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At least 1,261 records · Page 70Linked to original sources
PubMed1995

Electromyographic activity in cervices with very low Bishop score during labor.

OBJECTIVES: To investigate the activity of the smooth muscles in the cervix at the onset of induced labor and to further elucidate this activity in relation to uterine contractions and to the duration of the latent phase of labor, taking cervical ripeness into account. METHODS: Cervical electromyographic (EMG) activity was studied at the onset of labor induced with amniotomy and oxytocin. Bipolar measurement of cervical electrical activity was performed. The root mean square of the cervical EMG activity and the intensity of intrauterine pressure in two groups of parturients with different cervical ripeness were compared. RESULTS: The EMG activity was higher in the group with lower Bishop scores. We found a significant positive correlation between EMG activity and duration of the latent phase of labor. CONCLUSION: Smooth muscles in the human cervix are active during labor and act to some extent independently of the uterine corpus.

Amnion↗
PubMed1987

Prostaglandin E2 vaginal suppository for induction of labour: an efficient, safe and popular method.

Two different methods for induction of labour were randomly used in 100 women with a favourable cervix. The patients were treated with either prostaglandin vaginal suppositories containing 2.5 mg PGE2 in a base of Witepsol S55 (Dynamit Nobel) or intravenous infusion of oxytocin. The PGE2 vaginal suppository was significantly more efficient than the intravenous infusion of oxytocin in relation to the time interval from the start of induction of labour to delivery. Also the percentage of women who delivered within 48 hours (success rate) was higher in the suppository group. Significantly more women in the suppository group found this induction method recommendable.

Dinoprostone↗
PubMed1995

Abu Dhabi third stage trial: oxytocin versus Syntometrine in the active management of the third stage of labour.

OBJECTIVE: To compare the effect of oxytocin and Syntometrine when used as part of active management of third stage of labour on postpartum haemorrhage, hypertension, nausea/vomiting and retained placenta. STUDY DESIGN: A randomised double blind trial was conducted in the Obstetric Unit of Corniche Hospital, Abu Dhabi in the United Arab Emirates. Between 1 January 1991 and 30 June 1991, 2040 women were randomly allocated either to the oxytocin (n = 1017) or the Syntometrine (n = 1023) group. Twelve patients had to be excluded from the trial (oxytocin, 5; Syntometrine, 7) after randomisation because they no longer fulfilled the inclusion criteria. All women in the trial received either oxytocin 10 units or Syntometrine 1 ml (oxytocin 5 units+ergometrine (ergonovine) 0.5 mg) by intramuscular injection with delivery of the anterior shoulder of the baby. Relative risk with 95% confidence intervals was calculated for each variable. RESULTS: Oxytocin (10 units) alone was as effective as Syntometrine (1 ml) in preventing post-partum haemorrhage without an increase in the incidence of retained placenta. Median blood loss was similar in both groups. The incidences of nausea, vomiting and headache were significantly lower in the oxytocin group, as was the occurrence of a mean rise in diastolic and systolic blood pressures of 20 and 30 mmHg or more, respectively. CONCLUSION: Prophylactic administration of oxytocin 10 U in the third stage of labour, as part of active management, reduces the incidence of maternal nausea, vomiting, headache and rise in blood pressure than does Syntometrine 1 ml without adversely affecting the rate of post partum haemorrhage.

Adult↗
PubMed1996

A randomized comparison of prostaglandin E2, oxytocin, and the double-balloon device in inducing labor.

OBJECTIVE: To compare the efficacy of three methods for ripening and dilating the unfavorable cervix for induction of labor. METHODS: Pregnant women having an indication for induction of labor with a singleton vertex fetus, intact membranes, and Bishop score of no more than 4 were randomized to one of three induction methods: intravaginal prostaglandin (PG) E2 tablets (3 mg) followed by a second dose if labor did not start; continuous intravenous oxytocin drip; or the Atad Ripener Device, with inflation of both balloons and removal after 12 hours. For all patients, the cervix was assessed by the same investigator before induction and 12 hours later. RESULTS: Thirty subjects were included in the PGE2 group, 30 in the oxytocin group, and 35 in the Atad Ripener Device group. The postpartum course was comparable in all. The change in Bishop score in the PGE2 and Atad Ripener Device groups was significantly better than in the oxytocin group (median and range of 5[0-9] and 5[0-7], respectively, versus 2.5 [0-9]; P < .01). Cervical dilation more than 3 cm was more frequent in the Atad Ripener Device group compared with both the PGE2 and oxytocin groups (85.7 versus 50 and 23.3%, respectively; P < .01). The trial of induction failed in only two patients (5.7%) in the Atad Ripener Device group, compared with six (20%) in the PGE2 and 16 (53.3%) in the oxytocin groups (P < .001). Mean (+/- standard deviation) induction-to-delivery interval was 21.3 +/- 7.0 hours in the Atad Ripener Device group, 23.2 +/- 12.5 hours in the PGE2 group, and 28.2 +/- 14.7 hours in the oxytocin group. The success rate for vaginal delivery was significantly better in the Atad Ripener Device and PGE2 groups compared with the oxytocin group (77.1 and 70%, respectively, versus 26.7%; P < .01). CONCLUSION: The Atad Ripener Device had a significantly better success rate for cervical dilation and a lower failure rate than those for PGE2 and oxytocin. The PGE2 and Atad Ripener Device groups had better results than the oxytocin group in regard to Bishop score change and induction-to-delivery interval. The Atad Ripener Device may be a superior method for cervical ripening and labor induction in patients with unfavorable cervices.

Adult↗
PubMed1996

Prostaglandin E2 gel for cervical ripening in patients with an indication for delivery.

OBJECTIVE: To determine if labor can be induced safely and efficiently in patients with a medical or obstetric indication for delivery before 41 completed weeks of gestation by pre-induction cervical ripening with prostaglandin (PG) E2 gel. METHODS: One hundred eighteen women with confirmed indication for induction of labor before 41 completed weeks were randomized in a double-blind fashion to either intracervical PGE2 gel or placebo before induction by a standard oxytocin protocol. Data regarding the change in Bishop score, interval to complete dilation, maximal oxytocin dose required to establish labor, and route of delivery were collected. Apgar scores and umbilical artery pH were also recorded. RESULTS: The maximum oxytocin dose required to establish progressive labor was significantly lower in the PGE2 group (10.06 +/- 8.50 versus 13.35 +/- 9.27 mU/minute, P = .014). The cesarean rate was also significantly lower in the PGE2 group (13.1 versus 31.6%, P = .016). CONCLUSION: Pre-induction intracervical deposition of 1 mg PGE2 gel decreased the amount of oxytocin required to induce progressive labor and decreased the cesarean rate in patients who had medical or obstetric indications for delivery before 41 completed weeks. This was accomplished without negative effect on Apgar score or umbilical artery pH.

Adult↗
PubMed1996

Cervical priming with oral misoprostol in pre-labor rupture of membranes at term.

OBJECTIVE: To investigate the effectiveness of oral misoprostol as a cervical priming agent for patients presenting with pre-labor rupture of membranes at term. METHODS: Eighty patients presenting with pre-labor rupture of membranes at term were randomized to receive either 200 micrograms of misoprostol or 50 mg of vitamin B6 orally 1 hour after admission. Labor was induced with intravenous oxytocin infusion 12 hours after oral medication if the patient did not go into labor. We compared the induction rate, duration of labor, mode of delivery, and leaking-to-delivery interval in the two groups. RESULTS: The cervical score was significantly improved and the induction rate was also reduced in the misoprostol group when compared with the control group. The interval from recruitment to onset of labor, duration of labor, and the interval from recruitment to delivery were significantly shorter in the misoprostol group. The mode of delivery and the perinatal outcome were similar for the two groups. CONCLUSION: Oral misoprostol is an effective agent for cervical priming and labor induction in patients with pre-labor rupture of membranes at term.

Administration, Oral↗
PubMed1996

The noninvasive diagnosis and management of a uterine arteriovenous malformation.

BACKGROUND: Successful nonsurgical therapy of uterine arteriovenous malformations is rare, with most cases being diagnosed at hysterectomy. CASE: A uterine arteriovenous malformation was diagnosed by Doppler ultrasound, and its resolution after 1 week of treatment with methylergonovine maleate was observed. CONCLUSION: Although there are case reports regarding treatment of uterine arteriovenous malformations by embolization performed by interventional radiology, to our knowledge, the noninvasive long-term management of a uterine arteriovenous malformation has not been reported.

Adult↗
PubMed1996

Latent labor with an unknown uterine scar.

OBJECTIVE: To determine if avoiding the augmentation of ineffective contractions in women with unknown uterine scars would decrease the risk of cesarean for protraction disorders, compared with awaiting the onset of spontaneous labor. METHODS: Term gravidas with one or two unknown uterine scars in early labor were randomized to nonintervention (N = 101) and intervention (N = 96) groups. Nonintervention subjects were discharged if cervical change did not occur within 4 hours. Intervention subjects were admitted. Contractions that persisted for 4 hours without cervical change were augmented with oxytocin. RESULTS: Intervention subjects received oxytocin significantly more often (82 versus 55%, P < .001) and had a statistically significantly higher rate of uterine scar separation (5 versus 0%, P = .03). There was no difference between the two groups in length of active labor (4.0 versus 4.25 hours) or incidence of cesarean delivery (16 versus 17%). CONCLUSION: The augmentation of ineffective contractions during latent labor in gravidas with an unknown uterine scar does not increase the rate of cesarean delivery, but it is significantly more likely to result in uterine scar separations.

Adult↗
PubMed1996

Vaginal misoprostol for induction of labor: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness and safety of the vaginal application of misoprostol for induction of labor at term, with the interval duration from labor induction to vaginal birth as the primary outcome measure. METHODS: Two hundred twenty-two women with indications for induction of labor at term were randomized to receive either misoprostol 50 micrograms per vagina every 4 hours as needed or our standard approach (physician-chosen combinations of intracervical or vaginal dinoprostone every 6 hours, artificial rupture of membranes, and oxytocin infusion). RESULTS: Mean (+/-standard deviation) time to vaginal delivery was 753 +/- 588 minutes for misoprostol versus 941 +/- 506 minutes for the physician-chosen combination (P = .018). Oxytocin infusion was used less frequently (relative risk [RR] 0.48, 95% confidence interval [CI] 0.31-0.74). There was no significant difference in cesarean rate or maternal morbidity. Neonatal outcomes, including cord-blood acid-base analysis, were not significantly different. The estimated cost per patient in Canadian dollars for prostaglandins was $0.22 with misoprostol and $70.00 with standard therapy. CONCLUSION: Vaginal misoprostol is a cost-effective alternative to current labor-induction protocols. We found no evidence of harm to mother or newborn in substantive outcomes.

Administration, Intravaginal↗
PubMed1996

Clinical amnionitis and endometritis in patients with premature rupture of membranes: endocervical prostaglandin E2 gel versus oxytocin for induction of labor.

OBJECTIVE: To compare the rates of clinical amnionitis and endometritis in patients with premature rupture of membranes (PROM), using endocervical prostaglandin E2 (PGE2) gel for induction of labor versus immediate oxytocin induction of labor. METHODS: We randomized 118 patients to receive either endocervical 0.5 mg of PGE2 gel (study group) or immediate oxytocin induction of labor (control group). If labor was not established in the group receiving PGE2 gel in 24 hours, intravenous oxytocin was given in incremental doses. The rates of clinical amnionitis and endometritis in the two groups were analyzed. Also compared were hours of labor, duration of rupture of membranes and number of vaginal examinations. Student t test, chi 2, or Wilcoxon rank-sum test were used for statistical analysis, as appropriate. P < .05 was considered significant. RESULTS: The rates of clinical amnionitis were 5.3% in the PGE2 group and 8% in the control group. Endometritis developed in 1.7% of PGE2 patients and 3.2% of controls. These differences in maternal infection rates were not statistically significant. The two groups were comparable with respect to age, parity, and antepartum group B streptococcal colonization. No significant differences in hours of labor, duration of ruptured membranes, or vaginal examinations were observed. Neonatal outcome data (mean birth weight, Apgar scores at 1 and 5 minutes, Apgar score less than 7 at 5 minutes) were not statistically significant. CONCLUSION: Endocervical placement of 0.5 mg of PGE2 gel does not increase the incidence of clinical amnionitis and endometritis in patients with PROM at term when compared with immediate induction of labor with oxytocin.

Administration, Topical↗
PubMedDate not supplied

Characterization and ontogeny of PGE2 and PGF2 alpha receptors on the retinal vasculature of the pig.

The vasoconstrictor effects of PGE2 and PGF2 alpha are less pronounced on retinal vessels of the newborn than of the adult pig. We tested the hypothesis that the decreased vasomotor response to these prostaglandins might be due to relatively fewer receptors and/or different receptor subtypes (in the case of PGE2) on retinal vessels of the newborn animal. Binding studies using [3H]PGE2 and [3H]PGF2 alpha revealed that PGE2 (EP) and PGF2 alpha (FP) receptor densities in retinal microvessel membrane preparations from newborn animals were approximately 25% of those found in vessels from the adult. The Kd for PGF2 alpha did not differ; however, the Kd for PGE2 was less in newborn than in adult vessels. Competition binding studies using AH 6809 (EP1 antagonist), butaprost (EP2 agonist), M/+B 28,767 (EP3 agonist), and AH 23848B (EP4 antagonist) suggested that the retinal vessels of the newborn contained approximately equal number of EP1 and EP2 receptor subtypes whereas the main receptor subtype in the adult vessels was EP1. In addition, PGE2 and butaprost produced comparable increases in adenosine 3',5'-cyclic monophosphate synthesis in newborn and adult vessels. PGE2, 17-phenyl trinor PGE2 (EP1 agonist) and PGF2 alpha caused a 2.5 to 3-fold greater increase in inositol 1,4,5-triphosphate (IP3) formation in adult than in newborn preparations. It is concluded that fewer PGF2 alpha receptors and an associated decrease in receptor-coupled IP3 formation in the retinal vessels of the newborn could lead to weaker vasoconstrictor effects of PGF2 alpha on retinal vessels of the newborn than of adult pigs; fewer EP1 receptors (associated with vasoconstriction) and a relatively greater proportion of EP2 receptors (associated with vasodilation) might be responsible for the reduced retinal vasoconstrictor effects of PGE2 in the newborn.

Age Factors↗
PubMed1994

Evaluation of the meta-analyses on the effects, on both mother and baby, of the various components of 'active' management of the third stage of labour.

In their comprehensive review of controlled trials, Prendiville and Elbourne (1989) used the technique of meta-analysis to study the effects, on both mother and baby, of various aspects of third stage management, acknowledging some of the shortcomings of the trials used. This paper questions some of the conclusions which these authors drew and, drawing on other evidence (some of which has been published since the review), puts forward alternative interpretations of some of the meta-analyses. Reference is also made to the updated meta-analyses in the Cochrane Pregnancy and Childbirth Database (Elbourne, 1994a-h). In addition, this paper examines the extent to which the findings of the Bristol and Dublin third stage trials (Prendiville et al, 1988; Begley, 1990) add to our understanding of what is effective care during the third stage of labour.

Clinical Trials as Topic↗
PubMed1996

Intraumbilical vein injection of prostaglandin F2 alpha in retained placenta.

A randomized protocol was used to study the effect of intraumbilical prostaglandin F2 alpha (Hembate, Upjohn) and oxytocin injection in women with retained placenta. Prostaglandin F2 alpha, 20 mg, diluted to 20 ml in normal saline solution (10 women, group 1), 30 IU of oxytocin, diluted to 20 ml in normal saline solution (11 women, group 2), or 20 ml of normal saline solution alone (7 women, group 3), were injected into the umbilical vein 1 h after delivery. Nine women (group 4, controls) underwent manual removal of the retained placenta. In group 1, placental expulsion occurred in all patients and the duration of the placental expulsion after prostaglandin F2 alpha injection was 6.8 +/- 1.36 (mean +/- SE) min: in group 2, six placental expulsions occurred after 13.3 +/- 1.97 min (mean +/- SE); and in group 3, no effect was recorded after intraumbilical saline injection. We suggest that intraumbilical vein injection of prostaglandin F2 alpha might be a beneficial, non-surgical method for treating retained placenta. Oxytocin might reduce the incidence of manual lysis of the placenta and achieve partial success.

Adult↗