Tocolysis in women with advanced preterm labor: a secondary analysis of a randomized clinical trial.

Objective: To compare the efficacy of tocolytic treatment with indomethacin (I), magnesium sulfate (M) and nifedipine (N) for acute tocolysis in women with advanced cervical dilation (4-6 cm).

Methods: A single center, randomized trial was carried out involving patients in preterm labor (cervix 1-6 cm). Secondary analysis of women with advanced cervical dilation (cervix 4-6 cm) at 24-32 weeks' gestation who received intravenous M, oral N or I suppositories comprised this study population.

The use of 17-hydroxy progesterone in women with arrested preterm labor: a randomized clinical trial.

Background: The use of 17-alpha-hydroxyprogesterone caproate (17 P) has been shown to reduce preterm delivery in women who have had a prior preterm birth. The role of 17 P in women with arrested preterm labor is less certain.

Aims: To compare the preterm birth rate and neonatal outcome in women with arrested preterm labor randomized to receive 17 P or placebo.

A comparison of three tocolytics for preterm labor: a randomized clinical trial.

Objective: To compare the efficacy and maternal side effects of nifedipine (N), magnesium sulfate (M), and indomethacin (I) for acute tocolysis.

Methods: In this single center randomized trial, women in preterm labor 24-32 weeks' gestation received intravenous M, oral N, or I suppositories. The primary outcomes of interest were arrest of preterm labor (>48 h, ≥7 days), gestational age at delivery, and maternal side effects.

Effect of antenatal tocolysis on neonatal outcomes.

Objective: Detail adverse neonatal effects in pregnancies treated with indomethacin (I), magnesium sulfate (M) or nifedipine (N).

Methods: Women in acute preterm labor with cervical dilatation 1-6 cm were randomized to receive one of three first-line tocolytic drugs.

Results: There were 317 neonates (I = 103, M = 95, N = 119) whose mothers were treated with tocolytic therapy.

Postpartum thrombotic microangiopathic syndrome.

Objective: Characterization of syndromes for patients with life-threatening, progressively worsening hemolysis-elevated-liver-enzymes-and-platelet (HELLP) syndrome-like diseases and with thrombotic microangiopathies. RETROSPECTIVE STUDY DESIGN: Patients who underwent postpartum plasma-exchange (PPEX) for preeclampsia-related, and microangiopathy/coagulopathy illnesses unresponsive to medical therapy between 1994 and 2008 in our center and elsewhere.

Results: Nine patients were treated with PPEX in our center with 78% maternal survival.

Women with preterm premature rupture of the membranes do not benefit from weekly progesterone.

Objective: We sought to determine if 17-alpha-hydroxyprogesterone (17P) extends gestation vs placebo in women with preterm premature rupture of the membranes (PPROM).

Study Design: Women with vertex presentations with PPROM, 20-30 weeks' gestation, were randomized to receive weekly 17P or placebo in an attempt to prolong the pregnancy. A total of 69 patients (17P, n = 33; placebo, n = 36) were randomized into this study.

Prediction of placenta accreta by ultrasonography and color Doppler imaging.

Objective: To determine the accuracy of ultrasound and color flow Doppler to diagnose placenta accreta.

Methods: Respectively, ultrasound images consistent with signs of placenta accreta (concomitant previa, numerous vascular lacunae, absent lower uterine segment between bladder-placenta, turbulent or complicated blood flow at the uteroplacental interface) were correlated with findings at the time of surgery and pathologic examination.

Results: Over 64 months, 12 cases with suspected placenta accreta by ultrasound were studied.

Progesterone does not prevent preterm births in women with twins.

Objective: To compare preterm birth rate and neonatal outcome in twin gestations randomized to either 17 alpha-hydroxyprogesterone caproate (17P) or placebo.

Materials And Methods: Women with twin gestations between 20-30 weeks were randomized to receive weekly injections of either 250 mg 17P injection (Group I), or placebo (Group II). Maternal and neonatal outcome data was recorded.

Pregnancy loss after first trimester viability in women with sickle cell trait: a preliminary report.

Background: Traditionally, sickle cell trait has not been associated with a higher risk of fetal death, but we noted several, which led us to assess all such pregnancies.

Methods: In this retrospective study, 131 patients with sickle cell trait were analyzed over a two-year period. The Institutional Review Board approved the collection of deidentified data.

Metformin and insulin in the management of gestational diabetes mellitus: preliminary results of a comparison.

Objective: To compare glycemic control and neonatal outcomes in women with gestational diabetes mellitus (GDM) treated with metformin vs. insulin.

Study Design: Women with GDM not controlled with diet and exercise were randomized to metformin (n = 32) or insulin (n = 31).

Tocolytic preference for treatment of preterm labor.

Preterm labor remains the most common complication of pregnancy. Although tocolytic treatment is the standard of care in such women, there is no FDA approved drug for therapy, and there is no unanimity of drug regimens among physicians. This survey details the patterns of twenty Maternal-Fetal Medicine specialists who manage over 6,000 cases of preterm labor with intact membranes annually.

Non-immune hydrops fetalis: prenatal diagnosis and perinatal outcomes.

Purpose: To describe the perinatal outcomes after a prenatal diagnosis of non-immune hydrops fetalis (NIHF).

Methods: Retrospective case series. University of Mississippi ultrasound database from July 2000 to January 2003 was reviewed for cases of NIHF.

Fetal fibronectin and bacterial vaginosis are associated with preterm birth in women who are symptomatic for preterm labor.

Objective: The purpose of this study was to codify the relationship between bacterial vaginosis/fetal fibronectin and preterm labor/birth.

Study Design: In this prospective study, 185 women who were symptomatic for preterm labor were assessed for bacterial vaginosis and fetal fibronectin.

Results: These women comprised 4 groups: group A (n=23 women; +bacterial vaginosis/+fetal fibronectin); group B (n=31 women; -bacterial vaginosis/+fetal fibronectin); group C (n=47 women; +bacterial vaginosis/-fetal fibronectin); and group D (n=84 women; -bacterial vaginosis/-fetal fibronectin).

Diagnosis of postpartum infections: clinical criteria are better than laboratory parameter.

Background: Physiologic increases in the leukocyte count and segmental neutrophil percentage during pregnancy alter the ability of these indices to predict infection.

Methods: Women with cesarean deliveries were assessed by leukocyte counts and segmented neutrophil percentage as well as clinical signs to detect postoperative infection.

Results: In 157 consecutive patients undergoing cesarean deliveries there was a significant physiologic increase between the preoperative and postoperative leukocyte count (12.