A randomized clinical trial comparing vaginal misoprostol versus cervical Foley plus oral misoprostol for cervical ripening and labor induction.

We compared labor induced by vaginal misoprostol versus a supracervical Foley catheter and oral misoprostol. Singleton pregnancies at > or = 24 weeks' gestation were randomized to either an initial 25-microg dose of intravaginal misoprostol, followed by 50-microg intravaginal doses at 3- to 6-hour intervals, or a supracervical Foley balloon and 100 microg of oral misoprostol at 4- to 6-hour intervals. Primary outcome was time from induction to delivery.

Timing of prophylactic antibiotic administration in the uninfected laboring gravida: a randomized clinical trial.

Objective: The purpose of this prospective study was to determine whether the timing of prophylactic antibiotics at cesarean delivery influences maternal/neonatal infectious morbidity.

Study Design: In this double-blind placebo-controlled trial, cefazolin was given at skin incision (group A) or at cord clamping (group B). Patients were eligible for the trial if they had labored and required a cesarean delivery.

Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure.

Objective: To identify important clinical correlates of stroke in patients with preeclampsia and eclampsia.

Methods: The case histories of 28 patients who sustained a stroke in association with severe preeclampsia and eclampsia were scrutinized with particular attention to blood pressures.

Results: Stroke occurred antepartum in 12 patients, postpartum in 16.

Obstetric implications of antepartum corticosteroid therapy for HELLP syndrome.

Objective: We reviewed the impact of intravenous high-dose corticosteroid administration for preterm hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome on vaginal delivery rate and degree of clinically significant thrombocytopenia.

Methods: Retrospective analysis of 1991-2000 HELLP syndrome (platelets < 100,000/uL, lactate dehydrogenase > 600 IU/L, aspartate aminotransferase and/or alanine aminotransferase > 70 IU/L) data focusing on labor inductions for gestations of less than 34 weeks and increase in platelet count sufficient to permit regional anesthetic techniques.

Results: Antepartum high-dose corticosteroid use increased from 32% (1991-1995) to 67% (1996-2000) for 350 patients studied (n = 199, < 34 weeks; n = 151, > 34 weeks).

Maternal benefit of high-dose intravenous corticosteroid therapy for HELLP syndrome.

Objective: We compared maternal outcomes for patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome treated with or without high-dose corticosteroids to ameliorate maternal disease.

Study Design: An analysis of data for patients with HELLP syndrome (platelets, or=600 IU/L; aspartate aminotransferase and/or alanine aminotransferase level, >or=70 IU/L) who were treated during the 7-year epochs before and after the clinical trials in 1992 and 1993 demonstrated maternal benefit with high-dose dexamethasone.

Results: Corticosteroid use increased from 16% (39/246 patients) for fetal indication from 1985 to 1991 to 90% (205/228 patients) for maternal-fetal indications from 1994 to 2000.