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B M Mercer

Publications and source records attributed to B M Mercer.

At least 55 records · Page 3Linked to original sources
PubMed1996

The preterm prediction study: fetal fibronectin testing and spontaneous preterm birth. NICHD Maternal Fetal Medicine Units Network.

OBJECTIVE: To evaluate the presence of fetal fibronectin in the cervix and vagina as a screening test for spontaneous preterm birth. METHODS: Two thousand nine hundred twenty-nine women at ten centers were routinely screened every 2 weeks from 22-24 to 30 weeks for cervical and vaginal fetal fibronectin. A positive test was defined as a value equal to or greater than 50 ng/mL. The relation between a positive test at four gestational ages and spontaneous preterm birth at various intervals after the test was determined. RESULTS: In each testing period, 3-4% of the fetal fibronectin tests were positive. The correlation between cervical and vaginal fetal fibronectin at the same visit was always approximately 0.7 (P < .001), and that between cervical or vaginal fetal fibronectin in consecutive visits was between 0.17 and 0.25 (P < .001). The sensitivity of fetal fibronectin at 22-24 weeks to predict spontaneous preterm birth at less than 28 weeks was 0.63, and the relative risk for a positive versus negative test was 59. The specificity was always 96-98%, whereas the positive predictive value rose from 13% to 36% as the upper limit of the definition of preterm birth was increased from less than 28 to less than 37 weeks. The relative risk for spontaneous preterm birth after a positive fetal fibronectin test compared with a negative fetal fibronectin test varied substantially by testing period and by the definition of spontaneous preterm birth, but always remained greater than 4 and statistically significant. CONCLUSION: A positive cervical or vaginal fetal fibronectin test at 22-24 weeks predicted more than half of the spontaneous preterm births at less than 28 weeks (sensitivity 0.63). As the definition of spontaneous preterm birth was extended to include later gestational ages or when the fetal fibronectin test was performed later in pregnancy, the level of association between a positive fetal fibronectin test and spontaneous preterm birth, while remaining highly significant, tended to decrease. Although fetal fibronectin is an excellent test for predicting spontaneous preterm birth, we present no evidence that the use of this test will result in a reduction in spontaneous preterm birth.

Adult↗
PubMed1996

Fetal startle response observed under ultrasonography: a good predictor of a reassuring biophysical profile.

OBJECTIVE: To correlate the vibroacoustic stimulus-evoked fetal startle response observed under ultrasonography with the subsequent biophysical profile (BPP) score. METHODS: Vibroacoustic stimulation was applied under ultrasound observation to gravidas who had a nonreactive fetal heart rate in the first 10 minutes of monitoring. Fetal startle response was defined as a sudden movement of fetal extremities in the 2 seconds following stimulus. Subsequently, nonstress testing was completed and a BPP performed on all women who required vibroacoustic stimulation. The presence or absence of a fetal startle response was compared with the observed BPP score. RESULTS: Two hundred tests were performed at 35.3 +/- 3.7 weeks. After the vibroacoustic stimulation, 70% of the nonreactive tracings became reactive. Mothers perceived the fetal startle response after vibroacoustic stimulus in 93% of cases. All cases with a fetal startle response after a vibroacoustic stimulation had a subsequent BPP score of 8 or more (negative predictive value of 100%). In addition, all patients with a nonreassuring BPP score were in the group of patients with absent fetal startle response. However, the positive predictive value of an absent fetal startle response for a subsequent BPP score of 6 or less was only 10%. CONCLUSION: This preliminary study suggests that the fetal startle response predicts a BPP score equal to or greater than 8. After the availability of larger studies supporting these findings, this test could be used as a rapid antepartum test to predict fetal well-being.

Acoustic Stimulation↗
PubMed1996

The preterm prediction study: a clinical risk assessment system.

OBJECTIVE: Our aims were to develop a risk assessment system for the prediction of spontaneous preterm delivery using clinical information available at 23 to 24 weeks' gestation and to determine the predictive value of such a system. STUDY DESIGN: A total of 2929 women were evaluated between 23 and 24 weeks' gestation at 10 centers. Demographic factors, socioeconomic status, home and work environment, drug and alcohol use, and medical history were evaluated. Information regarding symptoms, cultures, and treatments in the current pregnancy were ascertained. Anthropomorphic and cervical examinations were performed. Univariate analysis and multivariate logistic regression were performed in a random selection, constituting 85% of the study population. The derived risk assessment system was applied to the remaining 15% of the population to evaluate its validity. RESULTS: A total of 10.4% of women were delivered of preterm infants. The multivariate models for spontaneous preterm delivery were highly associated with spontaneous preterm delivery (p < 0.0001). A low body mass index (<19.8) and increasing Bishop scores were significantly associated with spontaneous preterm delivery in nulliparous and multiparous women. Black race, poor social environment, and work during pregnancy were associated with increased risk for nulliparous women. Prior obstetric outcome overshadowed socioeconomic risk factors in multiparous women with a twofold increase in the odds of spontaneous preterm delivery for each prior spontaneous preterm delivery. Current pregnancy symptoms, including vaginal bleeding, symptomatic contractions within 2 weeks, and acute or chronic lung disease were variably associated with spontaneous preterm delivery in nulliparous and multiparous women. When the system was applied to the remainder of the population, women defined to be at high risk for spontaneous preterm delivery (> or = 20% risk) carried a 3.8-fold (nulliparous women) and 3.3-fold (multiparous women) higher risk of spontaneous preterm delivery than those predicted to be at low risk. However, the risk assessment system identified a minority of women who had spontaneous preterm deliveries. The sensitivities were 24.2% and 18.2% and positive predictive values were 28.6% and 33.3%, respectively, for nulliparous and multiparous women. CONCLUSIONS: Although it is possible to develop a graded risk assessment system that includes factors that are highly associated with spontaneous preterm delivery in nulliparous and multiparous women, such a system does not identify most women who subsequently have a spontaneous preterm delivery. This system has investigational value as the basis for evaluating new technologies designed to identify at-risk subpopulations.

Black People↗
PubMed1996

Oral terbutaline after parenteral tocolysis: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: Our purpose was to determine whether oral terbutaline, used after successful intravenous tocolysis, will prolong pregnancy and prevent recurrent preterm labor. STUDY DESIGN: After successful intravenous tocolysis, 203 women with preterm labor at 24 weeks' to 34 weeks 6 days' gestation were randomized to terbutaline (5 mg orally, every 4 hours) or placebo until 37 weeks' gestation. Women with recurrent preterm labor were treated with intravenous magnesium sulfate; if tocolysis was successful, they continued with the initial study medication. The primary outcome was the percentage delivered of their infants within 1 week of beginning oral tocolytic therapy. Latency, recurrent preterm labor, and maternal and neonatal outcomes were also assessed. RESULTS: Pregnancy outcome data were available in 200 women. There were no differences seen between the two groups in the incidence of delivery at 1 week (18% vs 24%, 95% confidence interval 0.44 to 1.29). In addition, there were no differences regarding median latency, mean gestational age at delivery, or the incidence of recurrent preterm labor (20% vs 16%, 95% confidence interval 0.64 to 2.71). Post hoc evaluation of 96 women enrolled before 32 weeks' gestation suggested pregnancy prolongation with maintenance oral terbutaline (p < 0.01). CONCLUSIONS: Maintenance oral terbutaline therapy initiated at 24 weeks' to 34 weeks 6 days' gestation after successful parenteral tocolysis is not associated with pregnancy prolongation or a reduction in the incidence of recurrent preterm labor.

Administration, Oral↗
PubMed1996

Serial amniotic fluid index in severe preeclampsia: a poor predictor of adverse outcome.

OBJECTIVE: The purpose of the study was to determine the relationship between low amniotic fluid index and intrauterine growth restriction and nonreassuring fetal testing in patients with severe preeclampsia. STUDY DESIGN: We reviewed the medical records of 136 women with severe preeclampsia managed conservatively for at least 48 hours. Patients were followed up with a daily nonstress test and amniotic fluid index. We evaluated amniotic fluid index < or = 5 cm and < or = 7 cm, measured on admission or just before delivery (i.e., final), and attempted to correlate these findings with the incidence of nonreassuring fetal testing necessitating cesarean section or the incidence of intrauterine growth restriction (birth weight < or = 10th percentile). RESULTS: One hundred seven patients had a cesarean section, but only 42 (39%) of these were for a nonreassuring fetal heart rate tracing or a persistent biophysical profile of < or = 4, and 38 (36%) of the pregnancies resulted in infants with intrauterine growth restriction. During expectant management, the amniotic fluid index worsened for 61 (45%) patients and improved or remained the same for 75 (55%). For those with an amniotic fluid index of < or = 5 cm both on admission and at delivery, there was a significantly higher incidence of intrauterine growth restriction compared with those with an amniotic fluid index > 5 cm (p = 0.007 and p = 0.029, respectively). However, there was no association between intrauterine growth restriction and an amniotic fluid index < or = 7 cm. Moreover, there was no difference in the frequency of nonreassuring fetal heart rate testing on the basis of amniotic fluid volume (p = 0.59) or intrauterine growth restriction (p = 0.4). CONCLUSIONS: For women with severe preeclampsia remote from term, an amniotic fluid index < or = 5 cm is predictive of intrauterine growth restriction but lacks sensitivity. There is no association between the amniotic fluid index status and frequency of cesarean section for fetal distress or nonreassuring fetal testing.

Adult↗
PubMed1996

The preterm prediction study: risk factors in twin gestations. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.

OBJECTIVE: Our purpose was to determine the association between the presence of bacterial vaginosis, fetal fibronectin, and a short cervix and the risk of spontaneous preterm birth of twins. STUDY DESIGN: We prospectively screened 147 women with twins at 24 and 28 weeks' gestation for more than 50 potential risk factors for spontaneous preterm birth. We also measured cervical length with ultrasound scans and tested for the presence of bacterial vaginosis. Fetal fibronectin level was evaluated every 2 weeks from 24 to 30 weeks' gestation. Outcomes included spontaneous preterm birth at < 32 weeks, < 35 weeks, and < 37 weeks. RESULTS: Among twin as compared with singleton pregnancies, a cervical length < or = 25 mm was more common at both 24 and 28 weeks, a statistically significant difference. There were no significant differences in most other risk factors. Of the factors evaluated by means of univariate analysis at 24 weeks, only a short cervix (< or = 25 mm) was consistently associated with spontaneous preterm birth. The odds ratio and 95% confidence interval for spontaneous preterm birth at < 32 weeks, < 35 weeks, and < 37 weeks were 6.9 (2.0 to 24.2), 3.2 (1.3 to 7.9), and 2.8 (1.1 to 7.7). At 28 weeks, a cervical length < or = 25 mm was not a strong predictor of spontaneous preterm birth. At both 28 weeks (odds ratio, 9.4; confidence interval, 1.0 to 67.7) and 30 weeks (odds ratio 46.1; confidence interval, 4.2 to 1381), a positive fetal fibronectin result was significantly associated with spontaneous preterm birth at < 32 weeks. Bacterial vaginosis at 24 or 28 weeks was not associated with spontaneous preterm birth of twins. Multivariate analysis confirmed the association between cervical length < or = 25 mm at the 24-week visit and spontaneous preterm birth and also confirmed that at 24 weeks the other risk factors were less consistently and often not statistically significantly associated with spontaneous preterm birth. Of the risk factors evaluated at 28 weeks, only a positive fetal fibronectin was associated with a significantly increased risk for spontaneous preterm birth. CONCLUSIONS: Most known risk factors for spontaneous preterm birth were not significantly associated with spontaneous preterm birth of twins. At 24 weeks, cervical length < or = 25 mm was the best predictor of spontaneous preterm birth at < 32 weeks, < 35 weeks, and < 37 weeks. Of the risk factors evaluated at 28 weeks, fetal fibronectin was the only statistically significant predictor of spontaneous preterm birth at < 32 weeks.

Adolescent↗
PubMed1996

Midtrimester premature rupture of the membranes.

Midtrimester premature rupture of the membranes is an uncommon adverse complication of pregnancy with an occurrence of approximately 0.65%. Significant perinatal and maternal morbidity includes pulmonary hypoplasia, restriction deformities, and sequelae of prematurity as well as maternal chorioamnionitis and endometritis. Moreover, 31% of survivors are affected by long-term complications such as chronic lung disease, neurological and developmental abnormalities. Fetal survival is evident with increasing latency and good residual amniotic fluid (largest vertical pocket > or = 2 cm). In this article, we review the relevant literature regarding prognosis, counseling, and management of the patient with membrane rupture in the midtrimester.

Female↗
PubMed1996

Antibiotic therapy for preterm premature rupture of the membranes.

Amniotic fluid studies and placental histopathological evaluation have confirmed the association between intrauterine infection and preterm premature rupture of the membranes (pPROM). This association is increasingly strong with pPROM at early gestational ages. The organisms associated with pPROM include a broad spectrum of aerobic and anaerobic gram-positive and gram-negative bacteria. In many cases, the patient presenting with pPROM will have overt intrauterine infection necessitating delivery. For those amenable to expectant management, the clinical course is usually of brief latency between membrane rupture and delivery. A number of well-designed prospective clinical trials have evaluated the utility of antibiotic treatment during the expectant management of pPROM. Taken together, these studies suggest broad spectrum antibiotic treatment of this population to enhance pregnancy prolongation, and to reduce maternal and neonatal infectious morbidity. There are some data suggesting the potential for a reduction in neonatal gestational age-dependent morbidity. We recommend aggressive adjunctive antibiotic treatment to prolong pregnancy and reduce morbidity in patients with pPROM, at gestations remote from term, when a significant improvement in neonatal outcome can anticipated with expectant management.

Anti-Bacterial Agents↗
PubMed1996

Selected issues in premature rupture of the membranes: herpes, cerclage, twins, tocolysis, and hospitalization.

A number of issues related to premature rupture of the membranes (PROM) are less common or have not been thoroughly evaluated. Genital herpes simplex colonization carries the potential for significant perinatal morbidity, particularly with primary infection and membrane rupture. Cervical cerclage is both a risk factor for preterm PROM (pPROM) and confounds the management of women with PROM. Twin gestations carry an increased risk of pPROM and earlier membrane rupture. Membrane rupture can involve the presenting or nonpresenting sac. In each case, the fetus with intact membranes is at risk due to brief latency or intrauterine infection after membrane rupture of its sibling. Prophylactic and therapeutic tocolysis remains controversial because of the high risk of intrauterine infection after PROM, and the lack of data demonstrating long-term efficacy. With increased attention to health care costs, home management of pPROM has recently been suggested as an alternative to hospitalization after pPROM. This article reviews the clinical course and management options regarding these issues. Also discussed are those issues for which there is controversy but little available data. Each of these issues offers fruitful ground for discussion and further study.

Cervix Uteri↗
PubMed1996

Group B streptococcus and pregnancy.

Group B streptococcus is a significant pathogen for both mother and child. routine urine culture in pregnancy will identify and allow treatment of women with asymptomatic bacteriuria. An optimal protocol for the prevention of neonatal sepsis has not yet been developed. While intrapartum antimicrobial prophylaxis appears to provide the best potential, each of the currently suggested protocols has significant drawbacks. Drawbacks include the potential for missing high-risk carriers, failure to treat a significant proportion of those destined to deliver an affected infant because no risk factors are present, and empirical treatment of a large proportion of the population in order to present significant disease in a few. Until an effective program of immunization becomes available, intrapartum prophylaxis of group B streptococcal carriers appears to offer the best hope of reducing the incidence of neonatal disease. Caregivers should adopt a uniform practice with regard to screening and prophylaxis. It is essential that any broad-based screening program include an evaluation of efficacy as well as complications including the development of new etiologic agents as causes of neonatal sepsis and the emergence of resistant bacteria. Further, mothers and newborns should be evaluated for drug adverse reactions and the impact of intrapartum prophylaxis on the use of prolonged empirical broad-spectrum antimicrobial therapy on the asymptomatic infant. Additional research is necessary regarding the required duration of therapy for optimal effect of intrapartum prophylaxis, the need for postnatal prophylaxis of the asymptomatic neonate, and the optimal agent for neonatal prophylaxis (penicillin versus broad-spectrum agents) if neonatal therapy is necessary after intrapartum prophylaxis.

Female↗
PubMed1995

Antimicrobial therapy in expectant management of preterm premature rupture of the membranes.

We review the impact of antimicrobial treatment on maternal and fetal outcome during expectant management of preterm premature rupture of the membranes. Relevant studies were retrieved from Medline (1966 to August, 1994) with the search term fetal-membrane-premature-rupture and antibiotics or antimicrobial, Excerpta Medica (1972 to August, 1994) with the search term premature fetus, membrane rupture, and antibiotic or antimicrobial therapy, and the Cochrane database of systemic reviews with the criterion antibiotics and prelabour rupture of membranes. We also obtained unpublished data from a randomised clinical trial of ceftizoxime versus placebo. The selected studies were randomised controlled trials of systemic antimicrobial therapy for prolongation of gestation in non-labouring women after preterm premature rupture of the membranes. Data extraction was done by a single reviewer. Studies were evaluated for post-randomisation exclusion and other confounding variables that might introduce analytical bias. Analysis was done with SAS statistical software by a blinded investigator. Antimicrobial therapy after preterm premature rupture of the membranes is associated with a reduced number of women delivering within 1 week (62 vs 76%; OR 0.51, 95% CI 0.41-0.68), and reduced diagnosis of maternal morbidity including chorioamnionitis (12 vs 23%; 0.45, 0.33-0.60) and postpartum infection (8 vs 12%; 0.63, 0.41-0.97). Fetal morbidity, including confirmed sepsis (5 vs 9%; 0.57, 0.36-0.88), pneumonia (1 vs 3%; 0.32, 0.11-0.96), and intraventricular haemorrhage (9 vs 14%; 0.65, 0.45-0.92) were less often diagnosed after antimicrobial therapy. Separate analysis of the six placebo-controlled trials revealed similar or improved odds of pregnancy prolongation, chorioamnionitis, neonatal sepsis, postpartum infection, positive infant blood cultures, and pneumonia. Antimicrobial therapy, when used in the expectant management of preterm premature rupture of the membranes is associated with prolongation of pregnancy and a reduction in the diagnosis of maternal and infant morbidity. Further study should be directed towards determination of optimal antimicrobial therapy, increasing pregnancy prolongation, and enhancement of corticosteroid therapy for induction of pulmonary maturity after preterm premature rupture of the membranes.

Anti-Bacterial Agents↗
PubMed1995

Prenatal screening for group B Streptococcus. I. Impact of antepartum screening on antenatal prophylaxis and intrapartum care.

OBJECTIVE: Our purpose was to evaluate current obstetric practice regarding screening and prophylaxis for group B Streptococcus and to evaluate the impact of screening on antepartum and intrapartum care. STUDY DESIGN: A total of 1232 members of the Society of Perinatal Obstetricians were asked to indicate their practices regarding screening for group B Streptococcus. Respondents were then asked their practices regarding antepartum and intrapartum prophylaxis on the basis of screening cultures, prior antimicrobial treatment, and other risk factors for neonatal sepsis. RESULTS: Of the 925 respondents (75.1%), 30.8% performed routine screening in all pregnancies: first prenatal visit (42.3%), 26 to 28 weeks (41.3%), and 34 to 38 weeks (22.1%). In addition, 65.9% would screen patients only under high-risk situations. Although 70.5% sample multiple sites, respondents were inconsistent regarding the sites from which cultures are obtained: distal vagina (64.2%), cervix (53.9%), proximal vagina (40.0%), anal canal (38.5%), and urethra (4.3%). A total of 34.7% of respondents would treat the patient at the time of a positive culture. Knowledge of maternal group B Streptococcus carriage would significantly alter intrapartum prophylaxis in low-risk (60.3% vs 0.5%) and various high-risk populations (74.0% to 98.4% vs 11.3% to 55.0%). However, no consensus as to optimal practice was identified. CONCLUSIONS: This survey demonstrates significant inconsistencies in screening and prophylaxis for group B Streptococcus by specialists in maternal-fetal medicine. In addition, it reveals that the recommendations of The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics are not routinely followed by these specialists. Knowledge of group B Streptococcus carriage significantly increases antepartum and intrapartum treatment regardless of the presence of other risk factors for neonatal sepsis. The impact of this practice on neonatal therapy warrants further evaluation.

Amoxicillin↗
PubMed1995

Prenatal screening for group B Streptococcus. II. Impact of antepartum screening and prophylaxis on neonatal care.

OBJECTIVES: Our purpose was to evaluate the current practice of antimicrobial prophylaxis of preterm and low-birth-weight infants and to determine the impact of intrapartum fever, group B Streptococcus carriage, intrapartum antimicrobial therapy, and duration of membrane rupture on neonatal therapy. STUDY DESIGN: A total of 1356 members of the American Academy of Pediatrics were asked their practice regarding neonatal screening and antimicrobial prophylaxis. Respondents were asked to define how maternal fever, group B Streptococcus carriage, intrapartum antimicrobial therapy, and prolonged membrane rupture would affect their decisions regarding neonatal therapy. RESULTS: A total of 982 responses were obtained (72.4%). Routine antimicrobial prophylaxis is given to asymptomatic preterm neonates by 33.7% of pediatricians. Prophylaxis is inconsistently given at 32 to 36 weeks but is nearly universal after intrapartum fever, regardless of intrapartum therapy. If empiric intrapartum prophylaxis was given before a preterm birth, both the incidence (47.1% vs 29.1%) and frequency of prolonged neonatal therapy (30.1% vs 17.4% > or = 7 days) would be increased. Knowledge of maternal group B Streptococcus carriage would lead to a 2.6-fold increase in treatment (75.1% vs 29.1%) and 1.8-fold increase in the incidence of prolonged therapy of preterm infants (30.9% vs 17.4%), with 45.3% giving antibiotics for > or = 1 week if intrapartum treatment had been instituted. Surprisingly, 18% of pediatricians would treat term neonates without any risk factors other than maternal group B streptococcal carriage, and 32.7% would continue treatment for > or = 7 days. The majority of pediatricians (82.6%) felt that intrapartum prophylaxis would reduce early-onset group B streptococcal sepsis, but only 46.0% felt overall neonatal sepsis would be decreased by such therapy. CONCLUSIONS: Antepartum screening and intrapartum prophylaxis against group B Streptococcus by obstetricians may lead to an increased incidence and duration of treatment of preterm and term neonates by the pediatrician. The efficacy, cost, and risk of such treatment in broadly applied screening and treatment programs should be considered before a standard of care is established.

Antibiotic Prophylaxis↗
PubMed1995

Efficacy of outpatient induction with low-dose intravaginal prostaglandin E2: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: Our purpose was to determine whether a protocol for outpatient induction is safe and effective for initiating labor. STUDY DESIGN: A randomized, double-blind, placebo-controlled trial was performed with 100 low-risk patients having well-dated pregnancies. Women with a Bishop score < or = 6 at 38 to 40 weeks' gestation were administered either 2 mg of intravaginal prostaglandin E2 gel or placebo for 5 consecutive days as outpatients while undergoing fetal monitoring. RESULTS: The median interval from randomization to delivery was 4 days in the prostaglandin E2 group (range 0 to 28 days) versus 10 days in the placebo group (range 0 to 26 days, p = 0.002). Twenty-seven of 50 patients (54%) in the prostaglandin E2 group were admitted for labor during the dosing interval compared with 10 placebo-treated patients (20%, p = 0.001). The mean gestational age at delivery was significantly reduced in the treatment group (39.9 +/- 1.0 weeks vs 40.5 +/- 0.99 weeks, p = 0.003) as was the incidence of postdates pregnancy (40% vs 66%, p = 0.016). Hyperstimulation was observed in one prostaglandin E2-treated patient, but no intervention was required. CONCLUSIONS: Outpatient low-dose prostaglandin E2 gel administration is effective for initiating labor in patients with an unfavorable cervix and appears safe if performed with adequate monitoring.

Administration, Intravaginal↗
PubMed1995

The use of a modified vaginal pouch for the diagnosis and management of premature rupture of the membranes.

A modified Reality vaginal pouch (Wisconsin Pharmacal, Jackson, Wis.) was effective in assessing membrane integrity in patients evaluated for suspected premature rupture of the membranes and was useful for collecting fluid in patients requiring pulmonary maturity studies. This technique does not alter the incidence of infection and is beneficial in the management of selected patients.

Amniotic Fluid↗
PubMed1995

Early versus late amniotomy for labor induction: a randomized trial.

OBJECTIVE: Our purpose was to determine the impact of early and late amniotomy on labor induction with continuous oxytocin infusion at term. STUDY DESIGN: A total of 209 women admitted for labor induction were randomized to early or late amniotomy. The early amniotomy group (n = 106) had membranes ruptured as soon as it was deemed safe and feasible. The late amniotomy group (n = 103) had membrane rupture performed at > or = 5 cm dilatation. The first 103 women received a continuous oxytocin infusion with incremental adjustments at 60-minute intervals as required. The next 106 women had adjustments every 30 minutes as required. Statistical analysis was confined to concurrent groups. RESULTS: Early amniotomy was associated with shorter labor (13.3 vs 17.8 hours, p = 0.001), chorioamnionitis (22.6% vs 6.8%, p = 0.002), and significant fetal umbilical cord compression (12.3% vs 2.9%, p = 0.017). The benefit regarding shortening of labor was limited to women having oxytocin increments every 30 minutes as required (13.3 vs 17.8 hours, p = 0.001). Alternatively, the increase in chorioamnionitis was confined to the 60-minute group (39% vs 11%, p < 0.001), which also demonstrated a trend toward increased moderate and severe variable decelerations (19.6% vs 6.4%, p = 0.08). CONCLUSIONS: When a protocol of 60-minute increments in oxytocin infusion rate is desired, amniotomy should be performed late in labor to reduce chorioamnionitis and significant umbilical cord compression. Alternatively, if early amniotomy is necessary, oxytocin should be adjusted every 30 minutes as tolerated.

Adolescent↗
PubMed1995

The accuracy and patient preference for self-collected group B Streptococcus cultures.

OBJECTIVE: Our purpose was to determine the accuracy of and patient attitudes regarding self-collected group B Streptococcus cultures. STUDY DESIGN: Women seen for prenatal care at 24 to 42 weeks' gestation were asked to collect distal vaginal and anal samples for group B Streptococcus. Subsequently, distal vaginal and anal samples were obtained by the nurse. The patients were then asked their preference toward self-sampling. RESULTS: A total of 251 women participated in the study. The incidence of positive group B Streptococcus cultures was 12.7%, 9.6%, 10.0%, and 7.6% for the patient-collected vaginal and anal and nurse-collected vaginal and anal specimens, respectively. The incidence of group B Streptococcus carriage was 17.5% and 13.5% for any positive patient- or provider-collected specimens, respectively, and 19.1% for any positive culture. Single patient-collected vaginal and anal and nurse-collected vaginal and anal samples were insensitive for group B Streptococcus carriage (67%, 50%, 52%, 40%, respectively). The combination of patient-collected samples was more sensitive than nurse-collected samples (sensitivity 91.7% vs 70.8%, p < 0.05). Repeat sampling of the vagina or anal canal did not offer significant additional benefit to a single culture. Overall, patient-collected samples were 98.4% accurate in predicting group B Streptococcus carriage versus 94.4% for nurses. A total of 58% of women preferred obtaining their own specimens, whereas 9.6% found the technique difficult. Ninety percent desired the option of self-sampling in the future. CONCLUSIONS: Single vaginal or anal cultures were insensitive in detecting group B Streptococcus carriage. Combined patient-collected cultures were more sensitive than provider-collected specimens. On the basis of accuracy and patient preference, women should be given the opportunity of combined vaginal-anal self-sampling for group B Streptococcus when indicated.

Adolescent↗