Groups In Mode Of Delivery Research Articles

The Effectiveness of Online Mindfulness Training for Psychologists - A Brief Report.

Mindfulness training (MT) in healthcare training has been associated with improvement in mental wellbeing and clinical skills such as empathy. Despite this, it is often challenging for professional psychology programs to include MT in the curriculum due to competing coursework demands and staffing requirements. The current study aimed to determine whether changes in mindfulness, self-compassion and tolerance of uncertainty were equivalent for those completing MT face-to-face on campus or online. Ninety-eight professional psychology trainees completed pre-post measures of Mindfulness, Self-compassion, and Tolerance of Uncertainty. Fifty-eight participants completed it on campus and 40 participants completed it online. A series of one-way ANOVAs found no significant differences in change between the two delivery mode groups on seven of the eight variables. There was a very small significant difference for self-compassion with those in the campus group showing slightly higher increases compared to the online group. Changes in mindfulness and related variables appear to be similar whether MT occurs face-to-face or via online delivery. Thus, providing online MT may address difficulties related to staffing and timetabling that previously prohibited its inclusion in coursework.

A Predictive Model for Perinatal Brain Injury Using Machine Learning Based on Early Birth Data.

It is difficult to predict perinatal brain injury, and performing brain magnetic resonance imaging (MRI) based on suspected injury remains a clinical challenge. Therefore, we aimed to develop a reliable method for predicting perinatal brain injury using a machine learning model with early birth data. Neonates admitted to our institution from January 2017 to June 2024 with a gestational age of ≥36 weeks, a birth weight of ≥1800 g, admission within 6 h of birth, and who underwent brain MRI to confirm perinatal brain injury were included. Various machine learning models, including gradient boosting, were trained using early birth data to predict perinatal brain injury. Synthetic minority over-sampling and adaptive synthetic sampling (ADASYN) were applied to address class imbalance. Model performance was evaluated using accuracy, F1 score, and ROC curves. Feature importance scores and Shapley additive explanations (SHAP) values were also calculated. Among 179 neonates, 39 had perinatal brain injury. There were significant differences between the injury and non-injury groups in mode of delivery, Apgar scores, capillary pH, lactate dehydrogenase (LDH) levels, and whether therapeutic hypothermia was performed. The gradient boosting model with the ADASYN method achieved the best performance. In terms of feature importance scores, the 1 min Apgar score was the most influential predictor. Additionally, SHAP analysis showed that LDH levels had the highest SHAP values. the gradient boosting model with ADASYN oversampling effectively predicts perinatal brain injury, potentially improving early detection for predicting long-term outcomes, reducing unnecessary MRI scans, and lowering healthcare costs.

Laminiria Tents versus Vaginal Prostaglandin in Cervical Ripening in Term Induction of Labor with Unfavorable Cervix: A Randomized Controlled Trial

Abstract Background Mechanical methods used for induction of labor received a great attention nowadays due to the serious side effects of the pharmacological methods. Hygroscopic dilators are considered important subtype of these mechanical methods. One of them is Laminaria which is a synthetic type of sea algae that induces cervical dilation by absorbing water from the cervix and gradually increasing in thickness. Objective To compare the effectiveness and safety of Laminiria tents to intravaginal prostaglandins for cervical ripening in induction of labor at term gestation in women with unfavorable cervix. Methods A total of 90 pregnant women at term gestation with unfavorable cervix admitted to the labor ward for induction of labor at Ain Shams University Maternity Hospital, in the period from March 2022 to March 2023, were enrolled in the study and underwent assessment using Bishop score with monitoring differences between two groups in mode of delivery, time to enter active phase, time to delivery, changes in bishop score and noted complications. This study was registered on clinicaltrials.gov with number (NCT06151925) Results In the present study we demonstrated that in laminaria group, there was 66.7% had NVD and 33.3% had CS while in prostaglandin group, there was 71.1% had NVD and 28.9% had CS in which there was no statistically significant difference between laminaria and prostaglandin groups regarding routes of delivery. In this study we demonstrated that Time needed to enter active phase (hours) in laminaria group was 16 (10 – 19) while in prostaglandin group was12 (8 – 16) in which there was a statistically significant difference between laminaria and prostaglandin groups regarding Time needed to enter active phase (hours) (p = 0.022). In this study we demonstrated that regarding induction delivery time (hours) in laminaria group was 20 (13 – 25) while in prostaglandin group was 16 (11 – 20) in which there was a statistically significant difference between laminaria and prostaglandin groups regarding induction delivery time (hours) (P = 0.036). Conclusion Vaginal prostaglandin is more effective than laminaria tent for ripening of cervix before induction and can decrease labor duration and time to delivery. However, for better results further studies with a larger sample size are recommended.

Association of Cesarean Delivery and Formula Supplementation with the Stool Metabolome of 6-Week-Old Infants.

Cesarean delivery and formula feeding have both been implicated as important factors associated with perturbations to the infant gut microbiome. To investigate the functional metabolic response of the infant gut microbial milieu to these factors, we profiled the stool metabolomes of 121 infants from a US pregnancy cohort study at approximately 6 weeks of life and evaluated associations with delivery mode and feeding method. Multivariate analysis of six-week stool metabolomic profiles indicated discrimination by both delivery mode and diet. For diet, exclusively breast-fed infants exhibited metabolomic profiles that were distinct from both exclusively formula-fed and combination-fed infants, which were relatively more similar to each other in metabolomic profile. We also identified individual metabolites that were important for differentiating delivery mode groups and feeding groups and metabolic pathways related to delivery mode and feeding type. We conclude based on previous work and this current study that the microbial communities colonizing the gastrointestinal tracts of infants are not only taxonomically, but also functionally distinct when compared according to delivery mode and feeding groups. Further, different sets of metabolites and metabolic pathways define delivery mode and diet metabotypes.

Impact of therapeutic rest in early labor on perinatal outcomes: a prospective study

Pain and exhaustion in early labor are important to address, yet treatment options are limited. Therapeutic rest has existed for decades, although medication regimens and management strategies vary. In addition, there are little prospective data on perinatal outcomes and patient satisfaction to support and guide its use as an outpatient pain control option. This study aimed to evaluate whether outpatient therapeutic rest in early labor using intramuscular morphine sulfate and promethazine is associated with differences in perinatal outcomes and to assess patient satisfaction with this therapy. This prospective cohort study was conducted at a tertiary care academic medical center from September 2017 to April 2020. Participants presenting to the hospital for labor evaluation were offered therapeutic rest if they met the following criteria: reassuring modified biophysical profile, cervical dilation of ≤5 cm without contraindications to vaginal delivery, and plan to discharge home after evaluation. The primary outcome was subsequent hospital admission in active labor, defined as cervical dilation of ≥6 cm. Secondary outcomes included hospitalization duration and perinatal outcomes. The outcomes between participants who accepted therapeutic rest and those who declined it were compared. All P values were calculated using the Fisher exact test, and multivariable regression was used to adjust for potential confounding baseline variables with P<.2. In addition, a prespecified sensitivity analysis was performed, limiting subjects to nulliparous participants. Furthermore, postpartum surveys were administered to a subset of women who received therapeutic rest. Of the 82 individuals offered therapeutic rest and consented for the study, 66 (80%) accepted and 16 (20%) declined. Although the rate of active labor at admission to the labor and delivery unit in the treatment group was markedly higher (26% [17 of 66] vs 13% [2 of 16]), this difference was not statistically significant (P=.3) (adjusted relative risk, 1.87; 95% confidence interval, 0.44-7.89). Women who received therapeutic rest were less likely to require induction of labor compared with those who declined therapeutic rest (adjusted relative risk, 0.15; 95% confidence interval, 0.041-0.54). There was no difference between the groups in mode of delivery, epidural use, length of hospitalization, maternal complications, or adverse neonatal outcomes. These findings persisted in our prespecified sensitivity analysis, limiting the study to nulliparous participants. A subset (27 of 66 [40%]) of women were surveyed after receiving therapeutic rest, and all women (n=27) who were surveyed reported satisfaction. There was no detectable difference in the primary outcome of active labor at admission between patients who accepted outpatient therapeutic rest and those who declined it. However, fewer participants in the treatment group eventually required induction of labor, and this group did not experience an increase in adverse perinatal outcomes. Among the participants surveyed, a high rate of treatment satisfaction was reported. This study suggested that therapeutic rest is a well-tolerated and effective option for outpatient pain control in early labor.

Relation between Mode of Delivery and Findings of Oto-Acoustic Emission Test Results

Introduction: Hearing loss, since birth, is an important public health issue round the globe with a prevalence ranging from 2-3/1000 live births. Neonates born by Caesarean Delivery (CD) refer for Oto-Acoustic Emissions (OAE) test more frequently compared to Vaginal Delivery (VD) soon after birth. During this study, the effects of the modes of delivery on the OAE test results were investigated. Aim: To study the effects of modes of delivery on the OAE test results. Materials and Methods: During this study 500 neonates, born beyond 37 weeks of gestation, at Dhiraj Hospital, Gujarat, India between January 2019-July 2019 without any associated risk factors were enrolled and divided on basis of their mode of delivery-vaginal or caesarean section. Before their discharge from hospital, OAE test was performed on the patients. Modes of delivery and OAE test results were collected and analysed. Results: Results reviled that there was a significant difference in OAE test failure rates between the two delivery mode groups. CD was significantly related to failed OAE. CD infants had a three-fold higher failure rate as compared to VD infants in OAE test (4.12% vs 1.3%). Conclusion: Neonates born by CD had significantly higher failure rates on first OAE as compared to VD. This shows that the mode of delivery contains a significant effect on the results of the hearing screening tests.

Exploring Differences in Business Undergraduate Perceptions by Preferred Classroom Delivery Mode

The purpose of this study was to compare business undergraduate online/hybrid course perceptions across three different preferred classroom environment delivery modes: online, hybrid or face-to-face (F2F). Four different perceptions were measured: perceived favorability of online/hybrid courses (PFoOc); intent to recommend online/hybrid courses; perceived learning; and timely graduation. Undergraduates who were taking at least one online or hybrid class voluntarily completed an online survey. In the fall 2015 a complete-data sample n of 264 respondents was obtained and in the spring 2016 the complete-data sample n was 272. Consistent results across both samples were found for three of four outcomes. Undergraduates who preferred either online or hybrid classroom delivery had significantly higher PFoOC and intent to recommend online/hybrid courses than students preferring F2F. There were no differences in perceived timely graduation across the three classroom delivery mode groups, and inconsistent results were found for perceived learning. The fall sample showed no differences on perceived learning but for the spring sample, undergraduates preferring either an online or hybrid delivery mode perceived higher learning than F2F preferred-mode students. A new, short four-item measure of PFoOC was found to reliable. As universities increase their online and hybrid course offerings keeping course integrity or equivalence between F2F and online/hybrid course sections will be important. Ways to increase the PFoOC for undergraduates who prefer F2F are suggested. Increased PFoOC should lead to higher intent to recommend online/hybrid courses.

Prenatally diagnosed congenital diaphragmatic hernia: optimal mode of delivery?

To evaluate if the delivery mode of infants with prenatally diagnosed congenital diaphragmatic hernia (CDH) affects the outcome. Data from the CDH Study Group database of infants with prenatal diagnosis between 2001-2015 were divided into four delivery mode groups: vaginal spontaneous, vaginal induced, elective caesarean section, and emergent caesarean section. Outcomes were analyzed in relation to the time of day of delivery and the gestational age at birth. A total of 3906 cases of prenatally diagnosed CDH were assessed, with an overall survival of 64%. There were no differences in patient characteristics, requirement for extracorporeal membrane oxygenation, length of hospital stay or intubation, requirement for O2 at 30 days or overall survival. The time of day at birth did not affect the outcome. There was no difference in outcome between the different delivery modes at similar gestational age (GA) at birth, with worse outcomes at lower GA. Neither the mode nor time of delivery seems to affect the overall outcome for patients with prenatally diagnosed CDH. Outcome is strongly associated with the GA at birth.

Student intention to use desktop web-conferencing according to course delivery modes in higher education

The aim of this study was to examine the predictive value of some factors on acceptance and use of desktop web-conferencing by students in a blended course, and according to course delivery modes, in higher education. Based on the Unified Theory of Acceptance and Use of Technology, this study tested a model encompassing six variables: behavioural intentions, performance expectancy, effort expectancy, social influence, facilitating conditions and autonomy. Data were collected on a sample of 376 undergraduate business students in a blended information system course using an online questionnaire. The results revealed that performance expectancy and social influence have a positive impact on behavioural intentions while autonomy has a negative direct effect and a positive indirect effect mediated by performance expectancy (R2 = 36%). The results also indicated different patterns of significant relationships between delivery mode groups and within the overall model, suggesting that course delivery mode plays a moderating role.

Retention, Progression and the Taking of Online Courses

Online learning continues to grow at post-secondary institutions across the United States, but many question its efficacy, especially for students most at-risk for failure. This paper engages that issue. It examines recent research on the success of community college students who take online classes and explores similar comparisons using 656,258 student records collected through the Predictive Analytics Reporting (PAR) Framework. In particular, the research investigated retention rates for students in three delivery mode groups — students taking only onground courses, students taking only online courses, and students taking some courses onground and some courses online at five primarily onground community colleges, five primarily onground four-year universities, and four primarily online institutions.&#x0D; Results revealed that taking some online courses did not result in lower retention rates for students enrolled in primarily onground community colleges participating in the PAR Framework. Moreover, although retention rates were lower for such students taking only online courses than for similar students taking only onground or blending their courses, much of the difference could be explained by extraneous factors. Essentially no differences in retention between delivery mode groups were found for students enrolled in primarily onground four-year universities participating in the PAR Framework, while at participating primarily online institutions, students blending their courses had slightly better odds of being retained than students taking exclusively onground or exclusively online courses. No differences between the latter groups were found at these institutions.&#x0D; Patterns of retention were similar regardless of gender across institutional categories, and were mostly similar regardless of Pell grant status with the exception of fully online students at traditional community colleges. Age, however, did differentially affect delivery mode effects. Older students taking only online courses were retained at higher rates than younger students taking only online courses at both primarily onground community colleges and primarily online institutions. The results suggest that, despite media reports to the contrary, taking online courses is not necessarily harmful to students’ chances of being retained, and may provide course-taking opportunities that otherwise might not be available, especially for nontraditional students.

Normal range of neonatal umbilical artery blood gas and influences of biological factors: a multicenter pilot study in China

Objective To study the influences of biological factors on umbilical artery blood gas (UABG) of the newborns and to establish the normal UABG range.Methods From March 2008 to September 2009,all newborns without anomalies whose 1 min Apgar score ≥ 8 born in six hospitals in China were consecutively enrolled into this study.Umbilical cord and blood samples were collected with standardized method.pH value,PO2,PCO2 and base excess (BE) of umbilical artery were detected by uniformed blood gas analyzer.The influences of biological factors,such as parity,fetal number,gender,gestational age,birth weight,relationship of birth weight to gestational age,and delivery mode on UABG were analyzed by analysis of variance (LSD test) and two-independent sample t test.Based on the investigation results,normal range of UABG of the newborns was established after ruling out biological influence factors.UABG reference values were expressed as (x)± 1.96s.Results Totally 20605 newborns were born in the six hospitals during the study period,among which 20191 newborns were enrolled in this study.Gender had no significant influence on UABG parameters (P＞0.05).pH (7.19±0.10) and BE [(-7.75±3.03) mmol/L] of newborns of primiparous were lower than those born from multiparous (P＜0.05).BE of second babies[(-7.60±3.02) mmol/L]was lower than that of babies born from mothers of more than three parities (P＜0.05).Compared to twins [PO2(2.91±1.21) kPa,PCO2 (7.18±1.43) kPa and BE (-6.84±3.26) mmol/L],the PO2 of singletons was higher [(3.16±1.24) kPa,t=3.612,P＜0.05],and PCO2 [(7.01± 1.65) kPa,t=2.092,P＜0.05] and BE [(-7.65 ± 3.11) mmol/L,t=2.930,P＜0.05] were lower.As gestational age increased,the value of pH,BE and PO2 decreased,and PCO2 increased (P＜0.05,respectively).pH and BE of low birth weight infants were higher than those of normal birth weight infants and macrosomia (P＜0.05 respectively).pH,BE and PO2 of small for gestational age infants were lower than those of appropriate and large for gestational age infants,while PCO2 was higher (P＜0.05 respectively).pH.PO2 and BE of cesarean scction group were higher than those of other delivery mode groups,while PCO2 was lower (P＜0.05 respectively).PO2 and BE of forceps group were lower than those of normal delivery group,while its PCO2 was higher (P＜0.05 respectively).After ruling out the influence factors,the normal ranges ((x)±1.96s) of UABG and BE of the 10645 singleton,term,normal delivered,normal birth weight,appropriate for gestational age,1 min Apgar score≥8,non anomalous newborns were (7.20±0.20) for pH,(-7.64±6.36) mmol/L for BE,(3.15±1.23) kPa for PO2 and (7.02±1.62) kPa for PCO2.Conclusions Many biological factors might affect UABG parameters.When using pH or BE threshold as one of the criteria for evaluation of birth asphyxia,the influences of biological factors should be considered. Key words: Umbilical arteries; Blood gas analysis; Reference values; Hydrogen-ion cincentration; Infant,newborn; Multicenter study

Comparison of the Efficacy of Foley Catheter Balloon with Dinoprostone Gel for Cervical Ripening at Term

Objective: The purpose of this study was to compare the efficacy of extra-amniotic Foley catheter with intra cervical Dinoprostone gel for preinduction cervical ripening. Study Design: A randomized, prospective study was conducted in the Department of Obstetrics and Gynecology, PGIMS Rohtak on 100 pregnant women admitted for induction of labor. Fifty patients were randomized to receive Dinoprostone gel and 50 patients to receive intracervical, extra-amniotic Foley catheter. Results: The two groups were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop scores. Both groups had a significant change in Bishop score (4.18 ± 1.81 and 4.6 ± 1.48 respectively, p < 0.001); however, there was no significant difference between the groups. Mean duration of induction to delivery was 18.51 ± 8.52 in Foley catheter group and 18.21 ± 11.13 in prostaglandin group, the difference being statistically insignificant. Among 50 cases of prostaglandin only single dose was sufficient for 23 (46%) cases to induce labor. But in 27 (54%) cases 2nd dose of prostaglandin were required. The expenditure of intervention showed that Rs. 325 were required for induction by prostaglandin as compared to Rs. 60/- for Induction by Foley’s catheter and the difference was highly significant statistically There was no difference between the groups in mode of delivery, infant weight, apgar score and intrapartum complications. Conclusion: In conclusion, although both Foley catheter and dinoprostone gel appear to be effective agents for cervical ripening. Foley catheter causes less fetal distress, cheap and safety profile of Foley catheter is such that it can be used on an out patient basis, but not dinoprostone gel. These results make Foley catheter comparable or even superior to dinoprostone gel for cervical ripening specially in developing countries.

A Study of the Predictive Relationships Between Faculty Engagement, Learner Satisfaction and Outcomes in Multiple Learning Delivery Modes

This study assessed the predictive relationships between faculty engagement, learner satisfaction, and outcomes across multiple learning delivery modes (LDMs). Participants were enrolled in courses with the options of three learning delivery modes: face-to-face, satellite broadcasting, and live video-streaming. The predictive relationship between faculty engagement and student satisfaction remained constant across the three learning delivery mode groups. In addition, faculty engagement was an effective predictor for learner satisfaction, regardless of LDM. Similarly, the predictive relationship between faculty engagement and learning outcomes as measured by final grades remained constant. The results also suggested that an increase in the faculty engagement score was accompanied by an increased probability of obtaining a better course final grade. Overall, findings from the study supported the importance of faculty engagement in student learning outcomes and satisfaction regardless of the LDM.

Support in the first stage of labour from a female relative: the first step in improving the quality of maternity services

Objective to undertake a substantial descriptive study to assess whether the provision of labour support, in hospitals in Jordan, by a female relative during the first stage of labour affected duration of labour, use of pharmacological pain relief, mode of delivery and the woman's postpartum perception of the birth experience. Design a non-randomised comparison study. Setting maternity ward in Al-Karak Hospital, the main governmental hospital in the south region of Jordan. Participants a convenience sample of 226 nulliparous women who had a single term fetus, were expecting an uncomplicated vaginal birth and were in spontaneous labour at the time of admission. Intervention supportive companionship from a female relative with no medical or nursing experience, concentrating on comfort, reassurance and praise. Results women who had support during labour were significantly less likely than those in the control group to have pharmacological pain relief, and were significantly more likely than those in the control group to report a good birth experience. There were no statistically significant differences between groups in mode of delivery or duration of labour. Conclusion labour support by a female relative is a cost-effective and beneficial practice to apply to intrapartum care in hospitals in developing countries with limited resources, such as Jordan. Labour support is not routine practice and is not permitted in Jordan, as in many other countries. Consideration should be given to change maternity systems to ensure that all women have access to such support.

Obstetric outcomes with a false-positive one-hour glucose challenge test by the Carpenter-Coustan criteria

Objective. Pregnancies complicated by a false-positive one-hour glucose challenge test (GCT), as determined by the National Diabetes Data Group (NDDG) criteria, have higher rates of adverse maternal and neonatal outcomes. This study was conducted to determine if pregnancies complicated by a false-positive GCT, as determined by the Carpenter-Coustan (CC) criteria, also have higher rates of adverse maternal and neonatal outcomes.Study design. In this retrospective case-control study, we compared 165 patients with a false-positive GCT, as determined by the Carpenter-Coustan criteria, to a cohort of 165 pregnant controls with a normal screening GCT. Multiple variables for maternal and neonatal outcomes were compared between the two groups.Results. The racial distribution and gestational age of delivery were similar in both groups. The study group had a higher one-hour GCT (148.2 mg/dl vs. 95.3 mg/dl, p < 0.001), was older (27.4 yrs vs. 23.8 years, p < 0.001), was more likely to be multiparous (71.5% vs. 58.2%, p = 0.011), and had a higher BMI (26.7 kg/m2 vs. 24.6 kg/m2, p = 0.002). There were no differences between the two groups in mode of delivery, birth weight, rates of macrosomia, shoulder dystocia, antenatal death and maternal laceration. There were also no differences between the two groups in rates of preeclampsia, chorioamnionitis, endometritis, ICN admission, neonatal hypoglycemia, Erb's palsy, clavicular fracture, neonatal sepsis, neonatal death or use of phototherapy.Conclusion. Women with a false-positive one-hour GCT by the Carpenter-Coustan criteria do not have higher rates of adverse perinatal outcomes. Using the Carpenter-Coustan criteria to diagnose GDM appears to be superior to NDDG criteria in terms of avoiding adverse maternal and neonatal outcomes.

Ambulatory epidural anesthesia and the duration of labor

Objectives: Ambulatory epidural analgesia has become a common option for women in labor in France. We tested the hypothesis that a method of epidural analgesia that allowed women to walk had specific advantages regarding mode of delivery, consumption of local anesthetic, oxytocin requirement, and labor duration. Methods: Two hundred and twenty-one women with uncomplicated pregnancies who presented in spontaneous labor between 36 and 42 weeks of gestation or who were scheduled for induced labor were randomly divided into two groups, ambulatory and non-ambulatory. All were given intermittent epidural injections of 0.1% ropivacaine with 0.6 μg/ml sufentanil for analgesia during labor ( P<0.05 was considered significant). None of the women had previous cesarean delivery. Results: There were no significant differences between the two groups in mode of delivery, consumption of local anesthetic, or oxytocin requirement. However, a significant difference was noted in labor duration (173.4±109.9 min vs. 236.4±130.6 min; P=0.001). Conclusions: Walking with ambulatory labor analgesia shortens labor duration but has no other effect on the progress and outcome of labor.

A comparison of intermittent vaginal administration of two different doses of misoprostol suppositories with continuous dinoprostone for cervical ripening and labor induction

To compare the efficacy of a vaginal insert administering continuous dinoprostone with vaginal suppositories containing two different doses of misoprostol for cervical ripening and induction of labor. In this prospective, randomized, double-blinded study, 118 patients with indications for induction of labor and an unfavorable Bishop score were randomly assigned to receive either continuous dinoprostone, misoprostol 35-microg suppositories, or misoprostol 50-microg suppositories. No significant differences were noted among the three groups in the change of Bishop score, induction of active labor or the time from initial treatment to delivery. Active labor occurred in roughly two-thirds of the patients in an average of about 5.7-6.7 h regardless of treatment assignment. When the two misoprostol groups were combined, a shorter interval from insertion to vaginal delivery was observed in the nulliparous women receiving misoprostol than those receiving continuous dinoprostone (21.3 vs. 27.2 h, p = 0.019). Except for the significantly lower incidence of tachysystole observed in the combined misoprostol group (3.8% vs. 15.4%, p = 0.036), there were no other significant differences between the groups in mode of delivery or in adverse maternal, fetal, or neonatal effects. Misoprostol suppositories appeared to be as effective and safe as continuous dinoprostone in inducing cervical ripening in this sample.

Does exposure to magnesium sulfate in utero decrease the risk of necrotizing enterocolitis in premature infants?

The objective of this study is to assess whether antenatal exposure to magnesium sulfate may decrease the risk of necrotizing enterocolitis in preterm infants. We have compared the rate of magnesium sulfate exposure before birth among 23 consecutive infants diagnosed with necrotizing enterocolitis with that of 46 controls matched by gestational age at delivery and gender. Relevant obstetric and neonatal variables were compared between the two groups using chi-square and Fisher's exact test for categorical data, and one-way analysis of variance for continuous variables, with a two-tailed p-value <0.05 considered significant. No significant differences were present between the two groups in mode of delivery (p=0.9), rate of Apgar score at five minutes below seven (p=0.4), prenatal exposure to indocin (p=0.5) or steroids (p=0.6), or neonatal administration of surfactant (p=0.1). Similar proportions of babies with necrotizing enterocolitis and controls were diagnosed with respiratory distress syndrome (p=0.5), intraventricular hemorrhage grades three or four (p=0.9), and sepsis (p=0.6). Babies with necrotizing enterocolitis had a significantly longer hospital stay (74.6+/-64.0 vs. 41.9+/-37.0 days, p=0.01) and intubation period (31.4+/-24.1 vs. 16.8+/-15.6 days, p=0.01) than controls. The rates of prenatal exposure to magnesium sulfate were similar in the necrotizing enterocolitis and control groups (30% vs. 39% respectively, p=0.4). Power analysis demonstrated that 385 babies would be required in each group to reach statistical significance (alpha=0.05, beta=80%). In this retrospective case-control study, maternal administration of magnesium sulfate prior to delivery does not appear to confer a significant protective effect for the neonatal occurrence of necrotizing enterocolitis.

A comparison of intermittent vaginal administration of two different doses of misoprostol suppositories with continuous dinoprostone for cervical ripening and labor induction

Purpose : To compare the efficacy of a vaginal insert administering continuous dinoprostone with vaginal suppositories containing two different doses of misoprostol for cervical ripening and induction of labor. Study design : In this prospective, randomized, double-blinded study, 118 patients with indications for induction of labor and an unfavorable Bishop score were randomly assigned to receive either continuous dinoprostone, misoprostol 35- &#119 g suppositories, or misoprostol 50- &#119 g suppositories. Results : No significant differences were noted among the three groups in the change of Bishop score, induction of active labor or the time from initial treatment to delivery. Active labor occurred in roughly two-thirds of the patients in an average of about 5.7-6.7 h regardless of treatment assignment. When the two misoprostol groups were combined, a shorter interval from insertion to vaginal delivery was observed in the nulliparous women receiving misoprostol than those receiving continuous dinoprostone (21.3 vs. 27.2 h, p = 0.019). Except for the significantly lower incidence of tachysystole observed in the combined misoprostol group (3.8% vs. 15.4%, p = 0.036), there were no other significant differences between the groups in mode of delivery or in adverse maternal, fetal, or neonatal effects. Conclusion : Misoprostol suppositories appeared to be as effective and safe as continuous dinoprostone in inducing cervical ripening in this sample.

A prospective, randomized comparison of Foley catheter insertion versus intracervical prostaglandin E 2 gel for preinduction cervical ripening

Objective: The objective of this study was to compare intracervical prostaglandin E 2 gel with insertion of a Foley bulb for efficacy in preinduction cervical ripening. Study Design: Women who came to the hospital for induction of labor with a Bishop score ≤5 were randomly assigned to treatment with either prostaglandin E 2 gel or a Foley bulb. Prostaglandin E 2 gel was used according to the manufacturer's recommendation. The Foley group had a number 14 Foley catheter inserted, inflated, and placed on traction. Immediately after Foley bulb extrusion or 6 hours after prostaglandin E 2 gel course completion, a dilute oxytocin solution was started if the patient was not in labor. Results: Seventy-seven women were entered into the Foley group and 72 were entered into the prostaglandin E 2 gel group. Both the Bishop score after preinduction ripening (6.5 vs 5.1, P < .001) and the change in Bishop score (3.5 vs 2.7, P = .015) were significantly higher in the Foley group. There were no differences between the groups in mode of delivery, infant weight, rate of hyperstimulation, shoulder dystocia, patient discomfort, epidural use, oxytocin use, or nonreassuring fetal heart rate patterns. The preinduction time (9.9 vs 17.2 hours, P < .001) and the total induction time (22.4 vs 30.4 hours, P < .001) were significantly shorter in the Foley group. Patient charges were 31% lower in the Foley group ( P < .001). Conclusion: Use of the Foley catheter resulted in a higher postinduction Bishop score, a greater change in Bishop score, a shorter induction time, and lower patient charges than did intracervical prostaglandin E 2 gel. (Am J Obstet Gynecol 1999;180:55-9.)