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PubMed1988

Discordant accelerated pulmonary maturation after adrenocorticotropic hormone-induced labor in twin sheep fetuses.

To examine the role of parturition on lung maturation in sheep, we studied parameters of lung development in singleton fetuses treated with pulsatile adrenocorticotropic hormone or saline solution from day 127 or twin pregnancies in which one fetus only received pulsatile adrenocorticotropic hormone from day 127 until labor occurred. These parameters were compared with those of term fetuses (145 days). Pulsatile adrenocorticotropic hormone provoked labor in a mean (+/- SEM) of 102.6 +/- 6.6 and 181.0 +/- 18.0 hours in single and twin pregnancies, respectively. Adrenal/body weight ratios increased similarly in adrenocorticotropic hormone-treated single and twin fetuses at delivery, and basal cortisol levels were two- to threefold higher prepartum in adrenocorticotropic hormone-treated fetuses. Little change in plasma cortisol levels occurred in singletons treated with saline solution or in twins not infused with adrenocorticotropic hormone. The lung weight/body weight was not altered in any group. Lung distensibility and stability were doubled to term values in fetuses treated with pulsatile adrenocorticotropic hormone compared with controls and untreated twins. Mean lavage phosphatidylcholine levels rose from 0.07 to 0.11 mg/gm in saline solution-treated or untreated fetuses to 0.20 to 0.23 mg/gm in pulsatile adrenocorticotropic hormone-treated singletons or twins, compared with 0.63 mg/gm at term. Phosphatidylcholine production increased from 0.51 dpm/gm/hr in saline solution-treated fetuses to 0.73 and 0.89 dpm/gm/hr in the single and twin pulsatile adrenocorticotropic hormone-infused fetuses, respectively; phosphatidylcholine production was 0.62 dpm/gm/hr in the noninfused twin. Lungs of twins treated with pulsatile adrenocorticotropic hormone were morphologically more mature than those of untreated twins. We conclude that fetal endocrine responses to exogenous adrenocorticotropic hormone, rather than the stimuli associated with labor per se, are responsible for lung maturation in the fetal sheep.

Adrenocorticotropic Hormone↗
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↗
PubMed1975

Secretion rate of prostaglandin F during induced labor in goats.

Relationships between plasma flow and plasma concentrations of prostaglandin F were examined in the utero-ovarian veins of three pregnant goats. Plasma flow, measured by veno-arterial dilution of para-Aminohippurate in two goats, was unchanged or increased slightly when PGF concentrations were elvated by short-term infusions of PGF2alpha into a uterine vein. Utero-ovarian plasma flow was measured during labor in two goats. Flow doubled during advanced labor and then decreased sharply to very low rates during the terminal expulsive phase of stage II labor. A total of 8.3 and 9.5 mg PGF was released into the utero-ovarian vein of two goats during the last 6 hours before fetal delivery and maximal release rates of approximately 100 ug. min-1 were obtained some 5-10 minutes before delivery was completed. The highest plasma concentrations of PGF were detected immediately after completion of fetal delivery when utero-ovarian plasma flows were lowest.

Adrenocorticotropic Hormone↗
PubMed1976

On the influence of prostaglandin F2alpha-induced labor at term on the metabolism and coagulation of mother and fetus.

11 pregnancies at term were terminated by dilatation of the uterine cervix, low amniotomy, and by intravenous administration of PGF2alpha. The average infusion time was 3 hours 55 minutes, and the average total dose of PGF2alpha amounted to 2.0 mg. Parameters of acid-base changes, carbohydrate and energic state changes, gas metabolism, and changes in coagulation and fibrinolysis in mother and in fetus were analyzed during labor and after birth. Labor activity and fetal cardiac action were monitored cardiotocographically. Checked against 50 uncomplicated spontaneous deliveries, we found no disadvantageous changes in the parameters investigated.

Acid-Base Equilibrium↗
PubMed1981

Effects of prostaglandin F2 alpha or oxytocin on serum estriol and its conjugates during induced labor.

Twelve patients underwent induction of labor at term, seven by prostaglandin F2 alpha (PGF) and five by oxytocin infusion. Serum samples were drawn before induction and at two hour intervals after infusion was started, throughout labor. The samples were analyzed for estriol (E3) and its principal conjugates, estriol-3-sulfate (E3-3S), estriol-16-glucosiduronate (E3-16G), estriol-3-glucosiduronate (E3-3G), and estriol-3-sulfate-16-glucosiduronate (E3-SG). No significant changes occurred before eight hours of infusion. Two pre-eclamptic patients showed a 100% increase in serum E3 while receiving PGF. The increases correlated best with rising levels of E3-SG. None of the five pre-eclamptic patients given oxytocin showed this striking changes. These observations raise the possibility that PGF may alter the metabolism of estriol in pre-eclamptic patients, during labor.

Estriol↗
PubMed1997

A double-blind comparison of the safety and efficacy of intravaginal misoprostol and prostaglandin E2 to induce labor.

OBJECTIVE: Our purpose was to compare the safety and efficacy of intravaginally administered misoprostol versus prostaglandin E2 for labor induction in a double-blind, randomized trial. STUDY DESIGN: One hundred three patients with indications for labor induction (including prelabor rupture of membranes) were randomized and received either misoprostol 50 micrograms or prostaglandin E2 (dinoprostone) 3 mg intravaginally. The dose was repeated 6, 24, and 30 hours after the first dose until active labor was achieved. For proper blinding, the drugs were prepared as identical-looking vaginal tablets. RESULTS: With use of a random number-generated table 52 patients were allocated to the misoprostol group and 51 to the prostaglandin E2 group. After exclusion of 3 patients, 50 in each group were evaluated. Delivery within 24 hours after administration occurred more often in the misoprostol group (70% vs 46% in the prostaglandin E2 group, p = 0.009), and fewer patients in this group needed more than two doses (12% vs 30%, p = 0.027). No difference in cesarean section rate (12% vs 14%, p = 0.67), fetal heart rate anomalies (33% vs 34%, p = 0.89), tachysystole (8% vs 14%, p = 0.37), hyperstimulation syndrome (0% vs 2%, not significant), meconium passage (28% vs 18%, p = 0.22), and fetal outcome (Apgar score at 1 and 5 minutes, arterial and venous umbilical cord blood pH, transfer to neonatal intensive care unit) was noted between the two groups. CONCLUSION: Intravaginal misoprostol is a safe drug for labor induction with superior effectiveness compared with intravaginal prostaglandin E2.

Administration, Intravaginal↗
PubMed2001

Physicians who induce labor for fetal macrosomia do not reduce cesarean delivery rates.

OBJECTIVE: To determine whether obstetricians with high rates of induction for the indication of fetal macrosomia had higher or lower cesarean section rates. STUDY DESIGN: Data were analyzed from 1432 deliveries with birthweights > 4000 g. Four physician populations were identified: a faculty service and three groups of private practitioners with induction rates 20% to 40%, 40% to 60% and > 60%. The average cesarean section rate was determined for each group as well as the percentage of each group's deliveries occurring before 39 weeks, at 39, at 40, and after 40 weeks. In addition, the relative risk of cesarean delivery was calculated for the entire study population. RESULTS: No correlation was found between the rate of induction of labor and the rate of cesarean section. Delivery of nulliparous and multiparous patients after 40 weeks carried an increased risk of cesarean section. Delivery of multiparous patients before 39 weeks did also. Obstetricians with induction rates > 40% significantly decreased the incidence of delivery after 40 weeks, which lowered their cesarean section rates, but no net lowering occurred because of increased rate of cesarean section < 39 weeks. CONCLUSION: A fetal weight of 4000 g or more is not an indication for induction of labor. For multiparous patients, induction at 38 weeks or before is associated with an increased rate of cesarean delivery.

Cesarean Section↗
PubMed1996

[Prostaglandin-induced labor--is the prostaglandin E2 vaginal gel a "new" alternative?].

In Germany, intracervical application of 0.5 mg PGE2 gel and the 3 mg PGE2 vaginal tablet are registered for induction of labour. Both methods are highly effective; however, the are associated with several problems in practice. Major problems of the intracervical route are the strict application of the gel into the cervical canal, not spreading it to the vaginal and/or extra-amniotic space, the "technical" difficulties of application in cases of an unfavourable cervix in a posterior position and the risk of artificial rupture of the membranes. The problems with the PGE2 vaginal tablet are the incalculable release and absorption, the unpredictable clinical response and the unclear definition of CTG monitoring intervals. The application of the 2 mg PGE2 vaginal gel has proved an efficient and practicable method for induction of labour in both the unfavourable and the favourable cervix. The advantages over the intracervical procedure are in particular the practicability and safety of administration, even in "anatomically" difficult situations (e.g., narrow cervical canal); the advantages over the PGE2 vaginal tablet are greater bioavailability with a quicker release and absorption, the more predictable clinical response and the closer correlation with the subsequent changes in cervical scores. Since well-defined comparative studies are lacking, no definite conclusions can so far be drawn regarding the method of choice for induction of labour. Recently, a prospective, randomised multi-centre study has gone under way to clarify this question.

Administration, Intravaginal↗
PubMed1994

[Induced labor with prostaglandin E2 gel after previous cesarean section].

With the rising rate of Caesarean sections, the number of pregnant patients with a previous Caesarean is increasing. Taking into consideration certain contraindications, it seems to be justified, to attempt induction of labour for vaginal delivery without major risk. However, the use of prostaglandins for cervical ripening in women with an unfavourable cervical status is particularly controversial. Thus, we analysed data from 385 trials of vaginal labour induction in a total of 522 patients with previous Caesarean section. Single or multiple cervical doses of prostaglandin-E2-gel had to be administered because of an unripe cervix (Bishop-score < 8) in 161 women for induction of labour for medical indications. 84.9% of those patients, in which labour induction was attempted after previous Caesarean section, delivered vaginally; 70% after two Caesareans. The highest success rates were seen after previous Caesarean for breech presentation, while there was still a vaginal delivery rate above 60% even after Caesarean for cephalopelvic disproportion or failure to progress. Maternal and foetal complications were seen with equal incidence in both study groups. Uterine ruptures totalling 0.5% were seen only in patients without cervical priming. Taking into consideration contraindications, intracervical application of PGE2-gel is a safe and effective method, even in patients after previous Caesarean section with clear advantages in case of an unripe cervix.

Administration, Intravaginal↗
PubMed1991

[Intravaginal PgE2 administration for inducing labor in premature rupture of fetal membranes].

In a prospective study, 121 patients with spontaneous rupture of the membranes of greater than 6 hours duration and unfavourable Bishop-Score (less than 6) were stimulated with 3 mg vaginal prostaglandin-E2-tablets. All patients started labour. Only one patient had a hyperstimulation which was corrected with betamimetics. There were no systemic side effects. Almost 90% of the women delivered on the first day. The rate of the Caesarean sections was low. There was no case of intraamniotic infection; the foetal outcome was good. In conclusion, vaginal prostaglandin-E2-tablets are safe to use in spontaneous rupture of the membranes.

Administration, Intravaginal↗