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Objectives: The purpose of this study was to compare the efficacy of cervical ripening with 2 Foley catheter balloon volumes. Study design: Pregnant women admitted for induction of labor with a term singleton gestation were randomly assigned for cervical ripening by a balloon inflated with 30 mL or 80 mL of sterile saline. Results: Two hundred and three women were included in the analysis. Ripening of the cervix with the larger balloon volume was associated with a significantly higher rate of post-ripening dilatation of 3 cm or more (76.0% vs 52.4%, P < .001). In primiparous women, the larger balloon volume resulted in a significantly higher rate of deliveries by 24 hours (71.4% vs 49%, P < .05), and a significantly less requirement of augmentation with oxytocin (69.3% vs 90.4%, P < .05). Conclusion: Ripening of the unfavorable cervix in primiparous women with a Foley catheter balloon inflated with 80 mL provided effective more dilatation, faster labor, and decreased need for oxytocin than with a balloon inflated with 30 mL of sterile saline. [ABSTRACT FROM AUTHOR]

: ObjectivesRipening of the cervix with a Foley catheter commonly results in cervical dilatation without contractions. We examined the outcome of labour in women who underwent induction of labour using a Foley catheter, followed by either 1. early amniotomy, or 2. augmentation of labour by oxytocin and late amniotomy: DesignProspective randomised clinical trial: SettingLabour and delivery ward of a university teaching hospital: ParticipantsPregnant women ≥38 weeks of a singleton gestation, who had had no prior caesarean section: MethodsAll women underwent cervical ripening using a Foley catheter. Following removal of the catheter, women were randomly assigned to either early (n = 80) or late amniotomy (n = 88).Main outcome measures Comparison of mode of delivery and duration of labour between the two groups: ResultsThe rate of caesarean section was significantly higher in the early amniotomy group compared with the late amniotomy group (25% vs 7.9%; relative risk 1.74; 95% CI 1.3 – 2.34). The increase in caesarean section rate was due primarily to dystocia (15% vs 3.3%; relative risk 1.8; 95% CI 1.32 – 2.45). When excluding caesarean deliveries, no significant difference was found in duration of labour between the groups (8.3 hours (3.8) vs 7.7 hours (2.9)): ConclusionsIn women who undergo cervical ripening with a Foley catheter, augmentation of labour by oxytocin followed by amniotomy during active labour results in a lower rate of caesarean delivery for dystocia [ABSTRACT FROM AUTHOR]

Abstract: Objective:: To compare maternal and neonatal morbidity associated with two methods to extract the impacted fetal head during Cesarean delivery. Study design:: We retrospectively analyzed cases with difficult extraction of the impacted fetal head during Cesarean section. We compared maternal and neonatal outcomes between cases that were delivered by head extraction following pushing through the vagina (‘push’ method) and those that were delivered by the reverse breech technique (‘pull’ method). Results:: We reviewed 3105 Cesarean section reports. Difficult extraction necessitating the ‘push’ or ‘pull’ methods was noted in 48 (1.5%) instances. Women that were delivered by the ‘pull’ method had significantly lower rate of postpartum fever (5% versus 46%; odds ratios, 0.06; 95% confidence intervals, 0.007–0.51) and extensions of the uterine incision (15% versus 50%; odds ratio, 0.17; 95% CI, 0.04–0.74) compared to those that were delivered by the ‘push’ method. Neonatal outcomes were good in all cases. Conclusions:: In cases with difficult extraction of the impacted fetal head during Cesarean section, ‘pull’ method may result in lower maternal morbidity compared to the traditional ‘push’ method. [Copyright &y& Elsevier]

Background IgE-mediated cow's milk–allergic (IgE-CMA) patients provide a valuable model for studying the relationship between dairy intake and bone mineral density (BMD) because they are unable to consume even minor amounts of dairy foods. Objective To determine the effects of dairy restriction on BMD in young adult IgE-CMA patients. Methods A prospective observational study was conducted from July 2012 to June 2013 at the Allergy unit of the Assaf-Harofeh Medical Center. Densitometric measurements of postpubertal patients diagnosed with IgE-CMA (group I, n = 33) were compared with those of volunteers matched for age and sex without IgE-CMA (control group II, n = 24). In a second analysis, group I and II patients were compared with IgE-CMA patients who after desensitization consumed milk for 12 to 39 months before analysis (group III, n = 12). Results Densitometric measurements (average T scores and Z scores) of the hip, femoral neck, and lumbar spine of IgE-CMA patients were significantly lower than of those in the control group ( P < .0001). A T score below −2.5 SD, identifying a risk for osteoporosis, was found in 27% of IgE-CMA patients but in none of the controls ( P = .0071). Calcium intake was severely reduced in allergic patients than in controls ( P < .0001). BMD measurements in group III were significantly greater than in group I ( P < .0001) and unchanged from the control group. Conclusions Patients with IgE-CMA have a significant risk of reduced BMD and early osteoporosis, which appears to be reversible on milk desensitization. Adequate calcium intake is not achieved while on a nondairy diet, requiring investigation into optimal nutritional protocols for these patients. [ABSTRACT FROM AUTHOR]

Objectives: To determine the pre-malignant and malignant potential of endometrial polyps and to assess whether different clinical parameters are associated with malignancy in the polyps. Study design: Four hundred and thirty consecutive cases of hysteroscopic diagnosis of endometrial polyp were retrieved. The medical records, preoperative vaginal sonography results and histopathology findings were reviewed. Statistical analysis was performed. Results: Hysteroscopy truly identified endometrial polyps in 95.7% of the cases. In 11.4% cases, hyperplasia without atypia was found in the endometrial polyp. In 3.3 and 3.0% of women pre-malignant or malignant conditions were found in the polyp. Older age, menopause status and polyps larger than 1.5 cm were associated with significant pre-malignant or malignant changes, although the positive predictive value for malignancy was low. All the malignant polyps were diagnosed only in postmenopausal women. The presence of postmenopausal or irregular vaginal bleeding, was not a predictor of malignancy in the polyp. Conclusions: Postmenopausal women with endometrial polyps are at increased risk of malignancy in the polyp. Those patients, whether symptomatic or not should be evaluated by hysteroscopic resection of the polyps. Asymptomatic premenopausal patients with polyps smaller than 1.5 cm can be observed. [Copyright &y& Elsevier]