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.
In our maternity unit, the incidence of women with gestational diabetes (GDM) has increased over the years without a corresponding increase in the incidence of women with pregestational (type 1 and 2) diabetes, the ratio being 2 to1 in 2002 and 5 to 1 in 2009. The Caesarean section rate (CSR) in women with GDM is high and now approaches the CSR in women with pregestational diabetes.
During this period, no babies born to women with pregestational diabetes had birth weights >4.5 kg while the mean incidence in birth weight >4.5kg was 3.1% in babies born to women with GDM.
Maternal obesity, an important screening risk factor for gestational diabetes, is increasing in prevalence among our pregnant population. In 2008, 60% of women with GDM had a booking body mass index (BMI) > 30 compared to 13.5% of our overall pregnant population.
Studies like the 2008 HAPO study have shown that maternal hyperglycaemia and maternal obesity are independent risk factors for adverse pregnancy outcomes such as delivery by Caesarean section and babies born with higher birth weights. The increasing prevalence of obesity in young pregnant women is draining overstretched healthcare resources. Women with GDM must adopt major lifestyle changes (healthy eating, diet, exercise) to reduce their risk of developing GDM in future pregnancies, type 2 diabetes and cardiovascular disease.
Abstract PM77
Caesarean section rate
2005
2006
2007
2008
2009
Pregestational diabetes
57.1%
63.2%
64.3%
50.0%
55.6%
Gestational diabetes
28.1%
31.6%
52.0%
40.4%
46.4%
Overall CSR
26.7%
23.1%
25.2%
24.7%
23.4
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