Obstetric outcomes and maternal satisfaction in nulliparous women using patient-controlled epidural analgesia.

OBJECTIVE: The purpose of this study was to compare obstetric outcomes and maternal satisfaction in nulliparous women in spontaneous labor who used patient-controlled epidural analgesia (PCEA) vs continuous epidural infusion (CEI). STUDY DESIGN: We conducted a double-masked trial of 270 nulliparous women who were assigned randomly to 3 groups (with a concentration 0.1% bupivacaine and 2 µg/mL fentanyl): group I, CEI-only (10 mL/h); group II, CEI + PCEA (CEI 10 mL/h plus PCEA 10 mL, at 20 minutes); group III, PCEA-only (10 mL, at 20 minutes). A PCEA bolus button was given to each subject. The primary outcome was the dosage of local anesthetic that was used. RESULTS: The total milligrams of bupivacaine that were used was less in the PCEA-only group compared with CEI: group I. 74.8 ± 36 mg; group II, 97.3 ± 53 mg; group III, 52.4 ± 42 mg (P < .001). Pain with pushing, however, was worse in the PCEA-only group. Median satisfaction scores were similar (scale, 0 [best] to 100 [worst]: group I, 0; group II, 0; group III, 0 (P = .23). CONCLUSION: PCEA results in less anesthetic used, and maternal satisfaction remains high without a continuous infusion. Pain with pushing, however, was worse with the PCEA alone.

Women's attitudes regarding mode of delivery and cesarean delivery on maternal request.

OBJECTIVE: To explore women's attitudes and beliefs regarding cesarean delivery and cesarean delivery on maternal request (CDMR). STUDY DESIGN: Anonymous questionnaires assessing patient demographics, knowledge, and attitudes about CDMR were distributed at the time of routine mid-trimester ultrasound appointment. RESULTS: Eight hundred thirty three out of 3929 (21.2%) potential participants completed the questionnaire. About 81.7% of participants indicated that they believed that vaginal delivery was a safer alternative for the mother and 72.8% believed that it was safer for the fetus. While only 6.1% of women thought that CDMR was 'a good idea', most believed that women should have the right to choose their mode of delivery and that the option should be offered to everyone (85.9% and 79.6%, respectively). Socioeconomic and demographic variables did not significantly influence the participants' responses. CONCLUSION: Majority of women believe that vaginal delivery is safer for the mother and baby and would prefer to have a vaginal delivery if given the option.

The accuracy of late third-trimester antenatal screening for group B streptococcus in predicting colonization at delivery.

We reevaluated the accuracy of antenatal group B streptococcal (GBS) culture results in predicting colonization at the time of delivery in a general practice setting. Patients who had late third-trimester antenatal GBS cultures were prospectively identified. A repeat GBS culture was performed when admitted in labor using a strict protocol and laboratory analysis. Sensitivity, specificity, and positive and negative predicative values were calculated. In comparing the office culture results to the intrapartum cultures in 1472 patients, the sensitivity was 51%, specificity 94%, positive predictive value 67%, and negative predictive value 88%. The antenatal positive culture rate of 15.4% was significantly lower than the 20.1% intrapartum positive culture rate. There were 144 patients (9.8%) who had false-negative antenatal culture results. Through office survey, several aspects of the recommended antenatal procedures were not followed. The results support the previously reported high specificity and negative predictive values for this test. The near 10% false-negative rate with the significant difference between the antenatal versus intrapartum positive culture rate highly suggests that late third-trimester culture accuracy may be affected if the specified procedures are not completely followed, including the culturing technique, the use of recommended transport medium, and the laboratory culture protocol.

A randomized, double-blinded, controlled trial comparing parenteral normal saline with and without dextrose on the course of labor in nulliparas.

OBJECTIVE: The objective of the study was to compare intravenous normal saline with and without dextrose on the course of labor in nulliparae. STUDY DESIGN: In a double-blinded, controlled trial, term, nulliparae with singletons in active labor were randomized into 1 of 3 groups receiving either normal saline (NS), NS with 5% dextrose (D5NS), or NS with 10% dextrose (D10NS) at 125 mL/h. The primary outcome was total length of labor from onset of study fluid in vaginally delivered subjects. Maternal and neonatal outcomes were also analyzed. RESULTS: Of 300 subjects enrolled, 289 met inclusion criteria and completed the study. In vaginally delivered subjects, significant differences were noted in the second stage (P = .01) and total length of labor (P = .02). No significant differences were observed in the cesarean section rates between the groups (P = .21). No differences were noted in maternal or neonatal secondary outcomes. CONCLUSION: Administration of a dextrose solution, regardless of concentration, was associated with a shortened labor course in term vaginally delivered nulliparae subjects in active labor.

Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study.

PURPOSE: We compared the effects of daily cranberry juice cocktail to those of placebo during pregnancy on asymptomatic bacteriuria and symptomatic urinary tract infections. MATERIALS AND METHODS: A total of 188 women were randomized to cranberry or placebo in 3 treatment arms of A-cranberry 3 times daily (58), B-cranberry at breakfast then placebo at lunch and dinner (67), and C-placebo 3 times daily (63). After 27.7% (52 of 188) of the subjects were enrolled in the study the dosing regimens were changed to twice daily dosing to improve compliance. RESULTS: There were 27 urinary tract infections in 18 subjects in this cohort, with 6 in 4 group A subjects, 10 in 7 group B subjects and 11 in 7 group C subjects (p = 0.71). There was a 57% and 41% reduction in the frequency of asymptomatic bacteriuria and all urinary tract infections, respectively, in the multiple daily dosing group. However, this study was not sufficiently powered at the alpha 0.05 level (CI 0.14-1.39 and 0.22-1.60, respectively, incidence rate ratios). Of 188 subjects 73 (38.8%) withdrew, most for gastrointestinal upset. CONCLUSIONS: These data suggest there may be a protective effect of cranberry ingestion against asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy. Further studies are planned to evaluate this effect.