Mark C. Williams

The value of the cervical score in predicting successful outcome of labor induction

Objective To compare cervical dilation and the Bishop score as correlates of successful labor induction and vaginal delivery and to determine whether the prognosis of postripening cervical characteristics varies with the method of ripening used. Methods Four hundred forty-three women with Bishop scores less than 9 who required induction of labor were assigned randomly to cervical ripening with prostaglandin E2 gel or hygroscopic dilation. The Bishop score and its component characteristics were evaluated as univariate correlates of successful induction of labor and vaginal delivery and then were assessed using logistic regression to adjust for other maternal and fetal factors. The differences in the association between method of ripening and successful labor induction were evaluated relative to pre-ripening and post-ripening cervical examination characteristics. Results Cervical dilation was a better correlate of successful labor induction and vaginal delivery than was the Bishop score, even after exclusion of patients with initial Bishop scores greater than 6 and dilation greater than 3.0. Both ripening methods yielded similar success in labor induction and vaginal delivery, but when categorized by post-ripening cervical examinations, patients undergoing hygroscopic ripening had lower rates of successful labor induction and vaginal delivery. Conclusion Cervical dilation is a better predictor of successful labor induction and vaginal delivery than either the Bishop score or any other Bishop score component characteristic. The likelihood of successful labor induction and vaginal delivery based on post-ripening cervical characteristics varies by the ripening method used.

Pre-induction cervical ripening : a randomized comparison of two methods

Objectives To compare two methods of pre-induction cervical ripening in a randomized clinical trial. Methods A single intracervical prostaglandin E2 (PGE2) gel application was compared with a single insertion of hygroscopic dilators in 441 women at term with unfavorable cervical scores. Induction success was defined as entry into active labor within 6 hours of oxytocin infusion. Results There was no statistical difference in pre- or post-ripening cervical scores. In the group receiving hygroscopic dilators, only 28% entered the active phase of labor within 6 hours of oxytocin infusion compared with 45% (P < .001) in the PGE2 group. Thus, in this study, a change in cervical score did not directly predict induction success. There was a higher rate of postpartum endometritis (24 versus 14%; P = .007) and suspected neonatal infection (10 versus 5%; P = .03) in the dilator group. Conclusions Pre-induction ripening by hygroscopic dilators and intracervical PGE2 was equivalent as measured by changes in the cervical score. The change in cervical score, however, was not predictive of successful induction, and PGE2 was more frequently associated with induction success. Hygroscopic dilators were associated with a higher incidence of postpartum maternal and neonatal infection because of a longer duration of labor. Hospital charges for intracervical PGE2 gel totaled

The effect of magnesium sulfate infusion on systemic and renal prostacyclin production.

522 compared with

Hormonal Modulation of Ishikawa Cells During Three-Dimensional Growth In Vitro

91 for the insertion of three dilators.

The effect of sample preparation and storage on maternal triple-marker screening.

Recent in vitro studies have suggested that magnesium sulfate (MgSO4) infusions may increase prostacyclin production. We studied the effect of MgSO4 infusion on prostacyclin (PGI2) metabolite excretion in women with either pregnancy induced hypertension or preterm labor. Excretion of renal and systemic metabolites of PGI2 was measured prior to and following the start of MgSO4 infusion in the two groups. An increased in renal PGI2 metabolite preterm labor excretion was noted in the hypertension group but no change was noted in systemic PGI2 excretion in either group. These data fail to support a generalized, short term increase in endothelial cell PGI2 production as the basis for the beneficial effect of MgSO4.

Cerebral palsy, perinatal depression and low ponderal index.

Objectives: The Ishikawa endometrial cancer cell line is hormonally responsive, expressing estrogen and progesterone receptors (ER, PR) when grown in traditional monolayer culture. The purpose of this paper is to demonstrate a three-dimensional spheroid culture system for cancer cells. We used this system to determine the response of the Ishikawa cell line to estradiol-17β (E), tamoxifen (T), megestrol acetate (MA), and progesterone (P). Methods: Ishikawa cells were incubated in polyurethane culture bags using phenol red-free media containing ethanol (0.1%, controls), E (1 μmol, or 1 nmol), T (1 μmol, or 10 nmol), MA (1 μmol, or 10 nmol), or P (1 μmol). Cellular morphology was assessed by hematoxylin and eosin staining, and expression of estrogen and progesterone receptors was determined immunohistochemically using an immunoperoxidase technique. Results: Cells in control cultures demonstrated minimal organization and lacked hormone receptors. In contrast, cells exposed to either E or T displayed significant glandular formation, with multicellular, microvilli-rich, columnar epithelia exhibiting polarized nuclear arrangements. Within 4 weeks, E- and T-treated cultures showed upregulated nuclear staining for PR, with little ER present. Cells treated with MA or P showed less glandular organization but expressed ER with PR downregulation. Conclusions: These data support the use of this novel three-dimensional culture system to study the modulation of tumor cell biologic activity in response to hormonal agents. Future applications of this model include examining in vitro responsiveness of cancer cells lines to additional biologic agents and chemotherapeutic regimens.

Persistent pulmonary hypertension of the neonate and asymmetric growth restriction

Objective To evaluate the effect of different sample collection, storage, and preparation techniques on serum alphafetoprotein (AFP), β-hCG, and unconjugated estriol (E3) concentrations. Methods A solution containing known concentrations of AFP, hCG, and unconjugated E3 was diluted in blood samples obtained from seven healthy male volunteers. Serum from each blood sample was removed immediately, and either assayed or frozen at −70C. Portions of the remaining blood were handled as follows: centrifuged and refrigerated, centrifuged and left at room temperature, not centrifuged and refrigerated, or not centrifuged and left at room temperature. Serum was removed from these samples for triplemarker analysis at 24, 48, 96, and 168 hours after the initial sample collection. Results Immediate freezing of serum and subsequent thawing resulted in a significant increase in β-hCG and unconjugated E3 levels, but no change in AFP levels. There was a significant effect over time on AFP, hCG, and unconjugated E3 concentrations. The change in AFP levels was influenced by centrifugation status, whereas all three analytes were influenced by refrigeration status. Conclusion Different sample collection, storage, and preparation techniques may affect maternal triple-marker screening.

Decreased birth weight/placenta ratio and asymmetric growth restriction

To determine whether asymmetric growth restriction, abnormally lean body morphology, is associated with cerebral palsy (CP) in infants born with perinatal depression, perinatally depressed Collaborative Perinatal Project infants were assessed. Rates of ponderal index less than 5% for gestational age and race (low PI), a marker for asymmetric growth, were compared in infants either neurologically normal or having CP at 7 years of age. Low PI was associated with CP in infants with Apgar scores of 0 to 3 at 10, 15 or 20 minutes in both of these groups, after exclusion of small‐for‐gestationalage infants, and was a significant individual correlate of cerebral palsy with multiple logistic regression. The attributable risk of cerebral palsy related to low PI was 12.4%.

Modulators of Prostaglandin E2 Synthesis in Human Amnion

Objective To evaluate the possible associations between persistent pulmonary hypertension of the neonate, need for extra-corporeal membranous oxygenation, small for gestational age (SGA), and low ponderal index for gestational age in infants with persistent pulmonary hypertension of the neonate and in matched controls. Methods Eighty-six infants with persistent pulmonary hypertension of the neonate delivered from 1991 to 1994 at our hospital were matched with 430 contemporaneous control singleton neonates. Birth weight and ponderal indices (100 × weight/length3) less than the tenth percentile for gestational age and gender were defined as SGA and low ponderal index, respectively. We assessed associations between these markers, the presence of persistent pulmonary hypertension of the neonate, and the need for extracorporeal membranous oxygenation. Results Low ponderal index was associated with persistent pulmonary hypertension of the neonate (odds ratio [OR] 5.4), whereas SGA was not. Low ponderal index (OR 4.0) was an independent correlate of persistent pulmonary hypertension of the neonate after adjustment with logistic regression for 5-minute Apgar scores less than 7, umbilical arterial pH less than 7.10, and presence of meconium. Low ponderal index was associated with need for extracorporeal membranous oxygenation in neonates with persistent pulmonary hypertension (P < .001). Conclusion Fetal developmental events may significantly affect neonatal pulmonary status. Diminished neonatal nutritional status, as measured by low ponderal index for gestational age, is associated with increased risk of persistent pulmonary hypertension of the neonate and severity of the disease process.

A randomized comparison of assisted vaginal delivery by obstetric forceps and polyethylene vacuum cup.

Abstract Background: Asymmetric intrauterine growth restriction (AsymIUGR) in normal birth weight (BW) infants is associated with increased perinatal morbidity, but without documented length or head circumference it cannot be assessed. Objective: To evaluate the association between decreased BW/placenta ratio and markers of AsymIUGR in normal BW, term infants. Method: There were 34,568 singleton, nonanomalous infants born at 36–44 weeks with BW equal to or exceeding the 10th percentile were evaluated for the Collaborative Perinatal Project. AsymIUGR markers were BW/length ratio, ponderal index, and BW/head circumference. AsymIUGR markers and BW/placenta weight less than the 10th percentile for gestation and gender were considered low. Five-minute Apgar score of 0–3 (low Apgar) was judged low. Relative risks with 95% confidence intervals, excluding 1.0, and P values Results: Low BW/placental weight ratio occurred in 1,912 (5.5%) infants and was associated with increased rates of low BW/length ratio, low ponderal index, low BW/head circumference ratio (relative risks 1.6, 1.3, and 2.0, respectively, all P Conclusions: Low BW/placental weight ratio is correlated with increased risk for AsymIUGR and low Apgar in term, nonanomalous, normal BW infants. Low BW/placental weight ratio may represent a useful, readily available marker for poor nutritional status at birth when birth length or head circumference are unavailable for analysis.