Titrated low-dose misoprostol may be a reasonable alternative for IOL in the presence of PROM, particularly in women with an unfavourable cervix. Safety and rare serious adverse events could not be evaluated in a trial of this size.
Obesity is a growing epidemic in the western world. We carried out a comparative analysis of the incidence of obstetric morbidity in three BMI categories in the ranges 30-40 to identify which BMI category was associated with greatest risk. This identification could help target limited maternity care resources to the group of women who would benefit most. There exists a scale continuum of risk of obstetric morbidity with maternal obesity: the greater the BMI, the greater the risk. However, pregnant women with mild or moderate obesity are still at significant risk of having pre-existing co-morbidities of developing antenatal complications and of being delivered by caesarean section than women with BMIs within the normal range. These women, at the time of antenatal booking, are currently not perceived by healthcare providers as having at-risk pregnancies and are therefore potentially denied access to best care.
The incidence of ectopic pregnancies is increasing. Common risk factors are tubal pathology, previous tubal surgery, previous ectopic pregnancy, intrauterine device use and embryo transfer. Levonelle-2, a progesterone-only postcoital contraceptive works by a combination of mechanisms including ovulation inhibition, prevention of fertilization, and inhibition of implantation. It is 85% effective and there have been 12 reported cases of ectopic pregnancy in the UK with its use. It is believed that progesterone slows the intratubal migration of the fertilized ovum. In the case reported here, a woman presented with an ectopic pregnancy after use of Levonelle-2 as postcoital contraception; there were no clinical predisposing risk factors. In the absence of any histological evidence of tubal damage, we suspect that the levonorgestrel from Levonelle-2 could have been responsible for delayed embryo transfer which resulted in the ectopic pregnancy.
Preterm birth has an incidence of around 5-8%, however more women will present with symptoms or signs of preterm labour and predicting which of these women will go on to deliver prematurely can be diffi cult. The authors performed an audit in our unit to examine the proportion of women presenting with threatened preterm labour and how these women were managed. At the time of the audit, the fetal fi bronectin test was not in use. In 1 month, almost 20% of admissions were with symptoms or signs of threatened preterm labour. Most of these women are managed by administering steroids and tocolysis if indicated and in a small number of patients, an in-utero transfer to another unit is necessary. In-utero transfer has a large cost implication, not to mention the social upheaval for the woman and her family and the effects on workload for the receiving unit. A recent Fibronectin pilot study performed across Greater Manchester has suggested that the use of Fibronectin testing for women who present in threatened preterm labour may prevent around 15% of in-utero transfers. The authors plan to use the results of our audit to provide us with a cost saving estimate upon the introduction of fi bronectin testing which is planned for later this year. The authors will then reaudit once fi bronectin is in use to demonstrate the cost effectiveness of this test and the way it can improve the maternity service for women.
References
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