The Yield of Abdominal Ultrasound in the Evaluation of Elevated Liver Enzymes during the Second and the Third Trimester of Pregnancy.

AIMS: To determine the clinical yield of abdominal ultrasound in the evaluation of elevated liver enzymes (ELEs) in the second and the third trimester of pregnancy. METHODS: A retrospective cohort study including all pregnant women admitted to a single tertiary care center was conducted between April 2011 and January 2015 with ELE. Inclusion criteria included gestational age above 24 weeks and ELEs, abdominal ultrasound report, and live fetus. Exclusion criteria included known maternal liver disease, structural or chromosomal fetal anomalies, and positive serology for viral hepatitis. All patients underwent abdominal ultrasound. A significant finding of this study led to a change in treatment. RESULTS: One hundred and twenty patients (41.8%) met inclusion criteria: 93 (77.5%) had a normal scan and 27 (22.5%) had abnormal findings. Significant ultrasound findings were found only in 2 (1.6%) patients: gallstones in the common bile duct and suspected autoimmune hepatitis. There were no significant differences between patients with and without ultrasound findings in the rate of cholestasis of pregnancy, preeclampsia, chronic hypertension, and gestation diabetes. CONCLUSION: Abdominal ultrasound examination in this population has a low clinical yield. The decision to perform an abdominal ultrasound must be individualized based on the obstetric history, clinical findings, and the level of liver enzymes.

Second dose of PGE2 vaginal insert versus Foley transcervical balloon for induction of labor after failure of cervical ripening with PGE2 vaginal insert.

PURPOSE: To determine the success rate of induction of labor (IOL) using Foley transcervical balloon (FTB) versus prostaglandin E2 (PGE2) vaginal insert, following failure of cervical ripening with PGE2 vaginal insert. MATERIALS AND METHODS: A retrospective cohort study of all pregnant women admitted for IOL with either FTB or PGE2 vaginal insert. Either second dose of PGE2 vaginal insert or FTB was used as a second line treatment after failure (not giving birth in 24 h from insertion) of first PGE2 vaginal insert. RESULTS: During the study period, 1162 women were admitted for IOL. Failure was reported in 322/852 (37.8%) in the FTB versus 162/310 (52.2%) in the PGE2 group (p < 0.001). Among 162 patients treated with PGE2 as first line who did not deliver after 24 h, 14 had spontaneous rupture of membranes, 15 underwent stripping and 42 were in still in active labor. The remainder were allocated to either second trial of PGE2 treatment (n = 58) or FTB (n = 33) with failure rate higher in the PGE2 group, not statistically significant (p = 0.23). CONCLUSION: IOL with FTB was not superior to PGE2 vaginal insert for IOL following failure of cervical ripening with PGE2 vaginal insert.

C-reactive protein and the mode of onset of labor in term pregnancies.

OBJECTIVE: To evaluate whether C-reactive protein (CRP) levels in maternal serum at post-date follow-up can predict the mode of onset of spontaneous delivery in term pregnancies and the interval to delivery. STUDY DESIGN: Women at 40 completed weeks of gestation were recruited. The interval from CRP sampling to delivery and mode of onset of delivery were noted. RESULTS: Sixty women were divided into 3 groups according to the mode of onset of labor. Group A presented with spontaneous onset of contractions, Group B presented with pre-labor ruptured membranes (PROM), and Group C completed 42 weeks without spontaneous initiation of labor. There was no association between CRP values and latency from time of sampling to delivery. Mean serum CRP in Group B (12.7 mg/l) was significantly higher than in either Group A(7.2 mg/l) or Group C (10.2 mg/l) (p=0.01). In addition, CRP values in the upper quartile (>12.2 mg/l) had a 37.5%positive predictive value for PROM, with a negative predictive value of 93%. CONCLUSION: Women whose labor will start with PROM have higher CRP values at post-date follow-up than women whose labor starts otherwise.