Biomedical subjects
Publications and source records attributed to J T Repke.
A 37-year-old woman with a history consistent with polycystic ovarian disease became pregnant and developed exceedingly high levels of serum testosterone. The female fetus showed no evidence of virilization. A clinical diagnosis of bilateral theca lutein cysts was made. Modes of fetal protection from maternal androgenemia as well as suggestions for future investigations are discussed.
Cardiac arrhythmias are not uncommon during pregnancy. The supraventricular tachyarrhythmias have been treated successfully with digoxin, propranolol, overdrive atrial pacing, electrocardioversion, and most recently with verapamil. Verapamil is the prototype calcium channel blockers. Its use in pregnancy has been limited though the experimental effects of verapamil on fetal heart activity and uterine contractility have been studied. Reported is a case of a digitalized hyperthyroid pregnant patient successfully treated with verapamil for supraventricular tachycardia. Continuous electronic fetal monitoring was used during the period of cardioversion. The excellent response to verapamil with its apparent absence of adverse maternal or fetal side effects would suggest that the use of verapamil in the treatment of supraventricular arrhythmias in pregnancy is safe and effective.
The optimal treatment for depressive disorders in pregnancy remains controversial. Clinicians are often hesitant to prescribe pharmacologic agents during pregnancy, especially in the first trimester, and the effects of electroconvulsive therapy in pregnancy have not been prospectively evaluated. The present case reports on the apparent safety and efficacy of electroconvulsive therapy for the treatment of depression in pregnancy when used in carefully selected and carefully monitored patients. Fetal heart rate monitoring and real-time ultrasonography were performed, and the results suggest that maternal electroconvulsive therapy has little effect on fetal status.
Women attending an inner-city prenatal clinic between February, 1987 and August, 1988 completed a questionnaire to assess risk factors for human immunodeficiency virus (HIV) infection. Women with risk factors were offered HIV testing. Testing was available to women without risk factors upon their request. Stored sera were obtained for anonymous HIV testing on patients not consenting for testing. Overall, 30 of 622 women (5%) tested HIV positive. Ten per cent of women acknowledging risk factors were seropositive vs 3% denying risk factors (P less than .001). Intravenous (IV) drug use was reported in 40% of seropositive women. However, 47% (14/30) of HIV seropositive women denied risk factors for infection. Limiting prenatal HIV screening to women acknowledging risk factors may fail to identify a substantial number of infected women. Screening for HIV infection, counseling, and education on risk reduction should be offered to all pregnant women.
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