Search

Objective The main purpose of this article is to evaluate whether identification and treatment of women with mild gestational diabetes mellitus (GDM) during pregnancy affects subsequent maternal body mass index (BMI), anthropometry, metabolic syndrome, and risk of diabetes. Study Design This is a follow-up study of women who participated in a randomized controlled treatment trial for mild GDM. Women were enrolled between 5 and 10 years after their index pregnancy. Participants underwent blood pressure, height, weight, and anthropometric measurements by trained nursing personnel using a standardized approach. A nurse-assisted questionnaire regarding screening and treatment of diabetes or hypercholesterolemia, diet, and physical activity was completed. Laboratory evaluation included fasting serum glucose, fasting insulin, oral glucose tolerance test, and a lipid panel. Subsequent diabetes, metabolic syndrome, obesity, and adiposity in those diagnosed with mild GDM and randomized to nutritional counseling and medical therapy (treated) were compared with those who underwent routine pregnancy management (untreated). Multivariable analyses were performed adjusting for race/ethnicity and years between randomization and follow-up visit. Results Four-hundred fifty-seven women with mild GDM during the index pregnancy were included in this analysis (243 treated; 214 untreated) and evaluated at a median 7 years after their index pregnancy. Baseline and follow-up characteristics were similar between treatment groups. Frequency of diabetes (9.2 vs. 8.5%, p =0.80), metabolic syndrome (32.2 vs. 34.3%, p =0.63), as well as adjusted mean values of homeostasis model assessment for insulin resistance (2.5 vs. 2.3, p =0.11) and BMI (29.4 vs. 29.1 kg/m2, p =0.67) were also not different. Conclusion Identification and treatment of women with mild GDM during pregnancy had no discernible impact on subsequent diabetes, metabolic syndrome, or obesity 7 years after delivery.

The purpose of this study was to evaluate the associations between measured amniotic fluid volume and outcome after preterm premature rupture of membranes (PROM).This was a secondary analysis of 290 women, with singleton pregnancies, who participated in a trial of antibiotic therapy for preterm PROM at 24(0) to 32(0) weeks. Each underwent assessment of the 4 quadrant amniotic fluid index (AFI) and a maximum vertical fluid pocket (MVP) before randomization. The impact of low AFI (5.0 cm) and low MVP (2.0 cm) on latency, amnionitis, neonatal morbidity, and composite morbidity (any of death, RDS, early sepsis, stage 2-3 necrotizing enterocolitis, and/or grade 3-4 intraventricular hemorrhage) was assessed. Logistic regression controlled for confounding factors including gestational age at randomization, GBS carriage, and antibiotic study group.Low AFI and low MVP were identified in 67.2% and 46.9% of women, respectively. Delivery occurred by 48 hours, 1 and 2 weeks in 32.4%, 63.5% and 81.7% of pregnancies, respectively. Both low AFI and low MVP were associated with shorter latency (P.001), and with a higher rate of delivery at 48 hours, 1, and 2 weeks (P = .02 for each). However, neither test offered significant additional predictive value over the risk in the total population. Low AFI and low MVP were not associated with increased amnionitis. After controlling for other factors, both low MVP and low AFI were associated with shorter latency (Por = .002), increased composite morbidity (P = .03), and increased RDS (Por = .01), but not with increased neonatal sepsis (P = .85) or pneumonia (P = .53). Alternatively, after controlling for fluid volume, gestational age, and GBS carriage, the antibiotic study group had longer latency, and suffered less common primary outcomes and neonatal sepsis.Oligohydramnios should not be a consideration in determining which women will be candidates for expectant management or antibiotic treatment when it is identified at initial assessment of preterm PROM remote from term.

The purpose of this study was to compare perinatal outcomes among women with conservatively treated preterm premature rupture of membranes at 24 to 32 weeks of gestation in the presence or absence of vaginal bleeding.This is a secondary analysis of 581 women with and without vaginal bleeding within 1 week of admission with preterm premature rupture of membranes at 24 to 32 weeks of gestation who were enrolled in a multicenter trial of antibiotic therapy during conservative treatment. The main outcome was latency to delivery. Other outcome variables included clinical abruptio placentae, amnionitis, perinatal death, severe intraventricular hemorrhage, and respiratory distress syndrome.Outcome data were available for 581 patients (n=50 with bleeding). Latency to delivery was not affected by the presence or absence of bleeding. In general, a history of bleeding was associated with higher frequencies of subsequently diagnosed abruptio placentae (12% vs 3.5%; P=.01), perinatal death (16% vs 4.9%; P=.006), intraventricular hemorrhage (14.3% vs 5.9%; P=.03), and respiratory distress syndrome (69.4% vs 40.4%; P.0001), when compared with those women with nonbleeding events. Women with bleeding were less likely to be black (42% vs 60%; P=.002) and had a lower mean gestational age at preterm premature rupture of membranes (27.6 vs 28.5 weeks; P=.02) when compared with white, Hispanic, and other. After an adjustment of data was made for potentially confounding factors, women with recent bleeding were more likely to be diagnosed with abruptio placentae at delivery (odds ratio, 2.8; 95% CI, 1.03-7.8; P=.04), and their infants were more likely to have respiratory distress syndrome (odds ratio, 3.1; 95% CI, 1.5-6.6; P=.004).Vaginal bleeding before preterm premature rupture of membranes is associated with increased rates of neonatal respiratory distress syndrome and abruptio placentae, but not with reduced latency to delivery.

OBJECTIVE: Low serum ferritin levels correlate with low iron stores, whereas high levels are associated with an acute-phase reaction. Our objective was to determine whether elevated levels of ferritin in the genital tract may be a potent marker to identify patients at risk for spontaneous preterm delivery. STUDY DESIGN: We performed a nested case-control study involving 182 women who had spontaneous preterm delivery and 182 term control subjects matched for race, parity, and recruitment center, and selected from 2929 women enrolled in the Preterm Prediction Study of the National Institute of Child Health and Development Maternal-Fetal Medicine Units Network. Cervical fluid ferritin was measured by use of radioimmunoassay. RESULTS: Cervical ferritin levels were significantly higher in women who subsequently had spontaneous early preterm delivery ( P =.002; and P =.004) than in term controls. A cervical ferritin of >75th percentile in the controls (>35.5 ng/mL) was found in 52.9% (9/17) of the women delivered CONCLUSIONS: Elevated cervical ferritin levels at 22 to 24 weeks of gestation in asymptomatic women are associated with subsequent spontaneous preterm birth. The strong correlation of cervical ferritin with other inflammatory markers provides support for the hypothesis of infection as a mediator of preterm delivery. (Am J Obstet Gynecol 2002;186:458-63.)

OBJECTIVE: To compare the rates and perinatal outcome in women who experienced preeclampsia in a previous pregnancy to those in women who developed preeclampsia as nulliparas. STUDY DESIGN: This is a secondary analysis of data from 2 separate multi-center trials of aspirin for prevention of preeclampsia. Women who had preeclampsia in a previous pregnancy (n = 598) were compared with nulliparous women (n = 2934). Outcome variables were rates of preeclampsia, preterm delivery at

Objective The purpose of this study was to determine whether hospital differences in the frequency of adverse obstetric outcomes are related to differences in care. Study Design The Assessment of Perinatal EXcellence cohort comprises 115,502 women and their neonates who were born in 25 hospitals in the United States between March 2008 and February 2011. Hierarchical logistic regression was used to quantify the amount of variation in postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite adverse neonatal outcome among hospitals that is explained by differences in patient characteristics, hospital characteristics, and obstetric care provided. Results The study included 115,502 women. For most outcomes, 20-40% of hospital differences in outcomes were related to differences in patient populations. After adjusting for patient-, provider-, and hospital-level factors, multiple care processes were associated with the predefined adverse outcomes; however, these care processes did not explain significant variation in the frequency of adverse outcomes among hospitals. Ultimately, 50-100% of the interhospital variation in outcomes was unexplained. Conclusion Hospital differences in the frequency of adverse obstetric outcomes could not be explained by differences in frequency of types of care provided.

Objective: The aim of this study was to determine whether epidural anesthesia during labor increased the frequencies of cesarean delivery, pulmonary edema, and renal failure among women with severe hypertensive disease. Study Design: We performed a secondary retrospective analysis of a subgroup population within a multicenter double-blind trial of low-dose aspirin therapy for women at high risk for development of preeclampsia. Subjects in whom severe hypertensive disease developed were selected. The primary outcomes were the overall frequencies of cesarean delivery among women with severe hypertensive disease who had labor with and without epidural anesthesia. Other maternal and neonatal outcomes were also compared between women who did and did not receive epidural anesthesia. Results: Among the women with severe hypertensive disease (n = 444) 327 had labor. Among the women with severe disease who had labor there was no difference in either the overall cesarean delivery rate (32.1% vs 28.0%; P = .44) or the rate of cesarean delivery for fetal distress or failure to progress (27.8% vs 22.0%; P = .26) between women who did and did not receive epidural analgesia. Women with chronic hypertension were more likely to have a cesarean delivery overall if they received epidural anesthesia, but there was otherwise no difference in the frequencies of cesarean delivery for these indications between women with and without epidural anesthesia within each of the high-risk groups. Pulmonary edema was rare and acute renal failure did not develop in any women. Conclusion: Epidural anesthesia use did not increase the frequencies of cesarean delivery, pulmonary edema, and renal failure among women with severe hypertensive disease. (Am J Obstet Gynecol 1999;181:1096-1101.)

To estimate the frequency of severe maternal morbidity, assess its underlying etiologies, and develop a scoring system to predict its occurrence.Supplemental Digital Content is Available in the Text.This was a secondary analysis of a Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network cohort of 115,502 women and their neonates born in 25 hospitals across the United States over a 3-year period. Women were classified as having severe maternal morbidity according to a scoring system that takes into account the occurrence of red blood cell transfusion (more than three units), intubation, unanticipated surgical intervention, organ failure, and intensive care unit admission. The frequency of severe maternal morbidity was calculated and the underlying etiologies determined. Multivariable analysis identified patient factors present on admission that were independently associated with severe maternal morbidity; these were used to develop a prediction model for severe maternal morbidity.Among 115,502 women who delivered during the study period, 332 (2.9/1,000 births, 95% confidence interval 2.6-3.2) experienced severe maternal morbidity. Postpartum hemorrhage was responsible for approximately half of severe maternal morbidity. Multiple patient factors were found to be independently associated with severe maternal morbidity and were used to develop a predictive model with an area under the receiver operating characteristic curve of 0.80.Severe maternal morbidity occurs in approximately 2.9 per 1,000 births, is most commonly the result of postpartum hemorrhage, and occurs more commonly in association with several identifiable patient characteristics.: II.

OBJECTIVE: Our purpose was to determine the association between the presence of bacterial vaginosis, fetal fibronectin, and a short cervix and the risk of spontaneous preterm birth of twins. STUDY DESIGN: We prospectively screened 147 women with twins at 24 and 28 weeks' gestation for more than 50 potential risk factors for spontaneous preterm birth. We also measured cervical length with ultrasound scans and tested for the presence of bacterial vaginosis. Fetal fibronectin level was evaluated every 2 weeks from 24 to 30 weeks' gestation. Outcomes included spontaneous preterm birth at RESULTS: Among twin as compared with singleton pregnancies, a cervical length ≤25 mm was more common at both 24 and 28 weeks, a statistically significant difference. There were no significant differences in most other risk factors. Of the factors evaluated by means of univariate analysis at 24 weeks, only a short cervix (≤25 mm) was consistently associated with spontaneous preterm birth. The odds ratios and 95% confidence interval for spontaneous preterm birth at CONCLUSIONS: Most known risk factors for spontaneous preterm birth were not significantly associated with spontaneous preterm birth of twins. At 24 weeks, cervical length ≤25 mm was the best predictor of spontaneous preterm birth at

There is currently no standard national approach to the management of category II fetal heart rate (FHR) patterns, yet such patterns occur in the majority of fetuses in labor. Under such circumstances, it would be difficult to demonstrate the clinical efficacy of FHR monitoring even if this technique had immense intrinsic value, since there has never been a standard hypothesis to test dealing with interpretation and management of these abnormal patterns. We present an algorithm for the management of category II FHR patterns that reflects a synthesis of available evidence and current scientific thought. Use of this algorithm represents one way for the clinician to comply with the standard of care, and may enhance our overall ability to define the benefits of intrapartum FHR monitoring.

To estimate determinants of and outcomes associated with activity restriction among women with a short cervix.This was a secondary analysis of a randomized trial of 17-α hydroxyprogesterone caproate for prevention of preterm birth among nulliparous women with singleton gestations and cervices less than 30 mm by midtrimester ultrasonography. Women were asked weekly whether they had been placed on pelvic, work, or nonwork rest. "Any activity restriction" was defined as being placed on any type of rest. Factors associated with any activity restriction were determined and the association between preterm birth and activity restriction was estimated with multivariable logistic regression.Of the 657 women in the trial, 646 (98%) responded to questions regarding activity restriction. Two hundred fifty-two (39.0%) were placed on any activity restriction at a median of 23.9 weeks (interquartile range 22.6-27.9 weeks). Women on activity restriction were older, more likely to have private insurance, less likely to be Hispanic, had a shorter cervical length, and were more likely to have funneling and intra-amniotic debris. Preterm birth at less than 37 weeks of gestation was more common among women placed on activity restriction (37% compared with 17%, P.001). After controlling for potential confounding factors, preterm birth remained more common among those placed on activity restriction (adjusted odds ratio 2.37, 95% confidence interval 1.60-3.53). Results were similar for preterm birth at less than 34 weeks of gestation.Activity restriction did not reduce the rate of preterm birth in asymptomatic nulliparous women with a short cervix.

Preterm premature rupture of the membranes (pPROM) occurs in 0.7 to 3.0% of all pregnancies and has been implicated in 30% of preterm deliveries.1–3 The perinatal morbidity linked to this event is directly related to the gestational age at delivery. In addition to the risks inherent in prematurity (e.g., respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis), pregnancies complicated by pPROM are at an increased risk for intra-amniotic infection, neonatal sepsis, pulmonary hypoplasia, placental abruption, and cord compression. The reported risk factors for pPROM include previous preterm delivery, previous pPROM, uterine overdistension, intrauterine infections, sexually transmitted diseases, cervical conization, vaginal bleeding, and drug use including tobacco.4,5 Although most studies have suggested an increase in the incidence of pPROM among patients who use tobacco,6–11 others, including data from the Collaborative Perinatal Project,12 have demonstrated no such association. In addition, the data addressing the possibility that pregnancies complicated by pPROM and tobacco use may be at risk for shorter latent periods and an increase in overall perinatal morbidity are both limited and contradictory. The objectives of this study were (1) to determine whether tobacco use was associated with an increase in the incidence of pPROM and (2) to evaluate the possibility that tobacco use further worsened perinatal morbidity (shorter latent period, increased risk of infection) among pregnancies complicated by pPROM. If tobacco use is associated with pPROM, this would represent a potentially “modifiable” risk factor for this common perinatal complication.

To estimate characteristics and outcomes of pregnant and immediately postpartum women hospitalized with influenza-like illness during the 2009-2010 influenza pandemic and the factors associated with more severe illness.An observational cohort in 28 hospitals of pregnant and postpartum (within 2 weeks of delivery) women hospitalized with influenza-like illness. Influenza-like illness was defined as clinical suspicion of influenza and either meeting the Centers for Disease Control and Prevention definition of influenza-like illness (fever 100.0°F or higher, cough, sore throat) or a positive influenza test.Of 356 women meeting eligibility criteria, 35 (9.8%) were admitted to the intensive care unit (ICU) and four (1.1%) died. Two hundred eighteen women (61.2%) were in the third trimester and 10 (2.8%) were postpartum. More than half (55.3%) were admitted in October and 25.0% in November with rapidly decreasing numbers thereafter. Antiviral therapy was administered to 10.1% of the women before hospitalization and to 88.5% during hospitalization. Factors associated with an increased likelihood of ICU admission included cigarette smoking (29.4% compared with 13.4%; odds ratio [OR] 2.77, 95% confidence interval [CI] 1.19-6.45) and chronic hypertension (17.1% compared with 3.1%; OR 6.86, 95% CI 2.19-21.51). Antiviral treatment within 2 days of symptom onset decreased the likelihood of ICU admission (31.4% compared with 56.6%, OR 0.36, 95% CI 0.16-0.77).Comorbidities, including chronic hypertension and smoking in pregnancy, increase the likelihood of ICU admission in influenza-like illness hospitalizations, whereas early antiviral treatment may reduce its frequency.II.

The aim of this study was to determine whether the amniotic fluid index differs according to whether a fetus is in breech or cephalic presentation.Between January 1995 and April 1996 the amniotic fluid index was measured both immediately before and after attempted external cephalic version. Amniotic fluid indexes were measured by a senior obstetric resident or attending physician. Preprocedure amniotic fluid indexes and change in amniotic fluid index after successful and failed external cephalic version were compared with unpaired and paired Student t tests, respectively. P.05 was considered statistically significant.Thirty consecutive women between 36 and 40 weeks' gestation with breech presentations were evaluated before undergoing an attempt at external cephalic version. The preprocedure amniotic fluid index was not different (P =.61) between women who had success (12.1 cm) and failure (11.4 cm) of attempts at external cephalic version. Successful external cephalic version was associated with a statistically significant increase (P.0001) in amniotic fluid index with respect to gestations with a persistent breech presentation (3.14 vs -0.35).Successful version from a breech to a cephalic presentation resulted in a significant increase in the amniotic fluid index. This should be considered when a breech presentation with a low normal amniotic fluid index is evaluated. Presentation of the fetus should be considered in evaluating amniotic fluid index distribution curves.

Objective The purpose of this study was to compare the efficacy of traditional abdominal cerclage (AC) with laparoscopic cerclage (LC). Study Design Eligible women had at least 1 second trimester pregnancy loss due to cervical insufficiency, and had undergone at least 1 failed transvaginal cerclage. A prospective cohort of patients undergoing LC was compared with a historical control group of patients who had AC. A successful primary outcome was defined as delivery of a viable infant with neonatal survival. Results We were able to evaluate 19 pregnancies following unique abdominal cerclage placement, 12 laparoscopic and 7 at the time of laparotomy. Nine of 12 (75%) undergoing LC and 5 of 7 (71%) pregnancies undergoing AC successfully delivered a viable infant ( P = .63). LC during pregnancy was successful in 4 of 5 (80%) cases as compared to 3 of 5 (60%) cases with AC during pregnancy ( P = 1.0). Conclusion Operative laparoscopy is a safe and effective alternative to laparotomy for the placement of abdominal cerclage.

This study was undertaken to determine whether women with recurrent spontaneous preterm births (rSPBs) have different clinical characteristics or systemic markers than those with isolated preterm (iSPBs) or recurrent term births (rTBs), when assessed remote from delivery.We compared clinical characteristics and findings (including cervical ultrasound, bacterial vaginosis, fetal fibronectin), maternal plasma markers obtained at 22 to 24 weeks' gestation (inflammatory cytokines, cortisol, and corticotrophin-releasing hormone), between women with rSPBs (2 or 3 consecutive SPBs and no TBs), iSPBs (1 SPB and 1 or 2 TBs), and rTBs (2 or 3 consecutive TBs and no SPBs).A total of 1257 women met our inclusion criteria; 47 rSPBs, 241 iSPBs (80 current and 161 prior iSPBs), and 969 rTBs. Before pregnancy, women with rSPBs had lower weights (P.0001) and body mass indexes (BMIs) (P.001), and were more likely to be less than 100 lbs (P = .008) or less than 19.8 kg/m2 BMI (P = .001). At 22 to 24 weeks those with rSPBs remained lighter and leaner, and had more advanced Bishop scores than iSPBs and rTBs. Ultrasound demonstrated progressive decrease in cervical length for those with rTBs, prior iSPBs, current iSPBs, and rSPBs, and also progressively more frequent short cervixes with worsening history (P.001). Cervical length was shorter for women of lower pregravid weight and BMI, but not with shorter height. At 22 to 24 weeks, women with rSPBs had more common uterine contractions and tocolytic agents, but not more infections or antibiotic therapy. Those with an SPB in the current gestation had higher fetal fibronectin levels and more frequent vaginal bleeding, regardless of prior outcome. Maternal cortisol and corticotrophin-releasing hormone were higher in women with iSPBs and rSPBs than in rTB controls, (P = .001 and .0027), a finding more apparent with SPB in the current pregnancy. However, maternal cytokines were not increased with either iSPBs or rSPBs.Women with rSPBs are leaner, contract more, have shorter cervixes, and have more advanced Bishop scores than women with iSPBs or rTBs.

This study was undertaken to estimate the frequency of inflammatory cytokine and Toll-like receptor gene polymorphisms in women with and without bacterial vaginosis (BV) in pregnancy.A secondary analysis was performed of pregnant women at less than 30 weeks' gestation enrolled as part of 2 multicenter studies. Eight hundred eighty-five women were assessed for BV (defined as Nugent's vaginal Gram stain score 7-10 and a pH4.5). Comparisons were made between women with or without BV. Extracted maternal DNA was analyzed for 7 cytokine (interleukin [IL] 1beta-511, IL1beta Exon 5 +3954, IL6-174, IL8-845, IL10-1082, tumor necrosis factor alpha-238 [TNFalpha-238], TNFalpha-308) and 2 Toll-like receptor (TLR-4 299, TLR-4 399) gene polymorphisms.BV was diagnosed in 497 women and 388 did not have BV. Genotype and allele frequency analyses revealed associations with BV and polymorphisms at the IL1beta Exon 5 +3954, IL6-174, IL10-1082, and TLR-4 399 loci. Women with BV were less likely to be homozygous (C/C) for IL1beta Exon 5 +3954 (P = .04). Women with BV were also less likely to have polymorphisms at the IL10-1082 (P = .03) and TLR-4 399 (P = .04) loci in the univariate analysis. Women with BV were more likely to be heterozygous (G/C) for the IL6-174 genotype (P.0001). Multivariate analysis, controlling for maternal race, confirmed the following associations with BV: IL1beta Exon 5 +3954 (odds Ratio [OR] 0.5, 95% CI 0.3-0.9) and IL6-174 (OR 2.2, 95% CI 1.6-3.1). In addition, polymorphism at the IL8-845 locus was associated with a decreased risk for BV (OR 0.6, 95% CI 0.4-1.0).After controlling for race, polymorphisms at the IL1beta Exon 5 +3954, IL6-174, and IL8-845 loci were associated with an altered rate of BV in pregnancy.

The purpose of this study was to determine whether sexual intercourse was associated with the treatment efficacy or the incidence of preterm birth in two large randomized trials in which metronidazole treatment of bacterial vaginosis or Trichomonas vaginalis did not reduce preterm birth.Secondary analysis of two multicenter, double-blind, placebo-controlled trials in which women with asymptomatic bacterial vaginosis on Gram stain or asymptomatic T vaginalis on culture were randomized at 16 to 23 weeks of gestation to metronidazole or placebo. In both studies, women took 2 g of metronidazole or placebo in the presence of a nurse (first dose) and were given a second dose to take 48 hours later. This regimen was repeated (third and fourth doses) at 24 to 29 weeks. At the time of the third dose, bacterial vaginosis and T vaginalis specimens were collected again. Patients who were randomly selected to receive metronidazole were analyzed for bacterial vaginosis and T vaginalis at 24 to 29 weeks and for preterm birth of37 weeks of gestation, according to intercourse between first and second doses and between the second and third doses. Continuous variables were compared with the use of the Wilcoxon rank-sum test; categoric variables were compared with the use of the chi(2 ) test, Fisher exact test, or the Mantel-Haenzel test of trend.Sexual intercourse between the first and second doses or between the second and third doses did not influence the incidence of bacterial vaginosis (18% vs 24%; relative risk, 0.7; 95% CI, 0.5-1.1; and 23% vs 20%; relative risk, 1.2; 95% CI, 0.9-1.6, respectively) or T vaginalis (4% vs 8%; relative risk, 0.5; 95% CI, 0.1-3.6; and 5% vs 10%; relative risk, 0.5; 95% CI, 0.2-1.1; respectively) at 24 to 29 weeks of gestation compared with no intercourse. In the T vaginalis trial, sexual intercourse between the first and second doses or between the second and third doses did not influence the incidence of preterm birth (13% vs 17%; relative risk, 0.8; 95% CI, 0.3-2.1; and 16% vs 17%; relative risk, 1.0; 95% CI, 0.6-1.6; respectively) compared with no intercourse. In the bacterial vaginosis trial, although sexual intercourse between the first and second doses did not influence the incidence of preterm birth (11% vs 12%; relative risk, 0.9; 95 % CI, 0.6-1.5), sexual intercourse between the second and third doses was associated with a reduction in the incidence of preterm birth (10% vs 16%; relative risk, 0.6; 95% CI, 0.4-0.9) compared with no intercourse.Sexual intercourse was associated with neither the efficacy of metronidazole treatment of bacterial vaginosis or T vaginalis nor with the incidence of preterm birth. In the bacterial vaginosis study, intercourse between the second and third doses had a negative association with preterm birth.

OBJECTIVE: We attempted to determine the effect on meconium aspiration syndrome from a selective approach of neonatal endotracheal intubation in meconium-exposed fetuses. STUDY DESIGN: All pregnancies delivered at the Medical College of Virginia in 1990 were included. Meconium was noted at membrane rupture and qualified as thick, moderate, or thin. Neonates underwent suctioning with a DeLee device at delivery. They were observed without endotracheal intubation if they fulfilled the following criteria: vaginal delivery, gestational age >37 weeks, birth weight >2500 gm, and anticipated Apgar score ≥8 at 1 minute. RESULTS: Of 4289 deliveries, 659 were exposed to meconium and 48% of infants were intubated. Birth weights, gestational ages at delivery, and umbilical arterial pH were similar between intubated and nonintubated neonates. Neonatal intensive care unit admissions were significantly higher in intubated neonates. All 9 neonates diagnosed with meconium aspiration syndrome were intubated at birth. CONCLUSIONS: Utilization of this protocol resulted in reduction of neonatal intubation. Meconium aspiration syndrome did not occur in the nonintubated group. (Am J Obstet Gynecol 1996;175:296-303.)

Limited reports exist about the frequency of compound presentation after external cephalic version. A compound hand and foot presentation is reported after external cephalic version in a woman desiring vaginal birth after cesarean delivery. We report a mechanism by which a forward roll during external cephalic version may predispose an infant in complete breech position to a compound foot presentation.

We sought to evaluate whether 17 alpha-hydroxyprogesterone caproate (17-OHP) reduces preterm birth (PTB) in nulliparous women with a midtrimester cervical length (CL)30 mm.In this multicenter randomized controlled trial, nulliparous women with a singleton gestation between 16 and 22 3/7 weeks with an endovaginal CL30 mm (10th percentile in this population) were randomized to weekly intramuscular 17-OHP (250 mg) or placebo through 36 weeks. The primary outcome was PTB37 weeks.The frequency of PTB did not differ between the 17-OHP (n = 327) and placebo (n = 330) groups (25.1% vs 24.2%; relative risk, 1.03; 95% confidence interval, 0.79-1.35). There also was no difference in the composite adverse neonatal outcome (7.0% vs 9.1%; relative risk, 0.77; 95% confidence interval, 0.46-1.30).Weekly 17-OHP does not reduce the frequency of PTB in nulliparous women with a midtrimester CL30 mm.

The accurate prediction and diagnosis of preterm labor continue to frustrate the clinician. This is partly due to a scarcity of cervical data from the early third trimester. A total of 760 prospective, serial, paired, and blinded pelvic examinations were done at 28 to 34 weeks of gestation for 191 patients without a history of preterm labor. If the cervix was dilated greater than or equal to 1 cm (internal os) or effaced greater than 30%, the relative risk of preterm labor was increased to 1.8 to 4.2. Negative predictive values for cervical status were greater than 92%, but positive predictive values were less than or equal to 18%. Change over time was unusual (dilatation increase greater than or equal to 1 cm or effacement increase greater than or equal to 40%), suggesting that a baseline late second-trimester examination could assist in the early but accurate diagnosis of preterm labor should it be suspected later in gestation. These data suggest that even in the low-risk patient, an early cervical examination could be beneficial.

A case of 45,X karyotype in association with low maternal serum alpha-fetoprotein levels is reported. Previous cases of trisomy have been linked to low alpha-fetoprotein levels. Cases of sex chromosome aneuploidy may be included in the group of aneuploidies with low levels of maternal serum alpha-fetoprotein.

Diagnosis and treatment of asymptomatic bacteriuria in pregnant patients can virtually eliminate pyelonephritis, the most common medical cause for antepartum hospitalization. However, the ever-increasing cost of the urine culture has led most clinicians away from routine urine screening. Uricult dip-slide paddles provide an inexpensive, efficient way to screen urine. Clean-catch urine specimens were obtained from 544 consecutive asymptomatic pregnant patients seen in the outpatient obstetric clinic at the Medical University of South Carolina. Specimens were analyzed by both traditional culture techniques and the Uricult dip-slide paddles. By comparison, the Uricult test detected 55 of the 56 significant gram-negative urinary pathogens found by culture. Detection of potential gram-positive pathogens is more difficult. A scheme is proposed that allows reliable, inexpensive surveillance in all pregnant patients. Hopefully, this algorithm will rekindle the obstetrician's interest in urine screening.

Platelet size and the distribution of platelet sizes are both increased in preeclamptic patients with normal platelet counts. These changes suggest that accelerated platelet production and consumption are both widespread in preeclampsia.

The plasma fibronectin concentration was abnormally elevated (greater than 400 micrograms/ml) in 16 of 17 normotensive gravid women who subsequently developed preeclampsia. Of this group, 13 had elevated levels detectable greater than or equal to 4 weeks before the onset of hypertension. Our results indicate that plasma fibronectin levels can be abnormally increased long before the onset of clinical symptoms and that abnormalities of this glycoprotein may be an early indication of this pathologic process.