OBJECTIVE:To describe the delivery outcomes in patients with stillborn infants after labor induction versus spontaneous onset of labor.STUDY DESIGN:A retrospective chart review was performed of singleton pregnancies complicated by fetal death over a three-year period when awaiting spontaneous onset of labor was a common practice. Exclusion criteria were prior multiple cesarean deliveries, placenta previa, preeclampsia or suspected abruptio placentae. Outcome measures included time spent in the labor and delivery unit and rates of maternal hemorrhagic morbidity and endomyometritis.RESULTS:Two hundred eight patients, 100 patients undergoing labor induction and 108 with spontaneous onset of labor, met the study criteria. Patients delivering after induction spent a longer time in the labor and delivery unit (13.7 versus 4.4 hours). The endomyometritis rate was higher in the spontaneous labor group (6% versus 1%). There were no differences in the frequency of postpartum hemorrhage, retained placenta or need for blood transfusion.CONCLUSION:Induction following diagnosis of fetal death is safe and may reduce maternal infectious morbidity.

OBJECTIVES:The objective of this study was to compare the efficacy and safety of two dosing regimens of misoprostol for cervical ripening and labor induction.METHODS:Patients who fulfilled the study criteria were randomized to received misoprostol 25 microg or 50 microg intravaginally every 3 h for a total of eight doses for cervical ripening or until labor was established. Endpoints for successful cervical ripening was achievement of Bishop score of nine or greater, and for labor induction reaching the active phase of labor in the first 24 h. The rates of success, duration of first and second stages of labor, type of delivery, significant side effects, and neonatal outcome were measured and compared between the two study groups. Two hundred and fifty-one patients were randomized in two groups--126 received 50 microg and 125 received 25 microg misoprostol. Demographics of the two study groups were similar.RESULTS:Patients in the 50 microg group had a shorter first stage (848 min vs. 1,122 min, P < 0.007), shorter induction-to-vaginal delivery interval (933 min vs. 1,194 min, P < 0.013), decreased incidence of oxytocin augmentation (53.9% vs. 68%, P < 0.015), and decreased total units of oxytocin (2,763 mU vs. 5,236 mU, P < 0.023), but there was a higher hyperstimulation rate (19% vs. 7.2%, P < 0.005).CONCLUSIONS:Successful induction rate, delivery types, and fetal outcome were similar in both groups. Although the rate of vaginal delivery and neonatal outcome were similar in both groups, the 50 microg regimen had shorter first and second stages of labor, and a higher hyperstimulation rate that was easily manageable, allowing for flexibility in using the higher dose in low-risk pregnancies.

BACKGROUND:We report the case of a 23-year-old pregnant woman with hemoptysis, cor pulmonale, and pulmonary artery sarcoma. The physiologic changes of pregnancy may have unmasked the pulmonary lesion.CASE:A 23-year-old woman presented at 28 weeks' gestation with acute onset of hemoptysis and dyspnea. A hilar mass was noted and a pulmonary embolus was diagnosed. Biopsy of the hilar mass was nondiagnostic. Emergency cesarean delivery was performed because of rapid clinical deterioration and an acute loss of fetal heart tones. Both mother and infant died. Autopsy of the mother demonstrated a large pulmonary artery sarcoma with metastases to both lungs and terminal bacterial bronchopneumonia.CONCLUSION:Hemodynamic changes of pregnancy may have unmasked the pulmonary lesion in this case. Pulmonary artery sarcoma is an extremely rare tumor.