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Purpose: Intracranial pressure (ICP) monitoring is in most studies considered essential in avoiding secondary brain injury in patients with intracranial pathologies. Invasive monitoring of ICP is accurate but is unavailable in many clinical and prehospital settings. Non-invasive modalities have historically been difficult to implement clinically. The retinal arteriovenous ratio (A/V ratio) has shown promise through its relationship with ICP. This study aimed to further elucidate the relationship between ICP, A/V ratio and the intraocular pressure (IOP) measured with non-invasive fundoscopy in a porcine model., Methods: We achieved controlled values of ICP ranging from normal (5-15 mmHg) to elevated (> 20 mmHg) within the same animal subject. Six pigs were included. ICP and IOP was measured using an intraparenchymal pressure monitor and a tonometer, respectively. Fundoscopy was performed at baseline and at predefined ICP values., Results: Mixed-effects linear regression revealed a significant inverse correlation between A/V ratio and ICP ≥ 20 mmHg (slope coefficient - 0.0026734 [95%-CI: -0.0039347 - (-0.0014121)], p < 0.001). For ICP < 20 mmHg there was no change in A/V ratio (p = 0.987). Similar results were seen for ICP > IOP with a mean IOP of 10 mmHg. A Wald test showed no significant difference between ICP > IOP and ICP ≥ 20 mmHg. ROC curve analysis revealed an AUC of 0.64 for ICP ≥ 20 mmHg and 0.71 for ICP > IOP., Conclusion: The results support the hypothesis that an increase in ICP was associated with a decrease in A/V ratio. Although a slightly better fit, the model of ICP > IOP was deemed less clinically relevant than ICP ≥ 20 mmHg because of the subjects' IOP. Further research integrating multifactorial models and machine learning is needed to enhance the diagnostic accuracy of A/V ratio via fundoscopy, enabling it to serve as a cost-effective screening tool., Competing Interests: Declarations. Ethics approval: The study was registered and approved by the Animal Experiments Inspectorate (Journal no. 2023-15-0201-01457). Picture materials are original and the authors have the right to their usage. Competing interests: The study was funded by Statumanu ICP ApS that is working on an algorithm for measuring the A/V ratio on fundus images. Niclas Lynge Eriksen has received funding from Statumanu ICP ApS for this study. Prior to this study being conceptualized, Mathias Just Nortvig received funding for his PhD from Statumanu ICP ApS. He also provided medical consulting to Statumanu ICP ApS. Prior to this study being conceptualized, Mikkel Schou Andersen received partial funding for his PhD from Statumanu ICP ApS. Frantz Rom Poulsen has no interests to declare., (© 2025. The Author(s).)

Purpose: Intracranial pressure (ICP) control is important to avoid secondary brain injury in patients with intracranial pathologies. Current methods for measuring ICP are invasive and carry risks of infection and hemorrhage. Previously we found correlation between ICP and the arteriole-venous ratio (A/V ratio) of retinal vessels in an outpatient setting. This study investigated the usability of fundoscopy for non-invasive ICP estimation with the addition of intraocular pressure (IOP) in patients in a neuro-intensive care unit (NICU)., Methods: This single-center prospective cohort study was conducted at the NICU of Odense University Hospital from September 2020 to May 2021. Adult patients with a Glasgow Coma Score of 8 or less, who underwent invasive pressure neuromonitoring were included. Fundoscopy videos were captured daily and analyzed using deep learning algorithms. The A/V ratio was calculated and correlated with ICP. The data was analyzed using mixed-effect linear regression models., Results: Forty patients were enrolled. Fifteen were included in the final analysis. ICP ranged from -1 to 31 mmHg (mean: 10.9, SD: 5.7), and IOP ranged from 4 to 13 mmHg (mean: 7.4, SD: 2.1). The A/V ratio showed a significant negative correlation with ICP > 15 mmHg (regression slope: -0.0659, 95%-CI: [-0.0665;-0.0653], p < 0.001). No significant change in A/V ratio was observed for ICP ≤ 15 mmHg. A similar significant correlation was found for ICP > IOP (regression slope: -0.0055, 95%-CI: [-0.0062;-0.0048], p < 0.001). Taking the IOP into account did not improve the model. The sensitivity analysis showed a sensitivity of 80.08% and a specificity of 22.51%, with an AUC of 0.6389., Conclusion: In line with our previous work, non-invasive fundoscopy is a potential tool for detecting elevated ICP. However, challenges such as image quality and diagnostic specificity remains. Further research with larger, multi-center studies are needed to validate the utility. Standardization may enhance the technique's clinical applicability., (© 2024. The Author(s).)

Objectives: This study asked the following questions: 1) Does HIV testing in pregnancy identify women who previously were not known to be HIV positive? 2) When in pregnancy are women identified as HIV infected? 3) Does HIV seroconversion occur during the prenatal care period?, Methods: Medical records of 97 women from two primarily indigent care hospitals in Houston, TX who were found to be HIV positive at delivery were reviewed to determine if they had tested positive during the prenatal care period. Demographics and time of gestation of the prenatal testing also were recorded. The outcome measures were: 1) number of women found positive during prenatal care; 2) week of gestation at discovery of HIV positivity; and 3) number of women seroconverting between the initiation of prenatal care and delivery., Results: Thirty women were known to be HIV positive prior to pregnancy. Fifty-six women were found to be positive during prenatal care and the seropositivity of 44 was discovered before the 34th week of pregnancy. Ten women were found to be positive at their first prenatal visit, which occurred after the 34th week. Date of testing was unknown for two women. Eleven women who received no prenatal care were found to be HIV positive at delivery. There were no seroconversions while women were under prenatal care., Conclusions: HIV testing at delivery did not find any HIV-positive women who had tested negative during prenatal care. Testing is very important for women who do not receive prenatal care. Making certain that high-risk women get into prenatal care also is very important.

This article examines the legal implications of studies showing that the probability of maternal-to-infant human immunodeficiency virus transmission can be reduced by physician interventions. These interventions require knowledge of a pregnant woman's human immunodeficiency status. Hence the offering of human immunodeficiency virus testing has become a standard of care in pregnancy. This standard of care is examined with respect to the following: (1) the physician's legal duty to the infant, (2) negligence for failing to test, (3) liability when testing only reduces the probability of transmission, (4) damages, (5) informing women about the results of their testing, (6) protecting against liability, and (7) dealing with human immunodeficiency virus-infected pregnant women. It is concluded that the physicians are likely to have legal difficulties if a human immunodeficiency virus-infected baby is born to a woman who was not offered testing or if testing is done without documenting consent. Suggestions are made for reducing liability when testing is done, when patients refuse testing, and when one is caring for human immunodeficiency virus-infected women.

Objective: To determine the prevalence of cutaneous anergy in pregnant and nonpregnant women who are seropositive for human immunodeficiency virus., Methods and Materials: The medical records of 159 women seropositive for human immunodeficiency virus were reviewed. Demographic characteristics and tuberculin skin test results were abstracted from the chart. Tuberculin skin testing was performed by the Mantoux method (5 tuberculin units of purified protein derivative injected intradermally). Anergy testing was performed using any two of the three following antigens; tetanus toxoid, mumps, or Candida skin test antigen. A positive tuberculin test was defined as induration of 5 mm or more, and a positive test for the other antigens was defined as any amount of induration over the skin test area. Anergy was defined as any amount of induration to the other antigens. A CD4+T lymphocyte count was obtained at the time of skin testing. Continuous variables were analyzed using the Mann Whitney-U test. Categorical data were analyzed with the chi-square or Fisher's exact test as appropriate. A two-tailed P value < 0.05 was considered significant., Results: There were 102 nonpregnant and 57 pregnant women who returned to have their skin test results read. There was no significant difference in the prevalence of positive, negative or anergic skin test results between groups. The CD4+T lymphocyte count (mean +/- standard deviation) in patients with anergic results was similar between pregnant (375 +/- 256/mm3) and nonpregnant (358 +/- 305/mm3) women (P = 0.64)., Conclusion: The prevalence of cutaneous anergy is similar among pregnant and nonpregnant women seropositive for human immunodeficiency virus.

Objectives: To assess the knowledge of universal precautions for the delivery and operating rooms by residents and students and to evaluate their use of universal precautions., Study Design: Obstetrics and gynecology (ob/gyn) residents (n = 30) and students (n = 31) from an inner-city, teaching hospital were polled by anonymous questionnaire to assess their knowledge of the appropriate barrier equipment for certain ob/gyn procedures. To determine actual compliance with universal precautions, 459 ob/gyn procedures were observed. We noted the use of appropriate barrier equipment for each procedure: gloves for pelvic exam and face shields, gowns, gloves, and booties for vaginal delivery, cesarean delivery, and dilation and curettage. The True Epistat statistical software program was used to perform simple regression analysis., Results: Thirty residents (100%) knew the appropriate barrier equipment required for each type of procedure performed. One student (< 1%) did not know that booties were appropriate for the surgical procedures. Rationale for lack of compliance with universal precautions elicited by the questionnaire included time constraints (64%), inconvenience (52%), and presumption that patient was not infected (34%). The observed rate of compliance with universal precautions by participants indicates that individual compliance was inversely related to the years of experience (overall compliance rate of students was 96%; for first-year residents, 92%, second-year residents, 89%, third-year residents, 84%, fourth-year residents, 78%; r = -0.9918, P = 0.0009)., Conclusions: Knowledge regarding universal precautions was nearly 100%, while overall observed compliance was only 89%. Compliance with universal precautions was better among students (96%) than among residents (88%). Compliance with universal precautions was inversely related to years of experience.

Objective: Our purpose was to determine whether a dilute solution of chlorhexidine used as a one-time vaginal wash intrapartum can reduce the incidence of intraamniotic infection or endometritis in laboring pregnant women., Study Design: Term pregnant women in labor were prospectively randomized to receive either 20 ml of 0.4% chlorhexidine (n = 481) or 20 ml of sterile water (n = 466) placebo. All patients were monitored for risk factors associated with intraamniotic infection. Continuous variables were compared with the Mann-Whitney U test and discrete variables were compared with Fisher's exact test., Results: No significant differences in infection were found between the chlorhexidine and placebo groups. During the study period 21 of 466 women (4.5%) had intraamniotic infection in the control group compared with 25 of 481 women (5.2%) receiving chlorhexidine (p = 0.65, 95% confidence interval 0.82 to 1.41). Nine women in the placebo group (1.9%) and 9 women in the chlorhexidine group (1.9%) had endometritis (p = 1.0, 95% confidence interval 0.62 to 1.56)., Conclusions: Our findings suggest that a one-time 0.4% chlorhexidine vaginal wash does not decrease the incidence of infectious morbidity in parturients, compared with the use of sterile water.

Objective: The purpose of this study was to determine if a dilute solution of chlorhexidine used as a one-time vaginal wash intrapartum can reduce the use of postnatal antibiotics and neonatal infection., Methods: Term pregnant women in labor were prospectively randomized to receive either 20 cc of 0.4% chlorhexidine (n = 481) or 20 cc of sterile water (n = 466) placebo. Exclusion criteria included fetal distress, clinical infection, cervical dilatation >6 cm, and known allergy to chlorhexidine. Outcome variables included the incidence of neonatal pneumonia, culture proven neonatal sepsis, and use of the antibiotics in the neonate. Continuous variables were compared using the Mann-Whitney U-test and discrete variables were compared with the chi-square test., Results: The length of ruptured membranes (mean +/- S.D.) between the chlorhexidine group (408 +/- 589 min) and control group (352 +/- 318 min) was not significantly different (P = 0.85, 95% confidence interval 354-462). Fifteen neonates (3.2%) in the chlorhexidine group and 9 (1.9%) in the control group received antibiotics in the postnatal period (P = 0.32, 95% confidence interval 0.72-3.72). There was one case of pneumonia in the control group and no cases of sepsis in either group., Conclusions: A one-time chlorhexidine vaginal wash does not decrease the use of antibiotics or incidence of neonatal infection in our population.

Background: Human immunodeficiency virus (HIV)-associated nephropathy typically leads to endstage renal disease requiring dialysis within 3-4 months. This report describes the prenatal course of a patient with HIV-associated nephropathy requiring dialysis during pregnancy., Case: A 23-year-old nulliparous, black female presented at 13 weeks gestation with a history of HIV-associated nephropathy and anemia. She had a CD4 count of 350/mm(3), a total urinary protein of 1.7 g/day, and a serum creatinine of 4.8 mg/dl. The patient was begun on zidovudine, 500 mg daily, and erythropoietin, 4,000 units weekly. At 23 weeks gestation, when she developed hypertension, a total urinary protein of 3.4 g/day, and a serum creatinine of 4.4 mg/dl, she was hospitalized. Her renal function continued to deteriorate, requiring hemodialysis. At 29-4/7 weeks, she developed preterm labor, for which she was placed on indomethacin. Four days later, at 30 weeks gestation, she delivered a viable male infant., Conclusion: HIV-associated nephropathy during pregnancy can be successfully managed with hemodialysis.

Objective: To determine whether prophylactic doxycycline at suction curettage for incomplete abortion decreases the rate of postoperative pelvic infection., Methods: We randomized 240 patients to receive intravenous doxycycline or placebo at curettage. Cervical specimens for gonorrhea and chlamydia were obtained preoperatively. Two weeks post-procedure, we evaluated all patients for infectious morbidity and repeated gonorrhea and chlamydia cultures. Statistical analysis used Mann-Whitney U test, McNemar test, or Fisher exact test, as appropriate., Results: There were no statistically significant differences in age, parity, gestational age, history of sexually transmitted disease, pelvic inflammatory disease, or multiple sex partners between the doxycycline and placebo groups. Preoperative gonorrhea or chlamydia isolates were positive in five (4.2%) and six (5%) of 120 doxycycline patients and four (3.3%) and eight (6.6%) of 120 controls (not significant). All preoperative gonorrhea isolates remained positive postoperatively. Seven (5.8%) controls had positive postoperative chlamydia isolates, as did one (0.8%) in the doxycycline group (P = .06). We diagnosed eight (6.6%) of 120 doxycycline patients and seven (5.8%) of 120 controls with infectious morbidity (not significant)., Conclusion: In our population of patients with incomplete abortion, the prevalence of gonorrhea and chlamydia was low, and prophylactic doxycycline did not decrease the rate of postoperative febrile morbidity.

A retrospective, case-control study was performed to determine whether pregnant women using cocaine had an increase in maternal infectious morbidity. Seventy-six women with urine drug screens positive for cocaine on admission to the labor and delivery unit were compared to 134 women who had negative urine drug screens. Patients were matched for risk factors associated with the development of intraamniotic infection and endometritis, such as parity, length of labor and length of membrane rupture. There was no significant difference in the incidence of intraamniotic infection or endometritis between the two groups. Thus, cocaine does not appear to increase the risk of peripartum infectious morbidity after controlling for well-established risk factors.

Objective: We hypothesized that prophylactic intrapartum amnioinfusion in pregnancies complicated by thick meconium will not decrease the incidence of fetal distress, cesarean section for fetal distress, or meconium below the cords., Study Design: Patients with thick meconium were randomized to amnioinfusion (n = 65) or control (n = 59). The amnioinfusion group received an 800 ml bolus of normal saline solution followed by a continuous infusion at 180 ml/hr. Continuous variables were compared by Student t test, and discrete variables were compared by chi 2 analysis and Fisher's exact test as appropriate., Results: The incidence of fetal distress (16 of 65 vs 8 of 59) and cesarean section for fetal distress (seven of 65 vs seven of 59) was not significantly different between the amnioinfusion and control groups, respectively. The rate of meconium below the cords (one of 65 vs eight of 59) was significantly lower in patients receiving amnioinfusion (relative risk 0.09, confidence interval 0.01 and 0.82, p = 0.02). Two cases of meconium aspiration syndrome occurred in control patients but in none receiving amnioinfusion (p = 0.22)., Conclusion: Prophylactic amnioinfusion in patients with thick meconium decreases the incidence of meconium below the cords and may subsequently have an impact on the incidence of meconium aspiration syndrome in larger series.

Objectives: Endotoxin, interleukin-1 beta, interleukin-6, and tumor necrosis factor-alpha have been implicated in the pathogenesis of preterm labor, but their acute effect on myometrial contractile activity is unknown. The objective of this study was to determine their effect on isolated pregnant murine myometrial contractile activity., Study Design: Isometric contractions were measured in myometrium isolated from pregnancy day 18 Swiss-Webster mice. Frequency, duration, amplitude, and integrated area were compared before and after the addition of endotoxin (10(3) and 10(4) ng/ml) (n = 6), interleukin-1 beta (10 and 10 ng/ml) (n = 6), interleukin-6 (1 and 10 ng/ml) (n = 6), and tumor necrosis factor-alpha (1 and 10 ng/ml) (n = 6). Results were analyzed with the Wilcoxon rank-sum test., Results: The addition of endotoxin, interleukin-1 beta, interleukin-6, or tumor necrosis factor-alpha did not result in a change in the contractile activity of isolated pregnant murine myometrium compared with control., Conclusion: Endotoxin, interleukin-1 beta, interleukin-6, and tumor necrosis factor-alpha do not acutely increase isolated murine myometrial contractile activity.

The objective of this study was to determine the rate of intra-amniotic infection in patients with meconium-stained amniotic fluid compared to controls. With a retrospective case-controlled study design, we compared 100 pregnant women with meconium to 100 pregnant women without meconium for the development of intra-amniotic infection. Patients delivered between September 1 and December 31, 1990. Exclusion criteria were active infection prior to labor or antibiotic use within the 7 days prior to delivery. We diagnosed clinical intra-amniotic infection in patients with ruptured membranes by a maternal temperature 100.4 degrees F or higher and any two of the following: maternal or fetal tachycardia, uterine tenderness, white blood cell count 10,500 mm3 or more, or foul-smelling amniotic fluid. Demographic variables, labor characteristics, maternal infectious morbidity, and neonatal outcome were analyzed using the Wilcoxin rank test, chi-square test, or Fisher's exact test as appropriate. The rate of clinical intra-amniotic infection was significantly higher in women with meconium-stained amniotic fluid (8%) compared with women with no meconium (2%) (p = 0.05).

The extended-spectrum cephalosporins provide better activity against gram-negative bacilli and anaerobes than first-generation agents. Cefoxitin and cefotetan (second-generation) and ceftriaxone (third-generation) have excellent activity against B. fragilis and are useful in the treatment of postoperative infections and pelvic inflammatory disease. The extended-spectrum cephalosporins are as efficacious as first-generation agents for prophylaxis of cesarean section and hysterectomy. The first-generation drugs, such as cefazolin, are considerably less expensive than these newer compounds, however, making first-generation agents the drugs of choice when used for prophylaxis. The majority of the third-generation agents should be reserved for the treatment of meningitis and resistant nosocomial infections.

Objective: To determine whether fetal fibronectin is a sensitive test for the detection of amniotic fluid (AF) in women with rupture of the membranes., Methods: In a multicenter clinical trial, pooling, ferning, and nitrazine tests were compared with fetal fibronectin in 339 women at term (study group) with a clinical history of rupture of the membranes and in 67 women at term receiving routine prenatal care (controls). Ruptured membranes was diagnosed if any two of the standard tests were positive. Fetal fibronectin in the cervicovaginal secretions was determined using a qualitative enzyme-linked immunosorbent assay test. Fetal fibronectin was considered positive at 50 ng/mL., Results: The sensitivity of fetal fibronectin in the women with ruptured membranes was 98.2%. No controls had ruptured membranes based on standard test results, but 13 women had fetal fibronectin present. The mean (+/- standard error) interval between sampling and delivery was significantly less in the women positive for fetal fibronectin (169.3 +/- 45.8 hours) than in those with no detectable fetal fibronectin (333.4 +/- 29.0 hours)., Conclusion: Fetal fibronectin is a sensitive test for detection of AF in the vagina and compares favorably to standard tests. Its low specificity suggests that the assay may detect an alteration in membrane integrity. In addition, in patients without rupture of the membranes, the interval between sampling and delivery is significantly shorter if fetal fibronectin is present. We speculate that the presence of fetal fibronectin in cervicovaginal secretions may be a marker for impending labor in gravidas without gross rupture of the membranes.

Apgar scores are used routinely to assess early neonatal status, but are less accurate in the preterm neonate because of developmental immaturity. Attention has been directed to umbilical cord gases as a method of neonatal evaluation. Using a retrospective chart review of all viable preterm births (24-36 weeks' gestation) between January 1986 and December 1989, we tabulated the umbilical cord gas indices of these infants. Fetuses with lethal congenital anomalies and those with abnormal heart rate tracings on admission were excluded from the data base, leaving 1872 infants. Cord arterial blood gas values were available for analysis in 74.4% of cases and cord venous gas values in 81.8%. The mean (+/- standard deviation [SD]) arterial and venous umbilical cord blood gas values for the preterm infants, were, respectively: pH, 7.26 +/- 0.08 and 7.33 +/- 0.07; oxygen pressure, 19.0 +/- 7.9 and 29.2 +/- 9.7 mmHg; carbon dioxide pressure, 53.0 +/- 10.0 and 43.4 +/- 8.3 mmHg; bicarbonate, 24.0 +/- 2.3 and 22.8 +/- 2.1 mEq/L; and base excess, -3.2 +/- 2.9 and -2.6 +/- 2.5 mEq/L. Acidemia was defined statistically as 2 SDs or more below the population mean. The incidence of 5-minute Apgar scores below 7 in the preterm infants was 8.5% and within this group, 17.8% were acidemic (arterial pH 7.10 or lower). More than 82% of neonates with 5-minute Apgar scores less than 7 had normal umbilical cord blood gases. There was no significant difference in umbilical arterial blood gas values between preterm infants and 1924 term deliveries at our institution between 1986-1988.(ABSTRACT TRUNCATED AT 250 WORDS)

There is evidence to suggest a decrease in natural killer cell cytotoxicity during pregnancy, but information regarding immune responsiveness to actual infection is limited. An in vitro study was undertaken to examine the effect of herpes simplex virus infection on natural killer cell cytotoxicity with peripheral blood mononuclear cells from pregnant (N = 8) and nonpregnant (N = 5) women. The peripheral blood mononuclear cells were separated by Ficoll-Hypaque centrifugation. Effector cells were incubated with live herpes simplex virus-1, ultraviolet-inactivated herpes simplex virus-1, or media alone for 18 hours at 37 degrees C. K562 target cells were used in a sodium chromate release assay with an effector-to-target cell ratio of 100:1. Baseline natural killer cell values (mean +/- SE) for pregnant patients (13.4% +/- 2.4%) and nonpregnant patients (19.8% +/- 3.7%) were similar. Natural killer cell cytotoxicity was significantly increased by incubation with live virus for both pregnant (37.5% +/- 6.2%) and nonpregnant subjects (49.8% +/- 7.6%). There was no difference in mean values between media and ultraviolet-inactivated herpes simplex virus-1-exposed samples for either group. Results suggest that (1) infection with live virus, but not viral antigen alone, can augment natural killer cell response in vitro and (2) natural killer cell response to herpes simplex virus-1 infection is not altered by pregnancy.

Pulmonary atresia comprises only 1% of all congenital heart defects. Counseling the parents on recurrence risks is difficult. We present a rare case of pulmonary atresia in two sibs, along with a review of the literature.

A retrospective study of vaginal birth after cesarean (VBAC) was conducted over 24 months. Of 152 women who had a previous cesarean, 141 were offered VBAC. Sixty-eight had an elective repeat cesarean, and 73 agreed to VBAC. These groups were similar with respect to age, race, parity, and weight. Fifty-nine of the VBAC patients delivered vaginally (80.8%). The two groups were compared for the incidence of febrile morbidity, endomyometritis, uterine dehiscence and estimated blood loss at delivery. There were no significant differences between the two groups or when each was compared with a control group of 69 routine vaginal deliveries except for the estimated blood loss and the number of days hospitalized (p less than 0.05). Neonatal morbidity was examined between the two groups by comparing the incidence of transient tachypnea and the number of newborns with suspected sepsis, as well as those requiring antibiotics or admission to the Neonatal Intensive Care Unit. The repeat cesarean group had a higher overall incidence of neonatal morbidity than the VBAC group, but this was not statistically significant. However, there was statistical significance (p less than 0.05) when comparing the number of days hospitalized between the infants in the VBAC group versus the repeat cesarean group. This study supports VBAC as a safe alternative to elective repeat cesarean for the patient and neonate. Data analysis was performed using Student's t test or chi-square analysis with a p less than 0.05 regarded as being statistically significant.