Fetal growth restriction is associated with a shortened interval to delivery in women undergoing expectant management of preeclampsia when disease is diagnosed prior to 34 weeks. These data may be helpful in counseling patients regarding the expected duration of pregnancy, guiding decision making regarding administration of steroids and determining the need for maternal transport.

Objective: To determine the association between biomarkers of ovarian reserve and luteal phase deficiency (LPD). Design: Secondary analysis of a prospective time-to-conceive cohort study. Setting: Not applicable. Patient(s): Women attempting conception, aged 30-44 years, without known infertility. Intervention(s): Measurement of early follicular phase serum levels of antim€ ullerian hormone, FSH, inhibin B, and E 2. Main Outcome Measure(s): The primary outcome was LPD, defined by luteal bleeding (LB) (R1 day of LB) or a short luteal phase length (%11 days). Result(s): Overall, 755 women provided information on 2,171 menstrual cycles and serum for measurement of at least one biomarker of ovarian reserve. There were 2,096 cycles from 754 women in the LB cohort, of which 40% experienced LB. After adjusting for age, race, previous miscarriages, and previous pregnancies, diminished ovarian reserve (DOR) was not significantly associated with LB. Low early follicular phase FSH levels increased the odds of LB (odds ratio [OR] 1.84; 95% confidence interval [CI] 1.25-2.71), as did high early follicular phase E 2 levels (OR 1.59; 95% CI 1.26-2.01). A total of 608 cycles from 286 women were included in the analysis of luteal phase length, of which 13% had a short luteal phase. After adjusting for age, there was no significant association between DOR and a short luteal phase. The risk of a short luteal phase decreased with increasing inhibin B (OR 0.61; 95% CI 0.45-0.81). Conclusion(s): Although DOR is not associated with LPD, hormone dysfunction in the early follicular phase may contribute to LPD in women of older reproductive age. (Fertil Steril Ò 2019;112:378-86. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

With the participation of four Swiss obstetric clinics, medically indicated inductions of birth (with living fetuses) were performed using a new, stable PGE2 gel, and documented according to a uniform protocol. The study was conducted to investigate the efficacy of 0.5 mg of PGE2, in 2.5 ml of a vehicle (Triacetin) not yet commercially available, for local cervical maturation (n = 41). Thirty-nine patients selected by prospective randomization, in whom birth was induced conventionally, served as a control group. The efficiency of the prostaglandin gel alone or respectively with additional administration of oxytocin was evaluated on the basis of the clear changes in the cervical findings observed within 12 or respectively 24 hours, the spontaneous births, or, in the case of cesarean deliveries, according to the pelvic score. Application of PGE2 alone led to impressive changes of the cervix score and, in 34 of the 41 cases, to regular contractions after an average time of 87 minutes. After 12 hours, prior to administration of oxytocin, 43% of the patients were already delivered. The combination of locally applied PGE2 gel with conventional oxytocin induction significantly increases the number of successful inductions. The percentage of unsuccessfully attempted inductions was reduced to 24% in the PGE2 gel group as compared to 44% in the control group.

BACKGROUND: Cervical cerclage placement has been shown to benefit women who have cervical insufficiency; however, the best type of suture to use for transvaginal cerclage placement is unknown. OBJECTIVE: The objective of the study was to evaluate the association between transvaginal cerclage suture thickness and pregnancy outcomes. STUDY DESIGN: This was a retrospective cohort study of women with a singleton, nonanomalous gestation who underwent history-, ultrasound-, or physical examinationeindicated transvaginal cerclage at a single tertiary care center (2013e2016). The primary outcome was gestational age at delivery. Secondary outcomes included preterm birth less than 34 weeks, chorioamnionitis, neonatal intensive care unit admission, and composite neonatal morbidity. Baseline characteristics and outcomes were compared by thickness of suture material: thick 5 mm braided polyester fiber (Mersilene tape) vs thin polyester braided thread (Ethibond) or polypropylene nonbraided monofilament (Prolene) with selection of suture type at the discretion of the provider. The association between thick suture and gestational age at delivery was estimated using Cox proportional hazard regression. Multivariable logistic regression was used to estimate the association between thick suture and the secondary outcomes. Effect modification of cerclage indication was also assessed. RESULTS: A total of 203 women met inclusion criteria: 120 with thick suture (59%) and 83 with thin suture (41%). Of these, 130 women had history-indicated, 35 had ultrasound-indicated, and 38 had examination-indicated cerclages. Compared with women who had thin suture, women with thick suture were more likely to have had a history-or ultrasoundindicated cerclage, rather than examination-indicated cerclage, and more likely to have had a Shirodkar or cervicoisthmic approach, rather than McDonald. Women with thick suture were also more likely to have received progesterone and had placement at earlier gestational age, but there were no differences in cervical examination at placement. After adjusting for confounding factors, thick suture was associated with longer pregnancy duration among women with ultrasound-indicated cerclage (adjusted hazard risk, 0.61, 95% confidence interval, 0.41e0.91) and examination-indicated cerclage (adjusted hazard risk, 0.30, 95% confidence interval, 0.15e0.58) but not with history-indicated cerclage (adjusted hazard risk, 1.27, 95% confidence interval, 0.83e1.94). Thick suture was also associated with lower odds of preterm birth <34 weeks, chorioamnionitis, and neonatal intensive care unit admission, compared with thin suture. CONCLUSION: Thick, compared with thin suture, for transvaginal cervical cerclage, was associated with longer duration of pregnancy among women with ultrasound-and examination-indicated cerclages and lower odds of chorioamnionitis and neonatal intensive care unit admission among all women, regardless of cerclage indication.

IOL are independently associated with a higher CD risk as compared to deliveries following IOL at 39 weeks' gestation.