Second-trimester labor induction is frequently complicated by significant morbidity. Although instrumental dilatation and evacuation is considered the safest method for second-trimester pregnancy termination, most younger physicians lack experience with this procedure. As a result, many physicians use vaginal prostaglandin suppositories for second trimester labor induction. Unfortunately, systemic side effects and in-complete abortion are common complications. We sought to compare the side effects and efficacy of intra-amniotic 15-methyl prostaglandin F2α (PGF2α) with intravaginal prostaglandin E2 (PGE2) for second-trimester labor induction. We compared outcomes in patients receiving intravaginal PGE2 (group A, N = 24) with intra-amniotic 15-methyl prostaglandin F2α (group B, N = 25) for midtrimester labor induction. Group A patients received intravaginal PGE2 20 mg every 3–4 hr, and group B patients received intra-amniotic 15-methyl PGF2α 2.5 mg. Eighty-eight percent of patients in group A successfully delivered by 24 hr, and all did by 36 hr. Eight patients in group A required surgical intervention due to incomplete abortion. Likewise, 96% and 100% of group B patients delivered within 24 and 36 hr, respectively. Only 1 patient in group B had an incomplete abortion. Significant gastrointestinal side effects were noted more often in group A than in group B patients (P < 0.001). The efficacy of intra-amniotic 15-methyl PGF2α for second trimester labor induction is confirmed in this study with significantly fewer systemic side effects and fewer cases requiring surgical intervention.
A survey of the members of the Society of Perinatal Obstetricians was conducted to determine the current strategies employed in the management of post term pregnancies. In November 1990 a questionnaire was mailed to 1,000 members and associates of The SPO. Six hundred seventy-nine (68%) questionnaires were returned. The results reflect that a variety of management strategies are employed in management of post term pregnancy. With uncertain dates, 91% of the responders intervene only if antepartum testing is abnormal. With certain dates at 287 days and a favorable cervix, 63% of the responders will induce labor. With an unfavorable cervix, 83% begin antepartum testing. At certain 294 days and a favorable cervix, 98% induced labor. If the cervix is unfavorable, 58% induced labor, the majority of the remainder initiate antepartum testing. The consensus of SPO members responding to this questionnaire is that antepartum testing should begin at 287 days and labor should be induced at 294 days.
Congenital Chagas disease is a growing concern, prioritized by the World Health Organization for public health action. El Salvador is home to some of the highest Chagas disease (Trypanosoma cruzi infection) burdens in the Americas, yet pregnancy screening remains neglected. This pilot investigation performed a maternal T. cruzi surveillance study in Western El Salvador among women presenting for labor and delivery. From 198 consented and enrolled pregnant women, 6% were T. cruzi positive by serology or molecular diagnosis. Half of the infants born to T. cruzi-positive women were admitted to the NICU for neonatal complications. Geospatial statistical clustering of cases was noted in the municipality of Jujutla. Older women and those knowing an infected relative or close friend were significantly more likely to test positive for T. cruzi infection at the time of parturition. In closing, maternal T. cruzi infections were significantly higher than national HIV or syphilis maternal rates, creating an urgent need to add T. cruzi to mandatory pregnancy screening programs.
Abstract Background Chagas disease (CD), Trypanosoma cruzi infection, is a neglected vector-borne disease endemic in Latin America for which < 1% of cases have been treated. WHO estimates that ∼9,000 infected neonatal cases occur annually via vertical transmission—US CDC estimates up to ∼300 incident neonatal cases annually. Maternal and neonatal misdiagnosis are principally attributed to the paucity of accurate diagnostic tools for this complex chronic parasitic infection, with current guidelines requiring confirmation testing at >9 months of age—a significant barrier for vulnerable populations already experiencing healthcare access limitations. Methods A maternal-infant CD program was established in Sonsonate, El Salvador through a collaboration between flagship universities and the Ministry of Health. Employing machine learning methods, we developed a histology-based parasite image recognition application to aid in triaging of at-risk cases. Second, we developed an innovative diagnostic workflow integrating Bayesian statistics and novel digital PCR methods to validate a new diagnostic tool for enhanced disease detection among mothers-infants. Results Since March 2022, a 6% seropositivity was noted among parturition women. Maternal CD status was significantly associated with pregnancy complications and neonatal complications (Apgar < 9 at 1 min and at 5 mins, NICU admission, et al). A customized convolutional neural network design employed on bifurcated Giemsa-stained blood smears revealed >90% parasite detection accuracy. Lastly, McNemar’s statistic found significantly increased diagnostic capacity between our novel dPCR approach vs conventional qPCR. Specifically, dPCR was 2.74 times more likely to detect parasitic DNA in maternal blood than qPCR; 9.5 times more likely in placental tissue; 4.5 times more likely in cord tissue. Conclusion Congenital transmission is a growing international clinical concern. Our preliminary results provide compelling evidence for both the need of novel diagnostics and support for incorporation of study-developed cutting-edge diagnostics to aid in timely clinical management of congenital CD. Disclosures All Authors: No reported disclosures
Objective: This prospective study was undertaken to examine the effects of subclinical intraamniotic infection on fetal behavioral patterns. Methods: Amniotic fluid was obtained from four groups of patients (n = 99): group 1, patients with preterm premature rupture of the fetal membranes (PPROM) without infection; group 2, patients with PPROM and infection; group 3, patients with preterm labor (PTL) and without infection; and group 4, patients with PTL and infection. Fetal biophysical profiles were obtained on admission to the labor suite. Amniotic fluid was analyzed for the presence of microorganisms and endotoxin to confirm intraamniotic infection; cytokines interleukin (IL)‐1β, IL‐6, and IL‐8 were also assayed. Results: We found no association between low scores for biophysical parameters and subclinical infection in patients with PPROM or PTL. Conclusions: We could not demonstrate that upon a patient′s admission to the labor hall absent fetal breathing and absent fetal movement, as well as reactivity, correlate with subclinical intraamniotic infection. Elevated cytokines, i.e. IL‐1β, IL‐6, and IL‐8 were associated with subclinical chorioamnionitis.
