Randomized clinical trial of metronidazole plus erythromycin to prevent spontaneous preterm delivery in fetal fibronectin–positive women

To estimate whether antibiotic treatment of asymptomatic women with a positive cervical or vaginal fetal fibronectin test in the second trimester would reduce the risk of spontaneous preterm delivery. Women were screened between 21 weeks 0 days and 25 weeks 6 days of gestation with cervical or vaginal swabs for fetal fibronectin. Women with a positive test (50 ng/mL or more) were randomized to receive metronidazole (250 mg orally three times per day) and erythromycin (250 mg orally four times per day) or identical placebo pills for 10 days. The primary outcome was spontaneous delivery before 37 weeks’ gestation after preterm labor or premature membrane rupture. A total of 16,317 women were screened for fetal fibronectin, and 6.6% had a positive test; 715 fetal fibronectin test–positive women consented to randomization. Outcome data were available for 703 women: 347 in the antibiotic group and 356 in the placebo group. The antibiotic and placebo groups were not significantly different for maternal age ( P = .051), ethnicity ( P = .849), marital status ( P = .127), education ( P = .244), and bacterial vaginosis ( P = .236). No difference was observed in spontaneous preterm birth before 37 weeks’ (odds ratio [OR] 1.17, 95% confidence interval [CI] 0.80, 1.70), less than 35 weeks’ (OR 0.92, 95% CI 0.54, 1.56), or less than 32 weeks’ (OR 1.94, 95% CI 0.83, 4.52) gestation in antibiotic- compared with placebo-treated women. Among women with a prior spontaneous preterm delivery, the rate of repeat spontaneous preterm delivery at less than 37 weeks’ gestation was significantly higher in the active drug compared with the placebo group (46.7% versus 23.9%, P = .039). Treatment with metronidazole plus erythromycin of asymptomatic women with a positive cervical or vaginal fetal fibronectin test in the late second trimester does not decrease the incidence of spontaneous preterm delivery

Randomized trial of inhaled beclomethasone dipropionate versus theophylline for moderate asthma during pregnancy

This study was undertaken to compare the efficacy of inhaled beclomethasone dipropionate to oral theophylline for the prevention of asthma exacerbation(s) requiring medical intervention. A prospective, double-blind, double placebo-controlled randomized clinical trial of pregnant women with moderate asthma was performed. There was no significant difference ( P = .554) in the proportion of asthma exacerbations among the 194 women in the beclomethasone cohort (18.0%) versus the 191 in the theophylline cohort (20.4%; risk ratio [RR] = 0.9, 95% CI = 0.6-1.3). The beclomethasone cohort had significantly lower incidences of discontinuing study medications caused by side effects (RR = 0.3, 95% CI = 0.1-0.9; P = .016), and proportion of study visits with forced expiratory volume expired in 1 second (FEV1) less than 80% predicted (0.284±0.331 vs 0.284±0.221, P = .039). There were no significant differences in treatment failure, compliance, or proportion of peak expiratory flow rate less than 80% predicted. There were no significant differences in maternal or perinatal outcomes. The treatment of moderate asthma with inhaled beclomethasone versus oral theophylline resulted in similar rates of asthma exacerbations and similar obstetric and perinatal outcomes. These results favor the use of inhaled corticosteroids for moderate asthma during pregnancy because of the improved FEV1 and because theophylline had more side effects and requires serum monitoring

The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure

Since publication of the 1980 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure,1 several events have occurred that affect successful management of hypertension: publication of major clinical trial results, introduction of new antihypertensive agents, evidence concerning effectiveness of nonpharmacologic treatment, and further analysis of the epidemiologic data-base relating BPs with the risk of premature morbidity and mortality. These events led the director of the National Heart, Lung, and Blood Institute (NHLBI), as chairman of the National High Blood Pressure Education Program Coordinating Committee, to establish a new Joint National Committee to revise earlier recommendations.This report includes recommendations on the following topics: (1) screening and referral procedures, (2) classification according to BPs, (3) use of nonpharmacologic therapies, (4) revised stepped-care approach, (5) management of mild hypertension, (6) patient-professional interaction, and (7) management of BP in special groups, including blacks, children, and pregnan