Eleven Asian mothers received TDF at the median gestational age of 29 (28-32) weeks and the median duration of TDF use before delivery was 10 (7-12) weeks. A significant reduction in serum HBV-DNA was achieved at delivery compared with baseline (mean 5.25 ± 1.79 vs. 8.87 ± 0.45 log(10) copies/mL, respectively; p < 0.01). Three had serum ALT levels more than 1.5 times the upper limit of normal and two of these normalized before delivery. The 11 infants were born with no obstetric complication or birth defects. Five infants were breastfed. All infants were hepatitis B surface antigen negative 28-36 weeks after birth. CONCLUSION: Our preliminary data suggest that TDF use in the third trimester is safe, and effectively prevents VT of HBV from high viremic HBeAg-positive mothers.

Bile acid ratio in diagnosis of intrahepatic cholestasis of pregnancy.

We sought to determine if the bile acid ratio of cholic acid to chenodeoxycholic acid (CA:CDCA) is an important component for diagnosis of intrahepatic cholestasis of pregnancy (ICP). We assessed the addition of bile acid CA:CDCA ratio information in diagnosing ICP in a database of patients evaluated for ICP by serum bile acids and hepatic transaminases. Patients were considered to test positive for ICP if there was elevation in total bile acid, CA:CDCA ratio, or transaminase. Of 231 specimens evaluated for ICP with bile acid and transaminases, 17.1% had elevated total bile acids, 29.4% had elevated transaminase, and 8.2% had an elevated bile acid ratio. Most specimens with elevated bile acid ratio also had elevated total bile acid; 35.5% of specimens tested positive by total bile acid and/or transaminases, increasing minimally to 35.9% with bile acid ratio information. Similar results were found using lower total bile acid and bile acid ratio thresholds. The bile acid CA:CDCA ratio contributed little to the diagnosis of ICP. The use of total bile acid and hepatic transaminases without bile acid ratios decreased positive tests by less than 2%.

Intrahepatic cholestasis of pregnancy: detection with urinary bile acid assays.

AIMS: To determine sensitivity and specificity of urine bile acid sulfate (UBAS) and non-sulfated urine bile acid (UBA) assays for detection of intrahepatic cholestasis of pregnancy (ICP). METHODS: Urine was collected prospectively from healthy and pruritic patients evaluated for ICP. Results were expressed as a ratio to urinary creatinine. RESULTS: Of 20 patients evaluated for ICP, 14 had confirmed ICP by serum testing and six had pruritus only. UBAS results were higher with ICP (P<0.001) and increased with gestational age in healthy controls. Adjusted for gestational age, the multiples of the median (MoM) were still higher (2.64+/-1.11, 1.05+/-0.54, P<0.001). The sensitivity was 100% and specificity 83% at 1.5 MoM in pruritic patients. UBA results were higher with ICP (23.0+/-9.8, 12.8+/-7.4, P<0.001), with sensitivity of 100% and specificity of 50% at 10.2 micromol/g cretinine. CONCLUSION: Urinary bile acids can detect or exclude ICP with serum abnormalities. Urine bile acid sulfates have higher specificity than non-sulfated urine bile acids at equivalent sensitivities, but co-detection of progestin sulfates is suspected.

Medical legal issues in the prevention of prematurity.

Preterm birth remains the leading cause of neonatal morbidity and mortality in the world today. This article discusses ways the treatment team can inform parents of probable outcomes and help them reach decisions about treatment for the newborn under emotionally fraught conditions. In addition to supporting the patient, these approaches may help the clinician avoid malpractice litigation.