Maternal factors associated with misperceptions of the second-trimester sonogram.

OBJECTIVE: Prior studies have shown that patients have poor understanding of prenatal screening tests. The purpose of this study was to evaluate the frequency with which patients have poor understanding of the sensitivity and safety of the second-trimester fetal sonogram and to identify maternal factors associated with poor understanding. METHOD: One hundred fifty-five women presenting for a routine fetal anatomy scan completed a survey that assessed their understanding of the diagnostic sensitivity and safety of ultrasound, their demographic characteristics, and the sources of information of their knowledge of ultrasound. The frequency of misperception with regard to sonographic sensitivity or safety was determined, and both univariable and multivariable analyses were performed to identify factors associated with misperception. RESULTS: Fifty-one percent of women had a misperception of the sensitivity or safety of a second-trimester sonogram. Although multiple characteristics (age, ethnicity, education, income, source of ultrasound information) were associated with this misperception in univariable analysis, only education and income remained independently associated with misperception in multivariable regression. CONCLUSION: Lower educational attainment and lower income are associated with misperception of the sensitivity and safety of a second-trimester sonogram.

Oral misoprostol and vaginal isosorbide mononitrate for labor induction: a randomized controlled trial.

OBJECTIVE: To estimate whether vaginal isosorbide mononitrate, added to oral misoprostol for cervical ripening and labor induction, shortens time to vaginal delivery. METHODS: A prospective, randomized trial was conducted. Women scheduled for labor induction between 32 and 42 weeks and with unfavorable cervices (modified Bishop score 6 or lower) were randomized to receive oral misoprostol every 4 hours, up to four doses, with or without isosorbide mononitrate every 6 hours, up to two doses. A strict protocol was used, including timing of oxytocin use and amniotomy. Side effects were assessed 6 hours after study initiation. One hundred forty-two patients were required to detect a change in time to vaginal delivery of 4 hours (alpha=.05 and beta=.20). Data were analyzed by intent to treat. Student's t, chi square, Fisher's exact, and Mann-Whitney tests were used where appropriate with P< or =.05 deemed significant. RESULTS: One hundred fifty-six women were randomized; three were excluded after randomization. Seventy-eight women received misoprostol, and 78 received misoprostol with isosorbide mononitrate. Demographic characteristics were similar between groups. The time to vaginal delivery was not reduced when isosorbide mononitrate was added to misoprostol. Cesarean delivery rates and contraction and fetal heart rate abnormalities were similar between groups. Side effects were also similar between groups, except that women given isosorbide mononitrate experienced headaches more often. Neonatal outcomes were similar between groups. CONCLUSION: The addition of vaginal isosorbide mononitrate to oral misoprostol for cervical ripening and labor induction did not reduce time to vaginal delivery and was associated with a greater incidence of headache. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00374621. LEVEL OF EVIDENCE: I.