The home as an appropriate setting for women undertaking cervical ripening before the induction of labour.

OBJECTIVES: to explore women's experiences of cervical ripening using isosorbide mononitrate (IMN) in the home as part of the main randomised controlled trial. DESIGN: qualitative study with semi-structured interviews carried out at three weeks post partum. Interview transcripts were analysed to identify recurrent themes, focusing on why women became involved in the study, their views about both the self-medication and the home setting, and whether they would repeat the experience. SETTING: the home. PARTICIPANTS: twenty women enrolled in the main randomised controlled trial. INTERVENTION: the study is part of a double-blind randomised controlled trial with 350 patients investigating whether a nitric oxide donor (IMN) used in cervical ripening improves the process of induction of labour. FINDINGS: women liked the opportunity to remain at home during the cervical ripening process. Timing and setting were central issues; women hoped that it would hasten labour, while the home was seen as a setting offering freedom, security and reassurance, as opposed to the hospital, seen as constraining. Two women reported problems with IMN but the remainder reported that they would repeat the experience. IMPLICATIONS FOR PRACTICE: women were very positive about the opportunity to undertake cervical ripening at home. It is important to explore this setting further for appropriate interventions.

The role of toll-like receptors (TLR-2 and -4) and triggering receptor expressed on myeloid cells 1 (TREM-1) in human term and preterm labor.

OBJECTIVE: To define the role of Toll-like receptors (TLR-2, TLR-4) and triggering receptor expressed on myeloid cells-1 (TREM-1) in pregnant human myometrium. STUDY DESIGN: Expression of TLR-2 and -4 mRNA and protein and TREM-1 mRNA was quantified in human myometrial samples. Subsequently, we investigated the effect of medroxyprogesterone acetate (MPA) as a functional inhibitor of the TLR agonist lipopolysaccharide (LPS). RESULTS: Messenger RNA expression of TLR-2 and -4 was significantly higher in myometrium at term compared with preterm (P = .009 and .016, respectively). Toll-like receptor-2 protein expression was significantly higher during labor (P = .002) compared with nonlaboring samples. Triggering receptor expressed on myeloid cells-1 mRNA expression was increased in both myometrium and cervix after labor at term (P < .05). Medroxyprogesterone acetate significantly suppressed LPS-induced production of interleukin 1b (IL-1b), IL-6, and IL-8 in vitro (P < .05). CONCLUSION: Toll-like receptors 2and 4 and TREM-1 are expressed in human myometrium and may play a role in the mechanism of labor at term, and their functional effects are inhibited by MPA.

Spontaneous pregnancy after bilateral salpingectomy.

OBJECTIVE: To report a rare case of spontaneous pregnancy following bilateral salpingectomy. DESIGN: Case report. SETTING: Maternity unit at a district general hospital in the United Kingdom. PATIENT(S): A healthy 38-year-old woman with a history of bilateral salpingectomy. INTERVENTION(S): Ultrasound scan and serum beta hcG used to diagnose the pregnancy and for follow-up. MAIN OUTCOME MEASURE(S): Recognition and successful management of the pregnancy. RESULT(S): The patient was diagnosed with a noncontinuing pregnancy that resolved spontaneously. CONCLUSION(S): A MEDLINE search revealed that this is the first reported case of spontaneous pregnancy following bilateral salpingectomy in the English-language literature and possibly only the second in world literature.

Postmenopausal bleeding due to chronic DIC.

'Bleeding disorders' are listed as a cause of postmenopausal bleeding even though there appear to be no reported cases. We present a case of postmenopausal bleeding, because of chronic DIC, which resulted from aortic aneurysm and was managed with replacement blood products and tranexamic acid.