Ampicillin-metronidazole treatment in idiopathic preterm labour: a randomised controlled multicentre trial

OBJECTIVE: To determine whether treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour will prolong the gestation and reduce maternal and neonatal infectious morbidity. DESIGN: Randomised controlled double-blind trial. SETTING: Six obstetric departments in the Copenhagen area. POPULATION: One hundred and twelve women with singleton pregnancies, with threatened idiopathic preterm labour and intact amniotic membranes at 26 to 34 weeks of gestation. METHODS: Random allocation to eight days intravenous and oral treatment with ampicillin and metronidazole, or placebo. MAIN OUTCOME MEASURES: Number of days from admission to delivery, gestational age at delivery, rates of preterm delivery, low birthweight, maternal infections and neonatal infections. RESULTS: Treatment with ampicillin and metronidazole was associated with a significant prolongation of pregnancy (admission to delivery 47.5 days versus 27 days, P < 0.05), higher gestational age at delivery (37 weeks versus 34 weeks, P < 0.05), decreased incidence of preterm birth (42% versus 65%, P < 0.05), and lower rate of admission to neonatal intensive care unit (40% versus 63%, P < 0.05), when compared with placebo treatment. Antibiotic treatment had no significant effects on infectious morbidity. CONCLUSIONS: Treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour significantly prolonged the gestation, but had no effects on maternal and neonatal infectious morbidity.     

Extra-amniotic saline infusion for induction of labour in antepartum fetal death: a cost effective method worthy of wider use

OBJECTIVE: To compare the effectiveness of extra-amniotic saline with intra-amniotic prostaglandin F2 alpha in inducing labour in pregnancies with intrauterine fetal death. DESIGN: A randomised controlled trial. PARTICIPANTS: One hundred and twenty-one women in the extra-amniotic saline group and 123 women in the intra-amniotic prostaglandin group, performed at Harare Maternity Hospital, Zimbabwe during the period October 1994 to February 1996. RESULTS: The two methods were equally effective in achieving delivery. The number of women not delivering within 48 hours of recruitment was 6% for the extra-amniotic saline group compared with 11% for the intra-amniotic prostaglandin group (relative risk [RR] 0.51, 95% CI 0.21-1.22). The extra-amniotic saline group required augmentation with Syntocinon more frequently than the intra-amniotic prostaglandin group: 22% compared with 7% (RR 3.1, 95% CI 1.5-6.2). There were more complications associated with the intra-amniotic prostaglandin group: five women developed hypertonic contractions compared with none in the extra-amniotic saline group. In addition 23% of women in the intra-amniotic prostaglandin group developed acute vasovagal-like symptoms lasting for about 10 to 15 minutes which were distressing for the women. There was no evidence of any increase in febrile morbidity from extra-amniotic saline (RR 0.8, 95% CI 0.75-1.1). CONCLUSION: Extra-amniotic saline infusion in successful in inducing labour in antepartum fetal deaths after 20 weeks of gestation. This method has been shown to be safe and well tolerated by the women and should be considered in areas with limited resources. This method should be evaluated further for inductions of labour with a live fetus.     

Fracture of the ossified Achilles tendon

OBJECTIVE: To analyse the relation between induced abortion and risk of subsequent miscarriage. DESIGN: Case-control study conducted between February 1990 and May 1995. PARTICIPANTS: Case group included 782 women (median age 32 years, range 14-46) admitted for spontaneous abortion (within the 12th week of gestation) to a network of obstetric departments in the greater Milan area. The control group was recruited among women who gave birth at term (> 37 weeks of gestation) to healthy infants on randomly selected days at the hospitals where cases had been identified. A total of 1543 controls (median age 30 years, range 14-45) were interviewed. RESULTS: A total of 102 cases (13%) and 181 controls (12%) reported one or more induced abortions. No clear relation emerged between miscarriage and induced abortions. In comparison with women reporting no induced abortion the odds ratio (OR) for miscarriage were 1.1 (95% CI 0.8-1.4) in women reporting one induced abortion and 0.9 (95% CI 0.4-1.8) in women reporting two or more. Likewise, there was no association between time since last and age at first induced abortion and risk of miscarriage. CONCLUSIONS: This study did not find any strong association between induced and spontaneous abortion.     

Identifying twin gestations at low risk for preterm birth with a transvaginal ultrasonographic cervical measurement at 24 to 26 weeks' gestation

OBJECTIVE: Because twins are a high-risk group for preterm birth, many clinicians routinely use prophylactic interventions such as home bed rest, hospital bed rest, oral tocolytics, or home uterine activity monitoring to prevent preterm delivery. We sought to identify twin gestations at low risk for spontaneous preterm birth with transvaginal ultrasonography of the cervix to avoid the unnecessary use of prophylactic interventions in these pregnancies. STUDY DESIGN: We measured cervical length at 24 to 26 weeks' gestation by transvaginal ultrasonography in women with twin gestations referred to our prematurity prevention clinic. Each delivery was classified as (1) spontaneous preterm birth < 34 weeks' gestation, (2) delivery at > or = 34 weeks' gestation with intervention, or (3) delivery at > or = 34 weeks' gestation without intervention. Intervention included strict bed rest at home or in the hospital, either parenteral or oral tocolysis, or both, or home uterine activity monitoring. Indicated preterm deliveries and patients with cerclage were excluded from this analysis. The ability of transvaginal cervical length to predict women who would deliver at > or = 34 weeks without intervention was evaluated. A cervical length of 35 mm was chosen by scatter diagram as the best cutoff to discriminate between the group delivered at term without intervention and the other two groups. RESULTS: Of 85 women with twin gestations who underwent ultrasonographic cervical length measurements at 24 to 26 weeks' gestation, 17 had spontaneous preterm birth at < 34 weeks, 23 were delivered at > or = 34 weeks but required intervention, and 45 were delivered at > or = 34 weeks without intervention. The mean cervical length for those delivered at > or = 34 weeks' gestation without intervention (36.4 +/- 5.8 mm) was significantly greater (p < 0.0001) than the mean for those delivered preterm (27.4 +/- 8.5) and those delivered at > or = 34 weeks' gestation who required intervention (27.7 +/- 10.5 mm). The sensitivity, specificity, and positive and negative predictive values of a cervical length > 35 mm for predicting delivery at > or = 34 weeks' gestation are 49%, 94%, 97%, and 31%, respectively. CONCLUSION: A transvaginal ultrasonographic measurement of the cervix of > 35 mm at 24 to 26 weeks in twin gestations can identify patients who are at low risk for delivery before 34 weeks' gestation.     

Treatment of severe forms of sickle cell anemia with bone marrow allograft: French experience (15 cases). SFGM

OBJECTIVE: To determine whether home uterine activity monitoring reduces the likelihood of preterm birth in women successfully treated for preterm labor in their current pregnancies. METHODS: Women between 20-34 weeks' gestation who had been treated successfully for preterm labor were solicited to participate in a randomized clinical trial of home uterine activity monitoring versus routine high-risk care. The sample size of 56 was based on power calculations using the results of earlier investigators. Twenty-eight women were randomized to home uterine activity monitoring and 29 were assigned to the type of care appropriate for women discharged after hospitalization for parenteral treatment of preterm labor. One of the routine-care subjects was lost to follow-up. The two groups were comparable in distribution for race, insurance status, multiple gestation, marital status, gestational age at beginning of the study, and incidence of prior preterm birth. RESULTS: The 28 women receiving routine care had a 54% incidence of preterm birth, whereas the incidence was 57% in monitored women (relative risk 1.08, 95% confidence interval 0.6-1.9; P = .79). The incidences of delivery before 32 weeks and 34 weeks also were unaffected by the intervention. CONCLUSION: Home uterine activity monitoring is not effective in reducing the likelihood of preterm delivery in patients successfully treated for preterm labor in their current pregnancies.     

Lower risks of adverse outcome in twins conceived by artificial reproductive techniques compared with spontaneously conceived twins

The outcomes of twins conceived by 136 women after medical assistance (MA) such as ovulation induction with or without assisted reproductive techniques, and twins conceived spontaneously (SP) by 72 women were compared. All 208 women were monitored from < 20 weeks gestation; they all delivered at > or = 24 weeks gestation. The chorionicity of the placenta was diagnosed antenatally and confirmed after delivery. There were 10 perinatal deaths; the physical and neurological status of the remaining 406 infants was assessed at 1 year of corrected age. There were no differences in gestational age at birth, the birth weights of the larger and smaller twins, the birth weight discordance, or the incidence of life-threatening major malformations between groups. Adverse infant outcomes, such as death, cerebral palsy and mental retardation occurred in nine (3.3%) of 272 MA twins compared with 12 (8.3%) of 144 SP twins (P < 0.05). The placenta was monochorionic in only three (2.2%) of 136 MA twin pregnancies compared with 41 (57%) of 72 SP twin pregnancies (P < 0.001). Of the 21 infants with adverse outcomes, nine had monochorionic placentas. Thus, the risk of an adverse outcome was 2.8-fold higher (95% confidence interval (CI) 1.2-6.4) in monochorionic twins than in dichorionic twins (10 versus 3.7%; P < 0.05). There was no difference in the incidence of adverse infant outcomes between SP (4.8%) and MA (3.4%) twins with dichorionic placentas. These findings suggest that ovulation induction in itself was not associated with an adverse outcome of twin pregnancies. The lower frequency of monochorionic placentas in MA twins may have been responsible for the lower risk of an adverse outcome in MA twins.     

Examination of wear in Duraloc acetabular components: two- to five-year evaluation of Hylamer and Enduron liners

BACKGROUND: The purpose was to determine the prognostic value of interleukin (IL) 1-alpha, IL-6 and IL-8 in cervico/vaginal secretion for preterm birth (<37 weeks of gestation) in twin pregnancies. METHODS: The study included screening of 121 women with twin pregnancies with sampling at 24, 26, 28, 30, 32 and 34 weeks of gestation. IL-1alpha, IL-6 and IL-8 was analyzed with ELISA immunoassays. The detection limit was 30 pg/mL for IL-1 and IL-8 and 40 pg/mL for IL-6. Vaginal fluid was smeared and dried for later evaluation of bacterial vaginosis (presence of clue cells). RESULTS: Spontaneous preterm birth occurred in 36 women and 65 women were delivered at term. IL-8 was significantly higher (p=0.03) in samples from women delivered preterm (median 3.72 ng/g mucus, range <0.07-220.00) compared with samples from women delivered at term (median 3.03 ng/g mucus, range <0.08-378.60). At 28 weeks of gestation, IL-8 (cut off 1.75 ng/g mucus) was associated with preterm delivery (relative risk 2.2, CI 95% 1.1-4.5) with a sensitivity, specificity, positive and negative predictive value of 78.8, 45.8, 44.8 and 79.4%, respectively. The levels of IL-1alpha and IL-6 were not significantly associated with preterm birth. Bacterial vaginosis was found in 47/541 (8.7%) samples analyzed. The levels of IL-1alpha and IL-8 were significantly higher in samples positive for bacterial vaginosis than in negative samples (p<0.0001 and p<0.01, respectively). There was no significant association between the level of IL-6 and bacterial vaginosis. CONCLUSIONS: IL-8, but not IL-1alpha and IL-6, was associated with preterm delivery but the relationship was too weak to be of predictive value for preterm birth in twin pregnancies. IL-1alpha and IL-8, but not IL-6, were associated with bacterial vaginosis.     

Pregnancy-related hospital use

OBJECTIVES:This article describes provincial variations in women's hospital use during pregnancy, childbirth and the postnatal period. DATA SOURCE: The data were extracted from the Person-Oriented Information Data Base, maintained by Health Statistics Division at Statistics Canada. This data base is comprised of hospital admission data submitted by general and allied hospitals to provincial and territorial governments and is considered complete for each jurisdiction. Data were not available for the Yukon Territory. ANALYTICAL TECHNIQUES: A group of 57,627 women who gave birth during October and November 1993 was identified from hospital admission records using selected ICD-9 and CCP codes. These records were then linked to other hospital admissions that occurred in the six months before and the four months after childbirth. MAIN RESULTS: Approximately 15% of women who gave birth in October and November 1993 were admitted to hospital at least once during the six months before childbirth. Only 4% were re-admitted during the four months after the birth.     

Infraclavicular brachial plexus block: parasagittal anatomy important to the coracoid technique

OBJECTIVE: This study's objective was to determine whether the concentrations of beta-human chorionic gonadotropin in the secretions of the cervix and vagina could be used to predict preterm delivery in a group of women at high risk for this complication. STUDY DESIGN: Women attending a prematurity prevention clinic at an inner-city hospital July 1, 1996-October 1, 1997, were invited to participate. From those who consented, secretions from the cervix and posterior vaginal fornix were sampled every 2 weeks until delivery, beginning at 24 weeks' gestation. Concentrations of beta-human chorionic gonadotropin were measured with a commercially available enzyme-linked immunosorbent assay. Providers of obstetric care were blinded to the results. Levels of beta-human chorionic gonadotropin in those who were delivered before 34 weeks' gestation and those who were delivered at term were compared. A value >50 mIU/mL was considered elevated. This cutoff value was determined according to beta-human chorionic gonadotropin values obtained during pregnancies that were delivered at term. RESULTS: Of the 146 women asked to participate, 77 consented. There was no difference between participants and nonparticipants with respect to age, race, indication for enrollment in the clinic, gestational age at delivery, or parity. Of the 77 participants, 24 (31%) were delivered before 37 weeks' gestation and 12 (16%) were delivered before 34 weeks' gestation. A single beta-human chorionic gonadotropin value >50 mIU/mL obtained between 24 and 28 weeks' gestation was associated with a significant increase in the incidence of delivery before 34 weeks' gestation (P = .03). This cutoff value had sensitivity, specificity, and positive and negative predictive values for predicting delivery before 34 weeks' gestation of 50%, 87%, 33%, and 93%, respectively. CONCLUSION: These data suggest that the concentration of beta-human chorionic gonadotropin in cervicovaginal secretions may be a useful predictor of preterm delivery.     

Pregnancies complicated by placenta praevia: what is appropriate management?

OBJECTIVE: To review the outcome of pregnancies complicated by placenta praevia over a three-year period (1991-1993) and to describe in detail the antenatal course and the events leading to delivery, assessing retrospectively whether there are clinical features predictive of outcome and whether outpatient management would be reasonable. DESIGN: A retrospective review of the case records of women with a pregnancy complicated by placenta praevia. SETTING: A tertiary referral teaching hospital in Edinburgh. RESULTS: There were 15,930 deliveries in the study period. Fifty-eight women (0.4%) had a placenta praevia in the third trimester, 42 of whom (72%) had at least one episode of bleeding. Overall, 62% of the women had a major praevia with no differences in the grade of praevia between those women who did or did not have bleeding. Both diagnosis and delivery occurred significantly earlier in women with antepartum bleeding than in those without (median gestation at diagnosis 28.6 weeks versus 33.3 weeks (P < 0.01) and at delivery 36.0 weeks versus 37.1 weeks (P = 0.04), respectively). Delivery by emergency caesarean section was more common in women with bleeding (62% versus 38%). An increasing number of bleeding episodes experienced by individuals was not associated with significant differences in outcomes. Rapid emergency delivery for bleeding was necessary for three women, in none of whom could the bleeding have been predicted. CONCLUSIONS: The clinical outcomes of placenta praevia are highly variable and cannot be predicted confidently from antenatal events. Nonetheless, in the majority of cases with or without bleeding and irrespective of the degree of praevia, outpatient management would appear safe and appropriate.     

Level of antifibrinogen antibodies in newborns and women during the postpartum period

In newborns and women who have just delivered antifibrinogen antibodies level was measured by means of immunoenzymatic method (ELISA). It has been found significantly higher antibodies level in women than in newborns. All newborns had lower antibodies level than their mothers. It has been found significantly lowered antibodies level before 38 week of gestation. Especially high antibodies level was observed in women who gave birth after 42 week of gestation and in newborns born in the same time.     

The anti-craving drug acamprosate inhibits the conditioned place aversion induced by naloxone-precipitated morphine withdrawal in rats

OBJECTIVE: To assess the influence of maternal race, age, marital status, and education on risk for earlier and later preterm births in twin pregnancies. METHODS: We analyzed 8109 white and 1906 black liveborn twin pregnancies in the Missouri Linked Sibship files for the years 1978-1990, using contingency tables and multiple logistic regression. RESULTS: Black twin gestations had 1.61-fold (95% confidence interval [CI] 1.46, 1.76) greater risk than whites for preterm birth before 34 weeks' gestation. However, there was no race difference after 33 weeks. Among whites, teen age, unmarried status, and education fewer than 12 years were independently associated with risk for delivery before 34 weeks in multivariate analysis (odds ratios [OR] 1.28-1.51, each P < or=.001). These associations were diminished or absent for preterm births after 33 weeks' gestation. White unmarried teen mothers with fewer than 12 years of education had 1.83-fold (95% CI 1.39, 2.40) greater risk for preterm birth before 34 weeks' gestation compared with white married women more than 19 years of age with at least 12 years of education. In blacks, this difference was 1.47-fold (95% CI 1.13, 1.92). In both races, these differences were absent after 33 weeks' gestation. CONCLUSION: Traditional sociodemographic risk factors were present for twin preterm birth, but mainly before 34 weeks' gestation. This, together with previous data from Missouri Linked Sibship files, indicates that dominant pathogenic mechanisms of early preterm birth in twin gestations are likely to be different from those causing later preterm twin birth. Therefore, gestational age should be accounted for in future studies seeking to identify predictive factors or biomechanisms for twin preterm birth.     

Oocyte donation to women of advanced reproductive age: pregnancy results and obstetrical outcomes in patients 45 years and older

We analysed the results of oocyte donation to women of advanced reproductive age (> or = 45 years old) and followed their pregnancies through to delivery in order to assess obstetrical outcomes. Patients (n = 162) aged 45-59 years (mean +/- SD; 47.3 +/- 3.4 years) underwent 218 consecutive attempts to achieve pregnancy. Oocytes (16.2 +/- 7.2 per retrieval) were provided by donors < or = 35 years old. Cleaving embryos (8.2 +/- 4.8 zygotes/couple) were transferred transcervically (4.5 +/- 1.1 per embryo transfer) to recipients prescribed oral micronized oestradiol and intramuscular progesterone. Following oocyte aspiration there were six instances of non-fertilization (2.8%) and 212 embryo transfers. A total of 103 pregnancies was established for an overall pregnancy rate (PR) of 48.6%, which included 17 preclinical pregnancies, 12 spontaneous abortions, and 74 delivered pregnancies (clinical PR 40.6%; delivered PR 34.9%). Multiple gestations were frequent (n = 29; 39.2% of pregnancies) and included 20 twins, seven triplets, and two quadruplets. Two of the triplet and both of the quadruplet pregnancies underwent selective reduction to twins. Antenatal complications occurred in 28 women (37.8% of deliveries) and included preterm labour (n = 9), gestational hypertension (n = 8), gestational diabetes (n = 6), carpel tunnel syndrome (n = 2), pre-eclampsia (n = 2), HELLP syndrome (n = 2), and fetal growth retardation (n = 2). 48 (64.8%) deliveries were by Caesarean section. The gestational age at delivery for singletons was 38.3 +/- 1.3 weeks (range 35-41 weeks), with birth weight 3218 +/- 513 g (range 1870-4775 g); twins 35.9 +/- 2.0 weeks (range 32-39 weeks), birth weight 2558 +/- 497 g (range 1700-3450 g); and triplets 33.5 +/- 0.7 weeks (range 32-34 weeks), birth weight 1775 +/- 190 g (range 1550-2100 g). Neonatal complications (4.6% of babies born) included growth retardation (n = 2), trisomy 21 (n = 1), ventricular septal defect (n = 1), and small bowel obstruction (n = 1). There were no maternal or neonatal deaths. We conclude that oocyte donation to women of advanced reproductive age is highly successful in establishing pregnancy. However, despite careful antenatal screening, obstetrical complications are common, often secondary to multiple gestation.     

Management of pregnancies beyond forty-one weeks' gestation with an unfavorable cervix

OBJECTIVE: Our purpose was to determine the optimal management of pregnancies beyond 41 weeks' gestation with a cervix unfavorable for induction. STUDY DESIGN: All uncomplicated pregnancies that reached 41 weeks' gestation with a Bishop score of < or = 4 were randomly assigned to one of three groups: (1) daily cervical examinations, (2) daily membrane stripping, or (3) daily placement of prostaglandin gel until 42 weeks. RESULTS: In 105 pregnancies the Bishop score on admission to labor and delivery was significantly greater in the groups receiving prostaglandin or stripping of the membranes versus the control group, whereas the converse was time of gestational age at delivery (p = 0.0001). Fewer patients required induction in the two treatment groups (20%, 17%) versus the control (69%) patients (p < 0.0001). CONCLUSIONS: Daily membrane stripping or daily placement of prostaglandin gel is successful in reducing the number of inductions at 42 weeks for postdatism.     

Maternal weight gain patterns and birth weight outcome in twin gestation

OBJECTIVE: To evaluate the association between maternal weight gain patterns, based on pregravid body mass index (BMI) and birth weight outcome in twins, and to make specific recommendations for maternal weight gain during twin gestation. METHODS: One hundred eighty-nine twin pregnancies were reviewed retrospectively. Weekly rates of maternal weight gain before 20 weeks, from 20 weeks to delivery, and for total gestation were calculated. Thresholds of weekly maternal weight gain were determined for underweight and normal-weight women. RESULTS: In underweight women, a higher weekly rate of gain before 20 weeks was associated with the birth of both twins weighing at least 2500 g (1.13 versus 0.70 lb/week, P = .017), when compared with mothers of at least one twin weighing less than 2500 g. A higher rate of weight gain from 20 weeks to delivery was associated with the delivery of twins weighing at least 2500 g in both underweight (1.92 versus 1.29 lb/week, P = .031) and normal weight (1.63 versus 1.29 lb/week, P = .046) women. No significant differences in weight gain patterns were found between overweight women delivering twins weighing less than 2500 g or at least 2500 g. A weekly rate of gain from 20 weeks' gestation to delivery of at least 1.75 lb/week in underweight women and at least 1.50 lb/week in normal-weight women was associated with the birth of both twins weighing at least 2500 g. After controlling for other potential determinants of birth weight, the threshold of 1.75 lb/week in underweight women showed a trend toward significance as an independent predictor of both twins weighing at least 2500 g (P = .06). CONCLUSION: Certain maternal weight gain patterns during twin pregnancy are associated with the birth of each twin weighing at least 2500 g. As with singletons, recommendations for maternal weight gain during twin pregnancy can be based on pregravid BMI.     

Changes in bone mineral density in patients with Paget''s disease treated with risedronate

Our purpose was to evaluate the impact of intravenous and oral tocolysis on prolongation of gestation for women with preterm uterine contractions and/or labor. Candidates for evaluation and treatment including women with contractions between 24 and 35 weeks. Two hundred women (group I) without cervical changes met the protocol criteria and 175 women (group II) who presented with or developed cervical changes were treated by protocol. A representative sample of both groups received oral terbutaline maintenance therapy until 37 weeks' gestation. Primary outcome variables included the length of gestation obtained following initial treatment and the preterm birth rate. Women in group II were twice as likely to deliver before 35 weeks, 23% versus 9.5%, respectively, and to have a delivery before 37 weeks' gestation, 45% versus 22%, respectively, (p < 0.05). There was no significant difference in days gained in utero for women on oral terbutaline for either group. Women in group II on oral therapy were more likely to be readmitted and retreated with parenteral tocolysis. In conclusion, oral maintenance tocolysis has no significant impact on further prolongation of pregnancy after intravenous tocolysis.     

The outcome of pregnancy and labor after a period of sterility

In a retrospective study is examine the effect of a previous state of sterility on the outcome of pregnancy and labor. For two years (1993-1994) there were 203 (2.6%) women who gave birth after 6.7% +/- 3.5 years of sterility. From the study are excluded 9 women (4.4%) with multifetal pregnancies and 13 cases (6.4%) with different diseases, which may adversely affect the pregnancy of the foetus. In the study group of 181 primiparous women the rate of premature labor is 2.2% which is significantly lower than the hospital incidence (11%) for the same period. The cesarean section (CS) rate after period of sterility is unreasonably high--69%. In the subgroup scheduled for vaginal labor CS are performed in 34% of cases. The indications for the elective CS are complex, less justifiable and partially due to non medical reasons. The past period of sterility has not adverse effect on the course of the vaginal labor or the state of the newborn at delivery.     

Obstetric risk: evaluation of existing indices and criteria

OBJECTIVES: To study the validity of the most common systems for evaluating obstetric risk in a random representative sample of pregnant Andalusian women. DESIGN: Crossover study of 1852 pregnancies of over 28 weeks and in which the women gave birth in the public hospitals of Andalusia (C.I. 95%, 7.5% accuracy). Information came from the maternity and neonatal clinical records and from a home visit after the birth. Sensitivity, specificity and predictive values of each cut suggested by the author in each system evaluated was calculated. Systems were compared with ROC curves. PARTICIPANTS: Andalusian women who gave birth in public hospitals. Measurements and main results. Obstetric risk was evaluated with the Nesbitt and Aubry (ASMI), Hobel, Coopland and IROM indices, with the criteria used in Malaga West District, and Bull's proposals for English general practitioners. The validity of the predictions was studied for premature birth, low birth-weight, the CIR, hypoxia in the new-born, pathological birth and lengthy hospital stays of mother and child. The low predictive power of the indices studied was demonstrated. The best were the Hobel, Coopland and IROM indices. The indices had greater predictive power than the referral criteria: this, appreciating the different philosophies underlying the systems which, independently of their validity, determine the number of pregnant women at risk. CONCLUSIONS: Since defining a pregnant woman as at risk is not innocuous, the research showed the importance of constructing systems, or at least validating existing ones, for the target community.     

Determinants of midterm outcome of partial left ventriculectomy in dilated cardiomyopathy

The objective of this study was to test the hypothesis that maternal CRH concentrations are elevated in women experiencing threatened preterm labor who subsequently give birth within 24 h compared to those in women who do not. We also characterized the changes in maternal plasma cortisol, ACTH, corticosteroid binding capacity (CBC), and CRH concentrations in 28 healthy pregnant women between 20-38 weeks gestation. Overall, maternal plasma CRH concentrations were significantly greater (P < 0.05) in those women giving birth within 24 h (1343.3 +/- 143.9 pg/mL; n = 81) compared to those in women who did not (714.5 +/- 64.8 pg/mL; n = 144) or those in normal subjects. This difference was present between 28-36 weeks, but not 24-28 weeks gestation. The ratio of maternal cortisol to CBC was also significantly greater (P < 0.05; 0.65 +/- 0.04; n = 82) in women giving birth within 24 h than in those who did not (0.55 +/- 0.02; n = 136). This difference was significant at all gestational ages studied. Elevated CRH concentrations and bioavailability of free cortisol may both be implicated in the pathogenesis of preterm labor in some women. Further prospective clinical trials are warranted to determine the positive and negative predictive values of maternal CRH concentrations and/or the ratio of cortisol/CBC for identifying women with threatened preterm labor destined to give birth within 24 h.