In this cohort of young women with rheumatologic disease, more women with prior CYC than without had amenorrhea, nulliparity, and infertility. GnRH-a co-therapy may prevent these adverse effects of CYC.

We report on a child with dextrocardia, atrial septal defect (ASD), severe developmental delay, hypotonia, 13 pairs of ribs, left preauricular choristoma, hirsutism, and craniofacial abnormalities. Prenatal cytogenetic evaluation showed karyotype 46,XY,?dup(8p)ish del(8)pter. Postnatal array CGH demonstrated a 6.8 Mb terminal deletion at 8p23.3–p23, an interstitial 31.1 Mb duplication within 8p23.1–p11, and a terminal duplication of 0.24 Mb at 22q13.33, refining the karyotype to 46,XY,der(8)dup(8)(p23.1p11.1)t(8;22)(p23.1;q13.1).ish der(8)dup(8)(p23.1p11.1)t(8;22)(p23.1;q13.1) (D8S504‐,MS607 + ,ARSA + ,D8Z1 + , RP115713 + +). Previous reports of distal 8p deletion, 8p duplication, and distal 22q duplication have shown similar manifestations, including congenital heart disease, intellectual impairment, and multiple minor anomalies. We correlate the patient's clinical findings with these particular areas of copy number. This case study supports the use of aCGH to identify subtle chromosomal rearrangement in infants with cardiac malformation as their most significant or only apparent birth defect. Additionally, it illustrates why aCGH is essential in the description of chromosome rearrangements, even those seemingly visible via routine karyotype. This method shows that there is often greater complexity submicroscopically, essential to an adequate understanding of a patient's genotype and phenotype. © 2012 Wiley Periodicals, Inc.

INTRODUCTION: Elective induction of labor has increased over time resulting in higher cesarean delivery rates. Maternal and neonatal outcomes of pregnancies undergoing pre-induction cervical ripening at 39 weeks were compared with those induced at later gestational ages. METHODS: Retrospective cohort study of singleton pregnancies induced without a medical indication and a Bishop score less than 8 or simplified Bishop score less than 5 at 39 0/7-6/7, 40 0/7-6/7, and 41 0/7-6/7 weeks between 2006 and 2015. Specific individual maternal and neonatal outcomes were compared. Chi-square, One-way ANOVA, and Fisher exact test were used for statistical analysis. RESULTS: Of the 718 identified pregnancies, 143 (19.9%) were induced at 39 weeks, 240 (33.4%) at 40 weeks, and 335 (46.6%) at 41 weeks. Nulliparity was significantly higher in the 41-week group than in the 40-, and the 39-week groups (78.8%, 64.5%, and 37.7%, respectively; P < .00001). Among nulliparous women, cesarean delivery was significantly lower at 39 weeks (27.7%) than at 40 weeks (34.4%), and at 41 weeks (47.7%) (P=.0003). Conversely, cesarean delivery rate was low and not significantly different among multiparous women at each of the gestational age groups. Postpartum hemorrhage and chorioamnionitis rates were significantly higher at 41 weeks compared with the other groups (all P < .0001). NICU admission, 5-minute Apgar scores less than 7, respiratory distress syndrome, and neonatal death rates did not differ significantly among the groups. CONCLUSION: Elective induction of labor at 39 weeks with unfavorable cervix was associated with favorable maternal outcomes and low cesarean delivery rate.