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Objective: To estimate prevalence rate of recent dengue infection in parturients, as well as the vertical transmission rate, and to compare pregnancy outcomes among infected women., Method: A prospective cohort study was performed. Maternal and paired umbilical cord bloods were taken at delivery. A brief questionnaire on febrile illness and dengue in pregnancy was completed by participants. The samples were sent to a World Health Organization Collaborating Center for Arbovirus Reference and Research. Maternal sera were tested with a dengue-specific immunoglobulin M (IgM) capture test. The paired umbilical cord serum was tested to determine when the maternal sample was positive. Dengue reverse transcriptase polymerase chain reaction (PCR) was performed on all dengue IgM-positive sera. Pregnancy outcome was extracted from delivery records., Results: A total of 2,958 parturients were enrolled, and 2,531 paired maternal-umbilical cord blood samples were available for testing. Dengue-specific IgM was positive in 63 of 2,531 (2.5%, 95% confidence interval [CI] 1.9-3.2%) maternal samples. Only 1 of 64 (1.6%, 95% CI 0.0-9.5%) of the paired umbilical cord sera was IgM-positive. All reverse transcriptase PCR tests were negative. Fifty-six of 63 (88.9%) of dengue IgM-positive women did not report a febrile illness in pregnancy. Apart from a higher mean age in dengue IgM-positive women of 30.6+/-5.2 compared with 29.2+/-4.9 years (P=.025) compared with dengue IgM-negative women, all other characteristics were similar. Rates of preterm birth, mode of delivery, postpartum hemorrhage, low birth weight, and neonatal outcomes were not different., Conclusion: Recent dengue infection was demonstrated in 2.5% of parturients, with a vertical transmission rate of 1.6%. Pregnancy outcome of recently infected women was not different., Level of Evidence: II.

Objective: To estimate the effect of coitus on the onset of labor., Methods: Women with a nonurgent labor induction at term were recruited. Women randomly assigned to the advised-coitus group were encouraged to have sex to promote the onset of labor. Controls were neither encouraged nor discouraged regarding coitus. Participants kept a coital and orgasm diary until delivery, and standard obstetric care was provided to both groups. Primary outcomes were reported coitus and spontaneous labor. Secondary outcomes included reported orgasms, initial Bishop score at the admission for induction, preterm rupture of membranes, use of dinoprostone, oxytocin, or epidural, meconium-stained amniotic fluid, cesarean delivery, maternal fever, and neonatal morbidity., Results: One hundred eight and 102 women randomly assigned to advised-coitus and control groups, respectively, were available for analysis. Women assigned to the advised-coitus group were more likely to report coital activity before delivery (60.2% compared with 39.6%, relative risk 1.5, 95% confidence interval 1.1-2.0; P=.004), but the spontaneous labor rate was no different (55.6% compared with 52.0%, relative risk 1.1, 95% confidence interval 0.8-1.4; P=.68). Cesarean delivery rate and neonatal and other secondary outcomes were also not different., Conclusion: Among women scheduled for labor induction who were advised to have sex, the increase in sexual activity did not increase the rate of spontaneous labor., Clinical Trial Registration: isrctn.org, http://isrctn.org, ISRCTN17998696

Objective: To determine the benefit of membrane sweeping at initiation of labor induction in conjunction with formal methods of labor induction., Methods: Two hundred seventy-four women at term with a singleton fetus in cephalic presentation and intact membranes were randomly assigned to receive membrane sweeping or no membrane sweeping at initiation of formal labor induction with either dinoprostone pessary or amniotomy. Outcome measures included mode of delivery, induction-to-delivery interval, dinosprostone dose, any oxytocin use and duration of oxytocin use in labor, visual analog score for pain associated with sweeping, and visual analog score for satisfaction with the birth process., Results: Two hundred sixty-four women (136 sweep and 128 no sweep) had their data analyzed. Ten women (4 sweep and 6 no sweep) were excluded because of exclusion criteria infringements. Swept women had higher spontaneous vaginal delivery rate (69% compared with 56%, P = .041), shorter induction to delivery interval (mean 14 compared with 19 hours, P = .003), fewer that required oxytocin use (46% compared with 59%, P = .037), shorter duration of oxytocin infusion (mean 2.6 compared with 4.3 hours, P = .001) and improved visual analog score for birth process satisfaction (mean 4.0 compared with 4.7, P = .015). The reduction in dinoprostone dose used (mean 1.2 compared with 1.3, P = .082) was not significant. Postsweeping visual analog score for pain (mean 4.7 compared with 3.5, P < .001) was significantly increased., Conclusion: Membrane sweeping at initiation of labor induction increased the spontaneous vaginal delivery rate, reduced oxytocic drug use, shortened induction to delivery interval, and improved patient satisfaction., Level of Evidence: I.