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Results of this study provided insights into the natural course of fatigue and HRQoL postpartum. Important differences in fatigue and HRQoL scores were observed between the 3 modes of delivery. These HRQoL measures can be used in future clinical trials to assess the effects of interventions postpartum.

Five patients with vital, unruptured interstitial pregnancies of less than 3 cm maximum diameter were treated successfully with methotrexate and leucovorin rescue. Four pregnancies showed cardiac activity. Diagnosis was established with transvaginal ultrasonography in all patients. The human chorionic gonadotrophin serum levels were measured to monitor the effectiveness of therapy. This is the first publication on methotrexate treatment for interstitial twin pregnancy and the first on instillation of methotrexate after puncture and aspiration of interstitial pregnancy. In all cases, total and uneventful regression of trophoblast tissue was achieved. No adverse reactions were observed. The advantages and drawbacks of these therapeutic approaches are discussed. Methotrexate appears to be an effective medical non-surgical treatment for unruptured interstitial pregnancy with or without cardiac activity, and preserves reproductive potential.

morbidities (sepsis, respiratory distress syndrome, pneumonia, acidosis, intraventricular and subgaleal hemorrhage, and trauma). There were no maternal or neonatal deaths. Multivariate analysis showed that variables associated with a failed TOL included epidural use [odds ratio (OR) 1.96; 95% confidence interval (CI), 1.2-3.2], birthweight >4000 g (OR 2.65; 95% CI, 1.70-4.13), and Asian and African American ethnicity (OR 1.7; 95% CI, 1.1-2.7 and OR 2.1; 95% CI, 1.2-3.6, respectively). Oxytocin and prostaglandin use for labor induction were not significantly associated with a failed TOL. Parity and prior vaginal births remained associated with a reduced risk of failed TOL.The authors concluded that failed TOL in women at term with prior CS is associated with increased maternal and neonatal morbidities. These risks, including the risk of uterine rupture, and the benefits of a successful TOL, play a role in a woman's decision to pursue a VBAC. Elective repeat CS is an established and widely accepted option, but its benefits and risks also must be considered.

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