Adjuvant Use of Rifampin for Refractory Intrahepatic Cholestasis of Pregnancy.

BACKGROUND: Intrahepatic cholestasis of pregnancy is an incompletely understood disease that poses significant fetal risks, including stillbirth. Treatment of intrahepatic cholestasis of pregnancy is aimed at relieving maternal symptoms and improving fetal outcomes. CASE: A 21-year-old gravid woman, 3 para 0111, presented at 27 2/7 weeks of gestation with severe intrahepatic cholestasis of pregnancy. Her clinical course was refractory to first-line therapy with ursodiol, and she was started on rifampin with rapid improvement of symptoms and transaminitis. Despite maternal improvement, she was delivered at 31 weeks of gestation for persistent nonreassuring fetal status. CONCLUSION: Rifampin may be an effective adjunctive therapy for intrahepatic cholestasis of pregnancy refractory to ursodiol alone. Additional research is needed to assess short-term and long-term maternal and newborn outcomes, because fetal deterioration still occurred in spite of maternal improvement.

Identifying Risk Factors for Cesarean Delivery in a Predominantly Hispanic Teenage Population: A 5-Year Retrospective Study.

STUDY OBJECTIVE: To identify risk factors for primary nonelective cesarean delivery, in a predominantly Hispanic teen population of an urban tertiary care center. DESIGN: Retrospective descriptive study. SETTING: A tertiary academic center with approximately 3000 deliveries per year. PARTICIPANTS: Our study population comprised all women (ages 13-19 years at time of delivery) who gave birth at our tertiary university hospital between July 2011 and July 2016. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Our main outcome of interest was primary nonelective cesarean delivery. RESULTS: Of the 958 included deliveries, 9.6% (92/958) were delivered via nonelective cesarean section. The population was 89% Hispanic with a mean age of 17.7 years. Age, body mass index at delivery, and neonatal birth weight were significantly associated with delivery via cesarean section. Mothers of neonates with extremes of birth weights (<2500 g, >4000 g) had higher odds of having a cesarean delivery, compared with neonates with normal birth weight (odds ratio, 3.27; 95% confidence interval, 1.90-5.63 and odds ratio, 4.43; 95% confidence interval, 1.33-14.72). CONCLUSION: Among adolescent patients, age, body mass index at delivery, and birth weight of the neonate were found to be risk factors that place the gravid teen at increased risk for cesarean delivery.

Intra-amniotic Dye Alternatives for the Diagnosis of Preterm Prelabor Rupture of Membranes.

Intra-amniotic dye instillation is a useful tool for evaluation of equivocal cases of preterm prelabor rupture of membranes and for genetic amniocentesis in multifetal gestation. Indigo carmine, the most used and studied dye, is no longer available. We sought to provide a resource of potential dyes for clinical use that summarizes dosing along with maternal, fetal, and neonatal outcomes. We reviewed the literature evaluating the use of alternative agents. Sodium fluorescein has proven clinical usefulness but has side effects when used intravenously. Phenol-sulfonphthalein has reported clinical utility with no cases of maternal, fetal, or neonatal side effects; however, it is not currently available in the United States. Indocyanine green has been used in pregnancy for other indications. Oral phenazopyridine hydrochloride may lead to a false-positive diagnosis of preterm prelabor rupture of membranes. Evans blue and methylene blue have adverse fetal and neonatal effects. Of the dye options available, fluorescein is a readily available commercial option that has the best evidence supporting use and safety for these indications.

Leiomyosarcoma of the uterine cervix associated with pregnancy: A case report and review of literature.

•Management of cervical leiomyosarcoma in pregnancy requires a multidisciplinary approach.•Ovarian preservation is preferred in young patients with early stage cervical leiomyosarcoma.•Routine lymphadenectomy in patients with early stage cervical leiomyosarcoma is not useful.