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D A Wing

Publications and source records attributed to D A Wing.

At least 19 recordsLinked to original sources
PubMed2000

A randomized comparison of oral and intravaginal misoprostol for labor induction.

OBJECTIVE: To compare oral misoprostol (100 microgram) to vaginal misoprostol (25 microgram) for cervical ripening and labor induction. METHODS: Two hundred thirty-six women with medical or obstetric indications for labor induction and undilated, uneffaced cervices were assigned randomly to receive 100 microgram of oral or 25 microgram of vaginal misoprostol every 4 hours for 24 hours. Intravenous oxytocin was then given using a standardized protocol. We anticipated that 31% of women treated orally and 50% of women treated vaginally would deliver vaginally within 24 hours of starting labor induction. RESULTS: Among 234 subjects, 121 received oral and 113 received vaginal misoprostol. The mean (+/- standard deviation [SD]) interval from start of induction to delivery was 1240 +/- 845 minutes for orally treated women and 1381 +/- 802 minutes for vaginally treated women (P =.06, log-transformed data). More orally treated women delivered vaginally in 24 hours than vaginally treated women (74 versus 54, P =.14, relative risk [RR] 1.14, 95% confidence interval [CI] 0.92, 1.40). One hundred six women (87.6%) who received oral misoprostol delivered vaginally, compared with 88 women (77.9%) who received vaginal misoprostol (P =.07). Oxytocin was given to 60 (49. 6%) orally treated and 59 (52.2%) vaginally treated subjects (P =. 69). More women in the oral group had tachysystole, nine compared with two (P =.06), hypertonus, and hyperstimulation. Frequencies of intrapartum complications and birth outcomes were similar between groups. CONCLUSION: Oral misoprostol 100 microgram and vaginal misoprostol 25 microgram were similarly effective for cervical ripening and labor induction. Oral administration was associated with trends toward higher likelihood of vaginal delivery and more uterine tachysystole.

Administration, Intravaginal↗
PubMed2000

Mifepristone for preinduction cervical ripening beyond 41 weeks' gestation: a randomized controlled trial.

OBJECTIVE: To compare the effect of mifepristone with placebo on cervical ripening before labor induction in prolonged pregnancies. METHODS: One hundred eighty women with pregnancies beyond 41 weeks and undilated, uneffaced cervices were assigned randomly to receive mifepristone 200 mg or placebo and observed for 24 hours. We then gave intravaginal misoprostol 25 microg every 4 hours or intravenous oxytocin. We expected 60% of placebo-treated and 80% of mifepristone-treated women to deliver vaginally within 48 hours. RESULTS: Among 180 subjects, 97 received mifepristone and 83 received placebo. The mean interval (+/- standard deviation [SD]) from start of induction to delivery was 2209 +/- 698 minutes for mifepristone-treated subjects and 2671 +/- 884 minutes for placebo-treated subjects (P <.001, log-transformed data). Twelve (13. 6%) mifepristone-treated women and seven (10.8%) placebo-treated women delivered vaginally on day 1 (P =.60). After 24 hours, the median Bishop score for both groups was 3 (0-11) (P =.51). One hundred thirty-one subjects required misoprostol, 65 (67.0%) were mifepristone-treated women, and 66 (79.5%) placebo-treated women (P =.06). The median (range) oxytocin dose was 871.5 (0-22,174) mU for mifepristone-treated women and 2021.0 (0-24,750) mU for placebo-treated women (P =.02). Seventy-seven (87.5%) mifepristone-treated women and 46 (70.8%) placebo-treated women delivered vaginally 48 hours after the start of treatment (P =.01). There were nine cesareans in the mifepristone group and 18 in the placebo group (P =.02). More nonreassuring fetal heart rate patterns and uterine contractile abnormalities occurred in mifepristone-treated subjects. There were no statistically significant differences in neonatal outcomes between groups. CONCLUSION: Mifepristone had a modest effect on cervical ripening when given 24 hours before labor induction, appearing to reduce the need for misoprostol and oxytocin compared with placebo.

Adult↗
PubMed2000

Longitudinal evaluation of activated protein C resistance among normal pregnancies of Hispanic women.

OBJECTIVE: This study was undertaken to describe pregnancy-associated activated protein C resistance and the presence of the factor V Leiden mutation in a sample population of pregnant Hispanic women. STUDY DESIGN: Twenty healthy Hispanic women with single intrauterine pregnancies were randomly selected. Blood samples were taken before 8 weeks' gestation, every 4 weeks during pregnancy, and at 6 weeks post partum. Samples were collected, separated, and stored at -70 degrees C until assay. Standard and modified partial thromboplastin time-based assays were used to evaluate response to activated protein C. A sensitivity ratio < or =2 indicated resistance to activated protein C. Repeated measures analysis of variance and unpaired t tests were used as appropriate. P <.05 was considered significant. RESULTS: Mean (+/-SEM) maternal age was 29 +/- 5 years, and most women were multiparous. Mean gestational age at delivery was 38 weeks' gestation, and the mean birth weight was 3000 g. According to the standard assay, 10 women (50%) acquired activated protein C resistance by 13 weeks' gestation, and this condition persisted through delivery and resolved post partum. Another two had preexisting activated protein C resistance. Results of the standard assay were significantly different for women with preexisting and pregnancy-associated activated protein C resistance (1.55 vs 2.18; P =.01). The modified assay distinguished between women with preexisting and pregnancy-associated activated protein C resistance at 8 weeks' gestation, 24 weeks' gestation, and post partum. The pregnancies of the women with preexisting activated protein C resistance were complicated by oligohydramnios at 34 weeks' gestation and required delivery at 36 weeks' gestation. One infant was small for gestational age. Allele-specific polymerase chain reaction analysis demonstrated that both patients with preexisting activated protein C resistance carried one copy of the factor V Leiden mutation. CONCLUSION: The incidences of pregnancy-associated and factor V Leiden mutation-associated activated protein C resistances in our cohort of gravid Hispanic women was higher than previously reported. Factor V Leiden-associated activated protein C resistance in two patients was associated with adverse perinatal outcome.

Adult↗
PubMed2000

Limited clinical utility of blood and urine cultures in the treatment of acute pyelonephritis during pregnancy.

OBJECTIVE: The purpose of this study was to determine the utility of urine and blood cultures in the clinical management of pregnant women with acute pyelonephritis. STUDY DESIGN: Data were pooled from three randomized controlled trials that were conducted at two university-based tertiary care centers and included 391 pregnant women with pyelonephritis. The results of urine and blood cultures were correlated with clinical management decisions, outcome, length of hospital stay, and cost. RESULTS: Results of 98% of urine cultures (382/391) and 99% of blood cultures (388/391) were available for analysis. The most common pathogen isolated was Escherichia coli, which was found in 79% of the urine cultures (300/382) and in 77% of the blood cultures (27/35). Susceptibility testing revealed 46% resistance to ampicillin; 7%, 2%, and 0% resistances to first-, second-, and third-generation cephalosporins, respectively; and 1% resistance to gentamicin. Six percent of the participants (25/391) required changes in antibiotic therapy, most commonly for persistent fever (6/25, 25%). Positive blood culture results directly influenced management by prolonging the duration of hospitalization, with means of 4.6 +/- 2.6 hospital days for women with bacteremia and 2.6 +/- 1.5 hospital days for women without bacteremia (P <.001) despite similar durations of symptoms. CONCLUSION: Urine and blood cultures with sensitivity testing had limited utility in the clinical management of pregnant women with pyelonephritis. Decisions to change antibiotic treatment were affected more by clinical course than by culture results. We suggest that elimination of blood and urine cultures might simplify management and result in significant cost savings without compromising patient care.

Acute Disease↗
PubMed1999

Labor induction with misoprostol.

Misoprostol, a prostaglandin E(1 ) analog, is widely used in the United States for cervical ripening and labor induction. Its use for these indications is not approved by the US Food and Drug Administration. The only Food and Drug Administration-approved indication in the product labeling is the treatment and prevention of intestinal ulcer disease resulting from nonsteroidal anti-inflammatory use. Multiple trials have proved that misoprostol is an effective agent for cervical ripening and labor induction in term pregnancy; however, investigations continue regarding the optimal dose, dosing regimen, and route of administration. Uterine contraction abnormalities are often found in association with higher misoprostol doses. Some trials also indicate increased frequencies of meconium passage, neonatal acidemia, and cesarean delivery for fetal distress in women receiving higher doses of misoprostol. Overall, most trials fail to demonstrate a significant change in the cesarean delivery rate with the use of this agent. Misoprostol is an effective agent for cervical ripening and labor induction when used in a judicious and cautious fashion.

Cesarean Section↗
PubMed1999

A comparison of orally administered misoprostol with vaginally administered misoprostol for cervical ripening and labor induction.

OBJECTIVE: Our purpose was to compare orally administered with vaginally administered misoprostol for cervical ripening and labor induction. MATERIAL AND METHODS: Two hundred twenty subjects with medical or obstetric indications for labor induction and undilated, uneffaced cervices were randomly assigned to receive orally administered or vaginally administered misoprostol. Fifty micrograms of oral misoprostol or 25 microgram of vaginal misoprostol was given every 4 hours. If cervical ripening (Bishop score of >/=8 or cervical dilatation of >/=3) or active labor did not occur, repeated doses were given to a maximum of 6 doses or 24 hours. Thereafter, oxytocin was administered intravenously by a standardized incremental infusion protocol to a maximum of 22 mU/min. RESULTS: Of the 220 subjects evaluated, 110 received orally administered misoprostol and 110 received vaginally administered misoprostol. Fewer subjects who received the oral preparation (34/110, 30.9%) were delivered vaginally within 24 hours of initiation of induction, in comparison with those who received the vaginal preparation (52/110, 47.3%) (P =.01). The average interval from start of induction to vaginal delivery was nearly 6 hours longer in the oral treatment group (mean and SD 1737.9 +/- 845.7 minutes) than in the vaginal treatment group (mean and SD 1393.2 +/- 767.9) (P =.005, log-transformed data). Orally treated patients required significantly more doses than vaginally treated patients (orally administered doses: mean and SD 3.3 +/- 1.7; vaginally administered doses: mean and SD 2.3 +/- 1.2) (P <.0001). Oxytocin administration was necessary in 83 (75.4%) of 110 orally treated subjects and in 65 (59.1%) of 110 vaginally treated subjects (P =.01, relative risk 1. 28, 95% confidence interval 1.06-1.54). Vaginal delivery occurred in 95 (86.4%) orally treated subjects and in 85 (77.3%) vaginally treated subjects (P =.08, relative risk 1.12, 95% confidence interval 0.99-1.27), with the remainder undergoing cesarean delivery. There was no difference in the incidence of uterine contractile abnormalities (tachysystole, hypertonus, or hyperstimulation), intrapartum complications, or neonatal outcomes between the 2 groups. CONCLUSIONS: Oral administration of 50-microgram doses of misoprostol appears less effective than vaginal administration of 25-microgram doses of misoprostol for cervical ripening and labor induction. Further investigation is needed to determine whether orally administered misoprostol should be used for cervical ripening and labor induction.

Administration, Intravaginal↗
PubMed1999

Outpatient treatment of acute pyelonephritis in pregnancy after 24 weeks.

OBJECTIVE: To compare outpatient to inpatient management of acute pyelonephritis in pregnancy beyond 24 weeks' gestation. METHODS: Ninety-two gravidas past 24 weeks' gestation, randomized to outpatient or inpatient therapy, received two 1-g doses of intramuscular ceftriaxone at 24-hour intervals while hospitalized, then were discharged and reevaluated within 48-72 hours or remained hospitalized until afebrile for 48 hours. Subjects received oral cephalexin after initial treatment. Urine cultures were done on admission and 5-14 days after therapy. Surveillance continued until delivery. We anticipated that 15% of outpatients and 0.01% of inpatients would require changes in antibiotic therapy. RESULTS: Twenty-one percent of women evaluated were excluded. Thirteen of 46 (28%) outpatients' hospitalization exceeded 24 hours. Six outpatients (13.0%) and one inpatient did not respond to initial therapy and were treatment failures (relative risk [RR] 1.82, 95% confidence interval [CI] 1.00, 3.31). Within 2 weeks of initial therapy, seven of 81 (8.6%) subjects had positive urine cultures, four outpatients versus three inpatients (P > .999). Eleven of 84 (13.1%) deliveries for which birth data were available occurred preterm (six of 41 outpatients versus five of 43 inpatients) (RR 1.14, 95% CI 0.61, 2.11). CONCLUSION: There were no significant differences in clinical responses or birth outcomes of inpatients or outpatients treated for acute pyelonephritis after 24 weeks' gestation if they completed their assigned protocols. Thirty percent of outpatients were unable to, and most women with acute pyelonephritis in the third trimester were not candidates for outpatient therapy.

Acute Disease↗
PubMed1998

Induction of labor with misoprostol for premature rupture of membranes beyond thirty-six weeks' gestation.

OBJECTIVE: Our purpose was to compare vaginally administered misoprostol (Cytotec) with intravenous oxytocin for labor induction in women with premature rupture of membranes beyond 36 weeks' gestation. STUDY DESIGN: Two hundred subjects with rupture of membranes without labor were randomly assigned to receive vaginally administered misoprostol or intravenous oxytocin. Twenty-five micrograms of misoprostol (Cytotec) was placed in the posterior vaginal fornix. If cervical ripening (Bishop score of > or = 8 or cervical dilatation of > or = 3 cm) or active labor did not occur, a single repeat dose of misoprostol was given 6 hours later. Oxytocin was administered intravenously by a standardized incremental infusion protocol to a maximum dose of 22 mU per minute. RESULTS: Of the 197 subjects evaluated, 98 received misoprostol and 99 oxytocin. The average interval from start of induction to vaginal delivery was about 1 hour longer in the misoprostol group (811.5 +/- 511.4 minutes) than in the oxytocin group (747.0 +/- 448.0 minutes) (P = .65, log transformed data). Oxytocin administration was necessary in 37 of 98 (37.8%) of misoprostol-treated subjects. Vaginal delivery occurred in 85 misoprostol-treated subjects (86.7%) and 82 (85.9%) oxytocin-treated subjects (relative risk 1.17, 95% confidence interval 0.78 to 1.78, P = .45) with the remainder undergoing cesarean birth. There was no difference in the incidence of tachysystole (six or more uterine contractions in a 10-minute window for two consecutive 10-minute periods) or hypertonus between the two groups. There was no significant difference in frequency of abnormal fetal heart rate tracings between the two groups (29.6% in the misoprostol group and 28.9% in the oxytocin group, P = .91). Chorioamnionitis was diagnosed in 28 (28.6%) misoprostol-treated subjects and 26 (26.3%) oxytocin-treated subjects (P = .72, relative risk 1.06, 95% confidence interval 0.78 to 1.45). No significant differences were found in the incidence of fetal meconium (8.1% and 9.1%), 1- or 5-minute Apgar scores < 7 (11.0% and 10.2% of 1-minute Apgar scores, and 2.0% and 2.0% of 5-minute Apgar scores), neonatal resuscitation (24.5% and 27.6%), or admission to the neonatal intensive care unit (25.5% and 32.3%) between the two groups. CONCLUSIONS: Vaginal administration of misoprostol (Cytotec) is an effective alternative to oxytocin infusion for labor induction in women with premature rupture of the membranes near term. The incidence of untoward effects is similar with use of the two agents.

Administration, Intravaginal↗
PubMed1998

Disruption of prior uterine incision following misoprostol for labor induction in women with previous cesarean delivery.

BACKGROUND: Although induction of labor in women with prior cesareans is controversial, we compared misoprostol to oxytocin in such women in a randomized trial. The investigation was terminated prematurely because of safety concerns. CASES: Disruption of the prior uterine incision was found in two of 17 misoprostol-treated women. The first woman underwent repeat cesarean delivery at 42 weeks because of fetal tachycardia and repetitive late decelerations. A 10-cm vertical rent in the anterior myometrium was discovered. The second woman underwent induction for fetal growth restriction. Loss of fetal heart tones and abnormal abdominal contour prompted emergent cesarean for suspected uterine rupture. An 8-cm longitudinal uterine defect was found. CONCLUSION: When misoprostol is used in women with previous cesareans, there is a high frequency of disruption of prior uterine incisions.

Administration, Intravaginal↗
PubMed1998

A randomized trial of three antibiotic regimens for the treatment of pyelonephritis in pregnancy.

OBJECTIVE: To compare the effectiveness of three antibiotic regimens for the treatment of acute pyelonephritis in pregnancy. METHODS: One hundred seventy-nine pregnant women earlier than 24 weeks' gestation who had acute pyelonephritis were randomized to 1) intravenous (i.v.) ampicillin and gentamicin, 2) i.v. cefazolin, or 3) intramuscular ceftriaxone. All participants then completed 10-day courses of oral cephalexin after primary treatment. A urine culture was performed on admission and 5-14 days after completion of therapy. Surveillance for persistent or recurrent infection and obstetric complications continued until delivery. On the basis of a two-sided hypothesis test and with alpha = .025, 60 subjects were needed in each group for statistical power greater than 80% to detect a difference between ceftriaxone and other antibiotics if hospital length of stay differed by 1 or more days. RESULTS: The treatment groups were similar in age, parity, temperature, gestational age, and initial white blood cell count. There were no statistically significant differences in length of hospitalization, hours until becoming afebrile, days until resolution of costovertebral angle tenderness, or infecting organism. There were no statistically significant differences in birth outcomes between the three groups. The average (standard deviation) age at delivery was 38.8 +/- 3.6 weeks. The average birth weight was 3274 +/- 523 g. Eleven (6.9%) of 159 subjects delivered prematurely. Escherichia coli was the most common uropathogen isolated (137 of 179, 76.5%). Blood cultures were positive for organisms in 15 cases (8.4%). At follow-up examination within 2 weeks of initial therapy, eight (5.0%) of 159 subjects had urine cultures positive for organisms. Ten women (6.3%) had cultures positive for organisms later in their antepartum course, and 10 other participants (6.3%) developed recurrent pyelonephritis. CONCLUSION: There are no significant differences in clinical response to antimicrobial therapy or birth outcomes among subjects treated with ampicillin and gentamicin, cefazolin, or ceftriaxone for acute pyelonephritis in pregnancy before 24 weeks' gestation.

Acute Disease↗
PubMed1998

Pyelonephritis.

Explore the source record for details and available documents.

Ambulatory Care↗
PubMed1997

A comparison of intermittent vaginal administration of misoprostol with continuous dinoprostone for cervical ripening and labor induction.

OBJECTIVE: Our purpose was to compare the effect of vaginal administration of misoprostol (Cytotec) with that of dinoprostone (Cervidil) on cervical ripening and labor induction. STUDY DESIGN: Two hundred patients with indications for induction of labor and unfavorable cervical examinations were randomly assigned to receive vaginally administered misoprostol (prostaglandin E1) or the dinoprostone (prostaglandin E2) vaginal insert. Twenty-five microgram tablets of misoprostol were placed in the posterior vaginal fornix every 4 hours for a maximum of six doses. Additional misoprostol was not given after either spontaneous rupture of membranes, adequate cervical ripening (Bishop score of > or = 8 or cervical dilatation of > or = 3 cm), or beginning of active labor. The vaginal insert, Cervidil, containing 10 mg of dinoprostone in a timed-release preparation was placed in the posterior vaginal formix for a maximum period of 24 hours. The vaginal insert was removed for spontaneous rupture of membranes, entry into active labor, adequate cervical ripening, or abnormality of uterine contractile pattern or fetal cardiac activity. RESULTS: Of the 200 patients enrolled, 99 were randomized to misoprostol and 101 to dinoprostone. The average interval from start of induction to vaginal delivery was 1 hour shorter in the misoprostol group (1296.7 +/- 722.1 minutes) than in the dinoprostone group (1360.0 +/- 792.0 minutes), but this difference was not statistically significant (p = 0.97). Oxytocin augmentation of labor was used in 50 (50.5%) misoprostol-treated patients and 43 (43.5%) dinoprostone-treated patients (relative risk 1.14, 95% confidence interval 0.86 to 1.51, p = 0.35). There were no significant differences between routes of delivery with misoprostol or dinoprostone. Overall, 38 patients (19.3%) had cesarean deliveries. There was a significantly lower prevalence of tachysystole (six or more uterine contractions in a 10-minute window for two consecutive 10-minute periods) in the misoprostol group (7.1%) than in the dinoprostone group (18.4%) (relative risk 0.52, 95% confidence interval 0.31 to 0.89, p = 0.02). There were no significant differences in frequency of uterine hyperstimulation or hypertonus. Abnormal fetal heart rate tracings were found in 23 (23.2%) of misoprostol-treated patients and 35 (35.7%) of dinoprostone-treated patients (relative risk 0.73, 95% confidence interval 0.52 to 1.01, p = 0.0546). No significant differences were found in meconium passage, 1- or 5-minute Apgar scores < 7, neonatal resuscitations, or admissions to the neonatal intensive care unit between the two groups. CONCLUSIONS: Vaginally administered misoprostol is as effective as dinoprostone for cervical ripening and the induction of labor. Mean time intervals to delivery, need for oxytocin augmentation, and routes of delivery were similar between the two groups. Incidence of uterine tachysystole with misoprostol every 4 hours was significantly less than with dinoprostone.

Cervix Uteri↗
PubMed1997

Usefulness of coagulation studies and blood banking in patients with symptomatic placenta previa.

We conducted this study to ascertain the usefulness of coagulation studies and blood bank utilization in the patient with symptomatic placenta previa. During a 2-year interval, 97 patients with uterine bleeding due to placenta previa diagnosed > or = 24 weeks' gestation were evaluated. The following studies were routinely obtained: complete blood count including platelet count, fibrinogen, prothrombin time, and a Kleihauer-Betke test. A type and cross-match was sent to the blood bank, and blood availability was maintained for all patients throughout the course of hospitalization. For 92 of 97 patients the laboratory values and need for immediate blood availability were analyzed. No abnormal prothrombin times or Kleihauer-Betke tests were found. There was one low fibrinogen value in a patient with a normal complete blood count. The initial hematocrits ranged from 16.5 to 40.0%, and the initial hemoglobins ranged from 5.5 to 14.1 mg/dL. Five patients had platelet counts of < or = 150 k/mm3 (range 75 to 149 k/mm3). Fourteen patients (14.6%) required transfusion, two received their transfusion antepartum and 12 received perioperative transfusion with a cesarean delivery. During this time period, only two patients required emergent delivery within 1 hr of presentation to the hospital. One patient had delayed seeking medical attention for more than 3 hr prior to admission despite significant hemorrhage. Coagulation studies and Kleihauer-Betke tests have limited utility in the symptomatic patient with uterine bleeding from placenta previa. Continuous availability of cross-matched blood in the antepartum period appears unnecessary as no patients in this investigation were transfused emergently.

Adolescent↗
PubMed1996

A comparison of differing dosing regimens of vaginally administered misoprostol for preinduction cervical ripening and labor induction.

OBJECTIVE: Our purpose was to compare two dosing regimens of vaginally administered misoprostol for preinduction cervical ripening and induction of labor. STUDY DESIGN: Five hundred twenty-two patients with indications for induction of labor and unfavorable cervices were randomly assigned to one of two dosing regimens of vaginally administered misoprostol. Twenty-five microgram tablets of misoprostol were placed in the posterior vaginal fornix either every 3 hours to a maximum of eight doses or every 6 hours to a maximum of four doses. The maximal period of cervical ripening was 24 hours regardless of the number of misoprostol doses administered. Medication was not given after either spontaneous rupture of membranes or the beginning of active labor. RESULTS: Among 522 patients enrolled, 261 were randomized to receive misoprostol every 3 hours and 261 to receive misoprostol every 6 hours. The average interval from start of induction to vaginal delivery was shorter in the 3-hour dosing group (1311.74 +/- 785.14 minutes) than in the 6-hour dosing group (1476.96 +/- 805.30 minutes) (p < 0.05). Oxytocin augmentation of labor occurred more commonly in the 6-hour dosing group (51.4%) than in the 3-hour dosing group (41.8%) (p < 0.05) [corrected]. There were no significant differences between routes of delivery. Overall, 108 patients (20.8%) were delivered by cesarean section. There was a slightly higher prevalence of tachysystole (six or more uterine contractions in a 10-minute window for two consecutive 10-minute periods) in the 3-hour group (14.6%) than in the 6-hour group (11.2%), but this difference was not statistically different. There were no significant differences in the frequency of uterine hyperstimulation or hypertonus. There was no significant difference between groups in the frequency of abnormal fetal heart rate tracings, meconium passage, 1- or 5-minute Apgar scores < 7, neonatal resuscitations, or admissions to the neonatal intensive care unit. CONCLUSIONS: Vaginally administered misoprostol is an effective agent for cervical ripening and induction of labor. Patients with the 6-hour dosing schedule had longer intervals to delivery, more frequently required oxytocin augmentation, and had more failed inductions than did patients with 3-hour dosing. Further investigation to characterize the safety of misoprostol is needed.

Administration, Intravaginal↗
PubMed1996

How frequently should the amniotic fluid index be performed during the course of antepartum testing?

OBJECTIVE: Our purpose was to evaluate the need for frequent amniotic fluid volume assessments in our antepartum testing unit. STUDY DESIGN: In a retrospective analysis of data accumulated over 1 year in our antepartum testing unit amniotic fluid index values performed at 3- to 4-day intervals were compared with follow-up values. Of 11,827 amniotic fluid index values, there were 6291 with follow-up values within 4 days. The results were stratified on the basis of the subsequent amniotic fluid index value and estimated gestational age. Comparisons were made relating to amniotic fluid index testing intervals of 4 versus 7 days. RESULTS: Patients with an amniotic fluid index > 8 cm had a 2.3% chance (128/5677) of having oligohydramnios (amniotic fluid index < or = 5.0 cm) in the next 4 days. Those patients with low-normal amniotic fluid index values (5 to 8 cm) had a 16.2% chance (96/593) of having oligohydramnios in the next 4 days. There were few patients with an amniotic fluid index < or = 5 cm who had subsequent amniotic fluid index values measured. Patients with an amniotic fluid index > 8 cm had a 2.2% chance (156/6946) of having oligohydramnios within 7 days, and those with low-normal amniotic fluid index values had a 16.3% chance (105/643) of having oligohydramnios with 7 days. Stratifying the results by gestational age reveals that patients at > or = 41 weeks of gestation had a 23.3% chance of having oligohydramnios within 4 days if the current amniotic fluid index was found to be 5 to 8 cm and a 7.4% chance if the current amniotic fluid index was found to be normal. Term (estimated gestational age of 37 to 40 weeks) patients had a similar risk of oligohydramnios in 4 days if the amniotic fluid index was low-normal (17.8%) but a risk of 3.6% if the amniotic fluid index was normal. CONCLUSIONS: For patients at < 41 weeks of gestation undergoing antepartum testing, weekly assessments of amniotic fluid index is probably adequate if the initial measurement is in the normal range (> or = 8 cm) because the risk of having oligohydramnios within 7 days is low (2.2%). For patients at < 41 weeks of gestation whose initial amniotic fluid index measurement is in the low-normal range (5 to 8 cm), a scheme of twice-weekly assessment is justified on the basis of a higher risk for an amniotic fluid index < or = 5 cm within 4 days (12.3%). For all patients at > or = 41 weeks of gestation, twice-weekly amniotic fluid index assessments are recommended regardless of the initial measurement.

Amniotic Fluid↗