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Periodontal DiseaseRaises Preterm Risk 
BY BETSY BATES
 Los Angeles Bureau
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. — Every prepregnancy consultationshould include a recommenda-tion for a full periodontal exam-ination, and patients should bemonitored throughout pregnan-cy for signs ofperiodontal dis-ease, Todd Hartsfield, D.D.S.,recommended.Evidence compiled from manystudies suggests that maternalperiodontal disease may be re-sponsible for 18% ofpreterm,low-birth-weight deliveries, hesaid at a meeting ofthe Obstet-rical and Gynecological Assem- bly ofSouthern California.Moreover, research suggeststhat in patients with periodonti-tis during the second trimester,deep instrumental cleaning,known among dentists as scaling and root planing, may substan-tially lower the risk ofpretermdelivery.Many ofthe studies detailing periodontal risk have appearedin dental journals that obstetri-cians never see, said Dr. Harts-field, director ofthe Dental Clin-ical and Prevention SupportCenter ofthe Inter TribalCoun-cil ofArizona in Phoenix.“I’d like to see more interplay between our professions,” Dr.Hartsfield said during a speciallecture at the meeting.“The dentist and dental hy-gienist should be a part ofthehealth team that is involved incaring for expectant mothers.”He recommended several pa-tient brochures offered by the American Dental Association, in-cluding “Women and Gum Dis-ease,” “What is Scaling and RootPlaning?” and “Gum Disease:The Warning Signs.”Dr. Hartsfield also suggested joint meetings oflocal dental andob.gyn. societies, and sessions inwhich dentists and dental hy-gienists could teach ob.gyn. nurs-es and practitioners to conduct“quick look” oral screenings dur-ing each routine prenatal visit.
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Periodontitis may cause 18% of preterm, low-birth-weightdeliveries; treatment in the second trimester may lower that risk.
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Periodontal
 page 4
1%2%3%4%5%
All itemsMedical care2003200220012000
Medical Care Spending Outstrips Inflation
Note: Based on Consumer Price Index (CPI) data from the Bureau ofLabor Statistics.Source: Centers for Disease Control and Prevention
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The Leading Independent Newspaper for the Obstetrician/Gynecologist—Since 1966
M
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15, 2005
 
www.eobgynnews.com
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BY ROBERT FINN
San Francisco Bureau
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. —Therapy with17
D
-hydroxyprogesteronecaproate to prevent recurrentpreterm birth is associated withan overall prolongation ofpreg-nancy, especially in women witha prior spontaneous birth before34 weeks’ gestation, CatherineY. Spong, M.D., reported.Weekly injections of17
D
-hy-droxyprogesterone caproate(17P) was associated with an av-erage pregnancy prolongationof1.5 weeks in women whoseearliest prior preterm birth was before 34 weeks’ gestation, shesaid at the annual meeting of the Society for Maternal-FetalMedicine.Women whose earliest priorpreterm birth was between 34and 37 weeks’ gestation exhibit-ed a trend toward a statisticallysignificant prolongation ofges-tation, but this did not reach sta-tistical significance, according toDr. Spong ofthe National Insti-tute ofChild Health and HumanDevelopment, Bethesda, Md.The study involved a sec-ondary analysis ofa double-masked, placebo-controlled trial
 Largest increase seen after fourth delivery.
Maternal MorbidityRises Sharply WithRepeat Cesareans
17P: Best for Prior PretermBirths Before 34 Weeks
BY ROBERT FINN
San Francisco Bureau
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. — Maternalmorbidity increases significantlywith each subsequent cesareandelivery, according to a largeprospective cohort study report-ed by Robert M. Silver, M.D., atthe annual meeting ofthe Soci-ety for Maternal-Fetal Medicine.Moreover, morbidity ratesshow a particularly large in-crease with the fourth and sub-sequent cesarean deliveries, ac-cording to the study, which was based on data from the MaternalFetal Medicine Units (MFMU)Network, created by the Na-tional Institute ofChild Healthand Human Development.The central conclusion ofthisstudy is that “the number ofin-tended pregnancies should be fac-tored into consideration ofpri-mary elective cesarean deliveryor attempted vaginal birth aftercesarean,” said Dr. Silver oftheUniversity ofUtah, Salt LakeCity.In addition, the study suggeststhat physicians should give seri-ous thought to a trial oflabor inwomen who are candidates for afirst cesarean delivery and whoare planning to have severalchildren.Ofthe 378,168 births followedprospectively by the 14 tertiarycare centers in the MFMU Net-work, there was a total of57,068
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