Preterm delivery is a public health issue of major proportion. More than 12&#x25; of deliveries in the United States that occur at less than 37 weeks gestation preterm labor (PTL) represents the largest single reason for preterm birth (PTB). Attempts to prevent PTB have been unsuccessful. This paper of maintenance tocolytic therapy will examine the efficacy and safety of the drugs, both oral and subcutaneous, which have been utilized for prolongation of pregnancy following successful arrest of a documented episode of acute preterm labor. The evidence for oral tocolytics as maintenance therapy as well as parenteral medications for such patients is offered. Finally, the effects in the United States of the Food and Drug Administration (FDA) action on such medications are reported.

John P. Elliott

John C. Morrison

The Evidence Regarding Maintenance Tocolysis

<i  >Objectives</i>. Hospital fear and avoidance of the routine hospital obstetrical interventions cause some women with low-risk pregnancies to spend most of the active labor period at home, and subsequently they present to the hospital for delivery. Our aim was to analyze the maternal and neonatal outcomes of pregnancies with a planned hospital birth, yet spending the first stage of labor at home without a health provider and completing the delivery in the hospital setting. <i  >Methods</i>. We retrospectively compared 238 pregnancies having home labor plus hospital delivery (study group) with 476 pregnancies that had spent the whole labor in the hospital setting, considering various maternal and neonatal outcomes. <i  >Results</i>. Cesarean and episiotomy rates were lower (<svg     style="vertical-align:-0.1638pt;width:75.025002px;" id="M1" height="11.375" version="1.1" viewBox="0 0 75.025002 11.375" width="75.025002"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
    
        
            <g transform="matrix(.017,-0,0,-.017,.062,11.112)"><path id="x1D443" d="M619 482q0 -69 -40.5 -119t-96 -72.5t-118.5 -26.5h-44l-70 20l-31 -151q-14 -67 0.5 -83t89.5 -22l-5 -28h-287l8 28q65 7 81.5 22t29.5 83l79 398q12 56 0.5 70.5t-78.5 20.5l7 28h255q108 0 164 -43t56 -125zM524 478q0 141 -146 141q-25 0 -47 -8q-16 -6 -20.5 -13.5&#xA;t-10.5 -39.5l-43 -241q37 -13 83 -13q67 0 125.5 45t58.5 129z" /></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><path id="x3C" d="M512 -3l-437 233v51l437 233v-58l-378 -200v-2l378 -199v-58z" /></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><path id="x30" d="M241 635q53 0 94 -28.5t63.5 -76t33.5 -102.5t11 -116q0 -58 -11 -112.5t-34 -103.5t-63.5 -78.5t-94.5 -29.5t-95 28t-64.5 75t-34.5 102.5t-11 118.5q0 58 11.5 112.5t34.5 103t64.5 78t95.5 29.5zM238 602q-32 0 -55.5 -25t-35.5 -68t-17.5 -91t-5.5 -105&#xA;q0 -76 10 -138.5t37 -107.5t69 -45q32 0 55.5 25t35.5 68.5t17.5 91.5t5.5 105t-5.5 105.5t-18 92t-36 68t-56.5 24.5z" /></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><path id="x2E" d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z" /></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,58.64,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,66.8,11.112)"><path id="x31" d="M384 0h-275v27q67 5 81.5 18.5t14.5 68.5v385q0 38 -7.5 47.5t-40.5 10.5l-48 2v24q85 15 178 52v-521q0 -55 14.5 -68.5t82.5 -18.5v-27z" /></g>

        
    
</svg> and <svg     style="vertical-align:-0.1638pt;width:66.875px;" id="M2" height="11.375" version="1.1" viewBox="0 0 66.875 11.375" width="66.875"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
    
        
            <g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,58.64,11.112)"><use xlink:href="#x31"/></g>

        
    
</svg>, resp.), but neonatal intensive care unit admissions of the infants were more prevalent (<svg     style="vertical-align:-0.1638pt;width:58.712502px;" id="M3" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
    
        
            <g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"/></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x31"/></g>

        
    
</svg>) in the study group. Other maternal and neonatal outcomes including neonatal mortality were comparable. <i  >Conclusion</i>. Although our preliminary data generally do support the safety of home active labor plus hospital delivery for low-risk pregnancies, the clinical implications of current data warrant further prospective trials. 


Ozlem Gun Eryilmaz

Nasuh Utku Dogan

Cavidan Gulerman

Leyla Mollamahmutoglu

Nedim Cicek

Ruya Deveer

Unattended Home Labor until Complete Cervical Dilatation Ending with Hospital Delivery: Analysis of 238 Pregnancies

As assisted reproductive technology (ART) methods become the mainstream of infertility treatment, it has become even more critical to reassess its safety. Following the results of a study published by the Robinson Institute in the New England Journal of Medicine, the risk of ART, especially intracytoplasmic sperm injection (ICSI), has never been so closely scrutinized. This paper traces the origins and development of ICSI, assesses the risks documented in the literature, and finally interprets the implications of the study for couples contemplating therapy. We support the need for continued vigilance towards ICSI and the importance in investigating male-factor infertility as a prequel to its use.

May Y. W. Wong

William L. Ledger

Is ICSI Risky?

The Cellient Automated Cell Block System (Hologic) can be used to process cervical scrapes to paraffin sections. For the first study on this subject, cervical scrapes were fixed in the formalin-free fixative BoonFix. This pilot study was limited to cases classified as atypical squamous lesion of unknown significance (ASCUS) and high-grade squamous lesion (HSIL) as diagnosed in the ThinPrep slide. The Cellient paraffin sections were classified into negative, atypical, CIN 1, CIN 2, and CIN 3. Multiple HPV genotypes were encountered in 79&#x25; of the scrapes. This study showed that the Cellient system for paraffin sections can be combined with HPV testing thanks to the formalin-free BoonFix. In two additional studies it was shown that such samples can also be used for morphotyping the vaginal microbiome and preparing cytologic ThinPrep slides.

Mathilde E. Boon

The Cellient System for Paraffin Histology Can Be Combined with HPV Testing and Morphotyping the Vaginal Microbiome Thanks to BoonFixing

<i>Objective</i>. To compare the efficacy of low-dose COC containing desogestrel (DSG) with drospirenone (DRSP) in the changes of premenstrual symptoms. <i>Methods</i>. In an open-label randomized controlled trial, 90 women with premenstrual syndrome who required COC were randomly recruited and allocated equally to receive either 6 cycles of 20 micrograms ethinyl estradiol (EE)/150 micrograms DSG (DSG group) or 20 micrograms EE/3&#x2009;mg DRSP (DRSP group) in 24/4 extended regimen. Analysis of covariance and repeated analysis of variance were used to determine the difference of mean Women's Health Assessment Questionnaire (WHAQ) scores changes between groups, within group, and in premenstrual, menstrual, and postmenstrual phases. <i>Results</i>. Baseline characteristics and WHAQ scores were comparable. At the ends of the 3rd and the 6th cycles, mean WHAQ scores of all the 3 phases in DRSP group showed significant reduction and were significantly lower than those in DSG group. DSG group showed significant reduction in both premenstrual and menstrual phases after the 6th cycle. Adverse effects were comparable in both groups. In conclusion, low-dose COC containing either DSG or DRSP reduced premenstrual symptoms, but the latter showed greater efficacy and earlier reduction.

Jirath Wichianpitaya

Surasak Taneepanichskul

A Comparative Efficacy of Low-Dose Combined Oral Contraceptives Containing Desogestrel and Drospirenone in Premenstrual Symptoms

<i  >Objectives</i>. To determine whether the initiation of treatment (preemptive treatment) before the symptoms of nausea and vomiting of pregnancy (NVP) versus when the symptoms begin can improve the outcome in patients at a high risk for recurrence of severe NVP. <i  >Study Design</i>. Prospective, randomized controlled trial. <i  >Results</i>. Preemptive therapy conferred a significant reduction in HG as compared to the previous pregnancy (<svg     style="vertical-align:-2.3205pt;width:72.75px;" id="M1" height="15.0875" version="1.1" viewBox="0 0 72.75 15.0875" width="72.75"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>. In the preemptive arm, there were 2.5-fold fewer cases of moderate-severe cases of NVP than those in the control group (15.4&#x25; versus 39.13&#x25;) in the first 3 weeks of NVP (<svg     style="vertical-align:-2.3205pt;width:64.587502px;" id="M2" height="15.0875" version="1.1" viewBox="0 0 64.587502 15.0875" width="64.587502"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,12.138)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,12.138)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,30.286,12.138)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,38.446,12.138)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,42.321,12.138)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,12.138)"><path id="x35" d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8&#xA;l-26 -65h-233z" /></g><g transform="matrix(.017,-0,0,-.017,58.64,12.138)"><use xlink:href="#x29"/></g>

		
	
</svg>. In the preemptive group, significantly more women had their NVP resolved before giving birth (78.2&#x25; versus 50&#x25;) (<svg     style="vertical-align:-2.3205pt;width:72.75px;" id="M3" height="15.0875" version="1.1" viewBox="0 0 72.75 15.0875" width="72.75"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,12.138)"><use xlink:href="#x1D443"/></g><g transform="matrix(.017,-0,0,-.017,15.582,12.138)"><path id="x3C" d="M512 -3l-437 233v51l437 233v-58l-378 -200v-2l378 -199v-58z" /></g><g transform="matrix(.017,-0,0,-.017,30.286,12.138)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,38.446,12.138)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,42.321,12.138)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,50.481,12.138)"><use xlink:href="#x30"/></g><g transform="matrix(.017,-0,0,-.017,58.64,12.138)"><path id="x32" d="M412 140l28 -9q0 -2 -35 -131h-373v23q112 112 161 170q59 70 92 127t33 115q0 63 -31 98t-86 35q-75 0 -137 -93l-22 20l57 81q55 59 135 59q69 0 118.5 -46.5t49.5 -122.5q0 -62 -29.5 -114t-102.5 -130l-141 -149h186q42 0 58.5 10.5t38.5 56.5z" /></g><g transform="matrix(.017,-0,0,-.017,66.8,12.138)"><use xlink:href="#x29"/></g>

		
	
</svg>. <i  >Conclusions</i>. Preemptive treatment with antiemetics is superior to the treatment that starts only when the symptoms have already occurred in decreasing the risk of severe forms of NVP.

Caroline Maltepe

Gideon Koren

Preemptive Treatment of Nausea and Vomiting of Pregnancy: Results of a Randomized Controlled Trial

<i  >Objectives</i>. The aim of the study was to investigate whether the use of the antifolate antibiotic trimethoprim during the 12 weeks before conception was associated with congenital malformations. <i  >Methods</i>. We conducted a nationwide register-based cohort study including all Danish women giving birth from 1997 to 2004. All women with at least one prescription of trimethoprim dispensed during the 12 weeks before conception were identified. <i  >Results</i>. There was a doubling of congenital malformations in offspring to women exposed to trimethoprim in the 12 weeks before conception. The adjusted odds ratio (OR) of major congenital malformation was 1.87, 95&#x25; confidence interval (CI) 1.25&#x2013;2.81. There was a significant increase in major malformations of the heart (<svg     style="vertical-align:-0.20474pt;width:71px;" id="M1" height="11.6875" version="1.1" viewBox="0 0 71 11.6875" width="71"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>; 1.18&#x2013;5.26) and limbs (<svg     style="vertical-align:-0.20473pt;width:71px;" id="M2" height="11.6875" version="1.1" viewBox="0 0 71 11.6875" width="71"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.363)"><use xlink:href="#x4F"/></g><g transform="matrix(.017,-0,0,-.017,12.608,11.363)"><use xlink:href="#x52"/></g><g transform="matrix(.017,-0,0,-.017,27.872,11.363)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,42.576,11.363)"><use xlink:href="#x32"/></g><g transform="matrix(.017,-0,0,-.017,50.736,11.363)"><use xlink:href="#x2E"/></g><g transform="matrix(.017,-0,0,-.017,54.611,11.363)"><path id="x31" d="M384 0h-275v27q67 5 81.5 18.5t14.5 68.5v385q0 38 -7.5 47.5t-40.5 10.5l-48 2v24q85 15 178 52v-521q0 -55 14.5 -68.5t82.5 -18.5v-27z" /></g><g transform="matrix(.017,-0,0,-.017,62.771,11.363)"><path id="x38" d="M249 635q70 0 116 -43t46 -105q0 -46 -28 -80q-22 -25 -80 -64q62 -35 97 -75t35 -99q0 -81 -63 -131t-135 -50q-83 0 -137.5 45.5t-54.5 123.5q0 52 45 95q29 28 89 64q-109 62 -109 155q0 66 50.5 115t128.5 49zM238 603q-42 0 -67.5 -31t-25.5 -72q0 -50 32.5 -79.5&#xA;t98.5 -62.5q61 48 61 124q0 59 -29.5 90t-69.5 31zM248 20q46 0 76.5 33.5t30.5 89.5q0 50 -39 85.5t-110 71.5q-81 -54 -81 -137q0 -67 35.5 -105t87.5 -38z" /></g>

		
	
</svg>; 1.13&#x2013;4.23). <i  >Conclusions</i>. In this study, we found an association between exposure to trimethoprim during the 12 weeks before conception and an increased risk of heart and limb defects.

Jon Tr&#xe6;rup Andersen

Morten Petersen

Espen Jimenez-Solem

Jeppe N&#xf8;rgaard Rasmussen

Nadia Lyhne Andersen

Shoaib Afzal

Kasper Broedbaek

Brian Rafn Hjelvang

Lars K&#xf8;ber

Christian Torp-Pedersen

Henrik Enghusen Poulsen

Trimethoprim Use prior to Pregnancy and the Risk of Congenital Malformation: A Register-Based Nationwide Cohort Study

<i>Introduction</i>. Noni (<i>Morinda citrifolia</i>) has been used for many years as an anti-inflammatory agent. We tested the efficacy of Noni in women with dysmenorrhea. <i>Method</i>. We did a prospective randomized double-blind placebo-controlled trial in 100 university students of 18 years and older over three menstrual cycles. Patients were invited to participate and randomly assigned to receive 400&#x2009;mg Noni capsules or placebo. They were assessed for baseline demographic variables such as age, parity, and BMI. They were also assessed before and after treatment, for pain, menstrual blood loss, and laboratory variables: ESR, hemoglobin, and packed cell volume. <i>Results</i>. Of the 1027 women screened, 100 eligible women were randomized. Of the women completing the study, 42 women were randomized to Noni and 38 to placebo. There were no significant differences in any of the variables at randomization. There were also no significant differences in mean bleeding score or pain score at randomization. Both bleeding  and pain scores gradually improved in both groups as the women were observed over three menstrual cycles; however, the improvement was not significantly different in the Noni group when compared to the controls. <i>Conclusion</i>. Noni did not show a reduction in menstrual pain or bleeding when compared to placebo.

H. M. Fletcher

J. Dawkins

C. Rattray

G. Wharfe

M. Reid

G. Gordon-Strachan

<i>Morinda citrifolia</i> (Noni) as an Anti-Inflammatory Treatment in Women with Primary Dysmenorrhoea: A Randomised Double-Blind Placebo-Controlled Trial

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<p><em>Obstetrics and Gynecology International</em> publishes articles related to obstetrics, maternal-fetal medicine, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, and sexual medicine.</p>


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Obstetrics and Gynecology International publishes articles related to obstetrics, maternal-fetal medicine, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, and sexual medicine.

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Obstetrics and Gynecology International