Prostaglandin E2 induction of labor and cervical ripening for term isolated oligohydramnios in pregnant women with Bishop score ≤ 5.

BACKGROUND: We aimed to evaluate the efficacy and safety of dinoprostone for cervical ripening and labor induction in patients with term oligohydramnios and Bishop score ≤ 5. METHODS: This was a prospective case-control study, which included 104 consecutive women with a Bishop score≤5. Participants were divided into two groups. Women with term isolated oligohydramnios and Bishop score≤5 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (prostaglandin E2; Group A, n=40). The control group, Group B, consisted of 64 cases of pregnancy with normal amniotic fluid volume (amniotic fluid index≥5 cm) and Bishop score≤5, and was matched for patient's age and parity. The primary outcome was time from induction to delivery; the secondary outcomes were the caesarean section (CS) rate, uterine hyperstimulation, rate of failed induction, and neonatal complications. RESULTS: The mean time interval from induction to delivery was not different between the two groups (p=0.849), but there was a statistically significant difference between the groups in terms of the CS rate (p=0.005). There were no differences between the groups in neonatal outcome or perinatal morbidity or mortality. CONCLUSION: Dinoprostone appears to be a safe alternative for induction of labor in pregnancies with oligohydramnios. Induction of labor with dinoprostone in term pregnancies with isolated oligohydramnios is associated with increased rate of CS but there is no higher risk of perinatal complications.

Effect of dose and duration of micronized progesterone treatment during the first trimester on incidence of glucose intolerance and on birth weight.

OBJECTIVE: The aim was to investigate the potential effect of oral progesterone therapy during the first trimester on glucose metabolism and on birth weight, and to assess the existence of dose-related differences. METHODS: One hundred and fifty women with a history of imminent abortion and who used micronized progesterone (MicP) (200-600 µg/day for 4-6 weeks), and 150 healthy pregnant women as a control group, were included in the study. Fasting blood glucose (FBG), hemoglobin A1c (HbA1c) and OGL were measured between 24 and 28 weeks of gestation. Patients were followed up to term and birth weight was recorded. RESULTS: Risk of abnormal FBG and OGL was increased by 4.5- and 9.4-fold, respectively, in patients receiving MicP (p < 0.001). Median birth weight and gestational age were 3,599 g (500) and 39.0 weeks (1.3) for the MicP exposed group and 3,120 g (210) and 39.4 weeks (1.5) for the control group, respectively. Median birth weight was significantly higher in the MicP-exposed group for a similar gestational age (p < 0.001). There were no dose-related differences between groups. CONCLUSION: MicP therapy during the first trimester of pregnancy might have undesirable effects on glucose metabolism, which stresses the need of larger studies to confirm this association.

A reliable way to predict intraabdominal adhesions at repeat cesarean delivery: scar characteristics.

OBJECTIVE: To evaluate association between scar characteristics and intraabdominal adhesions at repeat cesarean delivery. DESIGN: A prospective, cross-sectional study. SETTING: Tertiary Government Maternity Training Hospital in Ankara, Turkey. POPULATION: 295 pregnant women with at least one prior cesarean delivery. METHODS: All women were at least 36 weeks pregnant. Appearance of previous cesarean delivery scars was categorized into three groups - flat, depressed and elevated. Pigmentation status was also noted (non-pigmented or pigmented). MAIN OUTCOME MEASURES: Intraoperatively detected adhesions, evaluated and classified into three groups (no adhesion, filmy adhesion and dense adhesion groups) by a modified Nair's classification. RESULTS: Elevated scars had significantly more dense adhesion formation than depressed ones (31.4 vs. 12.7%, p=0.02). No difference was found for dense adhesions when depressed and flat scars were compared (12.7 vs. 6.8%, p=0.124). Of flat scars, 93.2% were free of dense adhesions. Pigmented scars had more dense adhesions than non-pigmented (26.6 vs. 9.3%, p<0.01). Using logistic regression analysis scar length, scar width and appearance of scar (flat or non-flat) were directly related to adhesion formation. CONCLUSION: There is an association between scar type and adhesions, particularly for hypertrophic scars and dense adhesions.