Indications for labor induction. Differences between university and community hospitals.

OBJECTIVE: To compare the rates of and indications for labor induction between a university hospital and two community hospitals and to examine the risk of cesarean delivery among labor induction cases. STUDY DESIGN: Labor induction cases over a six-month period were included (N = 536). Medical records were reviewed by a trained abstractor using a standardized form to determine maternal characteristics, reason for induction and perinatal outcomes. RESULTS: Rates of labor induction were significantly different between the three hospitals: university, 18.2%; community hospital A, 21.4%; community hospital B, 33.7% (P < .001). At the university hospital, 95% of labor inductions were medically indicated using American College of Obstetricians and Gynecologists (ACOG) criteria. Forty-four percent of labor inductions at community hospital A and 57% at community hospital B were for elective reasons. Cesarean rates among induction cases were highest at the university hospital (19%) as compared to community hospital A (15%) and community hospital B (11%), although the difference was not statistically significant. Parity, race and cervical status, but not elective induction, were significantly associated with cesarean delivery. CONCLUSION: Labor induction was more frequent in community hospitals but more likely to meet ACOG-approved indications at the university hospital. The more-frequent inductions at the community hospitals did not result in higher cesarean rates.

Induction of STAT and NFkappaB activation by the antitumor agents 5,6-dimethylxanthenone-4-acetic acid and flavone acetic acid in a murine macrophage cell line.

The antitumor agents flavone-8-acetic acid (FAA) and its dose-potent analogue 5,6-dimethylxanthenone-4-acetic acid (DMXAA), currently in clinical trials, have a novel mechanism of action that is mediated through their ability to induce a spectrum of cytokines. Since NFkappaB and STAT transcription factors participate in the regulation of a number of genes involved in immune and cytokine responses, we investigated whether these transcription factors were activated in the ANA-1 murine macrophage cell line by DMXAA and FAA compared with lipopolysaccharide (LPS), a bacterial component that induces an overlapping spectrum of cytokines. Activation of STAT1 and STAT3 was observed distinctly 4 hr after DMXAA and FAA stimulation. DMXAA and FAA induced NFkappaB translocation with slower kinetics of activation compared with LPS. STAT activation by DMXAA and FAA was inhibited by cycloheximide, indicating a requirement for de novo protein synthesis. The ANA-1 cells produced high titres of interferons (IFNs) in the culture supernatant after stimulation with DMXAA and FAA, and the addition of antibodies to IFNalpha/beta inhibited STAT activation, indicating that IFNs mediated STAT activation. NFkappaB activation, on the other hand, was not inhibitable with cycloheximide or with antibodies to IFNalpha/beta. NFkappaB activation appeared to be a direct action of the anticancer agents, whereas activation of the STAT proteins was due, in part, to the high titres of IFNs induced. These results demonstrate the significance of the IFN response in initiating the cascade of secondary events that may contribute to the overall antitumor efficacy of DMXAA and FAA in murine models.