Metoclopramide to augment lactation, does it work? A randomized trial.

OBJECTIVES: The objective of this study was to investigate the efficacy of metoclopramide on augmentation of milk production in mothers of premature newborns. METHODS: This was a randomized, double-blind, placebo-controlled trial. Women who delivered at ≤34 weeks of gestation, with no prior breastfeeding experience, singleton pregnancy, and no contraindications to using metoclopramide were eligible for entry. Twenty-five women were randomly assigned to receive 10 mg of metoclopramide or placebo three times daily for 8 days starting within 36 h of birth. Certified lactation nurses provided breastfeeding education. Breast milk expressed at each pumping session over the 8 days of treatment was recorded. RESULTS: Data from 18 patients were available for analysis. Milk production in both groups increased rapidly during the first 4 days and then more gradually to an average for the last 4 days of 633 ± 168 (9) ml/day [mean ± SEM (n)] for the placebo group and 459 ± 91 (10) ml/day for the metoclopramide group. Analysis with a repeated-measures ANOVA indicated a significant increase in milk production during the 8-day measurement period [within subjects p < 0.001]; however, there was no significant difference in milk production between the two groups [between subjects p = 0.427]. Side effects were similar between groups. CONCLUSION: In mothers with preterm babies, metoclopramide treatment does not augment (sample size had 80% power for detection of 50% difference) the breast milk production. Maternal interest, education, and support are recognized as mainstay in accomplishing successful lactation.

The role of continuous fetal monitoring in the management of preterm premature rupture of membranes.

OBJECTIVE: Continuous fetal monitoring (CFM) is often used in the management of preterm premature rupture of membranes (PPROM) but there is little evidence to support this approach. The objective of this study was to evaluate the clinical outcome of PPROM when managed by CFM. METHODS: A retrospective review was conducted of 129 cases PPROM outcomes for the period January 1, 1998 to December 31, 2003. All women underwent CFM. Delivery was carried out for non-reassuring fetal testing, vaginal bleeding, evidence of infection, positive vaginal pool phosphatidylglycerol when available, and spontaneous labor. RESULTS: Delivery was carried out because of an abnormal fetal heart tracing in 15 women (11.7%). The mean gestational age at admission was 32.2 weeks (95% CI 31.7-32.7), the mean gestational age at delivery was 32.7 weeks (95% CI 32.2-33.1), and the mean latency period was 3.3 days (95% CI 1.5-5.0). Gestational age at rupture of membranes was inversely correlated with latency period (n = 128, r = -0.372, p < 0.001). With regard to gestational age, gravidity, and latency period there was no significant difference noted with respect to why the subjects delivered. No intrauterine deaths occurred in the study. CONCLUSION: In our series, fetal heart rate tracing abnormalities were the indication for delivery in a small but significant percentage of conservatively managed PPROM cases. Our review suggests that a prospective trial of CFM versus intermittent monitoring techniques should be carried out.

Gastric rupture associated with pregnancy.

BACKGROUND: Spontaneous gastric rupture during pregnancy is rare. CASE: A young primigravida delivered a 34-week stillborn infant. Shortly after delivery, she developed signs of hypovolemic shock. Ultrasound examination showed a large amount of free intra-abdominal fluid. At laparotomy, gastric rupture was encountered and repaired. Congenital eventration of the left hemidiaphragm was also noted. After a complicated postoperative course, the patient recovered and has done well. CONCLUSION: Rapid surgical intervention for gastric rupture associated with pregnancy is necessary for maternal survival.

Prenatal detection of structural abnormalities of chromosome 18: associations with interphase fluorescence in situ hybridization (FISH) and maternal serum screening.

We describe two cases of prenatally ascertained isochromosome 18. Case 1 included both an isochromosome 18p and an isochromosome 18q, while Case 2 involved only an isochromosome 18q. Both of these cases were associated with a positive maternal serum triple screen trisomy 18 risk (greater than 1 in 100 risk). In addition, fluorescence in situ hybridization (FISH) was performed on uncultured amniotic fluid interphase cells in both cases looking for aneuploidy for chromosomes 13, 18, 21, X and Y. The results of the interphase analyses support the common knowledge that careful interpretation of interphase FISH analysis is necessary and that results should be followed by full cytogenetic analysis. To our knowledge these are the first reported cases of structurally abnormal chromosomes 18 being associated with a positive maternal serum triple screen for trisomy 18.

Perianal versus anorectal specimens: is there a difference in Group B streptococcal detection?

OBJECTIVE: To investigate whether specimens obtained from the perianal area have a Group B streptococcal culture detection rate similar to anorectal specimens. METHODS: This is a prospective cohort study at a tertiary care university-affiliated teaching hospital. A total of 136 pregnant women between 33 and 40 weeks' gestation were recruited. Three samples for Group B streptococcal culture detection were obtained from each subject in the following order: perianal sample, vaginoperianal sample, and an anorectal sample. The women were asked to rank their pain or discomfort with obtaining the anorectal sample. The vaginoperianal specimen is the standard sample obtained from antepartum patients in this clinic, and, therefore, it serves as the control. RESULTS: Of the 136 subjects, 26.5% of the control, vaginoperianal samples were positive for Group B streptococcal culture. In comparison, 27.2% of the anorectal specimens and 28.7% of the perianal specimens were positive for Group B streptococcal culture. There was no statistically significant difference in the detection of Group B streptococcal culture among the three sample sites. Evaluation of the pain experienced with an anorectal sampling showed that 68% of subjects ranked their pain between mild to moderate, and 5% noted severe pain. CONCLUSION: The Group B streptococcal detection rate was not different among the three sampling sites. Therefore, pregnant women do not need to be subjected to the additional pain of anorectal sampling to detect Group B Streptococcus.