Our findings show that utilization of the Bakri balloon is associated with a decreased rate of postpartum hysterectomy.

<b><i>Introduction:</i></b> Approximately 47% of women with an episode of preterm labor deliver at term; however, their infants are at greater risk of being small for gestational age and for neurodevelopmental disorders. In these cases, a pathologic insult may disrupt the homeostatic responses sustaining pregnancy. We tested the hypothesis of an involvement of components of the insulin-like growth factor (IGF) system. <b><i>Methods:</i></b> This is a cross-sectional study in which maternal plasma concentrations of pregnancy-associated plasma protease (PAPP)-A, PAPP-A2, insulin-like growth factor-binding protein 1 (IGFBP-1), and IGFBP-4 were determined in the following groups of women: (1) no episodes of preterm labor, term delivery (controls, <i>n</i> = 100); (2) episode of preterm labor, term delivery (<i>n</i> = 50); (3) episode of preterm labor, preterm delivery (<i>n</i> = 100); (4) pregnant women at term not in labor (<i>n</i> = 61); and (5) pregnant women at term in labor (<i>n</i> = 61). Pairwise differences in maternal plasma concentrations of PAPP-A, PAPP-A2, IGFBP-1, and IGFBP-4 among study groups were assessed by fitting linear models on log-transformed data and included adjustment for relevant covariates. Significance of the group coefficient in the linear models was assessed via t-scores, with <i>p</i> &lt; 0.05 deemed a significant result. <b><i>Results:</i></b> Compared to controls, (1) women with an episode of premature labor, regardless of a preterm or a term delivery, had higher mean plasma concentrations of PAPP-A2 and IGFBP-1 (each <i>p</i> &lt; 0.05); (2) women with an episode of premature labor who delivered at term also had a higher mean concentration of PAPP-A (<i>p</i> &lt; 0.05); and (3) acute histologic chorioamnionitis and spontaneous labor at term were not associated with significant changes in these analytes. <b><i>Conclusion:</i></b> An episode of preterm labor involves the IGF system, supporting the view that the premature activation of parturition is a pathologic state, even in those women who delivered at term.

INTRODUCTION: With increasing rates of cesarean sections throughout the country, the importance of preventing them has become a priority to all physicians. After the Consensus report by ACOG and the Society for MFM was published in March, 2014, we decided to utilize the recommendations in our labor and delivery department to attempt to reduce our Nulliparous, Term, Singleton, Vertex (NTSV) cesarean delivery rate over a one year time period. Our NTSV cesarean section rate in 2013 was 35%. Our benchmark was set at less than 24%.METHODS: 1) Recommendations and were made to the entire department regarding appropriate management of the first and second stages of labor. 2) Guidelines were set for elective inductions of labor between 39 0/7 weeks and 41 0/7 weeks to only allow those with bishop scores greater than 8. 3) Departmental and individual provider NTSV rates were shared with all physicians in an un-blinded fashion on a quarterly basis.RESULTS: Over a one-year time period we were able to reduce our NTSV cesarean section rates from 35% to 29.4%. Our second quarter of this year was 28.7%.CONCLUSION: While we have yet to reach our benchmark, we were able to decrease our NTSV cesarean section rates by over 5% in a one-year period. We continue to evaluate our procedures and educate our clinicians in an effort toward decreasing our NTSV cesarean section rate.