Randomized trial of intracervical versus posterior fornix dinoprostone for induction of labor.

Objective: To investigate whether intracervical placement of a sustained-release dinoprostone insert decreased the length of time to delivery when compared with placement in the posterior fornix.

Methods: Sixty-three patients were randomized to intracervical (n = 33) or posterior fornix (n = 30) placement of the initial dose. Dinoprostone was placed under direct visualization with a vaginal speculum and packing forceps.

Adenosine diphosphate-induced platelet activation inhibited by magnesium in a dose-dependent manner.

Objective: To examine the hypothesis that magnesium inhibits platelet activation at concentrations equivalent to therapeutic levels.

Methods: Fifteen subjects were enrolled: five healthy, female donors with regular, spontaneous menstrual cycles; five women with uncomplicated third-trimester pregnancies; and five preeclamptic subjects before magnesium therapy. Anticoagulated whole blood was added to tubes containing 0.

Placenta previa percreta with bladder invasion.

Background: Although the clinical presentation and imaging techniques can raise suspicion for placenta previa percreta, this potentially catastrophic condition may remain undiagnosed or its extent underappreciated until delivery. The decision to proceed with definitive surgery in cases of placenta previa percreta should be carefully considered.

Case: A case of placenta previa percreta with bladder invasion was diagnosed prenatally.

Labor induction with a prenatal diagnosis of fetal macrosomia.

Since our institution has a low cesarean rate (14%), it was our hypothesis that the rate of cesarean delivery in patients who underwent induction for macrosomia would be similar to the cesarean rate in patients with similar birth weights who entered labor spontaneously. A retrospective analysis of cases seen from December 1993 to July 1995 revealed 53 nondiabetic patients who underwent induction for fetal macrosomia. These study patients were matched to the next nondiabetic patient delivering a child of equal or greater birth weight who entered labor spontaneously.

Hysterotomy to effect vaginal delivery with mentum anterior head entrapment.

Background: Entrapment of the aftercoming head after mentum anterior rotation is a life-threatening complication of vaginal breech delivery. Few options exist when rotation and flexion from this position cannot be performed successfully either transabdominally or with vaginal maneuvers.

Case: A term primigravida presented with a singleton breech in advanced labor.