Calcium channel blockers as tocolytics.

This article reviews the clinical and basic science investigations regarding the safety and efficacy of calcium channel blockers as tocolytic agents. The authors reviewed the English language literature on the pharmacology and clinical applications of calcium antagonists in obstetrics. A MEDLINE (1966-2000) search was performed with the terms "calcium channel blockers," "randomized controlled trial," "preterm labor," "calcium antagonist," "tocolysis," and "nifedipine." References from these data sources were then used to find additional studies. Animal data and clinical trials in humans were included. The safety of these agents was researched in published data from the nonobstetric as well as obstetric literature. The calcium channel blockers most commonly used as tocolytics are nifedipine and nicardipine. These agents act to inhibit calcium influx across cell membranes, thereby decreasing tone in the smooth muscle of the vasculature. They act as profound vasodilatory agents and have minimal effect on the cardiac conduction system. Numerous randomized clinical trials have shown them to be as effective as beta-mimetics and magnesium in achieving tocolysis. When used for tocolysis, calcium antagonists have fewer maternal side effects than other tocolytics and have no adverse effect on fetal outcome.

Post-term induction of labor revisited.

Post-term pregnancy (longer than 42 weeks or 294 days) occurs in approximately 10% of all singleton gestations. The adverse outcomes of post-term pregnancy include a substantial increase in perinatal mortality and morbidity. ACOG currently recommends induction of labor for low-risk pregnancy during the 43rd week of gestation. However, that recommendation dates from 1989. Recent reports mandate reconsideration of the management of post-term pregnancy, including reinterpretation of the statistical risk of stillbirth in post-term pregnancies using ongoing (undelivered) rather than delivered pregnancies as the denominator, which shows a far higher risk to post-term fetuses than believed. Recent data also suggest that the risk of cesarean delivery after induction of labor at term is lower than reported, possibly because of improvements in methods for cervical ripening. Those findings provide rationale for earlier labor induction in low-risk pregnancies.

Cervical hydrosonography in pregnancy to assess cervical length by transabdominal ultrasound.

BACKGROUND: Some women's cervices cannot be evaluated because they are obscured by obesity or vertex-presenting fetuses. Measuring cervical length in these cases is difficult or impossible. TECHNIQUE: We hypothesized that the problem of obscured cervices on transabdominal ultrasound could be resolved by introducing sterile water into the vagina, creating a hydroacoustic window between the vaginal lumen and the cervix. Women with unmeasurable cervices on transabdominal ultrasound had repeat studies after introduction of 60 mL of sterile water into their vaginas, and cervical length measurements taken were compared with those made on transvaginal scans. EXPERIENCE: Six pregnant women were studied (four singleton, one twin, and one triplet pregnancy). In all cases, previously unidentifiable cervices were seen adequately. No complications were noted. Statistical analysis (kappa 0.66) suggested good correlation between transabdominal cervical hydrosonography and transvaginal measurements of cervical length. CONCLUSION: Introducing water into the vagina at transabdominal ultrasound can make an obscured cervix visible and measurable.

Pelvic pain.

Pelvic pain is a common symptom in the adolescent female. Acute pain may represent a life-threatening situation and torsion, ectopic pregnancy, and PID must be considered. For the young patient who presents with chronic pelvic pain, a multidisciplinary approach is essential to facilitate diagnosis and management. Whenever possible, organic disease such as endometriosis, adhesions, and obstructive malformations should be identified and treated as indicated. Developing a treatment team, recognizing psychosocial and environmental factors, and encouraging long-term relationships are critical components in the care of these patients and in the prevention of recurrent symptom formation and future disability.

Primary prevention of gynecologic cancers.

A shift from treatment to prevention of the three major gynecologic cancers is overdue. The traditional approach to cervical, endometrial, and ovarian cancers has been secondary or tertiary prevention--early detection and treatment or mitigation of damage, respectively. We reviewed the literature on these cancers to identify strategies for primary prevention. Cervical cancer behaves as a sexually transmitted disease. As with other such diseases, barrier and spermicidal contraceptives lower the risk of cervical cancer; the risk reduction approximates 50%. Combination oral contraceptives help prevent both endometrial and epithelial ovarian cancers. The risk of endometrial cancer among former oral contraceptive users is reduced by about 50% and that of ovarian cancer by about 30% to 60%. Weight control confers strong protection against endometrial cancer. Breast-feeding and tubal sterilization also appear to protect against ovarian cancer. Although women have a range of practical, effective measures available to reduce their risk of these cancers, few are aware of them. Without this information, women cannot make fully informed decisions about their health.