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Objective: To evaluate associations between Foley catheter use for cervical ripening and infectious morbidity.Data Sources: We searched computerized databases, references in published studies and textbook chapters without language restriction. Searches were performed in MEDLINE, PubMed, ClinicalTrials.gov, Web of Science, and the Cochrane Library from inception through December 2014. MeSH headings used included the terms "Foley catheter," "Foley balloon," "prostaglandin," "labor induction," and "cervical ripening."Methods Of Study Selection: We identified randomized controlled trials that compared Foley catheter with locally applied (vaginal or cervical) prostaglandin preparations for cervical ripening or labor induction. Selected studies evaluated maternal or neonatal infection with at least one of the following outcomes: chorioamnionitis, endometritis, pooled maternal infection, and neonatal infection. Excluded studies used double-balloon catheters, outpatient Foley management, extraamniotic saline infusions, pregnancy termination, and oral administration of medication in the prostaglandin arm.Tabulation, Integration, and Results: We identified 26 randomized trials including 5,563 women. Compared with prostaglandin preparations alone, patients who underwent cervical ripening with a Foley catheter had similar rates of chorioamnionitis (56/782 [7.2%] with Foley compared with 54/754 [7.2%] with prostaglandins; relative risk [RR] 0.96; 95% confidence interval [CI] 0.66-1.38), endometritis (40/1,042 [3.8%] compared with 35/991 [3.5%]; RR 1.03, 95% CI 0.66-1.6), pooled maternal infection (237/2,699 [8.8%] compared with 257/2,864 [9%]; RR 0.95, 95% CI 0.81-1.12), and neonatal infection (34/1,061 [3.2%] compared with 39/1,074 [3.6%]; RR 0.9, 95% CI 0.58-1.39). With subgroup analysis, excluding studies using preinsertion cervical cleansing or prophylactic antibiotics in the Foley arm, results were similar.Conclusion: Use of transcervical Foley catheters for cervical ripening and induction of labor is not associated with an increased risk of infectious morbidity. [ABSTRACT FROM AUTHOR]

The article offers information on the findings of the study regarding cervicovaginal fetal fibronectin as a predictor of preterm birth in patients with symptoms of preterm labor. The study was conducted on patients with 37 weeks of gestation. Sensitivity analyses were performed for studies using different fetal fibronectin assays. The study concluded that cervicovaginal fetal fibronectin has limited accuracy in predicting preterm birth.

Objective: To systematically review and summarize the medical literature regarding the effects of tocolysis with indomethacin on neonatal outcome. Data Sources: We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify studies pertaining to indomethacin tocolysis and neonatal outcome. Methods of Study Selection: We evaluated, abstracted data, and performed quantitative analyses in studies assessing the neonatal outcomes of patients undergoing tocolysis with indomethacin. Observational studies and randomized trials were included in this systematic review. Tabulation, Integration, and Results: Forty-six studies were identified, 28 of which met criteria for systematic review and meta-analysis. These 28 studies included 6,008 infants. Of these infants, 1,621 were exposed to indomethacin for tocolysis antenatally; 4,387 infants not exposed to indomethacin served as the comparison group. An estimate of pooled odds ratios with 95% confidence intervals was calculated for dichotomous outcomes using random- and fixed-effects models. Observational studies and randomized trials were analyzed separately. Pooled estimates from observational studies and randomized trials revealed no significant differences in the rates of intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis, or neonatal mortality between infants exposed to indomethacin antenatally and those not exposed. Meta-analysis of randomized trials revealed increased risk of bronchopulmonary dysplasia. However, the meta-analysis included only 3 randomized clinical trials, one of which showed increased risk. An association of bronchopulmonary dysplasia and indomethacin use was not noted in our analysis of observational studies. Conclusion: Although our pooled results did not identify significantly increased risks of adverse effects, the limited statistical power of published randomized trials does not allow us to exclude the possibility that indomethacin tocolysis increases the risk of adverse neonatal outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the effectiveness of 50 μg compared with 100 μg of repetitive misoprostol dosages administered sublingually for labor induction. METHODS: Two hundred twelve women who presented with an indication for cervical ripening and labor induction were randomly assigned to 50 μg or 100 μg of misoprostol tablets administered sublingually with double masking of treatment group dose allocation. The primary outcome was the interval from start of induction to vaginal delivery. RESULTS: Among the 203 evaluable participants, 102 were randomly assigned to the 50-μg group and 101 to the 100-μg group. The proportion of patients who delivered vaginally in less than 12 hours and less than 24 hours was significantly higher in the 100-μg group: 28% and 63% in the 100-μg group compared with 15% and 36% in the 50-μg group, respectively (P = .01 and P = .001). The incidence of tachysystole was significantly higher in the 100-μg group (P = .02). The incidence of hyperstimulation syndrome was higher in the 100-μg group, but not statistically significant (P = .46). With respect to the proportion of patients delivered after a single dose, mode of delivery, and perinatal outcome, no significant differences between treatment groups were observed. Regarding the need for oxytocin augmentation, 61% required augmentation in the 100-μg group compared with 81% in the 50 μg group (P = .002). CONCLUSION: One hundred micrograms of sublingual misoprostol is more effective than 50 μg of sublingual misoprostol, but is associated with a higher incidence of tachysystole and uterine hyperstimulation syndrome. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To perform an updated systematic review with meta-analysis to further elucidate the efficacy of progestational agents for the prevention of preterm births in patients at elevated risk. DATA SOURCES: Computerized databases, references in published studies, and textbook chapters in all languages were used to identify randomized controlled trials (RCTs) evaluating the use of progestational agents for the prevention of preterm births in women at elevated risk. METHODS OF STUDY SELECTION: We identified RCTs that compared progestational agents with placebo for patients at risk for preterm birth and evaluated at least one of the following: delivery before 37 weeks of gestation, birth weight less than 2,500 g, threatened preterm labor, respiratory distress syndrome, and perinatal mortality. The primary outcomes assessed were preterm delivery and perinatal mortality. TABULATION, INTEGRATION, AND RESULTS: Ten studies met inclusion criteria for this review. For each study with binary outcomes, an odds ratio (OR) with 95% confidence intervals (CIs) was calculated for selected outcomes. Homogeneity was tested across the studies. Compared with women allocated to receive placebo, those who received progestational agents had lower rates of preterm delivery (26.2% versus 35.9%; OR 0.45, 95% CI 0.25–0.80). Similar results were noted when comparing patients who were specifically treated with 17α-hydroxyprogesterone caproate (29.3% versus 40.9%; OR 0.45, 95% CI 0.22–0.93). Additionally, subjects allocated to receive 17α-hydroxypro-gesterone caproate had lower rates of birth weights less than 2,500 g (OR 0.50, 95% CI 0.36–0.71). No differences in rates of hospital admissions for threatened preterm labor or perinatal mortality were noted for subjects receiving progestational agents in general or for those receiving only 17α-hydroxyprogesterone caproate specifically. CONCLUSION: The use of progestational agents and 17α-hydroxyprogesterone caproate reduced the incidence of preterm birth and low birth weight newborns. [ABSTRACT FROM AUTHOR]

: ObjectiveTo compare routine labor induction with expectant management for patients who reach or exceed 41 weeks’ gestation.: Data sourcesComputerized databases, references in published studies, and textbook chapters in all languages were used to identify randomized controlled trials (RCTs) evaluating induction and expectant management of labor for postterm pregnancies.: Methods of study selectionWe identified RCTs that compared induction and expectant management for uncomplicated, singleton, live pregnancies of at least 41 weeks’ gestation and evaluated at least one of the following: perinatal mortality, mode of delivery, meconium-stained fluid, meconium aspiration syndrome, meconium below the cords, fetal heart rate (FHR) abnormalities during labor, cesarean deliveries for FHR abnormalities, abnormal Apgar scores, and neonatal intensive care unit (NICU) admissions. The primary outcomes assessed were cesarean delivery rate and perinatal mortality.: Tabulation, integration, and resultsSixteen studies met inclusion criteria for this review. For each study with binary outcomes, an odds ratio (OR) with 95% confidence intervals (CIs) was calculated for selected outcomes. Estimates of ORs for dichotomous outcomes were calculated using fixed and random-effects models. Homogeneity was tested across the studies. Compared with women allocated to expectant management, those who underwent labor induction had lower cesarean delivery rates (20.1% versus 22.0%) (OR 0.88; 95% CI 0.78, 0.99). Although subjects whose labor was induced experienced a lower perinatal mortality rate (0.09% versus 0.33%) (OR 0.41; 95% CI 0.14, 1.18), this difference was not statistically significant. Similarly, no significant differences were noted for NICU admission rates, meconium aspiration, meconium below the cords, or abnormal Apgar scores.: ConclusionA policy of labor induction at 41 weeks’ gestation for otherwise uncomplicated singleton pregnancies reduces cesarean delivery rates without compromising perinatal outcomes. [Copyright &y& Elsevier]

OBJECTIVE:To systematically review and summarize the medical literature regarding the effects of expectant management and labor induction on mode of delivery and perinatal outcomes in patients with suspected fetal macrosomia.DATA SOURCES:We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify studies assessing management of patients with suspected fetal macrosomia.METHODS OF STUDY SELECTION:We evaluated, abstracted data, and performed quantitative analyses in studies assessing the outcome of patients with suspected fetal macrosomia. Observational studies and randomized trials were included in this systematic review.TABULATION, INTEGRATION, AND RESULTS:Twenty-nine studies were identified, 11 of which met our criteria for systematic review and meta-analysis. These 11 studies included 3751 subjects. Of these, 2700 were managed expectantly, and 1051 underwent labor induction. We calculated an estimate of the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes, using random- and fixed-effects models for outcomes. Summary statistics for the nine observational studies showed that, compared with those whose labor was induced, women who experienced spontaneous onset of labor had a lower incidence of cesarean delivery (OR 0.39, 95% CI 0.30, 0.50) and higher rates of spontaneous vaginal delivery (OR 2.07, 95% CI 1.34, 3,19); however, significant differences in these outcomes were not noted when the two randomized trials were assessed. No differences were noted in rates of operative vaginal deliveries, incidence of shoulder dystocia, or abnormal Apgar scores in the analyses of the observational or randomized studies.CONCLUSION:Based on data from observational studies, labor induction for suspected fetal macrosomia results in an increased cesarean delivery rate without improving perinatal outcomes. Although their statistical power is limited, randomized clinical trials have not confirmed these findings. [Copyright &y& Elsevier]

OBJECTIVE:To estimate whether a dosage of 50 μg of misoprostol tablets moistened with 3% acetic acid and administered intravaginally is more efficacious for labor induction than a similar dosage regimen using dry tablets.METHODS:A total of 177 women who presented with an indication for cervical ripening and labor induction were randomly assigned to one of two treatment groups: 1) intravaginal misoprostol in dry tablet form, or 2) intravaginal misoprostol moistened with 1 mL of 3% acetic acid solution. The primary outcome assessed was the interval from start of induction to vaginal delivery. To detect at least a 3.5-hour difference in the primary outcome with 80% power, 87 subjects were required in each group.RESULTS:Among 162 patients evaluated, 80 were allocated to the misoprostol dry group and 82 to the misoprostol moistened group. No significant difference was noted for the mean ± standard deviation interval to vaginal delivery: 1130 ± 636 minutes for the group who received dry tablets and 1004 ± 636 minutes for those who received moistened misoprostol tablets (P = .25). Additionally, no statistically significant differences were noted between the groups with respect to need for oxytocin, proportion of patients delivered after a single dose, intrapartum complications (including tachysystole and uterine hyperstimulation), mode of delivery, or perinatal outcomes.CONCLUSION:Tablet moistening with 3% acetic acid solution does not seem to improve the efficacy of intravaginally administered misoprostol for labor induction. [Copyright &y& Elsevier]

OBJECTIVE: To systematically review published randomized controlled trials (RCTs) to compare the safety and efficacy of 25 μg versus 50 μg of intravaginal misoprostol for cervical ripening and labor induction.DATA SOURCES: We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify RCTs of misoprostol for cervical ripening and labor induction, which compared repeated doses of 25 μg and 50 μg.STUDY SELECTION: We evaluated, abstracted data, and assessed the quality of RCTs to compare the safety and efficacy of 25 μg versus 50 μg of intravaginal misoprostol for cervical ripening and labor induction.TABULATION, INTEGRATION, AND RESULTS: Five RCTs met inclusion criteria for meta-analysis. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for each outcome (random- and fixed-effects models). In addition, we aggregated the results of two separate studies, permitting an indirect comparison of the two doses being analyzed. In the meta-analysis, tachysystole and hyperstimulation syndrome appear to occur less frequently among women who received 25 μg of misoprostol than with 50 μg. However, neonatal outcomes appear to be comparable with the two doses. Regarding efficacy, use of the 50-μg dose was associated with a shorter interval to vaginal delivery, greater proportion of deliveries within 24 hours, and less frequent need for oxytocin augmentation. The indirect comparison of two studies yielded similar results.CONCLUSION: Published data indicate that intravaginal misoprostol at doses of 50 μg for cervical ripening and labor induction is more efficacious but it is unclear whether it is as safe as the 25-μg dose. [Copyright &y& Elsevier]

Presents a study on the determination of fetal lung maturity through visual assessment of the amniotic fluid turbidity. Number of patients with amniocentesis who were studies; Method for classifying the turbidity of amniotic fluid samples; Comparison of results with those of fluorescence polarization values for the same samples.

Reports on a case of trial of labor in which uterine rupture occurred following intrapartum amnioinfusion. Need for careful attention to amnioinfusion volumes; Administration in patients with a previous cesarean operation.

Objective: This systematic review and meta-analysis assess the efficacy and safety of rituximab (RTX) in treating idiopathic inflammatory myositis (IIM)., Methods: PubMed and Embase were systematically searched for trials and observational studies involving RTX use in IIM. Data were analyzed using a random-effects model to generate pooled estimates for overall response, complete remission, partial response, and adverse events, with subgroup analyses by myositis type and RTX dosage (PROSPERO registered number CRD42022353740). Risk of bias assessments were done using the Newcastle-Ottawa Scale for observational studies and risk of bias 1 tool for trials., Results: Seventeen studies (1 randomized controlled trial and 16 observational studies), encompassing 362 patients, were included. The overall pooled response rate was 70% (95% confidence interval [CI]: 57%-82%; I2 = 74%, p < 0.001). Complete remission occurred in 13% (95% CI: 3%-25%; I2 = 79%, p < 0.001) and partial response in 48% (95% CI: 30%-67%; I2 = 87%, p < 0.001), both with significant heterogeneity. Subgroup analysis revealed high response rates across all myositis types: polymyositis 69%, dermatomyositis 67%, antisynthetase syndrome 70%, juvenile dermatomyositis 60%, and immune-mediated necrotizing myopathy 86%. Response rates were similar between RTX induction doses of 1 g IV on days 0 and 14 (68%) and 375 mg/m 2 weekly for 4 weeks (71%). Reported adverse events totaled 120, including infusion reactions (18.5%) and infections (12.4%)., Conclusions: RTX shows a favorable clinical response in IIM treatment, though response rates vary. There was a significant heterogeneity in treatment effect estimates that are based on a small number of patients. The incidence of infusion reactions and infections highlights the need for careful monitoring. Further controlled trials are essential to refine treatment protocols and evaluate long-term outcomes for RTX's role in IIM., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)