Biomedical subjects

R P Prins

Publications and source records attributed to R P Prins.

8 recordsLinked to original sources

PubMed1997

Preinduction cervical ripening: a randomized prospective comparison of the efficacy and safety of intravaginal and intracervical prostaglandin E2 gel.

OBJECTIVE: The purpose of this study was to compare the effectiveness and safety of vaginally administered 5 mg prostaglandin E2 gel prepared in our hospital pharmacy with a commercially available 0.5 mg intracervical prostaglandin E2 gel. STUDY DESIGN: Eighty-three patients undergoing labor induction were randomly assigned to one of two groups for cervical ripening. Either a preparation of 5 mg of prostaglandin E2 was placed vaginally or a commercially available 0.5 mg of prostaglandin E2 was placed intracervically. A maximum of three doses at 6-hour intervals was administered before oxytocin was begun. RESULTS: Among the 83 patients evaluated, 44 were given vaginal gel and 39 were given intracervical gel. No statistically significant differences were observed between the two treatment groups with respect to the incidence of spontaneous versus induced labor, need for oxytocin augmentation, gel-to-induction interval, Bishop score change, maximum oxytocin dose, maximum dilatation rate, length of labor, cesarean section rate, fetal Apgar scores, fetal umbilical vein pH, or fetal umbilical artery pH. CONCLUSIONS: The two prostaglandin E2 formulations appear equivalent in efficacy and safety. Constraints placed on intracervical prostaglandin E2 gel make the vaginal preparation a desirable choice.

Administration, Intravaginal↗

PubMed1994

The second-born twin: can we improve outcomes?

OBJECTIVE: Second-born twin outcome was compared with that of the first-twin birth mate to determine whether there were differences, the reason for the differences, if any, and the clinical decisions that could be made to eliminate or ameliorate these differences. STUDY DESIGN: Twin pregnancies from 1989 through 1992 were retrospectively reviewed. Charts demonstrating both twins stillborn, either twin weighing < 500 gm, or either twin with a serious congenital anomaly were excluded from evaluation. After these exclusions 200 twin pairs remained for analysis. Each twin was compared directly with its birth mate. The first twin is postulated as having the best possible outcome for the pregnancy involved, and second-twin outcomes are compared with these. RESULTS: The second-born twin was more likely to be intubated, have respiratory distress syndrome, need resuscitation, and have lower 5-minute Apgar scores. Second-born twins had more nursery complications. The < 1500 gm group appeared to be at special risk. In this group there were more second-born twin neonatal deaths and much higher rates of intubation and resuscitation. Nonvertex presentation in the second-born twin increased chances for resuscitation, intubation, respiratory distress syndrome, and nursery complications. These outcomes in the second-born were not affected by cesarean delivery. CONCLUSIONS: The second-born twin is at increased risk of untoward outcome compared with its birth mate. Some of this risk can be attributed to birth weight. The risk posed by nonvertex presentation is small. Cesarean section delivery does not appear to eliminate the difference between first- and second-twin outcome. Prospective studies are needed.

Birth Order↗

PubMed1991

Glucose challenge testing in pregnancy.

This study examines results of routine glucose challenge screening in 608 third-trimester patients in a private practice setting. Four patient categories were defined on the basis of the results: normal, abnormal screen with normal glucose tolerance test, borderline glucose tolerance test, and gestational diabetes. When only standard prenatal management practices were used, the fetal outcomes in the four groups were not measurably different. The costs of these procedures resulted in an expenditure of $722.31 per diagnosis of gestational diabetes. This seems excessive in view of the negligible impact of these studies on fetal outcome. Our impression was that routine third-trimester dietary counseling, postprandial glucose monitoring without challenge testing, and evaluation of cases of suspected fetal macrosomia would result in comparable outcome at significantly reduced cost.

Adult↗

PubMed1986

Preinduction cervical ripening with sequential use of prostaglandin E2 gel.

Two hundred patients received a prostaglandin E2-containing gel for preinduction cervical ripening. The gel was administered every 6 hours until a Bishop score greater than or equal to 7 was obtained or the attending physician deemed induction necessary. Forty-eight percent of the patients labored "spontaneously" after one or more gel applications. The average cumulative change in Bishop score with sequential application of the gel was 2.7. Sequential application of the prostaglandin gel proved no more effective in the process of preinduction cervical ripening than single application of the gel with a similar period of observation.

Cervix Uteri↗

PubMed1983

A comparison of prostaglandin E2 gel and prostaglandin F2 alpha gel for preinduction cervical ripening.

The unfavorable cervix remains a major obstacle to the successful induction of labor. Reported are results from an ongoing study of topical prostaglandin preparations used to effect preinduction cervical ripening. The current study compares the efficacy of 40 mg of prostaglandin (PG) F2 alpha versus 5 mg of PGE2, applied to the cervix in a methyltylose gel the night before attempted induction of labor. A prospective double-blind protocol was used similar to that which previously established the efficacy of the 5 mg of PGE2 preparation versus placebo at this institution. Results indicate the superiority of the PGE2 preparation as measured by change in Bishop score, Pitocin requirement, rate of cervical dilatation, and percentage of failed inductions. Cesarean section rates were similar in the two study groups, and no fetal or maternal morbidity was attributable to the preinduction ripening technique.

Cervix Uteri↗

PubMed1983

Cervical ripening with intravaginal prostaglandin E2 gel.

Ripening of the cervix by intravaginal application of a prostaglandin-containing gel is evaluated. Thirty patients with an unfavorable cervix needing labor induction were studied in a double-blind, prospective fashion. The prostaglandin gel proved superior to placebo in ripening the cervix (P less than .05), reducing induction failures (P less than .025), diminishing the oxytocin dosage necessary for induction (P less than .05), and lowering the rate of cesarean section (.05 less than P less than .1). One hundred fifty additional patients with varying Bishop scores and differing clinical situations were also studied. There were 35 cesarean sections (23.3%), nine failed inductions (6%), a spontaneous labor rate of 46%, and an average Bishop score change of 2.5. Twenty patients with premature rupture of the membranes and an unfavorable cervix received a modified gel containing 2.5 mg of prostaglandin E2. Average Bishop score change was 2.9, and there was a 55% incidence of spontaneous labor.

Adult↗

PubMed1976

Isolated coccidioidomycosis of the uterus.

Coccidioidomycosis rarely involves the female genital tract. This report describes a case of coccidioidomycosis that was incidentally discovered involving the uterus of an asymptomatic 70 year old woman who had squamous carcinoma of the cervix. Reports of the few previously documented examples of coccidioidomycosis of the female genitalia are reviewed. Although the uterine lesion probably resulted from a solitary focus of dissemination from a clinically inapparent and completely resolved primary pulmonary infection, evidence is presented that it may have been a primary uterine infection.

Aged↗

PubMed1976

Vaginal embryogenesis, estrogens, and adenosis.

The recent outbreak of vaginal adenocarcinoma and the associated genital tract anomalies in women with histories of prenatal exposure to diethylstilbestrol (DES) has generated interest in vaginal embryogenesis and the influence of hormones on the developing genital tract. In this report the embryology of the vagina and the role of sex hormones in normal and abnormal sex duct development are presented and discussed in relation to the DES-induced anomalies. Although the teratogenic activity of DES in humans has been confirmed, the available evidence suggests that the clear cell carcinomas are initiated by endogenous estrogens and not the prenatally administered DES.

Abnormalities, Drug-Induced↗