Search

Objective This study aims to examine whether maternal household income is associated with histological evidence of chronic placental inflammation. Study Design A total of 152 participants completed surveys of household income and consented to placenta collection at delivery and postpartum chart review for birth outcomes. Placental inflammatory lesions were evaluated via histological examination of the membranes, basal plate, and villous parenchyma by a single, experienced pathologist. Associations between household income and the presence of inflammatory lesions were adjusted for known perinatal risk factors. Results Overall, 45% of participants reporting household income below $30,000/y had chronic placental inflammation, compared with 25% of participants reporting income above $100,000 annually (odds ratio [OR] = 4.23, 95% confidence interval [CI] = 1.25, 14.28; p = 0.02). Middle-income groups showed intermediate rates of chronic inflammatory lesions, at 40% for those reporting $30,000 and 50,000 (OR = 3.60, 95% CI = 1.05, 12.53; p = 0.04) and 38% for those reporting $50,000 to 100,000 (OR = 1.57, 95% CI = 0.60, 4.14; p = 0.36). Results remained significant after adjustment for maternal age, race, and marital status. Conclusion Chronic placental inflammation is associated with maternal household income. Greater occurrence of placental lesions in low-income mothers may arise from a systemic inflammatory response to social and physical environmental factors.

Objective To estimate the association between biomarkers of chronic stress during pregnancy and chronic placental inflammation. Study Design African-American and Caucasian pregnant women were recruited between May 2008 and July 2009. Blood samples were collected between 14 and 226/7 weeks and between 28 and 326/7 weeks of gestation. Samples were analyzed for serum C-reactive protein (CRP), Epstein-Barr virus (EBV) antibody, corticotropin-releasing hormone (CRH), and adrenocorticotropic hormone (ACTH). Placentas were collected at delivery and evaluated for chronic inflammation. Results Placentas were available from 88 of the 112 women enrolled in the study. EBV antibody levels were significantly higher during both the second and third trimester in women whose placentas demonstrated chronic villitis. CRP values also were significantly higher during the third trimester when chronic villitis was present. No association between placental chronic inflammation and CRH or ACTH was found. Conclusion Chronic placental inflammation is associated with elevated serum EBV antibody and CRP levels during pregnancy.

Background and Study Aims : Endoscopic extraction of bile duct stones may be complicated by impaction of the Dormia basket with captured stones, or rupture of the traction wire of the basket during mechanical lithotripsy. In an attempt to release impacted baskets by nonoperative means, we studied the efficacy of extracorporeal shock-wave lithotripsy in this dangerous clinical situation. Patients and Methods : Fourteen extracorporeal shock-wave treatments were performed in 12 consecutive patients (eight women and four men ; mean age 73.2 ± 13.2 years, range 46-86 years) with an electrohydraulic shock-wave lithotriptor, using fluoroscopy (n = 13) or ultrasound (n = 1) for targeting. A total of 1845 ± 334 (mean ± SD) shock-wave discharges at a voltage of 22 ± 4 kV were delivered per treatment. Nine treatment sessions (64%) were performed while patients were under general anesthesia. An attempt to extract the Dormia basket was made after disintegration of the captured stone had been confirmed by fluoroscopy. Results : It was possible to remove the Dormia basket by nonsurgical means in 11 of the 12 patients (92%) after one treatment session, and after three treatment sessions in the remaining patient. Thus, disintegration of the stones allowed extraction of the Dormia basket in all patients. None of the patients needed surgical intervention. All patients were rendered free of bile duct stones after extracorporeal shock-wave lithotripsy and subsequent endoscopic removal of the fragments. No adverse effects of shock-wave therapy with subsequent extraction of the Dormia baskets were observed. Conclusion : Shock-wave therapy represents a primary nonsurgical therapeutic option in patients with either impacted Dormia baskets or broken devices which cannot be extracted by endoscopic means.