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Objective The purpose of this study was to determine the efficacy of combination intravaginal misoprostol and intracervical Foley catheter for prelabor cervical ripening. Study design A prospective, randomized controlled trial was conducted. Women who were undergoing labor induction, with a singleton gestation ≥28 weeks and an unfavorable cervix (Bishop score ≤6), were assigned to one of three groups: (1) intravaginal misoprostol 25 μg every 3 hours, (2) intracervical 16F Foley catheter, or (3) combination misoprostol–Foley catheter. Results Among 146 patients, 49 patients were assigned to misoprostol, 54 patients were assigned to Foley catheter, and 43 patients were assigned to combination therapy. There was no difference in vaginal delivery rates (misoprostol, 63.3%; Foley, 57.4%; combination, 58.1%; P =.81). There were also no statistically significant differences in the interval between induction to active phase, active phase to delivery, or induction to delivery among the three groups. Conclusion Intravaginal misoprostol and intracervical Foley catheter are comparable for preinduction cervical ripening. The combination of the two methods did not provide additional efficacy.

The purpose of this study was to describe morbidity, mortality, and developmental outcomes among extremely low-birth-weight infants (500-750 g).This retrospective cohort study included 167 live-born infants born at Long Beach Memorial Medical Center between January 1990 and December 1995.Mortality rates were 86% among infants600 g and 44% among thoseor =600 g, and the rate decreased with increasing gestational age. The absence of chorioamnionitis (P =.01) and the use of antepartum corticosteroids (P.0001) or neonatal surfactant (P =.0001) were associated with survival. Sixty-four percent of studied infants had respiratory distress syndrome, and 17% had grade III or IV intraventricular hemorrhage. Among the 63 survivors 57% were tested at 30 months of corrected age with the Bayley Scales of Infant Development. Mild or significant delays were seen on the mental development index in 68% of these cases and on the psychomotor development index in 58% of cases.Morbidity and mortality rates and the rate of developmental delay among infants with birth weights between 500 and 750 g were significant.

PREMATURE RUPTURE OF MEMBRANES AMIE HOLLARD, RHONDA FLORA, PAMELA RUMNEY, JUDITH CHUNG, MICHAEL NAGEOTTE, University of California, Irvine, Maternal Fetal Medicine, Lincoln, Nebraska, University of California, Irvine, Maternal Fetal Medicine, Orange, California, Long Beach Memorial Medical Center, Maternal Fetal Medicine, Long Beach, California OBJECTIVE: Methylenetetrahydrofolate reductase (MTHFR) plays a role in folate/homocysteine metabolism. The common polymorphisms in the MTHFR gene are C677T and A1298C, the presence of which has been associated with adverse pregnancy outcome. Given that folate and homocysteine are involved in collagen synthesis, we hypothesize the presence of MTHFR mutations in the fetus may increase the risk for preterm premature rupture of membranes (PPROM). STUDY DESIGN: A nested case control pilot study of 2 groups. Group I (n = 18): patients with PPROM delivering between 24 and 35 weeks. Group II (n = 25): patients without PPROM delivering between 24 and 42 weeks. Patients with diabetes, hypertension, preeclampsia, or multiple gestations were excluded. At delivery, a placental biopsy was obtained. The fetal RNA was extracted and multiplex PCR/ RFLP was performed for the presence of C677T and A1298C alleles. Univariate analysis, Chi-Square, Fisher’s Exact, & unpaired t tests were used as appropriate. Significance was set at P ! .05. RESULTS: The allele frequencies for C677T & A1298C are 28% & 44%, and 48% & 44% for Group I and Group II respectively . In Group II, there was an equal distribution of of the alleles between patients delivering at ! or >34 weeks gestation. In the Caucasion patients, 100% of Group I patients and only 60% of Group II patients had one or more mutations present. However, in the combined population there was no overall increased risk of PPROM if the fetus had one or more C677T P = .31) or A1298C mutations (P = .98). CONCLUSION: In our study, it appears that the presence of fetal C677T and A1298C polymorphisms are not uniquely associated with PPROM, but it may influence PPROM in certain ethnic groups. The effect of maternal genotype was not evaluated in this study, there may be additive effect when both genotypes are considered concurrently. An unexpected finding in this study was the large number of control patients with either mutation. A larger sample size is needed to discern if a true association is found between the presence of MTHFR mutations and PPROM. S112 SMFM Abstracts

PATIENTS WITH GESTATIONAL DIABETES MELLITUS K. JENNIFER VOSS, JUDITH CHUNG, PAMELA RUMNEY, KIRK KEEGAN, CAROL MAJOR, University of California, Irvine, Obstetrics & Gynecology, Orange, CA Long Beach Memorial Medical Center, Obstetrics & Gynecology, Long Beach, CA OBJECTIVE: Treatment of patients with gestational diabetes mellitus has not necessarily been shown to reduce the risk of macrosomia in this population. This study evaluates the contribution of potentially modifiable interventions that may help to reduce the risk of macrosomia in gestational diabetics. STUDY DESIGN: A retrospective cohort study (June 2001-December 2002) was performed using data from the California Department of Health Services, Maternal Child Health Branch, and the California Diabetes and Pregnancy Program Data System (the system collects data from all patients referred to the California Sweet Success Program). Logistic regression was performed to estimate the odds of macrosomia, defined as >4000 grams. The following factors were evaluated in the multivariate model: ethnicity, parity, education, gestational age at delivery, maternal weight, and the interaction between ethnicity and preferred language. RESULTS: Of 8790 patients, there were 6406 gestational diabetics that met inclusion criteria. The incidence of macrosomia was 11.6%. Ethnicity, preferred language, and the interaction of ethnicity and preferred language did not appear to be predictive of macrosomia. However, when compared to patients with a college education ormore, the odds ofmacrosomia in patients with a high school education were 1.53 (95% CI 1.24-1.90). In patients with less than a high school education, the odds were 1.79 (95% CI 1.34-2.38). CONCLUSION:Gestational diabetics with a lower level of education appear to have an increased risk of macrosomia. Interventions directed towards improving communication and knowledge of the disease process in such patients may prove to be beneficial. (This analysis, interpretation, and conclusion are that of the authors and not of the California Department of Health Services, Maternal Child Health Branch, or the California Diabetes and Pregnancy Program).