摘要:

ObjectiveTo compare extra-amniotic saline infusion to intracervical dinoprostone gel for preinduction cervical ripening.MethodsWomen with Bishop scores less than 5 were assigned randomly to either extra-amniotic saline infusion (n= 26) or intracervical dinoprostone gel (n= 26) for preinduction cervical ripening. A sample size of 50 would have 80% power to detect a 10-hour difference in the mean time from start of cervical ripening to delivery for the two methods of intervention, with a type I error of .05.ResultsThe study populations were similar in age, gestational age, and initial Bishop score. They differed in parity, with 22 nulliparas in the extra-amniotic saline infusion group versus 13 in the dinoprostone gel group (relative risk [RR] 1.69, 95% confidence interval [CI] 1.11, 2.57). The number of women achieving a favorable Bishop score at 6 hours was greater with extra-amniotic saline infusion (n= 20) than dinoprostone gel (n= 9) (RR 2.14, 95% CI 1.22, 3.75). Mean time from start of ripening to delivery was 25.9 hours with extra-amniotic saline infusion and 30.2 hours with dinoprostone gel (P= .25). Birth weight, Apgar scores, umbilical artery pH, and infectious morbidity were similar between groups.ConclusionMore women achieved a favorable Bishop score at 6 and 12 hours after the start of cervical ripening with extra-amniotic saline infusion compared with dinoprostone gel. Saline infusion is as safe as dinoprostone gel for preinduction cervical ripening.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo compare the degree of absorption and the effect on uterine contractility of the prostaglandin E1analogue misoprostol after vaginal and oral administration.MethodsThirty women with a normal intrauterine pregnancy between 8 and 11 weeks' gestation who requested termination of pregnancy were given either 0.2 mg (orallyn= 5; vaginallyn= 6) or 0.4 mg (orallyn= 10; vaginallyn= 9) of misoprostol. Intrauterine pressure was recorded using a Grass polygraph connected to a pressure transducer 30 minutes before misoprostol was given and for 4 hours thereafter. At the end of the recording, suction curettage was performed. Blood samples were obtained at 0, 0.5, 1, 2, 4, and 6 hours for measurement of misoprostol, which was assayed by high-pressure liquid chromatography–mass spectrometry.ResultsIn all patients, the first effect was an increase in uterine tonus. After 0.4 mg of misoprostol administered orally, uterine tonus started to increase after a mean (± standard deviation) time of 7.8 ± 3.0 minutes and reached its maximum after 25.5 ± 5.0 minutes. The corresponding times after vaginal administration were 20.9 ± 5.3 minutes and 46.3 ± 20.7 minutes, respectively. The initial increase in tonus was also more pronounced after oral than after vaginal administration. After vaginal administration, all patients developed uterine contractions; the activity, measured in Montevideo units, increased continuously during the observation period. This was not the case after oral administration. Plasma levels of misoprostol were measured in 18 patients. The highest levels were found 30 minutes after oral treatment and 1–2 hours after vaginal administration.ConclusionThe long-lasting and continuously increasing uterine contractility after vaginal administration can be explained only in part by a direct effect of misoprostol. The longer period of elevated plasma levels of misoprostol may also have initiated the prolonged events leading to increased uterine contractility.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo compare station and cervical dilation at the time of epidural placement for predicting cesarean delivery risk.MethodsThis prospective cohort study included 275 women in labor with live, singleton fetuses at term in vertex presentations. We excluded women with preeclampsia or previous cesarean deliveries. A multiple logistic regression model evaluated demographic and labor-related variables' associations with cesarean risk.ResultsFifty-nine of the 275 patients receiving epidural analgesia (21.5%) were delivered by cesarean, whereas 216 (78.5%) delivered vaginally. Variables that proved to be statistically significant in increasing the likelihood of cesarean were station at time of epidural placement (odds ratio [OR] 5.3; 95% confidence interval [CI] 2.6, 11.0;P< .001) and nulliparity (OR 3.8, 95% CI 1.8, 8.0;P< .001). Cervical dilation at the time of epidural placement was not a statistically significant predictor (OR 1.2, 95% CI 0.9, 1.6;P= .26). Cesareans were performed in 43 of 129 women (33.3%) who received epidurals with the vertex at a −1 station or higher, whereas only 16 of 146 women (11.0%) had cesareans if placement of the epidural was done after the vertex had reached at least a zero station.ConclusionStation at the time of epidural placement was more accurate predicting cesarean risk than cervical dilation. Placement of the epidural after the fetal vertex has become engaged in the pelvis (at least a zero station) resulted in a substantially lower cesarean risk.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine the predictive value of each fetal heart rate (FHR) variable and of patterns of FHR variables for fetal asphyxia during labor.MethodsThis matched case-control study included an asphyxia group of 71 term infants with umbilical artery base deficit greater than 16 mmol/L and a control group of 71 term infants with umbilical artery base deficit less than 8 mmol/L. Each FHR record available for the 4 hours before delivery was scored in 10-minute cycles for each FHR variable. Selected patterns of important FHR variables were examined during the last hour before delivery for their predictive value for fetal asphyxia.ResultsThe FHR variables associated with fetal asphyxia included absent and minimal baseline variability and late and prolonged decelerations. Fetal heart rate patterns with absent baseline variability were the most specific but identified only 17% of the asphyxia group. The sensitivity of this test increased to 93% with the addition of less specific patterns. The estimated positive predictive value ranged from 18.1% to 2.6%, and the negative predictive value ranged from 98.3% to 99.5%.ConclusionA narrow 1-hour window of FHR patterns including minimal baseline variability and late or prolonged decelerations will predict fetal asphyxial exposure before decompensation and newborn morbidity. Thus, with careful interpretation, predictive FHR patterns can be a useful screening test for fetal asphyxia. However, supplementary tests are required to confirm the diagnosis and to identify the large number of false-positive patterns to avoid unnecessary intervention.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveGroup B streptococcal colonization in pregnancy has been associated with adverse perinatal outcomes, including intra-amniotic infection, postpartum endometritis, and neonatal sepsis. We sought to determine whether gestational diabetes increases the risk of maternal and neonatal morbidity from group B streptococcal colonization.MethodsGestational diabetic and nondiabetic women who underwent vaginal or anogenital culture for group B streptococcus colonization in pregnancy were followed up for pregnancy outcome. Antibiotic prophylaxis was not routinely given. Major perinatal morbidity included intra-amniotic infection, endometritis, and neonatal sepsis. Potential confounding variables included induction of labor, cesarean delivery, prematurity, maternal antibiotic use, and prolonged rupture of membranes.ResultsWe compared 446 gestational diabetic women to 1,046 nondiabetic women for outcome. Overall, 12% were colonized with group B streptococcus, with no difference in colonization rates between gestational diabetic (12%) and nondiabetic (12%) women. There were no differences in intraamniotic infection rates between gestational diabetic and nondiabetic women, whether group B streptococcus positive (16% compared with 13%) or group B streptococcus negative (10% compared with 11%). Likewise, endometritis did not differ (6–9%) regardless of diabetes or group B streptococcus status. Neonatal sepsis was higher in group B streptococcus-positive women overall (3% compared with 1%, odds ratio 3.71, 95% confidence interval 1.23, 10.81), but did not differ between diabetic and nondiabetic pregnancies.ConclusionGestational diabetes does not alter the perinatal morbidity associated with group B streptococcal colonization in pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundEndometrial ablation by means of photodynamic therapy is currently being evaluated as an outpatient treatment for dysfunctional uterine bleeding. Photodynamic therapy requires the activation of a photosensitizer by laser light. We describe a new device specifically designed to provide light delivery to the uterus for endometrial photodynamic therapy.InstrumentThe intrauterine light probe consists of the three flexible optical fibers converging to one bundle resembling the shape of the uterine cavity. Each of the fibers contains a cylindrical light diffuser.ExperienceThe intrauterine light probe was tested in removed human uteri for its capability to distribute light in a tissue-simulating scattering medium and to deliver sufficient light throughout the endometrium. The light distribution of the intrauterine light probe in the scattering medium is uniform on eight axes tested around the diffusing fibers. The pattern of light distribution in human uteri is similar to that in the medium. At the endomyometrial junction, there is still one third of the light applied to the endometrial surface whereas deeper in the myometrium, the light power drops to less than 10%.ConclusionWe propose a device that will deliver light to the uterine cavity to induce endometrial ablation by means of photodynamic therapy.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Obstetrics and gynecology has been transformed from a fee-for-service, unmanaged system to a prepaid managed system. This change poses significant ethical challenges, which we address. We show that obstetrician-gynecologists and medical institutions are moral co-fiduciaries of female and pregnant patients, that the obstetrician-gynecologist should be economically disciplined without capitulating to managed care, and that managed care organizations have an obligation to support the medical education and research from which they benefit.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo report our experience developing and implementing an introductory course on research methods for Canadian obstetrics and gynecology residents.MethodsA program entitled “An Introduction to Research,” originating at Queen's University, developed into an annual series of regional courses across Canada, under the auspices of the Association of Professors of Obstetrics and Gynaecology of Canada. Didactic lectures, interactive workshops, and online computer demonstrations introduced participants to the basic elements of clinical research.ResultsSince its inception, over 1000 participants have attended the program. Nearly all of the 296 respondents to a course evaluation agreed that the program was well organized, presented material at an appropriate level, and was useful.ConclusionThis course ensured that residents in obstetrics and gynecology across Canada were given a basic level of research training, as required by the Royal College of Physicians and Surgeons of Canada.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo evaluate the applicability and safety of the Zavanelli maneuver (manual return to the vagina of the partially born but undeliverable fetus with subsequent extraction by cesarean).Data SourcesMEDLINE computer database, Science Citation Index, and Index Medicus, 1985 through 1997 using the search terms Zavanelli maneuver, cephalic replacement, abdominal rescue, head entrapment, and shoulder dystocia.Method of Study SelectionEfforts to return 103 partially born but undeliverable fetuses to the uterus have been reported in 30 publications since the first case was reported in 1985. All cases were accepted for review, successful or not.Tabulation, Integration, and ResultsClinically relevant features were extracted from each case report. In 92 cases, fetuses presented by the vertex. Cephalic replacement was successful in 84 of those. In 11 cases, the fetus presented by the breech. Podalic replacement was successful in all of those. Seven women suffered tissue-disruptive trauma. There were no maternal deaths or fetal injuries ascribed to the maneuver.ConclusionThe 92% overall success rate is remarkable for a new procedure; even more noteworthy, in most cases it was applied by operators with no experience with it, and for cephalic replacement, it was used only after conventional maneuvers had failed. Using it early in the treatment of obstructed partial vaginal delivery is recommended.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID