Article Abstract:
Preterm birth, delivery of a fetus before the 37th completed week of pregnancy, is associated with a poor pregnancy outcome. Most preterm births occur in women who have known risk factors. Therefore, preterm prevention programs focus on identifying high-risk pregnancies and diagnosing preterm labor early so that effective management strategies can be employed as soon as possible. Home monitoring of uterine contractions has improved the early diagnosis of preterm labor. The patterns of uterine activity have not been well-studied in pregnancies at risk for early labor. Four situations that increase the risk for preterm labor include: premature rupture of the membranes surrounding the fetus (PROM) before the 28th week of pregnancy, recuperation from a recent operation (appendicitis, ovarian cyst removal), placenta previa (abnormal placement of the placenta near the cervix) or blunt trauma to the abdomen. Monitored uterine activity was studied among 98 patients with one of these four risk factors. The home monitors (ambulatory tocodynamometers) detected the frequency and duration of uterine contractions, and these data were then transmitted via the telephone to the study center. All of the patient groups experienced low-intensity, high-frequency contractions that did not last for more than 30 seconds. These contractions either disappeared or developed into true labor. The home monitoring system identified women in preterm labor one to two days before labor was diagnosed via patient-perceived symptoms or vaginal bleeding. Half of the women with placenta previa or PROM had persistent low-amplitude, high-frequency contractions. Although contractions were reduced after tocolytic agents were given, most went on to develop preterm labor. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Membrane stripping, in which physicians digitally separate the chorionic membranes from the lower portion of the uterus, has been used in obstetric patients who are at full term to decrease the likelihood of post-term pregnancies. The technique is frequently used, but has not been rigorously studied in terms of safety and effectiveness. The outcome of stripping membranes was evaluated in 90 patients, who were also compared with 90 patients who did not undergo the procedure. All women had a low risk of complications and gestational ages were firmly established. Patients who underwent stripping had significantly fewer clinic visits due to earlier delivery, and the incidence of post-term pregnancies was significantly lower in this group. However, the mode of delivery was similar between the two groups. Except for spotting after membrane stripping, no complications could be attributed to the procedure. The study indicates that stripping membranes is safe and effective in reducing the incidence of post-term pregnancies. Reduced anxiety, fewer office visits, and fetal surveillance resulting from use of the procedure suggest that the benefits outweigh the risks. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Membrane stripping appears to be a safe method of inducing labor at term. It appears to work by stimulating phospholipase A2 activity. Membrane stripping refers to manually separating the amniotic membrane from the lower part of the uterus. Thirty patients who were at 38 weeks or more gestation were randomly assigned either to have membrane stripping, to have a cervical evaluation or to a control group without cervical evaluation. At the initial evaluation blood samples and cervical swabs were taken to be analyzed for evidence of infection. Participants also had uterine contraction monitoring. Cervical swabs of the membrane were completed for all patients to analyze phospholipase A2 activity. When participants returned in labor or for an induction of labor at 42 weeks' gestation, cervical and blood samples were again taken. There was an increase in uterine contractions three and four hours after the stripping procedure. Levels of phospholipase A2 and prostaglandins, both important elements in the progression of labor, were also elevated.
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