Is the protocol for induction of labor in singletons applicable to twin gestations?

OBJECTIVE: To evaluate the success of induction of labor in twin gestations using standard protocols for misoprostol and oxytocin designed for singleton gestations. STUDY DESIGN: This retrospective cohort study involved all diamniotic twin gestations that were induced at > or = 32 weeks' gestation with intact membranes. Two singleton pregnancies were matched for each twin pregnancy. Use of intravaginal misoprostol and low-dose intravenous oxytocin was based on ACOG management guidelines. RESULTS: A small proportion (40 of 430 [9.3%]) of twins met the inclusion criteria for an induction of labor. Misoprostol was utilized less frequently with twins than with singletons (55% vs. 78%, p = 0.02) because of the higher preinduction Bishop score. Doses of oxytocin were comparable between the 2 groups. A high rate of vaginal delivery was seen in the twin and singleton groups (85.0% vs. 80.0%, p = 0.62) with similar neonatal outcomes. CONCLUSION: A standard protocol of labor induction for singleton gestations would apply for twins with overall favorable intrapartum outcomes.

Maternal obesity and nonstress testing.

We evaluated the impact of maternal obesity on the characteristics and results of nonstress tests (NST). This prospective 1-year cohort study included 2026 NSTs performed on 575 consecutively chosen women with singleton gestations ≥ 32 weeks and no known fetal anomalies. Body mass index (BMI) class was determined at the first prenatal visit. The primary outcome was the duration of fetal heart rate monitoring before a reactive result. Obese women were not more likely to have nonreactive NST results. The mean duration before obtaining a reactive result was unaffected by obesity after controlling for diabetes and gestational age. The overall number of NSTs per patient was higher in obese than in nonobese women (3.9 versus 3.1, P < 0.01). More tests per patient are performed among obese subjects, yet the ability to perform an NST and the duration before obtaining a final result were unaffected by obesity.

Low fatty acid concentrations in neonatal cord serum correlate with maternal serum.

OBJECTIVE: Lactating women in New Mexico have low levels of important fatty acids relative to reported international data. The objective was to correlate the proportions of long-chain polyunsaturated fatty acids (LCPUFA) in the serum phospholipids in mothers and newborns within the same population. METHODS: The serum phospholipids of 52 maternal:neonatal pairs were analyzed. Maternal samples from consecutive admissions were collected at hospital admission, and umbilical cord blood samples were collected at delivery. Fatty acid methyl esters were prepared and then separated and quantified by gas-liquid chromatography. RESULTS: The median maternal percentages of arachidonic acid (AA) (4.9%), eicosapentaenoic acid (EPA) (0.27%) and docosahexaenoic acid (DHA) (2.07%) were below reported international levels. The percentages of AA (9.6%) and DHA (3.2%) in cord serum phospholipids were much higher than maternal samples but remained lower than reported internationally, whereas cord EPA (1.1%) was higher than reported. The highest percentage of DHA in serum phospholipids was found in the Asian subjects (4.21 ± 0.41%), while the American Indian women had the lowest DHA percentage (1.38 ± 0.26%). The maternal DHA percentage was negatively correlated with parity (r = -0.22, p = 0.04). CONCLUSIONS: In the setting of low maternal levels of important fatty acids, their newborns did not accrue serum levels equivalent to reported international values.

Black widow spider envenomation in pregnancy.

OBJECTIVE: Little data exist regarding the optimal treatment and outcomes of pregnancies complicated by black widow spider envenomation. Our objective is to evaluate the clinical effects, medical outcomes, and treatment differences between pregnant and nonpregnant women. METHODS: This observational study is based on a review of the database maintained by the American Association of Poison Control Centers from 2003 to 2007. RESULTS: Of the 12,640 human black widow spider envenomations reported at 61 poison centers in the United States, 3194 (25.3%) involved women of reproductive age, defined as age 15-45 years of age, with 97 (3.0% of reproductive-age women) being pregnant. Comparing pregnant and nonpregnant women, there were no significant differences in recommended or administered treatments. Pregnant women were more likely than nonpregnant women (OR: 1.84, 95% CI: 1.20-2.83) to have outcomes coded as minor, moderate, or major rather than no effect. Significantly higher percentages of pregnant patients were treated at a healthcare facility where they were either released (36.1% vs. 19.9%, p < 0.001) or admitted (13.4% vs. 4.0%, p < 0.001), than nonpregnant women. There were no documented pregnancy losses. CONCLUSIONS: Black widow spider envenomation is a rare occurrence in pregnant women and the short-term outcomes appear to be favorable.