- Email: [email protected]
Familial occurrence of dystocia
320
Citations from the literature /International
Journal of Gynecology & Obstetrics 63 (1998) 315-326
lance for persistent or recurrent infection and obstetric complications continued until delivery. On the basis of a two-sided hypothesis test and with alpha = 0.025,60 subjects were needed in each group for statistical power greater than 80% to detect a difference between ceftriaxone and other antibiotics if hospital length of stay differed by 1 or more days. Results: The treatment groups were similar in age, parity, temperature, gestational age, and initial white blood cell count. There were no statistically significant differences in length of hospitalization, hours until becoming afebrile, days until resolution of costovertebral angle tenderness, or infecting organism. There were no statistically significant differences in birth outcomes between the three groups. The average (standard deviation) age at delivery was 38.8 + 3.6 weeks. The average birth weight was 3274 k 523 g. Eleven (6.9%) of 159 subjects delivered prematurely. Escherichia cofi was the most common uropathogen isolated (137 of 179, 76.5%). Blood cultures were positive for organisms in 15 cases (8.4%). At follow-up examination within 2 weeks of initial therapy, eight (5.0%) of 159 subjects had urine cultures positive for organisms. Ten women (6.3%) had cultures positive for organisms later in their antepartum course, and 10 other participants (6.3%) developed recurrent pyelonephritis. Conclusion: There are no significant differences in clinical response to antimicrobial therapy or birth outcomes among subjects treated with ampicillin and gentamicin, cefazolin, or ceftriaxone for acute pyelonephritis in pregnancy before 24 weeks’ gestation. Induction of labor with misoprostol for premature membranes beyond thirty-six weeks’ gestation
rupture of
Wing D.A.; Paul R.H. USA AM J OBSTET GYNECOL 1998 179/l (94-99) OBJECTIVE: Our purpose was to compare vaginally administered misoprostol (Cytotec) with intravenous oxytocin for labor induction in women with premature rupture of membranes beyond 36 weeks’ gestation. STUDY/DESIGN: Two hundred subjects with rupture of membranes without labor were randomly assigned to receive vaginally administered misoprostol or intravenous oxytocin. Twenty-five micrograms of misoprosto1 (Cytotec) was placed in the posterior vaginal fomix. If cervical ripening (Bishop score of 5 8 or cervical dilatation of zz3 cm) or active labor did not occur, a single repeat dose of misoprostol was given 6 h later. Oxytocin was administered intravenously by a standardized incremental infusion protocol to a maximum dose of 22 mU per minute. RESULTS: Of the 197 subjects evaluated, 98 received misoprostol and 99 oxytocin. The average interval from start of induction to vaginal delivery was about 1 h longer in the misoprostol group (811.5 f 511.4 min) than in the oxytocin group (747.0 k 446.0 min) (P = 0.65, log transformed data). Oxytocin administration was necessary in 37 of 98 (37.8%) of misoprostol-treated subjects. Vaginal delivery occurred in 85 misoprostol-treated subjects (86.7%) and 82 (85.9%) oxytocin-treated subjects (relative risk 1.17, 95% confidence interval 0.78 to 1.78, P = 0.45) with the remainder undergoing cesarean birth. There was no difference
in the incidence of tachysystole (six or more uterine contractions in a lo-min window for two consecutive lo-min periods) or hypertonus between the two groups. There was no significant difference in frequency of abnormal fetal heart rate tracings between the two groups (29.6% in the misoprostol group and 28.9% in the oxytocin group, P = 0.91). Chorioamnionitis was diagnosed in 28 (28.6%) misoprostol-treated subjects and 26 (26.3%) oxytocin-treated subjects (P = 0.72, relative risk 1.06, 95% confidence interval 0.78 to 1.45). No significant differences were found in the incidence of fetal meconium (8.1% and 9.1%), l- or 5-min Apgar scores < 7 (11.0% and 10.2% of 1-min Apgar scores, and 2.0% and 2.0% of 5-min Apgar scores), neonatal resuscitation (24.5% and 27.6%), or admission to the neonatal intensive care unit (25.5% and 32.3%) between the two groups. CONCLUSIONS: Vaginal administration of misoprostol (Cytotec) is an effective alternative to oxytocin infusion for labor induction in women with premature rupture of the membranes near term. The incidence of untoward effects is similar with use of the two agents. Tbe role of cytokines in cervical ripening: Correlations between the concentrations of cytokines and hyaluronic acid in cervical mucus and the induction of hyaluronic acid production by inflammatory cytokines by human cervical fibroblasts
Ogawa M.; Hirano H.; Tsubaki H.; Kodama H.; Tanaka T. Japan
AM J OBSTET GYNECOL 1998 179/l (105-110) OBJECTIVES: The purpose of our study was (1) to explain the relationship between levels of inflammatory cytokines and levels of hyaluronic acid in cervical mucus of pregnant women and (2) to investigate whether cytokines promote hyaluronic acid production by human ceIvica1 fibroblasts in vitro. STUDY DESIGN: The concentration of hyaluronic acid, interleukinlp, and interleukin-8 were measured in cervical mucus of pregnant women, and hyaluronic acid production by cytokinetreated (interleukin-1 p and interleukin-8) cultured fibroblasts was measured. RESULTS: Hyaluronic acid concentrations in the mucus of pregnant women with threatened premature labor were higher than in mucus of normal pregnant women (P < 0.05). Correlations were found between hyaluronic acid concentrations and interleukin-1 p (P = 0.018) and interleukin-8 (P = 0.003) concentrations in cervical mucus. Cytokines (especially interleukin-8) stimulated hyaluronic acid production by cultured cervical fibroblasts. CONCLUSION: Cytokines induce hyaluronic acid production by human cervical fibroblasts, which may promote cervical ripening. Familial
occurrence of dystocia
Berg-Lekas M.-L.; Hogberg U.; Winkvist A. Sweden
AM J OBSTET GYNECOL 1998 179/l (117-121) OBJECTIVE: A cohort study was conducted to determine the risk of dystocia for women whose mothers, sisters, or twin sisters had dystocia during childbirth. STUDY DESIGN: A linked database was constructed between 2 separate Swedish
Citations from the literature /International
Journal of Gynecology & Obstem’cs 63 (1998) 315-326
birth registries. Obstetric data on mothers giving birth to daughters during the period 1955to 1972were studied. Among these daughters, sister-couples and twins were identified. The daughters subsequently became mothers during 1973 and 1990 and obstetric data on the first deliveries were also studied. RESULTS: If a mother had dystocia when delivering her eldest daughter, this daughter had an increased risk of dystocia during her own first childbirth (odds ratio 1.7, 95% confidence inteIva1 1.2 to 2.4). If the mother had an assisted instrumental delivery (vacuum extraction, forceps, or cesarean section) because of dystocia, there was a higher risk for her daughter to have an instrumental delivery because of dystocia (odds ratio 1.8, 95% confidence interval 1.0 to 3.1). Among primiparous sisters the risk of an instrumental delivery because of dystocia in a younger sister was more than tripled (odds ratio 3.5, 95% conlidence interval 2.1 to 5.8) if her elder sister had dystocic labor requiring instrumental intervention. The risk among twins increased more than 20-fold (odds ratio 24.0, 95% confidence interval 1.5 to 794.5) if 1 twin sister had dystocia during her first childbirth. CONCLUSION: Dystocia has a familial occurrence, suggesting a possible genetic factor explaining inefficient uterine action. Regulation of interleukin 8 production in the term human placenta during labor and by antigestagens
Elliott C.L.; Kelly R.W.; Critchley H.O.D.; Riley SC.; Calder A.A. % J OBSTET GYNECOL 1998 179/l (215-220) OBJECTIVE: Our purpose was to assessthe effects of labor and antigestagens on production of interleukin 8 by the term human placenta and to localize interleukin 8 in first- and third-trimester placentas. STUDY DESIGN: The study was conducted by the Department of Obstetrics and Gynaecology of the University of Edinburgh. Five placentas were collected after spontaneous and cesarean deliveries. Explants were cultured in the presence of mifepristone, lilopristone, or onapristone. The production of interleukin 8 was determined by specific radioimmunoassay, and the immunolocalization of interleukin 8 was determined in sections of first- and third-trimester placentas. RESULTS: All explants produced interleukin 8. Production was significantly increased (P< 0.05) after spontaneous delivery. In placentas delivered spontaneously, onapristone significantly increased production of interleukin 8 (P < 0.051,whereas in those from cesarean deliveries lilopristone caused a significant increase in production (P < 0.05). In the third-trimester placenta interleukin 8 was localized in the perivascular area of fetal vessels. In first-trimester villi it was peripherally located in syncytiotrophoblast. CONCLUSION: The human placenta at term is capable of producing interleukin 8, which is localized around the perivascular area of the villi. Production is increased after spontaneous labor and to varying degrees by the antigestagens studied. Interleukin 8 may have a role in the onset of parturition by recruiting and activating neutrophils at the placental site.
Perinatal
321
outcomes in women witb asthma during pregnancy
Alexander S.; Dodds L.; Armson B.A. Canada
OBSTET GYNECOL 1998 92/3 (435-440) Objective: To determine whether adverse perinatal outcome is associated with asthma or asthma medication use during pregnancy. Methods: A retrospective cohort study was conducted of women who resided in Halifax County, Nova Scotia, and delivered between 1991 and 1993. Asthmatic women were classified into three groups, according to medication usage: no medications, beta agonists only, and steroids with or without other asthma medications. Outcomes compared among asthmatic and nonasthmatic women included maternal complications (pregnancy-induced hypertension, cesarean delivery, gestational diabetes, preterm birth, and antepartum and postpartum hemorrhage) and neonatal outcomes (low birth weight, congenital malformations, hyperbilirubinemia, and respiratory distress syndrome). Results: The cohort included 817 asthmatic women and 13709 nonasthmatic women. Overall, the prevalence of pregnancies complicated by asthma increased from 4.8% in 1991 to 6.9% in 1993.Asthmatic women were at increased risk for antepartum and postpartum hemorrhage, independent of medication usage. Asthmatic women taking steroids were at increased risk for pregnancy-induced hypertension (odds ratio [OR] 1.7; 95% confidence interval [CI] 1.0, 2.9). The only significant difference in neonatal outcome between asthma medication groups and nonasthmatic women was of an increased risk of hyperbilirubinemia in infants of women taking steroids (OR 1.9; 95% CI 1.1, 3.4). Conclusion: Risk of antepartum and postpartum hemorrhage is increased in asthmatic women, independent of medication usage. The increased incidence of neonatal hyperbilirubinemia and the borderline increased risk of pregnancy-induced hypertension may be complications of steroid use or may be related to poorly controlled asthma. Activated protein C resistance and factor V Leiden in patients with hemolysis, elevated liver enzymes, low platelets syndrome
Krauss T.; Augustin H.G.; Osmers R.; Meden H.; Unterhalt M.; Kuhn W. Germany OBSTET GYNECOL 1998 92/3 (457-460) Objective: Hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is characterized by a distinct activation of the coagulation system. A mutation of the gene coding for coagulation Factor V (Factor V Leiden) has been identified as the most frequent risk factor for thrombosis. To identify risk factors for HELLP syndrome, we determined coagulation parameters and the Factor V Leiden mutation in women who previously had developed HELLP syndrome. Methods: Coagulation parameters (activated protein C resistance, antithrombin, protein C, protein S) were determined in 21 women 6 months to 9 years after they had developed HELLP syndrome in the third trimester. In addition, these women were analyzed for the presence of the Factor V Leiden mutation. Results: Of these analyzed women, 33% (seven of 21) had an activated protein C resistance (activated protein C ratio less than 2.0).
Citations from the literature /International
Journal of Gynecology & Obstetrics 63 (1998) 315-326
lance for persistent or recurrent infection and obstetric complications continued until delivery. On the basis of a two-sided hypothesis test and with alpha = 0.025,60 subjects were needed in each group for statistical power greater than 80% to detect a difference between ceftriaxone and other antibiotics if hospital length of stay differed by 1 or more days. Results: The treatment groups were similar in age, parity, temperature, gestational age, and initial white blood cell count. There were no statistically significant differences in length of hospitalization, hours until becoming afebrile, days until resolution of costovertebral angle tenderness, or infecting organism. There were no statistically significant differences in birth outcomes between the three groups. The average (standard deviation) age at delivery was 38.8 + 3.6 weeks. The average birth weight was 3274 k 523 g. Eleven (6.9%) of 159 subjects delivered prematurely. Escherichia cofi was the most common uropathogen isolated (137 of 179, 76.5%). Blood cultures were positive for organisms in 15 cases (8.4%). At follow-up examination within 2 weeks of initial therapy, eight (5.0%) of 159 subjects had urine cultures positive for organisms. Ten women (6.3%) had cultures positive for organisms later in their antepartum course, and 10 other participants (6.3%) developed recurrent pyelonephritis. Conclusion: There are no significant differences in clinical response to antimicrobial therapy or birth outcomes among subjects treated with ampicillin and gentamicin, cefazolin, or ceftriaxone for acute pyelonephritis in pregnancy before 24 weeks’ gestation. Induction of labor with misoprostol for premature membranes beyond thirty-six weeks’ gestation
rupture of
Wing D.A.; Paul R.H. USA AM J OBSTET GYNECOL 1998 179/l (94-99) OBJECTIVE: Our purpose was to compare vaginally administered misoprostol (Cytotec) with intravenous oxytocin for labor induction in women with premature rupture of membranes beyond 36 weeks’ gestation. STUDY/DESIGN: Two hundred subjects with rupture of membranes without labor were randomly assigned to receive vaginally administered misoprostol or intravenous oxytocin. Twenty-five micrograms of misoprosto1 (Cytotec) was placed in the posterior vaginal fomix. If cervical ripening (Bishop score of 5 8 or cervical dilatation of zz3 cm) or active labor did not occur, a single repeat dose of misoprostol was given 6 h later. Oxytocin was administered intravenously by a standardized incremental infusion protocol to a maximum dose of 22 mU per minute. RESULTS: Of the 197 subjects evaluated, 98 received misoprostol and 99 oxytocin. The average interval from start of induction to vaginal delivery was about 1 h longer in the misoprostol group (811.5 f 511.4 min) than in the oxytocin group (747.0 k 446.0 min) (P = 0.65, log transformed data). Oxytocin administration was necessary in 37 of 98 (37.8%) of misoprostol-treated subjects. Vaginal delivery occurred in 85 misoprostol-treated subjects (86.7%) and 82 (85.9%) oxytocin-treated subjects (relative risk 1.17, 95% confidence interval 0.78 to 1.78, P = 0.45) with the remainder undergoing cesarean birth. There was no difference
in the incidence of tachysystole (six or more uterine contractions in a lo-min window for two consecutive lo-min periods) or hypertonus between the two groups. There was no significant difference in frequency of abnormal fetal heart rate tracings between the two groups (29.6% in the misoprostol group and 28.9% in the oxytocin group, P = 0.91). Chorioamnionitis was diagnosed in 28 (28.6%) misoprostol-treated subjects and 26 (26.3%) oxytocin-treated subjects (P = 0.72, relative risk 1.06, 95% confidence interval 0.78 to 1.45). No significant differences were found in the incidence of fetal meconium (8.1% and 9.1%), l- or 5-min Apgar scores < 7 (11.0% and 10.2% of 1-min Apgar scores, and 2.0% and 2.0% of 5-min Apgar scores), neonatal resuscitation (24.5% and 27.6%), or admission to the neonatal intensive care unit (25.5% and 32.3%) between the two groups. CONCLUSIONS: Vaginal administration of misoprostol (Cytotec) is an effective alternative to oxytocin infusion for labor induction in women with premature rupture of the membranes near term. The incidence of untoward effects is similar with use of the two agents. Tbe role of cytokines in cervical ripening: Correlations between the concentrations of cytokines and hyaluronic acid in cervical mucus and the induction of hyaluronic acid production by inflammatory cytokines by human cervical fibroblasts
Ogawa M.; Hirano H.; Tsubaki H.; Kodama H.; Tanaka T. Japan
AM J OBSTET GYNECOL 1998 179/l (105-110) OBJECTIVES: The purpose of our study was (1) to explain the relationship between levels of inflammatory cytokines and levels of hyaluronic acid in cervical mucus of pregnant women and (2) to investigate whether cytokines promote hyaluronic acid production by human ceIvica1 fibroblasts in vitro. STUDY DESIGN: The concentration of hyaluronic acid, interleukinlp, and interleukin-8 were measured in cervical mucus of pregnant women, and hyaluronic acid production by cytokinetreated (interleukin-1 p and interleukin-8) cultured fibroblasts was measured. RESULTS: Hyaluronic acid concentrations in the mucus of pregnant women with threatened premature labor were higher than in mucus of normal pregnant women (P < 0.05). Correlations were found between hyaluronic acid concentrations and interleukin-1 p (P = 0.018) and interleukin-8 (P = 0.003) concentrations in cervical mucus. Cytokines (especially interleukin-8) stimulated hyaluronic acid production by cultured cervical fibroblasts. CONCLUSION: Cytokines induce hyaluronic acid production by human cervical fibroblasts, which may promote cervical ripening. Familial
occurrence of dystocia
Berg-Lekas M.-L.; Hogberg U.; Winkvist A. Sweden
AM J OBSTET GYNECOL 1998 179/l (117-121) OBJECTIVE: A cohort study was conducted to determine the risk of dystocia for women whose mothers, sisters, or twin sisters had dystocia during childbirth. STUDY DESIGN: A linked database was constructed between 2 separate Swedish
Citations from the literature /International
Journal of Gynecology & Obstem’cs 63 (1998) 315-326
birth registries. Obstetric data on mothers giving birth to daughters during the period 1955to 1972were studied. Among these daughters, sister-couples and twins were identified. The daughters subsequently became mothers during 1973 and 1990 and obstetric data on the first deliveries were also studied. RESULTS: If a mother had dystocia when delivering her eldest daughter, this daughter had an increased risk of dystocia during her own first childbirth (odds ratio 1.7, 95% confidence inteIva1 1.2 to 2.4). If the mother had an assisted instrumental delivery (vacuum extraction, forceps, or cesarean section) because of dystocia, there was a higher risk for her daughter to have an instrumental delivery because of dystocia (odds ratio 1.8, 95% confidence interval 1.0 to 3.1). Among primiparous sisters the risk of an instrumental delivery because of dystocia in a younger sister was more than tripled (odds ratio 3.5, 95% conlidence interval 2.1 to 5.8) if her elder sister had dystocic labor requiring instrumental intervention. The risk among twins increased more than 20-fold (odds ratio 24.0, 95% confidence interval 1.5 to 794.5) if 1 twin sister had dystocia during her first childbirth. CONCLUSION: Dystocia has a familial occurrence, suggesting a possible genetic factor explaining inefficient uterine action. Regulation of interleukin 8 production in the term human placenta during labor and by antigestagens
Elliott C.L.; Kelly R.W.; Critchley H.O.D.; Riley SC.; Calder A.A. % J OBSTET GYNECOL 1998 179/l (215-220) OBJECTIVE: Our purpose was to assessthe effects of labor and antigestagens on production of interleukin 8 by the term human placenta and to localize interleukin 8 in first- and third-trimester placentas. STUDY DESIGN: The study was conducted by the Department of Obstetrics and Gynaecology of the University of Edinburgh. Five placentas were collected after spontaneous and cesarean deliveries. Explants were cultured in the presence of mifepristone, lilopristone, or onapristone. The production of interleukin 8 was determined by specific radioimmunoassay, and the immunolocalization of interleukin 8 was determined in sections of first- and third-trimester placentas. RESULTS: All explants produced interleukin 8. Production was significantly increased (P< 0.05) after spontaneous delivery. In placentas delivered spontaneously, onapristone significantly increased production of interleukin 8 (P < 0.051,whereas in those from cesarean deliveries lilopristone caused a significant increase in production (P < 0.05). In the third-trimester placenta interleukin 8 was localized in the perivascular area of fetal vessels. In first-trimester villi it was peripherally located in syncytiotrophoblast. CONCLUSION: The human placenta at term is capable of producing interleukin 8, which is localized around the perivascular area of the villi. Production is increased after spontaneous labor and to varying degrees by the antigestagens studied. Interleukin 8 may have a role in the onset of parturition by recruiting and activating neutrophils at the placental site.
Perinatal
321
outcomes in women witb asthma during pregnancy
Alexander S.; Dodds L.; Armson B.A. Canada
OBSTET GYNECOL 1998 92/3 (435-440) Objective: To determine whether adverse perinatal outcome is associated with asthma or asthma medication use during pregnancy. Methods: A retrospective cohort study was conducted of women who resided in Halifax County, Nova Scotia, and delivered between 1991 and 1993. Asthmatic women were classified into three groups, according to medication usage: no medications, beta agonists only, and steroids with or without other asthma medications. Outcomes compared among asthmatic and nonasthmatic women included maternal complications (pregnancy-induced hypertension, cesarean delivery, gestational diabetes, preterm birth, and antepartum and postpartum hemorrhage) and neonatal outcomes (low birth weight, congenital malformations, hyperbilirubinemia, and respiratory distress syndrome). Results: The cohort included 817 asthmatic women and 13709 nonasthmatic women. Overall, the prevalence of pregnancies complicated by asthma increased from 4.8% in 1991 to 6.9% in 1993.Asthmatic women were at increased risk for antepartum and postpartum hemorrhage, independent of medication usage. Asthmatic women taking steroids were at increased risk for pregnancy-induced hypertension (odds ratio [OR] 1.7; 95% confidence interval [CI] 1.0, 2.9). The only significant difference in neonatal outcome between asthma medication groups and nonasthmatic women was of an increased risk of hyperbilirubinemia in infants of women taking steroids (OR 1.9; 95% CI 1.1, 3.4). Conclusion: Risk of antepartum and postpartum hemorrhage is increased in asthmatic women, independent of medication usage. The increased incidence of neonatal hyperbilirubinemia and the borderline increased risk of pregnancy-induced hypertension may be complications of steroid use or may be related to poorly controlled asthma. Activated protein C resistance and factor V Leiden in patients with hemolysis, elevated liver enzymes, low platelets syndrome
Krauss T.; Augustin H.G.; Osmers R.; Meden H.; Unterhalt M.; Kuhn W. Germany OBSTET GYNECOL 1998 92/3 (457-460) Objective: Hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is characterized by a distinct activation of the coagulation system. A mutation of the gene coding for coagulation Factor V (Factor V Leiden) has been identified as the most frequent risk factor for thrombosis. To identify risk factors for HELLP syndrome, we determined coagulation parameters and the Factor V Leiden mutation in women who previously had developed HELLP syndrome. Methods: Coagulation parameters (activated protein C resistance, antithrombin, protein C, protein S) were determined in 21 women 6 months to 9 years after they had developed HELLP syndrome in the third trimester. In addition, these women were analyzed for the presence of the Factor V Leiden mutation. Results: Of these analyzed women, 33% (seven of 21) had an activated protein C resistance (activated protein C ratio less than 2.0).