Oral versus vaginal misoprostol for labor induction.

Objective: To compare the safety and effectiveness of vaginal with oral misoprostol for induction of labor.

Methods: A total of 107 women with clinical indication for induction were randomly assigned to receive oral or vaginal misoprostol. Doses of 100 microg of oral or 25 microg of vaginal misoprostol were given every 3-4 hours.

Central diabetes insipidus: a complication of ventriculoperitoneal shunt malfunction during pregnancy.

During pregnancy ventriculoperitoneal shunts have reported complication rates of 30% to 60%. In this case a functionally occluded shunt resulted in prolonged increased intracranial pressure, pituitary stalk damage, and permanent central diabetes insipidus. This complication of ventriculoperitoneal shunt occlusion during pregnancy has not been previously reported.

Comparison of pancuronium and vecuronium for fetal neuromuscular blockade during invasive procedures.

Neuromuscular blocking agents, used to arrest fetal motion for invasive intrauterine procedures, may cause temporary fetal heart rate changes. After 21 invasive procedures using either pancuronium bromide or vecuronium bromide, post-procedure fetal heart rate tracings were retrospectively compared. Pancuronium was associated with an increased fetal heart rate and decreased beat-to-beat variability for 2.

Clomiphene-induced quintuplets with a failed attempt at delayed-interval delivery.

Clomiphene citrate is widely used for ovulation induction. It is associated with a 6 to 17% incidence of multiple gestation. We report on a 27-year-old para 0010 patient who, after an initial evaluation for secondary infertility of 2 years' duration, was deemed to have oligo-ovulation.

Risk factors for preterm delivery in a healthy cohort.

To examine whether risk factors differed among subgroups of preterm (< 37 weeks of gestation) deliveries, we studied a cohort of 1,825 enlisted servicewomen who delivered from 1987 through 1990 at four U.S. Army medical centers.

Sonographic assessment of amniotic fluid in normal twin pregnancy.

A sonographic standard for assessment of amniotic fluid volume in normal twin pregnancy is provided. In 210 uncomplicated twin pregnancies, amniotic fluid volume was assessed sonographically, by measuring the total amniotic fluid index (AFI), as well as the deepest single vertical pocket in each sac. The mean AFI was greater than values found in singleton gestations; the AFI increased up to 27 weeks' gestation, and decreased thereafter.

Vesicouterine fistula after cesarean section. A case report.

A 27-year-old woman, gravida 3, para 2002, underwent repeat cesarean section and inadvertent cystotomy, with subsequent development of a vesicouterine fistula. The fistula did not resolve with prolonged bladder catheterization and required total abdominal hysterectomy with resection of the fistula tract and primary closure for definitive treatment.

Antenatal hospitalization among enlisted servicewomen, 1987-1990.

Objective: To describe the prevalence of, and indications for, antenatal hospitalization among women who delivered live and stillborn infants.

Methods: We reviewed the records of a cohort of 1825 black and white enlisted women who delivered from 1987-1990 at the four largest Army medical centers in the United States. Women with multiple gestations and those whose pregnancies ended before 20 weeks' gestation were excluded.

Recurrence of Treacher Collins' syndrome with sonographic findings.

Treacher Collins' syndrome, or mandibulofacial dysostosis, is a rare, autosomal-dominant disorder. We describe the recurrence of this anomaly in the fetus of a patient who previously had delivered a severely affected infant. The ultrasonographic findings of hydramnios, absence of fetal swallowing movements, and poor growth of the biparietal diameter and head circumference permitted us to suggest the diagnosis antenatally of another affected child.

Management of osteogenesis imperfecta in pregnancy. A case report.

Osteogenesis imperfecta (OI) is a metabolic disorder of connective tissue; it is typically characterized by blue sclera, bone fragility and deformity secondary to repetitive fractures. The severity of the disease in the infant cannot be predicted by the phenotypic presentation of the mother. We present a case report and review literature and discuss the prenatal diagnosis, evaluation criteria and guidelines for delivery.

Extraneous factors and their influences on fetal acid-base status.

The relevance of extraneous factors on fetal and neonatal respiratory gas exchange and acid-base balance must be considered when interpreting umbilical cord blood values. However, although many of these factors can alter these values to a minor degree, the clinical impact is negligible in the unstressed fetus. The more important clinical aspect of these findings is the reassurance that conditions commonly initiated through appropriate clinical endeavors, such as regional anesthesia or tocolysis, generally have no significant adverse effects on the fetus.

The perioperative morbidity of scheduled cesarean hysterectomy.

Objective: To compare the outcomes of patients undergoing scheduled cesarean hysterectomy with those of women treated with cesarean delivery and subsequent hysterectomy.

Methods: Through a retrospective review of 43 patients, we investigated the morbidity associated with scheduled cesarean hysterectomy and compared these findings with the combined morbidity of scheduled cesarean delivery and subsequent abdominal hysterectomy in a control population. Controls were included only if the subsequent hysterectomy was performed within 3 years of the index cesarean delivery.

Preterm delivery among black and white enlisted women in the United States Army.

Objective: To examine black-white differences in preterm delivery in a healthy population who had unrestricted access to prenatal care.

Methods: We conducted a retrospective cohort study of 842 black and 1026 white enlisted servicewomen who delivered a singleton infant of 20 or more weeks' gestation from July 1, 1987 through September 30, 1990 at four Army Medical Centers in the United States. Data were collected by reviewing maternal and newborn records.

Use of a standard preparatory diet for the oral glucose tolerance test. Is it necessary?

A prospective investigation was performed to evaluate the necessity of a diet containing greater than or equal to 150 g/d of carbohydrate for three days before the oral glucose tolerance test (OGTT). Thirty-seven obstetric patients who had a value of greater than or equal to 135 mg/dL on the one-hour, 50-g oral glucose screening test underwent a subsequent OGTT. The patients were alternately assigned to one of two groups.

Reproducibility of the oral glucose tolerance test in pregnancy.

This prospective investigation evaluated the reproducibility of the 100 gm oral glucose tolerance test. Sixty-four obstetric patients with greater than or equal to 135 mg/dl on the 50 gm oral glucose screening test were scheduled for the 100 gm test. All patients repeated the oral glucose tolerance test in 1 to 2 weeks.

Role of amniotic fluid cytogenetic analysis in the evaluation of recent fetal death.

Chromosome abnormalities may be present in approximately 10% of cases of fetal death. Because of cell maceration and autolysis, the likelihood of successful karyotype analysis of fetal tissue varies inversely with the time between fetal death and delivery. In an attempt to reduce the influence of these postmortem changes, we obtained amniotic fluid cells for cytogenetic studies from 12 fetuses as soon as possible after the diagnosis of fetal death was confirmed.

Prenatal diagnosis of chondrodysplasia punctata by sonography.

The rhizomelic form of chondrodysplasia punctata is a lethal autosomal recessive disorder of unknown cause. It is characterized by marked shortening and bowing of the proximal limbs, vertebral column abnormalities, eye and skin defects, severe mental retardation, and recurrent infection. Previously, antenatal diagnosis of this condition was made by radiography.

The evaluation of urine pH in screening for asymptomatic bacteriuria in pregnancy.

The purpose of this prospective investigation was to determine whether an alteration in urine pH, either by itself or in combination with other rapid screening tests, could be used to identify asymptomatic bacteriuria in pregnant women. Clean catch urine specimen was used to evaluate 510 asymptomatic obstetric patients. Urine specimens were tested for pH, leukocyte esterase activity, and the presence of nitrites.

The duration of labor in primiparas undergoing vaginal birth after cesarean delivery.

The purpose of this retrospective investigation was to evaluate the duration of labor in women having a trial of labor after a previous low transverse cervical cesarean delivery for dystocia. We specifically sought to determine whether these patients experienced a labor similar to that of the nulliparous or multiparous woman. During the study period, 73 women who had previously undergone a cesarean for dystocia had a successful trial of labor.

Reliability of fetal buttock blood sampling in assessing the acid-base balance of the breech fetus.

This prospective investigation was undertaken to compare fetal buttock capillary blood pH and umbilical artery and vein pH in fetuses presenting by the breech. The study group comprised ten term patients with singleton fetuses in the frank breech presentation who met established criteria for vaginal breech delivery. All patients had a normal labor pattern.

Hydrops fetalis and premature closure of the ductus arteriosus: a review.

The purpose of this report is to describe a case of nonimmune hydrops fetalis that resulted from an unusual congenital heart defect, premature closure of the ductus arteriosus. In this fetus, the ductal closure was not associated with other heart defects such as tetralogy of Fallot or truncus arteriosus, nor was it related to maternal use of nonsteroidal antiinflammatory agents. Despite adequate digitalization of the mother, the fetus died of congestive heart failure at 29 weeks of gestation.

Benefits of posturethropexy bladder conditioning. Fact or fiction?

The influence of intermittent bladder catheter clamping upon detrusor tone in female postsurgical urethropexy patients was investigated. Thirteen patients who underwent retropubic urethropexy procedures were studied from March 1982 to December 1982. Utilizing a Corometrics 112 Fetal Monitor, intravesicle pressures were obtained in response to known volumes of saline solution instilled into the bladder.

Estimated weight of the term fetus. Accuracy of ultrasound vs. clinical examination.

A prospective analysis was done of the accuracy of fetal weight estimation comparing clinical and ultrasound estimation with actual birth weight in 100 women at term. The mean error of clinical estimation was 277 g, or 79.4 g/kg, for a 7.