Showing papers in "Archives of Gynecology and Obstetrics in 2009"

The pathophysiology of endometriosis and adenomyosis: tissue injury and repair

Abstract: Introduction This study presents a unifying concept of the pathophysiology of endometriosis and adenomyosis. In particular, a physiological model is proposed that provides a comprehensive explanation of the local production of estrogen at the level of ectopic endometrial lesions and the endometrium of women affected with the disease.

Serum 25-hydroxyvitamin D concentrations in obese and non-obese women with polycystic ovary syndrome

Abstract: To investigate the correlation between serum 25-hydroxyvitamin D (25-OH-VD) concentrations and metabolic parameters in obese and non-obese women with polycystic ovary syndrome (PCOS). One hundred women with PCOS were divided into two groups, obese and non-obese, according to their body mass index (BMI). Waist-to-hip ratio (WHR), Ferriman–Gallwey score, homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol, triglycerides, calcium, 25-OH-VD, LH/FSH, total testosterone, and DHEAS were measured. The serum 25-OH-VD mean levels were 56.31% lower in the obese PCOS patients. There was an association of increased HOMA-IR, BMI, WHR, triglycerides, total testosterone, and DHEAS with decreased 25-OH-VD concentrations in the obese PCOS patients. Low serum 25-OH-VD concentrations result from the presence of obesity and insulin resistance. However, the dependency between PCOS and hypovitaminosis D is questionable. Hypovitaminosis D should be kept in mind while managing obese women with PCOS.

Prevalence of primary dysmenorrhea in young adult female university students.

Abstract: To determine the prevalence of primary dysmenorrhea and attitudes and behavior toward dysmenorrhea in the female students of an university toward this problem. A total of 1,266 female university students were anonymously surveyed by doctors. It was found that mean age of the surveyed students was 21.02 ± 2.13 years, mean menarche age was 13.3 ± 1.4 years, and menstruation frequency was 32.58 ± 19.8 days. Of the students, 45.3% were found to suffer pain in each menstruation, 42.5% in some and 12.2% in none. Of those with primary dysmenorrhea, 66.9% were established to take analgesic drugs. Prevalence of primary dysmenorrhea was found higher than that cited in the literature. It was established that although the rate of consultation with health professionals about menstruation and related changes was low, use of agents known to be effective in primary dysmenorrhea treatment was highly common.

Utilization of carbetocin for prevention of postpartum hemorrhage after cesarean section: a randomized clinical trial

Abstract: Purpose A randomized study involving pregnant women was conducted to compare the effectiveness of a single intravenous (IV) injection of carbetocin with that of a standard 2-h oxytocin IV infusion with respect to intraoperative blood loss in the prevention of uterine atony after cesarean section (CS). The two treatments also were compared for safety and ability to maintain adequate uterine tone and to reduce the incidence and severity of postpartum hemorrhage (PPH) in women at risk for this condition.

Maternal periodontal status and preterm low birth weight delivery: a case-control study

Abstract: Objectives To assess the association between severity and extent of maternal periodontal disease and preterm birth/low birth weight (PLBW) among women in the north of Jordan.

Pregnancy outcome in patients with homozygous sickle cell disease in a university hospital, Eastern Saudi Arabia.

Abstract: Objective To evaluate the maternal and fetal outcome in pregnant women with sickle cell disease and to highlight the complications encountered during pregnancy and delivery at a university hospital in the Eastern Saudi Arabia.

The effect of Ramadan fasting on maternal serum lipids, cortisol levels and fetal development.

Abstract: Objective To determine the effects of fasting during the month of Ramadan on fetal development and maternal serum cortisol and lipid profile.

Tubal ectopic pregnancy: diagnosis and management

Abstract: Ectopic pregnancy is the gynaecological emergency par excellence and remains the leading cause of pregnancy-related first trimester deaths in the UK. Its prevalence continues to rise because of increases in the incidence of the risk factors predisposing to ectopic pregnancy. Classically, the diagnosis is based on a history of pelvic pain associated with amenorrhoea, a positive pregnancy test with or without slight vaginal bleeding. While the immediate differential diagnosis includes threatened or inevitable miscarriage, the likelihood of ectopic pregnancy is increased if transvaginal sonography (TVS) reveals an empty uterine cavity, and is confirmed if an adnexal mass with or without an embryo is seen. However, the diagnosis is often not that simple, especially when the patient presents early, has minimal pain, is haemodynamically stable, and TVS shows an empty uterus but no obvious adnexal mass. This could then be an early intrauterine pregnancy, or could indeed be an ectopic-a diagnosis of pregnancy of unknown location is made while additional investigations are made. The latter usually include serial measurements of serum beta human chorionic gonadotrophin (beta-hCG) and repeat TVS. Changes in beta-hCG levels in normal, failing and ectopic pregnancy are now reasonably well characterised, and at early stages of presentation where the risk of rupture of an ectopic are minimal, the patient can often be managed as an outpatient while the diagnosis is pursued. In the patient who presents with pain and haemodynamic instability, the diagnosis is often obvious, and the management is immediate laparotomy. However, in modern gynaecological practice in the developed world the vast majority of ectopic pregnancies present early, and the general consensus is that laparoscopic management offers both economic and aesthetic advantages, and should be used whenever possible. Salpingectomy (excision of the fallopian tube containing the ectopic) is performed if the contra-lateral tube is healthy, while salpingotomy (linear incision made in the fallopian tube with removal of ectopic pregnancy and conservation of tube) is performed if the contra-lateral tube is unhealthy. Medical therapy using methotrexate given systemically or injected directly into the ectopic pregnancy is an option occasionally used with good results. There appear to be no major differences in subsequent fertility outcomes, or risk of recurrence of ectopic pregnancy, between the surgical or medical treatments. Although the rates of ectopic pregnancy are not falling in the developed world, mortality and morbidity are falling mainly due to early and improving diagnostic and treatment modalities. Mass screening and treatment of Chlamydia in the young, sexually active populations, and education regarding risk factors, may in future result in a reduction in the rates. Lack of resource mean that the picture may remain dismal for some time to come in the developing world, but the development of basic protocols, improved training and the infusion of basic resources may go a long way to improving the situation.

Bladder injuries during cesarean section in a University Hospital: a 25-year review

Abstract: Objectives The objective was to determine the prevalence of bladder injury during cesarean section (CS) and identify the risk factors causing these injuries, their management and the outcome.

The sexual activity during pregnancy among a group of Iranian women.

Abstract: Background Pregnancy is the best time in a woman’s life. Hormonal and physiological changes influence women’s well-being, mood, and sexual behavior.

The effects of microwave emitted by cellular phones on ovarian follicles in rats.

Abstract: The aim of this study was to investigate whether there were any toxic effects of microwaves of cellular phones on ovaries in rats. In this study, 82 female pups of rats, aged 21 days (43 in the study group and 39 in the control group) were used. Pregnant rats in the study group were exposed to mobile phones that were placed beneath the polypropylene cages during the whole period of pregnancy. The cage was free from all kinds of materials, which could affect electromagnetic fields. A mobile phone in a standby position for 11 h and 45 min was turned on to speech position for 15 min every 12 h and the battery was charged continuously. On the 21st day after the delivery, the female rat pups were killed and the right ovaries were removed. The volumes of the ovaries were measured and the number of follicles in every tenth section was counted. The analysis revealed that in the study group, the number of follicles was lower than that in the control group. The decreased number of follicles in pups exposed to mobile phone microwaves suggest that intrauterine exposure has toxic effects on ovaries. We suggest that the microwaves of mobile phones might decrease the number of follicles in rats by several known and, no doubt, countless unknown mechanisms.

Imatinib use during pregnancy and breast feeding: a case report and review of the literature

Abstract: Introduction The development of imatinib as a therapeutic agent targeting BCR-ABL has increased the treatment options for chronic myeloid leukemia (CML) by significantly impacting outcomes, and imatinib is recommended by treatment guidelines as the first-line therapy. However, treatment of maternal CML with imatinib during gestation is not recommended because of the potential risk to the fetus.

Diagnosis and laparoscopic management of 11 consecutive cases of cornual ectopic pregnancy

Abstract: To determine the pre-operative diagnosis by two dimensional ultrasound scan and the outcome of the laparoscopic management of cornual ectopic pregnancy. Prospective database cohort study. Whipps Cross University Hospital, UK (District General Hospital). Eleven patients with cornual ectopic pregnancy presenting in our hospital between January 2003 and December 2007. Laparoscopic cornuostomy or cornual resection. Pre-operative diagnosis by ultrasound scan, conversion rate to laparotomy, successful laparoscopy (not requiring further treatment), complication rate and duration of hospital stay. The mean gestational age was 8 ± 2 weeks. All 11 patients presented with abdominal pain and vaginal bleeding and two (18%) patients became haemodynamically unstable before laparoscopy. There were five (45%) patients with risk factors for ectopic pregnancy. The mean serum β-human chorionic gonadotropin (β-hcg) was15,263 ± 12,045 μm/ml. One patient did not have a transvaginal scan as it was decided to proceed to surgery on clinical grounds. The diagnosis of ectopic pregnancy was correct at initial scan in nine (90%) of the ten patients who had transvaginal scans as one patient was misdiagnosed at the first scan. However, an ectopic pregnancy was diagnosed on a second ultrasound scan assessment. Initial laparoscopy was negative in one of the nine patients diagnosed as having an ectopic pregnancy. The diagnosis was later confirmed following serial serum β-hcg monitoring, a repeat scan and a second laparoscopy. Ten (91%) of the 11 patients had successful operative laparoscopy as one (9%) patient had conversion to laparotomy. Among patients who had laparoscopic surgery, cornuostomy was performed in three (30%) patients while cornual resection was performed in the other seven (70%) patients. One (10%) of the patients who had laparoscopic surgery needed further treatment with systemic methotrexate. This patient had a cornual resection and was the only complication following laparoscopic surgery. The mean hospital stay was 2 days. This presentation of one of the larger series of patients with cornual ectopic pregnancy managed by laparoscopic surgery reveals that experience at ultrasonography and laparoscopic technique can lead to earlier diagnosis and few cases requiring laparotomy or further treatment. In addition laparoscopic surgery for cornual ectopic is safe and lends itself to conservative approach (cornuostomy) in selected cases.

Intimate partner violence and correlates in pregnant HIV positive Nigerians.

Abstract: Objective To determine the prevalence, types and correlates of intimate partner violence (IPV) in pregnant Nigerian living with HIV.

Colon penetration by a copper intrauterine device: a case report with literature review

Abstract: The present case report describes colon injury subsequent to uterine penetration which is associated with the use of an intrauterine device (IUD). A 29-year-old multiparous woman, who presented with vague abdominal pain, had a TCu 380A inserted at her postpartum third month visit. The T-shaped segment of the IUD was found to be lodged within the lumen of a colon segment which was 60 cm far from the ileocecal valve. The vertical copper-bearing limb of the IUD extruded from the colon wall beyond the mesenteric edge and partially penetrated the fundal wall. After the affected colon segment was resected, an end-to-end anastomosis was made. Recovery period was uneventful. The incidence of uterine penetration is affected by the IUD type, the timing of insertion related to pregnancy termination, the position of uterus, insertion technique, the experience of the operator and the follow-up period. The location of missing IUDs can be determined by ultrasonography, X-ray or computed tomography imaging.

High mean platelet volume, low-grade systemic coagulation and fibrinolytic activation are associated with androgen and insulin levels in polycystic ovary syndrome.

Abstract: Objectives The present study was designed to determine (a) the coagulation parameters, WBC and MPV levels; (b) whether there was any association between androgen and mean platelet volume and low-grade systemic coagulation in PCOS patients.

Obstetric morbidity and the diagnostic dilemma in pregnancy in rudimentary horn: retrospective analysis.

Abstract: Background Pregnancy in rudimentary horn of uterus, a form of ectopic gestation, is associated with significant rates of morbidity and mortality. Despite the recent advances in the ultrasonography, diagnosis of cornual pregnancy still remains elusive; with confirmatory diagnosis usually made during laparotomy. The aim of the present study is to analyze the obstetric implications and the diagnostic dilemma of rudimentary horn pregnancy.

The role of thrombocytosis in prognostic evaluation of epithelial ovarian tumors.

Abstract: Background Thrombocytosis has been reported in a variety of solid tumors, including certain gynecologic cancers such as endometrial, vulvar, and cervical cancers. The present study aims to determine the incidence of thrombocytosis in women with epithelial ovarian tumors and to evaluate its association with clinical and pathologic prognostic factors.

Neonatal outcome in preterm deliveries between 23 and 27 weeks' gestation with and without preterm premature rupture of membranes.

Abstract: To characterize neonatal morbidity and mortality rates in extreme preterm deliveries (between 23 and 27 weeks’ gestation) with and without PPROM, and to evaluate the association between PPROM and chorioamnionitis. A retrospective population-based study was conducted on preterm singleton pregnancies delivered between 23 and 27 weeks’ gestation from 1988 to 2007. Immediate neonatal morbidity and mortality rates in pregnancies complicated by PPROM were compared to pregnancies with intact membranes. A multivariate analysis was conducted in order to determine the independent association between PPROM and chorioamnionitis. Out of 1,437 preterm deliveries, 236 (16.4%) were complicated with PPROM. There were more neonates with low 1 min (61.0 vs. 42.5%; P = 0.001) and low 5 min (30.1 vs. 23.8%; P = 0.042) Apgar scores (of less than 7) in pregnancies complicated by PPROM than in the comparison group. There were more cases of chorioamnionitis in the PPROM group born at 23–24 weeks’ gestation (33.8 vs. 17.0%; P < 0.001), and in the PPROM group born at 25–27 weeks (42.0 vs. 15.5%; P < 0.001). In the group born at 23–24 weeks’ gestation, there were more postpartum deaths (PPD) in the PPROM group (70.0 vs. 54.8%; P = 0.013); however, there was no significant difference in PPD in the groups born at 25–27 weeks. In the group born at 23–24 weeks, as well as at 25–27 weeks, there were fewer antepartum deaths (APD) in the PPROM group as compared to the control group (16.3 vs. 32.6%; P = 0.002, and 5.3 vs. 36.3%; P < 0.001; respectively). After adjusting for gestational age and gender, using a multivariate analysis, the association between PPROM and chorioamnionitis remained significant (OR = 3.32; 95% CI 2.43–4.51, P < 0.001). PPROM is associated with adverse perinatal outcome in deliveries between 23 and 27 weeks’ gestation. Moreover, PPROM is an independent risk factor for chorioamnionitis.

Screening for gestational diabetes: usefulness of clinical risk factors

Abstract: There is little consensus regarding selective or universal screening for gestational diabetes. The aim of this study is to determine the influence of risk factors on incidence of GDM in Iranian population by using 75 g OGTT. At the first prenatal visit, 924 pregnant women were assessed for age, BMI, obstetric history, family history of diabetes, and diagnosis of polycystic ovary syndrome before pregnancy. All eligible women underwent 2-h 75 g oral glucose tolerance test. Gestational diabetes was diagnosed according to American Diabetes Association criteria. During study period, 68 [7.4% (95% CI 5.9–9.2)] cases of GDM were found. Age, pre-pregnancy BMI, and family history of DM were the independent clinical predictors of GDM. In women with age <25, BMI ≤ 24.9, and negative family history for diabetes, the risk of GDM was 0.008 (0.001–0.044). This risk increased to 0.250 (0.102–0.495) in women with age ≥30, BMI ≥ 30 and positive family history for diabetes. With selective screening and without screening in low risk group, we will do 13.6% (126 of 924) less screening tests while missing potentially 1.5% (1 of 68) of GDM cases. Age, BMI, and family history of diabetes were independent risk factors in developing gestational diabetes. Concerning these factors, we do not miss substantial number of GDM cases with selective screening.

Prevalence of urinary incontinence and other urological problems during pregnancy: a questionnaire based study

Abstract: Objective To find out the prevalence of various urological symptoms in pregnant women, the status before pregnancy, and their perceived impact

Severe acute obstetric morbidity (near-miss): a review of the relative use of its diagnostic indicators

Abstract: Objective To assess the most commonly employed diag-nostic indicators of severe maternal morbidity (obstetric near-miss). Methods Review of the literature from January 1989 to August 2008. Results Fifty-one manuscripts met the eligibility criteria, and 96 indicators were utilized at least once. Admission to intensive care unit (n= 28 studies) was the indicator most frequently utilized, followed by eclampsia and hemorrhage (n= 27), blood transfusion (n= 26) and emergent hysterec-tomy (n=24). Conclusion Considering these Wndings, a trial version of a 13-item instrument for diagnosing obstetric near-miss is proposed. It includes the indicators eclampsia, severe hypertension, pulmonary edema, cardiac arrest, obstetrical hemorrhage, uterine rupture, admission to intensive care unit, emergent hysterectomy, blood transfusion, anesthetic accidents, urea >15 mmol/l or creatinine >400 mmol/l, oli-guria (<400 ml/24 h) and coma. Further studies should focus on consensual deWnitions for these indicators and evaluate the psychometric proprieties of this trial version.

Computer-aided detection mammography for breast cancer screening: systematic review and meta-analysis

Abstract: Mammography is generally accepted as the best available breast cancer screening method; however, some cancers detectable on mammography images are missed. Computer-aided detection (CAD) systems for mammography are intended to reduce false negatives by marking suspicious areas of the mammograms for reviewers to consider. Although the prospect of improving the sensitivity of screening mammograms has led to the diffusion of CAD for mammography, little is known about its diagnostic accuracy. To assess the diagnostic performance of CAD for screening mammography in terms of sensitivity and specificity and incremental recall, biopsy, and cancer diagnosis rates. Published literature identified by systematic literature searches of 17 databases, including MEDLINE, EMBASE, and the Cochrane Library, searched through 25 September 2008. A reviewer and an information specialist selected full-length English-language articles that enrolled asymptomatic women for routine breast cancer screening and provided data needed for our analyses using criteria established a priori. We identified 75 potentially relevant publications, of which 7 (9%) were included. Data were extracted and internal validity was assessed by a single review author, and forms were approved by the co-authors. Three studies (n = 347,324) reported sensitivity and specificity, or data to calculate them, and five studies (n = 51,162) reported data to calculate incremental rates of cancer diagnoses and recall and biopsy of women who did not have breast cancer. The pooled sensitivity was 86.0% (95% CI 84.2–87.6%) and specificity was 88.2% (95% CI 88.1–88.3%). Of the 100,000 women screened, CAD yielded an additional 50 (95% CI 30–80) correct breast cancer diagnoses, 1,190 (95% CI 1,090–1,290) recalls of healthy women, and 80 (95% CI 60–100) biopsies of healthy women. A total of 96% (95% CI 93.9–97.3%) of women recalled based upon CAD and 65.1% (95% CI 52.3–76.0%) of women biopsied based upon CAD were healthy. No studies reported patient-oriented clinical outcomes.

Predicting fetal asphyxia in intrahepatic cholestasis of pregnancy

Abstract: Intrahepatic cholestasis of pregnancy (ICP) is a disease associated with high-perinatal morbidity and mortality rates. It is important to have parameters that aid in predicting fetal outcomes. Certain parameters affecting asphyxia in newborns to mothers with ICP are evaluated in this study. One hundred eighty-seven cholestatic pregnancies were analyzed, retrospectively. Fetal asphyxia was defined as an APGAR score of less than 7 at 5 min postpartum. Predictors of asphyxia in ICP were analyzed by binary multivariate logistic regression analysis. Thirty-six of the cholestatic pregnancies ended up having an asphyctic newborn at the time of delivery (19.2%). There was a statistically significance difference in the levels of total bile acids (TBA) (42.4 ± 15.2 vs. 33.8 ± 12.9 μmol/L, P < 0.01), HDL cholesterol (54.2 ± 15.9 vs. 61.3 ± 12.2, P = 0.01), total cholesterol (279.0 ± 51.4 vs. 257.7 ± 51.6, P = 0.02), and triacylglycerol (299.4 ± 94.6 vs. 260.4 ± 118.7) between the asphytic and nonasphytic group. Binary multivariate logistic regression analysis demonstrated that TBA levels (OR 1.04, 95% CI 1.01–1.08, P = 0.03) and exposure time (OR 1.11, 95% CI 1.05–1.17, P < 0.01) were the most important independent variables predicting fetal asphyxia in ICP. In this study, it has been demonstrated that for the evaluation of fetal status, increased TBA levels in the mother and increased exposure time for the fetus to these increased values of TBA within the maternal circulation system help to predict increased risk of asphyxia in newborns to ICP mothers.

Endometrial effects of letrozole and clomiphene citrate in women with polycystic ovary syndrome using spiral artery Doppler

Abstract: Objectives To compare the effects of letrozole and clomiphene citrate (CC) on endometrial response in PCOS using subendometrial spiral artery Doppler.

Status of essential trace metals in biological samples of diabetic mother and their neonates

Abstract: There is accumulating facts that the metabolism of essential trace elements is altered in diabetic patients. The aim of present study was to compare the status of essential trace elements, chromium (Cr), manganese (Mn), and zinc (Zn) in biological samples (whole blood, urine and scalp hair) of insulin dependent diabetic mothers (age ranged 30–40) and their newly born infants (n = 76). An age matched 68 non-diabetic mothers and their infants, residing in the same locality, were selected as referents. For a comparative study, the biological samples of non-diabetic and diabetic pregnant and non pregnant of same age group and socio-economics status were also analysed. The biological samples (scalp hair, blood and urine) were collected from study and referent groups. The Cr, Mn and Zn concentrations in all three biological samples were determined by a flame/electrothermal atomic absorption spectrometer, prior to microwave assisted acid digestion. The validity and accuracy of the methodology was checked by certified reference materials (CRMs) and using conventional wet acid digestion method on same CRMs. The mean values of Cr, Mn and Zn in scalp hair and blood samples of diabetic mothers and their infants were significantly lower as compared to the referent mothers-infants pairs (p < 0.01), while urinary excretion of all these elements were high in diabetic mother–infant pair samples. The deficiencies of essential trace elements, Cr, Mn and Zn in biological samples of diabetic women, may play role in the pathogenesis of diabetes mellitus and impacts on their neonates.

Cytokine and immune cell levels in peritoneal fluid and peripheral blood of women with early- and late-staged endometriosis.

Abstract: To investigate the level of cytokines and immune cells in the peripheral blood (PB) and peritoneal fluid (PF) of different stages of endometriosis. A prospective study was conducted to include 97 women with (n 60) and without (n 37) histopathologically confirmed endometriosis. Based on rASRM classification, stage I/II and stage III/IV were categorized as early-and late-staged endometriosis. Prior to surgery, 10 ml of blood was withdrawn from antecubital vein and serum was obtained. Aliquots were made and stored at −70°C until assayed for cytokines. PF was aspirated from the pouch of Douglas. Peripheral and PF samples were analyzed by ELISA in terms of IL-2, IL-4, IL-10 and IFN-γ. Determinations of T helper, T suppressor, NK, and B cells were assessed by using cluster determinant-3 (CD-3), CD4, CD8, CD25, CD28, CD45, CD16, CD23 and antibodies against early T cell activation antigens such as CD45RA/CD45RO, CD-69 and late activation antigens such as HLA-DR. A multiparameter flow cytometry was applied to detect the cell activation antigen expression. In terms of cytokine levels in PB and PF’s of control group and early- and late-staged endometriosis cases, no significant difference was depicted in the cytokine levels (p > 0.05). Levels of immune cells did not differ between three groups (p > 0.05). The result of this study did not show any significant difference in PB and PF cytokine and lymphocyte subgroups between normal and early- and late-staged endometriosis.

Best evidence continuous medical education.

Abstract: Health care professionals need to approach their profession with a view to life long learning. They need to develop a strategy to meet their learning needs in a reflective and effective manner. Continuous medical educational (CME) is the traditional tool for learning and updating knowledge. Most of them are in the forms of courses, conferences, journal clubs and workshops. They are mostly didactic sessions and evidence suggests that they are not effective to improve the clinical skills and attitude. Systematic review of teaching evidence-based medicine shows that interactive and clinically integrated learning is the most effective form of learning. It enhances knowledge and skills. Professionals should view CME in a holistic manner in the context of continuous professional development (CPD) and even in the wider concept of knowledge translation, which encompasses both CME and CPD. e Learning is one of the most important forms of non-traditional CME. It provides an efficient and increasingly interactive delivery system that can handle complex and layered information. More work needs to be done to see its effectiveness for practising clinicians.

Tumor markers in mature cystic teratomas of the ovary.

Abstract: Objective The objective of this study was to evaluate the serum levels of tumor markers in patients with ovarian mature cystic teratomas.

Caffeine in pregnancy.

Abstract: Caffeine is probably the most frequently ingested pharmacologically active substance in the world. It is found in common beverages (coffee, tea, soft drinks), in products containing cocoa or chocolate, and in medications. Because of its wide consumption at different levels by most segments of the population, the public and the scientific community have expressed interest in the potential for caffeine to produce adverse effects on human health. Reproductive-aged and pregnant women are ‘at risk’ subgroups of the population who may require specific advice on moderating their daily caffeine intake. This article highlights the implications of caffeine intake in pregnancy, reviews the latest evidence-based information available on this subject, and offers recommendations (practical advice) for the obstetrician–gynecologists proving peripartum care to these potentially complicated pregnancies.