NEJM â Collection Updates for Pregnancy

ORIGINAL ARTICLE: Outcomes after Internal versus External Tocodynamometry for Monitoring Labor

Thu, 28Â JanÂ 2010 00:00:00 -05:00

Background: It has been hypothesized that internal tocodynamometry, as compared with external monitoring, may provide a more accurate assessment of contractions and thus improve the ability to adjust the dose...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2009 â A 28-Year-Old Pregnant Woman with Acute Cardiac Failure

Thu, 17Â DecÂ 2009 00:00:00 -05:00

Dr. Brad W. Butcher (Medicine): A 28-year-old woman was admitted to this hospital 2 days post partum because of cardiac failure.

The patient had been well, except for gestational diabetes mellitus,...

CLINICAL PROBLEM-SOLVING: A Crisis in Late Pregnancy

Thu, 03Â DecÂ 2009 00:00:00 -05:00

A 31-year-old woman in the 37th week of an uncomplicated pregnancy presented to the emergency department with sudden onset of severe bitemporal headache and shortness of breath. Her medical history...

INTERACTIVE MEDICAL CASE: A Crisis in Late Pregnancy

Thu, 12Â NovÂ 2009 00:00:00 -05:00

A 31-year-old woman in the 37th week of pregnancy presented to the emergency room of another hospital with sudden onset of severe bitemporal headache and shortness of breath. She was...

IMAGES IN CLINICAL MEDICINE: Peripartum Diastasis of the Symphysis Pubis

Jason M. Parker, M.D. and Modushudan Bhattacharjee, M.B., B.S. — Thu, 05Â NovÂ 2009 00:00:00 -05:00

A 21-year-old primigravida at nearly 40 weeks' gestation presented with a spontaneous onset of pelvic pain and difficulty in walking. After a rapid delivery, the postpartum physical examination revealed pain...

CORRESPONDENCE: Cumulative Live-Birth Rates in a Trial of Single-Embryo or Double-Embryo Transfer

Ann Thurin-Kjellberg, M.D., Catharina Olivius, and Christina Bergh, M.D., Ph.D. — Thu, 29Â OctÂ 2009 00:00:00 -05:00

To the Editor: We previously reported in the Journal1 the results of a randomized, controlled trial comparing pregnancy outcomes in patients undergoing in vitro fertilization (IVF) involving a fresh single-embryo...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2009 â A 35-Year-Old Woman with Fever, Abdominal Pain, and Hypotension after Cesarean Section

Thu, 22Â OctÂ 2009 00:00:00 -05:00

Dr. Claudius H.O. Conrad (Surgery): A 35-year-old woman was transferred to this hospital because of abdominal pain, fever, and hypotension.

Three days earlier, an elective cesarean section was performed at another...

EDITORIAL: Gestational Diabetes â Whom Do We Treat?

David A. Sacks, M.D. — Thu, 01Â OctÂ 2009 00:00:00 -05:00

In 1964, O'Sullivan and Mahan1 proposed glucose-tolerance-test criteria to define gestational diabetes mellitus â that is, any degree of glucose intolerance that first occurs or is first identified during pregnancy....

REVIEW ARTICLE: Maternal and Neonatal Herpes Simplex Virus Infections

Lawrence Corey, M.D., and Anna Wald, M.D., M.P.H. — Thu, 01Â OctÂ 2009 00:00:00 -05:00

An estimated 25 to 65% of pregnant women in the United States have genital infection with herpes simplex virus type 1 (HSV-1) or HSV type 2 (HSV-2).1 Neonatal HSV infection,...

ORIGINAL ARTICLE: A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes

Thu, 01Â OctÂ 2009 00:00:00 -05:00

Background: It is uncertain whether treatment of mild gestational diabetes mellitus improves pregnancy outcomes.

Methods: Women who were in the 24th to 31st week of gestation and who met the criteria...

BOOK REVIEW:

Thu, 06Â AugÂ 2009 00:00:00 -05:00

On June 15, 1591, in the spectacular closing of the infamous North Berwick witch trials, Euphemia Maclean (also known as Eufame MacAlyane or Ewfame Mackallean) was burned alive on Castle...

BOOK REVIEW:

Thu, 06Â AugÂ 2009 00:00:00 -05:00

A woman pregnant with twins, already the mother of a healthy 3-year-old daughter, suddenly finds herself in unstoppable labor at 23 weeks of gestation. Knowing the high morbidity and mortality...

BOOK REVIEW:

Thu, 23Â JulÂ 2009 00:00:00 -05:00

Much has changed in the field of reproduction since 1978, when Louise Brown, the first âtest-tube baby,â was born. In the United States, approximately 1 in 80 births is now...

CLINICAL PRACTICE: Ectopic Pregnancy

Kurt T. Barnhart, M.D., M.S.C.E. — Thu, 23Â JulÂ 2009 00:00:00 -05:00

A healthy 29-year-old woman who has been trying to conceive presents with vaginal spotting for the past 5 days and intermittent crampy abdominal pain in her left lower quadrant for...

ORIGINAL ARTICLE: Lack of Association between Folate-Receptor Autoantibodies and Neural-Tube Defects

Thu, 09Â JulÂ 2009 00:00:00 -05:00

Background: A previous report described the presence of autoantibodies against folate receptors in 75% of serum samples from women with a history of pregnancy complicated by a neural-tube defect, as...

ORIGINAL ARTICLE: Rates of Serious Infection after Changes in Regimens for Medical Abortion

Thu, 09Â JulÂ 2009 00:00:00 -05:00

Background: From 2001 through March 2006, Planned Parenthood health centers throughout the United States provided medical abortion (abortion by means of medication) principally by a regimen of oral mifepristone followed...

BOOK REVIEW:

Thu, 18Â JunÂ 2009 00:00:00 -05:00

This book is an entertaining combination of a memoir, an explanation of the physiology and evolution of childbearing, a discussion of fetal and newborn physiology, and a history of the...

ORIGINAL ARTICLE: Evaluation of Universal Antenatal Screening for Group B Streptococcus

Thu, 18Â JunÂ 2009 00:00:00 -05:00

Background: Group B streptococcal disease is one of the most common infections in the first week after birth. In 2002, national guidelines recommended universal late antenatal screening of pregnant women...

CLINICAL PRACTICE: Prenatal Screening for Aneuploidy

Deborah A. Driscoll, M.D., and Susan Gross, M.D. — Thu, 11Â JunÂ 2009 00:00:00 -05:00

A 37-year-old woman, gravida 1, seeks prenatal care at 8 weeks' gestation. Her family history and medical history are unremarkable. What would you advise regarding her risk of fetal chromosomal...

ORIGINAL ARTICLE: The Safety of Metoclopramide Use in the First Trimester of Pregnancy

Thu, 11Â JunÂ 2009 00:00:00 -05:00

Background: In various countries, metoclopramide is the antiemetic drug of choice in pregnant women, but insufficient information exists regarding its safety in pregnancy.

Methods: We investigated the safety of metoclopramide use...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 16-2009 â A 32-Year-Old Pregnant Woman with an Abnormal Fetal Ultrasound Study

Thu, 21Â MayÂ 2009 00:00:00 -05:00

A 32-year-old pregnant woman was admitted to the hospital at 23.1 weeks of gestation, because of an abnormal fetal ultrasound study.

Approximately 15 weeks earlier, a home urine test for human...

CLINICAL PRACTICE: Asthma in Pregnancy

Michael Schatz, M.D., and Mitchell P. Dombrowski, M.D. — Thu, 30Â AprÂ 2009 00:00:00 -05:00

A 23-year-old nonsmoking woman (gravida 1, para 0) presents at 11 weeks' gestation with an 8-year history of asthma, which has worsened over the past year. She reports asthma symptoms...

EDITORIAL: Which Drug for the Pregnant Woman with Epilepsy?

TorbjÃ¶rn Tomson, M.D. — Thu, 16Â AprÂ 2009 00:00:00 -05:00

Approximately 25,000 children are born in the United States each year to mothers with epilepsy.1 Most of these women need to continue taking medication during pregnancy, since uncontrolled seizures may...

CLINICAL PRACTICE: Molar Pregnancy

Ross S. Berkowitz, M.D., and Donald P. Goldstein, M.D. — Thu, 16Â AprÂ 2009 00:00:00 -05:00

A healthy 37-year-old woman presents at 10 weeks of pregnancy with vaginal bleeding. Physical examination shows that the uterine size is appropriate for gestational age. The level of serum human...

ORIGINAL ARTICLE: Cognitive Function at 3 Years of Age after Fetal Exposure to Antiepileptic Drugs

Thu, 16Â AprÂ 2009 00:00:00 -05:00

Background: Fetal exposure of animals to antiepileptic drugs at doses lower than those required to produce congenital malformations can produce cognitive and behavioral abnormalities, but cognitive effects of fetal exposure...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: A Lesson in Tolerance â Maternal Instruction to Fetal Cells

William J. Burlingham, Ph.D. — Thu, 26Â MarÂ 2009 00:00:00 -05:00

Most people would agree that mothers are influential in shaping their children's outlook on life. A recent study by Mold and colleagues1 discloses a new facet of maternal influence: maternal...

EDITORIAL: One Step Closer to a CMV Vaccine

Cornelia L. Dekker, M.D., and Ann M. Arvin, M.D. — Thu, 19Â MarÂ 2009 00:00:00 -05:00

In this issue of the Journal, Pass and colleagues describe the results of a phase 2 trial of a vaccine containing recombinant cytomegalovirus (CMV) glycoprotein B subunit antigen combined with...

ORIGINAL ARTICLE: Vaccine Prevention of Maternal Cytomegalovirus Infection

Thu, 19Â MarÂ 2009 00:00:00 -05:00

Background: Congenital infection with cytomegalovirus (CMV) is an important cause of hearing, cognitive, and motor impairments in newborns.

Methods: In this phase 2, placebo-controlled, randomized, double-blind trial, we evaluated a vaccine...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2009 â A 36-Year-Old Woman with Headache, Hypertension, and Seizure 2 Weeks Post Partum

Thu, 12Â MarÂ 2009 00:00:00 -05:00

Dr. W. Taylor Kimberly: A 36-year-old woman was admitted to the hospital because of headaches, hypertension, and seizures.

Nineteen days before the current admission, she delivered healthy twins at 35.6 weeks...

CORRESPONDENCE: Iodine Content of Prenatal Multivitamins in the United States

Angela M. Leung, M.D., Elizabeth N. Pearce, M.D., and Lewis E. Braverman, M.D. — Thu, 26Â FebÂ 2009 00:00:00 -05:00

To the Editor: Normal thyroid function in fetuses and breast-fed infants, which is dependent on sufficient maternal dietary intake of iodine, is crucial for normal neurocognitive development.1 Children of mothers...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2009 â A Pregnant Woman with a Large Mass in the Fetal Oral Cavity

Thu, 26Â FebÂ 2009 00:00:00 -05:00

A 29-year-old pregnant woman was transferred to this hospital at 38 weeks 4 days of gestation because of a large mass that had been detected in the fetal oral cavity...

BOOK REVIEW:

Thu, 05Â FebÂ 2009 00:00:00 -05:00

In his book, Outliers: The Story of Success (New York: Little, Brown, 2008), Malcolm Gladwell asks, Why do some people succeed, living remarkably productive and impactful lives, while so many...

CLINICAL PRACTICE: Primary Ovarian Insufficiency

Lawrence M. Nelson, M.D. — Thu, 05Â FebÂ 2009 00:00:00 -05:00

A 30-year-old woman presents with a history of no menses since she stopped taking oral contraceptives 6 months ago in order to conceive. She had undergone puberty that was normal...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2009 â A 39-Year-Old Pregnant Woman with Fever after a Trip to Africa

Patrick Duff, M.D., William H. Barth, Jr., M.D., and Miriam D. Post, M.D. — Thu, 29Â JanÂ 2009 00:00:00 -05:00

A 39-year-old woman in the first trimester of her first pregnancy was seen in the obstetrics and gynecology clinic of this hospital at 14 weeks of gestation because of a...

ORIGINAL ARTICLE: Cumulative Live-Birth Rates after In Vitro Fertilization

Thu, 15Â JanÂ 2009 00:00:00 -05:00

Background: Outcomes of in vitro fertilization (IVF) treatment are traditionally reported as pregnancies per IVF cycle. However, a couple's primary concern is the chance of a live birth over an...

EDITORIAL: Making Small Risks Even Smaller

Michael F. Greene, M.D. — Thu, 08Â JanÂ 2009 00:00:00 -05:00

Cesarean sections performed without antecedent labor are associated with a higher risk of respiratory distress than those performed after the onset of labor, despite the fact that they may have...

IMAGES IN CLINICAL MEDICINE: Diagnosis of Uterine Rupture on CT

Alexandra Grosvenor Eller, M.D. and Barbra Fisher, M.D., Ph.D. — Thu, 08Â JanÂ 2009 00:00:00 -05:00

A 34-year-old woman with seven previous cesarean deliveries and a history of scant prenatal care presented at 32 weeks' gestation with constant, vague lower abdominal pain that had worsened over...

ORIGINAL ARTICLE: Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes

Thu, 08Â JanÂ 2009 00:00:00 -05:00

Background: Because of increased rates of respiratory complications, elective cesarean delivery is discouraged before 39 weeks of gestation unless there is evidence of fetal lung maturity. We assessed associations between...

IMAGES IN CLINICAL MEDICINE: Postpartum Venous Thromboembolism

Ronen Zalts, M.D. and Tony Hayek, M.D. — Thu, 18Â DecÂ 2008 00:00:00 -05:00

A previously healthy 34-year-old woman, gravida 7, para 5, presented on postpartum day 14 with severe low back pain, chest pain, dyspnea, and substantial swelling of both legs after an...

CORRESPONDENCE: Successful Pregnancy after Microsurgical Transplantation of an Intact Ovary

Sherman J. Silber, M.D., Gedis Grudzinskas, M.D., and Roger G. Gosden, Ph.D. — Thu, 11Â DecÂ 2008 00:00:00 -05:00

To the Editor: Successful human ovarian transplantation was first reported with the use of a cortical-tissue grafting technique in monozygotic twins who were discordant for premature ovarian failure.1 Subsequently, six...

REVIEW ARTICLE: Venous Thromboembolic Disease and Pregnancy

Paul E. Marik, M.D., and Lauren A. Plante, M.D., M.P.H. — Thu, 06Â NovÂ 2008 00:00:00 -05:00

Pulmonary embolism and deep-vein thrombosis are the two components of a single disease called venous thromboembolism. Approximately 30% of apparently isolated episodes of pulmonary embolism are associated with silent deep-vein...

ORIGINAL ARTICLE: Effectiveness of Maternal Influenza Immunization in Mothers and Infants

Thu, 09Â OctÂ 2008 00:00:00 -05:00

Background: Young infants and pregnant women are at increased risk for serious consequences of influenza infection. Inactivated influenza vaccine is recommended for pregnant women but is not licensed for infants...

EDITORIAL: Antenatal Magnesium Sulfate for Neuroprotection before Preterm Birth?

Fiona J. Stanley, M.D., and Caroline Crowther, F.R.A.N.Z.C.O.G. — Thu, 28Â AugÂ 2008 00:00:00 -05:00

Preterm infants are at increased risk for serious, lifelong neurologic abnormalities such as cerebral palsy.12 As the survival of preterm infants has improved with advances in perinatal care,2 the occurrence...

ORIGINAL ARTICLE: A Randomized, Controlled Trial of Magnesium Sulfate for the Prevention of Cerebral Palsy

Thu, 28Â AugÂ 2008 00:00:00 -05:00

Background: Research suggests that fetal exposure to magnesium sulfate before preterm birth might reduce the risk of cerebral palsy.

Methods: In this multicenter, placebo-controlled, double-blind trial, we randomly assigned women at...

EDITORIAL: Preeclampsia â A Glimpse into the Future?

Ravi Thadhani, M.D., M.P.H., and Caren G. Solomon, M.D., M.P.H. — Thu, 21Â AugÂ 2008 00:00:00 -05:00

Preeclampsia, a disorder of pregnancy characterized by elevated blood pressure and proteinuria, complicates approximately 5% of pregnancies.1 Although several risk factors for this condition are well recognized, including nulliparity, extremes...

ORIGINAL ARTICLE: Preeclampsia and the Risk of End-Stage Renal Disease

Thu, 21Â AugÂ 2008 00:00:00 -05:00

Background: It is unknown whether preeclampsia is a risk marker for subsequent end-stage renal disease (ESRD).

Methods: We linked data from the Medical Birth Registry of Norway, which contains data on...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2008 â A 35-Year-Old Woman with Postpartum Confusion, Agitation, and Delusions

Adele C. Viguera, M.D., Anne D. Emmerich, M.D., and Lee S. Cohen, M.D. — Thu, 31Â JulÂ 2008 00:00:00 -05:00

Dr. Alexia E. Koukopoulos (Psychiatry): A 35-year-old woman was admitted to the inpatient psychiatry service of this hospital 5 days after the birth of her first child because of confusion,...

ORIGINAL ARTICLE: Long-Term Medical and Social Consequences of Preterm Birth

Dag Moster, M.D., Ph.D., Rolv Terje Lie, Ph.D., and Trond Markestad, M.D., Ph.D. — Thu, 17Â JulÂ 2008 00:00:00 -05:00

Background: Advances in perinatal care have increased the number of premature babies who survive. There are concerns, however, about the ability of these children to cope with the demands of...

EDITORIAL: Breast-Feeding, Antiretroviral Prophylaxis, and HIV

Glenda E. Gray, M.B., B.Ch., and Haroon Saloojee, M.B., B.Ch. — Thu, 10Â JulÂ 2008 00:00:00 -05:00

More than 200,000 of the 500,000 new human immunodeficiency virus (HIV) infections that occur each year in children are the result of transmission of the virus through the mother's breast...

ORIGINAL ARTICLE: Extended Antiretroviral Prophylaxis to Reduce Breast-Milk HIV-1 Transmission

Thu, 10Â JulÂ 2008 00:00:00 -05:00

Background: Effective strategies are urgently needed to reduce mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) through breast-feeding in resource-limited settings.

Methods: Women with HIV-1 infection who were breast-feeding infants...

REVIEW ARTICLE: Effect of In Utero and Early-Life Conditions on Adult Health and Disease

Thu, 03Â JulÂ 2008 00:00:00 -05:00

A long latency period between an environmental trigger and the onset of subsequent disease is widely recognized in the etiology of certain cancers, yet this phenomenon is not generally considered...

EDITORIAL: Gestational Diabetes â Setting Limits, Exploring Treatments

Jeffrey L. Ecker, M.D., and Michael F. Greene, M.D. — Thu, 08Â MayÂ 2008 00:00:00 -05:00

Pregnancy is associated with relative carbohydrate intolerance and insulin resistance. Gestational diabetes mellitus (carbohydrate intolerance first diagnosed during pregnancy) has long been recognized as a risk factor for a number...

ORIGINAL ARTICLE: Metformin versus Insulin for the Treatment of Gestational Diabetes

Thu, 08Â MayÂ 2008 00:00:00 -05:00

Background: Metformin is a logical treatment for women with gestational diabetes mellitus, but randomized trials to assess the efficacy and safety of its use for this condition are lacking.

Methods: We...

ORIGINAL ARTICLE: Hyperglycemia and Adverse Pregnancy Outcomes

The HAPO Study Cooperative Research Group — Thu, 08Â MayÂ 2008 00:00:00 -05:00

Background: It is controversial whether maternal hyperglycemia less severe than that in diabetes mellitus is associated with increased risks of adverse pregnancy outcomes.

Methods: A total of 25,505 pregnant women at...

SPECIAL ARTICLE: A Behavioral Intervention to Improve Obstetrical Care

Thu, 01Â MayÂ 2008 00:00:00 -05:00

Background: Implementation of evidence-based obstetrical practices remains a significant challenge. Effective strategies to disseminate and implement such practices are needed.

Methods: We randomly assigned 19 hospitals in Argentina and Uruguay to...

ORIGINAL ARTICLE: Association between Obesity during Pregnancy and Increased Use of Health Care

Thu, 03Â AprÂ 2008 00:00:00 -05:00

Background: In the United States, obesity during pregnancy is common and increases obstetrical risks. An estimate of the increase in use of health care services associated with obesity during pregnancy...

ORIGINAL ARTICLE: Cervical Length at Mid-Pregnancy and the Risk of Primary Cesarean Delivery

Thu, 27Â MarÂ 2008 00:00:00 -05:00

Background: Physiological and biochemical studies suggest that normal parturition at term is dependent on programmed development of the uterus in early pregnancy. It is recognized that a short cervix in...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2008 â A 33-Year-Old Pregnant Woman with Swelling of the Left Breast and Shortness of Breath

Lawrence N. Shulman, M.D., Rachel A. Hitt, M.D., and Judith A. Ferry, M.D. — Thu, 31Â JanÂ 2008 00:00:00 -05:00

A 33-year-old pregnant woman was admitted to the hospital at 30.7 weeks' gestation because of swelling of the left breast, shortness of breath, and tachycardia.

The patient had received prenatal care...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2008 â A 38-Year-Old Woman with Postpartum Visual Loss, Shortness of Breath, and Renal Failure

Thu, 17Â JanÂ 2008 00:00:00 -05:00

Dr. Esperance A. Schaefer (Medicine): A 38-year-old woman was admitted to the hospital, because of blurred vision and shortness of breath, 2 weeks after a cesarean section had been performed...

EDITORIAL: Prenatal Corticosteroids â Early Gain, Long-Term Questions

Alan D. Stiles, M.D. — Thu, 20Â SepÂ 2007 00:00:00 -05:00

A single course of prenatal corticosteroid therapy has been shown to accelerate fetal lung maturation when premature delivery is imminent.123 This therapy reduces morbidity and mortality in premature newborns by...

ORIGINAL ARTICLE: Long-Term Outcomes after Repeat Doses of Antenatal Corticosteroids

Thu, 20Â SepÂ 2007 00:00:00 -05:00

Background: Previous trials have shown that repeat courses of antenatal corticosteroids improve some neonatal outcomes in preterm infants but reduce birth weight and increase the risk of intrauterine growth restriction....

ORIGINAL ARTICLE: Outcomes at 2 Years of Age after Repeat Doses of Antenatal Corticosteroids

Thu, 20Â SepÂ 2007 00:00:00 -05:00

Background: We previously reported the results of a randomized, controlled trial showing that repeat doses of antenatal corticosteroids reduced the risk of respiratory distress syndrome and serious neonatal morbidity. However,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2007 â A 30-Year-Old Pregnant Woman with Intrauterine Fetal Death

Ronald S. Gibbs, M.D., and Drucilla J. Roberts, M.D. — Thu, 30Â AugÂ 2007 00:00:00 -05:00

A 30-year-old primigravida was admitted to the hospital in active spontaneous labor at 39.7 weeks' gestation.

The patient had received prenatal care at this hospital since 11.1 weeks' gestation. She had...

ORIGINAL ARTICLE: Medical Abortion and the Risk of Subsequent Adverse Pregnancy Outcomes

Jasveer Virk, M.S., M.P.H., Jun Zhang, Ph.D., M.D., and JÃ¸rn Olsen, M.D., Ph.D. — Thu, 16Â AugÂ 2007 00:00:00 -05:00

Background: The long-term safety of surgical abortion in the first trimester is well established. Despite the increasing use of medical abortion (abortion by means of medication), limited information is available...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2007 â A 20-Year-Old Pregnant Woman with Altered Mental Status

Thu, 09Â AugÂ 2007 00:00:00 -05:00

A 20-year-old pregnant woman was admitted to this hospital at 26 weeks of gestation because of dizziness, confusion, and difficulty walking.

Ten weeks before admission, the patient had a positive result...

EDITORIAL: Progesterone and Preterm Labor â Still No Definite Answers

Jim G. Thornton, M.D. — Thu, 02Â AugÂ 2007 00:00:00 -05:00

In 1930, Willard Allen and George Corner named the steroid hormone that they had extracted from rabbit ovaries âprogestinâ because they believed, rightly, that it helped maintain pregnancy.1 Removal of...

CLINICAL PROBLEM-SOLVING: A Growing Problem â A 36-year-old pregnant woman at 21 weeks of gestation presented with a 4-week history of a dry, nonproductive cough

Wendy W. Yeh, M.D., Sanjay Saint, M.D., M.P.H., and Steven E. Weinberger, M.D. — Thu, 02Â AugÂ 2007 00:00:00 -05:00

A 36-year-old pregnant woman at 21 weeks of gestation presented with a 4-week history of a dry, nonproductive cough. The patient said she had no fever, chills, dyspnea, chest pain,...

REVIEW ARTICLE: Prevention of Preterm Delivery

Hyagriv N. Simhan, M.D., M.S.C.R., and Steve N. Caritis, M.D. — Thu, 02Â AugÂ 2007 00:00:00 -05:00

Preterm birth is defined as birth before the completion of 37 weeks of gestation. The frequency of preterm birth in the United States increased from 10.7% in 1992 to 12.3%...

ORIGINAL ARTICLE: Progesterone and the Risk of Preterm Birth among Women with a Short Cervix

Thu, 02Â AugÂ 2007 00:00:00 -05:00

Background: Previous randomized trials have shown that progesterone administration in women who previously delivered prematurely reduces the risk of recurrent premature delivery. Asymptomatic women found at midgestation to have a...

ORIGINAL ARTICLE: A Trial of 17 Alpha-Hydroxyprogesterone Caproate to Prevent Prematurity in Twins

Thu, 02Â AugÂ 2007 00:00:00 -05:00

Background: In singleton gestations, 17 alpha-hydroxyprogesterone caproate (17P) has been shown to reduce the rate of recurrent preterm birth. This study was undertaken to evaluate whether 17P would reduce the...

SPECIAL ARTICLE: Trends in the Use of Intracytoplasmic Sperm Injection in the United States

Tarun Jain, M.D., and Ruchi S. Gupta, M.D., M.P.H. — Thu, 19Â JulÂ 2007 00:00:00 -05:00

Background: Intracytoplasmic sperm injection (ICSI) was initially developed as part of in vitro fertilization (IVF) to treat male-factor infertility. However, despite the added cost, uncertain efficacy, and potential risks of...

ORIGINAL ARTICLE: Reduction in Neural-Tube Defects after Folic Acid Fortification in Canada

Thu, 12Â JulÂ 2007 00:00:00 -05:00

Background: In 1998, folic acid fortification of a large variety of cereal products became mandatory in Canada, a country where the prevalence of neural-tube defects was historically higher in the...

ORIGINAL ARTICLE: In Vitro Fertilization with Preimplantation Genetic Screening

Thu, 05Â JulÂ 2007 00:00:00 -05:00

Background: Pregnancy rates in women of advanced maternal age undergoing in vitro fertilization (IVF) are disappointingly low. It has been suggested that the use of preimplantation genetic screening of cleavage-stage...

EDITORIAL: Preimplantation Genetic Screening in Older Mothers

John A. Collins, M.D. — Thu, 05Â JulÂ 2007 00:00:00 -05:00

Preimplantation genetic diagnosis, first described in 1990,1 involves removing one or two cells from an embryo for genetic testing in order to prevent transmission of genetic disorders from a parent...

EDITORIAL: Teratogenicity of SSRIs â Serious Concern or Much Ado about Little?

Michael F. Greene, M.D. — Thu, 28Â JunÂ 2007 00:00:00 -05:00

In the fall of 2005, GlaxoSmithKline called attention to recently collected safety data indicating an increased risk of major congenital malformations among infants exposed during organogenesis to GlaxoSmithKline's selective serotonin...

ORIGINAL ARTICLE: Use of Selective Serotonin-Reuptake Inhibitors in Pregnancy and the Risk of Birth Defects

Thu, 28Â JunÂ 2007 00:00:00 -05:00

Background: Information regarding the safety of selective serotonin-reuptake inhibitors (SSRIs) in human pregnancy is sparse. Concern has been raised about the risk of congenital heart defects associated with the use...

ORIGINAL ARTICLE: First-Trimester Use of Selective Serotonin-Reuptake Inhibitors and the Risk of Birth Defects

Thu, 28Â JunÂ 2007 00:00:00 -05:00

Background: The risk of birth defects after antenatal exposure to selective serotonin-reuptake inhibitors (SSRIs) remains controversial.

Methods: We assessed associations between first-trimester maternal use of SSRIs and the risk of birth...

IMAGES IN CLINICAL MEDICINE: Gravid Uterus in an Incisional Hernia

Charu Chanana, M.D. and Neena Malhotra, M.D. — Thu, 12Â AprÂ 2007 00:00:00 -05:00

A 32-year-old healthy woman, gravida 6 with two living children, presented at our clinic for the termination of pregnancy at 18 weeks of gestation. Her only previous abdominal surgeries had...

ORIGINAL ARTICLE: Vitamins and Perinatal Outcomes among HIV-Negative Women in Tanzania

Thu, 05Â AprÂ 2007 00:00:00 -05:00

Background: Prematurity and low birth weight are associated with high perinatal and infant mortality, especially in developing countries. Maternal micronutrient deficiencies may contribute to these adverse outcomes.

Methods: In a double-blind...

PERSPECTIVE: Making Motherhood Safe in Developing Countries

Thu, 05Â AprÂ 2007 00:00:00 -05:00

This year marks the 20th anniversary of the Safe Motherhood Conference in Nairobi, an event that launched a global initiative to reduce maternal mortality in developing countries. At that time,...

PERSPECTIVE: Cesarean Delivery and the RiskâBenefit Calculus

Thu, 01Â MarÂ 2007 00:00:00 -05:00

In 1937, an article in the Journal describing 10 years of births at Boston City Hospital revealed an overall rate of cesarean delivery of about 3%.1 Recently released 2005 data...

EDITORIAL: Treating the Polycystic Ovary Syndrome the Old-Fashioned Way

David S. Guzick, M.D., Ph.D. — Thu, 08Â FebÂ 2007 00:00:00 -05:00

Of the estimated 6.7 million women with fertility problems in the United States, 35% have received drugs to induce ovulation.1 The most common cause of anovulation among infertile women is...

ORIGINAL ARTICLE: Clomiphene, Metformin, or Both for Infertility in the Polycystic Ovary Syndrome

Thu, 08Â FebÂ 2007 00:00:00 -05:00

Background: The polycystic ovary syndrome is a common cause of infertility. Clomiphene and insulin sensitizers are used alone and in combination to induce ovulation, but it is unknown whether one...

CLINICAL PRACTICE: In Vitro Fertilization

Bradley J. Van Voorhis, M.D. — Thu, 25Â JanÂ 2007 00:00:00 -05:00

A 37-year-old woman who has never been pregnant and her 40-year-old husband have been attempting to conceive a child for the past 3 years. An infertility evaluation has shown no...

REVIEW ARTICLE: Parturition

Roger Smith, M.B., B.S., Ph.D. — Thu, 18Â JanÂ 2007 00:00:00 -05:00

The mechanisms that instigate parturition in humans have been remarkably elusive, but some parts of the puzzle have begun to come together. A key change in the field was the...

ORIGINAL ARTICLE: Response to Antiretroviral Therapy after a Single, Peripartum Dose of Nevirapine

Thu, 11Â JanÂ 2007 00:00:00 -05:00

Background: A single dose of nevirapine during labor reduces perinatal transmission of human immunodeficiency virus type 1 (HIV-1) but often leads to viral nevirapine resistance mutations in mothers and infants.

Methods:...

IMAGES IN CLINICAL MEDICINE: Benign Diffuse Breast Hyperplasia during Pregnancy

Shikha Pasrija, M.D. and Nayantara Sharma, M.D. — Thu, 28Â DecÂ 2006 00:00:00 -05:00

A 24-year-old woman, para 2, who was 36 weeks pregnant, presented with massive diffuse enlargement of both breasts, which had progressed since conception (Panel A). There had been no such...

EDITORIAL: Obstetricians Still Await a Deus ex Machina

Michael F. Greene, M.D. — Thu, 23Â NovÂ 2006 00:00:00 -05:00

Intrapartum electronic fetal heart-rate monitoring was introduced with great enthusiasm in the early 1970s. Most cases of cerebral palsy were thought to result from asphyxia during the intrapartum period, and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2006 â A 35-Year-Old Pregnant Woman with New Hypertension

Thu, 23Â NovÂ 2006 00:00:00 -05:00

Dr. Andrea L. Utz (Endocrinology): A 35-year-old pregnant woman (gravida 2, para 1) was admitted to this hospital at 19 weeks and 6 days of gestation because of the recent...

ORIGINAL ARTICLE: Fetal Pulse Oximetry and Cesarean Delivery

Thu, 23Â NovÂ 2006 00:00:00 -05:00

Background: Knowledge of fetal oxygen saturation, as an adjunct to electronic fetal monitoring, may be associated with a significant change in the rate of cesarean deliveries or the infant's condition...

EDITORIAL: Preterm Birth and Periodontal Disease

Robert L. Goldenberg, M.D., and Jennifer F. Culhane, Ph.D. — Thu, 02Â NovÂ 2006 00:00:00 -05:00

Preterm births (those occurring before 37 weeks of gestation) make up 12.5% of births in the United States. They account for 70% of perinatal deaths and nearly half of all...

ORIGINAL ARTICLE: Treatment of Periodontal Disease and the Risk of Preterm Birth

Thu, 02Â NovÂ 2006 00:00:00 -05:00

Background: Maternal periodontal disease has been associated with an increased risk of preterm birth and low birth weight. We studied the effect of nonsurgical periodontal treatment on preterm birth.

Methods: We...

ORIGINAL ARTICLE: Soluble Endoglin and Other Circulating Antiangiogenic Factors in Preeclampsia

Thu, 07Â SepÂ 2006 00:00:00 -05:00

Background: Alterations in circulating soluble fms-like tyrosine kinase 1 (sFlt1), an antiangiogenic protein, and placental growth factor (PlGF), a proangiogenic protein, appear to be involved in the pathogenesis of preeclampsia....

EDITORIAL: Explaining and Predicting Preeclampsia

Marshall D. Lindheimer, M.D., and Jason G. Umans, M.D., Ph.D. — Thu, 07Â SepÂ 2006 00:00:00 -05:00

Preeclampsia, either alone or superimposed on another disorder, is a major cause of maternal and fetal death and the leading cause of premature delivery worldwide.1 Underappreciated is the strain that...

PERSPECTIVE: Preimplantation Diagnosis for Genetic Susceptibility

Thu, 10Â AugÂ 2006 00:00:00 -05:00

On May 10, 2006, the regulator of assisted reproduction in the United Kingdom â the Human Fertilisation and Embryology Authority (HFEA) â decided to include susceptibilities to certain cancers in...

EDITORIAL: Diagnosing Hemolytic Disease of the Fetus â Time to Put the Needles Away?

Kenneth J. Moise, Jr., M.D. — Thu, 13Â JulÂ 2006 00:00:00 -05:00

The RhD (Rh0[D]) antigen is considered the most immunogenic of the antigens found on the surface of the human red cell. In 1941, Levine, Katzin, and Burham1 showed that antibodies...

ORIGINAL ARTICLE: Doppler Ultrasonography versus Amniocentesis to Predict Fetal Anemia

Thu, 13Â JulÂ 2006 00:00:00 -05:00

Background: Pregnancies complicated by Rh alloimmunization have been evaluated with the use of serial invasive amniocentesis to determine bilirubin levels by measuring in the amniotic fluid the change in optical...

EDITORIAL: ACE Inhibitors and Congenital Anomalies

J.M. Friedman, M.D., Ph.D. — Thu, 08Â JunÂ 2006 00:00:00 -05:00

Angiotensin-convertingâenzyme (ACE) inhibitors are among the most widely prescribed antihypertensive agents in the United States, but when used in the second half of pregnancy, they can cause oligohydramnios, fetal growth...

ORIGINAL ARTICLE: Major Congenital Malformations after First-Trimester Exposure to ACE Inhibitors

Thu, 08Â JunÂ 2006 00:00:00 -05:00

Background: Use of angiotensin-convertingâenzyme (ACE) inhibitors during the second and third trimesters of pregnancy is contraindicated because of their association with an increased risk of fetopathy. In contrast, first-trimester use...

EDITORIAL: Antioxidants and the Prevention of Preeclampsia â Unresolved Issues

Arun Jeyabalan, M.D., and Steve N. Caritis, M.D. — Thu, 27Â AprÂ 2006 00:00:00 -05:00

Preeclampsia is a pregnancy-specific, multisystem disorder that can have considerable adverse effects on the mother and the fetus. In developing countries, preeclampsia is a major cause of death among pregnant...

ORIGINAL ARTICLE: Vitamins C and E and the Risks of Preeclampsia and Perinatal Complications

Thu, 27Â AprÂ 2006 00:00:00 -05:00

Background: Supplementation with antioxidant vitamins has been proposed to reduce the risk of preeclampsia and perinatal complications, but the effects of this intervention are uncertain.

Methods: We conducted a multicenter, randomized...

IMAGES IN CLINICAL MEDICINE: Umbilical-Cord Prolapse at 29 Weeks' Gestation

Michael Belfort, M.D., Ph.D. — Thu, 20Â AprÂ 2006 00:00:00 -05:00

A 23-year-old woman (gravida 1, para 0) was admitted at 29 1/7 weeks' gestation because of preterm premature rupture of the membranes. Her membranes had ruptured four days earlier, as...

SOUNDING BOARD: Ethical Considerations Related to Pregnancy in Transplant Recipients

Lainie Friedman Ross, M.D., Ph.D. — Thu, 23Â MarÂ 2006 00:00:00 -05:00

By 1998, 40 years after the first child had been born to a transplant recipient,1 more than 7000 women with renal transplants in the United States had had successful pregnancies,2...

REVIEW ARTICLE: Pregnancy in Recipients of Solid Organs â Effects on Mother and Child

Dianne B. McKay, M.D., and Michelle A. Josephson, M.D. — Thu, 23Â MarÂ 2006 00:00:00 -05:00

The first child born to a transplant recipient turned 48 years old on March 10, 2006.1 When the field of transplantation was first developing, physicians worried about the teratogenicity of...

EDITORIAL: The Promise of Single-Embryo Transfer

Laura A. Schieve, Ph.D. — Thu, 16Â MarÂ 2006 00:00:00 -05:00

Worldwide, the use of assisted reproductive technology is increasing.123 The technology, which includes such treatments for infertility as in vitro fertilization, accounts for 2 to 3 percent of births in...

ORIGINAL ARTICLE: In Vitro Fertilization with Single Blastocyst-Stage versus Single Cleavage-Stage Embryos

Thu, 16Â MarÂ 2006 00:00:00 -05:00

Background: Single-embryo transfer has been recommended to reduce the incidence of multiple gestations when in vitro fertilization is performed in women under 36 years of age. We designed a prospective,...

SPECIAL ARTICLE: Changes in Abortions and Births and the Texas Parental Notification Law

Theodore Joyce, Ph.D., Robert Kaestner, Ph.D., and Silvie Colman, B.B.A. — Thu, 09Â MarÂ 2006 00:00:00 -05:00

Background: On January 1, 2000, Texas began enforcement of a law that requires physicians to notify a parent of a minor child seeking an abortion at least 48 hours before...

EDITORIAL: Depressing Observations on the Use of Selective Serotonin-Reuptake Inhibitors during Pregnancy

James L. Mills, M.D. — Thu, 09Â FebÂ 2006 00:00:00 -05:00

Persistent pulmonary hypertension of the newborn (PPHN) is a serious condition that typically occurs in full-term or near-term infants. Before birth, the fetus receives oxygenated blood from the placenta; a...

ORIGINAL ARTICLE: Selective Serotonin-Reuptake Inhibitors and Risk of Persistent Pulmonary Hypertension of the Newborn

Thu, 09Â FebÂ 2006 00:00:00 -05:00

Background: Persistent pulmonary hypertension of the newborn (PPHN) is associated with substantial infant mortality and morbidity. A previous cohort study suggested a possible association between maternal use of the selective...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2005 â A 29-Year-Old Pregnant Woman with the Nephrotic Syndrome and Hypertension

Thu, 15Â DecÂ 2005 00:00:00 -05:00

A 29-year-old pregnant woman with systemic lupus erythematosus was admitted to the hospital because of renal failure at 20 weeks 6 days of gestation.

The patient, a native of Panama, had...

ORIGINAL ARTICLE: Fatal Toxic Shock Syndrome Associated with after Medical Abortion

Thu, 01Â DecÂ 2005 00:00:00 -05:00

Endometritis and toxic shock syndrome associated with Clostridium sordellii have previously been reported after childbirth and, in one case, after medical abortion. We describe four deaths due to endometritis and...

PERSPECTIVE: Fatal Infections Associated with Mifepristone-Induced Abortion

Michael F. Greene, M.D. — Thu, 01Â DecÂ 2005 00:00:00 -05:00

The Population Council submitted a new drug application to the Food and Drug Administration (FDA) on March 14, 1996, for the progesterone antagonist mifepristone (also known as RU 486) to...

CLINICAL PRACTICE: Long-Acting Methods of Contraception

Herbert B. Peterson, M.D., and Kathryn M. Curtis, Ph.D. — Thu, 17Â NovÂ 2005 00:00:00 -05:00

A healthy, multiparous 23-year-old woman requests advice about contraception. Her last child was conceived while she was using oral contraceptives, which she took irregularly. She wants no more children and...

EDITORIAL: Choosing the Best Prenatal Screening Protocol

Joe Leigh Simpson, M.D. — Thu, 10Â NovÂ 2005 00:00:00 -05:00

Prenatal genetic diagnosis for numerical chromosomal abnormalities (aneuploidy) was once simple. In the 1970s, women who were at least 35 years of age at delivery were offered an invasive procedure,...

ORIGINAL ARTICLE: First-Trimester or Second-Trimester Screening, or Both, for Down's Syndrome

Thu, 10Â NovÂ 2005 00:00:00 -05:00

Background: It is uncertain how best to screen pregnant women for the presence of fetal Down's syndrome: to perform first-trimester screening, to perform second-trimester screening, or to use strategies incorporating...

EDITORIAL: Immunotherapy for Congenital Cytomegalovirus Infection

Patrick Duff, M.D. — Thu, 29Â SepÂ 2005 00:00:00 -05:00

Cytomegalovirus (CMV) is an extremely important perinatal pathogen. Each year, approximately 1 percent of susceptible women seroconvert during pregnancy. Although sexual transmission of CMV can occur, most pregnant women acquire...

ORIGINAL ARTICLE: Passive Immunization during Pregnancy for Congenital Cytomegalovirus Infection

Thu, 29Â SepÂ 2005 00:00:00 -05:00

Background: Currently, there is no effective intervention for a primary cytomegalovirus (CMV) infection during pregnancy.

Methods: We studied pregnant women with a primary CMV infection. The therapy group comprised women whose...

EDITORIAL: Meconium Aspiration Syndrome â More Than Intrapartum Meconium

Michael G. Ross, M.D., M.P.H. — Thu, 01Â SepÂ 2005 00:00:00 -05:00

Meconium, the fecal material that accumulates in the fetal colon throughout gestation, is a term derived from the Greek mekoni, meaning poppy juice or opium. Beginning with Aristotle's observation of...

ORIGINAL ARTICLE: Amnioinfusion for the Prevention of the Meconium Aspiration Syndrome

Thu, 01Â SepÂ 2005 00:00:00 -05:00

Background: It is uncertain whether amnioinfusion (infusion of saline into the amniotic cavity) in women who have thick meconium staining of the amniotic fluid reduces the risk of perinatal death,...

EDITORIAL: Pregnancy Failure and Misoprostol â Time for a Change

Beverly Winikoff, M.D., M.P.H. — Thu, 25Â AugÂ 2005 00:00:00 -05:00

Pregnancy failure in the first trimester is one of the commonest reasons for women to seek emergency medical services. Indeed, curettage for this indication was responsible for up to three...

ORIGINAL ARTICLE: A Comparison of Medical Management with Misoprostol and Surgical Management for Early Pregnancy Failure

Thu, 25Â AugÂ 2005 00:00:00 -05:00

Background: Misoprostol is increasingly used to treat women who have a failed pregnancy in the first trimester. We assessed the efficacy, safety, and acceptability of this treatment in a large,...

IMAGES IN CLINICAL MEDICINE: Central Serous Chorioretinopathy in Pregnancy

George L. Mayo, M.D. and Michael J. Tolentino, M.D. — Thu, 18Â AugÂ 2005 00:00:00 -05:00

A 32-year-old black woman who was seven months pregnant presented with a three-day history of blurring and greenish discoloration of her central vision in the left eye. Visual acuity was...

CLINICAL PROBLEM-SOLVING: Double Jeopardy

Thu, 07Â JulÂ 2005 00:00:00 -05:00

A 36-year-old woman in her 34th week of pregnancy presented to the emergency department after the onset of severe substernal chest pain. The chest pain was sudden in onset and...

IMAGES IN CLINICAL MEDICINE: Ruptured Ectopic Pregnancy

Sandra D. Lyden, M.D. and Lillian Nojadera, M.D. — Thu, 07Â JulÂ 2005 00:00:00 -05:00

A 33-year-old woman, para 2, presented to the emergency department with a report of vaginal bleeding and abdominal pain of several days' duration. She had no history of pelvic inflammatory...

REVIEW ARTICLE: Potential Options for Preservation of Fertility in Women

Rogerio A. Lobo, M.D. — Thu, 07Â JulÂ 2005 00:00:00 -05:00

The choice of delaying pregnancy has become the norm for many women in developed countries. Among some women, however, achieving pregnancy may be difficult or impossible at a later time....

EDITORIAL: Gestational Diabetes Mellitus â Time to Treat

Michael F. Greene, M.D., and Caren G. Solomon, M.D., M.P.H. — Thu, 16Â JunÂ 2005 00:00:00 -05:00

Gestational diabetes mellitus, broadly defined as carbohydrate intolerance beginning or first recognized during pregnancy,12 was originally described decades ago and has since been the subject of extensive research. Yet the...

ORIGINAL ARTICLE: Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes

Thu, 16Â JunÂ 2005 00:00:00 -05:00

Background: We conducted a randomized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications.

Methods: We randomly assigned women between 24 and...

SPECIAL ARTICLE: An Intervention Involving Traditional Birth Attendants and Perinatal and Maternal Mortality in Pakistan

Thu, 19Â MayÂ 2005 00:00:00 -05:00

Background: There are approximately 4 million neonatal deaths and half a million maternal deaths worldwide each year. There is limited evidence from clinical trials to guide the development of effective...

ORIGINAL ARTICLE: Autoantibodies to Folate Receptors in the Cerebral Folate Deficiency Syndrome

Thu, 12Â MayÂ 2005 00:00:00 -05:00

In infantile-onset cerebral folate deficiency, 5-methyltetrahydrofolate (5MTHF) levels in the cerebrospinal fluid are low, but folate levels in the serum and erythrocytes are normal. We examined serum specimens from 28...

PERSPECTIVE: Autoimmune Folate Deficiency and the Rise and Fall of âHorror Autotoxicusâ

Robert S. Schwartz, M.D. — Thu, 12Â MayÂ 2005 00:00:00 -05:00

In 1904, a little more than a century ago, Julius Donath, a senior physician working in the Vienna Merchants' Hospital, and Karl Landsteiner, the chair of the pathology department at...

IMAGES IN CLINICAL MEDICINE: Painless Loss of Vision after Vomiting

Grace S. Zhang, M.D. and Jeevan R. Mathura, Jr., M.D. — Thu, 28Â AprÂ 2005 00:00:00 -05:00

A 24-year-old woman (gravida 3, para 2) who was 30 weeks' pregnant with twins was admitted for preterm labor. Six days earlier, she had vomited and noticed an acute onset...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2005 â A 32-Year-Old Pregnant Woman with an Abnormal Fetal Karyotype

Thu, 14Â AprÂ 2005 00:00:00 -05:00

A 32-year-old woman in the 17th week of her first pregnancy was referred for genetic counseling after her fetus had been found to have an abnormal karyotype. She had had...

EDITORIAL: Pain Relief during Labor

William Camann, M.D. — Thu, 17Â FebÂ 2005 00:00:00 -05:00

The pain of childbirth is arguably one of the most severe types of pain a woman will endure in her lifetime. Relief of the pain of childbirth has always been...

ORIGINAL ARTICLE: The Risk of Cesarean Delivery with Neuraxial Analgesia Given Early versus Late in Labor

Thu, 17Â FebÂ 2005 00:00:00 -05:00

Background: Epidural analgesia initiated early in labor (when the cervix is less than 4.0 cm dilated) has been associated with an increased risk of cesarean delivery. It is unclear, however,...

PERSPECTIVE: Population and Development â Shifting Paradigms, Setting Goals

Allan Rosenfield, M.D., and Karyn Schwartz — Thu, 17Â FebÂ 2005 00:00:00 -05:00

At the first United Nationsâsponsored international conference on population â held in Bucharest, Romania, in 1974 â the United States and other Western nations advocated the implementation of programs aimed...

PERSPECTIVE: Reproductive Tourism and the Regulatory Map

Debora Spar, Ph.D. — Thu, 10Â FebÂ 2005 00:00:00 -05:00

Consider the case of Sharon Saarinen. In 2002, the 38-year-old hairdresser traveled to Beirut in desperate pursuit of a baby. Four years earlier, she and her husband had had their...

EDITORIAL: Vaginal Birth after Cesarean Revisited

Michael F. Greene, M.D. — Thu, 16Â DecÂ 2004 00:00:00 -05:00

The U.S. total cesarean delivery rate has risen from 4 percent of deliveries in 1950 to 26 percent in 2002.1 Concerned about the rising rate of cesarean deliveries, and noting...

ORIGINAL ARTICLE: Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery

Thu, 16Â DecÂ 2004 00:00:00 -05:00

Background: The proportion of women who attempt vaginal delivery after prior cesarean delivery has decreased largely because of concern about safety. The absolute and relative risks associated with a trial...

EDITORIAL: Elective Single-Embryo Transfer â Has Its Time Arrived?

Owen K. Davis, M.D. — Thu, 02Â DecÂ 2004 00:00:00 -05:00

Since its introduction in 1978,1 human in vitro fertilization has rapidly become one of the most successful and widely used techniques in the treatment of infertility. Worldwide, an estimated 1.2...

ORIGINAL ARTICLE: Elective Single-Embryo Transfer versus Double-Embryo Transfer in in Vitro Fertilization

Thu, 02Â DecÂ 2004 00:00:00 -05:00

Background: The risks of premature birth and perinatal death are increased after in vitro fertilization. These risks are mainly due to the high incidence of multiple births, which relates to...

IMAGES IN CLINICAL MEDICINE: Peripartum Dissection of the Right Coronary Artery

Aaron Frimerman, M.D. and Simcha R. Meisel, M.D. — Thu, 11Â NovÂ 2004 00:00:00 -05:00

A 35-year-old woman was evaluated for presyncope several days after giving birth. The results of physical examination were unremarkable, but her electrocardiogram showed transient ST depressions in leads II, III,...

PERSPECTIVE: Nondisjunction â A View from Ringside

Neil E. Lamb, Ph.D., and Terry J. Hassold, Ph.D. — Thu, 04Â NovÂ 2004 00:00:00 -05:00

Chromosome nondisjunction lands a heavy blow on the chin of humanity. The improper segregation of chromosomes during meiosis leads to chromosomally unbalanced eggs or sperm. If these gametes participate in...

PERSPECTIVE: Minimal Intervention â Nurse-Midwives in the United States

Mona T. Lydon-Rochelle, C.N.M., Ph.D. — Thu, 04Â NovÂ 2004 00:00:00 -05:00

I first observed childbirth in 1973 during a rotation at the Boston Lying-In Hospital, where I witnessed many women in labor screaming in a scopolamine stupor. What I remember most...

PERSPECTIVE: Advanced Maternal Age â How Old Is Too Old?

Linda J. Heffner, M.D., Ph.D. — Thu, 04Â NovÂ 2004 00:00:00 -05:00

The past decade has seen a remarkable shift in the demographics of childbearing in the United States. The number of first births per 1000 women 35 to 39 years of...

ORIGINAL ARTICLE: Second-Trimester Maternal Serum Levels of Alpha-Fetoprotein and the Subsequent Risk of Sudden Infant Death Syndrome

Thu, 02Â SepÂ 2004 00:00:00 -05:00

Background: Unexplained stillbirth and the sudden infant death syndrome (SIDS) share some features. A raised maternal serum level of alpha-fetoprotein during the second trimester of pregnancy is a marker of...

PERSPECTIVE: SIDS â A Syndrome in Search of a Cause

Michael H. Malloy, M.D. — Thu, 02Â SepÂ 2004 00:00:00 -05:00

The sudden infant death syndrome (SIDS) was initially defined in 1969 with the goal of identifying infants who had similar characteristics before sudden death so that a common underlying mechanism...

PERSPECTIVE: The Changing Faces of Children with Cleft Lip and Palate

John B. Mulliken, M.D. — Thu, 19Â AugÂ 2004 00:00:00 -05:00

Many expectant parents worry, consciously or unconsciously, that their baby will be born with a malformation. Cleft lip with or without cleft palate is one of the most common birth...

EDITORIAL: Increased Levothyroxine Requirements in Pregnancy â Why, When, and How Much?

Anthony Toft, M.D. — Thu, 15Â JulÂ 2004 00:00:00 -05:00

Those with sufficiently long memories must be somewhat bemused by the successive controversies surrounding the treatment of primary hypothyroidism, a condition viewed by many as simple, satisfying to manage, and...

EDITORIAL: Antiretroviral Agents â How Best to Protect Infants from HIV and Save Their Mothers from AIDS

Hoosen Coovadia, M.D. — Thu, 15Â JulÂ 2004 00:00:00 -05:00

Preventing transmission of human immunodeficiency virus type 1 (HIV-1) and caring for those already infected are essential services in any comprehensive program, and enhancing the mutually beneficial effect of each...

ORIGINAL ARTICLE: Timing and Magnitude of Increases in Levothyroxine Requirements during Pregnancy in Women with Hypothyroidism

Thu, 15Â JulÂ 2004 00:00:00 -05:00

Background: Hypothyroidism during pregnancy has been associated with impaired cognitive development and increased fetal mortality. During pregnancy, maternal thyroid hormone requirements increase. Although it is known that women with hypothyroidism...

ORIGINAL ARTICLE: Intrapartum Exposure to Nevirapine and Subsequent Maternal Responses to Nevirapine-Based Antiretroviral Therapy

Thu, 15Â JulÂ 2004 00:00:00 -05:00

Background: A single intrapartum dose of nevirapine for the prevention of mother-to-child transmission of human immunodeficiency virus (HIV) leads to the selection of resistance mutations. Whether there are clinically significant...

ORIGINAL ARTICLE: Single-Dose Perinatal Nevirapine plus Standard Zidovudine to Prevent Mother-to-Child Transmission of HIV-1 in Thailand

Thu, 15Â JulÂ 2004 00:00:00 -05:00

Background: Although zidovudine prophylaxis decreases the rate of transmission of the human immunodeficiency virus (HIV) type 1 substantially, a large number of infants still become infected. We hypothesized that the...

EDITORIAL: TwinâTwin Transfusion â As Good as It Gets?

Nicholas M. Fisk, Ph.D., and Paula Galea, M.D. — Thu, 08Â JulÂ 2004 00:00:00 -05:00

The twin-to-twin transfusion syndrome poses a major challenge for fetal therapy. Untreated, it results in inordinate perinatal mortality and morbidity. It affects two babies, both of whom are structurally normal....

ORIGINAL ARTICLE: Endoscopic Laser Surgery versus Serial Amnioreduction for Severe Twin-to-Twin Transfusion Syndrome

Thu, 08Â JulÂ 2004 00:00:00 -05:00

Background: Monochorionic twin pregnancies complicated by severe twin-to-twin transfusion syndrome at midgestation can be treated by either serial amnioreduction (removal of large volumes of amniotic fluid) or selective fetoscopic laser...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2004 â A 46-Year-Old Woman with Pelvic-Floor Relaxation after a Second Vaginal Delivery

Lori R. Berkowitz, M.D. — Thu, 24Â JunÂ 2004 00:00:00 -05:00

A 46-year-old woman was admitted to the hospital because of pelvic discomfort and urinary symptoms.

The patient had been well until 10 months earlier, when she had experienced the rapid but...

PERSPECTIVE: Waiting for Plan B â The FDA and Nonprescription Use of Emergency Contraception

Robert Steinbrook, M.D. — Thu, 03Â JunÂ 2004 00:00:00 -05:00

The proposal to switch levonorgestrel emergency contraception (sold under the brand name Plan B) to over-the-counter status in the United States is in limbo. In May, the Food and Drug...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2004 â A 38-Year-Old Woman with Acute Onset of Pain in the Chest

Thu, 15Â AprÂ 2004 00:00:00 -05:00

A 38-year-old woman was admitted to the hospital because of the acute onset of pain in the chest and upper back.

Two weeks before admission, the patient had given birth by...

IMAGES IN CLINICAL MEDICINE: Fetus Papyraceus

Gary Sutkin, M.D. and Viviane Mamlok, M.D. — Thu, 15Â AprÂ 2004 00:00:00 -05:00

A 19-year-old woman (gravida 1, para 0) delivered a healthy, 3270-g female infant at 38 weeks' gestation. The pregnancy had been uncomplicated except for the death of a twin, which...

SPECIAL ARTICLE: Trends in Embryo-Transfer Practice and in Outcomes of the Use of Assisted Reproductive Technology in the United States

Tarun Jain, M.D., Stacey A. Missmer, Sc.D., and Mark D. Hornstein, M.D. — Thu, 15Â AprÂ 2004 00:00:00 -05:00

Background: During the past decade in the United States, increasing attention has been paid to lowering the incidence of multiple gestations resulting from the use of assisted reproductive technology. To...

PERSPECTIVE: Assisted Reproductive Technology in the United States

Robert W. Rebar, M.D., and Alan H. DeCherney, M.D. — Thu, 15Â AprÂ 2004 00:00:00 -05:00

Of the 60.2 million women in the United States who were of reproductive age in 1995, about 1.2 million, or 2 percent, had had an infertility-related medical appointment within the...

EDITORIAL: The FDA, Politics, and Plan B

Jeffrey M. Drazen, M.D., Michael F. Greene, M.D., and Alastair J.J. Wood, M.D. — Thu, 08Â AprÂ 2004 00:00:00 -05:00

The recent decision by the Food and Drug Administration (FDA) to postpone a decision on the proposal to switch levonorgestrel emergency contraception (sold under the brand name Plan B) to...

ORIGINAL ARTICLE: Previous Preterm and Small-for-Gestational-Age Births and the Subsequent Risk of Stillbirth

Thu, 19Â FebÂ 2004 00:00:00 -05:00

Background: Some causes of stillbirth may also lead to fetuses that are small for gestational age (have a low birth weight with respect to their gestational age) or are delivered...

PERSPECTIVE: Small-for-Gestational-Age Infants and Risk of Fetal Death in Subsequent Pregnancies

Jun Zhang, Ph.D., M.D., and Mark A. Klebanoff, M.D., M.P.H. — Thu, 19Â FebÂ 2004 00:00:00 -05:00

One of the triumphs of modern obstetrics has been the dramatic reduction in late fetal mortality (defined as the rate of antepartum or intrapartum fetal death at 20 weeks of...

ORIGINAL ARTICLE: Circulating Angiogenic Factors and the Risk of Preeclampsia

Thu, 12Â FebÂ 2004 00:00:00 -05:00

Background: The cause of preeclampsia remains unclear. Limited data suggest that excess circulating soluble fms-like tyrosine kinase 1 (sFlt-1), which binds placental growth factor (PlGF) and vascular endothelial growth factor...

PERSPECTIVE: Preeclampsia â Searching for the Cause

Caren G. Solomon, M.D., M.P.H., and Ellen W. Seely, M.D. — Thu, 12Â FebÂ 2004 00:00:00 -05:00

Three to 5 percent of pregnancies in the United States are complicated by preeclampsia, a multisystem disorder characterized by hypertension and proteinuria that occurs after 20 weeks of pregnancy. Preeclampsia...

REVIEW ARTICLE: Sex Determination and Differentiation

David T. MacLaughlin, Ph.D., and Patricia K. Donahoe, M.D. — Thu, 22Â JanÂ 2004 00:00:00 -05:00

Sex determination, which depends on the sex-chromosome complement of the embryo, is established by multiple molecular events that direct the development of germ cells, their migration to the urogenital ridge,...

ORIGINAL ARTICLE: Autoantibodies against Folate Receptors in Women with a Pregnancy Complicated by a Neural-Tube Defect

Thu, 08Â JanÂ 2004 00:00:00 -05:00

Background: In the absence of clinical folate deficiency, periconceptional supplementation with folic acid reduces a woman's risk of having an infant with a neural-tube defect. Since antiserum to folate receptors...

PERSPECTIVE: Folic Acid and the Prevention of Neural-Tube Defects

Nicholas J. Wald, D.Sc., F.R.C.P. — Thu, 08Â JanÂ 2004 00:00:00 -05:00

In 1991, a randomized trial funded by the Medical Research Council demonstrated that folic acid supplementation before pregnancy and during its early stages markedly reduced the risk of neural-tube defects...

SOUNDING BOARD: Systematic Identification of Drugs That Cause Birth Defects â A New Opportunity

Allen A. Mitchell, M.D. — Thu, 25Â DecÂ 2003 00:00:00 -05:00

Patients, prescribers, and policymakers often assume that the most serious short-term adverse effects of a drug are identified in pre-marketing studies, so recognition of unexpected harm after widespread use raises...

ORIGINAL ARTICLE: A Randomized Trial of Fetal Endoscopic Tracheal Occlusion for Severe Fetal Congenital Diaphragmatic Hernia

Thu, 13Â NovÂ 2003 00:00:00 -05:00

Background: Experimental and clinical data suggest that fetal endoscopic tracheal occlusion to induce lung growth may improve the outcome of severe congenital diaphragmatic hernia. We performed a randomized, controlled trial...

PERSPECTIVE: Fetal Surgery for Congenital Diaphragmatic Hernia

Katharine D. Wenstrom, M.D. — Thu, 13Â NovÂ 2003 00:00:00 -05:00

Diaphragmatic hernia occurs when any of the four separate structures making up the diaphragm (the septum transversum, pleuroperitoneal membranes, dorsal mesentery of the esophagus, and body wall) fail to grow...

CLINICAL PRACTICE: Emergency Contraception

Carolyn Westhoff, M.D. — Thu, 06Â NovÂ 2003 00:00:00 -05:00

A healthy 19-year-old woman comes in for a routine appointment. She is sexually active in a monogamous relationship. Pregnancy is not currently desired. Her partner uses condoms most of the...

IMAGES IN CLINICAL MEDICINE: Intraabdominal Pregnancy after Hysterectomy

Harold C. Wiesenfeld, M.D. and Richard S. Guido, M.D. — Thu, 16Â OctÂ 2003 00:00:00 -05:00

A 31-year-old woman underwent total abdominal hysterectomy for menorrhagia. Her reported last menstrual period had occurred six days before surgery. Twelve weeks after surgery, computed tomography of the abdomen and...

EDITORIAL: Screening for Down's Syndrome â Too Many Choices?

Michael T. Mennuti, M.D., and Deborah A. Driscoll, M.D. — Thu, 09Â OctÂ 2003 00:00:00 -05:00

An increased risk of fetal Down's syndrome (trisomy 21) is the most common reason for offering prenatal genetic diagnosis. The chance of giving birth to a child with Down's syndrome...

ORIGINAL ARTICLE: First-Trimester Screening for Trisomies 21 and 18

Thu, 09Â OctÂ 2003 00:00:00 -05:00

Background: Screening for aneuploid pregnancies is routinely performed after 15 weeks of gestation and has a sensitivity of approximately 65 percent, with a false positive rate of 5 percent. First-trimester...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2003 â A Newborn Boy with Petechiae and Thrombocytopenia

Thu, 14Â AugÂ 2003 00:00:00 -05:00

A newborn boy was admitted to a special-care nursery because of petechiae and thrombocytopenia.

The boy had been delivered at this hospital at 39 weeks' gestation to a 32-year-old woman who...

IMAGES IN CLINICAL MEDICINE: A Fetus with Hypogenesis of the Corpus Callosum

Christine M. Glastonbury, M.B., B.S. and Anne M. Kennedy, M.R.C.P. — Thu, 07Â AugÂ 2003 00:00:00 -05:00

On routine prenatal ultrasonography, the cavum septum pellucidum was absent and a possible posterior fossa malformation was noted in a 31-week male fetus with a normal karyotype. A magnetic resonance...

IMAGES IN CLINICAL MEDICINE: Complex Umbilical-Cord Knot

William Camann, M.D. and James Marquardt, M.D. — Thu, 10Â JulÂ 2003 00:00:00 -05:00

A 29-year-old woman was in spontaneous labor at term after an uncomplicated pregnancy. The second stage of labor was notable for persistent, severe, and variable decelerations in the fetal heart...

ORIGINAL ARTICLE: A Report of Dizygous Monochorionic Twins

Thu, 10Â JulÂ 2003 00:00:00 -05:00

It is an accepted medical doctrine that monochorionic twins are exclusively monozygous. This doctrine is supported by two studies that assessed placental pathological features and multiple serologic markers of zygosity...

ORIGINAL ARTICLE: Low-Molecular-Weight Heparin versus a Coumarin for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer

Thu, 10Â JulÂ 2003 00:00:00 -05:00

Background: Patients with cancer have a substantial risk of recurrent thrombosis despite the use of oral anticoagulant therapy. We compared the efficacy of a low-molecular-weight heparin with that of an...

PERSPECTIVE: Nonidentical Twins with a Single Placenta â Disproving Dogma in Perinatal Pathology

Raymond W. Redline, M.D. — Thu, 10Â JulÂ 2003 00:00:00 -05:00

Generations of trainees have been taught that monochorionic twin placentas are monozygotic. A report by Souter et al. in this issue of the Journal (pages 154â158) invalidates this simple rule...

CLINICAL PRACTICE: Valvular Heart Disease in Pregnancy

Sharon C. Reimold, M.D., and John D. Rutherford, M.B., Ch.B. — Thu, 03Â JulÂ 2003 00:00:00 -05:00

A 29-year-old woman with a history of mitral stenosis who has a St. Jude Medical mitral-valve prosthesis presents for evaluation before attempting to conceive. She is concerned about the risks...

EDITORIAL: Progesterone and Preterm Delivery â DÃ©jÃ Vu All Over Again

Michael F. Greene, M.D. — Thu, 12Â JunÂ 2003 00:00:00 -05:00

It has become almost a platitude to lament the complexity and intractability of the problem of preterm delivery, the poor predictive value of screening tests for its occurrence, its resistance...

ORIGINAL ARTICLE: Prevention of Recurrent Preterm Delivery by 17 Alpha-Hydroxyprogesterone Caproate

Thu, 12Â JunÂ 2003 00:00:00 -05:00

Background: Women who have had a spontaneous preterm delivery are at greatly increased risk for preterm delivery in subsequent pregnancies. The results of several small trials have suggested that 17...

ORIGINAL ARTICLE: Preimplantation Diagnosis for Sonic Hedgehog Mutation Causing Familial Holoprosencephaly

Thu, 10Â AprÂ 2003 00:00:00 -05:00

The sonic hedgehog (SHH) gene is a human homologue of the drosophila gene encoding inductive signals involved in patterning the early embryo and which is highly functionally conserved in many...

SOUNDING BOARD: Elective Primary Cesarean Delivery

Howard Minkoff, M.D., and Frank A. Chervenak, M.D. — Thu, 06Â MarÂ 2003 00:00:00 -05:00

In 1985, the Journal published an article advocating elective cesarean delivery.1 Although it was provocative, the article had little effect on obstetrical standards. At that time, most efforts within the...

ORIGINAL ARTICLE: Urinary Incontinence after Vaginal Delivery or Cesarean Section

Thu, 06Â MarÂ 2003 00:00:00 -05:00

Background: It is uncertain whether women who deliver by cesarean section have an increased risk of urinary incontinence as compared with nulliparous women and whether women who deliver vaginally have...

REVIEW ARTICLE: Regional Anesthesia and Analgesia for Labor and Delivery

Thu, 23Â JanÂ 2003 00:00:00 -05:00

In 1847, the Scottish obstetrician James Simpson administered ether to a woman during labor to treat the pain of childbirth. He was impressed with the degree of analgesia associated with...

ORIGINAL ARTICLE: A Comparison of Magnesium Sulfate and Nimodipine for the Prevention of Eclampsia

Thu, 23Â JanÂ 2003 00:00:00 -05:00

Objective Magnesium sulfate may prevent eclampsia by reducing cerebral vasoconstriction and ischemia. Nimodipine is a calcium-channel blocker with specific cerebral vasodilator activity. Our objective was to determine whether nimodipine is...

PERSPECTIVE: Magnesium Sulfate for Preeclampsia

Michael F. Greene, M.D. — Thu, 23Â JanÂ 2003 00:00:00 -05:00

For centuries, practitioners of midwifery have feared the occurrence of convulsions during pregnancy because they carried a particularly grave prognosis for both mother and fetus. In 17th-century Paris, eclampsia was...

SPECIAL ARTICLE: Effects of a Law against Early Postpartum Discharge on Newborn Follow-up, Adverse Events, and HMO Expenditures

Thu, 19Â DecÂ 2002 00:00:00 -05:00

Background: Concern about harm to newborns from early postpartum discharges led to laws establishing minimum hospital stays in the mid-1990s. We evaluated the effects of an early-discharge protocol (a hospital...

EDITORIAL: Should Insurance Coverage for in Vitro Fertilization Be Mandated?

Thu, 29Â AugÂ 2002 00:00:00 -05:00

Not long ago, in vitro fertilization was the stuff of science fiction.1 Even after the birth of the first baby from in vitro fertilization in 1978, such births were initially...

SPECIAL ARTICLE: Insurance Coverage and Outcomes of in Vitro Fertilization

Tarun Jain, M.D., Bernard L. Harlow, Ph.D., and Mark D. Hornstein, M.D. — Thu, 29Â AugÂ 2002 00:00:00 -05:00

Background: Although most insurance companies in the United States do not cover in vitro fertilization, a few states mandate such coverage.

Methods: We used 1998 data reported to the Centers for...

IMAGES IN CLINICAL MEDICINE: Neonatal Rash Due to Herpes Gestationis

Nissa I. Erickson, M.D. and Richard L. Ellis, M.D. — Thu, 29Â AugÂ 2002 00:00:00 -05:00

Figure 1. A 6-day-old infant with a 48-hour history of facial lesions had been born at 37 weeks of gestation after a spontaneous vaginal delivery without complications. According to her...

EDITORIAL: Prevention of Neonatal Group B Streptococcal Infection

Thu, 25Â JulÂ 2002 00:00:00 -05:00

The highest annual death rate before the sixth decade of life occurs during the first year of life.1 Most deaths during the first year occur during the perinatal period, particularly...

ORIGINAL ARTICLE: Dermoid Inclusion Cysts and Early Spinal Cord Tethering after Fetal Surgery for Myelomeningocele

Thu, 25Â JulÂ 2002 00:00:00 -05:00

02072523.xml Myelomeningocele occurs in approximately 1 of every 2000 live births.1 The prenatal incidence is higher, because many parents elect to terminate the pregnancy, once the diagnosis has been...

ORIGINAL ARTICLE: A Population-Based Comparison of Strategies to Prevent Early-Onset Group B Streptococcal Disease in Neonates

Thu, 25Â JulÂ 2002 00:00:00 -05:00

Background: 02072522.xml Guidelines issued in 1996 in the United States recommend either screening of pregnant women for group B streptococcal colonization by means of cultures (screening approach) or assessing clinical...

PERSPECTIVE: Fetal Surgery for Myelomeningocele

Thu, 25Â JulÂ 2002 00:00:00 -05:00

The most common nonlethal malformation in the spectrum of neural-tube defects is myelomeningocele. This defect, caused by failure of the neural tube to close completely at about four weeks of...

CLINICAL PRACTICE: Postpartum Depression

Thu, 18Â JulÂ 2002 00:00:00 -05:00

A woman visits the doctor for her six-week postpartum evaluation. She reports that she cannot sleep even if her baby sleeps. She cries daily and worries constantly. She does not...

IMAGES IN CLINICAL MEDICINE: Chondrodysplasia Punctata

Marja W. Wessels, M.D. and Patrick J. Willems, M.D., Ph.D. — Thu, 11Â JulÂ 2002 00:00:00 -05:00

Figure 1. Chondrodysplasia punctata was diagnosed in a 22-week-old fetus. This heterogeneous condition involves genetic defects in peroxisomal, cholesterol, or vitamin K metabolism and acquired embryopathies caused by maternal malabsorption...

EDITORIAL: Clotting and Hemorrhage in the Placenta â A Delicate Balance

Thu, 04Â JulÂ 2002 00:00:00 -05:00

Increased susceptibility to deep-vein thrombosis is a well-known facet of pregnancy and the puerperium, with the greatest risk occurring during the puerperium. It remains unclear, however, whether a genetically determined...

ORIGINAL ARTICLE: Absence of Association of Thrombophilia Polymorphisms with Intrauterine Growth Restriction

Thu, 04Â JulÂ 2002 00:00:00 -05:00

Background: Previous data have demonstrated associations between thrombophilia polymorphisms in pregnant women and an increased risk of intrauterine growth restriction in their offspring, but this finding remains uncertain.

Methods: We performed...

EDITORIAL: Good News about Oral Contraceptives

Thu, 27Â JunÂ 2002 00:00:00 -05:00

The development of oral contraceptives stands as a major advance in women's health in the past century. By virtue of their ability to prevent pregnancy in 99 percent of women...

REVIEW ARTICLE: Management of Human Immunodeficiency Virus Infection in Pregnancy

D. Heather Watts, M.D. — Thu, 13Â JunÂ 2002 00:00:00 -05:00

An estimated 16.4 million women worldwide are living with human immunodeficiency virus (HIV) infection; 600,000 children are infected annually, most of them by mother-to-child transmission.1 Interventions designed to reduce perinatal...

ORIGINAL ARTICLE: Antiretroviral Therapy during Pregnancy and the Risk of an Adverse Outcome

Thu, 13Â JunÂ 2002 00:00:00 -05:00

Background: Some studies suggest that combination antiretroviral therapy in pregnant women with human immunodeficiency virus type 1 (HIV-1) infection increases the risk of premature birth and other adverse outcomes of...

SOUNDING BOARD: Ooplasmic Transfer â Proceed with Care

Thu, 07Â MarÂ 2002 00:00:00 -05:00

This is an exciting time in the field of human gamete biology, with the real possibility that advances will result in both wider application and an increased efficiency of current...

EDITORIAL: Infertility Treatment â More Risks and Challenges

Thu, 07Â MarÂ 2002 00:00:00 -05:00

Infertility is defined by the failure to conceive after 12 months of unprotected intercourse, and it affects an estimated 10 percent of the population of reproductive age in the United...

REVIEW ARTICLE: The Antiphospholipid Syndrome

Jerrold S. Levine, M.D., D. Ware Branch, M.D., and Joyce Rauch, Ph.D. — Thu, 07Â MarÂ 2002 00:00:00 -05:00

Antiphospholipid antibodies are a family of autoantibodies that exhibit a broad range of target specificities and affinities, all recognizing various combinations of phospholipids, phospholipid-binding proteins, or both. The term âantiphospholipid...

ORIGINAL ARTICLE: Low and Very Low Birth Weight in Infants Conceived with Use of Assisted Reproductive Technology

Thu, 07Â MarÂ 2002 00:00:00 -05:00

Background: The increased risk of low birth weight associated with the use of assisted reproductive technology has been attributed largely to the higher rate of multiple gestations associated with such...

ORIGINAL ARTICLE: The Risk of Major Birth Defects after Intracytoplasmic Sperm Injection and in Vitro Fertilization

Thu, 07Â MarÂ 2002 00:00:00 -05:00

Background: It is not known whether infants conceived with use of intracytoplasmic sperm injection or in vitro fertilization have a higher risk of birth defects than infants conceived naturally.

Methods: We...

EDITORIAL: Predicting Premature Delivery â No Easy Task

Thu, 24Â JanÂ 2002 00:00:00 -05:00

Premature delivery is a leading cause of infant death. Approximately 5000 infants die each year in the United States from complications of prematurity and low birth weight. During the past...

ORIGINAL ARTICLE: Frequency of Uterine Contractions and the Risk of Spontaneous Preterm Delivery

Thu, 24Â JanÂ 2002 00:00:00 -05:00

Background: The measurement of the frequency of uterine contractions has not been useful for reducing the rate of preterm delivery in randomized trials. Nonetheless, ambulatory monitoring of contractions continues to...

ORIGINAL ARTICLE: Outcomes in Young Adulthood for Very-Low-Birth-Weight Infants

Thu, 17Â JanÂ 2002 00:00:00 -05:00

Background: Very-low-birth-weight infants (those weighing less than 1500 g) born during the initial years of neonatal intensive care have now reached young adulthood.

Methods: We compared a cohort of 242 survivors...

IMAGES IN CLINICAL MEDICINE: Spontaneous Resolution of a Pubic-Symphysis Diastasis

David Chang, M.D. and Bruce S. Markman, M.D. — Thu, 03Â JanÂ 2002 00:00:00 -05:00

Figure 1. A 27-year-old, 45-kg primigravid woman presented in early labor at 40 weeks' gestation. Six hours into her labor, an urgent vacuum-assisted vaginal delivery was performed because of fetal...

ORIGINAL ARTICLE: The Interval between Pregnancies and the Risk of Preeclampsia

Rolv SkjÃ¦rven, Ph.D., Allen J. Wilcox, M.D., Ph.D., and Rolv T. Lie, Ph.D. — Thu, 03Â JanÂ 2002 00:00:00 -05:00

Background: The risk of preeclampsia is generally lower in second pregnancies than in first pregnancies, but not if the mother has a new partner for the second pregnancy. One explanation...

EDITORIAL: Preimplantation Genetic Diagnosis by Comparative Genomic Hybridization

Thu, 22Â NovÂ 2001 00:00:00 -05:00

Currently, the most common techniques for prenatal diagnosis are amniocentesis, performed between 14 and 22 weeks' gestation, and chorionic-villus sampling, performed between 14 and 20 weeks' gestation. Although generally regarded...

REVIEW ARTICLE: Implantation and the Survival of Early Pregnancy

Errol R. Norwitz, M.D., Ph.D., Danny J. Schust, M.D., and Susan J. Fisher, Ph.D. — Thu, 08Â NovÂ 2001 00:00:00 -05:00

Human reproduction entails a fundamental paradox: although it is critical to the survival of the species, the process is relatively inefficient. Maximal fecundity (the probability of conception during one menstrual...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery

Brett J. Berman, M.D. and William T. Katsiyiannis, M.D. — Thu, 18Â OctÂ 2001 00:00:00 -05:00

Figure 1. A 78-year-old woman has colicky right-flank pain associated with nausea and vomiting. What does the abdominal radiograph show?...

IMAGES IN CLINICAL MEDICINE: Hydatidiform Mole

J.F. Graadt van Roggen, M.B., Ch.B., Ph.D. and V.T.H.B.M. Smit, M.D., Ph.D. — Thu, 16Â AugÂ 2001 00:00:00 -05:00

Figure 1. A 29-year-old woman with no previous pregnancies presented with a nine-week history of amenorrhea. The serum levels of the beta subunit of chorionic gonadotropin (peak, 117,000 U per...

ORIGINAL ARTICLE: Failure of Metronidazole to Prevent Preterm Delivery among Pregnant Women with Asymptomatic Infection

Thu, 16Â AugÂ 2001 00:00:00 -05:00

Background: Infection with Trichomonas vaginalis during pregnancy has been associated with preterm delivery. It is uncertain whether treatment of asymptomatic trichomoniasis in pregnant women reduces the occurrence of preterm delivery.

Methods:...

ORIGINAL ARTICLE: Parity, Oral Contraceptives, and the Risk of Ovarian Cancer among Carriers and Noncarriers of a or Mutation

Thu, 26Â JulÂ 2001 00:00:00 -05:00

Background: Multiparity and the use of oral contraceptives reduce the risk of ovarian cancer, but their effects on this risk in women with a BRCA1 or BRCA2 mutation are unclear.

Methods:...

EDITORIAL: Vaginal Delivery after Cesarean Section â Is the Risk Acceptable?

Thu, 05Â JulÂ 2001 00:00:00 -05:00

Nearly 40 years ago, Douglas et al. documented the risk of uterine rupture during a trial of labor after cesarean section.1 Among more than 2000 women with scars from prior...

ORIGINAL ARTICLE: Risk of Uterine Rupture during Labor among Women with a Prior Cesarean Delivery

Thu, 05Â JulÂ 2001 00:00:00 -05:00

Background: Each year in the United States, approximately 60 percent of women with a prior cesarean delivery who become pregnant again attempt labor. Concern persists that a trial of labor...

EDITORIAL: Peripartum Cardiomyopathy

Thu, 24Â MayÂ 2001 00:00:00 -05:00

Peripartum cardiomyopathy is a poorly understood condition whose incidence in the United States is 1 per 3000 to 4000 live births.1 Previous descriptions of the disorder were based on a...

ORIGINAL ARTICLE: Maternal and Fetal Outcomes of Subsequent Pregnancies in Women with Peripartum Cardiomyopathy

Thu, 24Â MayÂ 2001 00:00:00 -05:00

Background: Peripartum cardiomyopathy is a rare but sometimes fatal form of heart failure. Little is known about the outcomes of subsequent pregnancies in women who have had the disorder.

Methods: Through...

ORIGINAL ARTICLE: Intrauterine Transmission of Cytomegalovirus to Infants of Women with Preconceptional Immunity

Thu, 03Â MayÂ 2001 00:00:00 -05:00

Background: Preconceptional immunity against cytomegalovirus (CMV) provides only partial protection against intrauterine transmission of the virus. Whether congenital CMV infection in the offspring of women who are seropositive for CMV...

ORIGINAL ARTICLE: The Teratogenicity of Anticonvulsant Drugs

Thu, 12Â AprÂ 2001 00:00:00 -05:00

Background: The frequency of major malformations, growth retardation, and hypoplasia of the midface and fingers, known as anticonvulsant embryopathy, is increased in infants exposed to anticonvulsant drugs in utero. However,...

EDITORIAL: Risk Factors for Preeclampsia

Thu, 22Â MarÂ 2001 00:00:00 -05:00

An estimated 50,000 women per year worldwide die from preeclampsia. Preeclampsia is more likely to develop in women whose mothers had preeclampsia than in women whose mothers did not.1 The...

ORIGINAL ARTICLE: Paternal and Maternal Components of the Predisposition to Preeclampsia

Thu, 22Â MarÂ 2001 00:00:00 -05:00

Background: There is an inherited maternal predisposition to preeclampsia. Whether there is a paternal component, however, is not known.

Methods: We used records of the Utah Population Database to identify 298...

EDITORIAL: Use of Misoprostol in Pregnancy

Thu, 04Â JanÂ 2001 00:00:00 -05:00

The article by Goldberg et al. in this issue of the Journal reviews the evidence supporting the use of misoprostol in women at various stages of pregnancy.1 The authors identified...

REVIEW ARTICLE: Misoprostol and Pregnancy

Alisa B. Goldberg, M.D., Mara B. Greenberg, B.S., and Philip D. Darney, M.D. — Thu, 04Â JanÂ 2001 00:00:00 -05:00

Misoprostol is a prostaglandin E1 analogue that has been approved by the Food and Drug Administration (FDA) to be taken orally for the prevention and treatment of gastric ulcers associated...

ORIGINAL ARTICLE: Caffeine Intake and the Risk of First-Trimester Spontaneous Abortion

Thu, 21Â DecÂ 2000 00:00:00 -05:00

Background: Some epidemiologic studies have suggested that the ingestion of caffeine increases the risk of spontaneous abortion, but the results have been inconsistent.

Methods: We performed a population-based, caseâcontrol study of...

ORIGINAL ARTICLE: Folic Acid Antagonists during Pregnancy and the Risk of Birth Defects

Thu, 30Â NovÂ 2000 00:00:00 -05:00

Background: Multivitamin supplementation in pregnant women may reduce the risks of cardiovascular defects, oral clefts, and urinary tract defects in their infants. We evaluated whether the folic acid component of...

ORIGINAL ARTICLE: Safety of Withholding Heparin in Pregnant Women with a History of Venous Thromboembolism

Thu, 16Â NovÂ 2000 00:00:00 -05:00

Background: Women with a history of venous thromboembolism may be at increased risk for venous thromboembolic events during pregnancy. In these women, the decision to give or withhold heparin in...

REVIEW ARTICLE: Nonsurgical Treatment of Ectopic Pregnancy

Gary H. Lipscomb, M.D., Thomas G. Stovall, M.D., and Frank W. Ling, M.D. — Thu, 02Â NovÂ 2000 00:00:00 -05:00

In the United States, the annual incidence of ectopic pregnancy increased from 0.37 percent of pregnancies in 1948 to 1.97 percent in 1992.1 Despite the continued increase in incidence, the...

EDITORIAL: Oral Hypoglycemic Drugs for Gestational Diabetes

Thu, 19Â OctÂ 2000 00:00:00 -05:00

Gestational diabetes mellitus has been a contentious subject since it was first described. From a global perspective, authors have questioned its very existence, the burden of morbidity that it causes,...

IMAGES IN CLINICAL MEDICINE: Mullerian Adenosarcoma and Early Pregnancy

Keith F. Izban, M.D. and Saro Gooneratne, M.D. — Thu, 19Â OctÂ 2000 00:00:00 -05:00

Figure 1. A 34-year-old mother of two children had had menometrorrhagia, lethargy, and episodic abdominal pain for several months. A trial of oral contraceptives provided no relief. Dilation and curettage...

ORIGINAL ARTICLE: A Comparison of Glyburide and Insulin in Women with Gestational Diabetes Mellitus

Thu, 19Â OctÂ 2000 00:00:00 -05:00

Background: Women with gestational diabetes mellitus are rarely treated with a sulfonylurea drug, because of concern about teratogenicity and neonatal hypoglycemia. There is little information about the efficacy of these...

ORIGINAL ARTICLE: A Trial of Shortened Zidovudine Regimens to Prevent Mother-to-Child Transmission of Human Immunodeficiency Virus Type 1

Thu, 05Â OctÂ 2000 00:00:00 -05:00

Background: The optimal duration of zidovudine administration to prevent perinatal transmission of human immunodeficiency virus type 1 (HIV-1) should be determined to facilitate its use in areas where resources are...

EDITORIAL: Rolling Back Malaria in Pregnancy

Thu, 31Â AugÂ 2000 00:00:00 -05:00

Malarial infection during pregnancy is a major public health problem in tropical and subtropical regions throughout the world. In endemic areas, pregnant women are the main group of adults at...

ORIGINAL ARTICLE: Increased Susceptibility to Malaria during the Early Postpartum Period

Thu, 31Â AugÂ 2000 00:00:00 -05:00

Background: Pregnancy is associated with increased susceptibility to malaria. It is generally agreed that this increased risk ends with delivery, but the possible persistence of increased susceptibility during the puerperium...

ORIGINAL ARTICLE: Rapid Detection of Group B Streptococci in Pregnant Women at Delivery

Thu, 20Â JulÂ 2000 00:00:00 -05:00

Background: Group B streptococcal infections are an important cause of neonatal morbidity and mortality. A rapid method for the detection of this organism in pregnant women at the time of...

EDITORIAL: In Treating Infertility, Are Multiple Pregnancies Unavoidable?

Thu, 06Â JulÂ 2000 00:00:00 -05:00

The demand for high rates of pregnancy among women treated for infertility has encouraged a tacit acceptance of certain complications of the treatment. This is especially true when treatment results...

ORIGINAL ARTICLE: Reducing the Risk of High-Order Multiple Pregnancy after Ovarian Stimulation with Gonadotropins

Thu, 06Â JulÂ 2000 00:00:00 -05:00

Background: The incidence of multiple gestation after therapy for infertility is especially high among women in whom ovulation is induced with gonadotropins. Whether the number of high-order multiple pregnancies (those...

REVIEW ARTICLE: Intrauterine Infection and Preterm Delivery

Thu, 18Â MayÂ 2000 00:00:00 -05:00

Preterm delivery is the chief problem in obstetrics today, accounting for 70 percent of perinatal mortality and nearly half of long-term neurologic morbidity.12 Approximately 10 percent of all births are...

REVIEW ARTICLE: Medical Termination of Pregnancy

Thu, 30Â MarÂ 2000 00:00:00 -05:00

Termination of pregnancy has been practiced since antiquity. Although many societies accept this practice, some reject it, and it is sometimes even considered a crime. The most widely used methods...

EDITORIAL: Antibiotics for the Prevention of Preterm Birth

Thu, 24Â FebÂ 2000 00:00:00 -05:00

Preterm birth is the greatest cause of perinatal mortality and morbidity in the developed world. The cause of spontaneous preterm birth is multifactorial, but infection has been implicated in up...

ORIGINAL ARTICLE: Metronidazole to Prevent Preterm Delivery in Pregnant Women with Asymptomatic Bacterial Vaginosis

Thu, 24Â FebÂ 2000 00:00:00 -05:00

Background: Bacterial vaginosis has been associated with preterm birth. In clinical trials, the treatment of bacterial vaginosis in pregnant women who previously had a preterm delivery reduced the risk of...

EDITORIAL: The Challenge of Thrombophilia in MaternalâFetal Medicine

Thu, 10Â FebÂ 2000 00:00:00 -05:00

Twenty years ago we did not have a problem with thrombophilia as a cause of venous thromboembolism in pregnant and postpartum women, or rather, we did not know we had...

ORIGINAL ARTICLE: Prothrombin and Factor V Mutations in Women with a History of Thrombosis during Pregnancy and the Puerperium

Thu, 10Â FebÂ 2000 00:00:00 -05:00

Background: Venous thromboembolism is a leading cause of morbidity and mortality during pregnancy and the puerperium. However, the role of mutations in the prothrombin and factor V genes and other...

ORIGINAL ARTICLE: Noninvasive Diagnosis by Doppler Ultrasonography of Fetal Anemia Due to Maternal Red-Cell Alloimmunization

Thu, 06Â JanÂ 2000 00:00:00 -05:00

Background: Invasive techniques such as amniocentesis and cordocentesis are used for diagnosis and treatment in fetuses at risk for anemia due to maternal red-cell alloimmunization. The purpose of our study...

EDITORIAL: Noninvasive Testing for Fetal Anemia

Thu, 06Â JanÂ 2000 00:00:00 -05:00

Despite the introduction of anti-D immune globulin (Rh immunoglobulin) for the prevention of anti-D red-cell alloimmunization, hemolytic disease of the newborn continues to occur because of the lack or failure...

ORIGINAL ARTICLE: Group B Streptococcal Disease in the Era of Intrapartum Antibiotic Prophylaxis

Thu, 06Â JanÂ 2000 00:00:00 -05:00

Background: Group B streptococcal infections are a leading cause of neonatal mortality, and they also affect pregnant women and the elderly. Many cases of the disease in newborns can be...

EDITORIAL: Notification about Early-Release Articles

Thu, 30Â DecÂ 1999 00:00:00 -05:00

Five times during the past year, the Journal has released articles early by posting them on our site on the World Wide Web (http://www.nejm.org). The decision to release an article...

ORIGINAL ARTICLE: Second-Trimester Serum Chorionic Gonadotropin Concentrations and Complications and Outcome of Pregnancy

Thu, 30Â DecÂ 1999 00:00:00 -05:00

Background: Maternal serum chorionic gonadotropin is measured to screen for fetal chromosomal abnormalities. Whether the results can also be used to predict the risk of complications or an adverse outcome...

ORIGINAL ARTICLE: Predictors of Success of Methotrexate Treatment in Women with Tubal Ectopic Pregnancies

Thu, 23Â DecÂ 1999 00:00:00 -05:00

Background: The use of methotrexate for the treatment of women with tubal ectopic pregnancies is now common practice. However, the clinical and hormonal determinants of the success of this treatment...

EDITORIAL: Birth Injury and Method of Delivery

Thu, 02Â DecÂ 1999 00:00:00 -05:00

In May 1998, the Food and Drug Administration (FDA) issued a public health advisory to all practitioners who deliver babies. The advisory, entitled âNeed for Caution When Using Vacuum Assisted...

REVIEW ARTICLE: Gestational Diabetes Mellitus

Siri L. Kjos, M.D., and Thomas A. Buchanan, M.D. — Thu, 02Â DecÂ 1999 00:00:00 -05:00

Gestational diabetes mellitus is defined as glucose intolerance that is first detected during pregnancy.1 This simple definition belies the complexity of a condition that spans a spectrum of glycemia, pathophysiology,...

ORIGINAL ARTICLE: Effect of Mode of Delivery in Nulliparous Women on Neonatal Intracranial Injury

Thu, 02Â DecÂ 1999 00:00:00 -05:00

Background: Infants delivered by vacuum extraction or other operative techniques may be more likely to sustain major injuries than those delivered spontaneously, but the extent of the risk is unknown.

Methods:...

EDITORIAL: Caffeine â Filtering the Facts

Thu, 25Â NovÂ 1999 00:00:00 -05:00

The article by Klebanoff and colleagues1 in this issue of the Journal adds to the growing body of literature examining the association of caffeine intake with adverse pregnancy outcomes and...

ORIGINAL ARTICLE: Maternal Serum Paraxanthine, a Caffeine Metabolite, and the Risk of Spontaneous Abortion

Thu, 25Â NovÂ 1999 00:00:00 -05:00

Background: Whether the consumption of caffeine during pregnancy increases the risk of spontaneous abortion is controversial. Prior studies have determined caffeine consumption by questionnaire. We used a biologic marker, serum...

REVIEW ARTICLE: Neural-Tube Defects

Thu, 11Â NovÂ 1999 00:00:00 -05:00

Each year spina bifida and anencephaly, the two most common forms of neural-tube defects, occur in 1 in 1000 pregnancies in the United States1 and an estimated 300,000 or more...

EDITORIAL: Periventricular Leukomalacia â Prospects for Prevention

Thu, 14Â OctÂ 1999 00:00:00 -05:00

Modern perinatal care, including careful fetal surveillance, antenatal administration of glucocorticoids, surfactant therapy, and ventilatory assistance, has improved survival rates for infants with very low birth weights (less than 1500...

ORIGINAL ARTICLE: Antenatal Glucocorticoid Treatment and Cystic Periventricular Leukomalacia in Very Premature Infants

Thu, 14Â OctÂ 1999 00:00:00 -05:00

Background: Antenatal glucocorticoid therapy decreases the incidence of several complications among very premature infants. However, its effect on the occurrence of cystic periventricular leukomalacia, a major cause of cerebral palsy,...

ORIGINAL ARTICLE: The Influence of Gestational Age and Smoking Habits on the Risk of Subsequent Preterm Deliveries

Thu, 23Â SepÂ 1999 00:00:00 -05:00

Background: Previous preterm delivery and maternal smoking are associated with increased risks of preterm delivery. It is not known whether gestational age at the time of a preterm delivery is...

REVIEW ARTICLE: The Control of Labor

Thu, 26Â AugÂ 1999 00:00:00 -05:00

Labor is the physiologic process by which a fetus is expelled from the uterus to the outside world. Labor is defined as an increase in myometrial activity or, more precisely,...

ORIGINAL ARTICLE: Obstetrical Outcomes among Women with Extrapulmonary Tuberculosis

Thu, 26Â AugÂ 1999 00:00:00 -05:00

Background: The prevalence of tuberculosis, especially extrapulmonary tuberculosis, is increasing worldwide. Because information on the outcome of pregnancy among women with extrapulmonary tuberculosis is limited, we studied the course of...

EDITORIAL: Maternal Hypothyroidism and Fetal Development

Thu, 19Â AugÂ 1999 00:00:00 -05:00

Thyroid deficiency during the latter two thirds of gestation and the first months after delivery can result in mental retardation and sometimes neurologic deficits. Whether thyroid hormone is needed during...

ORIGINAL ARTICLE: Maternal Thyroid Deficiency during Pregnancy and Subsequent Neuropsychological Development of the Child

Thu, 19Â AugÂ 1999 00:00:00 -05:00

Background: When thyroid deficiency occurs simultaneously in a pregnant woman and her fetus, the child's neuropsychological development is adversely affected. Whether developmental problems occur when only the mother has hypothyroidism...

EDITORIAL: Prenatal Screening for Down's Syndrome â A Search for the Family's Values

Thu, 12Â AugÂ 1999 00:00:00 -05:00

Since the introduction of amniocentesis for the prenatal detection of genetic diseases, there has been a progressive refinement of the criteria used to determine who should be offered the test....

ORIGINAL ARTICLE: Integrated Screening for Down's Syndrome Based on Tests Performed during the First and Second Trimesters

N.J. Wald, F.R.C.P., D.Sc., H.C. Watt, M.Sc., and A.K. Hackshaw, M.Sc. — Thu, 12Â AugÂ 1999 00:00:00 -05:00

Background: Both first-trimester screening and second-trimester screening for Down's syndrome are effective means of selecting women for chorionic-villus sampling or amniocentesis, but there is uncertainty about which screening method should...

EDITORIAL: Reducing the Risk of MaternalâInfant Transmission of HIV by Attacking the Virus

Thu, 05Â AugÂ 1999 00:00:00 -05:00

The findings of AIDS Clinical Trials Group (ACTG) Protocol 0761 opened the door to a major effort to reduce perinatal infection with the human immunodeficiency virus (HIV). We have witnessed...

ORIGINAL ARTICLE: Maternal Levels of Plasma Human Immunodeficiency Virus Type 1 RNA and the Risk of Perinatal Transmission

Thu, 05Â AugÂ 1999 00:00:00 -05:00

Background: The importance of plasma levels of human immunodeficiency virus type 1 (HIV-1) RNA in pregnant women in relation to the other factors known to influence the risk of transmission...

ORIGINAL ARTICLE: Risk Factors for Perinatal Transmission of Human Immunodeficiency Virus Type 1 in Women Treated with Zidovudine

Thu, 05Â AugÂ 1999 00:00:00 -05:00

Background: Maternal, obstetrical, and infant-related factors associated with the risk of perinatal transmission of human immunodeficiency virus type 1 (HIV-1) were identified before the widespread use of zidovudine therapy in...

ORIGINAL ARTICLE: Transplacental Transmission of Natural-Killer-Cell Lymphoma

Thu, 08Â JulÂ 1999 00:00:00 -05:00

The placenta is an organ of embryonic origin that supports the growing fetus by facilitating the transfer of nutrients from the mother. It is not well understood how the allogeneic...

EDITORIAL: Cancer during Pregnancy

Thu, 08Â JulÂ 1999 00:00:00 -05:00

Cancer is rare during pregnancy, occurring in only about 1 per 1000 live births. More than half the cases are tumors of the uterine cervix, breast, or thyroid, which can...

ORIGINAL ARTICLE: Time of Implantation of the Conceptus and Loss of Pregnancy

Thu, 10Â JunÂ 1999 00:00:00 -05:00

Background: Implantation of the conceptus is a key step in pregnancy, but little is known about the time of implantation or the relation between the time of implantation and the...

ORIGINAL ARTICLE: A Fetal Fatty-Acid Oxidation Disorder as a Cause of Liver Disease in Pregnant Women

Thu, 03Â JunÂ 1999 00:00:00 -05:00

Background: Acute fatty liver of pregnancy and the HELLP syndrome (hemolysis, elevated liver-enzyme levels, and a low platelet count) are serious hepatic disorders that may occur during pregnancy in women...

EDITORIAL: Good News and Bad for Women with Birth Defects

Thu, 08Â AprÂ 1999 00:00:00 -05:00

Most parents of a child with a birth defect focus their attention on short-term considerations regarding the child's health. Once these worries abate, parents begin to think about the child's...

ORIGINAL ARTICLE: A Population-Based Study of Survival and Childbearing among Female Subjects with Birth Defects and the Risk of Recurrence in Their Children

Rolv SkjÃ¦rven, Ph.D., Allen J. Wilcox, M.D., Ph.D., and Rolv T. Lie, Ph.D. — Thu, 08Â AprÂ 1999 00:00:00 -05:00

Background: and Methods: Persons with birth defects are at high risk for death during the perinatal period and infancy. Less is known about the later survival or reproduction of such...

ORIGINAL ARTICLE: The Mode of Delivery and the Risk of Vertical Transmission of Human Immunodeficiency Virus Type 1 â A Meta-Analysis of 15 Prospective Cohort Studies

The International Perinatal HIV Group — Thu, 01Â AprÂ 1999 00:00:00 -05:00

Background: To evaluate the relation between elective cesarean section and vertical transmission of human immunodeficiency virus type 1 (HIV-1), we performed a meta-analysis using data on individual patients from 15...

EDITORIAL: Elective Cesarean Delivery to Reduce the Transmission of HIV

Thu, 01Â AprÂ 1999 00:00:00 -05:00

Each year in the United States 6000 to 7000 women with human immunodeficiency virus (HIV) infection give birth. Worldwide, about 2.3 million HIV-infected women give birth each year. The transmission...

IMAGES IN CLINICAL MEDICINE: Yolk Sac with Blood Island

Isao Katayama, M.D. and Hidekazu Kayano, M.D. — Thu, 25Â FebÂ 1999 00:00:00 -05:00

Figure 1. A 31-year-old woman who had had amenorrhea for 53 days was found to have a left tubal pregnancy. Ultrasonography (Panel A) demonstrated a gestational sac (GS) containing an...

EDITORIAL: Cocaine, Smoking, and Spontaneous Abortion

Thu, 04Â FebÂ 1999 00:00:00 -05:00

In 1991 the Senate Committee on Appropriations approached the National Institute of Child Health and Human Development with a request and an offer. The request was to design a definitive...

ORIGINAL ARTICLE: Cocaine and Tobacco Use and the Risk of Spontaneous Abortion

Thu, 04Â FebÂ 1999 00:00:00 -05:00

Background: Cigarette smoking and cocaine use may be risk factors for spontaneous abortion, but data supporting such a link are limited.

Methods: We studied the associations between cocaine and tobacco use...

EDITORIAL: The Management of Infertility

Thu, 21Â JanÂ 1999 00:00:00 -05:00

The proportion of women in the United States who think they have a fertility problem increased from 5.7 percent in 1988 to 7.7 percent in 1995.1 This growing perception of...

ORIGINAL ARTICLE: Efficacy of Superovulation and Intrauterine Insemination in the Treatment of Infertility

Thu, 21Â JanÂ 1999 00:00:00 -05:00

Background: Induction of superovulation with gonadotropins and intrauterine insemination are frequently used to treat infertility. We conducted a large, randomized, controlled clinical trial of these treatments.

Methods: We studied 932 couples...

ORIGINAL ARTICLE: Increased Frequency of Genetic Thrombophilia in Women with Complications of Pregnancy

Thu, 07Â JanÂ 1999 00:00:00 -05:00

Background: Obstetrical complications such as severe preeclampsia, abruptio placentae, fetal growth retardation, and stillbirth are associated with intervillous or spiral-artery thrombosis and inadequate placental perfusion. Whether these complications are associated...

SOUNDING BOARD: The Risks of Lowering the Cesarean-Delivery Rate

Thu, 07Â JanÂ 1999 00:00:00 -05:00

In 1995, the rate of cesarean delivery in the United States was 21 percent.1 The goal of Healthy People 2000, a project of the Department of Health and Human Services,...

EDITORIAL: Thrombophilias and Adverse Outcomes of Pregnancy â What Should a Clinician Do?

Thu, 07Â JanÂ 1999 00:00:00 -05:00

Approximately 1 to 5 percent of pregnant women have serious complications of pregnancy, such as severe preeclampsia, abruptio placentae, intrauterine fetal death, or severe fetal growth retardation. The rates are...

ORIGINAL ARTICLE: Familial Gestational Hyperthyroidism Caused by a Mutant Thyrotropin Receptor Hypersensitive to Human Chorionic Gonadotropin

Thu, 17Â DecÂ 1998 00:00:00 -05:00

Some degree of stimulation of the thyroid gland by human chorionic gonadotropin is common during early pregnancy.123 When serum chorionic gonadotropin concentrations are abnormally high â for example, in women...

ORIGINAL ARTICLE: First-Trimester Growth and the Risk of Low Birth Weight

Thu, 17Â DecÂ 1998 00:00:00 -05:00

Background: Previous studies have demonstrated a correlation between first-trimester size and birth weight. It is not known, however, whether low birth weight is related to first-trimester growth. We sought to...

EDITORIAL: RhD Hemolytic Disease of the Newborn

Thu, 10Â DecÂ 1998 00:00:00 -05:00

Hemolytic disease of the fetus and newborn was first described in 1609 in a set of twins by a French midwife: the first twin was hydropic and stillborn, and the...

ORIGINAL ARTICLE: Prenatal Diagnosis of Fetal RhD Status by Molecular Analysis of Maternal Plasma

Thu, 10Â DecÂ 1998 00:00:00 -05:00

Background: The ability to determine fetal RhD status noninvasively is useful in the treatment of RhD-sensitized pregnant women whose partners are heterozygous for the RhD gene. The recent demonstration of...

EDITORIAL: Short (And Shorter) Courses of Zidovudine

Thu, 12Â NovÂ 1998 00:00:00 -05:00

In this issue of the Journal, Wade and colleagues1 present data on the outcomes of short, prophylactic courses of zidovudine administered to infants born to women infected with the human...

ORIGINAL ARTICLE: Determinants of Preterm Birth Rates in Canada from 1981 through 1983 and from 1992 through 1994

Thu, 12Â NovÂ 1998 00:00:00 -05:00

Background: The rates of preterm birth have increased in many countries, including Canada, over the past 20 years. However, the factors underlying the increase are poorly understood.

Methods: We used data...

ORIGINAL ARTICLE: Thermocoagulation for the Early Treatment of Pregnancy with an Acardiac Twin

Charles Rodeck, D.Sc., Anne Deans, M.D., and Eric Jauniaux, M.D. — Thu, 29Â OctÂ 1998 00:00:00 -05:00

In twin pregnancy with acardia, which occurs in about 1 in 35,000 deliveries, the heart and usually other organs fail to develop in one twin.1 The acardiac (ârecipientâ) twin receives...

SPECIAL ARTICLE: Risk Factors for Infant Homicide in the United States

Thu, 22Â OctÂ 1998 00:00:00 -05:00

Background: Homicide is the leading cause of infant deaths due to injury. More than 80 percent of infant homicides are considered to be fatal child abuse. This study assessed the...

ORIGINAL ARTICLE: Risk Factors for Preeclampsia, Abruptio Placentae, and Adverse Neonatal Outcomes among Women with Chronic Hypertension

Thu, 03Â SepÂ 1998 00:00:00 -05:00

Background: Women with chronic hypertension who become pregnant have an increased risk of preeclampsia and adverse neonatal outcomes. However, within this group, the risk factors for these adverse events are...

EDITORIAL: Two-Embryo Transfer â The Future Looks Bright

Thu, 27Â AugÂ 1998 00:00:00 -05:00

In this issue of the Journal, Templeton and Morris describe the use of a large data base to define clinical factors that are predictive of pregnancy and of multiple gestation...

ORIGINAL ARTICLE: Reducing the Risk of Multiple Births by Transfer of Two Embryos after in Vitro Fertilization

Allan Templeton, M.D., and Joan K. Morris, Ph.D. — Thu, 27Â AugÂ 1998 00:00:00 -05:00

Background: In vitro fertilization is associated with a high risk of multiple births, which is a direct consequence of the number of embryos transferred. However, other factors that contribute to...

ORIGINAL ARTICLE: Perinatal Transmission of the Agent of Human Granulocytic Ehrlichiosis

Thu, 06Â AugÂ 1998 00:00:00 -05:00

Human granulocytic ehrlichiosis was first described in the United States, in the northern Midwest, in 1994.1 Human granulocytic ehrlichiosis is caused by an organism, still referred to as the agent...

EDITORIAL: Effects of Pregnancy and Delivery on Disease Activity in Multiple Sclerosis

Thu, 30Â JulÂ 1998 00:00:00 -05:00

Multiple sclerosis, an organ-specific autoimmune disease of the central nervous system, affects 250,000 to 350,000 persons in the United States. It is at least twice as common among women as...

REVIEW ARTICLE: Prevention of Premature Birth

Robert L. Goldenberg, M.D., and Dwight J. Rouse, M.D. — Thu, 30Â JulÂ 1998 00:00:00 -05:00

Preterm birth, which occurs in 11 percent of all pregnancies, is responsible for the majority of neonatal deaths and nearly one half of all cases of congenital neurologic disability, including...

ORIGINAL ARTICLE: Rate of Pregnancy-Related Relapse in Multiple Sclerosis

Thu, 30Â JulÂ 1998 00:00:00 -05:00

Background: and Methods: Multiple sclerosis often occurs in young women, and the effect of pregnancy on the disease is poorly understood. We studied 254 women with multiple sclerosis during 269...

ORIGINAL ARTICLE: Lack of Effect of Walking on Labor and Delivery

Thu, 09Â JulÂ 1998 00:00:00 -05:00

Background: and Methods: Walking during labor may reduce patients' discomfort and improve outcomes. We conducted a randomized trial of walking during active labor to determine whether it altered the duration...

EDITORIAL: Managing Labor â Never Walk Alone

Thu, 09Â JulÂ 1998 00:00:00 -05:00

In 1833, William P. DeWees wrote that during labor âthe patient should be directed to keep as quiet as possible and that the preposterous custom of obliging her to walk...

EDITORIAL: Self-Administered Emergency Contraception â A Second Chance

Thu, 02Â JulÂ 1998 00:00:00 -05:00

To be effective, postcoital contraception must be available 24 hours a day, seven days a week. In this issue of the Journal, Glasier and Baird present the results of a...

ORIGINAL ARTICLE: The Effects of Self-Administering Emergency Contraception

Anna Glasier, M.D., and David Baird, D.Sc. — Thu, 02Â JulÂ 1998 00:00:00 -05:00

Background: Emergency postcoital contraception prevents pregnancy, but it must be prescribed by a doctor and taken within 72 hours of intercourse. It has been proposed that emergency contraception be made...

ORIGINAL ARTICLE: Use of Misoprostol during Pregnancy and MÃ¶bius' Syndrome in Infants

Thu, 25Â JunÂ 1998 00:00:00 -05:00

Background: Patients with upper gastrointestinal ulceration may be treated with misoprostol, but it is not recommended for pregnant women because it may stimulate uterine contractions and cause vaginal bleeding and...

ORIGINAL ARTICLE: Early Pregnancy Termination with Mifepristone and Misoprostol in the United States

Thu, 30Â AprÂ 1998 00:00:00 -05:00

Background: Mifepristone and a prostaglandin have been used successfully to terminate pregnancy in Europe and China. We report the results of a large U.S. study of mifepristone and misoprostol in...

ORIGINAL ARTICLE: Identification of Fetal DNA and Cells in Skin Lesions from Women with Systemic Sclerosis

Carol M. Artlett, Ph.D., J. Bruce Smith, M.D., and Sergio A. Jimenez, M.D. — Thu, 23Â AprÂ 1998 00:00:00 -05:00

Background: Systemic sclerosis is a disease of unknown origin which often occurs in women after their childbearing years. It has many clinical and histopathological similarities to chronic graft-versus-host disease. Recent...

REVIEW ARTICLE: Drugs in Pregnancy

Gideon Koren, M.D., Anne Pastuszak, M.Sc., and Shinya Ito, M.D. — Thu, 16Â AprÂ 1998 00:00:00 -05:00

Before marketing a new drug, the manufacturer almost never tests the product in pregnant women to determine its effects on the fetus. Consequently, most drugs are not labeled for use...

ORIGINAL ARTICLE: Screening of Maternal Serum for Fetal Down's Syndrome in the First Trimester

Thu, 02Â AprÂ 1998 00:00:00 -05:00

Background: Screening of maternal serum to identify fetuses with Down's syndrome is now routinely offered during the second trimester of pregnancy. Prenatal screening by means of serum assays or ultrasonographic...

EDITORIAL: Hemolytic Disease of the Newborn: Progenitor Cells and Late Effects

Thu, 19Â MarÂ 1998 00:00:00 -05:00

The history of hemolytic disease of the newborn dates to the 1600s, when a French midwife described the birth of twins, one of whom had fatal hydrops fetalis and the...

EDITORIAL: Low-Dose Aspirin for Preeclampsia â The Unresolved Question

Thu, 12Â MarÂ 1998 00:00:00 -05:00

Preeclampsia, defined as hypertension and proteinuria or nondependent edema after 20 weeks' gestation, is a common complication of pregnancy. Endothelial-cell dysfunction with vasospasm, pathologic coagulation, and hypersensitivity to pressor substances...

ORIGINAL ARTICLE: Low-Dose Aspirin to Prevent Preeclampsia in Women at High Risk

Thu, 12Â MarÂ 1998 00:00:00 -05:00

Background: Whether low-dose aspirin prevents preeclampsia is unclear. It is not recommended as prophylaxis in women at low risk for preeclampsia but may reduce the incidence of the disease in...

REVIEW ARTICLE: Premature Rupture of the Fetal Membranes

Samuel Parry, M.D., and Jerome F. Strauss III, M.D., Ph.D. — Thu, 05Â MarÂ 1998 00:00:00 -05:00

The membranes surrounding the amniotic cavity are composed of the amnion and the chorion, which are closely adherent layers consisting of several cell types, including epithelial cells, mesenchymal cells, and...

ORIGINAL ARTICLE: Births after Intracytoplasmic Injection of Sperm Obtained by Testicular Extraction from Men with Nonmosaic Klinefelter's Syndrome

Thu, 26Â FebÂ 1998 00:00:00 -05:00

Klinefelter's syndrome is a form of hypergonadotropic hypogonadism and infertility resulting from a supernumerary X chromosome (47,XXY), with an incidence of approximately 1 case in 500 phenotypic males.12 Some men...

ORIGINAL ARTICLE: Antenatal Thyrotropin-Releasing Hormone to Prevent Lung Disease in Preterm Infants

Thu, 19Â FebÂ 1998 00:00:00 -05:00

Background: Pulmonary disease is common in preterm infants, despite antenatal glucocorticoid therapy. The addition of antenatal thyrotropin-releasing hormone therapy has been reported to decrease pulmonary morbidity in these infants.

Methods: We...

EDITORIAL: Outcome of Assisted Reproductive Technology

Thu, 15Â JanÂ 1998 00:00:00 -05:00

The birth in 1978 of Louise Brown, the first child conceived by in vitro fertilization, may be considered a milestone in the alleviation of long-standing infertility for many couples, especially...

EDITORIAL: High Prepregnancy Body-Mass Index â A MaternalâFetal Risk Factor

Thu, 15Â JanÂ 1998 00:00:00 -05:00

Obesity is one of the most common nutritional problems complicating pregnancy in developed countries. Maternal obesity has been defined in various ways, including a body weight above 80 to 114...

IMAGES IN CLINICAL MEDICINE: Fetal Micturition

Roque Devesa, M.D., Ph.D. and Margarita Torrents, M.D. — Thu, 15Â JanÂ 1998 00:00:00 -05:00

Figure 1. A 29-year-old woman (gravida 1, para 0) underwent a routine ultrasound examination at 32 weeks of gestation. Her pregnancy had been uneventful. Ultrasonography revealed a male fetus. The...

ORIGINAL ARTICLE: A True Hermaphrodite Chimera Resulting from Embryo Amalgamation after in Vitro Fertilization

Thu, 15Â JanÂ 1998 00:00:00 -05:00

High rates of successful pregnancy after in vitro fertilization depend on placing more than one embryo into the mother, a practice resulting in a 30-to-35-fold increase in dizygotic-twin deliveries.1 Increased...

ORIGINAL ARTICLE: Prepregnancy Weight and the Risk of Adverse Pregnancy Outcomes

Thu, 15Â JanÂ 1998 00:00:00 -05:00

Background: Obesity before pregnancy is associated with an increased risk of several adverse outcomes of pregnancy. The risk profiles among lean, normal, or mildly overweight women are not, however, well...

EDITORIAL: Prevention of Preterm Birth

Thu, 01Â JanÂ 1998 00:00:00 -05:00

Advances in the care of preterm infants have blunted what otherwise should have been a constant public outcry about the static rate of preterm birth, the leading cause of perinatal...

ORIGINAL ARTICLE: Monitoring Women at Risk for Preterm Labor

Thu, 01Â JanÂ 1998 00:00:00 -05:00

Background: Preterm birth is a major cause of perinatal morbidity and mortality. Whether the rate of preterm birth can be reduced by frequent contact between nurses and pregnant women or...

EDITORIAL: Analgesia for Labor

Thu, 11Â DecÂ 1997 00:00:00 -05:00

In 1992, the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists issued a joint statement on pain during labor that included the following: âLabor results in...

ORIGINAL ARTICLE: Epidural Analgesia Compared with Combined SpinalâEpidural Analgesia during Labor in Nulliparous Women

Thu, 11Â DecÂ 1997 00:00:00 -05:00

Background: Among nulliparous women, there appears to be an association between the use of epidural analgesia during labor and an increased risk of dystocia. We tested the hypothesis that combined...

EDITORIAL: Ultrasonographic Screening for Fetal Aneuploidy

Thu, 04Â DecÂ 1997 00:00:00 -05:00

For decades, a maternal age of more than 35 years on the expected date of delivery has been an accepted indication for amniocentesis for fetal karyotyping, given the moderate increase...

EDITORIAL: Screening for Gestational Diabetes Mellitus

Thu, 27Â NovÂ 1997 00:00:00 -05:00

Gestational diabetes mellitus was originally defined by O'Sullivan and Mahan1 in a group of 752 unselected pregnant women in Boston as indicated by two or more blood glucose concentrations that...

ORIGINAL ARTICLE: Selective Screening for Gestational Diabetes Mellitus

Thu, 27Â NovÂ 1997 00:00:00 -05:00

Background: The usual approach to detecting gestational diabetes mellitus is to screen all pregnant women by measuring their plasma glucose after a 50-g oral glucose load at 24 to 28...

EDITORIAL: Emergency Contraception â Expanding Opportunities for Primary Prevention

Thu, 09Â OctÂ 1997 00:00:00 -05:00

Unintended pregnancies are endemic in the United States, and the costs are huge.1 The traditional approach to this problem has been primary prevention (contraception), backed up by secondary prevention (induced...

REVIEW ARTICLE: Emergency Postcoital Contraception

Anna Glasier, M.D. — Thu, 09Â OctÂ 1997 00:00:00 -05:00

Emergency postcoital contraception may be defined as the use of a drug or device to prevent pregnancy after intercourse. Unwanted pregnancy is common; worldwide, about 50 million pregnancies are terminated...

SOUNDING BOARD: Welfare Reform and the Obstetrical Care of Immigrants and Their Newborns

Thu, 04Â SepÂ 1997 00:00:00 -05:00

On August 22, 1996, President Bill Clinton signed the Personal Responsibility and Work Opportunity Reconciliation Act. Although it does not affect the ability of low-income citizens to obtain Medicaid health...

ORIGINAL ARTICLE: The Acquisition of Herpes Simplex Virus during Pregnancy

Thu, 21Â AugÂ 1997 00:00:00 -05:00

Background: The acquisition of genital herpes during pregnancy has been associated with spontaneous abortion, prematurity, and congenital and neonatal herpes. The frequency of seroconversion, maternal symptoms of the disease, and...

ORIGINAL ARTICLE: Laparoscopic Surgery in Infertile Women with Minimal or Mild Endometriosis

Thu, 24Â JulÂ 1997 00:00:00 -05:00

Background: Minimal or mild endometriosis is frequently diagnosed in infertile women. It is often treated by resection or ablation of the lesions, but whether this improves fertility has not been...

EDITORIAL: Autoantibodies and Pregnancy Loss

Thu, 17Â JulÂ 1997 00:00:00 -05:00

Two articles in this issue of the Journal12 focus on autoantibodies as a cause of pregnancy loss. Rand and coworkers describe a mechanism by which antiphospholipid antibodies could cause placental...

ORIGINAL ARTICLE: Pregnancy Loss in the Antiphospholipid-Antibody Syndrome â A Possible Thrombogenic Mechanism

Thu, 17Â JulÂ 1997 00:00:00 -05:00

Background: The mechanisms of vascular thrombosis and pregnancy loss in the antiphospholipid-antibody syndrome are unknown. Levels of annexin V, a phospholipid-binding protein with potent anticoagulant activity, are markedly reduced on...

ORIGINAL ARTICLE: Prednisone and Aspirin in Women with Autoantibodies and Unexplained Recurrent Fetal Loss

Thu, 17Â JulÂ 1997 00:00:00 -05:00

Background: Recurrent fetal loss has been well described in women with antiphospholipid antibodies. Such women also often have other autoantibodies commonly found in patients with systemic lupus erythematosus. Treating them...

ORIGINAL ARTICLE: Trial of Calcium to Prevent Preeclampsia

Thu, 10Â JulÂ 1997 00:00:00 -05:00

Background: Previous trials have suggested that calcium supplementation during pregnancy may reduce the risk of preeclampsia. However, differences in study design and a low dietary calcium intake in the populations...

EDITORIAL: Prevention or Early Treatment of Preeclampsia

Thu, 10Â JulÂ 1997 00:00:00 -05:00

Preeclampsia continues to be a major health problem. It is a leading cause of maternal mortality in developed countries and is associated with a fivefold increase in perinatal mortality. It...

ORIGINAL ARTICLE: Paternity by Intrauterine Insemination with Sperm from a Man with 5Î±-Reductase-2 Deficiency

Thu, 03Â AprÂ 1997 00:00:00 -05:00

Male pseudohermaphroditism results from the abnormal differentiation of male external genitalia in a genotypic male. One cause of male pseudohermaphroditism is a deficiency of 5Î±-reductase-2, the enzyme that converts testosterone...

ORIGINAL ARTICLE: The Risk of Ectopic Pregnancy after Tubal Sterilization

Thu, 13Â MarÂ 1997 00:00:00 -05:00

Background: Tubal sterilization is an increasingly common method of contraception in the United States. Although pregnancy after sterilization is uncommon, it can occur and may be ectopic. We used data...

ORIGINAL ARTICLE: Neurodevelopment of Children Exposed in Utero to Antidepressant Drugs

Thu, 23Â JanÂ 1997 00:00:00 -05:00

Background: Many women of reproductive age have depression, necessitating therapy with either a tricyclic antidepressant drug or a drug, such as fluoxetine, that inhibits the reuptake of serotonin. Whether these...

ORIGINAL ARTICLE: Treatment of X-Linked Severe Combined Immunodeficiency by in Utero Transplantation of Paternal Bone Marrow

Thu, 12Â DecÂ 1996 00:00:00 -05:00

Severe combined immunodeficiency is a congenital syndrome due to various genetic abnormalities that cause susceptibility to infection, failure to thrive, lymphoid hypoplasia, very low levels of T lymphocytes, and hypogammaglobulinemia.12...

REVIEW ARTICLE: Chorionic Tumors

Ross S. Berkowitz, M.D., and Donald P. Goldstein, M.D. — Thu, 05Â DecÂ 1996 00:00:00 -05:00

Chorionic tumors, or gestational trophoblastic diseases, originate from placental tissues and are among the rare human tumors that can be cured even in the presence of widespread metastasis.1234 Gestational trophoblastic...

EDITORIAL: Beginning to Make Progress against HIV

Thu, 28Â NovÂ 1996 00:00:00 -05:00

For nearly three years we have known that zidovudine is efficacious in preventing transmission of the human immunodeficiency virus (HIV) from mother to infant.1 A randomized, placebo-controlled trial, AIDS Clinical...

ORIGINAL ARTICLE: Maternal Viral Load, Zidovudine Treatment, and the Risk of Transmission of Human Immunodeficiency Virus Type 1 from Mother to Infant

Thu, 28Â NovÂ 1996 00:00:00 -05:00

Background: and Methods: A placebo-controlled trial has shown that treatment with zidovudine reduces the rate at which human immunodeficiency virus type 1 (HIV-1) is transmitted from mother to infant. We...

ORIGINAL ARTICLE: Preeclampsia â A State of Sympathetic Overactivity

Thu, 14Â NovÂ 1996 00:00:00 -05:00

Background: Preeclampsia is characterized by a marked increase in peripheral vascular resistance leading to an increase in blood pressure, but the triggering mechanisms are unclear.

Methods: To determine whether augmented sympathetic...

EDITORIAL: Insulin-Like Growth Factor I â An Important Intrauterine Growth Factor

Thu, 31Â OctÂ 1996 00:00:00 -05:00

The importance of insulin-like growth factor I (IGF-I) in regulating the effects of growth hormone on postnatal growth and development is well established, but its role during the prenatal period...

EDITORIAL: Insulin-Like Growth Factor I â An Important Intrauterine Growth Factor

Thu, 31Â OctÂ 1996 00:00:00 -05:00

The importance of insulin-like growth factor I (IGF-I) in regulating the effects of growth hormone on postnatal growth and development is well established, but its role during the prenatal period...

ORIGINAL ARTICLE: Intrauterine Growth Retardation and Postnatal Growth Failure Associated with Deletion of the Insulin-Like Growth Factor I Gene

Thu, 31Â OctÂ 1996 00:00:00 -05:00

Insulin-like growth factor I (IGF-I) mediates the majority of the growth-promoting effects of growth hormone (GH) after birth.1 In the prenatal period, GH does not appear to have a major...

ORIGINAL ARTICLE: Intrauterine Growth Retardation and Postnatal Growth Failure Associated with Deletion of the Insulin-Like Growth Factor I Gene

Thu, 31Â OctÂ 1996 00:00:00 -05:00

Insulin-like growth factor I (IGF-I) mediates the majority of the growth-promoting effects of growth hormone (GH) after birth.1 In the prenatal period, GH does not appear to have a major...

EDITORIAL: Treating Depression in Pregnancy

Thu, 03Â OctÂ 1996 00:00:00 -05:00

Pregnancy is frequently thought of as a time of emotional well-being for women, but it does not protect them from mood instability. In fact, it is a risk factor for...

ORIGINAL ARTICLE: Birth Outcomes in Pregnant Women Taking Fluoxetine

Thu, 03Â OctÂ 1996 00:00:00 -05:00

Background: Although fluoxetine is the most frequently prescribed antidepressant drug in the United States, its safety in pregnant women has not been established.

Methods: From 1989 through 1995, we prospectively identified...

ORIGINAL ARTICLE: Intellectual Impairment in Children Exposed to Polychlorinated Biphenyls in Utero

Joseph L. Jacobson, Ph.D., and Sandra W. Jacobson, Ph.D. — Thu, 12Â SepÂ 1996 00:00:00 -05:00

Background: In utero exposure to polychlorinated biphenyls, a ubiquitous environmental contaminant, has been linked to adverse effects on neurologic and intellectual function in infants and young children. We assessed whether...

ORIGINAL ARTICLE: Pregnancy and the Risk of Stroke

Thu, 12Â SepÂ 1996 00:00:00 -05:00

Background: It is widely believed that pregnancy increases the risk of stroke, but there are few data available to quantify that risk.

Methods: We identified all female patients 15 through 44...

EDITORIAL: Toward Fewer Cesarean Sections â The Role of a Trial of Labor

Thu, 05Â SepÂ 1996 00:00:00 -05:00

The delivery of one of every four infants by cesarean section in the United States during the late 1980s and early 1990s aroused concern that many of these operations were...

ORIGINAL ARTICLE: Comparison of a Trial of Labor with an Elective Second Cesarean Section

Thu, 05Â SepÂ 1996 00:00:00 -05:00

Background: In an attempt to reduce the rate of cesarean section, obstetricians now offer a trial of labor to pregnant women who have had a previous cesarean section. Although a...

REVIEW ARTICLE: Liver Disease in Pregnancy

Tamsin A. Knox, M.D., M.P.H., and Lori B. Olans, M.D., M.P.H. — Thu, 22Â AugÂ 1996 00:00:00 -05:00

Liver disease is a rare complication of pregnancy, but when it occurs it may do so in a dramatic and tragic fashion for both mother and infant. Diseases such as...

EDITORIAL: Pregnancy and Renal Disease

Thu, 25Â JulÂ 1996 00:00:00 -05:00

Of all the medical disorders that add risk to pregnancy, renal disease has long ranked among those most feared by physicians. Not only are the renal and vascular manifestations of...

REVIEW ARTICLE: Treatment of Hypertension in Pregnant Women

Baha M. Sibai, M.D. — Thu, 25Â JulÂ 1996 00:00:00 -05:00

Hypertensive disorders are the most common medical complications of pregnancy and are an important cause of maternal and perinatal morbidity and mortality worldwide.1 During normal pregnancy, systolic pressure changes little;...

ORIGINAL ARTICLE: Outcome of Pregnancy in Women with Moderate or Severe Renal Insufficiency

David C. Jones, M.D., and John P. Hayslett, M.D. — Thu, 25Â JulÂ 1996 00:00:00 -05:00

Background: Pregnant women with mild preexisting renal disease have relatively few complications of pregnancy, but the risks of maternal and obstetrical complications in women with moderate or severe renal insufficiency...

REVIEW ARTICLE: Venous Thromboembolism during Pregnancy

Marc R. Toglia, M.D., and John G. Weg, M.D. — Thu, 11Â JulÂ 1996 00:00:00 -05:00

Venous thromboembolism is an uncommon but leading cause of illness and death during pregnancy and the puerperium.12 It has been reported to occur in 1 in 1000 to 1 in...

EDITORIAL: Reducing Mother-to-Infant Transmission of HIV â The Door Remains Open

Thu, 20Â JunÂ 1996 00:00:00 -05:00

As of the end of 1995, over 90 percent of the reported cases of AIDS in children were acquired through mother-to-infant transmission of the human immunodeficiency virus (HIV).1 Nearly all...

ORIGINAL ARTICLE: Obstetrical Factors and the Transmission of Human Immunodeficiency Virus Type 1 from Mother to Child

Thu, 20Â JunÂ 1996 00:00:00 -05:00

Background: A substantial proportion of perinatally acquired infections with the human immunodeficiency virus type 1 (HIV-1) occur at or near delivery, which suggests that obstetrical factors may have an important...

ORIGINAL ARTICLE: Dimeric Inhibin A as a Marker for Down's Syndrome in Early Pregnancy

Thu, 09Â MayÂ 1996 00:00:00 -05:00

Background: In screening for Down's syndrome in the second trimester of pregnancy, the concentrations of alpha-fetoprotein, the Î² subunit of human chorionic gonadotropin, and intact human chorionic gonadotropin in maternal...

EDITORIAL: Premature Rupture of the Membranes at Term

Thu, 18Â AprÂ 1996 00:00:00 -05:00

Premature rupture of the membranes, which is defined as rupture before the onset of labor, complicates 5 to 10 percent of all pregnancies. Preterm rupture of the membranes has received...

ORIGINAL ARTICLE: Induction of Labor Compared with Expectant Management for Prelabor Rupture of the Membranes at Term

Thu, 18Â AprÂ 1996 00:00:00 -05:00

Background: As the interval between rupture of the fetal membranes at term and delivery increases, so may the risk of fetal and maternal infection. It is not known whether inducing...

EDITORIAL: Cerebral Palsy and Intrapartum Fetal Monitoring

Thu, 07Â MarÂ 1996 00:00:00 -05:00

LaÃ«nnec's invention of the stethoscope in 1806 was soon followed by auscultation of the fetal heart, which was pioneered by Kergaradec. Hoping to hear the fetus crying and splashing about...

ORIGINAL ARTICLE: Uncertain Value of Electronic Fetal Monitoring in Predicting Cerebral Palsy

Thu, 07Â MarÂ 1996 00:00:00 -05:00

Background: Electronic monitoring of the fetal heart rate is commonly performed, in part to detect hypoxia during delivery that may result in brain injury. It is not known whether specific...

EDITORIAL: Cervical Incompetence and Preterm Delivery

Thu, 29Â FebÂ 1996 00:00:00 -05:00

Premature delivery is one of the most troublesome problems in obstetrics. Occurring in 10 percent of all pregnancies, premature delivery is the second most important contributor to perinatal mortality, after...

ORIGINAL ARTICLE: The Length of the Cervix and the Risk of Spontaneous Premature Delivery

Thu, 29Â FebÂ 1996 00:00:00 -05:00

Background: The role of the cervix in the pathogenesis of premature delivery is controversial. In a prospective, multicenter study of pregnant women, we used vaginal ultrasonography to measure the length...

NEJM â Collection Updates for Pregnancy

ORIGINAL ARTICLE: Outcomes after Internal versus External Tocodynamometry for Monitoring Labor

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2009 â A 28-Year-Old Pregnant Woman with Acute Cardiac Failure

CLINICAL PROBLEM-SOLVING: A Crisis in Late Pregnancy

INTERACTIVE MEDICAL CASE: A Crisis in Late Pregnancy

IMAGES IN CLINICAL MEDICINE: Peripartum Diastasis of the Symphysis Pubis

CORRESPONDENCE: Cumulative Live-Birth Rates in a Trial of Single-Embryo or Double-Embryo Transfer

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2009 â A 35-Year-Old Woman with Fever, Abdominal Pain, and Hypotension after Cesarean Section

EDITORIAL: Gestational Diabetes â Whom Do We Treat?

REVIEW ARTICLE: Maternal and Neonatal Herpes Simplex Virus Infections

ORIGINAL ARTICLE: A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes

BOOK REVIEW:

BOOK REVIEW:

BOOK REVIEW:

CLINICAL PRACTICE: Ectopic Pregnancy

ORIGINAL ARTICLE: Lack of Association between Folate-Receptor Autoantibodies and Neural-Tube Defects

ORIGINAL ARTICLE: Rates of Serious Infection after Changes in Regimens for Medical Abortion

BOOK REVIEW:

ORIGINAL ARTICLE: Evaluation of Universal Antenatal Screening for Group B Streptococcus

CLINICAL PRACTICE: Prenatal Screening for Aneuploidy

ORIGINAL ARTICLE: The Safety of Metoclopramide Use in the First Trimester of Pregnancy

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 16-2009 â A 32-Year-Old Pregnant Woman with an Abnormal Fetal Ultrasound Study

CLINICAL PRACTICE: Asthma in Pregnancy

EDITORIAL: Which Drug for the Pregnant Woman with Epilepsy?

CLINICAL PRACTICE: Molar Pregnancy

ORIGINAL ARTICLE: Cognitive Function at 3 Years of Age after Fetal Exposure to Antiepileptic Drugs

CLINICAL IMPLICATIONS OF BASIC RESEARCH: A Lesson in Tolerance â Maternal Instruction to Fetal Cells

EDITORIAL: One Step Closer to a CMV Vaccine

ORIGINAL ARTICLE: Vaccine Prevention of Maternal Cytomegalovirus Infection

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2009 â A 36-Year-Old Woman with Headache, Hypertension, and Seizure 2 Weeks Post Partum

CORRESPONDENCE: Iodine Content of Prenatal Multivitamins in the United States

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2009 â A Pregnant Woman with a Large Mass in the Fetal Oral Cavity

BOOK REVIEW:

CLINICAL PRACTICE: Primary Ovarian Insufficiency

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2009 â A 39-Year-Old Pregnant Woman with Fever after a Trip to Africa

ORIGINAL ARTICLE: Cumulative Live-Birth Rates after In Vitro Fertilization

EDITORIAL: Making Small Risks Even Smaller

IMAGES IN CLINICAL MEDICINE: Diagnosis of Uterine Rupture on CT

ORIGINAL ARTICLE: Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes

IMAGES IN CLINICAL MEDICINE: Postpartum Venous Thromboembolism

CORRESPONDENCE: Successful Pregnancy after Microsurgical Transplantation of an Intact Ovary

REVIEW ARTICLE: Venous Thromboembolic Disease and Pregnancy

ORIGINAL ARTICLE: Effectiveness of Maternal Influenza Immunization in Mothers and Infants

EDITORIAL: Antenatal Magnesium Sulfate for Neuroprotection before Preterm Birth?

ORIGINAL ARTICLE: A Randomized, Controlled Trial of Magnesium Sulfate for the Prevention of Cerebral Palsy

EDITORIAL: Preeclampsia â A Glimpse into the Future?

ORIGINAL ARTICLE: Preeclampsia and the Risk of End-Stage Renal Disease

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2008 â A 35-Year-Old Woman with Postpartum Confusion, Agitation, and Delusions

ORIGINAL ARTICLE: Long-Term Medical and Social Consequences of Preterm Birth

EDITORIAL: Breast-Feeding, Antiretroviral Prophylaxis, and HIV

ORIGINAL ARTICLE: Extended Antiretroviral Prophylaxis to Reduce Breast-Milk HIV-1 Transmission

REVIEW ARTICLE: Effect of In Utero and Early-Life Conditions on Adult Health and Disease

EDITORIAL: Gestational Diabetes â Setting Limits, Exploring Treatments

ORIGINAL ARTICLE: Metformin versus Insulin for the Treatment of Gestational Diabetes

ORIGINAL ARTICLE: Hyperglycemia and Adverse Pregnancy Outcomes

SPECIAL ARTICLE: A Behavioral Intervention to Improve Obstetrical Care

ORIGINAL ARTICLE: Association between Obesity during Pregnancy and Increased Use of Health Care

ORIGINAL ARTICLE: Cervical Length at Mid-Pregnancy and the Risk of Primary Cesarean Delivery

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2008 â A 33-Year-Old Pregnant Woman with Swelling of the Left Breast and Shortness of Breath

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2008 â A 38-Year-Old Woman with Postpartum Visual Loss, Shortness of Breath, and Renal Failure

EDITORIAL: Prenatal Corticosteroids â Early Gain, Long-Term Questions

ORIGINAL ARTICLE: Long-Term Outcomes after Repeat Doses of Antenatal Corticosteroids

ORIGINAL ARTICLE: Outcomes at 2 Years of Age after Repeat Doses of Antenatal Corticosteroids

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2007 â A 30-Year-Old Pregnant Woman with Intrauterine Fetal Death

ORIGINAL ARTICLE: Medical Abortion and the Risk of Subsequent Adverse Pregnancy Outcomes

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2007 â A 20-Year-Old Pregnant Woman with Altered Mental Status

EDITORIAL: Progesterone and Preterm Labor â Still No Definite Answers

CLINICAL PROBLEM-SOLVING: A Growing Problem â A 36-year-old pregnant woman at 21 weeks of gestation presented with a 4-week history of a dry, nonproductive cough

REVIEW ARTICLE: Prevention of Preterm Delivery

ORIGINAL ARTICLE: Progesterone and the Risk of Preterm Birth among Women with a Short Cervix

ORIGINAL ARTICLE: A Trial of 17 Alpha-Hydroxyprogesterone Caproate to Prevent Prematurity in Twins

SPECIAL ARTICLE: Trends in the Use of Intracytoplasmic Sperm Injection in the United States

ORIGINAL ARTICLE: Reduction in Neural-Tube Defects after Folic Acid Fortification in Canada

ORIGINAL ARTICLE: In Vitro Fertilization with Preimplantation Genetic Screening

EDITORIAL: Preimplantation Genetic Screening in Older Mothers

EDITORIAL: Teratogenicity of SSRIs â Serious Concern or Much Ado about Little?

ORIGINAL ARTICLE: Use of Selective Serotonin-Reuptake Inhibitors in Pregnancy and the Risk of Birth Defects

ORIGINAL ARTICLE: First-Trimester Use of Selective Serotonin-Reuptake Inhibitors and the Risk of Birth Defects

IMAGES IN CLINICAL MEDICINE: Gravid Uterus in an Incisional Hernia

ORIGINAL ARTICLE: Vitamins and Perinatal Outcomes among HIV-Negative Women in Tanzania

NEJM â Collection Updates for Pregnancy

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2009 â A 28-Year-Old Pregnant Woman with Acute Cardiac Failure

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2009 â A 35-Year-Old Woman with Fever, Abdominal Pain, and Hypotension after Cesarean Section

EDITORIAL: Gestational Diabetes â Whom Do We Treat?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 16-2009 â A 32-Year-Old Pregnant Woman with an Abnormal Fetal Ultrasound Study

CLINICAL IMPLICATIONS OF BASIC RESEARCH: A Lesson in Tolerance â Maternal Instruction to Fetal Cells

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2009 â A 36-Year-Old Woman with Headache, Hypertension, and Seizure 2 Weeks Post Partum

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2009 â A Pregnant Woman with a Large Mass in the Fetal Oral Cavity

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2009 â A 39-Year-Old Pregnant Woman with Fever after a Trip to Africa

EDITORIAL: Preeclampsia â A Glimpse into the Future?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2008 â A 35-Year-Old Woman with Postpartum Confusion, Agitation, and Delusions

EDITORIAL: Gestational Diabetes â Setting Limits, Exploring Treatments

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2008 â A 33-Year-Old Pregnant Woman with Swelling of the Left Breast and Shortness of Breath

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2008 â A 38-Year-Old Woman with Postpartum Visual Loss, Shortness of Breath, and Renal Failure

EDITORIAL: Prenatal Corticosteroids â Early Gain, Long-Term Questions

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2007 â A 30-Year-Old Pregnant Woman with Intrauterine Fetal Death

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 24-2007 â A 20-Year-Old Pregnant Woman with Altered Mental Status

EDITORIAL: Progesterone and Preterm Labor â Still No Definite Answers

CLINICAL PROBLEM-SOLVING: A Growing Problem â A 36-year-old pregnant woman at 21 weeks of gestation presented with a 4-week history of a dry, nonproductive cough

EDITORIAL: Teratogenicity of SSRIs â Serious Concern or Much Ado about Little?

PERSPECTIVE: Cesarean Delivery and the RiskâBenefit Calculus

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2006 â A 35-Year-Old Pregnant Woman with New Hypertension

EDITORIAL: Diagnosing Hemolytic Disease of the Fetus â Time to Put the Needles Away?

EDITORIAL: Antioxidants and the Prevention of Preeclampsia â Unresolved Issues

REVIEW ARTICLE: Pregnancy in Recipients of Solid Organs â Effects on Mother and Child

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2005 â A 29-Year-Old Pregnant Woman with the Nephrotic Syndrome and Hypertension

EDITORIAL: Meconium Aspiration Syndrome â More Than Intrapartum Meconium

EDITORIAL: Pregnancy Failure and Misoprostol â Time for a Change

EDITORIAL: Gestational Diabetes Mellitus â Time to Treat

PERSPECTIVE: Autoimmune Folate Deficiency and the Rise and Fall of âHorror Autotoxicusâ

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2005 â A 32-Year-Old Pregnant Woman with an Abnormal Fetal Karyotype

PERSPECTIVE: Population and Development â Shifting Paradigms, Setting Goals

EDITORIAL: Elective Single-Embryo Transfer â Has Its Time Arrived?

PERSPECTIVE: Nondisjunction â A View from Ringside

PERSPECTIVE: Minimal Intervention â Nurse-Midwives in the United States

PERSPECTIVE: Advanced Maternal Age â How Old Is Too Old?

PERSPECTIVE: SIDS â A Syndrome in Search of a Cause

EDITORIAL: Increased Levothyroxine Requirements in Pregnancy â Why, When, and How Much?

EDITORIAL: Antiretroviral Agents â How Best to Protect Infants from HIV and Save Their Mothers from AIDS