Brenner tumor of the ovary with extensive stromal luteinization presenting in pregnancy: report of a case and review of the literature.

Brenner tumor in pregnancy is rare, with only two reported cases in association with intrauterine pregnancy. A 30-year-old woman, G1P0, was found to have an adnexal mass at 15 weeks of gestation. The mass was resected at Cesarean section and found to be a Brenner tumor with areas of stromal luteinization. Brenner tumor should be considered in the differential diagnosis of adnexal masses presenting during pregnancy. The stromal luteinization was probably related to the hormonal environment of the pregnancy.

Weekly administration of prostaglandin E2 gel compared with expectant management in women with previous cesareans. Prepidil Gel Study Group.

OBJECTIVE: To compare the clinical effectiveness and safety of outpatient administration of intracervical prostaglandin (PG) E2 gel with expectant treatment for women desiring vaginal births after cesareans. METHODS: This was a randomized, multicenter investigation involving term pregnant women who each had one previous low-transverse cesarean and an unfavorable cervix (Bishop score no more than 6), and who was a candidate for vaginal delivery. They were assigned to receive 0.5 mg of PGE2, (Prepidil; Pharmacia-Upjohn, Kalamazoo, MI) intracervically at 39 weeks' gestation, repeated at weekly office visits for up to three doses, or expectant treatment. The main outcome variable was vaginal birth. RESULTS: Of 294 cases, 143 received gel and 151 were treated expectantly. No differences between groups were found for maternal age, race, or Bishop score. Compared with the expectant treatment group, the PGE2 gel group was not more likely to deliver sooner or vaginally (57% versus 55%, P = .68). The onset of labor, duration of labor among those delivering vaginally, and 1- and 5-minute Apgar scores were not different between groups. No uterine ruptures occurred, and adverse effects were equally likely in both groups. CONCLUSION: Although its safety was confirmed for outpatient use, weekly doses of intracervical PGE2 did not improve the likelihood of vaginal births after cesareans.

Endothelin stimulation of rat uterine segment contractility is estrogen-dependent.

To determine whether the effect of endothelin upon in vitro uterine contractility requires estrogen, immature female Long Evans rats were subcutaneously injected daily for 3 days with either estradiol benzoate or vehicle. The uterine contractile response to endothelin (5 or 100 nM) was measured. A response to endothelin in vehicle-treated animals exposed to physiologic (5.6 mM) or high (70.6 mM) potassium levels was also noted. Vehicle-treated uteri did not respond to endothelin; the contractions in estrogen-treated uteri increased by 288%. With high potassium, and without estrogen, no response to endothelin was seen. These data indicate that the contractile effect of endothelin on the uterus requires estrogen.

Pregnancy complicated by autoimmune polyglandular syndrome type II: a case report.

Autoimmune polyglandular syndrome may complicate pregnancy and be confused with hyperemesis gravidarum as a cause of hypoglycemia and electrolyte imbalance in the first trimester of pregnancy. Autoimmune polyglandular syndromes are uncommon disorders characterized by the development and presentation of multiple endocrine and organ dysfunction. To our knowledge, we present the first case of an autoimmune polyglandular syndrome complicating pregnancy. A 26-year-old woman, gravida 5 para 3 at 12 weeks gestation, presented with hyperemesis and signs and symptoms consistent with adrenal insufficiency and hypothyroidism. Evaluation revealed autoimmune polyglandular syndrome type II. Autoimmune polyglandular syndromes are a myriad group of diseases characterized by polyglandular dysfunction. These syndromes should be kept in mind when dealing with pregnant patients presenting with hyperemesis and an electrolyte imbalance who do not improve with the usual treatment for hyperemesis. An endocrine dysfunction such as polyglandular syndrome may exist.

Attempted vaginal birth after cesarean section: a multicenter comparison of outpatient prostaglandin E(2) gel with expectant management.

Objective: To compare the clinical effectiveness and safety of outpatient administration of an intracervical prostaglandin (PG) E(2) gel with expectant management for women with an unfavorable cervix who wish to attempt a vaginal birth after cesarean section.Study Design: This outpatient study was a randomized, multicenter investigation involving pregnant women at term with one previous low transverse cesarean section. Each had an unfavorable cervix (Bishop score

Clinical amnionitis and endometritis in patients with premature rupture of membranes: endocervical prostaglandin E2 gel versus oxytocin for induction of labor.

OBJECTIVE: To compare the rates of clinical amnionitis and endometritis in patients with premature rupture of membranes (PROM), using endocervical prostaglandin E2 (PGE2) gel for induction of labor versus immediate oxytocin induction of labor. METHODS: We randomized 118 patients to receive either endocervical 0.5 mg of PGE2 gel (study group) or immediate oxytocin induction of labor (control group). If labor was not established in the group receiving PGE2 gel in 24 hours, intravenous oxytocin was given in incremental doses. The rates of clinical amnionitis and endometritis in the two groups were analyzed. Also compared were hours of labor, duration of rupture of membranes and number of vaginal examinations. Student t test, chi 2, or Wilcoxon rank-sum test were used for statistical analysis, as appropriate. P < .05 was considered significant. RESULTS: The rates of clinical amnionitis were 5.3% in the PGE2 group and 8% in the control group. Endometritis developed in 1.7% of PGE2 patients and 3.2% of controls. These differences in maternal infection rates were not statistically significant. The two groups were comparable with respect to age, parity, and antepartum group B streptococcal colonization. No significant differences in hours of labor, duration of ruptured membranes, or vaginal examinations were observed. Neonatal outcome data (mean birth weight, Apgar scores at 1 and 5 minutes, Apgar score less than 7 at 5 minutes) were not statistically significant. CONCLUSION: Endocervical placement of 0.5 mg of PGE2 gel does not increase the incidence of clinical amnionitis and endometritis in patients with PROM at term when compared with immediate induction of labor with oxytocin.

Epidemiology of sexually transmitted diseases among pregnant adolescents.

OBJECTIVE: The purpose of this study was to determine the epidemiology of sexually transmitted diseases (STDs) among pregnant adolescents. METHODS: Charts of all patients (n = 735) who attended the Maternal and Infant Care Clinic at University Hospital, Newark, NJ, between July 1, 1991, and June 30, 1992, were reviewed for STDs which included gonorrhea, chlamydia, syphilis, and human immunodeficiency virus (HIV). At the first prenatal visit, each registrant had endocervical specimens obtained to detect gonorrhea and chlamydia. A serum sample was obtained for syphilis screening. HIV testing was made available to all patients and testing was done on a voluntary basis. The same STD screening that was done at the initial visit was repeated at 28 and 36 weeks. RESULTS: Twenty-five percent of patients tested positive for one or more STDs. The mean patient age was 17.3 years. The mean gestational age at first visit was 19.5 weeks. The mean number of visits was 7.3. The following STDs were identified: 4.8% of patients tested positive for gonorrhea, 20.9% tested positive for chlamydia, and 1.7% tested positive for syphilis. Twenty-one percent of patients had a positive STD diagnosed at the initial visit. Another 4.8% of patients had an STD diagnosed at some time after the initial visit when the initial screen was negative for STDs. An additional 1% of patients who initially tested positive for an STD had subsequent screening which revealed another STD (different organism). Seven patients tested HIV positive. Sixty-one percent of patients with STDs agreed to HIV testing. One patient had HIV coexistent with another STD. CONCLUSIONS: Pregnant adolescents are at risk for multiple STDs. HIV testing should be offered. STD screening should be repeated in the third trimester in adolescent patients.

Cardiac mechanics and function in obese normotensive persons with normal coronary arteries.

Obesity is associated with several cardiac abnormalities, but its effects on cardiac loading conditions and contractile function are controversial. The frequent coexistence of obesity with systemic hypertension and coronary artery disease further complicates evaluation of cardiac function in obese persons. Therefore, cardiac mechanics and contractile function were examined at cardiac catheterization in 14 obese persons (50 +/- 5% overweight) who were free of systemic hypertension and angiographic coronary narrowing. Twelve lean subjects who underwent catheterization for chest pain, found to be free of cardiac abnormalities, served as control subjects. Preload, estimated as end-diastolic stress, was greater in obese persons (48 +/- 5 kdynes/cm2) than in lean persons (32 +/- 3 kdynes/cm2) (p less than 0.01). Afterload, estimated by end-systolic stress, was also greater in obese persons: 124 +/- 15 kdynes/cm2 vs 95 +/- 6 kdynes/cm2 (p less than 0.05). Ejection fraction was similar in obese (0.69 +/- 0.02) and lean persons (0.71 +/- 0.02). Mean velocity of circumferential fiber shortening and the ratio of end-systolic stress to end-systolic volume index were also similar in both groups. The value for stress velocity of fiber shortening relation fell within the range of the normal subjects in all but 1 obese subject. Thus, although abnormalities in loading conditions are present in normotensive persons who are moderately obese, contractile function is usually normal.