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A study is conducted to determine whether unscheduled cesarean deliveries have complication rates that vary by shift of occurrence, and morbidities are evaluated by delivery shift hypothesizing that such complications would be more frequent during the night shift (11 PM-7 AM) due to sleep deprivation of staff. Results indicate that though neonatal intensive care unit admissions increase at night, maternal and neonatal complications of cesarean delivery do not increase with delivery during the night shift.

The rate of successful trial of labor after previous cesarean delivery for dystocia is assessed in a large cohort based on the relative birth weights of the two pregnancies. It is likely that increased fetal size relative to previous birth weight plays a significant role in the outcome of a subsequent trial of labor for patients with previous cesarean delivery for dystocia, reducing chances of vaginal delivery.

The success rates of vaginal birth after cesarean (VBAC) delivery, uterine rupture and major maternal/perinatal outcomes are compared between women, with previous cesarean deliveries undergoing trial of labor (TOL) with preterm and term pregnancies, and also maternal and neonatal morbidities in women with preterm pregnancies undergoing a TOL versus repeat cesarean delivery without labor (RCD). The likelihood of VBAC success after TOL in preterm pregnancies is comparable to term gestations, with a lower risk of uterine rupture, and perinatal outcomes are similar with preterm TOL and RCD.

A study was undertaken to determine whether women with recurrent spontaneous preterm births (rSPBs) having different clinical characteristics or systemic markers than those with isolated preterm (iSPBs) or recurrent term births (rTBs), when assessed remote from delivery. Women with rSPBs are leaner, contract more, have shorter cervixes, and have more advanced Bishop scores than women with iSPBs or rTBs.

A study was conducted to characterize risk factors associated with nonanomalous stillborn (SB) infants and to ascribe the probability of fetal survival by gestational age among high-risk pregnancies on a compiled database of all SB infants and an equivalent number of controls. The result showed that SB in nonanomalous infants in Utah is more common among pregnancies complicated by placental abruption, hydramnios, cord prolapse, and essential hypertension.

A study was conducted to estimate whether midpregnancy genitourinary tract infection with Chamydia trachomtis is associated with an increased risk of subsequent preterm delivery. The results revealed that the treatment of Chlamydia trachomtis was not associated with a decreased frequency of preterm birth.

A study is carried out to test the hypothesis that maternal asthma symptoms and pulmonary function are related to adverse perinatal outcomes. It is found that lower pulmonary function during pregnancy is associated with increased gestational hypertension and prematurity in the pregnancies of women with asthma, which can be due to inadequate asthma control or factors that are associated with increased asthma severity.

The frequency of inflammatory cytokine and Toll-like receptor gene polymorphisms in women with and without bacterial vaginosis (BV) in pregnancy is estimated. Results conclude that after controlling for race, polymorphisms at the interleukin (IL) 1beta Exon 5 + 3954, IL6-174, and IL8-845 loci are associated with an altered rate of BV in pregnancy.

The success rates and risks in women with a twin pregnancy who attempt a trial of labor after cesarean delivery are identified. A trial of labor with twins after previous cesarean delivery does not appear to increase maternal morbidity.

The recent population-based trends in maternal overweight and obesity and its adverse outcomes are identified. Study found a significant increase in maternal overweight and obesity, which may result in an increased risk of cesarean delivery, preeclampsia, eclampsia, dystocia and macrosomia.

The relationship between chorioamnionitis and its duration to adverse maternal, fetal and neonatal outcomes is examined. Chorioamnionitis is reported to increasingly cause maternal and neonatal morbidity after cesarean at term.

The comparison of the efficacy of inhaled beclomethasone dipropionate to oral theophylline for the prevention of moderate asthma exacerbations requiring medical intervention are described. The use of corticosteroids for moderate asthma during pregnancy is more effective, as it has improved forced expiratory volume expired in 1 second (FEV1), than theophylline.

Research has been conducted on preterm biths. The authors have investigated early pregnancy markers which could predict preterm births, and they report that women with vaginal pH of 4.5 or greater and Gram stain score of 9 to 10 have increased preterm births.

Having sexual intercourse during pregnancy does not appear to affect the treatment of bacterial vaginosis or the risk of premature birth, according to two large studies of bacterial vaginosis. Bacterial vaginosis is a bacterial infection of the vagina. Some studies suggest that intercourse during pregnancy increases the risk of premature birth but other studies have not confirmed the association.

High blood pressure in the brain rather than increased blood flow may cause the seizures that occur in women with a serious complication of pregnancy called preeclampsia. A study of 192 pregnant women with preeclampsia found that blood flow in the brain was normal but blood pressure was higher than normal.

Fetal pulse oximetry may reduce the rate of cesarean delivery in fetuses with abnormal heart rate patterns, according to a study of 1,010 women. Fetal pulse oximetry involves placing a catheter with an oxygen sensor at the tip inside the vagina. The sensor can measure oxygen levels through the skin on the baby's scalp.

The drug atosiban can delay premature labor for up to seven days, according to a study of 501 pregnant women in premature labor. This drug inhibits oxytocin, a hormone that make the uterus contract. The drug is sold under the trade name Antocin.

Magnesium sulfate appears to lower cerebral perfusion pressure whereas the calcium channel blocker nimodipine increases it. Cerebral perfusion pressure is blood pressure in the brain. Pregnant women with preeclampsia may have high pressure or low pressure and this will determine which treatment should be used. Doppler ultrasound can be used to measure the pressure.

Byline: Michael A. Belfort, George R. Saade, Charlotta Grunewald, Gary A. Dildy, Michael A. Varner, Henry Nisell Keywords: Central retinal artery; Doppler ultrasonography; middle cerebral artery; ophthalmic artery; preeclampsia Abstract: Objective: The object of the study was to test the hypothesis that preeclampsia leads to an abnormal vascular response to increasing blood pressure in cerebral vessels by analyzing the relationship between mean arterial pressure and resistance index in the central retinal, ophthalmic, and middle cerebral arteries in women with normal pregnancies and women with preeclampsia. Study Design: Transcranial and color flow Doppler ultrasonographic studies were used to determine systolic, diastolic, and mean velocities and the resistance indexes in the central retinal, ophthalmic, and middle cerebral arteries in 24 women with normal pregnancies and 18 women with preeclampsia. In each group the relationship between the mean arterial pressure and the resistance index was determined for each artery by means of linear regression analysis. The Pearson correlation coefficients for each mean arterial pressure versus resistance index relationship were compared between the groups. In a separate analysis middle cerebral artery data obtained from 79 women with preeclampsia (with and without headache) were compared with data from the normal pregnancy group and analyzed in terms of the relationship between mean arterial pressure and resistance index. Results: The resistance index in women with normal pregnancies decreased with increasing mean arterial pressure in all 3 vessels studied (ophthalmic artery r = -0.33, central retinal artery r = -0.43, middle cerebral artery r = -0.30). In the women with preeclampsia, however, as mean arterial pressure increased the resistance index increased in the orbital vessels and decreased in the middle cerebral artery (ophthalmic artery r = 0.54, central retinal artery r = 0.65, middle cerebral artery r = -0.25). The correlation coefficients in the women with preeclampsia were significantly different from those in the women with normal pregnancies for the ophthalmic and central retinal arteries (P = .001) but not for the middle cerebral artery (P = .8). Within-group analysis in the patients with normal pregnancies showed no differences between the correlation coefficients of the studied vessels. In the women with preeclampsia the ophthalmic artery (P = .02) and the central retinal artery (P = .005) were significantly different from the middle cerebral artery but not from each other. Women with preeclampsia who had headache had a different correlation coefficient for the middle cerebral artery than did those without headache (r = -0.34 versus r = 0.23; P < .001). The correlation coefficient for the middle cerebral artery for women with preeclampsia without headache was not significantly different from the central retinal artery and ophthalmic artery correlation coefficients in the general preeclampsia group. Conclusions: Women with preeclampsia demonstrate a different relationship between blood pressure and resistance index in the ophthalmic and central retinal arteries than do women with normal pregnancies. In the middle cerebral artery, however, preeclampsia does not appear to affect the resistance index response to increasing mean arterial pressure in women with headache. In women with preeclampsia without headache the relationship seen in the ophthalmic artery and central retinal artery is preserved in the middle cerebral artery. This may indicate a failure in the autoregulatory capacity of the middle cerebral artery in the presence of headache. Alternatively, the resistance index response in the ophthalmic artery and central retinal artery may represent small-caliber vessel vasospasm that is not present in the middle cerebral artery in women with preeclampsia who have headache. (Am J Obstet Gynecol 1999;180:601-7.) Author Affiliation: Salt Lake City, Utah, Galveston, Texas, and Stockholm, Sweden From the Divisions of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, University of Utah School of Medicine,.sup.a The University of Texas Medical Branch at Galveston,.sup.b and the Huddinge Hospital, Karolinska Institute..sup.c Article History: Received 25 June 1998; Revised 16 October 1998; Accepted 29 October 1998 Article Note: (footnote) [star] Supported in part by an American Heart Association Grant-in-Aid Award (M.A.B.) and by grant 9512 from the Swedish Medical Research Council (H.N.)., [star][star] Reprint requests: Michael A. Belfort, MD, Division of Perinatology, Utah Valley Regional Medical Center, 1034 N 500 West, Provo, UT 84604., a 0002-9378/99 $8.00 + 0 6/1/95480

Variations of the tumor necrosis factor-alpha (TNF-alpha) gene do not appear to predispose women to premature labor despite associations with increased TNF-alpha levels during premature labor. Tests of TNF-alpha gene variations were performed on 203 women who delivered prematurely and their premature infants. Results were compared with published genetic frequencies. The T1 and T2 genetic variation frequencies seen in these mothers and infants were similar to those found in the general population.

Mothers who carry the factor V Leiden genetic mutation appear to be at increased risk for miscarriage or blood clots in the placenta. Blood samples from 139 mothers with spontaneous miscarriages, 396 mothers with placental blood clots, and 403 mothers with routine deliveries were analyzed for the factor V Leiden mutation. Women with blood clots covering more than 10% of the placenta were 10 times more likely to carry the mutation than those with less widespread clotting. Women who had miscarried were twice as likely to carry the mutation as those with routine deliveries.

The prevalence of factor V Leiden mutation among childbearing women may indicate the need for prenatal genetic testing to detect the mutation. Presence of the factor V Leiden mutation predisposes women to developing blood clots. Researchers tested DNA from the blood of 407 women who comprised a low-risk obstetric population. Fourteen women (3%) carried the Leiden mutation, and four of these women (28%) developed blood clots in the deep veins. Another woman with the mutation experienced a depletion of clotting factors leading to vaginal bleeding. She required delivery at 20 weeks of pregnancy.

Pregnant women older than 45 years of age may have an uncomplicated pregnancy and delivery. They may, however, be at increased risk for cesarean delivery and their infants may be at greater risk for genetic birth defects. Researchers identified 79 mothers 45 years of age and older who delivered between 1985 and 1994. Forty-seven percent of these women had complications during pregnancy including 10.1% with preeclampsia and 12.7% with gestational diabetes. The cesarean delivery rate in this population was 31.7%. Ten percent of the infants had genetic abnormalities.

Low-dose oxytocin therapy and prostaglandin E2 (PGE2) gel may produce equally good results among women undergoing cervical ripening prior to induction of labor. A group of 158 women beyond 28 weeks gestation undergoing induction with an unfavorable cervix (Bishop score at or below 5) were randomly assigned to PGE2 therapy or low-dose I.V. oxytocin. All women received both therapies, but in one group, the gel contained no PGE2, and in the other, the I.V. contained saline. Two doses of gel were given six hours apart and the I.V. was run for 12 hours. Women with PGE2 ripening were equally likely to have a Bishop score greater than or equal to 6 at time of induction (64% vs. 52%) and to have a vaginal birth (76% vs. 75%). Women were more likely to give birth within 24 hours with PGE2 ripening (64% vs. 47%), but the few hours' difference was not clinically important. Hyperstimulation during cervical ripening occurred only during PGE2 ripening.

Chorion cells appear to produce fibronectin when exposed to endotoxins and components of the immune system. The chorion is the outermost layer of the membrane that contains amniotic fluid. Fibronectin is a glycoprotein that has been associated with premature labor. Endotoxins are toxins contained in the cell walls of some bacteria. They are released when the bacteria die. Chorion cells from placentas were cultured. Some samples were incubated with endotoxins. The samples were also exposed to aspirin and interleukin-1-beta (IL-1-beta) and tumor necrosis factor (TNF), components of the body's immune response. Fetal fibronectin levels increased as the cells' culture time period increased. Fetal fibronectin levels also increased when endotoxins were introduced. Chorionic production of fibronectin also rose in the presence of IL-1-beta and TNF.

Magnesium sulfate is frequently used to prevent seizures in pregnant women with eclampsia and preeclampsia, pregnancy-induced disorders featuring high blood pressure and other dysfunctions. Visual disturbances are somewhat common in these patients and may be related to complications associated with high blood pressure. Visual dysfunction is often a sign of worsening of eclampsia. Although intravenous magnesium sulfate is effective and relatively safe, it may be responsible for some of the visual disturbances. To better determine the cause of visual problems in patients with eclampsia disorders, 13 women with such disorders were evaluated during and after magnesium sulfate therapy. Abnormal visual signs and symptoms were common, especially blurred or double vision, and these varied in the women during therapy. Many of the visual disturbances were most likely due to effects on the brain pathways that control vision, but other symptoms were attributable to effects of magnesium on the peripheral visual system. The visual problems could be discriminated from those resulting from retinal detachment, a somewhat common complication of eclampsia. All abnormalities normalized after termination of the treatment. Serious complications such as muscle weakness, respiratory depression, and arrhythmia (irregular, uncoordinated heartbeat) were not found. Obstetricians should be aware of these potential side effects of magnesium sulfate therapy and observe and treat patients with eclampsia disorders accordingly. (Consumer Summary produced by Reliance Medical Information, Inc.)

Finding no fetal fibronectin in cervical secretions appears to be strongly associated with full-term birth in a population of women at low-risk for premature delivery, but its presence may not necessarily predict premature delivery. Researchers periodically tested for fetal fibronectin between 24 and 34 weeks gestation in 108 women at low risk for premature birth. Eight women had a spontaneous premature birth. A negative fibronectin test corrected predicted 97% of full-term births while a positive test only correctly predicted one-third of premature births.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2009.07.045 Byline: Tracy A. Manuck, Courtney C. Maclean, Robert M. Silver, Michael W. Varner Keywords: expectant management; latency; perinatal outcome; prematurity; preterm premature rupture of membranes Abstract: Preterm premature rupture of membranes (PPROM) is the leading identifiable cause of prematurity. We hypothesized that, when controlled for delivery gestational age, potential prolonged exposure to inflammation/infection could be harmful to the developing fetus. Author Affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, and Intermountain Healthcare Maternal Fetal Medicine, Salt Lake City, UT Article History: Received 23 February 2009; Revised 24 April 2009; Accepted 16 July 2009 Article Note: (footnote) Authorship and contribution to the article is limited to the 4 authors indicated. There was no outside funding or technical assistance with the production of this article., Cite this article as: Manuck TA, Maclean CC, Silver RM, et al. Preterm premature rupture of membranes: does the duration of latency influence perinatal outcomes? Am J Obstet Gynecol 2009;201:414.e1-6.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2009.05.022 Byline: Jennifer E. Warren (a), Lesa M. Nelson (c), Gregory J. Stoddard (b), M. Sean Esplin (a), Michael W. Varner (a), Robert M. Silver (a) Keywords: cervical insufficiency; IL-10; inflammation; polymorphisms Abstract: Our objective was to determine whether polymorphisms in the promoter region of the interleukin-10 gene are more common in women with cervical insufficiency compared with controls. Author Affiliation: (a) Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah (b) Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah (c) Taueret Laboratories, Salt Lake City, Utah Article History: Received 2 September 2008; Revised 12 February 2009; Accepted 14 May 2009 Article Note: (footnote) Cite this article as: Warren JE, Nelson LM, Stoddard GJ, et al. Polymorphisms in the promoter region of the interleukin-10 (IL-10) gene in women with cervical insufficiency. Am J Obstet Gynecol 2009;201:372.e1-5.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.06.078 Byline: Kjersti M. Aagaard-Tillery (a), T. Flint Porter (a), Robert H. Lane (c), Michael W. Varner (a), D. Yvette Lacoursiere (b) Keywords: gestational diabetes; intrauterine growth restriction; maternal hypertension; maternal obesity; maternal underweight; pregnancy; small-for-gestational-age infant; smoking; tobacco Abstract: The objective of the study was to evaluate whether maternal tobacco use is associated with an attenuation in fetal birthweight among women with nutritional and uteroplacental constraints. Author Affiliation: (a) Division of Maternal-Fetal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT (b) General Division, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT (c) Division of Neonatology, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT. Article History: Received 27 February 2007; Revised 3 May 2007; Accepted 29 June 2007 Article Note: (footnote) Cite this article as: Aagaard-Tillery KM, Porter TF, Lane RH, et al. In utero tobacco exposure is associated with modified effects of maternal factors on fetal growth. Am J Obstet Gynecol 2008;198:66.e1-66.e6.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.06.004 Byline: Calla Holmgren (a)(b), Kjersti M. Aagaard-Tillery (a)(b), Robert M. Silver (a), T. Flint Porter (b), Michael Varner (a) Keywords: hyperemesis gravidarum; nasoduodenal; nasogastric; peripherally inserted central catheter; pregnancy Abstract: The objective of the study was to evaluate the use of interventions such as a peripherally inserted central catheters (PICC) line or nasogastric (NG)/nasoduodenal (ND) tube with the use of medications alone in the management of pregnancies with hyperemesis. Author Affiliation: (a) Departments of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT (b) Intermountain Heath Care, Salt Lake City, UT. Article History: Received 16 January 2007; Revised 28 March 2007; Accepted 5 June 2007 Article Note: (footnote) Cite this article as: Holmgren C, Aagaard-Tillery KM, Silver RM, et al. Hyperemesis in pregnancy: An evaluation of treatment strategies with maternal and neonatal outcomes. Am J Obstet Gynecol 2008;198:56.e1-56.e4.