ABSTRACT
PURPOSE: To compare the efficacy of a vaginal insert administering continuous dinoprostone with vaginal suppositories containing two different doses of misoprostol for cervical ripening and induction of labor. STUDY DESIGN: In this prospective, randomized, double-blinded study, 118 patients with indications for induction of labor and an unfavorable Bishop score were randomly assigned to receive either continuous dinoprostone, misoprostol 35-microg suppositories, or misoprostol 50-microg suppositories. RESULTS: No significant differences were noted among the three groups in the change of Bishop score, induction of active labor or the time from initial treatment to delivery. Active labor occurred in roughly two-thirds of the patients in an average of about 5.7-6.7 h regardless of treatment assignment. When the two misoprostol groups were combined, a shorter interval from insertion to vaginal delivery was observed in the nulliparous women receiving misoprostol than those receiving continuous dinoprostone (21.3 vs. 27.2 h, p = 0.019). Except for the significantly lower incidence of tachysystole observed in the combined misoprostol group (3.8% vs. 15.4%, p = 0.036), there were no other significant differences between the groups in mode of delivery or in adverse maternal, fetal, or neonatal effects. CONCLUSION: Misoprostol suppositories appeared to be as effective and safe as continuous dinoprostone in inducing cervical ripening in this sample.
Subject(s)
Cervical Ripening/drug effects , Dinoprostone/administration & dosage , Dinoprostone/therapeutic use , Misoprostol/administration & dosage , Misoprostol/therapeutic use , Oxytocics/administration & dosage , Oxytocics/therapeutic use , Pessaries , Administration, Intravaginal , Apgar Score , Double-Blind Method , Female , Humans , Infant, Newborn , Labor Onset/drug effects , Labor, Induced , Male , Parity , Pregnancy , Pregnancy Outcome , Prospective Studies , Time FactorsABSTRACT
OBJECTIVE: To determine attitudes and practices of obstetricians in maternal-fetal medicine fellowship programs regarding the management of human immunodeficiency virus (HIV) infection and the use of zidovudine during pregnancy. METHODS: We sent a questionnaire to the directors of all 78 approved maternal-fetal medicine fellowship programs. The responses, reflecting the consensus of the staffs of each program, were obtained and tabulated. RESULTS: Although their programs annually provide care for more than 2100 pregnant women infected with HIV, less than 25% of all maternal-fetal medicine fellowship directors reported that their patients participate in multicenter studies of HIV infection complicating pregnancy. Nearly two-thirds of the infected women are excluded from such multicenter studies. More than 70% of all program directors believe that zidovudine should be offered to symptomatic pregnant women infected with HIV; one-half question whether zidovudine poses short-term fetal risks. Nevertheless, nearly half of all HIV-infected pregnant women they manage are excluded from trials of zidovudine therapy during pregnancy. CONCLUSIONS: Many HIV-infected pregnant women who receive care in clinics of maternal-fetal medicine fellowship programs are excluded from multicenter studies. Consideration should be given to creating a national registry for this important, currently unreported, clinical resource.
Subject(s)
Fellowships and Scholarships , HIV Infections/drug therapy , Health Knowledge, Attitudes, Practice , Obstetrics , Pregnancy Complications, Infectious/drug therapy , Zidovudine/therapeutic use , Clinical Trials as Topic/statistics & numerical data , Female , Humans , Obstetrics/education , Perinatology/education , Pregnancy , Specialty Boards , United StatesABSTRACT
We report a case of cystic hygroma and diffuse lymphangiectasia detected by sonogram at 12 weeks' gestation. Fetal karyotype was normal. At 20 weeks' gestation, herniation of the bowel into the chest was noted. At delivery, the infant was diagnosed as having Fryns' syndrome. This is the first reported case of Fryns' syndrome presenting with cystic hygroma.
Subject(s)
Hernia, Diaphragmatic/diagnostic imaging , Lung/abnormalities , Lymphangioma/diagnostic imaging , Ultrasonography, Prenatal , Adult , Bone and Bones/abnormalities , Female , Hernias, Diaphragmatic, Congenital , Humans , Pregnancy , Pregnancy Trimester, First , Pregnancy Trimester, Second , SyndromeABSTRACT
A case of pancreatitis associated with type I primary hyperlipoproteinemia in pregnancy is reported, with a review of the literature. There have been 11 cases of hyperlipidemic pancreatitis during pregnancy reported in the English literature since 1956. This case is the first report of adult respiratory distress syndrome complicating hyperlipidemic pancreatitis in pregnancy. Guidelines for prevention and management of this rare disorder are presented.