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Objective: We tested the hypothesis that apoptotic trophoblasts from pregnancies associated with fetal growth restriction caused by preeclampsia or cigarette use exhibit enhanced expression of the proapoptotic proteins p53 and Bax and diminished expression of the antiapoptotic protein Bcl-2., Study Design: Placentas were obtained from women with uncomplicated pregnancies (n = 4) or from women with pregnancies complicated by fetal growth restriction associated with preeclampsia, cigarette use, or both (n = 7). Placental sections were examined by means of hematoxylin and eosin and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) staining, as well as by detection of cytokeratin 18 cleavage products indicative of apoptosis. The expression of p53 was examined by means of Western immunoblotting and immunohistochemistry. The expression of Bax, Bcl-2, Bak, and Bcl-X(L) was analyzed by immunoblotting., Results: More apoptosis was found in the trophoblast layer of villi from pregnancies complicated by fetal growth restriction than in the trophoblast layer of villi from control pregnancies. The enhanced apoptosis correlated with up-regulation of p53, primarily in cytotrophoblast nuclei. There was no difference between the two groups in expression of the proteins from the Bcl-2 family., Conclusions: The expression of p53, but not members of the Bcl-2 family of proteins is up-regulated in human placental villi from pregnancies complicated by fetal growth restriction. We speculate that conditions predisposing to placental hypoxia lead to p53-mediated apoptosis in trophoblasts and thereby contribute to placental dysfunction.

: 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]

The standard management of early-stage invasive cervical cancer in early pregnancy is radical hysterectomy with the fetus in situ. We describe a case of early invasive cervical cancer in pregnancy that was treated with a conservative surgical approach.A nulliparous pregnant women at 15 weeks of gestation was diagnosed with stage IA2 invasive cervical cancer. She declined a radical hysterectomy, desiring to continue the pregnancy. A repeat cervical conization with retroperitoneal lymph node dissection was followed by radical trachelectomy 6 weeks after delivery. Currently she has 2 children, and there is no evidence of recurrence.Conservative stepwise surgical management of early invasive cervical cancer in the first half of pregnancy was a feasible approach in this woman who wished to continue the pregnancy. [ABSTRACT FROM AUTHOR]