Increased doses of vaginal progesterone for the prevention of preterm birth in twin pregnancies: a randomised controlled double-blind multicentre trial.

OBJECTIVE: Previous trials have shown little benefit for preventing preterm birth in twin pregnancies using 90-200 mg of daily vaginal natural progesterone. Higher doses have not been tested. Our aim was to determine the efficacy and safety of two different daily doses of vaginal natural progesterone (200 and 400 mg), compared with placebo, for preventing preterm birth in unselected twin pregnancies. DESIGN: Randomised controlled double-blind multicentre trial (1:1:1). SETTING: The study was carried out in five university centres from Valencia, Murcia and Alicante (Spain). POPULATION: Women with dichorionic diamniotic twin pregnancies. METHODS: The women self-inserted two vaginal pessaries daily, containing placebo (n = 96), 200 mg of natural progesterone (n = 97) or 400 mg of natural progesterone (n = 97), from 20 to 34 weeks of gestation or delivery. Randomisation was performed by an external centre. Data were analysed on an intention-to-treat basis. MAIN OUTCOME MEASURE: Preterm birth rate. RESULTS: The baseline characteristics for placebo and progesterone groups were similar. Comparison of the three groups and analysis of progesterone-treated versus untreated women showed similar pregnancy and neonatal outcomes. The proportion of preterm and very preterm births, low birthweight, perinatal mortality and neonatal morbidity showed no differences between the three groups. Similar results were also obtained when comparing the 200- versus 400-mg progesterone groups. No serious adverse effects were encountered. CONCLUSIONS: Vaginal progesterone therapy was generally well tolerated, but failed to prevent preterm births in unselected dichorionic diamniotic twin pregnancies. The 400-mg progesterone dose offered no advantages over the 200-mg regimen.

Pulsatile versus continuous oxytocin infusion for the oxytocin challenge test.

In a prospective study, 140 patients had an oxytocin challenge test with either a continuous or a pulsed infusion (one minute of infusion in every five minutes). Both infusion regimens had similar success rates in terms of uterine contractions (97.1 vs 98.6%). The potency ratio (pulsed versus continuous infusion) was significant at 2.7 (1.27 to 5.2), which means that more uterine activity was induced with each mU of oxytocin with pulsatile than with continuous administration. The total amount of oxytocin required to obtain three good contractions in 10 minutes was about 40% less with pulsed administration than with continuous infusion, but the test took 40 minutes longer with the pulsed than with the continuous infusion (P < 0.01).

Análisis de la mortalidad fetal en el Hospital Universitario La Fe: estudio comparativo 1996-2000 frente a 2001-2005 / Analysis of fetal mortality in the Hospital Universitario La Fe: comparison between 1996-2000 vs 2001-2005

Objective: To evaluate fetal deaths in the last 10 years by comparing two time periods and to analyze possible causes and variations of fetal mortality. Material and methods: We examined the fetal death rate between 1996 and 2005. Two groups were compared: group A included fetal deaths occurring in the period 1996-2000 and group B comprised those occurring in the period 2001-2005. Maternal, delivery and fetal characteristics were analyzed. Results: The fetal death rate at our hospital was 6.25 per 1000 births. Fetal death mainly occurred in Spanish mothers aged between 20 and 35 years old. Birth weight was between 500 and 1000 g in 53.4% of deaths and gestational age was less than 28 weeks in 32.5%. Mortality was higher in multiple pregnancies than in single pregnancies. Comparison of the two groups showed no significant differences in fetal death rate but a statistically significant increase (p <0.05) was found in patients aged less than 20 years old (1.2% vs. 6.9%) and foreigners (4.7% vs. 15.5%). There was a nonsignificant increase in fetal mortality in assisted reproductive pregnancies (5.8% vs. 9.2%). The cause of death was unexplained in 20.3% of fetal deaths. The most frequent causes registered were funicular abnormalities (13.3%), chorioamnionitis (8.7%), premature rupture of fetal membranes (8.4%), and abruptio (6.7%). Conclusion: The fetal death rate did not decrease during the periods studied and increased among young women and foreigners (AU)

Objetivo: Evaluar la mortalidad fetal en los últimos 10 años dividiéndola en 2 períodos, y analizar las posibles causas y variaciones de ésta. Material y métodos: Se estudia la tasa de mortalidad fetal (TMF) entre los años 1996 y 2005. Se comparan 2 grupos, el Grupo A con las muertes fetales entre 1996-2000 y el grupo B con los casos entre 2001-2005. Se estudian variables maternas, relacionadas con el parto, y fetales. Resultados: La TMF en nuestro medio fue del 6,25‰ recién nacidos. Principalmente se dio en madres españolas de entre 20 y 35 años. El peso fetal fue, en el 53,4% de los casos, de entre 500-1.500 g y el 32,5% era de edad gestacional < 28 semanas. La mortalidad está incrementada en las gestaciones múltiples respecto a las únicas. Al comparar los 2 grupos no ha habido diferencias significativas en la TMF, pero sí se evidencia un aumento estadísticamente significativo (p < 0,05) de pacientes < 20 años (el 1,2 frente al 6,9%) y extranjeras (el 4,7 frente al 15,5%). Sin embargo, aumenta la mortalidad en gestaciones de reproducción asistida (el 5,8 frente al 9,2%), sin alcanzar significación estadística. La causa de muerte fue, en el 20,3% de los casos, desconocida destacan como causas registradas la patología funicular (13,3%), la corioamnionitis (8,7%), la rotura prematura de membranas pretérmino (8,4%) y el desprendimiento prematuro de la placenta normoinserta (6,7%). Conclusión: No ha disminuido la TMF en los últimos años, aumentando entre gestantes extranjeras y jóvenes (AU)