Biomedical subjects

Manju Monga

Publications and source records attributed to Manju Monga.

At least 19 recordsLinked to original sources

PubMed2006

Spontaneous version following preterm premature rupture of membranes.

Our objective was to determine the rate of spontaneous version following preterm premature rupture of membranes (PPROM). Medical charts over a 4-year period were reviewed. All women with PPROM and singleton gestation between 24 and 34 weeks gestation were included; 65 patients met the inclusion criteria. By ultrasound on admission, 48 were cephalic 16 were breech, and one was transverse lie. Mean amniotic fluid index on admission was 5.1 +/- 4.8 cm (standard deviation) and was not associated with fetal presentation at delivery. Spontaneous version from cephalic presentation at admission to noncephalic presentation at delivery occurred in one pregnancy (2.2%). Spontaneous version from noncephalic presentation at admission to cephalic presentation at delivery occurred in three pregnancies (17.6%; p = 0.05). Among women with noncephalic presentation at delivery (n = 15), 73.3% had a cesarean, compared with 23.4% of those with cephalic presentation at delivery (p < 0.05). Spontaneous version, particularly from cephalic to noncephalic presentation, is unlikely following PPROM.

Adolescent↗

PubMed2006

Expression of transient receptor channel proteins in human fundal myometrium in pregnancy.

OBJECTIVE: Cation channels comprised of transient receptor potential (TrpC) proteins may play a role in signal-regulated calcium entry and calcium homeostasis in myometrium. The objective of this study was to determine the relative abundance of specific TrpC mRNAs expressed in human myometrium and determine if TrpC mRNA and protein concentrations differ in fundal myometrium before and after the onset of labor. METHODS: A quantitative real-time polymerase chain reaction (Q-RT-PCR) procedure was developed for determining the concentration of TrpC mRNA expression in immortalized and primary human myometrial cells and myometrial fundus tissues from patients before and after the onset of labor. The corresponding TrpC proteins were detected by Western blot analysis and immunohistochemistry. RESULTS: hTrpC1, 3, 4, 5, 6, and 7 mRNAs were expressed in two lines of immortalized human myometrial cells and in primary human myocytes. In all of these cells, hTrpC1 and hTrpC4 mRNAs were the most abundant, followed by hTrpC6. A similar distribution was observed in fundal myometrium samples from patients before and after the onset of labor. hTrpC4 mRNA was significantly lower after the onset of labor; there were no significant changes in the concentrations of other TrpC mRNAs. Immunohistochemistry identified hTrpC1, 3, 4, and 6 proteins in myometrial smooth muscle cells. Western blot analysis of myometrial membranes demonstrated no statistically significant changes in hTrpC1, 3, 4, and 6 proteins between samples collected before and after the onset of labor. CONCLUSIONS: We have demonstrated that hTrpC1 and hTrpC4 are the most abundant TrpC mRNAs in human myometrium, with TrpC6 being the next most abundant. There was no increase in TrpC mRNA or protein in fundal myometrium with the onset of labor. Nonetheless, these isoforms may play significant roles in signal regulated calcium entry in human myometrium.

Calcium↗

PubMed2006

Utility of Acute Physiology, Age, and Chronic Health Evaluation (APACHE III) score in maternal admissions to the intensive care unit.

OBJECTIVE: A mean Acute Physiology, Age, and Chronic Health Evaluation (APACHE III) score of > 50 is associated with increased intensive care unit mortality rate in nonpregnant cardiac and trauma patients. The objective was to determine the usefulness of the APACHE III score in maternal admissions to an intensive care unit in a tertiary care center in an urban multicultural city. STUDY DESIGN: This was a retrospective review of all maternal admissions (> 20 weeks of gestation or after delivery) to an intensive care unit between January 2002 and May 2004. Demographics, obstetric and medical history, and 20 physiologic variables that comprise the APACHE III were recorded. The minimum APACHE III score (lowest risk of death) is 0; maximum is 299. The association between APACHE III score and maternal death was assessed with Mann Whitney U test. Significance was assumed at a probability value of < .05. RESULTS: Fifty-eight subjects met the study criteria. Thirty percent of these women were admitted antepartum (27 +/- 1.0 weeks of gestation); 31% of the women were admitted on the day of delivery; and 29% of the women were admitted after delivery. Mean maternal age was 27 +/- 6.7 years. Acute conditions that resulted in transfer to the intensive care unit included preeclampsia (24%), cardiorespiratory disease (21%), hemorrhage (16%), infection (12%), trauma (7%), and thromboembolism (3%). Fifty-five percent of the women had no previous underlying obstetric complications, and 98% of the women had no underlying chronic health condition. Fifty-eight percent of the women received care in a medical intensive care unit; 28% of the women received care in a surgical intensive care unit; 10% of the women received care in a cardiac intensive care unit, and 3% of the women received care in a neurologic intensive care unit. The mean intensive care unit stay was 3.7 +/- 4.6 days, and the mean hospital stay was 9.0 +/- 7 days. Three patients died; the rest of the patients went home in good condition. The median APACHE III score was 34 (range, 14-102) and was not correlated with maternal death. CONCLUSION: The APACHE III is not associated with risk of intensive care unit-related maternal death.

APACHE↗

PubMed2005

Racial-ethnic differences in genetic amniocentesis uptake.

The objective of this study was to determine the role of health beliefs in genetic amniocentesis acceptance in a diverse racial-ethnic population. Participants completed a previously-validated questionnaire consisting of three sections: (1) demographics, (2) amniocentesis knowledge, and (3) health beliefs, which assessed perceived susceptibility, seriousness of potential impact, benefits of testing, and barriers to testing. The results showed that Hispanic women were less likely to accept amniocentesis (51.5% vs. Caucasian 82.8%, African American 82.9%, Asian 82.8%). Education level was the only demographic factor higher among acceptors. Women who accepted amniocentesis had higher perceived seriousness, susceptibility, and benefits HBM scores and higher knowledge scores than women who declined. HBM scores and knowledge predicted the amniocentesis decision correctly 91.5% of the time. Individual health beliefs and knowledge play a greater role in genetic amniocentesis acceptance than do demographic factors such as race-ethnicity.

Amniocentesis↗

PubMed2005

The effect of parenthood on perceived quality of life in teens.

OBJECTIVE: To describe the perceived quality of life of teen mothers. STUDY DESIGN: The Medical Outcomes Survey-Short Form 36, version 2 is a scale that measures a subject's perception of 8 health dimensions. The Medical Outcomes Survey-Short Form 36, version 2 and a demographics survey were completed by women during obstetric or gynecologic visits to a resident continuity clinic. Mean scores were compared between women with children and those without. RESULTS: There was no significant difference between adults or teens, with or without children, in any health component scale with the exception of social functioning. When compared with the normative population age, all groups in our population scored significantly on physical functioning and role-physical subscales. In addition, teens with children scored lower on the role-emotional subscale. CONCLUSION: Perceived quality of life in teen mothers does not appear to be lower than quality of life in teens without children or adult women.

Adolescent↗

PubMed2005

Ultrasound diagnosis of coexisting molar pregnancy following referral for abnormal serum screen.

Complete hydatidiform mole and coexistent fetus is a rare occurrence. We report a case of a patient referred for abnormal serum screen and vaginal bleeding in the second trimester of pregnancy. Ultrasound revealed a cystic and solid mass along the posterior uterine wall with multiple hypoechoic (honeycomb) areas noted, consistent with molar degeneration of the placenta. Separate from this mass was a coexisting viable fetus with normal fetal anatomy and distinct anterior placenta. At delivery, a large cystic mass of placental tissue appeared to be implanted separately from a normal-appearing fetus and placenta. The mass weighed 184 g and contained multiple 1- to 1.5-cm cysts throughout. Microscopic sections revealed hydropic chorionic villi with central cistern formation and nonpolar trophoblastic hyperplasia with atypia, compatible with complete hydatidiform mole. This case illustrates that the diagnosis of coexisting molar pregnancy after referral for abnormal serum screen should be considered, especially if maternal serum beta-human chorionic gonadotropin is high and the patient has vaginal bleeding.

Adult↗

PubMed2005

Arrhythmogenic right ventricular cardiomyopathy with implantable cardioverter defibrillator placement in pregnancy.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disorder that predominantly affects the right side of the heart and causes ventricular arrhythmias. In many patients the disease is familial. ARVC may account for as many as 5% of unexpected sudden deaths. We report a case of ARVC diagnosed at 21 weeks gestation treated with an implantable cardiac defibrillator. The remainder of her pregnancy was uneventful and the patient underwent induction of labor at 39 weeks gestation with a passive second stage forceps-assisted delivery resulting in delivery of a normal infant. In the gravida with cardiac arrhythmias, defibrillator placement may offer a safe, life-preserving treatment and should be considered.

Adult↗

PubMed2005

Racial bias in patient selection of an obstetrician.

OBJECTIVE: The objective of this study was to determine racial bias in patient selection of an obstetrician. METHODS: Obstetrical patients referred for genetic counseling at a community hospital were included. Self-reported patient race/ethnicity were compared with obstetrician's race/ethnicity. RESULTS: The patient population (n = 1,519) was 27.8% white, 25% Hispanic, 22.5% black, 20.5% Asian, and 4.3% other. Physician race/ethnicity was 47.8% white, 28.8% Asian, 14.4% Hispanic, and 9% black. Patient race/ethnicity and physician race/ethnicity were correlated (contingency coefficient = 0.54, P < 0.001). White and Asian patients were more likely to select obstetricians of their own racial background (72.7% and 66.6%) than were Hispanic or black patients (36% and 24.6%, P < 0.001). Patients of all races were more likely to be under the care of a physician of their own race than of a different race. CONCLUSIONS: In an urban community with a racially diverse population, there is a strong racial bias in patient selection of an obstetrician.

Asian↗

PubMed2005

Former-resident self-assessment: a tool for residency program curriculum evaluation in obstetrics and gynecology.

OBJECTIVE: To determine recent residents' confidence in managing problems in obstetrics and gynecology. STUDY DESIGN: All former residents from 1998 to 2002 were invited to participate. They were asked to complete a 32-item survey to assess confidence in obstetric and gynecologic care using Likert-scale responses. The study was approved by the local institutional review board. The t test was used for statistical analysis; p<0.05 was considered significant. RESULTS: Twenty-eight individuals graduated from the program during the study period; 61% responded to the survey. Respondents reported the lowest confidence in the business aspects of medicine, gynecologic ultrasound, laparoscopically assisted hysterectomy, pessary placement and cancer staging. They reported the highest confidence in routine obstetrics, laparoscopic sterilization, contraception, abnormal Pap smears, abdominal surgery and diagnostic laparoscopy, along with other categories. CONCLUSION: Residents are confident about management of most problems in obstetrics and gynecology. Periodic review of graduates' perceptions of training may be useful in modifying the curriculum.

Clinical Competence↗

PubMed2004

Clinical correlates of pain with amniocentesis.

OBJECTIVE: The purpose of this study was to determine whether sensory or affective dimensions of pain with genetic amniocentesis are associated with identifiable clinical correlates. STUDY DESIGN: Women completed the short-form McGill Pain Questionnaire after second-trimester genetic amniocentesis. The effect of maternal weight, parity, previous amniocentesis, previous surgery, history of menstrual cramps, maternal anxiety, presence of fibroid tumors, and depth and location of needle insertion on pain intensity was determined. The T-test, correlation matrix, Kruskal-Wallis test, and multiple logistic regression were used for analysis; a probability value of <.05 was considered significant. RESULTS: One hundred twenty-one women were enrolled: 19.3% reported no pain, 42.9% described the pain as mild, 31.1% described the pain as discomforting, and 6.7% described the pain as distressing or horrible. Mean intensity of pain was 1.6+/-1.3 (on a scale of 0-7). Pain was most often described as sharp, cramping, fearful, and stabbing. Anxiety and pain were increased in women with an indication of abnormal serum screen as compared with women with advanced maternal age. Anxiety and a history of menstrual cramps were associated with increased affective dimensions of pain and had moderate correlation with quantified pain intensity. A history of previous amniocentesis and needle insertion in the lower one third of the uterus were associated with increased pain. Maternal weight, parity, previous surgery, fibroid tumors, and depth of needle insertion were not correlated with perceived pain. Presence or absence of an accompanying person was not associated with pain intensity. CONCLUSION: Women report mild pain or discomfort with genetic amniocentesis. Increased pain is associated with increased maternal anxiety, a history of menstrual cramps, a previous amniocentesis, and insertion of the needle in the lower uterus.

Adult↗

PubMed2004

Diagnosis of pulmonary embolism: a cost-effectiveness analysis.

OBJECTIVE: Pulmonary embolism is a major cause of maternal death. The work up for suspected pulmonary embolism is complex, with many potential diagnostic options. We performed a cost analysis to evaluate which of several diagnostic strategies was the most cost-effective with the least number of deaths from pulmonary embolism. STUDY DESIGN: We created a decision tree to evaluate the following strategies: (1) Compression ultrasonography followed by anticoagulation (if there is a positive result) or secondary tests, ventilation perfusion scans or spiral computed tomography (if there is a negative result); high probability ventilation perfusion scans (a positive test result) resulted in anticoagulation; low probability ventilation perfusion scans (a negative test) resulted in no treatment; intermediate tests that resulted in a second test (computed tomography or pulmonary angiography). (2) Ventilation perfusion scans as a primary test followed by anticoagulation. (3) Computed tomography followed by anticoagulation (if there is a positive result). The following assumptions were made: The incidence of pulmonary embolism in pregnant women with suspected pulmonary embolism is 5%; 40% of documented pulmonary embolisms have a positive compression ultrasound result; 10% of ventilation perfusion scans for suspected pulmonary embolism are high probability, 60% are indeterminate, and 30% are low probability for pulmonary embolism; the sensitivity of computed tomography is 95%; the sensitivity of angiography is 98%. The assumed mortality rate of treated pulmonary embolism is 0.7% and of untreated pulmonary embolism in pregnancy is 15% (range, 10%-50%). The angiography-associated mortality rate is 0.5%, and the anticoagulation associated mortality rate is 0.2%. The following costs were used for the model: compression ultrasonography, 200.00 dollars; ventilation perfusion scans, 400.00 dollars; angiography, 1000.00 dollars; computed tomography, 500.00 dollars; and anticoagulation, 5982.00 dollars. With baseline assumptions, spiral computed tomography as the initial diagnostic regimen was found to be the most cost-effective at 17,208 dollars per life saved. Sensitivity analyses were performed over a wide range of assumptions that included alteration of the probability of pulmonary embolism, the sensitivity of computed tomography, ventilation perfusion scans, and compression ultrasonography, the cost of computed tomography, and the mortality rate of untreated pulmonary embolism. Our findings remained robust over a wide range of assumptions. CONCLUSION: Suspected pulmonary embolism remains a diagnostic quandary. Our analysis indicated that spiral computed tomography offers the most cost-effective method for diagnosing this potentially fatal condition.

Cost-Benefit Analysis↗

PubMed2004

Thromboembolic disease in pregnancy.

Venous thromboembolic disease is a major cause of maternal morbidity and mortality. Virchow's triad of hypercoagulability, venous stasis, and vascular damage all occur during pregnancy. The risk of venous thromboembolism is five to six times higher during pregnancy and the puerperium. Risk factors include age greater than 35, antiphospholipid antibodies, inherited thrombophilias, operative delivery, increased parity, obesity, mechanical heart valves,and family history. Prophylactic and therapeutic anticoagulation is recommended for women at risk. Low molecular weight heparins are safe and effective in most cases.

Anticoagulants↗

PubMed2004

Role of ultrasound in screening patients at risk for preterm delivery.

The ultrasound assessment of the cervix has contributed to the understanding of the pathways to preterm birth. Transvaginal ultrasound measurement of the cervix provides an objective and noninvasive tool for the evaluation of cervical status. Despite widespread use of this procedure, standardization of measurement indications, technique, and interval between examinations has not been achieved. The American College of Radiology has recently recommended that the cervix and lower uterine segment be imaged as part of every obstetric ultra-sound examination in the second trimester. These guidelines specifically suggest a search for a short cervix (less than 30 mm) or funneling. The expert panel on women's imaging further recommended evaluating the cervix sonographically on both the initial examination and all follow-up examinations for twin gestations. The American Institute of Ultrasound in Medicine guidelines indicate that evaluation of the uterus, including cervix, should be performed, but does not indicate specifically that the cervix should be measured. In contrast, the American College of Obstetricians and Gynecologists, although recognizing that cervical length assessment may be helpful in predicting the risk of preterm delivery (particularly from a negative predictive value), does not recommend routine use of cervical length measurement because of the lack of proved treatment or intervention methods. A review of the literature suggests that at the time of this writing the role of routine screening of low-risk women with cervical length assessment by ultrasound is not supported. In contrast, in women at risk for preterm delivery(eg, women with a prior history of preterm birth or women with multiple gestations) cervical length assessment may be useful for its negative predictive value. At present, however, there is no therapeutic intervention that has been proved to decrease the risk of preterm delivery in women with a documented cervix on ultrasound.

Cervix Uteri↗

PubMed2004

Maternal stressors during prolonged antepartum hospitalization following transfer for maternal-fetal indications.

Our objective was to identify stressors in women requiring prolonged hospitalization following maternal-fetal transfer to a tertiary care center. Using a modified version of the previously validated Antepartum Hospital Stressors Inventory (AHSI), all women transferred to our university-based maternal-fetal service between May 2000 and June 2002 and hospitalized for greater than 1 month completed a semi-structured interview. The AHSI uses Likert scales to evaluate environment, health factors, communication with health care providers, family separation, self-image, and emotional and family status issues as stressors. Nine consecutive women met inclusion criteria and all agreed to participate. Median maternal age was 27 years (range 19 to 33), and gestational age at transfer was 25 weeks (range 20 to 31). Parity ranged from 0 to 3 and educational level ranged from grade 2 to graduate degrees. The women were from Caucasian, Hispanic, and Asian racial-ethnic backgrounds; all were married. Median distance from transferring hospital was 20 miles (range 10 to 275 miles). All patients reported separation from family, sleeping alone, anxiety about the pregnancy and the baby's health, boredom, and eating hospital meals as the greatest stressors. Stress was relieved in all women by ultrasounds, family members staying in the room, cable television, and internet access. Routine beauty maintenance, massage, physical therapy, and continued contact with referring physician were also cited as stress alleviators. Following maternal-fetal transfer, prolonged antepartum hospitalization is associated with stress that may be alleviated by access to the outside world via television and the internet, liberal visitation, access to health and beauty maintenance, and ongoing contact with the referring physician.

Adult↗

PubMed2004

Burnout in residency: a statewide study.

OBJECTIVE: To determine the prevalence of burnout in residents in obstetrics and gynecology through the use of a validated tool. METHODS: The Maslach Burnout Inventory Human Services questionnaire is a previously validated tool that measures burnout. Obstetrics and gynecology residents from Texas were invited to participate in this study in 2002. The Maslach Burnout Inventory Human Services questionnaire and a demographic survey were distributed to each resident. Responses were anonymous and returned by mail. Contingency coefficient and chi2 tests were used for analysis; values of P < 0.05 were significant. RESULTS: Residents (n = 368) from 17 programs in Texas were surveyed. Responses were received from 14 programs (82.4%), with 136 surveys (37%) returned. Overall, 38.2% reported high emotional exhaustion, 47.1% reported high depersonalization, and 19.1% reported reduced personal accomplishment. The number of residents experiencing true burnout (high emotional exhaustion, high depersonalization, and low personal accomplishment) was 17.6% (n = 24). CONCLUSIONS: High levels of emotional exhaustion and depersonalization occur in some residents. Burnout in residents included in this study was approximately 18%.

Burnout, Professional↗

PubMed2003

Postdates pregnancy in an indigent population: the financial burden.

OBJECTIVE: The objective of this study was to determine the comparative financial burden of twice-weekly fetal testing from 41 weeks of gestation until delivery, as compared with early dating ultrasound evaluation in an indigent population. STUDY DESIGN: All women who were seen for antepartum testing for postdating pregnancy at Lyndon Baines Johnson Hospital were enrolled. Patient age, parity, gestational age at initiation of prenatal care, the number of prenatal visits, gestational age at first ultrasound scan, and the number of biophysical profiles that were performed before delivery were recorded. The labor and delivery database was searched for all deliveries at >41 weeks of gestation. The charge for a single ultrasound scan at <20 weeks of gestation was compared with twice-weekly testing in the population as a whole with the use of three strategies (no dating ultrasound scans and biophysical profiles until delivery, routine dating ultrasound scan and routine induction at 41 weeks of gestation, and current practice at our institution). RESULTS: One hundred twenty-seven subjects with postdated pregnancy were enrolled (mean age, 25.2 years; median parity, 0 [range, 0-6]). The mean gestational age at the initiation of prenatal care was 21.2 +/- 10.5 weeks. Forty-seven women (38.0%) initiated care at <20 weeks. The mean number of biophysical profiles performed before delivery was 1.5 +/- 1.34; the mean gestational age at delivery was 42.1 +/- 0.87 weeks (spontaneous labor, 39.6%; induced labor, 40.4%). The charge for a biophysical profile is $492.90 US dollars and $551.00 US dollars for a 20-week ultrasound scan; there is no difference in the charge for induced or spontaneous labor. During the 4-month study period, 1638 patients were delivered at our hospital; 341 patients were delivered at >41 weeks of gestation. The estimated financial burden of antenatal testing of 341 patients from 41 weeks to delivery was calculated to be $252,118 US dollars, compared with $902,538 US dollars for a single ultrasound scan at 20 weeks for the entire population of 1638 patients. The estimated financial burden of current practice (10% of patients with no prenatal care, 38% of patients with examination at <20 weeks who were eligible for dating ultrasound scanning, and 37% of patients with examination for postdate testing) was $402,457 US dollars. CONCLUSION: Patients who were seen for postdate antepartum testing in an indigent population lack early initiation of prenatal care and early ultrasound scans. Because on average only 1.5 biophysical profiles are performed per patient before delivery, routine early ultrasound scanning and routine induction at 41 weeks of gestation would add considerable financial burden to the system.

Adult↗

PubMed2003

Perceived quality of life in pregnant adolescent girls.

OBJECTIVE: The purpose of this study was to describe the perceived quality of life and functional status of pregnant adolescent girls. STUDY DESIGN: The Medical Outcomes Survey-Short Form 36, version 2, is a multi-item scale that measures a subject's perception of eight health components. These questionnaires and demographic surveys were completed by teen patients aged 14 to 18 years during antenatal visits to a university-based resident continuity clinic. Mean scores (0 points indicates the poorest perceived health and functional status, 100 points indicates the highest perceived health and functional status) were then compared with mean scores for women in the general population of all ages and, specifically, women aged 18 to 24 years. RESULTS: Forty-two pregnant adolescent girls participated (median age, 16 years; median education level, 10th grade). Ninety-two percent of the girls belonged to a racial-ethnic minority, and all qualified for Medicaid. Pregnant adolescent girls had slightly lower overall scores for all components of perceived quality of life, with the exception of the vitality component. Scores were significantly lower than normative scores (by >1 SD) for only the physical functioning component. CONCLUSION: There appears to be little change in perceived quality of life in pregnant adolescent girls. This information may be useful in the provision of comprehensive care to pregnant adolescent girls.

Adolescent↗

PubMed2003

Work hours for practicing obstetrician-gynecologists: the reality of life after residency.

OBJECTIVE: Recently the Accreditation Council for Graduate Medical Education placed restrictions on all residency programs that limited work hours to 80 hours per week. The objective of this study was to determine the work hours for practicing obstetrician-gynecologists in an urban center. STUDY DESIGN: A questionnaire about physician demographics and work hours was mailed to all obstetrician-gynecologists in Houston in June 2002. Chi(2) testing was used for statistical analysis. RESULTS: One hundred eighty-nine surveys were mailed. One hundred surveys (56%) were returned complete and analyzed. Sixty-two physicians reported working >80 hours per week. Physicians were more likely to work >80 hours per week if they were men or if they were >50 years old. Marital status and having children living at home did not affect work hours. CONCLUSION: Most obstetrician-gynecologists in Houston work longer hours than the number of hours that is imposed by the Accreditation Council for Graduate Medical Education resident work hour guidelines.

Female↗