Objective To assess cerclage to prevent recurrent preterm birth in women with short cervix. Study Design Women with prior spontaneous preterm birth <34 weeks were screened for short cervix, and randomly assigned to cerclage if cervical length was <25 mm. Results Of 1014 women screened, 302 were randomized; 42% of women not assigned and 32% of those assigned to cerclage delivered <35 weeks (p=0.09). In planned analyses, birth <24 weeks (p=0.03) and perinatal mortality (p=0.046) were less frequent in the cerclage group. There was a significant interaction between cervical length and cerclage. Birth <35 weeks (p = 0.006) was reduced in the <15 mm stratum with a null effect in the 15–24 mm stratum. Conclusion In women with a prior spontaneous preterm birth <34 weeks and cervical length <25 mm, cerclage reduced previable birth and perinatal mortality but did not prevent birth <35 weeks, unless cervical length was <15 mm.

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Modern management of class F patients can result in good perinatal outcomes. Renal function studies early in pregnancy can be used to define the risk of perinatal morbidity and long-term progression of renal disease.

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Third-trimester amniocentesis performed with continuous ultrasound guidance has a high success rate and low risk for complications.

The objectives of this study are to compare the neonatal risks and benefits of antenatal single-course versus repeated-course corticosteroids in singleton and multiple-gestation pregnancies. A comprehensive analysis was performed of the inpatient records of all neonates admitted to our center from 1 January 1994 through 31 May 1999. The primary outcome measure was survival without chronic lung disease (CLD). Secondary outcome measures included birth weight; head circumference; interval weight ratios; respiratory disease severity; intraventricular hemorrhage rate and severity; severe retinopathy of prematurity; early infection; and hospital days. All singletons 27-32 completed weeks' gestation, and multiples 26-32 weeks' gestation, whose mothers had received betamethasone before delivery, were included. One hundred and fifteen singleton and 53 multiple-gestation infants (total 168) were stratified by multiplicity, gestational-age (< or =29 or > or =30 weeks), and number of steroid courses. Repeated courses of antenatal betamethasone were not associated with greater survival without CLD, in either singleton- or multiple-gestation infants. In singletons there was no difference in any outcome measure between groups. In multiples, the only difference was greater postnatal weight gain in the lower gestation group. Mean birth head circumference was smaller in repetitively-treated singletons < or =29 weeks. There are no clinically significant neonatal benefits of repeated-course antenatal steroids in singletons > or =27 weeks estimated gestational age (EGA) or multiple-gestation infants > or =26 weeks EGA. Prospective randomized trials of single-course versus repetitive antenatal corticosteroid therapy are warranted.