Obstetrics

WASHINGTON — Women with a history of preeclampsia or eclampsia had more than twice the risk of developing cardiovascular disease than that of women with uncomplicated pregnancies, based on results of a meta-analysis that included more than 100,000 preeclamptic women.

Results from previous studies have shown associations between preeclampsia and increased risk of stroke and hypertension later in life.

To evaluate the long-term risk for cardiovascular problems in women with preeclampsia or eclampsia (referred to as PET), Dr. Sarah McDonald and her colleagues at McMaster University, Hamilton, Ont., conducted a meta-analysis of 5 case-control studies and 10 cohort studies. The studies included data from 118,990 preeclamptic women and 2.3 million women without PET.

The selected studies examined the development of cardiovascular disease or mortality at more than 6 weeks post partum in women with and without PET. Most (11 of 15) studies focused on women aged younger than 56 years.

The results were presented in a poster at the annual congress of the International Society for the Study of Hypertension in Pregnancy. Overall, there was a graded relationship between the severity of PET and the risk of cardiac disease. Women with severe PET had a fivefold increase in risk compared with women who did not have PET. The risk ratios for cardiac disease for mild, moderate, and severe PET were 2.00, 2.99, and 5.36, respectively.

In a pooled analysis of the case-control studies, women with a history of PET were more than twice as likely to develop cardiac disease (odds ratio 2.47). In a pooled analysis of the cohort studies, women with history of preeclampsia had a significantly increased risk of cardiac disease (relative risk 2.33), cardiovascular mortality (relative risk 2.29), cerebrovascular disease (relative risk 2.03), and peripheral artery disease (relative risk 1.87).

Despite the large numbers of patients in this meta-analysis, more research is needed to determine the mechanisms behind the association between PET and heart disease, and to develop interventions to prevent these complications, the researchers noted.

Dr. McDonald stated that she had no financial conflicts to disclose.

WASHINGTON — Women with a history of preeclampsia or eclampsia had more than twice the risk of developing cardiovascular disease than that of women with uncomplicated pregnancies, based on results of a meta-analysis that included more than 100,000 preeclamptic women.

Results from previous studies have shown associations between preeclampsia and increased risk of stroke and hypertension later in life.

To evaluate the long-term risk for cardiovascular problems in women with preeclampsia or eclampsia (referred to as PET), Dr. Sarah McDonald and her colleagues at McMaster University, Hamilton, Ont., conducted a meta-analysis of 5 case-control studies and 10 cohort studies. The studies included data from 118,990 preeclamptic women and 2.3 million women without PET.

The selected studies examined the development of cardiovascular disease or mortality at more than 6 weeks post partum in women with and without PET. Most (11 of 15) studies focused on women aged younger than 56 years.

The results were presented in a poster at the annual congress of the International Society for the Study of Hypertension in Pregnancy. Overall, there was a graded relationship between the severity of PET and the risk of cardiac disease. Women with severe PET had a fivefold increase in risk compared with women who did not have PET. The risk ratios for cardiac disease for mild, moderate, and severe PET were 2.00, 2.99, and 5.36, respectively.

In a pooled analysis of the case-control studies, women with a history of PET were more than twice as likely to develop cardiac disease (odds ratio 2.47). In a pooled analysis of the cohort studies, women with history of preeclampsia had a significantly increased risk of cardiac disease (relative risk 2.33), cardiovascular mortality (relative risk 2.29), cerebrovascular disease (relative risk 2.03), and peripheral artery disease (relative risk 1.87).

Despite the large numbers of patients in this meta-analysis, more research is needed to determine the mechanisms behind the association between PET and heart disease, and to develop interventions to prevent these complications, the researchers noted.

Dr. McDonald stated that she had no financial conflicts to disclose.

WASHINGTON — Women with a history of preeclampsia or eclampsia had more than twice the risk of developing cardiovascular disease than that of women with uncomplicated pregnancies, based on results of a meta-analysis that included more than 100,000 preeclamptic women.

Results from previous studies have shown associations between preeclampsia and increased risk of stroke and hypertension later in life.

To evaluate the long-term risk for cardiovascular problems in women with preeclampsia or eclampsia (referred to as PET), Dr. Sarah McDonald and her colleagues at McMaster University, Hamilton, Ont., conducted a meta-analysis of 5 case-control studies and 10 cohort studies. The studies included data from 118,990 preeclamptic women and 2.3 million women without PET.

The selected studies examined the development of cardiovascular disease or mortality at more than 6 weeks post partum in women with and without PET. Most (11 of 15) studies focused on women aged younger than 56 years.

The results were presented in a poster at the annual congress of the International Society for the Study of Hypertension in Pregnancy. Overall, there was a graded relationship between the severity of PET and the risk of cardiac disease. Women with severe PET had a fivefold increase in risk compared with women who did not have PET. The risk ratios for cardiac disease for mild, moderate, and severe PET were 2.00, 2.99, and 5.36, respectively.

In a pooled analysis of the case-control studies, women with a history of PET were more than twice as likely to develop cardiac disease (odds ratio 2.47). In a pooled analysis of the cohort studies, women with history of preeclampsia had a significantly increased risk of cardiac disease (relative risk 2.33), cardiovascular mortality (relative risk 2.29), cerebrovascular disease (relative risk 2.03), and peripheral artery disease (relative risk 1.87).

Despite the large numbers of patients in this meta-analysis, more research is needed to determine the mechanisms behind the association between PET and heart disease, and to develop interventions to prevent these complications, the researchers noted.

Dr. McDonald stated that she had no financial conflicts to disclose.

WASHINGTON — Staphylococcus aureus colonization increases significantly in the first 2 months of life and appears to be positively associated with maternal carriage, based on a study of 200 mother-neonate pairs.

At delivery, S. aureus detection among 165 infants was 8%; at discharge, detection among 190 infants was 7%. However, at age 2 months, 33% of infants were colonized with S. aureus—17% with methicillin-resistant S. aureus (MRSA), Dr. Clarence B. (Buddy) Creech II said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

“In those mothers who had no evidence of nasal colonization at 2 months, the vast majority of their infants also remained uncolonized. However, among those mothers who had methicillin-susceptible S. aureus (MSSA) nasal colonization [at 2 months], 51% of their infants were nasally colonized with MSSA.” Of mothers with MRSA nasal colonization, 45% of their infants had nasal MRSA colonization at 2 months.

“We were able to detect MRSA carriage in a significant number of mothers and infants; however, we have not observed many infections in this cohort,” Dr. Creech said in an interview. The findings demonstrate that staphylococci are commensal organisms and part of normal flora. “The question that remains is whether certain strains of staphylococci, in certain hosts, are more likely to cause disease than others.”

Pregnant women were recruited at the time of group B streptococcus (GBS) screening between gestational weeks 35 and 37. At that time, nasal swabs for S. aureus and rectovaginal swabs for GBS and S. aureus were taken. Nasal swabs were repeated in the mother on the day of delivery and at 2 months post partum. Neonatal nasal and umbilical swabs were obtained within 2 hours of birth and nasal swabs were repeated on the day of discharge and at 2 months.

At the time of the presentation, 431 pregnant women had been enrolled. Dr. Creech, of the pediatric infectious diseases department at Vanderbilt University, Nashville, Tenn., presented data on the first 200 mother-neonate pairs with data out to the 2-month period. Mothers were primarily recruited from academic private practice and an obstetric resident clinic serving an inner-city Medicare population in Nashville.

Nasal S. aureus colonization of mothers in pregnancy was 23.5%—12% for MSSA and 11.5% for MRSA. Rectovaginal S. aureus colonization of mothers during pregnancy was 17%—13% for MSSA and 4% for MRSA. It was not always possible to obtain neonatal swabs within 2 hours of delivery. In all, 165 infants were evaluable at delivery. Neonatal MSSA detection at delivery (not necessarily colonization) was 5% and MRSA detection was 3%; 190 infants were evaluable at discharge. Neonatal MSSA detection at discharge was 2%; MRSA detection was 5%.

Of the 136 mothers who did not have S. aureus colonization during enrollment, 96% of their infants did not have S. aureus detected at delivery, 3% of infants had MSSA, and 1% had MRSA. Of the 21 mothers who had MSSA colonization at enrollment, 67% of their infants did not have S. aureus detected at delivery, 19% of infants had MSSA, and 14% had MRSA. Of the eight women who had MRSA colonization during enrollment, 62% of their infants did not have S. aureus detected at delivery, 13% of infants had MSSA, and 25% had MRSA.

Two babies developed disease during the first 5–7 weeks. One infant had an abscess that required drainage and intravenous antibiotics. The other infant developed purulent conjunctivitis. The isolates from these infections matched very closely the USA300 strain with staphylococcal cassette chromosome mecIV and were Panton-Valentine leukocidin toxin positive.

With regard to women colonized with S. aureus during pregnancy, “there [are] no data to suggest that prophylactic antibiotics that cover S. aureus would be of any benefit. Many infants in whom MRSA was detected within 2 hours of birth had no evidence of S. aureus at discharge or at 2 months follow-up,” he said.

Dr. Creech disclosed financial relationships with several pharmaceutical companies.

WASHINGTON — Staphylococcus aureus colonization increases significantly in the first 2 months of life and appears to be positively associated with maternal carriage, based on a study of 200 mother-neonate pairs.

At delivery, S. aureus detection among 165 infants was 8%; at discharge, detection among 190 infants was 7%. However, at age 2 months, 33% of infants were colonized with S. aureus—17% with methicillin-resistant S. aureus (MRSA), Dr. Clarence B. (Buddy) Creech II said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

“In those mothers who had no evidence of nasal colonization at 2 months, the vast majority of their infants also remained uncolonized. However, among those mothers who had methicillin-susceptible S. aureus (MSSA) nasal colonization [at 2 months], 51% of their infants were nasally colonized with MSSA.” Of mothers with MRSA nasal colonization, 45% of their infants had nasal MRSA colonization at 2 months.

“We were able to detect MRSA carriage in a significant number of mothers and infants; however, we have not observed many infections in this cohort,” Dr. Creech said in an interview. The findings demonstrate that staphylococci are commensal organisms and part of normal flora. “The question that remains is whether certain strains of staphylococci, in certain hosts, are more likely to cause disease than others.”

Pregnant women were recruited at the time of group B streptococcus (GBS) screening between gestational weeks 35 and 37. At that time, nasal swabs for S. aureus and rectovaginal swabs for GBS and S. aureus were taken. Nasal swabs were repeated in the mother on the day of delivery and at 2 months post partum. Neonatal nasal and umbilical swabs were obtained within 2 hours of birth and nasal swabs were repeated on the day of discharge and at 2 months.

At the time of the presentation, 431 pregnant women had been enrolled. Dr. Creech, of the pediatric infectious diseases department at Vanderbilt University, Nashville, Tenn., presented data on the first 200 mother-neonate pairs with data out to the 2-month period. Mothers were primarily recruited from academic private practice and an obstetric resident clinic serving an inner-city Medicare population in Nashville.

Nasal S. aureus colonization of mothers in pregnancy was 23.5%—12% for MSSA and 11.5% for MRSA. Rectovaginal S. aureus colonization of mothers during pregnancy was 17%—13% for MSSA and 4% for MRSA. It was not always possible to obtain neonatal swabs within 2 hours of delivery. In all, 165 infants were evaluable at delivery. Neonatal MSSA detection at delivery (not necessarily colonization) was 5% and MRSA detection was 3%; 190 infants were evaluable at discharge. Neonatal MSSA detection at discharge was 2%; MRSA detection was 5%.

Of the 136 mothers who did not have S. aureus colonization during enrollment, 96% of their infants did not have S. aureus detected at delivery, 3% of infants had MSSA, and 1% had MRSA. Of the 21 mothers who had MSSA colonization at enrollment, 67% of their infants did not have S. aureus detected at delivery, 19% of infants had MSSA, and 14% had MRSA. Of the eight women who had MRSA colonization during enrollment, 62% of their infants did not have S. aureus detected at delivery, 13% of infants had MSSA, and 25% had MRSA.

Two babies developed disease during the first 5–7 weeks. One infant had an abscess that required drainage and intravenous antibiotics. The other infant developed purulent conjunctivitis. The isolates from these infections matched very closely the USA300 strain with staphylococcal cassette chromosome mecIV and were Panton-Valentine leukocidin toxin positive.

With regard to women colonized with S. aureus during pregnancy, “there [are] no data to suggest that prophylactic antibiotics that cover S. aureus would be of any benefit. Many infants in whom MRSA was detected within 2 hours of birth had no evidence of S. aureus at discharge or at 2 months follow-up,” he said.

Dr. Creech disclosed financial relationships with several pharmaceutical companies.

WASHINGTON — Staphylococcus aureus colonization increases significantly in the first 2 months of life and appears to be positively associated with maternal carriage, based on a study of 200 mother-neonate pairs.

At delivery, S. aureus detection among 165 infants was 8%; at discharge, detection among 190 infants was 7%. However, at age 2 months, 33% of infants were colonized with S. aureus—17% with methicillin-resistant S. aureus (MRSA), Dr. Clarence B. (Buddy) Creech II said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

“In those mothers who had no evidence of nasal colonization at 2 months, the vast majority of their infants also remained uncolonized. However, among those mothers who had methicillin-susceptible S. aureus (MSSA) nasal colonization [at 2 months], 51% of their infants were nasally colonized with MSSA.” Of mothers with MRSA nasal colonization, 45% of their infants had nasal MRSA colonization at 2 months.

“We were able to detect MRSA carriage in a significant number of mothers and infants; however, we have not observed many infections in this cohort,” Dr. Creech said in an interview. The findings demonstrate that staphylococci are commensal organisms and part of normal flora. “The question that remains is whether certain strains of staphylococci, in certain hosts, are more likely to cause disease than others.”

Pregnant women were recruited at the time of group B streptococcus (GBS) screening between gestational weeks 35 and 37. At that time, nasal swabs for S. aureus and rectovaginal swabs for GBS and S. aureus were taken. Nasal swabs were repeated in the mother on the day of delivery and at 2 months post partum. Neonatal nasal and umbilical swabs were obtained within 2 hours of birth and nasal swabs were repeated on the day of discharge and at 2 months.

At the time of the presentation, 431 pregnant women had been enrolled. Dr. Creech, of the pediatric infectious diseases department at Vanderbilt University, Nashville, Tenn., presented data on the first 200 mother-neonate pairs with data out to the 2-month period. Mothers were primarily recruited from academic private practice and an obstetric resident clinic serving an inner-city Medicare population in Nashville.

Nasal S. aureus colonization of mothers in pregnancy was 23.5%—12% for MSSA and 11.5% for MRSA. Rectovaginal S. aureus colonization of mothers during pregnancy was 17%—13% for MSSA and 4% for MRSA. It was not always possible to obtain neonatal swabs within 2 hours of delivery. In all, 165 infants were evaluable at delivery. Neonatal MSSA detection at delivery (not necessarily colonization) was 5% and MRSA detection was 3%; 190 infants were evaluable at discharge. Neonatal MSSA detection at discharge was 2%; MRSA detection was 5%.

Of the 136 mothers who did not have S. aureus colonization during enrollment, 96% of their infants did not have S. aureus detected at delivery, 3% of infants had MSSA, and 1% had MRSA. Of the 21 mothers who had MSSA colonization at enrollment, 67% of their infants did not have S. aureus detected at delivery, 19% of infants had MSSA, and 14% had MRSA. Of the eight women who had MRSA colonization during enrollment, 62% of their infants did not have S. aureus detected at delivery, 13% of infants had MSSA, and 25% had MRSA.

Two babies developed disease during the first 5–7 weeks. One infant had an abscess that required drainage and intravenous antibiotics. The other infant developed purulent conjunctivitis. The isolates from these infections matched very closely the USA300 strain with staphylococcal cassette chromosome mecIV and were Panton-Valentine leukocidin toxin positive.

With regard to women colonized with S. aureus during pregnancy, “there [are] no data to suggest that prophylactic antibiotics that cover S. aureus would be of any benefit. Many infants in whom MRSA was detected within 2 hours of birth had no evidence of S. aureus at discharge or at 2 months follow-up,” he said.

Dr. Creech disclosed financial relationships with several pharmaceutical companies.

WASHINGTON — Use of real-time polymerase chain reaction to screen for group B Streptococcus in the delivery room could reduce the use of intrapartum antibiotics by more than half, compared with antenatal screening alone, the findings of a single-center study of 232 pregnant women suggest.

Current CDC guidelines call for vaginal and rectal swabs at 35–37 weeks' gestation and for all women with cultures positive for group B Streptococcus (GBS) to receive intravenous antibiotic prophylaxis during labor and delivery (MMWR 2002;51[RR11]:1–22). This practice has greatly reduced the rates of neonatal sepsis in the United States, but it is imperfect. Women whose status is unknown at the time of labor also must receive prophylaxis, resulting in overtreatment, while cultures can fail to detect GBS in women who are lightly colonized, resulting in failure to treat.

Rapid testing at the time of delivery using real-time polymerase chain reaction (RT-PCR) has the potential to solve these problems, Dr. Stefan Gerber and his associates said in a poster presentation at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

Of 232 women presenting for vaginal birth at University Center Hospital, Lausanne (Switzerland) in an 8-month span, 19% (44) had positive GBS cultures at 35–37 weeks, 65% (152) had negative cultures, and 16% (36) had unknown GBS status at the time of delivery. Per the guidelines, 34% of the women (80) received prophylactic antibiotics during labor, but treatment was completed (at least two doses or at least 4 hours of intravenous antibiotics) in just 21% (17).

Lower vaginal and rectal swabs were obtained in all the women in the delivery room, and GBS detection was performed by both culture and RT-PCR, using Cepheid's Xpert GBS test, which runs on the GeneXpert System, a fully automated molecular testing system. Results were available in 75 minutes (compared with 2 days for cultures). By RT-PCR, just 15% (35) of the women were GBS positive, suggesting that 19% (45) of the women had received unnecessary prophylaxis, Dr. Gerber and his associates at the hospital reported.

Of the 35 PCR-positive women, 7 had negative cultures—presumably because they were only lightly colonized—and therefore would not have received antibiotics under the antenatal screening guidelines.

All 35 PCR-positive women received prophylaxis but just 7 (22%) completed it.

Since further work-up of the newborn is required when the mother doesn't receive complete antimicrobial prophylaxis, RT-PCR could potentially represent a significant cost saving. An ongoing study is investigating the cost-effectiveness of the approach, Dr. Gerber said in an interview.

Moreover, unlike cultures, which must be performed by technicians, the RT-PCR was performed by the midwives themselves. The technology could also be used by labor and delivery nurses or obstetricians, Dr. Gerber said in an interview.

Dr. Gerber stated that he had no financial ties to Cepheid. The company provided the equipment for the study, but no additional funding.

Most insurance plans cover the Xpert GBS test, which was approved by the Food and Drug Administration in 2006. It is categorized as “moderate complexity” by the FDA, meaning that non-laboratory health care professionals such as physicians and nurses can run the test, a Cepheid spokesman said in an interview.

The spokesman declined to say how many Xpert GBS tests are currently in use, but he did say that as of the last quarter of 2008, there were 848 GeneExpert Systems installed worldwide, capable of running the GBS test.

WASHINGTON — Use of real-time polymerase chain reaction to screen for group B Streptococcus in the delivery room could reduce the use of intrapartum antibiotics by more than half, compared with antenatal screening alone, the findings of a single-center study of 232 pregnant women suggest.

Current CDC guidelines call for vaginal and rectal swabs at 35–37 weeks' gestation and for all women with cultures positive for group B Streptococcus (GBS) to receive intravenous antibiotic prophylaxis during labor and delivery (MMWR 2002;51[RR11]:1–22). This practice has greatly reduced the rates of neonatal sepsis in the United States, but it is imperfect. Women whose status is unknown at the time of labor also must receive prophylaxis, resulting in overtreatment, while cultures can fail to detect GBS in women who are lightly colonized, resulting in failure to treat.

Rapid testing at the time of delivery using real-time polymerase chain reaction (RT-PCR) has the potential to solve these problems, Dr. Stefan Gerber and his associates said in a poster presentation at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

Of 232 women presenting for vaginal birth at University Center Hospital, Lausanne (Switzerland) in an 8-month span, 19% (44) had positive GBS cultures at 35–37 weeks, 65% (152) had negative cultures, and 16% (36) had unknown GBS status at the time of delivery. Per the guidelines, 34% of the women (80) received prophylactic antibiotics during labor, but treatment was completed (at least two doses or at least 4 hours of intravenous antibiotics) in just 21% (17).

Lower vaginal and rectal swabs were obtained in all the women in the delivery room, and GBS detection was performed by both culture and RT-PCR, using Cepheid's Xpert GBS test, which runs on the GeneXpert System, a fully automated molecular testing system. Results were available in 75 minutes (compared with 2 days for cultures). By RT-PCR, just 15% (35) of the women were GBS positive, suggesting that 19% (45) of the women had received unnecessary prophylaxis, Dr. Gerber and his associates at the hospital reported.

Of the 35 PCR-positive women, 7 had negative cultures—presumably because they were only lightly colonized—and therefore would not have received antibiotics under the antenatal screening guidelines.

All 35 PCR-positive women received prophylaxis but just 7 (22%) completed it.

Since further work-up of the newborn is required when the mother doesn't receive complete antimicrobial prophylaxis, RT-PCR could potentially represent a significant cost saving. An ongoing study is investigating the cost-effectiveness of the approach, Dr. Gerber said in an interview.

Moreover, unlike cultures, which must be performed by technicians, the RT-PCR was performed by the midwives themselves. The technology could also be used by labor and delivery nurses or obstetricians, Dr. Gerber said in an interview.

Dr. Gerber stated that he had no financial ties to Cepheid. The company provided the equipment for the study, but no additional funding.

Most insurance plans cover the Xpert GBS test, which was approved by the Food and Drug Administration in 2006. It is categorized as “moderate complexity” by the FDA, meaning that non-laboratory health care professionals such as physicians and nurses can run the test, a Cepheid spokesman said in an interview.

The spokesman declined to say how many Xpert GBS tests are currently in use, but he did say that as of the last quarter of 2008, there were 848 GeneExpert Systems installed worldwide, capable of running the GBS test.

WASHINGTON — Use of real-time polymerase chain reaction to screen for group B Streptococcus in the delivery room could reduce the use of intrapartum antibiotics by more than half, compared with antenatal screening alone, the findings of a single-center study of 232 pregnant women suggest.

Current CDC guidelines call for vaginal and rectal swabs at 35–37 weeks' gestation and for all women with cultures positive for group B Streptococcus (GBS) to receive intravenous antibiotic prophylaxis during labor and delivery (MMWR 2002;51[RR11]:1–22). This practice has greatly reduced the rates of neonatal sepsis in the United States, but it is imperfect. Women whose status is unknown at the time of labor also must receive prophylaxis, resulting in overtreatment, while cultures can fail to detect GBS in women who are lightly colonized, resulting in failure to treat.

Rapid testing at the time of delivery using real-time polymerase chain reaction (RT-PCR) has the potential to solve these problems, Dr. Stefan Gerber and his associates said in a poster presentation at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

Of 232 women presenting for vaginal birth at University Center Hospital, Lausanne (Switzerland) in an 8-month span, 19% (44) had positive GBS cultures at 35–37 weeks, 65% (152) had negative cultures, and 16% (36) had unknown GBS status at the time of delivery. Per the guidelines, 34% of the women (80) received prophylactic antibiotics during labor, but treatment was completed (at least two doses or at least 4 hours of intravenous antibiotics) in just 21% (17).

Lower vaginal and rectal swabs were obtained in all the women in the delivery room, and GBS detection was performed by both culture and RT-PCR, using Cepheid's Xpert GBS test, which runs on the GeneXpert System, a fully automated molecular testing system. Results were available in 75 minutes (compared with 2 days for cultures). By RT-PCR, just 15% (35) of the women were GBS positive, suggesting that 19% (45) of the women had received unnecessary prophylaxis, Dr. Gerber and his associates at the hospital reported.

Of the 35 PCR-positive women, 7 had negative cultures—presumably because they were only lightly colonized—and therefore would not have received antibiotics under the antenatal screening guidelines.

All 35 PCR-positive women received prophylaxis but just 7 (22%) completed it.

Since further work-up of the newborn is required when the mother doesn't receive complete antimicrobial prophylaxis, RT-PCR could potentially represent a significant cost saving. An ongoing study is investigating the cost-effectiveness of the approach, Dr. Gerber said in an interview.

Moreover, unlike cultures, which must be performed by technicians, the RT-PCR was performed by the midwives themselves. The technology could also be used by labor and delivery nurses or obstetricians, Dr. Gerber said in an interview.

Dr. Gerber stated that he had no financial ties to Cepheid. The company provided the equipment for the study, but no additional funding.

Most insurance plans cover the Xpert GBS test, which was approved by the Food and Drug Administration in 2006. It is categorized as “moderate complexity” by the FDA, meaning that non-laboratory health care professionals such as physicians and nurses can run the test, a Cepheid spokesman said in an interview.

The spokesman declined to say how many Xpert GBS tests are currently in use, but he did say that as of the last quarter of 2008, there were 848 GeneExpert Systems installed worldwide, capable of running the GBS test.

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

Melanoma Missed in Nail Bed Lesion
A man, age 51, visited his family practitioner with a raw spot in the nail bed of his right middle finger that would not heal. He was referred to a hand surgeon, who treated the lesion and sent a tissue sample to pathology in February 2004. The pathologist noted an abnormality, but testing for carcinoma was negative.

Over the succeeding eight months, the lesion did not heal, and antibiotics were prescribed. Swelling consistent with an infection developed in the patient's elbow and armpit. When a second biopsy of the finger and elbow was performed in October, a diagnosis of melanoma was made. By that time, the cancer had metastasized to the man's lungs, brain, and other organs. The original tissue samples taken in February were reexamined, and melanoma was found. The patient died in January 2005.

The defendants claimed that a reasonable work-up of the specimen had been done. They also argued that the cancer must have been so well developed in February that an earlier diagnosis made at that time would not have changed the outcome.

According to a published account, a $1.5 million verdict was returned.

Cephalohematoma and Seizures Blamed on Vacuum Extractor Delivery
The plaintiff infant's mother, age 24, was admitted to the defendant hospital at 40 weeks, three days' gestation for scheduled induction of labor. Labor progressed normally, with some nonreassuring fetal heart tones for part of the time. When the mother was completely dilated, she was told to start pushing.

Nonreassuring fetal heart tones occurred for a few minutes when the infant's head was crowning. The defendant attending Ob-Gyn decided to use a vacuum extractor and allowed his first-year resident to perform the procedure while he supervised. The delivery notes indicated that only one pull was required for the baby to be delivered.

The newborn weighed 8 lb 15 oz. In the nursery records, no perinatal asphyxia was noted, but molding of the head was noted. The baby's 25-hour hospital stay was uneventful, with no abnormalities seen.

Three days after the birth, a visiting nurse was sent by the hospital to check on the mother and the baby at home. She found that the baby was not feeding well and was jaundiced. The mother was advised to take the child to the hospital, where he was found to have a cephalohematoma.

The baby later suffered seizures and was taken to another hospital, where cephalohematoma and bleeding deep inside the brain were found. Vacuum delivery was a suspected cause, but abuse and/or neglect were also possible. X-rays were normal, and blood study results ruled out any bleeding disorder. The infant later developed mild cerebral palsy and continued to experience a seizure disorder. He also had mild behavioral problems and learning deficits.

The plaintiff claimed that a cesarean delivery should have been performed to avoid a traumatic delivery after nonreassuring fetal heart tones. The plaintiff claimed that the vacuum delivery was performed incorrectly and that the resident should not have been allowed to perform it. The plaintiff claimed that the vacuum was placed on the wrong part of the infant's head, that excessive force was used, and that the head was pulled to one side, making delivery more difficult.

The defendants contended that a cesarean delivery was not necessary, based on reassuring fetal heart monitor strips and the infant's normal neonatal course during his hospital stay. The defendants further argued against evidence of trauma, since the vacuum extractor succeeded with just one pull and was attached for only one to two minutes. The defendants suggested that the injury could have occurred after the child left the hospital. The defendants also maintained that the child was doing well and that his seizures could be corrected with surgery.

According to a published account, a settlement of $1,125,000 was reached. This included $200,000 from the Ob-Gyn's insurer and the remainder from the hospital.

One of Two MRI Orders Never Processed
In early October 2005, a 52-year-old woman began to experience back pain and weakness in her legs. Two months earlier, she had had back pain that was attributed to an injury at the gym. Results on plain x-rays of the spine that were ordered by her family physician in October were negative.

Two days later, her symptoms became much worse. She experienced extreme weakness and numbness in one leg and began to have bowel and bladder difficulty. Her family physician admitted her to the hospital and ordered an MRI of the lumbar spine to rule out a tumor. He also requested a neurology consult. The neurologist examined the patient and formulated a differential diagnosis of either transverse myelitis or a tumor in the T10 area. The neurologist ordered a thoracolumbar MRI to rule out spinal cord compression.

Both MRIs were ordered through the hospital, but only the family physician's lumbar MRI request was processed, and results were negative for tumor. According to a hospital chart note written by a nurse on the MRI report, the results were reported to the neurologist at 6:30 pm.

The neurologist denied ever receiving this call. He claimed that the next day, he spoke with a radiologist who informed him that the spine had been scanned up and down, and no tumor had been found. The neurologist did not chart this conversation, and he could not recall the name of the radiologist with whom he spoke. The neurologist did not chart that the MRI was negative, nor did he ever read the MRI report. The neurologist reached a diagnosis of transverse myelitis.

Within four days, the patient had lost the ability to bear weight on her legs and had lost all bowel and bladder function. The neurologist saw her every day and maintained the diagnosis of transverse myelitis.

In late November, the woman began to experience new symptoms in her hands. Another doctor ordered an MRI of the thoracic spine, which revealed a large tumor at T10. In spite of surgery, the woman remained completely paraplegic. She was given a diagnosis of stage 3 multiple myeloma.

The plaintiff charged the hospital with negligence for failing to perform the MRI ordered by the neurologist. She also charged the neurologist as negligent for failing to follow up on his order by reviewing the existing MRI report; doing so would have alerted him to the fact that the MRI he ordered was never performed.

The hospital conceded some fault but claimed that the neurologist was also negligent. The hospital also placed blame on the family physician for trying to read his own x-rays and claimed that a radiologist would have seen evidence of the tumor.

According to a published account, a $775,000 settlement was reached. This included $500,000 from the hospital and $275,000 from the neurologist.

Follow-Up Instructions Misunderstood—or Unheeded?
After a January 2000 motor vehicle accident, a 24-year-old man was transported to a hospital emergency department (ED). Among his lab test results was an elevated creatinine level of 2.6, and his blood pressure was slightly elevated. The defendant ED physician claimed that he told the patient he had had an abnormal kidney function test and believed it was understood that the patient would follow up with his family health care provider regarding this concern and his injuries from the accident. Since the patient felt fine despite his injuries, he did not follow up with his family clinician.

In August 2002, the patient experienced acute renal failure; it was discovered that he had only one kidney, and it had failed. He was placed on dialysis and at the time of trial was on a waiting list to undergo kidney transplantation.

The plaintiff claimed that the defendant had not made it clear to him that the follow-up visit was needed to investigate his creatinine level. The defendant contended that when he released the patient from the ED, the patient signed discharge instructions, including an agreement to seek follow-up treatment. The defendant claimed that the patient's outcome was his own fault.

According to a published report, a verdict of $8.48 million was returned. 

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

Melanoma Missed in Nail Bed Lesion
A man, age 51, visited his family practitioner with a raw spot in the nail bed of his right middle finger that would not heal. He was referred to a hand surgeon, who treated the lesion and sent a tissue sample to pathology in February 2004. The pathologist noted an abnormality, but testing for carcinoma was negative.

Over the succeeding eight months, the lesion did not heal, and antibiotics were prescribed. Swelling consistent with an infection developed in the patient's elbow and armpit. When a second biopsy of the finger and elbow was performed in October, a diagnosis of melanoma was made. By that time, the cancer had metastasized to the man's lungs, brain, and other organs. The original tissue samples taken in February were reexamined, and melanoma was found. The patient died in January 2005.

The defendants claimed that a reasonable work-up of the specimen had been done. They also argued that the cancer must have been so well developed in February that an earlier diagnosis made at that time would not have changed the outcome.

According to a published account, a $1.5 million verdict was returned.

Cephalohematoma and Seizures Blamed on Vacuum Extractor Delivery
The plaintiff infant's mother, age 24, was admitted to the defendant hospital at 40 weeks, three days' gestation for scheduled induction of labor. Labor progressed normally, with some nonreassuring fetal heart tones for part of the time. When the mother was completely dilated, she was told to start pushing.

Nonreassuring fetal heart tones occurred for a few minutes when the infant's head was crowning. The defendant attending Ob-Gyn decided to use a vacuum extractor and allowed his first-year resident to perform the procedure while he supervised. The delivery notes indicated that only one pull was required for the baby to be delivered.

The newborn weighed 8 lb 15 oz. In the nursery records, no perinatal asphyxia was noted, but molding of the head was noted. The baby's 25-hour hospital stay was uneventful, with no abnormalities seen.

Three days after the birth, a visiting nurse was sent by the hospital to check on the mother and the baby at home. She found that the baby was not feeding well and was jaundiced. The mother was advised to take the child to the hospital, where he was found to have a cephalohematoma.

The baby later suffered seizures and was taken to another hospital, where cephalohematoma and bleeding deep inside the brain were found. Vacuum delivery was a suspected cause, but abuse and/or neglect were also possible. X-rays were normal, and blood study results ruled out any bleeding disorder. The infant later developed mild cerebral palsy and continued to experience a seizure disorder. He also had mild behavioral problems and learning deficits.

The plaintiff claimed that a cesarean delivery should have been performed to avoid a traumatic delivery after nonreassuring fetal heart tones. The plaintiff claimed that the vacuum delivery was performed incorrectly and that the resident should not have been allowed to perform it. The plaintiff claimed that the vacuum was placed on the wrong part of the infant's head, that excessive force was used, and that the head was pulled to one side, making delivery more difficult.

The defendants contended that a cesarean delivery was not necessary, based on reassuring fetal heart monitor strips and the infant's normal neonatal course during his hospital stay. The defendants further argued against evidence of trauma, since the vacuum extractor succeeded with just one pull and was attached for only one to two minutes. The defendants suggested that the injury could have occurred after the child left the hospital. The defendants also maintained that the child was doing well and that his seizures could be corrected with surgery.

According to a published account, a settlement of $1,125,000 was reached. This included $200,000 from the Ob-Gyn's insurer and the remainder from the hospital.

One of Two MRI Orders Never Processed
In early October 2005, a 52-year-old woman began to experience back pain and weakness in her legs. Two months earlier, she had had back pain that was attributed to an injury at the gym. Results on plain x-rays of the spine that were ordered by her family physician in October were negative.

Two days later, her symptoms became much worse. She experienced extreme weakness and numbness in one leg and began to have bowel and bladder difficulty. Her family physician admitted her to the hospital and ordered an MRI of the lumbar spine to rule out a tumor. He also requested a neurology consult. The neurologist examined the patient and formulated a differential diagnosis of either transverse myelitis or a tumor in the T10 area. The neurologist ordered a thoracolumbar MRI to rule out spinal cord compression.

Both MRIs were ordered through the hospital, but only the family physician's lumbar MRI request was processed, and results were negative for tumor. According to a hospital chart note written by a nurse on the MRI report, the results were reported to the neurologist at 6:30 pm.

The neurologist denied ever receiving this call. He claimed that the next day, he spoke with a radiologist who informed him that the spine had been scanned up and down, and no tumor had been found. The neurologist did not chart this conversation, and he could not recall the name of the radiologist with whom he spoke. The neurologist did not chart that the MRI was negative, nor did he ever read the MRI report. The neurologist reached a diagnosis of transverse myelitis.

Within four days, the patient had lost the ability to bear weight on her legs and had lost all bowel and bladder function. The neurologist saw her every day and maintained the diagnosis of transverse myelitis.

In late November, the woman began to experience new symptoms in her hands. Another doctor ordered an MRI of the thoracic spine, which revealed a large tumor at T10. In spite of surgery, the woman remained completely paraplegic. She was given a diagnosis of stage 3 multiple myeloma.

The plaintiff charged the hospital with negligence for failing to perform the MRI ordered by the neurologist. She also charged the neurologist as negligent for failing to follow up on his order by reviewing the existing MRI report; doing so would have alerted him to the fact that the MRI he ordered was never performed.

The hospital conceded some fault but claimed that the neurologist was also negligent. The hospital also placed blame on the family physician for trying to read his own x-rays and claimed that a radiologist would have seen evidence of the tumor.

According to a published account, a $775,000 settlement was reached. This included $500,000 from the hospital and $275,000 from the neurologist.

Follow-Up Instructions Misunderstood—or Unheeded?
After a January 2000 motor vehicle accident, a 24-year-old man was transported to a hospital emergency department (ED). Among his lab test results was an elevated creatinine level of 2.6, and his blood pressure was slightly elevated. The defendant ED physician claimed that he told the patient he had had an abnormal kidney function test and believed it was understood that the patient would follow up with his family health care provider regarding this concern and his injuries from the accident. Since the patient felt fine despite his injuries, he did not follow up with his family clinician.

In August 2002, the patient experienced acute renal failure; it was discovered that he had only one kidney, and it had failed. He was placed on dialysis and at the time of trial was on a waiting list to undergo kidney transplantation.

The plaintiff claimed that the defendant had not made it clear to him that the follow-up visit was needed to investigate his creatinine level. The defendant contended that when he released the patient from the ED, the patient signed discharge instructions, including an agreement to seek follow-up treatment. The defendant claimed that the patient's outcome was his own fault.

According to a published report, a verdict of $8.48 million was returned. 

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.

Melanoma Missed in Nail Bed Lesion
A man, age 51, visited his family practitioner with a raw spot in the nail bed of his right middle finger that would not heal. He was referred to a hand surgeon, who treated the lesion and sent a tissue sample to pathology in February 2004. The pathologist noted an abnormality, but testing for carcinoma was negative.

Over the succeeding eight months, the lesion did not heal, and antibiotics were prescribed. Swelling consistent with an infection developed in the patient's elbow and armpit. When a second biopsy of the finger and elbow was performed in October, a diagnosis of melanoma was made. By that time, the cancer had metastasized to the man's lungs, brain, and other organs. The original tissue samples taken in February were reexamined, and melanoma was found. The patient died in January 2005.

The defendants claimed that a reasonable work-up of the specimen had been done. They also argued that the cancer must have been so well developed in February that an earlier diagnosis made at that time would not have changed the outcome.

According to a published account, a $1.5 million verdict was returned.

Cephalohematoma and Seizures Blamed on Vacuum Extractor Delivery
The plaintiff infant's mother, age 24, was admitted to the defendant hospital at 40 weeks, three days' gestation for scheduled induction of labor. Labor progressed normally, with some nonreassuring fetal heart tones for part of the time. When the mother was completely dilated, she was told to start pushing.

Nonreassuring fetal heart tones occurred for a few minutes when the infant's head was crowning. The defendant attending Ob-Gyn decided to use a vacuum extractor and allowed his first-year resident to perform the procedure while he supervised. The delivery notes indicated that only one pull was required for the baby to be delivered.

The newborn weighed 8 lb 15 oz. In the nursery records, no perinatal asphyxia was noted, but molding of the head was noted. The baby's 25-hour hospital stay was uneventful, with no abnormalities seen.

Three days after the birth, a visiting nurse was sent by the hospital to check on the mother and the baby at home. She found that the baby was not feeding well and was jaundiced. The mother was advised to take the child to the hospital, where he was found to have a cephalohematoma.

The baby later suffered seizures and was taken to another hospital, where cephalohematoma and bleeding deep inside the brain were found. Vacuum delivery was a suspected cause, but abuse and/or neglect were also possible. X-rays were normal, and blood study results ruled out any bleeding disorder. The infant later developed mild cerebral palsy and continued to experience a seizure disorder. He also had mild behavioral problems and learning deficits.

The plaintiff claimed that a cesarean delivery should have been performed to avoid a traumatic delivery after nonreassuring fetal heart tones. The plaintiff claimed that the vacuum delivery was performed incorrectly and that the resident should not have been allowed to perform it. The plaintiff claimed that the vacuum was placed on the wrong part of the infant's head, that excessive force was used, and that the head was pulled to one side, making delivery more difficult.

The defendants contended that a cesarean delivery was not necessary, based on reassuring fetal heart monitor strips and the infant's normal neonatal course during his hospital stay. The defendants further argued against evidence of trauma, since the vacuum extractor succeeded with just one pull and was attached for only one to two minutes. The defendants suggested that the injury could have occurred after the child left the hospital. The defendants also maintained that the child was doing well and that his seizures could be corrected with surgery.

According to a published account, a settlement of $1,125,000 was reached. This included $200,000 from the Ob-Gyn's insurer and the remainder from the hospital.

One of Two MRI Orders Never Processed
In early October 2005, a 52-year-old woman began to experience back pain and weakness in her legs. Two months earlier, she had had back pain that was attributed to an injury at the gym. Results on plain x-rays of the spine that were ordered by her family physician in October were negative.

Two days later, her symptoms became much worse. She experienced extreme weakness and numbness in one leg and began to have bowel and bladder difficulty. Her family physician admitted her to the hospital and ordered an MRI of the lumbar spine to rule out a tumor. He also requested a neurology consult. The neurologist examined the patient and formulated a differential diagnosis of either transverse myelitis or a tumor in the T10 area. The neurologist ordered a thoracolumbar MRI to rule out spinal cord compression.

Both MRIs were ordered through the hospital, but only the family physician's lumbar MRI request was processed, and results were negative for tumor. According to a hospital chart note written by a nurse on the MRI report, the results were reported to the neurologist at 6:30 pm.

The neurologist denied ever receiving this call. He claimed that the next day, he spoke with a radiologist who informed him that the spine had been scanned up and down, and no tumor had been found. The neurologist did not chart this conversation, and he could not recall the name of the radiologist with whom he spoke. The neurologist did not chart that the MRI was negative, nor did he ever read the MRI report. The neurologist reached a diagnosis of transverse myelitis.

Within four days, the patient had lost the ability to bear weight on her legs and had lost all bowel and bladder function. The neurologist saw her every day and maintained the diagnosis of transverse myelitis.

In late November, the woman began to experience new symptoms in her hands. Another doctor ordered an MRI of the thoracic spine, which revealed a large tumor at T10. In spite of surgery, the woman remained completely paraplegic. She was given a diagnosis of stage 3 multiple myeloma.

The plaintiff charged the hospital with negligence for failing to perform the MRI ordered by the neurologist. She also charged the neurologist as negligent for failing to follow up on his order by reviewing the existing MRI report; doing so would have alerted him to the fact that the MRI he ordered was never performed.

The hospital conceded some fault but claimed that the neurologist was also negligent. The hospital also placed blame on the family physician for trying to read his own x-rays and claimed that a radiologist would have seen evidence of the tumor.

According to a published account, a $775,000 settlement was reached. This included $500,000 from the hospital and $275,000 from the neurologist.

Follow-Up Instructions Misunderstood—or Unheeded?
After a January 2000 motor vehicle accident, a 24-year-old man was transported to a hospital emergency department (ED). Among his lab test results was an elevated creatinine level of 2.6, and his blood pressure was slightly elevated. The defendant ED physician claimed that he told the patient he had had an abnormal kidney function test and believed it was understood that the patient would follow up with his family health care provider regarding this concern and his injuries from the accident. Since the patient felt fine despite his injuries, he did not follow up with his family clinician.

In August 2002, the patient experienced acute renal failure; it was discovered that he had only one kidney, and it had failed. He was placed on dialysis and at the time of trial was on a waiting list to undergo kidney transplantation.

The plaintiff claimed that the defendant had not made it clear to him that the follow-up visit was needed to investigate his creatinine level. The defendant contended that when he released the patient from the ED, the patient signed discharge instructions, including an agreement to seek follow-up treatment. The defendant claimed that the patient's outcome was his own fault.

According to a published report, a verdict of $8.48 million was returned. 

PHOENIX — Flexibility in scheduling would help depressed women access cognitive-behavioral therapy during or just after pregnancy, a survey of 24 women found. A little more respect would be nice too, respondents said.

Results of the qualitative survey informed a revision of a cognitive-behavioral treatment manual that will be tested in a randomized, controlled trial with 60 women comparing the revised therapy model with treatment as usual, Heather A. Flynn, Ph.D., said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

She and her associates used the Edinburgh Postnatal Depression Scale to screen 274 pregnant or postpartum women in the waiting rooms of five obstetrics clinics. The Structured Clinical Interview for DSM Disorders identified 24 of these women, who completed a questionnaire about their preferences for receiving cognitive-behavioral therapy, with major depressive disorder or minor depression. The women said they would prefer to get CBT in an obstetrician's office or at home by telephone. Postpartum women said that having child care available at the clinic would be a big help. “We're actually doing that now,” said Dr. Flynn, an assistant professor of psychiatry at the University of Michigan, Ann Arbor.

All 24 women spontaneously reported that they have felt judged, disrespected, or stigmatized by health care workers. “Women did not feel that they were listened to” as they tried to get help, she said.

The women did not acknowledge that what they were experiencing was depression, however, and did not want therapy to be presented as treatment for depression. “The way you present treatment is very important,” Dr. Flynn suggested.

The investigators preliminarily tested an eight-session program of CBT in 12 patients, all of whom showed up for the first three sessions that were conducted with prenatal care visits at the obstetrics clinic. Overall, half of all sessions needed to be rescheduled in order for 78% of the sessions to be completed, she reported. One woman stopped therapy; three completed the eight sessions; and eight patients are still in therapy.

The 11 patients who completed or who continue therapy have benefited from treatment, Dr. Flynn said, and they report high satisfaction with the program. “The more flexible we are, the more likely that we're going to retain these women in therapy,” she said.

Several previous studies found that approximately 75% of women with depression during pregnancy or the postpartum period go undiagnosed or untreated, Dr. Flynn said. One of the main barriers seems to be difficulty in accessing treatment. “The treatments are probably fine. It's just that women are not accessing them,” she said. “They may or may not be ambivalent about treatment. It's just that they have chaotic lives.”

Most of the women in her pilot studies had incomes below the poverty line, and a few were homeless. Many lacked transportation. “We need to be as flexible as possible to accommodate these women,” she said.

PHOENIX — Flexibility in scheduling would help depressed women access cognitive-behavioral therapy during or just after pregnancy, a survey of 24 women found. A little more respect would be nice too, respondents said.

Results of the qualitative survey informed a revision of a cognitive-behavioral treatment manual that will be tested in a randomized, controlled trial with 60 women comparing the revised therapy model with treatment as usual, Heather A. Flynn, Ph.D., said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

She and her associates used the Edinburgh Postnatal Depression Scale to screen 274 pregnant or postpartum women in the waiting rooms of five obstetrics clinics. The Structured Clinical Interview for DSM Disorders identified 24 of these women, who completed a questionnaire about their preferences for receiving cognitive-behavioral therapy, with major depressive disorder or minor depression. The women said they would prefer to get CBT in an obstetrician's office or at home by telephone. Postpartum women said that having child care available at the clinic would be a big help. “We're actually doing that now,” said Dr. Flynn, an assistant professor of psychiatry at the University of Michigan, Ann Arbor.

All 24 women spontaneously reported that they have felt judged, disrespected, or stigmatized by health care workers. “Women did not feel that they were listened to” as they tried to get help, she said.

The women did not acknowledge that what they were experiencing was depression, however, and did not want therapy to be presented as treatment for depression. “The way you present treatment is very important,” Dr. Flynn suggested.

The investigators preliminarily tested an eight-session program of CBT in 12 patients, all of whom showed up for the first three sessions that were conducted with prenatal care visits at the obstetrics clinic. Overall, half of all sessions needed to be rescheduled in order for 78% of the sessions to be completed, she reported. One woman stopped therapy; three completed the eight sessions; and eight patients are still in therapy.

The 11 patients who completed or who continue therapy have benefited from treatment, Dr. Flynn said, and they report high satisfaction with the program. “The more flexible we are, the more likely that we're going to retain these women in therapy,” she said.

Several previous studies found that approximately 75% of women with depression during pregnancy or the postpartum period go undiagnosed or untreated, Dr. Flynn said. One of the main barriers seems to be difficulty in accessing treatment. “The treatments are probably fine. It's just that women are not accessing them,” she said. “They may or may not be ambivalent about treatment. It's just that they have chaotic lives.”

Most of the women in her pilot studies had incomes below the poverty line, and a few were homeless. Many lacked transportation. “We need to be as flexible as possible to accommodate these women,” she said.

PHOENIX — Flexibility in scheduling would help depressed women access cognitive-behavioral therapy during or just after pregnancy, a survey of 24 women found. A little more respect would be nice too, respondents said.

Results of the qualitative survey informed a revision of a cognitive-behavioral treatment manual that will be tested in a randomized, controlled trial with 60 women comparing the revised therapy model with treatment as usual, Heather A. Flynn, Ph.D., said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

She and her associates used the Edinburgh Postnatal Depression Scale to screen 274 pregnant or postpartum women in the waiting rooms of five obstetrics clinics. The Structured Clinical Interview for DSM Disorders identified 24 of these women, who completed a questionnaire about their preferences for receiving cognitive-behavioral therapy, with major depressive disorder or minor depression. The women said they would prefer to get CBT in an obstetrician's office or at home by telephone. Postpartum women said that having child care available at the clinic would be a big help. “We're actually doing that now,” said Dr. Flynn, an assistant professor of psychiatry at the University of Michigan, Ann Arbor.

All 24 women spontaneously reported that they have felt judged, disrespected, or stigmatized by health care workers. “Women did not feel that they were listened to” as they tried to get help, she said.

The women did not acknowledge that what they were experiencing was depression, however, and did not want therapy to be presented as treatment for depression. “The way you present treatment is very important,” Dr. Flynn suggested.

The investigators preliminarily tested an eight-session program of CBT in 12 patients, all of whom showed up for the first three sessions that were conducted with prenatal care visits at the obstetrics clinic. Overall, half of all sessions needed to be rescheduled in order for 78% of the sessions to be completed, she reported. One woman stopped therapy; three completed the eight sessions; and eight patients are still in therapy.

The 11 patients who completed or who continue therapy have benefited from treatment, Dr. Flynn said, and they report high satisfaction with the program. “The more flexible we are, the more likely that we're going to retain these women in therapy,” she said.

Several previous studies found that approximately 75% of women with depression during pregnancy or the postpartum period go undiagnosed or untreated, Dr. Flynn said. One of the main barriers seems to be difficulty in accessing treatment. “The treatments are probably fine. It's just that women are not accessing them,” she said. “They may or may not be ambivalent about treatment. It's just that they have chaotic lives.”

Most of the women in her pilot studies had incomes below the poverty line, and a few were homeless. Many lacked transportation. “We need to be as flexible as possible to accommodate these women,” she said.

WASHINGTON — Blood type AB appears to be a risk factor for preeclampsia, based on the findings of a population-based study of 100,000 consecutive pregnancies in Finland.

Maternal blood type, routinely recorded in pregnancy, may be another way of identifying women at risk for preterm preeclampsia, especially those with other risk factors such as a high body mass index, first pregnancy, or twin pregnancy, said Dr. Hannele Laivuori of the department of medical genetics at the University of Helsinki and colleagues. The results were presented as a poster at the annual congress of the International Society for the Study of Hypertension in Pregnancy.

To examine whether ABO blood type and factor V Leiden clotting factor are associated with preeclampsia risk, the researchers reviewed data from a national registry of blood types of pregnant women and a national registry of medical records.

The nested study population included 248 women who met criteria for preeclampsia and 679 women without preeclampsia who were control subjects. The women gave blood samples and completed questionnaires to supplement the information from their medical records.

Overall, women with the AB blood type were more than twice as likely to develop preeclampsia (odds ratio, 2.1) and nearly four times as likely to develop preterm preeclampsia (OR, 3.8) as were women with blood types A, B, or O. Preterm preeclampsia was defined as preeclampsia at less than 34 weeks' gestation. When only a first pregnancy was analyzed, the association between blood type AB and preeclampsia was significant only for preterm preeclampsia.

“Factor V Leiden was not a risk factor for preeclampsia in this study population,” the researchers noted.

Age, education level, and place of residence (rural vs. urban) were similar for those with and without preeclampsia. After investigators controlled for confounding factors, a high body mass index before pregnancy, first pregnancy, and twin pregnancy were significantly associated with an increased risk of preeclampsia.

The findings support those of the few previous studies on this topic, including an Italian study that found women with blood type AB were three times as likely to develop preeclampsia as were women with other blood types (J. Hum. Hypertens. 1995;9:623–5).

The study was supported in part by the Red Cross Finland Blood Service.

Dr. Laivuori stated that she had no relevant financial conflicts to disclose.

WASHINGTON — Blood type AB appears to be a risk factor for preeclampsia, based on the findings of a population-based study of 100,000 consecutive pregnancies in Finland.

Maternal blood type, routinely recorded in pregnancy, may be another way of identifying women at risk for preterm preeclampsia, especially those with other risk factors such as a high body mass index, first pregnancy, or twin pregnancy, said Dr. Hannele Laivuori of the department of medical genetics at the University of Helsinki and colleagues. The results were presented as a poster at the annual congress of the International Society for the Study of Hypertension in Pregnancy.

To examine whether ABO blood type and factor V Leiden clotting factor are associated with preeclampsia risk, the researchers reviewed data from a national registry of blood types of pregnant women and a national registry of medical records.

The nested study population included 248 women who met criteria for preeclampsia and 679 women without preeclampsia who were control subjects. The women gave blood samples and completed questionnaires to supplement the information from their medical records.

Overall, women with the AB blood type were more than twice as likely to develop preeclampsia (odds ratio, 2.1) and nearly four times as likely to develop preterm preeclampsia (OR, 3.8) as were women with blood types A, B, or O. Preterm preeclampsia was defined as preeclampsia at less than 34 weeks' gestation. When only a first pregnancy was analyzed, the association between blood type AB and preeclampsia was significant only for preterm preeclampsia.

“Factor V Leiden was not a risk factor for preeclampsia in this study population,” the researchers noted.

Age, education level, and place of residence (rural vs. urban) were similar for those with and without preeclampsia. After investigators controlled for confounding factors, a high body mass index before pregnancy, first pregnancy, and twin pregnancy were significantly associated with an increased risk of preeclampsia.

The findings support those of the few previous studies on this topic, including an Italian study that found women with blood type AB were three times as likely to develop preeclampsia as were women with other blood types (J. Hum. Hypertens. 1995;9:623–5).

The study was supported in part by the Red Cross Finland Blood Service.

Dr. Laivuori stated that she had no relevant financial conflicts to disclose.

WASHINGTON — Blood type AB appears to be a risk factor for preeclampsia, based on the findings of a population-based study of 100,000 consecutive pregnancies in Finland.

Maternal blood type, routinely recorded in pregnancy, may be another way of identifying women at risk for preterm preeclampsia, especially those with other risk factors such as a high body mass index, first pregnancy, or twin pregnancy, said Dr. Hannele Laivuori of the department of medical genetics at the University of Helsinki and colleagues. The results were presented as a poster at the annual congress of the International Society for the Study of Hypertension in Pregnancy.

To examine whether ABO blood type and factor V Leiden clotting factor are associated with preeclampsia risk, the researchers reviewed data from a national registry of blood types of pregnant women and a national registry of medical records.

The nested study population included 248 women who met criteria for preeclampsia and 679 women without preeclampsia who were control subjects. The women gave blood samples and completed questionnaires to supplement the information from their medical records.

Overall, women with the AB blood type were more than twice as likely to develop preeclampsia (odds ratio, 2.1) and nearly four times as likely to develop preterm preeclampsia (OR, 3.8) as were women with blood types A, B, or O. Preterm preeclampsia was defined as preeclampsia at less than 34 weeks' gestation. When only a first pregnancy was analyzed, the association between blood type AB and preeclampsia was significant only for preterm preeclampsia.

“Factor V Leiden was not a risk factor for preeclampsia in this study population,” the researchers noted.

Age, education level, and place of residence (rural vs. urban) were similar for those with and without preeclampsia. After investigators controlled for confounding factors, a high body mass index before pregnancy, first pregnancy, and twin pregnancy were significantly associated with an increased risk of preeclampsia.

The findings support those of the few previous studies on this topic, including an Italian study that found women with blood type AB were three times as likely to develop preeclampsia as were women with other blood types (J. Hum. Hypertens. 1995;9:623–5).

The study was supported in part by the Red Cross Finland Blood Service.

Dr. Laivuori stated that she had no relevant financial conflicts to disclose.

MUNICH — For women who were born with a congenital heart defect that was subsequently repaired, a healthy, event-free pregnancy is a roll of the dice.

“The risk to the mother and child is considerable in some cases, but not in all women” who become pregnant after having an atrial switch operation for transposition of the great arteries (TGA) as a child, Dr. Vessie Trigas said at the annual meeting of the European Society of Cardiology.

The risk is “unpredictable,” and therefore, these women need careful follow-up throughout pregnancy, ideally at a center that specializes in managing adults with congenital heart diseases, said Dr. Trigas, a congenital heart disease researcher at the German Heart Center in Munich.

Women who have undergone a TGA procedure “need to be informed that they can worsen” when pregnant, she added.

TGA is one of the most common congenital heart defects, accounting for about 5%–8% of congenital heart cases. If untreated, most children with TGA die before they are 2 years old, but with an atrial switch operation, most patients survive into at least their 30s.

To examine the effect and outcome of pregnancy in women with repaired TGA, Dr. Trigas and her associates reviewed the records of 60 pregnancies in 34 women who were followed at any one of three centers in Munich, Berlin, and Zurich. A total of 20 women had a history of isolated TGA as infants, and 14 had complex TGA that included other complications. Their average age at TGA repair was 19 months, with the latest done at 14 years. Their average age at first pregnancy was 25 years, ranging from 16 to 34 years. Their average age at the last pregnancy was 27 years; the oldest woman was 35 years old. The average duration of follow-up was almost 5 years.

Prior to pregnancy, 28 women were in functional class I, 5 were in class II, and 1 woman did not have her functional class documented in her records. Pregnancy led to class deterioration in seven women, but none of the women died during pregnancy.

Serious cardiac events during pregnancy included two cases of decompensation, and two other decompensation episodes that required resuscitation during delivery. Right ventricular dysfunction progressed in five patients. Tricuspid valve regurgitation progressed in three patients. Subpulmonary valve obstruction progressed in one woman and a new obstruction appeared in another. Systemic venous obstruction progressed in one woman, and three women developed new baffle leaks.

Obstetric complications occurred during 26 pregnancies, and included premature contractions in 9, vaginal bleeding in 5, dyspnea in 5, and premature rupture of membranes in 4.

Forty-four of the pregnancies resulted in term deliveries, and there were 16 abortions; 11 were miscarriages and 5 were induced. Births occurred at 29–42 weeks of gestation, with a median of 39 weeks. Sixteen deliveries were normal vaginal deliveries, 4 involved the use of forceps or suction assistance, and 24 were by cesarean section. Eleven deliveries were premature, at less than 37 weeks' gestation. The average birth weight was 2,910 g, with a range of 910–4,160 g. Three infants were born at less than 1,500 g. None of the infants had a congenital heart defect at birth.

Delivery emergencies included a need for resuscitation because of cardiac arrest in two women, and one case of cardiac and renal failure at 8 weeks post partum.

These women need careful follow-up throughout pregnancy, ideally at a specialized center. DR. TRIGAS

MUNICH — For women who were born with a congenital heart defect that was subsequently repaired, a healthy, event-free pregnancy is a roll of the dice.

“The risk to the mother and child is considerable in some cases, but not in all women” who become pregnant after having an atrial switch operation for transposition of the great arteries (TGA) as a child, Dr. Vessie Trigas said at the annual meeting of the European Society of Cardiology.

The risk is “unpredictable,” and therefore, these women need careful follow-up throughout pregnancy, ideally at a center that specializes in managing adults with congenital heart diseases, said Dr. Trigas, a congenital heart disease researcher at the German Heart Center in Munich.

Women who have undergone a TGA procedure “need to be informed that they can worsen” when pregnant, she added.

TGA is one of the most common congenital heart defects, accounting for about 5%–8% of congenital heart cases. If untreated, most children with TGA die before they are 2 years old, but with an atrial switch operation, most patients survive into at least their 30s.

To examine the effect and outcome of pregnancy in women with repaired TGA, Dr. Trigas and her associates reviewed the records of 60 pregnancies in 34 women who were followed at any one of three centers in Munich, Berlin, and Zurich. A total of 20 women had a history of isolated TGA as infants, and 14 had complex TGA that included other complications. Their average age at TGA repair was 19 months, with the latest done at 14 years. Their average age at first pregnancy was 25 years, ranging from 16 to 34 years. Their average age at the last pregnancy was 27 years; the oldest woman was 35 years old. The average duration of follow-up was almost 5 years.

Prior to pregnancy, 28 women were in functional class I, 5 were in class II, and 1 woman did not have her functional class documented in her records. Pregnancy led to class deterioration in seven women, but none of the women died during pregnancy.

Serious cardiac events during pregnancy included two cases of decompensation, and two other decompensation episodes that required resuscitation during delivery. Right ventricular dysfunction progressed in five patients. Tricuspid valve regurgitation progressed in three patients. Subpulmonary valve obstruction progressed in one woman and a new obstruction appeared in another. Systemic venous obstruction progressed in one woman, and three women developed new baffle leaks.

Obstetric complications occurred during 26 pregnancies, and included premature contractions in 9, vaginal bleeding in 5, dyspnea in 5, and premature rupture of membranes in 4.

Forty-four of the pregnancies resulted in term deliveries, and there were 16 abortions; 11 were miscarriages and 5 were induced. Births occurred at 29–42 weeks of gestation, with a median of 39 weeks. Sixteen deliveries were normal vaginal deliveries, 4 involved the use of forceps or suction assistance, and 24 were by cesarean section. Eleven deliveries were premature, at less than 37 weeks' gestation. The average birth weight was 2,910 g, with a range of 910–4,160 g. Three infants were born at less than 1,500 g. None of the infants had a congenital heart defect at birth.

Delivery emergencies included a need for resuscitation because of cardiac arrest in two women, and one case of cardiac and renal failure at 8 weeks post partum.

These women need careful follow-up throughout pregnancy, ideally at a specialized center. DR. TRIGAS

MUNICH — For women who were born with a congenital heart defect that was subsequently repaired, a healthy, event-free pregnancy is a roll of the dice.

“The risk to the mother and child is considerable in some cases, but not in all women” who become pregnant after having an atrial switch operation for transposition of the great arteries (TGA) as a child, Dr. Vessie Trigas said at the annual meeting of the European Society of Cardiology.

The risk is “unpredictable,” and therefore, these women need careful follow-up throughout pregnancy, ideally at a center that specializes in managing adults with congenital heart diseases, said Dr. Trigas, a congenital heart disease researcher at the German Heart Center in Munich.

Women who have undergone a TGA procedure “need to be informed that they can worsen” when pregnant, she added.

TGA is one of the most common congenital heart defects, accounting for about 5%–8% of congenital heart cases. If untreated, most children with TGA die before they are 2 years old, but with an atrial switch operation, most patients survive into at least their 30s.

To examine the effect and outcome of pregnancy in women with repaired TGA, Dr. Trigas and her associates reviewed the records of 60 pregnancies in 34 women who were followed at any one of three centers in Munich, Berlin, and Zurich. A total of 20 women had a history of isolated TGA as infants, and 14 had complex TGA that included other complications. Their average age at TGA repair was 19 months, with the latest done at 14 years. Their average age at first pregnancy was 25 years, ranging from 16 to 34 years. Their average age at the last pregnancy was 27 years; the oldest woman was 35 years old. The average duration of follow-up was almost 5 years.

Prior to pregnancy, 28 women were in functional class I, 5 were in class II, and 1 woman did not have her functional class documented in her records. Pregnancy led to class deterioration in seven women, but none of the women died during pregnancy.

Serious cardiac events during pregnancy included two cases of decompensation, and two other decompensation episodes that required resuscitation during delivery. Right ventricular dysfunction progressed in five patients. Tricuspid valve regurgitation progressed in three patients. Subpulmonary valve obstruction progressed in one woman and a new obstruction appeared in another. Systemic venous obstruction progressed in one woman, and three women developed new baffle leaks.

Obstetric complications occurred during 26 pregnancies, and included premature contractions in 9, vaginal bleeding in 5, dyspnea in 5, and premature rupture of membranes in 4.

Forty-four of the pregnancies resulted in term deliveries, and there were 16 abortions; 11 were miscarriages and 5 were induced. Births occurred at 29–42 weeks of gestation, with a median of 39 weeks. Sixteen deliveries were normal vaginal deliveries, 4 involved the use of forceps or suction assistance, and 24 were by cesarean section. Eleven deliveries were premature, at less than 37 weeks' gestation. The average birth weight was 2,910 g, with a range of 910–4,160 g. Three infants were born at less than 1,500 g. None of the infants had a congenital heart defect at birth.

Delivery emergencies included a need for resuscitation because of cardiac arrest in two women, and one case of cardiac and renal failure at 8 weeks post partum.

These women need careful follow-up throughout pregnancy, ideally at a specialized center. DR. TRIGAS

WASHINGTON—Perinatal outcomes were slightly, but not significantly, better in renal transplant recipients who were immunosuppressed with cyclosporine, compared with those given azathioprine, according to findings from a study involving 59 pregnant women at a single research center.

“There are no described rates of maternal mortality for women with renal transplants,” noted Dr. Vicenç Cararach, who presented study results at the annual meeting of the International Society of Obstetric Medicine.

Dr. Cararach and colleagues at the University of Barcelona compared 27 patients who were treated with azathioprine and prednisone (1973–1991) and 32 patients who were treated with cyclosporine and prednisone (1992–2007).

Overall, 3 patients (11%) in the azathioprine group and 2 patients (6%) in the cyclosporine group delivered at less than 32 weeks' gestation. An average of 13 infants in each group had birth weights below 2500 grams.

There were no maternal deaths in either group, and the three reported perinatal deaths all occurred in the azathioprine group.

More cases of premature rupture of membranes occurred in the azathioprine group, while more cases of preeclampsia and intrauterine growth restriction were found in the cyclosporine group.

Although these differences were not significant because of the limited number of cases, “it does not mean that they were not clinically important,” Dr. Cararach noted.

Creatinine levels during pregnancy were similar between the two groups, he said. However, 3 years after pregnancy, creatinine levels were higher in the cyclosporine group, which raises some concerns about renal function with long-term cyclosporine use, Dr. Cararach added.

The results support those from previous studies demonstrating that perinatal outcomes are generally positive among renal transplant recipients, he said.

However, the elevated risk of premature birth remains a concern. And there are long-term risks for hypertension and infection that deserve further study, he noted.

Dr. Cararach stated that he had no financial conflicts of interest.

WASHINGTON—Perinatal outcomes were slightly, but not significantly, better in renal transplant recipients who were immunosuppressed with cyclosporine, compared with those given azathioprine, according to findings from a study involving 59 pregnant women at a single research center.

“There are no described rates of maternal mortality for women with renal transplants,” noted Dr. Vicenç Cararach, who presented study results at the annual meeting of the International Society of Obstetric Medicine.

Dr. Cararach and colleagues at the University of Barcelona compared 27 patients who were treated with azathioprine and prednisone (1973–1991) and 32 patients who were treated with cyclosporine and prednisone (1992–2007).

Overall, 3 patients (11%) in the azathioprine group and 2 patients (6%) in the cyclosporine group delivered at less than 32 weeks' gestation. An average of 13 infants in each group had birth weights below 2500 grams.

There were no maternal deaths in either group, and the three reported perinatal deaths all occurred in the azathioprine group.

More cases of premature rupture of membranes occurred in the azathioprine group, while more cases of preeclampsia and intrauterine growth restriction were found in the cyclosporine group.

Although these differences were not significant because of the limited number of cases, “it does not mean that they were not clinically important,” Dr. Cararach noted.

Creatinine levels during pregnancy were similar between the two groups, he said. However, 3 years after pregnancy, creatinine levels were higher in the cyclosporine group, which raises some concerns about renal function with long-term cyclosporine use, Dr. Cararach added.

The results support those from previous studies demonstrating that perinatal outcomes are generally positive among renal transplant recipients, he said.

However, the elevated risk of premature birth remains a concern. And there are long-term risks for hypertension and infection that deserve further study, he noted.

Dr. Cararach stated that he had no financial conflicts of interest.

WASHINGTON—Perinatal outcomes were slightly, but not significantly, better in renal transplant recipients who were immunosuppressed with cyclosporine, compared with those given azathioprine, according to findings from a study involving 59 pregnant women at a single research center.

“There are no described rates of maternal mortality for women with renal transplants,” noted Dr. Vicenç Cararach, who presented study results at the annual meeting of the International Society of Obstetric Medicine.

Dr. Cararach and colleagues at the University of Barcelona compared 27 patients who were treated with azathioprine and prednisone (1973–1991) and 32 patients who were treated with cyclosporine and prednisone (1992–2007).

Overall, 3 patients (11%) in the azathioprine group and 2 patients (6%) in the cyclosporine group delivered at less than 32 weeks' gestation. An average of 13 infants in each group had birth weights below 2500 grams.

There were no maternal deaths in either group, and the three reported perinatal deaths all occurred in the azathioprine group.

More cases of premature rupture of membranes occurred in the azathioprine group, while more cases of preeclampsia and intrauterine growth restriction were found in the cyclosporine group.

Although these differences were not significant because of the limited number of cases, “it does not mean that they were not clinically important,” Dr. Cararach noted.

Creatinine levels during pregnancy were similar between the two groups, he said. However, 3 years after pregnancy, creatinine levels were higher in the cyclosporine group, which raises some concerns about renal function with long-term cyclosporine use, Dr. Cararach added.

The results support those from previous studies demonstrating that perinatal outcomes are generally positive among renal transplant recipients, he said.

However, the elevated risk of premature birth remains a concern. And there are long-term risks for hypertension and infection that deserve further study, he noted.

Dr. Cararach stated that he had no financial conflicts of interest.

WASHINGTON—A maternal history of preeclampsia may identify adults who are at increased risk for stroke: Adults whose mothers had severe preeclampsia were almost twice as likely to have strokes as were adults whose mothers did not have preeclampsia, based on data from more than 6,000 singleton pregnancies in Finland.

This study is one of the first to examine the long-term health risks of the offspring of women who had preeclampsia, Dr. Eero Kajantie said at the annual congress of the International Society for the Study of Hypertension in Pregnancy. “We know surprisingly little about which pregnancy conditions are associated with increased risk for coronary heart disease and stroke” among offspring.

Previous studies have shown that these women are at increased risk for coronary heart disease and stroke later in life. Also, their children are prone to high blood pressure during childhood, said Dr. Kajantie of the National Public Health Institute in Helsinki. Dr. Kajantie and his colleagues based their conclusion on a review of data from 6,410 members of the Helsinki Birth Cohort, who were born as singletons between 1934 and 1944.

Overall, 284 pregnancies (4.4%) were complicated by preeclampsia and 1,592 (24.8%) met criteria for hypertension without proteinuria. Among the children of these pregnancies, 464 (7.2%) had a diagnosis of coronary heart disease and 272 (4.2%) had a diagnosis of stroke. Diagnoses of CHD and stroke were collected from national hospital discharge records and death registries. The risk of stroke was almost twice as likely in the 164 adults whose mothers had severe preeclampsia (hazard ratio, 1.7), after the researchers controlled for sex, low birth weight, and gestational age.

The researchers also found that hypertension was a significant predictor of stroke, but was not a significant predictor of CHD.

Dr. Kajantie stated that he had no financial conflicts to disclose.

WASHINGTON—A maternal history of preeclampsia may identify adults who are at increased risk for stroke: Adults whose mothers had severe preeclampsia were almost twice as likely to have strokes as were adults whose mothers did not have preeclampsia, based on data from more than 6,000 singleton pregnancies in Finland.

This study is one of the first to examine the long-term health risks of the offspring of women who had preeclampsia, Dr. Eero Kajantie said at the annual congress of the International Society for the Study of Hypertension in Pregnancy. “We know surprisingly little about which pregnancy conditions are associated with increased risk for coronary heart disease and stroke” among offspring.

Previous studies have shown that these women are at increased risk for coronary heart disease and stroke later in life. Also, their children are prone to high blood pressure during childhood, said Dr. Kajantie of the National Public Health Institute in Helsinki. Dr. Kajantie and his colleagues based their conclusion on a review of data from 6,410 members of the Helsinki Birth Cohort, who were born as singletons between 1934 and 1944.

Overall, 284 pregnancies (4.4%) were complicated by preeclampsia and 1,592 (24.8%) met criteria for hypertension without proteinuria. Among the children of these pregnancies, 464 (7.2%) had a diagnosis of coronary heart disease and 272 (4.2%) had a diagnosis of stroke. Diagnoses of CHD and stroke were collected from national hospital discharge records and death registries. The risk of stroke was almost twice as likely in the 164 adults whose mothers had severe preeclampsia (hazard ratio, 1.7), after the researchers controlled for sex, low birth weight, and gestational age.

The researchers also found that hypertension was a significant predictor of stroke, but was not a significant predictor of CHD.

Dr. Kajantie stated that he had no financial conflicts to disclose.

WASHINGTON—A maternal history of preeclampsia may identify adults who are at increased risk for stroke: Adults whose mothers had severe preeclampsia were almost twice as likely to have strokes as were adults whose mothers did not have preeclampsia, based on data from more than 6,000 singleton pregnancies in Finland.

This study is one of the first to examine the long-term health risks of the offspring of women who had preeclampsia, Dr. Eero Kajantie said at the annual congress of the International Society for the Study of Hypertension in Pregnancy. “We know surprisingly little about which pregnancy conditions are associated with increased risk for coronary heart disease and stroke” among offspring.

Previous studies have shown that these women are at increased risk for coronary heart disease and stroke later in life. Also, their children are prone to high blood pressure during childhood, said Dr. Kajantie of the National Public Health Institute in Helsinki. Dr. Kajantie and his colleagues based their conclusion on a review of data from 6,410 members of the Helsinki Birth Cohort, who were born as singletons between 1934 and 1944.

Overall, 284 pregnancies (4.4%) were complicated by preeclampsia and 1,592 (24.8%) met criteria for hypertension without proteinuria. Among the children of these pregnancies, 464 (7.2%) had a diagnosis of coronary heart disease and 272 (4.2%) had a diagnosis of stroke. Diagnoses of CHD and stroke were collected from national hospital discharge records and death registries. The risk of stroke was almost twice as likely in the 164 adults whose mothers had severe preeclampsia (hazard ratio, 1.7), after the researchers controlled for sex, low birth weight, and gestational age.

The researchers also found that hypertension was a significant predictor of stroke, but was not a significant predictor of CHD.

Dr. Kajantie stated that he had no financial conflicts to disclose.

SEATTLE — Obstetricians should ensure that their hospitals' plans for pandemic flu take into account the unique needs of pregnant women, according to Dr. Richard H. Beigi of the department of obstetrics, gynecology, and reproductive sciences at Magee-Womens Hospital in Pittsburgh.

“Clearly, [obstetricians] take care of a special and often overlooked population that is very relevant when you think about pandemic influenza,” Dr. Beigi said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology. For starters, pregnant women are often viewed as immunocompromised. Also, providers have little control over the timing of labor and delivery, so healthy women will continue to need hospital services in a pandemic. And any planning must include the neonatal intensive care unit and consider visitation policies for family members.

“A lot of the planning for disasters typically doesn't involve obstetricians, and pregnant women are often forgotten in policy issues, planning forums, and such. So that really puts anybody who cares for pregnant women in a critical role. … I truly believe that if we don't pay attention to this issue, nobody else is going to,” he said.

Dr. Beigi reported on a survey of 12 large U.S. maternity hospitals that found 78% had formal plans in the event of pandemic flu regarding communication, surge capacity, and service degradation. However, fewer than half of the hospitals had plans for stockpiling and ensuring access to supplies.

“The biggest challenge these hospitals noted was really the ethical issues—how to determine who is going to get these limited supplies” and how to coordinate efforts with public health agencies, he said.

Dr. Beigi described the planning and preparation for pandemic flu at his own hospital, which has nearly 10,000 deliveries per year. The hospital formed a pandemic flu task force, which has tackled such issues as improving communication, dealing with surge capacity, triaging patients to keep those with and without flu apart, degrading services (by canceling elective procedures, for example), and distributing limited supplies of vaccine, medications, and equipment in both effective and ethical ways.

“Every hospital has its own issues,” he commented. “I would suggest that [planning be] done in a very hospital-specific manner,” involving not only health care providers and administrators, but also facilities staff, security, and ethicists. “In general, obstetricians are not critical care trained, so by definition, we often have to partner with other specialties,” Dr. Beigi said. “This is not necessarily a problem, but it is a layer of complexity that makes our hospital preparedness a little more challenging.”

He added that obstetricians will soon receive some therapeutic guidance from the Centers for Disease Control and Prevention, which recently formed a committee specifically to address the issue of pandemic flu in pregnancy. The resulting guidelines are expected to be published later this year. In particular, the committee has discussed three lines of defense: vaccines, antivirals, and nonpharmacologic interventions.

Vaccination in the event of pandemic flu entails many issues, such as rapid production and distribution, according to Dr. Beigi. In addition, research suggests that fewer than half of obstetric patients and office personnel would accept or recommend a vaccine that had not been tested in pregnant women. “So that could potentially be an issue we would have to deal with in the face of a pandemic,” he said.

The antiviral agent oseltamivir (Tamiflu) may have some activity against the avian flu virus, said Dr. Beigi. The drug is pregnancy category C. Although a postmarketing study of pregnant women exposed to oseltamivir found no adverse outcomes, only 61 women were studied (J. Antimicrob. Chemother. 2005;55 [suppl. 1]:i5-i21).

Dr. Beigi reported that he had no conflicts of interest related to his presentation.

Planning for disasters typically doesn't involve obstetricians, and pregnant women are often forgotten. DR. BEIGI

SEATTLE — Obstetricians should ensure that their hospitals' plans for pandemic flu take into account the unique needs of pregnant women, according to Dr. Richard H. Beigi of the department of obstetrics, gynecology, and reproductive sciences at Magee-Womens Hospital in Pittsburgh.

“Clearly, [obstetricians] take care of a special and often overlooked population that is very relevant when you think about pandemic influenza,” Dr. Beigi said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology. For starters, pregnant women are often viewed as immunocompromised. Also, providers have little control over the timing of labor and delivery, so healthy women will continue to need hospital services in a pandemic. And any planning must include the neonatal intensive care unit and consider visitation policies for family members.

“A lot of the planning for disasters typically doesn't involve obstetricians, and pregnant women are often forgotten in policy issues, planning forums, and such. So that really puts anybody who cares for pregnant women in a critical role. … I truly believe that if we don't pay attention to this issue, nobody else is going to,” he said.

Dr. Beigi reported on a survey of 12 large U.S. maternity hospitals that found 78% had formal plans in the event of pandemic flu regarding communication, surge capacity, and service degradation. However, fewer than half of the hospitals had plans for stockpiling and ensuring access to supplies.

“The biggest challenge these hospitals noted was really the ethical issues—how to determine who is going to get these limited supplies” and how to coordinate efforts with public health agencies, he said.

Dr. Beigi described the planning and preparation for pandemic flu at his own hospital, which has nearly 10,000 deliveries per year. The hospital formed a pandemic flu task force, which has tackled such issues as improving communication, dealing with surge capacity, triaging patients to keep those with and without flu apart, degrading services (by canceling elective procedures, for example), and distributing limited supplies of vaccine, medications, and equipment in both effective and ethical ways.

“Every hospital has its own issues,” he commented. “I would suggest that [planning be] done in a very hospital-specific manner,” involving not only health care providers and administrators, but also facilities staff, security, and ethicists. “In general, obstetricians are not critical care trained, so by definition, we often have to partner with other specialties,” Dr. Beigi said. “This is not necessarily a problem, but it is a layer of complexity that makes our hospital preparedness a little more challenging.”

He added that obstetricians will soon receive some therapeutic guidance from the Centers for Disease Control and Prevention, which recently formed a committee specifically to address the issue of pandemic flu in pregnancy. The resulting guidelines are expected to be published later this year. In particular, the committee has discussed three lines of defense: vaccines, antivirals, and nonpharmacologic interventions.

Vaccination in the event of pandemic flu entails many issues, such as rapid production and distribution, according to Dr. Beigi. In addition, research suggests that fewer than half of obstetric patients and office personnel would accept or recommend a vaccine that had not been tested in pregnant women. “So that could potentially be an issue we would have to deal with in the face of a pandemic,” he said.

The antiviral agent oseltamivir (Tamiflu) may have some activity against the avian flu virus, said Dr. Beigi. The drug is pregnancy category C. Although a postmarketing study of pregnant women exposed to oseltamivir found no adverse outcomes, only 61 women were studied (J. Antimicrob. Chemother. 2005;55 [suppl. 1]:i5-i21).

Dr. Beigi reported that he had no conflicts of interest related to his presentation.

Planning for disasters typically doesn't involve obstetricians, and pregnant women are often forgotten. DR. BEIGI

SEATTLE — Obstetricians should ensure that their hospitals' plans for pandemic flu take into account the unique needs of pregnant women, according to Dr. Richard H. Beigi of the department of obstetrics, gynecology, and reproductive sciences at Magee-Womens Hospital in Pittsburgh.

“Clearly, [obstetricians] take care of a special and often overlooked population that is very relevant when you think about pandemic influenza,” Dr. Beigi said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology. For starters, pregnant women are often viewed as immunocompromised. Also, providers have little control over the timing of labor and delivery, so healthy women will continue to need hospital services in a pandemic. And any planning must include the neonatal intensive care unit and consider visitation policies for family members.

“A lot of the planning for disasters typically doesn't involve obstetricians, and pregnant women are often forgotten in policy issues, planning forums, and such. So that really puts anybody who cares for pregnant women in a critical role. … I truly believe that if we don't pay attention to this issue, nobody else is going to,” he said.

Dr. Beigi reported on a survey of 12 large U.S. maternity hospitals that found 78% had formal plans in the event of pandemic flu regarding communication, surge capacity, and service degradation. However, fewer than half of the hospitals had plans for stockpiling and ensuring access to supplies.

“The biggest challenge these hospitals noted was really the ethical issues—how to determine who is going to get these limited supplies” and how to coordinate efforts with public health agencies, he said.

Dr. Beigi described the planning and preparation for pandemic flu at his own hospital, which has nearly 10,000 deliveries per year. The hospital formed a pandemic flu task force, which has tackled such issues as improving communication, dealing with surge capacity, triaging patients to keep those with and without flu apart, degrading services (by canceling elective procedures, for example), and distributing limited supplies of vaccine, medications, and equipment in both effective and ethical ways.

“Every hospital has its own issues,” he commented. “I would suggest that [planning be] done in a very hospital-specific manner,” involving not only health care providers and administrators, but also facilities staff, security, and ethicists. “In general, obstetricians are not critical care trained, so by definition, we often have to partner with other specialties,” Dr. Beigi said. “This is not necessarily a problem, but it is a layer of complexity that makes our hospital preparedness a little more challenging.”

He added that obstetricians will soon receive some therapeutic guidance from the Centers for Disease Control and Prevention, which recently formed a committee specifically to address the issue of pandemic flu in pregnancy. The resulting guidelines are expected to be published later this year. In particular, the committee has discussed three lines of defense: vaccines, antivirals, and nonpharmacologic interventions.

Vaccination in the event of pandemic flu entails many issues, such as rapid production and distribution, according to Dr. Beigi. In addition, research suggests that fewer than half of obstetric patients and office personnel would accept or recommend a vaccine that had not been tested in pregnant women. “So that could potentially be an issue we would have to deal with in the face of a pandemic,” he said.

The antiviral agent oseltamivir (Tamiflu) may have some activity against the avian flu virus, said Dr. Beigi. The drug is pregnancy category C. Although a postmarketing study of pregnant women exposed to oseltamivir found no adverse outcomes, only 61 women were studied (J. Antimicrob. Chemother. 2005;55 [suppl. 1]:i5-i21).

Dr. Beigi reported that he had no conflicts of interest related to his presentation.

Planning for disasters typically doesn't involve obstetricians, and pregnant women are often forgotten. DR. BEIGI