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Background: Cervical ripening of an unfavorable cervix can be achieved by placement of a transcervical catheter. Advantages of this method include both lower cost and lower risk of tachysystole than other methods. Despite widespread use with varying degrees of applied tension, an unanswered question is whether there is an advantage to placing the transcervical catheter to tension compared with placement without tension., Objective: The purpose of this study was to determine whether tension placed on a transcervical balloon catheter that is inserted for cervical ripening results in a faster time to delivery., Study Design: This was a prospective, randomized controlled trial; 140 women who underwent cervical ripening (Bishop score, ≤6) were assigned randomly to a balloon catheter with applied tension vs no tension. Tension was created when the catheter was taped to the patient's thigh and tension was reapplied in 30-minute increments. There were 67 patients in the tension group and 73 patients in the no tension group. Low-dose oxytocin (maximum, 6 mU/min) was administered after catheter placement. The primary outcome was time from catheter insertion to delivery. A secondary outcome was time from insertion to catheter expulsion. The Kolmogorov-Smirnov test was used to determine whether the data were distributed normally. Survival curves that used lifetables were constructed from time of catheter insertion to delivery and from time of catheter insertion to catheter expulsion and were compared with the use of the Wilcoxon (Gehan) Breslow statistic. A probability value of <.05 was set to denote statistical significance., Results: Baseline characteristics were similar between groups. The median time from catheter insertion to delivery was not significantly different between the tension group and the no tension group (16.2 vs 16.9 hours; P=.814). The median time from catheter insertion to expulsion, however, was significantly less in the tension group vs the no tension group (2.6 vs 4.6 hours; P<.001), respectively. Vaginal delivery within 24 hours was not significantly different between the tension and no tension groups (41/52 [79%] vs 37/52 [71%]; P=.365) nor were there significant differences in cesarean delivery rates between the tension and no tension groups (17/67 [25%] vs 27/73 [37%]; P=.139)., Conclusion: Application of tension did not result in faster delivery times but did result in faster times to catheter expulsion., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Surgical site infections (SSIs) are an important cause of morbidity following cesarean delivery, particularly in obese patients. Methods to reduce SSIs after cesarean delivery would have an important impact in obese obstetric patients., Objective: The purpose of this study was to determine whether the Alexis O cesarean delivery retractor, a barrier self-retaining retractor, reduces SSIs and wound disruptions in obese patients undergoing cesarean delivery., Study Design: This was a randomized controlled trial of obese women (body mass index ≥ 30 kg/m(2)) undergoing nonemergent cesarean delivery. Patients were randomized to the treatment group (using the Alexis O cesarean delivery retractor) or to the control group (using conventional handheld retractors). The primary outcome was SSI or wound disruption during the 30 day postoperative period. Secondary outcomes included operative time, estimated blood loss, change in hemoglobin, antiemetic use, length of postoperative hospital stay, hospital readmission, and other postoperative complications., Results: A total of 301 patients were enrolled in the study. One hundred forty-four patients were randomized to the treatment group and 157 to the control group. Baseline characteristics and indications for cesarean delivery were similar between the 2 groups. Median body mass index was 40.1 kg/m(2). There were no significant differences between the treatment and the control group in the primary outcome of SSI or wound disruption rates at the 30 day assessment (20.6% vs 17.6%, P = .62), during the postoperative inpatient hospitalization or at the 1-2 week postoperative visit. There were also no differences in the primary outcome when adjusting for obesity class or thickness of the subcuticular layer. Patients in the treatment group had lower rates of uterine exteriorization (54.3% vs 87.3%, P < .001), but there were no differences in all other outcomes., Conclusion: Use of the Alexis retractor in cesarean delivery deliveries did not decrease SSI or wound disruption rates in an obese population. Its use as a retractor should be left to the discretion of the surgeon and clinical circumstances., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: Women commonly experience low back pain during pregnancy. We examined whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to reduce pain, impairment, and disability in the antepartum period., Study Design: A prospective, randomized trial of 169 women was conducted. Baseline evaluation occurred at 24-28 weeks' gestation, with follow-up at 33 weeks' gestation. Primary outcomes were the Numerical Rating Scale (NRS) for pain and the Quebec Disability Questionnaire (QDQ). Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants., Results: The MOM group demonstrated significant mean reductions in Numerical Rating Scale scores (5.8 ± 2.2 vs 2.9 ± 2.5; P < .001) and Quebec Disability Questionnaire scores (4.9 ± 2.2 vs 3.9 ± 2.4; P < .001) from baseline to follow-up evaluation. The group that received standard obstetric care demonstrated no significant improvements., Conclusion: A multimodal approach to low back and pelvic pain in mid pregnancy benefits patients more than standard obstetric care., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Objective: To determine whether survival is different in "early" (23(0/7)-23(3/7) weeks) vs "late" (23(4/7)-23(6/7) weeks) infants., Study Design: Records of 126 consecutive liveborn infants delivered at 23(0/7) to 23(6/7) weeks' gestation from 2001-2010 were examined using the Vermont Oxford Network database. Infants born at 23 0/7 to 23 3/7 weeks were grouped into "early" and those at 23 4/7 to 23 6/7 weeks were "late." Clinical characteristics were compared between groups and multivariate analyses were used to predict survival., Results: Seventy-two infants were early and 54 were late. Survival was 25% vs 56%, respectively (P < .001). The early group was less likely to receive steroids (43% vs 65%; P = .016) and had a lower mean birthweight (547 g vs 596 g; P < .001). No difference in other factors was seen between groups. No change in survival was observed during the study period in either group., Conclusion: Late 23-week infants have improved survival compared with early infants. Delaying delivery as little as 24-96 hours may improve survival for 23-week infants., (Copyright © 2012 Mosby, Inc. All rights reserved.)

Objective: We assessed the screening and remediation of home lead hazards prenatally in a high-risk population, hypothesizing that average blood-lead level and the number of poisonings would drop by 25%., Study Design: One hundred fifty-two women underwent prenatal home inspections by certified lead inspectors. The hazards that were identified were remediated. The blood-lead levels of children of participating women were compared with matched control subjects., Results: Blood-lead levels were obtained from 60 children and compared with matched control subjects. The average blood-lead level of children in the treatment group was 2.70 μg/dL vs 3.73 μg/dL in control subjects (P = .019). The percentage of children with levels >10 μg/dL in the treatment group was 0% vs 4.2% in control subjects (P = .128)., Conclusion: Screening and remediation of houses of pregnant women is effective to reduce the average blood-lead level and number of children that exceed the federal level of concern for lead poisoning in a high-risk population., (Copyright © 2012 Mosby, Inc. All rights reserved.)

Background: The surfactant/albumin ratio is a popular fetal lung maturity (FLM) test that will be unavailable in the near future. We conducted surveys of obstetricians and clinical laboratorians to assess FLM testing trends from the perspectives of both disciplines and to identify how both communities might adapt to the loss of the surfactant/albumin ratio., Methods: 2067 physicians were surveyed about their familiarity with and clinical utility of various FLM tests. 6137 laboratorians were surveyed about their FLM test menu and volumes., Results: Twenty-five percent of physicians indicated a decrease in FLM test ordering and the frequency of FLM testing has decreased significantly (p=0.011) since 1998. The surfactant/albumin ratio is the most frequently offered FLM test and was the test of choice for 62% of physicians. Without the surfactant/albumin ratio, 68% of physicians would order the lecithin/sphingomyelin ratio and 44% would order the lamellar body count (LBC) which were offered by 18 and 13% of laboratories, respectively. 16% of laboratories were planning to offer the LBC within 24 months., Conclusions: FLM testing is decreasing. The loss of the surfactant/albumin ratio will increase the demand for the lecithin/sphingomyelin ratio and the LBC, yet few laboratories offer either test and most are not planning to offer the LBC., (2010 Elsevier B.V. All rights reserved.)

Objective: To estimate the effect of antenatal glucocorticoid administration on fetal lung maturity in pregnancies with known fetal lung immaturity between the 34th and 37th weeks of gestation., Study Design: Pregnancies between 34(0/7) and 36(6/7) weeks undergoing amniocentesis to determine fetal lung maturity were targeted. Women with negative results (TDx-FLM-II <45 mg/g) were randomly assigned to intramuscular glucocorticoid injection or no treatment. A repeat TDx-FLM-II test was obtained 1 week after enrollment., Results: Thirty-two women who met inclusion criteria were randomly assigned. Seven women delivered within a week of testing for fetal lung maturity, and were excluded from the analysis. Ten received glucocorticoid and 15 did not. Women assigned to glucocorticoids had a mean increase TDx-FLM-II in 1 week of 28.37 mg/g. Women assigned to no-treatment had an increase of 9.76 mg/g (P < .002)., Conclusion: A single course of intramuscular glucocorticoids after 34 weeks in pregnancies with documented fetal lung immaturity significantly increases TDx- FLM-II., (Copyright (c) 2010 Mosby, Inc. All rights reserved.)

Objective: We tested the hypothesis that short interpregnancy intervals (IPIs) increase the risk for preterm birth (PTB), recurrence of PTB, and delivery at early extremes of gestational age., Study Design: Using the Missouri Department of Health's birth certificate database, we performed a population-based cohort study of 156,330 women who had 2 births from 1989-1997. The association between IPI and subsequent pregnancy outcome was assessed., Results: The shortest IPIs (<6 months) increased the risk of extreme PTB (adjusted odds ratio, 1.41; 95% CI, 1.13-1.76). IPIs of <6 months and 6-12 months increased the overall risk of PTB (adjusted odds ratios, 1.48 [95% CI, 1.37-1.61] and 1.14 [95% CI, 1.06-1.23], respectively) and PTB recurrence (adjusted odds ratios, 1.44 [95% CI, 1.19-1.75] and 1.24 [95% CI, 1.02-1.50], respectively)., Conclusion: The risk of PTB and its recurrence increases with short IPIs, even after adjustment for coexisting risk factors. This highlights the importance of counseling women with either an initial term or preterm birth to wait at least 12 months between delivery and subsequent conception.

Objective: We compared the safety of celecoxib, a selective cyclo-oxygenase-2 inhibitor, with the safety of the nonselective cyclo-oxygenase inhibitor indomethacin, when it was administered for treatment of preterm labor., Study Design: In a randomized, double-blind, placebo-controlled trial, 24 pregnant women in preterm labor at 24 to 34 weeks of gestation received either indomethacin or celecoxib for 48 hours. Clinical assessment, fetal sonography, and Doppler blood flow studies of the fetal ductus arteriosus were performed daily., Results: Mean maximum ductal flow velocity was significantly elevated over baseline (82.9 +/- 4.6 cm/s vs 111.14 +/- 14.3 cm/s; P =.02) after 24 hours of indomethacin, but not celecoxib. Both medications were associated with a transient decrease in amniotic fluid volume, with a greater effect by indomethacin. The medications were equally effective in the maintenance of tocolysis. There were no significant maternal or neonatal adverse events., Conclusion: In this initial evaluation, the safety of short-term celecoxib in women with preterm labor was superior to that of indomethacin.