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Inducibility scoring
Amniotic Fluid Antibodies to Herpes Bradley J, Yeager A, Dyson D, et al.: Neutralization of herpes simplex virus by antibody in amniotic fluid. Obstet Gynecol 60:318, 1982. This study demonstrates that amniotic fluid is capable of neutralizing herpes simplex virus (HSV) and that its capacity to do so can be predicted from the serum titer of the mother. All women who had serum titers of 1:40 or higher gave birth to infants with serum titers of 1:40 or higher. Eighty-three percent of the amniotic fluid samples obtained at term from mothers with serum titers of 1:40 or higher neutralized 500 pfu/O.l ml. The mean number of infectious particles (pfu) per lesion in women with recurrent infection is about 300-600 pfu, therefore the quantity of neutralizing antibody found in amniotic fluid appears to be clinically relevant. Where premature infants are concerned, their lower IgG levels cause them to derive less benefit from the mothers’ titers, and this is borne out in the higher incidence of HSV infection among premature infants.
Prediction of True Postmature Infants Rayburn W, Motley M, Stempel L, et al.: Antepartum prediction of the postmature
infant.
Obstet
Gynecol
60: 148, 1982. This prospective study was designed to evaluate whether current methods are able to predict postmaturity with some degree of accuracy. Clinical findings, fetal heart rate testing (mainly nonstress tests), and fetal movement charting were not found to be useful predictors. The researchers were surprised to find
that single voiding estrogen:creatinine ratios were significantly lower (P < 0.0001) in fetuses with subsequent findings of postmaturity, and all subnormal values were associated with postmature infants. Twenty-four of 29 pregnancies with oligohydramnios diagnosed by ultrasound produced postmature infants, and 110 of 118 pregnancies with either pockets or an adequate volume of fluid produced infants who were not postmature.
Inducibility Scoring Lange A, Secher N, Westergaard J, et al.: Prelabor evaluation of inducibility. Obstet Gynecol 60: 137, 1982. This study proposes a new pelvic scoring system for evaluation of inducibility as the result of complex calculations based upon large numbers of attempted inductions. Data were collected on 381 patients admitted for induction of labor after premature rupture of membranes, and 808 other patients admitted for medically indicated induction of labor. Patients with favorable cervical conditions were induced with primary amniotomy, followed by either oxytocin or prostaglandin stimulation if needed (337 cases). The remaining 471 cases with unfavorable cervical conditions were induced without amniotomy. Multiple regression analyses were used to evaluate the predictive value of the Bishop score as well as other factors thought to be related to the duration of labor and to the inducibility of labor (latency period). The influence of parity on the duration of labor was found to be highly significant, yet it had little effect on inducibility. All patients whose cervical conditions allowed for primary amniotomy were de-
30 Copyright
Journal @ 1983 by the American
livered within 21 hr. In 290 (61.6%) of the 471 patients whose labor was induced without amniotomy, labor was established within 8 hr, and all delivered within the first day of treatment. One hundred thirteen (24%) were delivered on the second day, and the remaining 68 (14.4%) delivered at a later time. After much complex analysis, the only factor which seemed to be highly significant with respect to predicting inducibility was prelabor cervical condition, and cervical dilation was found to have two to three times the influence accorded it by Bishop. Station, consistency, and position of the cervix were less significant factors. The authors conclude that “A closed cervix is the worst possible prognostic sign, irrespective of almost all the other factors.”
College of Nurse-Midwives
of Nurse-Midwifery
Subsequent Pregnancies Following Early Losses Kossmann J, Bard H: Subsequent pregnancy following the loss of an early preterm newborn infant weighing less than 1000 grams. Obstet Gynecol 60:74, 1982. In an effort to provide counseling based upon solid data for women considering pregnancies after having lost infants of less than 1000 g these authors collected data from 84 such women over a 5-year period. Forty of these women became pregnant again during the study period. Thirty-six (90%) delivered larger older infants who did survive. The mean gestational age was 37.6 & 3 weeks, and mean birthweight was 2754 * 754 g. A control group of 565 women who delivered normal infants at term within the study period was also collected. Of these, 170 women subsequently became
l
Vol.
28,
No.
1, January/February 0091.2182/83/010030+3$03.00
1983
’
Prediction of True Postmature Infants Rayburn W, Motley M, Stempel L, et al.: Antepartum prediction of the postmature
infant.
Obstet
Gynecol
60: 148, 1982. This prospective study was designed to evaluate whether current methods are able to predict postmaturity with some degree of accuracy. Clinical findings, fetal heart rate testing (mainly nonstress tests), and fetal movement charting were not found to be useful predictors. The researchers were surprised to find
that single voiding estrogen:creatinine ratios were significantly lower (P < 0.0001) in fetuses with subsequent findings of postmaturity, and all subnormal values were associated with postmature infants. Twenty-four of 29 pregnancies with oligohydramnios diagnosed by ultrasound produced postmature infants, and 110 of 118 pregnancies with either pockets or an adequate volume of fluid produced infants who were not postmature.
Inducibility Scoring Lange A, Secher N, Westergaard J, et al.: Prelabor evaluation of inducibility. Obstet Gynecol 60: 137, 1982. This study proposes a new pelvic scoring system for evaluation of inducibility as the result of complex calculations based upon large numbers of attempted inductions. Data were collected on 381 patients admitted for induction of labor after premature rupture of membranes, and 808 other patients admitted for medically indicated induction of labor. Patients with favorable cervical conditions were induced with primary amniotomy, followed by either oxytocin or prostaglandin stimulation if needed (337 cases). The remaining 471 cases with unfavorable cervical conditions were induced without amniotomy. Multiple regression analyses were used to evaluate the predictive value of the Bishop score as well as other factors thought to be related to the duration of labor and to the inducibility of labor (latency period). The influence of parity on the duration of labor was found to be highly significant, yet it had little effect on inducibility. All patients whose cervical conditions allowed for primary amniotomy were de-
30 Copyright
Journal @ 1983 by the American
livered within 21 hr. In 290 (61.6%) of the 471 patients whose labor was induced without amniotomy, labor was established within 8 hr, and all delivered within the first day of treatment. One hundred thirteen (24%) were delivered on the second day, and the remaining 68 (14.4%) delivered at a later time. After much complex analysis, the only factor which seemed to be highly significant with respect to predicting inducibility was prelabor cervical condition, and cervical dilation was found to have two to three times the influence accorded it by Bishop. Station, consistency, and position of the cervix were less significant factors. The authors conclude that “A closed cervix is the worst possible prognostic sign, irrespective of almost all the other factors.”
College of Nurse-Midwives
of Nurse-Midwifery
Subsequent Pregnancies Following Early Losses Kossmann J, Bard H: Subsequent pregnancy following the loss of an early preterm newborn infant weighing less than 1000 grams. Obstet Gynecol 60:74, 1982. In an effort to provide counseling based upon solid data for women considering pregnancies after having lost infants of less than 1000 g these authors collected data from 84 such women over a 5-year period. Forty of these women became pregnant again during the study period. Thirty-six (90%) delivered larger older infants who did survive. The mean gestational age was 37.6 & 3 weeks, and mean birthweight was 2754 * 754 g. A control group of 565 women who delivered normal infants at term within the study period was also collected. Of these, 170 women subsequently became
l
Vol.
28,
No.
1, January/February 0091.2182/83/010030+3$03.00
1983
’