- Email: [email protected]
84: Proton magnetic resonance spectroscopy of the fetal brain: an assessment of clinical feasibility
Oral Concurrent Session 8
Clinical OB, etc
83 Neonatal outcome following primary elective caesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry
Table 1. Intrapartum characteristics & neonatal outcomes. Data are given as percents.
Spontaneous labor
Tachysystole (nⴝ104)
No tachysystole (nⴝ965)
26.9
30.8
www.AJOG.org
P value 0.42
..........................................................................................................................................................................................
Received oxytocin 23.0 25.7 0.56 .......................................................................................................................................................................................... FHR baseline ⬎160 bpm 16.4 5.4 ⬍0.001 .......................................................................................................................................................................................... Marked variability 12.5 6.0 0.012 .......................................................................................................................................................................................... Time in Category II 42.4 43.0 0.87 .......................................................................................................................................................................................... Operative vaginal delivery 12.5 6.8 0.036 .......................................................................................................................................................................................... Cesarean delivery 11.5 10.7 0.78 .......................................................................................................................................................................................... 5-minute Apgar ⬍7 1.0 1.4 0.74 .......................................................................................................................................................................................... NICU admission 5.8 4.0 0.40 .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.096
82 The second stage of labor and epidural use: a larger effect than previously suggested Yvonne Cheng1, James Nicholson2, Brian Shaffer1, Deirdre Lyell3, Aaron Caughey1 1
University of California, San Francisco, San Francisco, California, University of Pennsylvania, Philadelphia, Pennsylvania, 3 Stanford University, Stanford, California
2
OBJECTIVE: To examine the length of labor with and without an epidural to estimate the appropriate adjustment of non-epidural labor curves. STUDY DESIGN: Retrospective cohort study of 38,273 laboring women at a single institution. Median lengths of the first and second stages of labor were examined stratifying by epidural use and parity. Comparisons were made with the Kruskal-Wallis test. RESULTS: We found that the median length of labor was statistically significantly longer in the setting of epidural for both nulliparous and multiparous women (p⬍0.001). Interestingly, the 95%iles for the second stage of labor were more than two hours longer for nulliparous women and almost three hours longer for multiparas (p⬍0.001).
Freke A. Wilmink1, Chantal W.P.M. Hukkelhoven2, Simone Lunshof3, Ben Willem J Mol4, Joris A.M Van Der Post5, Dimitri N.M. Papatsonis6 1
Amphia Hospital Breda, Obstetrics and Gynecology, Breda, Netherlands, The Netherlands Perinatal Registry, Utrecht, Netherlands, 3Amphia Hospital, Department of Obstetrics and Gynecology, Breda, Netherlands, 4 Academic Medical Center, Amsterdam, Obstetrics and Gynecology, Amsterdam, Netherlands, 5Academic Medical Centre, Amsterdam, Obstetrics and Gynecology, Amsterdam, Netherlands, 6Amphia Hospital Breda, Department of Obstetrics and Gynecology, Breda, Netherlands 2
OBJECTIVE: Cesarean Section at term but before 39 weeks is associated
with increased perinatal morbidity.1 We wanted to evaluate the number and timing of elective caesarean sections at term in the Netherlands and to assess perinatal morbidity and mortality associated with this timing. STUDY DESIGN: Data from the Netherlands Perinatal Registry concerning 1,300,099 births between January 1, 2000 to December 31, 2006 of single and multiple pregnancies were analysed for perinatal outcome after elective caesarean section at term. The primary outcome was defined as a composite measure of neonatal mortality until the 28th day, and/ or neonatal morbidity which exists of any of the following adverse events: admission to the neonatal intensive care unit, Respiratory Distress Syndrome, wet lung syndrome/ Transient Tachypneu of the Newborn (TTN), pneumothorax, respiratory support (i.e. intermittent positive pressure ventilation, continuous positive airway pressure), intracranial haemorrhage, convulsions, hypoglycaemia and sepsis. RESULTS: Primary caesarean section occurred in 6.8% (n ⫽ 86,981) of 1,287,428 liveborns. After excluding emergency caesarean section, multiple pregnancies, fetus with congenital anomalies and mothers with an adverse medical or obstetric history and/ or complications of pregnancy that could influence the risk of neonatal morbidity, 30,613 (35.2%) elective caesarean sections remained. Neonates born at 37 or 38 completed weeks of gestation (57.8% of all elective caesarean sections) were, compared to neonates born after 39 completed weeks of gestation, at significantly higher risk for the composite bad outcome. The absolute risks were 8.6% and 5.9%, respectively, corresponding with adjusted odds ratios (95% confidence interval) of 2.8 (2.3 to 3.4) and 1.9 (1.6 to 2.2) for 37 and 38 weeks respectively.Factors that could influence the primary outcome are currently being analysed. CONCLUSION: In The Netherlands, more than 50% of the elective caesarean sections are applied before 39 weeks, thus jeopardizing neonatal outcome. (1)Tita et al. NEJM 2009;360:111-20. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.098
84 Proton magnetic resonance spectroscopy of the fetal brain: an assessment of clinical feasibility
Table: Median and 95%ile of the First and Second Stage of Labor CONCLUSION: While recommendations for intervention during the
second stage of labor have been made based upon a one-hour difference in the setting of epidural use, it appears that the 95%ile is actually two to three hours longer with an epidural. The length of labor needs further study in the setting of modern obstetric practice to delineate appropriate versus unnecessary intervention. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.097
S46
Adam Wolfberg1, Courtenay Pettigrew1, Andrea Loberg2, Michael House1, Rafeeque Bhadelia3, Rick Robertson4, Adre Du Plessis4, Robert Mulkern4 1 Tufts Medical Center, Boston, Massachusetts, 2University of Chicago, Chicago, Illinois, 3Beth Israel Deaconess Medical Center, Radiology, Boston, Massachusetts, 4Children’s Hospital Boston, Boston, Massachusetts
OBJECTIVE: To assess spectral quality of routine proton magnetic res-
onance spectroscopy (H-MRS) of the fetal brain. STUDY DESIGN: We performed fetal H-MRS on 51 pregnant women
(Gestational age 24-40 weeks) with a 1.5 T MRI (Philips Medical Systems) using a four element pelvic coil array. Each study included at least one single voxel proton spectroscopic interrogation of 4 to 8 ml volumes of fetal brain (TR/TE/NEX ⫽ 1500 ms/144 ms/64, ⬃ 95 s acquisitions). Spectra (N ⫽ 64) were processed semi-automatically with manufacturer supplied software to estimate peak areas for choline (Cho, 3.2 ppm), creatine (Cr, 3.0 ppm)), N-acetyl aspartate (NAA, 2.0 ppm) and, when present, lactate (1.3 ppm) and the second
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009
www.AJOG.org
Clinical OB, etc
creatine resonance (Cr2, 3.9 ppm). Spectra were rated into categories 1, 2 or 3 where 1 ⫽ high quality, good metabolite ratios, 2 ⫽ spectra requiring further post-processing (additional peak fits, filtering, phasing, baseline correction, etc) to extract metabolite ratios, and 3 ⫽ diagnostically useless spectra. RESULTS: 42% of the spectra were category 1 and 38% of the spectra were category 2, requiring additional post-processing, primarily fitting of lipid contamination peaks and or improved baseline considerations. 20% of the spectra were rated category 3 with fetal/maternal motion resulting in large lipid contamination peaks, inadequate water suppression, and poorly phased, ill-defined metabolite resonances. A low amplitude inverted lactate doublet was discerned in at least 3 subjects. Cho/Cr ratio showed a trend towards decreasing with gestational age as reported previously. CONCLUSION: Single voxel proton spectroscopy is feasible in the clinical setting and, despite fetal/maternal motion and the presence of substantial lipid depots, surprisingly robust. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.099
Oral Concurrent Session 8
said they were able to complete a meaningful research project. While 61.7% planned an academic career, 89.6% stated that their career would not be purely research. 85.2 % of fellows had not heard of the “Fast Track” option, and only 6.3% of those who knew about the “Fast Track” chose to participate. CONCLUSION: MFM fellows-in-training are concerned about proficiency in ultrasound-guided procedures and mentoring during their fellowship. The “Fast Track” option is underutilized likely because fellows are not aware of this option. Overall fellows felt they were able complete meaningful research projects, and were well trained in ultrasound and managing maternal complications. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.100
86 Membrane sweeping with labor induction - A randomized control trial Lori Day1, Diedre Fleener2, Janet Andrews2 1 University of Iowa, Obstetrics and Gynecology, Iowa City, Iowa, 2University of Iowa, Iowa City, Iowa
OBJECTIVE: Membrane sweeping (or stripping) performed in the out-
85 The current state of MFM fellowships: results from the SMFM fellow survey Cynthia Gyamfi1, Yair Blumenfeld2, Patrick Ramsey3, Michael Foley4, Sarah Kilpatrick5, Katharine Wenstrom6 1
Columbia University, Obstetrics & Gynecology, New York, New York, Stanford University, Obstetrics & Gynecology, Stanford, California, University of Alabama at Birmingham, Obstetrics & Gynecology, Birmingham, Alabama, 4University of Arizona, Obstetrics & Gynecology, Tucson, Arizona, 5University of Illinois at Chicago, Obstetrics & Gynecology, Chicago, Illinois, 6Women and Infant’s Hospital of Rhode Island, Obstetrics & Gynecology, Providence, Rhode Island 2 3
OBJECTIVE: To describe fellowship training and satisfaction among current maternal-fetal medicine fellows following the change from a 2-year to a 3-year fellowship training program. STUDY DESIGN: A 37-item questionnaire was emailed to Associate Fellow Members of the Society for Maternal-Fetal Medicine on two occasions one month apart in early 2008. The questions focused on fellowship program selection, mentorship, research and clinical time, ultrasound, procedures, knowledge of the “Fast Track” option, future goals, and overall satisfaction with maternal-fetal medicine. RESULTS: The survey was sent to 165 fellows, with 118 returned for a 71.5% response rate. Fifty eight percent of respondents were female, 74.6% were married/partnered and 59% had dependents. 7.8% of respondents were in a combined program, the most common of which was genetics (85.7%), followed by critical care (14.3%). When asked which portion of fellowship training was the least adequate, the most common response, 29.8%, was “ultrasound-guided procedures”. When asked what the greatest concern was upon finishing fellowship, 26.8% cited having sufficient procedure experience, while 25.2% cited completing their thesis. Of multiple training areas, most respondents felt their program was strongest in maternal complications (30.7%) followed by ultrasound training (25.4%). Though 29.8% of respondents stated they have inadequate mentorship, 86.1%
patient setting can decrease the need for post-term labor induction. Our objective was to determine the benefit of membrane sweeping when used as an adjunct at the start of the labor induction process. STUDY DESIGN: A prospective, randomized controlled trial was performed. Pregnant women who were undergoing labor induction after 34 weeks were screened. Eligible women were randomly assigned to membrane sweeping at the time of labor induction (case) or no sweeping with the first vaginal exam (control). Multiple gestations and chorioamnionitis at induction onset were excluded. Primary outcomes of interest were induction-to-delivery time and mode of delivery. Secondary outcomes included oxytocin usage and percentage delivering within 24 hours. Other variables regarding maternal and neonatal outcomes were gathered. RESULTS: 192 women were randomized; 147 delivered vaginally with a cesarean delivery rate of 23.4%. There was no difference in background characteristics between cases and controls, including parity, Bishop score, BMI, maternal age or gestational age. There was a trend toward shorter induction-to-delivery interval in cases than controls (19.9 versus 18.7 hours, respectively). The trend of shorter induction was more pronounced when comparing only women who delivered vaginally (17.4 versus 15.5 hours). However, these trends were not statistically significant. There was no difference in mode of delivery between cases and controls. There was no difference in percentage delivering in 24 hours, total oxytocin usage, maternal or neonatal complications. CONCLUSION: A trend toward shorter induction-to-delivery interval exists when membranes are swept at the time of labor induction. Given the common nature of labor induction, this finding could be useful in decreasing the time to delivery for women undergoing induction without increasing risks to either mother or infant. A larger clinical trial of the potential benefit of membrane sweeping is warranted. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.101
Supplement to DECEMBER 2009 American Journal of Obstetrics & Gynecology
S47
Clinical OB, etc
83 Neonatal outcome following primary elective caesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry
Table 1. Intrapartum characteristics & neonatal outcomes. Data are given as percents.
Spontaneous labor
Tachysystole (nⴝ104)
No tachysystole (nⴝ965)
26.9
30.8
www.AJOG.org
P value 0.42
..........................................................................................................................................................................................
Received oxytocin 23.0 25.7 0.56 .......................................................................................................................................................................................... FHR baseline ⬎160 bpm 16.4 5.4 ⬍0.001 .......................................................................................................................................................................................... Marked variability 12.5 6.0 0.012 .......................................................................................................................................................................................... Time in Category II 42.4 43.0 0.87 .......................................................................................................................................................................................... Operative vaginal delivery 12.5 6.8 0.036 .......................................................................................................................................................................................... Cesarean delivery 11.5 10.7 0.78 .......................................................................................................................................................................................... 5-minute Apgar ⬍7 1.0 1.4 0.74 .......................................................................................................................................................................................... NICU admission 5.8 4.0 0.40 .......................................................................................................................................................................................... 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.096
82 The second stage of labor and epidural use: a larger effect than previously suggested Yvonne Cheng1, James Nicholson2, Brian Shaffer1, Deirdre Lyell3, Aaron Caughey1 1
University of California, San Francisco, San Francisco, California, University of Pennsylvania, Philadelphia, Pennsylvania, 3 Stanford University, Stanford, California
2
OBJECTIVE: To examine the length of labor with and without an epidural to estimate the appropriate adjustment of non-epidural labor curves. STUDY DESIGN: Retrospective cohort study of 38,273 laboring women at a single institution. Median lengths of the first and second stages of labor were examined stratifying by epidural use and parity. Comparisons were made with the Kruskal-Wallis test. RESULTS: We found that the median length of labor was statistically significantly longer in the setting of epidural for both nulliparous and multiparous women (p⬍0.001). Interestingly, the 95%iles for the second stage of labor were more than two hours longer for nulliparous women and almost three hours longer for multiparas (p⬍0.001).
Freke A. Wilmink1, Chantal W.P.M. Hukkelhoven2, Simone Lunshof3, Ben Willem J Mol4, Joris A.M Van Der Post5, Dimitri N.M. Papatsonis6 1
Amphia Hospital Breda, Obstetrics and Gynecology, Breda, Netherlands, The Netherlands Perinatal Registry, Utrecht, Netherlands, 3Amphia Hospital, Department of Obstetrics and Gynecology, Breda, Netherlands, 4 Academic Medical Center, Amsterdam, Obstetrics and Gynecology, Amsterdam, Netherlands, 5Academic Medical Centre, Amsterdam, Obstetrics and Gynecology, Amsterdam, Netherlands, 6Amphia Hospital Breda, Department of Obstetrics and Gynecology, Breda, Netherlands 2
OBJECTIVE: Cesarean Section at term but before 39 weeks is associated
with increased perinatal morbidity.1 We wanted to evaluate the number and timing of elective caesarean sections at term in the Netherlands and to assess perinatal morbidity and mortality associated with this timing. STUDY DESIGN: Data from the Netherlands Perinatal Registry concerning 1,300,099 births between January 1, 2000 to December 31, 2006 of single and multiple pregnancies were analysed for perinatal outcome after elective caesarean section at term. The primary outcome was defined as a composite measure of neonatal mortality until the 28th day, and/ or neonatal morbidity which exists of any of the following adverse events: admission to the neonatal intensive care unit, Respiratory Distress Syndrome, wet lung syndrome/ Transient Tachypneu of the Newborn (TTN), pneumothorax, respiratory support (i.e. intermittent positive pressure ventilation, continuous positive airway pressure), intracranial haemorrhage, convulsions, hypoglycaemia and sepsis. RESULTS: Primary caesarean section occurred in 6.8% (n ⫽ 86,981) of 1,287,428 liveborns. After excluding emergency caesarean section, multiple pregnancies, fetus with congenital anomalies and mothers with an adverse medical or obstetric history and/ or complications of pregnancy that could influence the risk of neonatal morbidity, 30,613 (35.2%) elective caesarean sections remained. Neonates born at 37 or 38 completed weeks of gestation (57.8% of all elective caesarean sections) were, compared to neonates born after 39 completed weeks of gestation, at significantly higher risk for the composite bad outcome. The absolute risks were 8.6% and 5.9%, respectively, corresponding with adjusted odds ratios (95% confidence interval) of 2.8 (2.3 to 3.4) and 1.9 (1.6 to 2.2) for 37 and 38 weeks respectively.Factors that could influence the primary outcome are currently being analysed. CONCLUSION: In The Netherlands, more than 50% of the elective caesarean sections are applied before 39 weeks, thus jeopardizing neonatal outcome. (1)Tita et al. NEJM 2009;360:111-20. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.098
84 Proton magnetic resonance spectroscopy of the fetal brain: an assessment of clinical feasibility
Table: Median and 95%ile of the First and Second Stage of Labor CONCLUSION: While recommendations for intervention during the
second stage of labor have been made based upon a one-hour difference in the setting of epidural use, it appears that the 95%ile is actually two to three hours longer with an epidural. The length of labor needs further study in the setting of modern obstetric practice to delineate appropriate versus unnecessary intervention. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.097
S46
Adam Wolfberg1, Courtenay Pettigrew1, Andrea Loberg2, Michael House1, Rafeeque Bhadelia3, Rick Robertson4, Adre Du Plessis4, Robert Mulkern4 1 Tufts Medical Center, Boston, Massachusetts, 2University of Chicago, Chicago, Illinois, 3Beth Israel Deaconess Medical Center, Radiology, Boston, Massachusetts, 4Children’s Hospital Boston, Boston, Massachusetts
OBJECTIVE: To assess spectral quality of routine proton magnetic res-
onance spectroscopy (H-MRS) of the fetal brain. STUDY DESIGN: We performed fetal H-MRS on 51 pregnant women
(Gestational age 24-40 weeks) with a 1.5 T MRI (Philips Medical Systems) using a four element pelvic coil array. Each study included at least one single voxel proton spectroscopic interrogation of 4 to 8 ml volumes of fetal brain (TR/TE/NEX ⫽ 1500 ms/144 ms/64, ⬃ 95 s acquisitions). Spectra (N ⫽ 64) were processed semi-automatically with manufacturer supplied software to estimate peak areas for choline (Cho, 3.2 ppm), creatine (Cr, 3.0 ppm)), N-acetyl aspartate (NAA, 2.0 ppm) and, when present, lactate (1.3 ppm) and the second
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009
www.AJOG.org
Clinical OB, etc
creatine resonance (Cr2, 3.9 ppm). Spectra were rated into categories 1, 2 or 3 where 1 ⫽ high quality, good metabolite ratios, 2 ⫽ spectra requiring further post-processing (additional peak fits, filtering, phasing, baseline correction, etc) to extract metabolite ratios, and 3 ⫽ diagnostically useless spectra. RESULTS: 42% of the spectra were category 1 and 38% of the spectra were category 2, requiring additional post-processing, primarily fitting of lipid contamination peaks and or improved baseline considerations. 20% of the spectra were rated category 3 with fetal/maternal motion resulting in large lipid contamination peaks, inadequate water suppression, and poorly phased, ill-defined metabolite resonances. A low amplitude inverted lactate doublet was discerned in at least 3 subjects. Cho/Cr ratio showed a trend towards decreasing with gestational age as reported previously. CONCLUSION: Single voxel proton spectroscopy is feasible in the clinical setting and, despite fetal/maternal motion and the presence of substantial lipid depots, surprisingly robust. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.099
Oral Concurrent Session 8
said they were able to complete a meaningful research project. While 61.7% planned an academic career, 89.6% stated that their career would not be purely research. 85.2 % of fellows had not heard of the “Fast Track” option, and only 6.3% of those who knew about the “Fast Track” chose to participate. CONCLUSION: MFM fellows-in-training are concerned about proficiency in ultrasound-guided procedures and mentoring during their fellowship. The “Fast Track” option is underutilized likely because fellows are not aware of this option. Overall fellows felt they were able complete meaningful research projects, and were well trained in ultrasound and managing maternal complications. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.100
86 Membrane sweeping with labor induction - A randomized control trial Lori Day1, Diedre Fleener2, Janet Andrews2 1 University of Iowa, Obstetrics and Gynecology, Iowa City, Iowa, 2University of Iowa, Iowa City, Iowa
OBJECTIVE: Membrane sweeping (or stripping) performed in the out-
85 The current state of MFM fellowships: results from the SMFM fellow survey Cynthia Gyamfi1, Yair Blumenfeld2, Patrick Ramsey3, Michael Foley4, Sarah Kilpatrick5, Katharine Wenstrom6 1
Columbia University, Obstetrics & Gynecology, New York, New York, Stanford University, Obstetrics & Gynecology, Stanford, California, University of Alabama at Birmingham, Obstetrics & Gynecology, Birmingham, Alabama, 4University of Arizona, Obstetrics & Gynecology, Tucson, Arizona, 5University of Illinois at Chicago, Obstetrics & Gynecology, Chicago, Illinois, 6Women and Infant’s Hospital of Rhode Island, Obstetrics & Gynecology, Providence, Rhode Island 2 3
OBJECTIVE: To describe fellowship training and satisfaction among current maternal-fetal medicine fellows following the change from a 2-year to a 3-year fellowship training program. STUDY DESIGN: A 37-item questionnaire was emailed to Associate Fellow Members of the Society for Maternal-Fetal Medicine on two occasions one month apart in early 2008. The questions focused on fellowship program selection, mentorship, research and clinical time, ultrasound, procedures, knowledge of the “Fast Track” option, future goals, and overall satisfaction with maternal-fetal medicine. RESULTS: The survey was sent to 165 fellows, with 118 returned for a 71.5% response rate. Fifty eight percent of respondents were female, 74.6% were married/partnered and 59% had dependents. 7.8% of respondents were in a combined program, the most common of which was genetics (85.7%), followed by critical care (14.3%). When asked which portion of fellowship training was the least adequate, the most common response, 29.8%, was “ultrasound-guided procedures”. When asked what the greatest concern was upon finishing fellowship, 26.8% cited having sufficient procedure experience, while 25.2% cited completing their thesis. Of multiple training areas, most respondents felt their program was strongest in maternal complications (30.7%) followed by ultrasound training (25.4%). Though 29.8% of respondents stated they have inadequate mentorship, 86.1%
patient setting can decrease the need for post-term labor induction. Our objective was to determine the benefit of membrane sweeping when used as an adjunct at the start of the labor induction process. STUDY DESIGN: A prospective, randomized controlled trial was performed. Pregnant women who were undergoing labor induction after 34 weeks were screened. Eligible women were randomly assigned to membrane sweeping at the time of labor induction (case) or no sweeping with the first vaginal exam (control). Multiple gestations and chorioamnionitis at induction onset were excluded. Primary outcomes of interest were induction-to-delivery time and mode of delivery. Secondary outcomes included oxytocin usage and percentage delivering within 24 hours. Other variables regarding maternal and neonatal outcomes were gathered. RESULTS: 192 women were randomized; 147 delivered vaginally with a cesarean delivery rate of 23.4%. There was no difference in background characteristics between cases and controls, including parity, Bishop score, BMI, maternal age or gestational age. There was a trend toward shorter induction-to-delivery interval in cases than controls (19.9 versus 18.7 hours, respectively). The trend of shorter induction was more pronounced when comparing only women who delivered vaginally (17.4 versus 15.5 hours). However, these trends were not statistically significant. There was no difference in mode of delivery between cases and controls. There was no difference in percentage delivering in 24 hours, total oxytocin usage, maternal or neonatal complications. CONCLUSION: A trend toward shorter induction-to-delivery interval exists when membranes are swept at the time of labor induction. Given the common nature of labor induction, this finding could be useful in decreasing the time to delivery for women undergoing induction without increasing risks to either mother or infant. A larger clinical trial of the potential benefit of membrane sweeping is warranted. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.101
Supplement to DECEMBER 2009 American Journal of Obstetrics & Gynecology
S47