The impact of maternal body mass on the effectiveness of 17 alpha-hydroxyprogesterone caproate.

OBJECTIVE: To examine the impact of maternal prepregnancy body mass index (BMI) on rates of recurrent preterm delivery (PTD) in women receiving 17alpha-hydroxyprogesterone caproate (17P) prophylaxis. STUDY DESIGN: The study population was identified from a large perinatal database containing prospectively collected information from women at high risk for PTD. We included patients with a current singleton pregnancy and a history of PTD who received weekly nursing visits and 17P 250 mg intramuscular injections beginning at 16.0 to 20.9 weeks' gestation. The data were stratified by number of prior PTDs (1 or >1) and maternal prepregnancy BMI (lean, normal, overweight and obese). Primary study outcomes included the rates of recurrent PTD at <35 and 32 weeks' gestation, and pregnancy loss at <24 weeks' gestation. RESULTS: Delivery outcomes for 606 women receiving 17P were analyzed. There were no significant differences found in the incidence of preterm labor, the rates of recurrent PTD or pregnancy loss at <35, 32 or 24 weeks between the BMI groups. CONCLUSION: Maternal prepregnancy BMI does not appear to influence the rates of recurrent PTD in women with singleton gestation receiving 17P prophylaxis. Larger studies are needed to confirm our findings.

Evaluation of Computer-aided Strategies for Teaching Medical Students Prenatal Ultrasound Diagnostic Skills.

OBJECTIVE: To evaluate whether computer-based learning (CBL) improves newly acquired knowledge and is an effective strategy for teaching prenatal ultrasound diagnostic skills to third-year medical students when compared with instruction by traditional paper-based methods (PBM). STUDY DESIGN: We conducted a randomized, prospective study involving volunteer junior (3(rd) year) medical students consecutively rotating through the Obstetrics and Gynecology clerkship during six months of the 2005-2006 academic year. The students were randomly assigned to permuted blocks and divided into two groups. Half of the participants received instruction in prenatal ultrasound diagnostics using an interactive CBL program; the other half received instruction using equivalent material by the traditional PBM. Outcomes were evaluated by comparing changes in pre-tutorial and post instruction examination scores. RESULTS: All 36 potential participants (100%) completed the study curriculum. Students were divided equally between the CBL (n = 18) and PBM (n = 18) groups. Pre-tutorial exam scores (mean+/-s.d.) were 44%+/-11.1% for the CBL group and 44%+/-10.8% for the PBL cohort, indicating no statistically significant differences (p>0.05) between the two groups. After instruction, post-tutorial exam scores (mean+/-s.d.) were increased from the pre-tutorial scores, 74%+/-11% and 67%+/-12%, for students in the CBL and the PBM groups, respectively. The improvement in post-tutorial exam scores from the pre-test scores was considered significant (p<0.05). When post-test scores for the tutorial groups were compared, the CBL subjects achieved a score that was, on average, 7 percentage points higher than their PBM counterparts, a statistically significant difference (p < 0.05). CONCLUSION: Instruction by either CBL or PBM strategies is associated with improvements in newly acquired knowledge as reflected by increased post-tutorial examination scores. Students that received CBL had significantlyhigher post-tutorial exam scores than those in the PBM group, indicating that CBL is an effective instruction strategy in this setting.

Effectiveness and infectious morbidity of outpatient cervical ripening with a Foley catheter.

OBJECTIVE: To assess the effectiveness and infectious morbidity of outpatient cervical ripening with a Foley catheter. STUDY DESIGN: Labor inductions utilizing a Foley catheter for cervical ripening from January 1994 to October 1999 were retrospectively reviewed. The inductions were divided into inpatient and outpatient groups. Vaginal delivery rates and infectious morbidity were compared between the 2 groups. RESULTS: There were 315 inpatient and 300 outpatient cases. The observed differences in vaginal delivery rates and infectious morbidity were not clinically or statistically significant. However, there was insufficient power to exclude a type II error. The cost savings was $165,000, and there is the potential to save $750 per patient with this method. CONCLUSION: Outpatient cervical ripening with a Foley catheter is clinically effective, does not result in excess infectious morbidity and is more cost effective as compared to inpatient cervical ripening.