Review of NVP and HG and Early Pharmacotherapeutic Intervention

NVP occurs in 50–90% of pregnancies, making it a common medical condition in pregnancy. Women present differently with any combination of signs and symptoms. It is appropriate to take the pregnancy-related versus nonpregnancy-related approach when determining the cause of nausea and vomiting but other causes should be considered. The most common etiologies for NVP include the hormonal changes associated with pregnancy, the physiologic changes in the gastrointestinal tract, and a genetic predisposition. Up to 10% of women will require pharmacotherapy to treat the symptoms of NVP despite conservative measures. ACOG currently recommends that a combination of oral pyridoxine hydrochloride and doxylamine succinate be used as first-line treatment for NVP if pyridoxine monotherapy does not relieve symptoms. A review of NVP and early pharmacotherapeutic management is presented due to the fact that NVP is largely undertreated, and investigations into the safe and effective pharmacotherapies available to treat NVP are lacking

Discussion required for correct interpretation

Thank you for the opportunity to comment on the editorial by Romero and colleagues [1], which raises a number of important and interesting questions. Such discussion is mandatory if results of scientific techniques such as gene array are to be correctly interpreted and used as the basis for future improvements in patient care

Labor-associated gene expression in the human uterine fundus, lower segment, and cervix

Background Preterm labor, failure to progress, and postpartum hemorrhage are the common causes of maternal and neonatal mortality or morbidity. All result from defects in the complex mechanisms controlling labor, which coordinate changes in the uterine fundus, lower segment, and cervix. We aimed to assess labor-associated gene expression profiles in these functionally distinct areas of the human uterus by using microarrays. Methods and Findings Samples of uterine fundus, lower segment, and cervix were obtained from patients at term (mean +/- 6 SD = 39.1 +/- 0.5 wk) prior to the onset of labor (n = 6), or in active phase of labor with spontaneous onset (n = 7). Expression of 12,626 genes was evaluated using microarrays ( Human Genome U95A; Affymetrix) and compared between labor and non-labor samples. Genes with the largest labor-associated change and the lowest variability in expression are likely to be fundamental for parturition, so gene expression was ranked accordingly. From 500 genes with the highest rank we identified genes with similar expression profiles using two independent clustering techniques. Sets of genes with a probability of chance grouping by both techniques less than 0.01 represented 71.2%, 81.8%, and 79.8% of the 500 genes in the fundus, lower segment, and cervix, respectively. We identified 14, 14, and 12 those sets of genes in the fundus, lower segment, and cervix, respectively. This enabled networks of coregulated and co-expressed genes to be discovered. Many genes within the same cluster shared similar functions or had functions pertinent to the process of labor. Conclusions Our results provide support for many of the established processes of parturition and also describe novel-to-labor genes not previously associated with this process. The elucidation of these mechanisms likely to be fundamental for controlling labor is an important prerequisite to the development of effective treatments for major obstetric problems - including prematurity, with its long-term consequences to the health of mother and offspring

Preconceptional Folate Supplementation and the Risk of Spontaneous Preterm Birth: A Cohort Study

In an analysis of a cohort of pregnant women, Radek Bukowski and colleagues describe an association between taking folic acid supplements and a reduction in the risk of preterm birth

Critical care obstetrics

This work is intended to supplement, rather than duplicate, general texts of critical care medicine. We do not address all conditions that may affect the pregnant woman.xvii, 733 hlm.: ilus.; 23 c

Profiles of Gene Expression in the Uterine Lower Segment from Women before or after the Onset of Labor

<p>Each panel shows profiles of the genes within one of the clusters determined jointly by K-means and hierarchical clustering. On the <i>x</i>-axis, samples from individual patients are arranged and represented by vertical lines. Non-labor samples (gray background) are shown on the left and labor (white background) on the right. The <i>y</i>-axis represents the level of gene expression as a number of standard deviations from the mean of all observations for each gene ( <i>z</i>-score). </p

Validation of the Microarray Findings by RT-PCR

<p>Relative abundance of mRNA, normalized to S-18, encoding the gene for REA, RXR, and GAPDH in the myometrium obtained from the uterine fundus in five non-laboring (NL) and five spontaneously laboring (L) patients. Box limits represent 25th and 75th quartiles, line within the box represents median, and whiskers represent 5th and 95th percentiles.</p