Spirituality in Pregnancy.

Spirituality with its impact on health outcomes continues to emerge in the medical literature. This article discusses the role of spirituality in pregnancy, childbirth, and postpartum. It highlights the importance of more fully integrating this concept into births traditionally attended by physicians and midwives in the hospital setting. This discussion covers birthing practices ingrained with culture and spirituality. The article concludes with strategies to elicit and integrate spirituality into routine practice to provide improved health care to patients and to find more fulfillment in the role as birth attendant.

Chlamydia trachomatis Infection: Screening and Management.

OBJECTIVE: To review current criteria and rationale for Chlamydia trachomatis screening, testing methods, and treatment of infection. METHODS: Review of the literature. RESULTS: C. trachomatis urogenital infections are an important public health problem. Screening for C. trachomatis in women age 25 and younger and men and women of any age at increased risk allows for the early treatment of disease, avoiding morbidity such as pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain, and reducing health care costs. CONCLUSION: Current screening recommendations are not being implemented satisfactorily. Home-based methods of screening are acceptable and may improve universal screening rates.

Progress of labor in women induced with misoprostol versus the Foley catheter.

OBJECTIVE: To estimate and compare the duration and progress of labor in women induced with misoprostol vs Foley catheter plus oxytocin. STUDY DESIGN: We performed a retrospective cohort study of labor progress among 617 consecutive term pregnancies induced with misoprostol (n = 503) or Foley catheter plus oxytocin (n = 114) who completed the first stage of labor. Labor duration and progress in the entire cohort, and stratified by parity, were compared in multivariable interval-censored regression models adjusting for maternal obesity and birthweight. Repeated-measures analysis with 9th degree polynomial modeling was used to construct average labor curves. RESULTS: Total duration of labor was not significantly different in women induced with misoprostol compared with the Foley catheter (median duration from 1 to 10 cm: 12 vs 14.2 hours, P = .19). Progress from 1 to 4 cm was more rapid with the Foley catheter (median: 3.4 vs 5.6 hours, P < .01), although progress from 4 to 10 cm was slower (median: 6.3 vs 3.6 hours, P < .01). Labor curves demonstrated transition from latent to active labor at about 4 cm cervical dilatation with misoprostol and at 6 cm for the Foley catheter. Similar general patterns were noted for nulliparous and multiparous women, except for a shorter duration of labor with the Foley catheter among multiparous women. CONCLUSION: Induction of labor with the Foley catheter is associated with more rapid initial cervical dilation, but transition to active labor occurs later compared with misoprostol. These differences should be considered in the management of induced labor.

Discussion: 'Abnormal anal cytology in HIV-infected women' by Baranoski et al.

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Baranoski AS, Tandon R, Weinberg J, et al. Risk factors for abnormal anal cytology over time in HIV-infected women. Am J Obstet Gynecol 2012;207:107.e1-8.