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Dinoprostone vaginal insert is more efficient than cervical gel in promoting cervical priming and labor induction in low-Bishop-score patients at term. The vaginal insert placement seems to be safe for the mother and the newborn, although larger studies are required to investigate uterine hyperstimulation incidence.

Objective: Evidence of meconium-stained amniotic fluid (AF) during labor suggests implementation of close monitoring of fetal well-being. We have investigated whether the presence of meconium in the AF on admission for labor is as important a predictor of neonatal outcome as a change in AF color during labor. Methods: AF characteristics on admission for labor at term (37–42 weeks) and their changes during labor were recorded in all singleton pregnancies during an 8-year period (1992–1999). Excluded were stillbirths on admission, congenital anomalies, and elective cesarean sections. The presence of meconium and its consistency (light or thick) were documented on admission by inspection with transcervical amnioscopy in women with intact membranes or in the vaginal pool in those with ruptured membranes. Changes in AF color or consistency during labor were recorded and correlated with the obstetric and neonatal outcome. Statistical analysis utilized χ² for trend, with p < 0.05 considered significant. Results: 19,090 women were admitted in labor at term during the study period and fulfilled the study inclusion criteria and had amniotic fluid evaluation available. The appearance of meconium or worsening in thickness of meconium during labor was associated with higher rates of Apgar scores <7 at 5 min (clear AF on admission and at delivery 0.6%; light or thick meconium on admission and no change at delivery 0.8%; clear AF on admission and light or thick meconium at delivery 3.2%, and light meconium on admission and thick meconium at delivery 2.5%; p < 0.001) and umbilical artery pH <7.10 (the respective rates in the four groups were 1.7, 1.8, 3.6, and 3.8%; p < 0.001). Conclusion: The appearance or thickening of meconium during labor has a greater predictive ability for depressed neonates than the presence of meconium on admission.

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An estimated 6% to 8% women develop hypertension during pregnancy, which has been linked with asthma, through either the condition itself or treatment such as oral corticosteroids. Steroid use also has been linked with an increased risk of preeclampsia. This large population-based case-control study was planned to determine whether inhaled steroids increase the risk of either pregnancy-induced hypertension or preeclampsia in asthmatic women. Participants were 3505 women with asthma, 14-44 years of age, who had 4593 pregnancies in the years 1990-2000. As many as 10 control women at 30 or more weeks gestation were selected for each case. Sociodemographic factors were similar in the case and control groups.There were 302 cases of pregnancy-induced hypertension, representing 6.6% of the study population. They included 128 cases of gestational hypertension, 165 cases of preeclampsia, and 9 cases of eclampsia. More case women than controls were prescribed inhaled corticosteroids before and during pregnancy, and more were taking oral steroids. Case women who took more than 3 doses of a short-acting ␤ 2 agonist per week before pregnancy were at increased risk of pregnancy-induced hypertension, but this level of treatment during pregnancy correlated with a lower risk. Cases more often visited an emergency department for asthma. Using inhaled steroids while pregnant was not associated with the risk of either preeclampsia or pregnancy-induced hypertension. There was no dose-response relationship with inhaled steroids for either of these conditions. Oral steroids were, however, significantly associated with pregnancy-induced hypertension; the adjusted odds ratio was 1.57, and the 95% confidence interval was 1.02-2.41.This study failed to significantly relate the use of inhaled corticosteroids to either pregnancy-induced hypertension or preeclampsia in asthmatic women. These women should be encouraged to continue using inhaled steroids while pregnant to control their asthma. ABSTRACTThere is limited evidence that periodontitis is associated with preterm birth, but why it might induce inflammation and premature termination of pregnancy remains uncertain. The investigators evaluated periodontal status in 36 women at risk of miscarriage or preterm delivery. Amniocentesis was carried out at 15-20 weeks gestation, and a full-mouth periodontal examination was done at approximately the same time. The criterion for periodontitis was at least 1 site with a probing depth of 5 mm or greater in each quadrant. The 2 sites with the deepest pockets were chosen for microbial sampling of intraoral plaque. Vaginal smears also were obtained and cytokine levels estimated in amniotic fluid samples.Chronic periodontitis was diagnosed in 20% of women delivering within the normal period and in 83% of those who had a preterm delivery and an infant with low birth weight. All women with preterm gestations had regularly received dental care. Probing depths differed significantly in the preterm and full-term cases. In no case was the amniotic fluid infec...

Gestational age at delivery and birth weight discordance are the most important independent predictors of perinatal mortality or morbidity among preterm twins.

Gestational age at delivery and birth weight discordance are the most important independent predictors of perinatal mortality or morbidity among preterm twins.