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Ondersma SJ, Beatty JR, Puder KS, Janisse J, Svikis DS. Feasibility and Acceptability of e-Screening and Brief Intervention and Tailored Text Messaging for Marijuana Use in Pregnancy. J Womens Health (Larchmt) 2019; 28:1295-1301. [PMID: 30657434 PMCID: PMC6743084 DOI: 10.1089/jwh.2018.7169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: There are at present no evidence-based interventions for marijuana use during pregnancy, despite it being by far the most commonly used illicit drug during pregnancy. Lack of treatment-seeking, combined with implementation challenges, has limited the extent to which at-risk women receive interventions of any kind. This study sought to evaluate the feasibility and acceptability of two high-reach technology-based interventions: electronic screening and brief intervention (e-SBI) and tailored text messaging, delivered either alone or in combination. Materials and Methods: In this exploratory feasibility trial, pregnant women seeking prenatal care services and scoring positive for marijuana use risk (n = 45) were randomly assigned to e-SBI, text messaging, or e-SBI plus text messaging. We examined completion rates and acceptability ratings as a function of intervention condition and participant characteristics. Results: All participants assigned to receive the e-SBI (n = 30) were able to complete it during the in-clinic baseline session. Participants assigned to text messaging (n = 30) received a median of 24 text messages before giving birth; 6 of 30 (20%) chose to end text messages before giving birth. Acceptability ratings for the e-SBI were high, with most being above 4.4 on a 5-point scale (e.g., for ease of use, respectfulness, and helpfulness). Acceptability ratings for some aspects of the texting intervention were also high (e.g., for ease of understanding and respectfulness). Participants in the combined e-SBI plus texting condition chose to stop messages at a rate of 13.3% (2 of 15), versus 26.7% (4 of 15) in the texting-only condition (p = 0.37). Conclusions: These two high-reach intervention elements showed strong feasibility and modest to high acceptability. Future efforts evaluating efficacy are warranted, and should specifically examine the possibility that combining text messaging with a brief intervention may promote retention.
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Affiliation(s)
- Steven J. Ondersma
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, Detroit, Michigan
| | - Jessica R. Beatty
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan
| | - Karoline S. Puder
- Department of Obstetrics & Gynecology, Wayne State University, Detroit, Michigan
| | - James Janisse
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | - Dace S. Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
- Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, Virginia
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Gray J, Beatty JR, Svikis DS, Puder KS, Resnicow K, Konkel J, Rice S, McGoron L, Ondersma SJ. Electronic Brief Intervention and Text Messaging for Marijuana Use During Pregnancy: Initial Acceptability of Patients and Providers. JMIR Mhealth Uhealth 2017; 5:e172. [PMID: 29117931 PMCID: PMC5700401 DOI: 10.2196/mhealth.7927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/23/2017] [Accepted: 09/10/2017] [Indexed: 12/23/2022] Open
Abstract
Background Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples but have not yet been applied to marijuana use in pregnancy. Objective The objective of the study was to evaluate, among pregnant women and prenatal care providers, the acceptability of an electronic brief intervention and text messaging plan for marijuana use in pregnancy. Methods Participants included patients (n=10) and medical staff (n=12) from an urban prenatal clinic. Patient-participants were recruited directly during a prenatal care visit. Those who were eligible reviewed the interventions individually and provided quantitative and qualitative feedback regarding software acceptability and helpfulness during a one-on-one interview with research staff. Provider-participants took part in focus groups in which the intervention materials were reviewed and discussed. Qualitative and focus group feedback was transcribed, coded manually, and classified by category and theme. Results Patient-participants provided high ratings for satisfaction, with mean ratings for respectfulness, interest, ease of use, and helpfulness ranging between 4.4 and 4.7 on a 5-point Likert scale. Of the 10 participants, 5 reported that they preferred working with the program versus their doctor, and 9 of 10 said the intervention made them more likely to reduce their marijuana use. Provider-participants received the program favorably, stating the information presented was both relevant and important for their patient population. Conclusions The findings support the acceptability of electronic brief intervention and text messaging for marijuana use during pregnancy. This, combined with their ease of use and low barrier to initiation, suggests that further evaluation in a randomized trial is appropriate.
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Affiliation(s)
- Justin Gray
- Merrill Palmer Skillman Institute, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Jessica R Beatty
- Merrill Palmer Skillman Institute, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Dace S Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States.,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States.,Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
| | - Karoline S Puder
- School of Medicine, Department of Obstetrics and Gynecology, Wayne State Unviersity, Detroit, MI, United States
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Janine Konkel
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Shetoya Rice
- Merrill Palmer Skillman Institute, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Lucy McGoron
- Merrill Palmer Skillman Institute, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Steven J Ondersma
- Merrill Palmer Skillman Institute, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
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Huang B, Faucette AN, Pawlitz MD, Pei B, Goyert JW, Zhou JZ, El-Hage NG, Deng J, Lin J, Yao F, Dewar RS, Jassal JS, Sandberg ML, Dai J, Cols M, Shen C, Polin LA, Nichols RA, Jones TB, Bluth MH, Puder KS, Gonik B, Nayak NR, Puscheck E, Wei WZ, Cerutti A, Colonna M, Chen K. Interleukin-33-induced expression of PIBF1 by decidual B cells protects against preterm labor. Nat Med 2017; 23:128-135. [PMID: 27918564 PMCID: PMC5512431 DOI: 10.1038/nm.4244] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/03/2016] [Indexed: 12/12/2022]
Abstract
Preterm birth (PTB) is a leading cause of neonatal death worldwide. Intrauterine and systemic infection and inflammation cause 30-40% of spontaneous preterm labor (PTL), which precedes PTB. Although antibody production is a major immune defense mechanism against infection, and B cell dysfunction has been implicated in pregnancy complications associated with PTL, the functions of B cells in pregnancy are not well known. We found that choriodecidua of women undergoing spontaneous PTL harbored functionally altered B cell populations. B cell-deficient mice were markedly more susceptible than wild-type (WT) mice to PTL after inflammation, but B cells conferred interleukin (IL)-10-independent protection against PTL. B cell deficiency in mice resulted in a lower uterine level of active progesterone-induced blocking factor 1 (PIBF1), and therapeutic administration of PIBF1 mitigated PTL and uterine inflammation in B cell-deficient mice. B cells are a significant producer of PIBF1 in human choriodecidua and mouse uterus in late gestation. PIBF1 expression by B cells is induced by the mucosal alarmin IL-33 (ref. 9). Human PTL was associated with diminished expression of the α-chain of IL-33 receptor on choriodecidual B cells and a lower level of active PIBF1 in late gestation choriodecidua. These results define a vital regulatory cascade involving IL-33, decidual B cells and PIBF1 in safeguarding term pregnancy and suggest new therapeutic approaches based on IL-33 and PIBF1 to prevent human PTL.
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Affiliation(s)
- Bihui Huang
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Azure N Faucette
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Michael D Pawlitz
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Bo Pei
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Joshua W Goyert
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Jordan Zheng Zhou
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Nadim G El-Hage
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Jie Deng
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason Lin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Fayi Yao
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Robert S Dewar
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Japnam S Jassal
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Maxwell L Sandberg
- Leadership in Medicine Program, Union College, Schenectady, New York, USA
| | - Jing Dai
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Montserrat Cols
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cong Shen
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lisa A Polin
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
| | - Ronald A Nichols
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology-Med Ed, Beaumont Dearborn Hospital, Dearborn, Michigan, USA
| | - Theodore B Jones
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology-Med Ed, Beaumont Dearborn Hospital, Dearborn, Michigan, USA
| | - Martin H Bluth
- Department of Pathology, Wayne State University, Detroit, Michigan, USA
| | - Karoline S Puder
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Bernard Gonik
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Nihar R Nayak
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Elizabeth Puscheck
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Wei-Zen Wei
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
| | - Andrea Cerutti
- Catalan Institute for Research and Advanced Studies, Barcelona Biomedical Research Park, Barcelona, Spain
- Program for Inflammatory and Cardiovascular Disorders, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
- Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Mucosal Immunology Studies Team, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Marco Colonna
- Mucosal Immunology Studies Team, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kang Chen
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
- Mucosal Immunology Studies Team, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Abstract
This study sought to identify delivery complications associated with stillbirth labour and delivery. We conducted a retrospective chart review evaluating stillbirth demographics, pregnancy and maternal risk factors, and complications of labour and delivery. We performed bivariable analysis and multivariable logistic regression to evaluate factors associated with medical complications and variations by race. Our cohort included 543 mothers with stillbirth, of which two-thirds were African-American. We noted high rates of shoulder dystocia, clinical chorioamnionitis, postpartum haemorrhage and retained placenta in women with stillbirths. Thirty-three women (6%) experienced at least one serious maternal complication. Complication rates did not vary by maternal race. Providers who perform obstetrical care should be alert to the high rate of maternal medical complications associated with labour and delivery of a stillbirth foetus.
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Affiliation(s)
- K J Gold
- a Department of Family Medicine and Department of Obstetrics and Gynecology , University of Michigan , US
| | - E L Mozurkewich
- b Department of Obstetrics and Gynecology , University of New Mexico , US
| | - K S Puder
- c Department of Obstetrics and Gynecology , Wayne State University , US
| | - M C Treadwell
- d Department of Obstetrics and Gynecology , University of Michigan , US
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Schimp VL, Hallak M, Puder KS, Orabi N, Gonik B. Multiple brain infarcts associated with severe preeclampsia. J Stroke Cerebrovasc Dis 2007; 10:244-6. [PMID: 17903833 DOI: 10.1053/jscd.2001.26855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2000] [Indexed: 11/11/2022] Open
Abstract
Posterior occipital and parietal lobe infarcts shown by computed tomography (CT) scan and magnetic resonance imaging have been associated with eclampsia. Gray-white matter, infarct-like lesions of the right basal ganglia, right posterior parietal, and left posterior parieto-occipital lobes were found by CT scan in a patient at 26 weeks gestation with severe preeclampsia and neurologic deficits. A magnetic resonance image taken 3 days postpartum had similar abnormalities, despite total resolution of the patient's symptomatology. A repeat CT scan performed 6 weeks postpartum showed complete resolution of the multiple infarctions. This is a unique case report that describes these severe brain-imaging findings in a patient with severe preeclampsia and neurologic deficits.
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Affiliation(s)
- V L Schimp
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
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Abstract
BACKGROUND: Pertussis is a highly communicable, vaccine-preventable respiratory disease. Although the largest number of reported cases is among young infants, the most rapidly increasing incidence in the USA is in adolescents and young adults. Importantly, adult family members are the likely major reservoir, infecting susceptible infants before completion of childhood vaccination. We studied maternal-neonatal paired blood samples for the presence of pertussis-related antibodies to assess level of immunity and passive transplacental antibody passage. METHODS. Unselected maternal-neonatal cord blood samples were collected from 101 term deliveries in a single urban uninsured/underinsured hospital setting. Sera were analyzed for anti-pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (PRN) IgG antibodies by enzyme-linked immunosorbent assay (ELISA). Antibody titers were calculated using reference line methodology. Antibody values were log-transformed to establish geometric mean titers (GMT) for analysis. Student's t-test, Mann-Whitney, Pearson correlation and chi square were used for statistical comparisons as appropriate. RESULTS. Mean (SD) maternal age, gestational age and birth weight were 26.8 (6.8) years, 38.9 (1.4) weeks and 3239 (501) g, respectively. Detectable maternal levels of anti-PT, FHA and PRN were found in 34.7%, 95.0% and 80.2%, respectively. Maternal GMT (SD) for PT, FHA and PRN were 4.4 (2.6), 26.6 (3.1) and 12.3 (2.9), respectively. There was no significant relationship between PT, FHA or PRN detection or antibody GMT and maternal age. Maternal anti-PT, FHA and PRN were highly correlated with neonatal cord blood values. CONCLUSION: Despite previous childhood immunization, a large number of parous women have low or undetectable pertussis-related antibody levels, suggesting susceptibility to infection. Even with efficient transplacental passage of these antibodies, neonates similarly have limited measurable protection as detected by cord blood sampling. These data support the need for adolescent or adult vaccination against Bordetella pertussis. Healthcare providers and their clients should be aware of the risk for infant infection via family member transmission.
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Affiliation(s)
- Bernard Gonik
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48235, USA.
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7
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Jin B, Al-Abbadi MA, Puder KS. Pathologic quiz case: a 32-year-old woman with an abnormal female fetus at 19 weeks of gestation. Cyclopia. Arch Pathol Lab Med 2005; 129:e19-20. [PMID: 15628921 DOI: 10.5858/2005-129-e19-pqcayw] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Bo Jin
- Department of Pathology, Sinai-Grace Hospital, Detroit, MI 48235, USA.
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Abstract
OBJECTIVE To evaluate the prevalence and trend of folic acid awareness among Michigan mothers during 1996-1999 and to identify maternal characteristics predictive of folic acid awareness. METHODS We analyzed data from the Michigan Pregnancy Risk Assessment Monitoring System, a population-based survey of women with recent live births. A positive response to the question, "Before you became pregnant, did you know that folic acid could help prevent some birth defects?" was used as an indicator of folic acid awareness. Logistic regression was used to evaluate trends in folic acid awareness prevalence and the association between folic acid awareness and certain maternal characteristics. RESULTS Of the women invited to participate, 7252 responded (67.3%). Overall, folic acid awareness increased from 1996 to 1999 (60.3-71.4%; P < .001). However, folic acid awareness decreased for women with no high school education from 1997 to 1999 (59.3-13.8%, P = .05). In addition, folic acid awareness was lower among black women (adjusted odds ratio [OR] 0.43; 95% confidence interval [CI] 0.4, 0.5, versus other races), women with unplanned pregnancies (adjusted OR 0.6; 95% CI 0.5, 0.8, versus those with planned pregnancies), and those with no high school education (adjusted OR 0.08; 95% CI 0.03, 0.2, versus women with college education). CONCLUSION Although folic acid awareness has increased among Michigan mothers overall during 1996-1999, it has decreased among women with less than a high school education, and substantial gaps exist among socioeconomic subgroups. Continued efforts are needed to improve folic acid awareness and consumption of folic acid among women of reproductive age, with special attention focused on populations experiencing gaps or declines in folic acid awareness.
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Affiliation(s)
- Chidinma N Alozie Arole
- Epidemic Intelligence Service (assigned to the Michigan Department of Community Health), Epidemiology Program Office, USA.
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9
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Abstract
BACKGROUND Incarceration of the gravid uterus occurs in the early second trimester in approximately one in 3000 pregnancies. If conventional manual attempts at restoring the uterine fundus to the anterior position are unsuccessful, correction by an invasive laparotomy procedure is necessary. We describe a minimally invasive technique to dislodge the incarcerated gravid uterus. TECHNIQUE Gravid patients with an incarcerated uterus refractory to manual reduction are administered sedation, and one to two enemas. After sedation, manual reduction is attempted again. If unsuccessful, a colonoscope is passed above the level of the uterine fundus generating external anterior forces, which dislodge the uterus from beneath the sacral promontory. EXPERIENCE The procedure was performed six times in five patients. One patient required a second procedure because of recurrence of the condition. All procedures were successful. No pregnancy losses occurred after the procedure, and no complications of colonoscopy were encountered. CONCLUSION Colonoscopic release of the incarcerated gravid uterus is an option when attempts at manual reduction fail. This procedure may avoid laparotomy to correct this condition.
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Abstract
OBJECTIVE Inflammation on Papanicolaou (Pap) smear has been associated with a 30-50% incidence of bacterial vaginosis (BV), a recognized risk factor for preterm delivery. We determined whether inflammation on Pap smear is associated with preterm delivery. STUDY DESIGN 5,348 cases were studied with complete prenatal data including the potential confounder of treatment with antibiotics. Cases were categorized by presence (n = 1,139) or absence (n = 4,209) of inflammation on Pap smear. RESULTS In the inflammation group the proportion of African Americans was lower (66.9 vs. 74.5%; p < 0.001). There were no significant differences (t test) for maternal age, gravidity, history of preterm delivery, or gestational age at delivery between inflammation and noninflammation groups. Multiple stepwise regression analysis showed that maternal age, history of preterm delivery, and African American race were all significantly positively associated with preterm delivery. Treatment with metronidazole during the pregnancy was significantly negatively associated with preterm delivery. Inflammation on Pap smear, gonorrhea detected during the pregnancy and prenatal treatment with erythromycin were not associated. CONCLUSION Unlike bacterial vaginosis, inflammation on routine Pap smear does not appear to be a risk for subsequent preterm birth. We are unable to use inflammation on Pap smear as a surrogate for more specific diagnosis of bacterial vaginosis.
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Affiliation(s)
- J M Lanouette
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Mich., USA
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11
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Hallak M, Sachar V, Puder KS, Lauria MR, Tomlinson M, Gonik B. Early puerperal vaginal ultrasonography (US) of the post cesarean uterus. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80545-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Berry SM, Romero R, Gomez R, Puder KS, Ghezzi F, Cotton DB, Bianchi DW. Premature parturition is characterized by in utero activation of the fetal immune system. Am J Obstet Gynecol 1995; 173:1315-20. [PMID: 7485345 DOI: 10.1016/0002-9378(95)91378-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE At birth the fetus emerges from a sterile environment into a nonsterile one. This process is associated with activation of the fetal immune system which protects the fetus against infection in the newborn period. We conducted this study to determine whether activation of the monocyte-neutrophil system occurs in fetuses before premature birth. STUDY DESIGN Forty patients in premature labor with intact membranes underwent cordocentesis for research purposes. Fetal blood was analyzed with the use of flow cytometry to measure the cell surface markers CD11c, CD13, CD15, and CD67, which are associated with monocyte and neutrophil activation, and CD14 and CD63, which were used as controls. RESULTS Twenty-eight percent (11/40) of the infants were delivered prematurely within 72 hours of entering the study while the remainder were delivered at term. Our data clearly indicate that premature infants delivered within 72 hours had a higher percentage of CD11c, CD13, CD15, and CD67 than those delivered at term. In contrast, there were no significant differences in the percentages of CD14 and CD63. CONCLUSION Activation of the monocyte-neutrophil system exists in fetuses destined for premature delivery. These findings indicate that premature parturition is associated with in utero immune system activation.
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Affiliation(s)
- S M Berry
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, MI 48201-1498, USA
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Puder KS, Humes RA, Gold RL, Bawle EV, Goyert GL. The genetic implication for preceding generations of the prenatal diagnosis of interrupted aortic arch in association with unsuspected DiGeorge anomaly. Am J Obstet Gynecol 1995; 173:239-41. [PMID: 7631695 DOI: 10.1016/0002-9378(95)90204-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We present a case of prenatally diagnosed interrupted aortic arch with a ventricular septal defect in the presence of maternal congenital heart disease, which led to the detection of segmental monosomy of chromosome 22q11.2 in both patients. The implications of detecting a microdeletion and the importance of a multidisciplinary approach to prenatal diagnosis and counseling are discussed.
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Affiliation(s)
- K S Puder
- Department of Obstetrics and Gynecology, Children's Hospital of Michigan, Hutzel Hospital, Detroit, USA
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Berry SM, Lecolier B, Smith RS, Bercau G, Dombrowski MP, Puder KS, Kithier K, Bidat L, Johnson MP, Cotton DB. Predictive value of fetal serum beta 2-microglobulin for neonatal renal function. Lancet 1995; 345:1277-8. [PMID: 7746060 DOI: 10.1016/s0140-6736(95)90928-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
When fetal urinary-tract malformations (UTM) are discovered, management is based on the prediction of postnatal renal function, currently made by fetal urinary biochemistry and sonography. Serum beta 2-microglobulin has been used postnatally to estimate renal function and does not cross the placenta. We investigated the relation between fetal serum beta 2-microglobulin and renal function by comparing 64 unaffected fetuses and 15 fetuses with UTM. A beta 2-microglobulin above a 5.6 mg/L cut-off gave cross-validated sensitivity of 80.0%, specificity of 98.6%, a positive predictive value of 88.9%, and a negative predictive value of 97.1% for our cohort study.
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Affiliation(s)
- S M Berry
- Division of Maternal Fetal Medicine, Wayne State University, Detroit, Michigan, USA
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16
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Puder KS, Sherer DM, Ross RD, Silva ML, King ME, Treadwell MC, Romero R. Prenatal ultrasonographic diagnosis of ductus arteriosus aneurysm with spontaneous neonatal closure. Ultrasound Obstet Gynecol 1995; 5:342-345. [PMID: 7614141 DOI: 10.1046/j.1469-0705.1995.05050342.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Aneurysm of the ductus arteriosus may be either spontaneous or acquired as a complication of surgical closure of a patent duct. Patients may be asymptomatic or present with a wide spectrum of symptoms, including hoarseness, respiratory symptoms, aortic or pulmonary thrombosis or embolism, or rupture of the aneurysm. We present the first report of prenatal ultrasonographic diagnosis of isolated ductus arteriosus aneurysm. The aneurysm presented at 39 weeks as an enlarged, dilated, vascular structure 15 mm in diameter, which began at the bifurcation of the main pulmonary artery and ended in the descending aorta. Doppler imaging demonstrated turbulent flow in this lesion. Following spontaneous delivery, a bidirectional shunt in the ductus arteriosus was found on the 1st day, but the caliber of the vessel was normal. An almost completely functionally closed ductus was found on the 2nd day. Spontaneous resolution of the lesion was confirmed by magnetic resonance imaging at 4 weeks of age.
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Affiliation(s)
- K S Puder
- Division of Maternal-Fetal Medicine, Hutzel Hospital, Detroit, Michigan, USA
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Berry SM, Puder KS, Bottoms SF, Uckele JE, Romero R, Cotton DB. Comparison of intrauterine hematologic and biochemical values between twin pairs with and without stuck twin syndrome. Am J Obstet Gynecol 1995; 172:1403-10. [PMID: 7755045 DOI: 10.1016/0002-9378(95)90469-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Our purpose was to compare hematologic and biochemical values in cordocentesis specimens from twin pairs with and without stuck twin syndrome. STUDY DESIGN Cordocentesis was performed on 38 twin pairs. Assignment to the stuck twin syndrome group (n = 8) was based on ultrasonographic findings of discordant size and amniotic fluid volume, concordant gender, and a single placenta. A receiver-operator characteristic curve was constructed with the use of intertwin hemoglobin differences. For the stuck twin syndrome group regression analysis of gestational age and intertwin hemoglobin difference was done. RESULTS We found significant (p = 0.03) intertwin differences in hemoglobin between the stuck twin syndrome group (mean 5.35 gm/dl, range 0.5 to 15.4 gm/dl) and the comparison group (mean 0.10 gm/dl, range 0.0 to 2.4 gm/dl). A nearly significant relationship between gestational age and intertwin hemoglobin difference was noted in the stuck twin syndrome group. When the hemoglobin difference was > 2.4 gm/dl, all cases had stuck twin syndrome (sensitivity = 50%, specificity = 100%, positive predictive value = 100%, negative predictive value = 91%). In the stuck twin syndrome group there was a trend toward larger intertwin differences in albumin and total protein. Intertwin blood gas values between the groups did not differ, but the average PO2 was lower when the smaller twins of the two groups were compared. CONCLUSION An intertwin difference in hemoglobin > 2.4 gm/dl is consistent with stuck twin syndrome. Large intertwin hemoglobin differences and imbalances in albumin and total protein may be seen in stuck twin syndrome.
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Affiliation(s)
- S M Berry
- Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, MI 48201, USA
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Puder KS, Martier SS, gonik B, Sokol RJ. Does routine prenatal ultrasound (US) examination detect fetal alcohol syndrome (FAS)? Am J Obstet Gynecol 1995. [DOI: 10.1016/0002-9378(95)91050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Puder KS, Sorokin Y, Bottoms SF, Hallak M, Cotton DB. Amnioinfusion: does the choice of solution adversely affect neonatal electrolyte balance? Obstet Gynecol 1994; 84:956-9. [PMID: 7970476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine whether various solutions commonly used in amnioinfusion during labor affect neonatal electrolyte and blood gas values. METHODS Amnioinfusion for thick meconium or severe variable fetal heart rate decelerations is used at our institution according to a standardized protocol. During alternating 3-week periods, the only solution made available for amnioinfusion was either normal saline or Ringer's lactate. Bolus volume, rate, and duration of infusion were determined by the individual physicians. At delivery, cord blood was collected for electrolyte and blood gas determination. These values were compared between the two solution groups and to a non-infused control group. RESULTS Complete data on neonatal electrolytes and blood gas values were available on 53 infusion patients (20 Ringer's lactate, 33 normal saline) and 39 non-infusion patients. Comparing infusion to non-infusion patients and those infused with Ringer's lactate to those with normal saline, we found no significant difference in demographics, neonatal outcome variables, duration of labor, neonatal electrolytes, and cord blood gas values. Infusion variables (bolus volume, infusion rate, hours infused, and total volume infused) did not differ between solutions. Total volume and hours of infusion were closely correlated with each other (r = 0.93, P < .001); both were correlated with neonatal chloride (r = 0.38 and r = 0.36, respectively; P < .005). No cases of hypernatremia or hyperchloremia were found in any of the groups. The type of solution used had no effect on the neonatal chloride trend. CONCLUSION The use of both normal saline and Ringer's lactate for indicated amnioinfusion in labor appears to have no clinically significant effect on neonatal electrolytes.
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Affiliation(s)
- K S Puder
- Division of Maternal-Fetal Medicine, Hutzel Hospital, Wayne State University, Detroit, Michigan
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Quintero RA, Puder KS, Bardicef M, Rossman K, Acosta L, Esclapés M, Cotton DB. Hydrolaparoscopy in the rabbit: a fine model for the development of operative fetoscopy. Am J Obstet Gynecol 1994; 171:1139-42. [PMID: 7943087 DOI: 10.1016/0002-9378(94)90052-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Our goal was to become adept at performing laparoscopic procedures within a fluid medium and at using miniature instruments in a small animal model. STUDY DESIGN Adult female New Zealand rabbits underwent carbon dioxide laparoscopy while they were under general anesthesia with the use of 2 mm instruments. The abdominal cavity was filled with lactated Ringer's solution. Visualization of the intraabdominal organs and surgical procedures were performed below the fluid level. RESULTS Excellent visualization of the abdominal organs below the fluid level was obtained. Several surgical tasks were accomplished, including cutting and coagulation of the uterine horns with monopolar electrocautery, creation of a defect in the mesovarium and mesometrium, extracorporeal knot tying, and intraabdominal cutting of suture material. Relatively high amounts of energy were needed during electrocautery within the liquid medium (> 25 W). Occasional fluid and gas leakage through the skin punctures was prevented with accessory clamps. CONCLUSION Hydrolaparoscopy can be performed in the rabbit with miniature instruments. As it simulates the human intraamniotic environment, it is a useful model for the development of operative fetoscopy.
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Affiliation(s)
- R A Quintero
- Department of Obstetrics and Gynecology, Hutzel Hospital, Wayne State University, Detroit, MI 48201
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Quintero RA, Reich H, Puder KS, Bardicef M, Evans MI, Cotton DB, Romero R. Brief report: umbilical-cord ligation of an acardiac twin by fetoscopy at 19 weeks of gestation. N Engl J Med 1994; 330:469-71. [PMID: 8289853 DOI: 10.1056/nejm199402173300705] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- R A Quintero
- Department of Obstetrics and Gynecology, Hutzel Hospital, Wayne State University, Detroit 48201
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Quintero RA, Puder KS, Cotton DB. Embryoscopy and fetoscopy. Obstet Gynecol Clin North Am 1993; 20:563-81. [PMID: 8278150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The introduction of transabdominal fiberoptic thin-gauge visualization of the embryo or fetus in the first trimester allows an earlier diagnosis of congenital anomalies currently beyond the resolution of ultrasound. In addition, it has the true potential of providing access to the fetal circulation at an early age, an accomplishment that would have enormous diagnostic and therapeutic implications. In the second and third trimester, operative fetoscopic techniques promise to open a new frontier in the diagnosis and management of fetal surgical and medical conditions.
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Affiliation(s)
- R A Quintero
- Department of Obstetrics and Gynecology, Wayne State University-Hutzel Hospital, Detroit, Michigan
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Abstract
Methamphetamine has been marketed illicitly since the 1960s. Much of the street material was illicitly synthesized. Although methamphetamine quality was variable in the past decade, it has emerged since 1978 as the only street stimulant which is likely to contain what it purports to contain. Although there is a small volume of legitimate methamphetamine still made by the pharmaceutical industry, most material analyzed by street-drug laboratories appears to have been illegitimately synthesized and not diverted. For a decade, relatively little methamphetamine was submitted to street-drug analytical labs. In recent years, although the absolute volume of methamphetamine submissions changed little, this drug made up the bulk of alleged stimulant samples submitted to such facilities because of the paucity of amphetamine submissions. Methamphetamine synthesis and use appears to constitute a small but continuing portion of the illicit drug market.
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Affiliation(s)
- K S Puder
- Department of Pharmacology, City University of New York Medical School, New York
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Puder KS, Morgan JP. Persuading by citation: an analysis of the references of fifty-three published reports of phenylpropanolamine's clinical toxicity. Clin Pharmacol Ther 1987; 42:1-9. [PMID: 3595063 DOI: 10.1038/clpt.1987.100] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
References cited in scientific articles may be used as data to characterize a body of reports. We examined the references and citations in 53 articles reporting adverse reactions to phenylpropanolamine. We classified the type of reference (case report, human or nonhuman experimental, editorial, or review) and read frequently cited articles to compare their content to their citational use. We searched the references for articles that we thought pertinent including the prospective clinical trial literature and studies comparing phenylpropanolamine with amphetamine. We learned that writers of these reports relied on other case reports and generally ignored experimental literature. These authors also often cited articles so that the original intent was not reflected. Publications presenting an alternative view were largely ignored. This analysis produces some evidence of bias against phenylpropanolamine and that the phenylpropanolamine adverse reaction literature may reflect chiefly social and clinical opinion.
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