Diagnostic value of amniotic fluid inflammatory biomarkers for subclinical chorioamnionitis.

OBJECTIVE: To determine the value of measuring amniotic fluid inflammatory biomarkers for diagnosis of subclinical chorioamnionitis. METHODS: A prospective study was conducted among pregnant women with cervical dilation, preterm premature rupture of membranes, threatened late abortion, or threatened premature labor who attended a tertiary care hospital in Guangzhou, China, between June 1, 2012, and January 31, 2014. Participants were divided into two groups according to the presence or absence of subclinical chorioamnionitis. Surface-enhanced laser desorption/ionization time-of-flight mass spectroscopy (SELDI-TOF-MS) was used to detect human neutrophil defensins (HNP-1 and HNP-2), calgranulins A (S100A8), and calgranulins C (S100A12) in amniocentesis samples. RESULTS: Overall, 22 patients had subclinical chorioamnionitis and 17 patients did not. Positive test results for HNP-2 were noted for more patients with subclinical chorioamnionitis than for those without for HNP-2 (19 [86%] vs 2 [12%]; P<0.001), HNP-1 (19 [86%] vs 5 [29%]; P=0.001), S100A12 (20 [91%] vs 9 [53%]; P=0.011), and S100A8 (12 [55%] vs 0; P<0.001). When three or four of these biomarkers were present, the accuracy for a diagnosis of subclinical chorioamnionitis was 89.7%. The sensitivity, specificity, positive predictive value, and negative predictive value were 81.8%, 100.0%, 100.0%, and 81.0%, respectively. CONCLUSION: Detection of inflammatory biomarkers in the amniotic fluid by SELDI-TOF-MS exhibited high diagnostic accuracy for subclinical chorioamnionitis.

Double-balloon catheter vs. dinoprostone vaginal insert for induction of labor with an unfavorable cervix.

PURPOSE: To compare a double-balloon catheter and dinoprostone vaginal insert for induction of labor with an unfavorable cervix. METHODS: Patients with a Bishop score of ≤6 requiring labor induction at term received either a double-balloon catheter or a dinoprostone vaginal insert. The primary outcome was vaginal delivery rate within 24 h, and the secondary outcome was cesarean section rate. RESULTS: A total of 155 women were included; 76 received induction with a double-balloon catheter and 79 with the dinoprostone vaginal insert. The groups were similar with respect to maternal age, body mass index, gravidity, parity, baseline Bishop score, and indications for induction. Gestational age at induction was similar between the groups (double balloon 40.52 ± 0.86 weeks; dinoprostone 40.60 ± 0.79 weeks, P = 0.516). There was no difference in the vaginal delivery rate within 24 h (50 vs. 53.2 %, P = 0.694) or the cesarean section rate (39.5 vs. 31.6 %, P = 0.185) between the groups. More patients in the double-balloon catheter group required oxytocin administration than in the dinoprostone group (75 vs. 31.65 %, respectively, P < 0.001), but uterine hyperstimulation was less frequent in the double-balloon catheter group (0 vs. 10.1 %, respectively, P = 0.007). Neonatal outcomes were similar between the groups. CONCLUSION: Double-balloon catheter and dinoprostone vaginal insert are associated with similar vaginal delivery and cesarean section rates and neonatal outcomes.

A comparison of maternal and neonatal outcomes between water immersion during labor and conventional labor and delivery.

BACKGROUND: Water immersion during the first stage of labor can reduce the length of the first stage and epidural/spinal analgesia use; however, there is limited information regarding other outcomes. Our purpose was to compare maternal and neonatal outcomes of women who underwent water immersion during the first stage of labor with those who underwent conventional labor and delivery. METHODS: Healthy primipara with singleton pregnancies and cephalic presentation were included in the study. Patients were allowed to choose water immersion during labor or conventional labor and delivery. For water immersion, the water temperature was maintained at 35-38°C and subjects left the tub on complete cervical dilatation. A visual analogue scale (VAS) was used to assess pain during labor. Other outcome measures included duration of labor, type of delivery, blood loss, pelvic floor dysfunction and symptoms of stress urinary incontinence (SUI) at 42 days after delivery, infant Apgar scores, and need for transfer of the infant to the neonatal intensive care unit. RESULTS: Thirty eight subjects (mean age, 28.66 ± 3.08 y) received water immersion and 70 (mean age, 27.89 ± 2.99 y) underwent conventional labor and delivery. There were no differences in maternal height, weight, age, gestational age, gravidity, and newborn weight between the groups (all, p>0.05). VAS pain scores were significantly greater in the conventional labor group at 30 min and 60 min after a cervical dilatation of 3 cm (30 min: 10 [9, 10] vs. 6 [5, 8]; 60 min: 10 [10, 10] vs. 7 [6, 8], respectively, both, p<0.001). The duration of labor and postpartum bleeding were similar between the groups (all, p>0.05). The cesarean section rate was higher in the conventional labor group (32.9% vs. 13.2%, p=0.026). The 1-minute and 5-minute Apgar scores were similar between the groups. Maternal and neonatal culture results were similar between the groups. SUI symptoms at 42 days after delivery was significantly higher in the conventional labor group (25.5% vs. 6.1%, respectively, p=0.035). CONCLUSIONS: Water immersion can reduce labor pain, and is associated with a lower rate of cesarean delivery and SUI symptoms at 42 days.