Instrumental delivery of the fetal head at the time of elective repeat cesarean: a randomized pilot study.

We sought to ascertain whether the routine use of instruments, forceps or vacuum, at the time of elective repeat cesarean delivery, permits a delivery that is as safe for mother and infant and as easy for mother and physician as traditional manual delivery of the fetal head. In this prospective study 44 women undergoing elective repeat cesarean were randomized to deliver by Vacuum (V), Forceps (F), or by Manual (M) means. Groups were compared with regard to demographic variables and maternal and neonatal outcomes. Deliveries were timed from entry into the uterus until full delivery of the infant. Maternal pain scores were assessed using a 10-cm visual analog scale. There were no differences in demographic variables except that the M group had fewer women with up to two cesareans. A large percentage of women in each group were delivered with the randomized instrument. Use of the V did not demonstrate fewer extensions of the uterine incision or lesser amounts of blood loss as measured by serial hemoglobin determinations. There was a trend for the F group to require a longer period of time for delivery (p = 0.061). Women in the V group reported significantly lower pain scores (p = 0.015). There were no serious neonatal injuries. The routine use of instruments at the time of elective repeat cesarean delivery appears safe and effective.

DNA probe for beta-hemolytic group B Streptococcus. Diagnostic accuracy in threatened preterm labor.

OBJECTIVE: To determine the diagnostic accuracy of a DNA probe for beta-hemolytic group B Streptococcus (GBS) in women with threatened preterm labor. STUDY DESIGN: Two identical vaginal/perianal samples were collected from 75 pregnant women who were being evaluated for threatened preterm labor. One sample was managed in the traditional manner, with direct plating onto blood agar followed by plating after 8 and 24 hours of LIM broth enhancement. The "gold standard" was 24 hours of LIM broth enhancement followed by blood agar plating. The second sample was placed in LIM broth, and DNA probe testing was performed after incubation for 8 and 24 hours. RESULTS: The prevalence of GBS colonization by the gold standard culture was 32%. After 8 hours of incubation in LIM broth, the DNA probe had poor sensitivity (79%); however, after 24 hours of incubation in LIM broth the DNA probe sensitivity rose to 96%. The DNA probe demonstrated only one false negative result after 24 hours of LIM broth enhancement. All DNA probe results were known 25 hours after sample collection. CONCLUSION: This DNA probe gave results nearly identical to those of standard cultures and allowed a substantial saving of time.

Fetal but not maternal serum cytokine levels correlate with histologic acute placental inflammation.

Our objective was to determine if placental histologic acute inflammation is related to maternal and fetal serum cytokine levels in preterm labor, using a data set previously constructed blinded to histopathologic information. To this goal in 1992, 32 consecutive patients at 20-36 weeks with progressive labor and tocolytic failure were recruited. Maternal serum sampled during the active phase of labor, and fetal (umbilical vein) serum were assayed by ELISA for levels of soluble interleukin-1 beta (IL-1 beta), soluble interleukin-2 receptor (IL-2 R), and interleukin 6 (IL-6) (T-Cell Diagnostics). Acute placental inflammation was scored by two groups blinded to clinical data, and the average scores analyzed for relationships to serum cytokine levels. Weighted kappa values, reflecting interobserver agreement in scoring of acute inflammation, were: amnion 0.84; choriodecidua 0.84; umbilical cord 0.85; and chorionic plate 0.73. Fetal levels of IL-1 beta and IL-2 R were higher with grade 3-4 acute amnionitis than with grades 0-2 (p = 0.022 and p = 0.023). Fetal levels of all three cytokines were higher in grade 3-4 umbilical vasculitis (IL-1 beta p = 0.008, IL-2 R p = 0.01, and IL-6 p = 0.03). In contrast, maternal serum cytokine levels were not associated with presence or severity of histologic evidence of acute placental inflammation. Histologic acute inflammation was not related to duration of labor, interval from membrane rupture to delivery, and presence or duration of antibiotic therapy. We conclude that fetal serum, but not maternal serum cytokine levels, are correlated with histologic evidence of acute placental inflammation, and may reflect a predominant placental origin of the cytokines.

Prenatal diagnosis of trisomy 12 mosaicism: physical and developmental follow-up.

Follow-up evaluations were performed on a child at the ages of 2 years 8 months and also at 5 years who had been found on prenatal amniocentesis to be mosaic for trisomy 12. Eight of 36 colonies (22 per cent) were trisomy 12 at amniocentesis, with the remaining colonies showing a normal female karyotype. Cord blood, amnion, chorion, placental, and skin fibroblast chromosome studies failed to show any further evidence of a trisomy 12 cell line. At her evaluations, the child had normal physical and neurological findings. Psychomotor development was appropriate for age on screening.

Maternal and umbilical cord serum interleukin levels in preterm labor with clinical chorioamnionitis.

OBJECTIVE: Our purpose was to determine whether interleukin-1 beta, interleukin-6, and the soluble receptor for interleukin-2 levels in maternal and umbilical cord sera differed among patients with and without clinical chorioamnionitis delivered prematurely. STUDY DESIGN: Between February and November 1992, 32 women who were delivered between 20 and 36 weeks' gestation were enrolled in a prospective study to determine the levels of interleukin-1 beta, soluble interleukin-2 receptor, and interleukin-6 in maternal and umbilical cord serum. Cytokines were measured by enzyme-linked immunosorbent assay. Chorioamnionitis was identified by the presence of clinical markers in 12 patients. RESULTS: Soluble interleukin-2 receptor concentrations in maternal serum were significantly higher in women with clinical chorioamnionitis than in those without chorioamnionitis (median 400 U/ml, range 100 to 2100 U/ml vs median 275 U/ml, range 100 to 1300 U/ml, p < 0.04). Umbilical cord interleukin-6 concentrations were significantly higher in the presence of clinical chorioamnionitis than in the absence of chorioamnionitis (median 12.5 pg/ml, range 0 to 400 pg/ml vs median 0 pg/ml, range 0 to 25 pg/ml; p < 0.02). For patients with clinical chorioamnionitis there was a positive correlation between maternal and umbilical cord IL-2 receptor levels (r = 0.752, p < 0.01). No significant differences in maternal interleukin-1 beta or maternal interleukin-6 determinations were noted. Likewise, the umbilical cord interleukin-1 beta and IL-2 receptor concentrations were unchanged in the presence of clinical chorioamnionitis. CONCLUSIONS: This study demonstrates that for patients with preterm labor and clinical chorioamnionitis, maternal serum levels of IL-2 receptor, and umbilical cord serum levels of interleukin-6 are significantly increased compared with patients without chorioamnionitis.