Vitamin C and E supplementation to prevent spontaneous preterm birth: a randomized controlled trial.

Objective: To estimate whether maternally administered vitamins C and E lower the risk of spontaneous preterm birth.

Methods: This is a secondary analysis of a randomized, double-masked, placebo-controlled trial in nulliparous women at low-risk administered 1,000 mg vitamin C and 400 international units vitamin E or placebo daily from 9 to 16 weeks of gestation until delivery. Outcomes include preterm birth attributable to premature rupture of membranes (PROM) and total spontaneous preterm births (spontaneous preterm birth attributable to PROM or spontaneous labor).

A new system for determining the causes of stillbirth.

Objective: To describe the methods for assigning the cause of death for stillbirths enrolled in the Stillbirth Collaborative Research Network (SCRN).

Methods: A complete evaluation, including postmortem examination, placental pathology, medical record abstraction, and maternal interview was available on 512 stillbirths among 500 women. These 512 stillbirths were evaluated for cause of death using the definitions outlined in this report.

Comparison of transverse and vertical skin incision for emergency cesarean delivery.

Objective: To compare incision-to-delivery intervals and related maternal and neonatal outcomes by skin incision in primary and repeat emergent cesarean deliveries.

Methods: From 1999 to 2000, a prospective cohort study of all cesarean deliveries was conducted at 13 hospitals comprising the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Maternal-Fetal Medicine Units Network. This secondary analysis was limited to emergent procedures, defined as those performed for cord prolapse, abruption, placenta previa with hemorrhage, nonreassuring fetal heart rate tracing, or uterine rupture.

Mode of delivery in women with antepartum fetal death and prior cesarean delivery.

We describe obstetric outcomes in a group of patients with prior cesarean delivery (CD) presenting with an intrauterine fetal demise (IUFD). A secondary analysis of an observational study of women with prior CD was performed. All antepartum singleton pregnancies with a prior CD and IUFD ≥20 weeks' gestation or 500 g were evaluated.

Maternal and neonatal outcomes of repeat cesarean delivery in women with a prior classical versus low transverse uterine incision.

We compared maternal and neonatal outcomes following repeat cesarean delivery (CD) of women with a prior classical CD with those with a prior low transverse CD. The Maternal Fetal Medicine Units Network Cesarean Delivery Registry was used to identify women with one previous CD who underwent an elective repeat CD prior to the onset of labor at ≥36 weeks. Outcomes were compared between women with a previous classical CD and those with a prior low transverse CD.

Second trimester cervical length and risk of preterm birth in women with twin gestations treated with 17-α hydroxyprogesterone caproate.

Objective: To compare rates of preterm birth before 35 weeks based on cervical length measurement at 16-20 weeks in women with twin gestations who received 17-α hydroxyprogesterone caproate (17OHPC) or placebo.

Methods: This is a secondary analysis of a randomised, double-blind, placebo-controlled trial of twin gestations exposed to 17OHPC or placebo. Baseline transvaginal ultrasound evaluation of cervical length was performed prior to treatment assignment at 16-20 weeks.

Vitamins C and E to prevent complications of pregnancy-associated hypertension.

Background: Oxidative stress has been proposed as a mechanism linking the poor placental perfusion characteristic of preeclampsia with the clinical manifestations of the disorder. We assessed the effects of antioxidant supplementation with vitamins C and E, initiated early in pregnancy, on the risk of serious adverse maternal, fetal, and neonatal outcomes related to pregnancy-associated hypertension.

Methods: We conducted a multicenter, randomized, double-blind trial involving nulliparous women who were at low risk for preeclampsia.

Progesterone receptor genotype, family history, and spontaneous preterm birth.

Objective: To examine whether women with a personal or family history of preterm birth are more likely to have genetic variation in the human progesterone receptor (hPR).

Methods: Women with a singleton preterm birth at less than 37 weeks of gestation between 2002 and 2006 were identified from a prospectively collected clinical and biologic obstetric database (cases). Women in the control group were those with only term deliveries at or above 38 weeks of gestation.

Neonatal outcomes in twin pregnancies delivered moderately preterm, late preterm, and term.

We compared neonatal outcomes in twin pregnancies following moderately preterm birth (MPTB), late preterm birth (LPTB), and term birth. A secondary analysis of a multicenter, randomized controlled trial of multiple gestations was conducted. MPTB was defined as delivery between 32 (0)/(7) and 33 (6)/(7) weeks and LPTB between 34 (0)/(7) and 36 (6)/(7) weeks.

Influence of maternal asthma and asthma severity on newborn morphometry.

Objective: To determine if maternal asthma or asthma severity affects newborn morphometry.

Study Design: A secondary analysis was performed on data collected in a multicenter prospective observational cohort study of asthma in pregnancy. Patients enrolled included women with asthma stratified by severity of disease and controls.

Failed operative vaginal delivery.

Objective: To compare maternal and neonatal outcomes in women undergoing second-stage cesarean delivery after a trial of operative vaginal delivery with those in women undergoing second-stage cesarean delivery without such an attempt.

Methods: This study is a secondary analysis of the women who underwent second-stage cesarean delivery. The maternal outcomes examined included blood transfusion, endometritis, wound complication, anesthesia use, and maternal death.

Neonatal outcomes and operative vaginal delivery versus cesarean delivery.

We compared outcomes for neonates with forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. This is a secondary analysis of a randomized trial in laboring, low-risk, nulliparous women at >or=36 weeks' gestation. Neonatal outcomes after use of forceps, vacuum, and cesarean were compared among women in the second stage of labor at station +1 or below (thirds scale) for failure of descent or nonreassuring fetal status.

Omega-3 fatty acid supplementation to prevent recurrent preterm birth: a randomized controlled trial.

Objective: To assess whether the addition of an omega-3 long-chain polyunsaturated fatty acid supplement would reduce preterm birth in women with at least one prior spontaneous preterm birth receiving 17alpha-hydroxyprogesterone caproate.

Methods: We conducted a randomized, double-masked, placebo-controlled trial in 13 centers. Women with a history of prior spontaneous singleton preterm birth and a current singleton gestation were assigned to either a daily omega-3 supplement (1,200 mg eicosapentaenoic acid and 800 mg docosahexaenoic acid) or matching placebo from 16-22 through 36 weeks of gestation.

White's classification of maternal diabetes and vaginal birth after cesarean delivery success in women undergoing a trial of labor.

Objective: To estimate the rate of vaginal birth after cesarean delivery (VBAC) success in diabetic women based on White's Classification.

Methods: This is a secondary analysis of an observational study conducted at 19 medical centers of women attempting VBAC. Diabetic women with singleton gestations, one prior cesarean delivery, and cephalic presentation who underwent a trial of labor were included.

Perioperative antibiotic prophylaxis for nonlaboring cesarean delivery.

Objective: To estimate the efficacy of antibiotic prophylaxis at the time of nonlaboring cesarean delivery in reducing postpartum infection-related complications.

Methods: We performed a secondary analysis of an observational study of cesarean deliveries performed at 13 centers from 1999-2000. Patients were included if they had cesarean delivery before labor, did not have intrapartum infection, and were not given antibiotics at delivery for reasons other than prophylaxis.

The effect of active and passive household cigarette smoke exposure on pregnant women with asthma.

Background: The article was designed to estimate the effect of active and passive household cigarette smoke exposure on asthma severity and obstetric and neonatal outcomes in pregnant women with asthma.

Methods: We used a secondary observational analysis of pregnant women with mild and moderate-severe asthma enrolled in a prospective observational cohort study of asthma in pregnancy and a randomized clinical trial (RCT) comparing inhaled beclomethasone and oral theophylline. A baseline questionnaire detailing smoking history and passive household smoke exposure was given to each patient.

Does information available at admission for delivery improve prediction of vaginal birth after cesarean?

We sought to construct a predictive model for vaginal birth after cesarean (VBAC) that combines factors that can be ascertained only as the pregnancy progresses with those known at initiation of prenatal care. Using multivariable modeling, we constructed a predictive model for VBAC that included patient factors known at the initial prenatal visit as well as those that only become evident as the pregnancy progresses to the admission for delivery. We analyzed 9616 women.

A multicenter, randomized trial of treatment for mild gestational diabetes.

Background: It is uncertain whether treatment of mild gestational diabetes mellitus improves pregnancy outcomes.

Methods: Women who were in the 24th to 31st week of gestation and who met the criteria for mild gestational diabetes mellitus (i.e.

Preterm premature rupture of membranes: does the duration of latency influence perinatal outcomes?

Objective: Preterm premature rupture of membranes (PPROM) is the leading identifiable cause of prematurity. We hypothesized that, when controlled for delivery gestational age, potential prolonged exposure to inflammation/infection could be harmful to the developing fetus.

Study Design: We studied a retrospective cohort of pregnancies with PPROM at 22.

The effect of 17-alpha hydroxyprogesterone caproate on the risk of gestational diabetes in singleton or twin pregnancies.

Objective: To compare the rates of gestational diabetes among women who received serial doses of 17-alpha hydroxyprogesterone caproate vs placebo.

Study Design: Secondary analysis of 2 double-blind randomized placebo-controlled trials of 17-alpha hydroxyprogesterone caproate given to women at risk for preterm delivery. The incidence of gestational diabetes was compared between women who received 17-alpha hydroxyprogesterone caproate or placebo.

Newborn adiposity measured by plethysmography is not predicted by late gestation two-dimensional ultrasound measures of fetal growth.

Noninvasive measures of fetal and neonatal body composition may provide early identification of children at risk for obesity. Air displacement plethysmography provides a safe, precise measure of adiposity and has recently been validated in infants. Therefore, we explored relationships between term newborn percent body fat (%BF) measured by air displacement plethysmography to 2-dimensional ultrasound (2-D US) biometric measures of fetal growth and maternal and umbilical cord endocrine activity.

The frequency and complication rates of hysterectomy accompanying cesarean delivery.

Objective: To estimate the frequency, indications, and complications of cesarean hysterectomy.

Methods: This was a prospective, 2-year observational study at 13 academic medical centers conducted between January 1, 1999, and December 31, 2000, on all women who underwent a hysterectomy at the time of cesarean delivery. Data were abstracted from the medical record by study nurses.

Polymorphisms in the promoter region of the interleukin-10 (IL-10) gene in women with cervical insufficiency.

Objective: Our objective was to determine whether polymorphisms in the promoter region of the interleukin-10 gene are more common in women with cervical insufficiency compared with controls.

Study Design: We conducted a case-control study. Histories and blood were obtained from 121 cases and 157 controls.

Outcomes of expectantly managed preterm premature rupture of membranes occurring before 24 weeks of gestation.

Objective: To assess contemporary outcomes in expectantly managed preterm premature rupture of membranes (PROM) before 24 weeks of gestation.

Methods: We analyzed all patients with singleton pregnancies and preterm PROM before 24 weeks of gestation from 2001 to 2007. Patients immediately electing delivery, delivering within 12 hours of preterm PROM, carrying anomalous fetus(es), or multiple gestations were excluded.