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Biomedical subjects

Y Yogev

Publications and source records attributed to Y Yogev.

At least 19 recordsLinked to original sources
PubMed2006

Prostaglandin E2 induction of labor for isolated oligohydramnios in women with unfavorable cervix at term.

OBJECTIVE: To evaluate the maternal and neonatal outcomes of pregnancies complicated with isolated oligohydramnios at term, managed by induction of labor. METHODS: We conducted a retrospective case-control study. 138 women with uncomplicated oligohydramnios at term [amniotic fluid index (AFI) < or =5 cm] and a low Bishop score (< or =6) underwent induction of labor with prostaglandin E2. These women were compared to 67 women who underwent induction of labor at 42 weeks' gestation and 276 women at low-risk pregnancy and spontaneous onset of labor, matched for parity and race. RESULTS: Cesarean section (CS) rate was similar in the study and the post-date group (17.4 and 17.9%, respectively), but significantly higher than the spontaneous labor group (5.8%, OR 3.42, 95% CI 1.75-6.68). No differences were found with other outcomes. CONCLUSION: Pregnancies with isolated oligohydramnios at term apparently are not at higher risk of perinatal complications, but induction of labor is associated with increased rate of CS.

Case-Control Studies↗
PubMed2004

Accuracy of sonographically estimated fetal weight in 840 women with different pregnancy complications prior to induction of labor.

OBJECTIVES: To evaluate the accuracy of sonographically estimated fetal weight (EFW) shortly before induction of labor in the presence of different pregnancy complications, and to define possible variables affecting it. METHODS: The study sample consisted of 840 women with singleton pregnancies and cephalic presentation who were admitted to our unit for induction of labor between January 1999 and December 2000. All underwent detailed ultrasound assessment for EFW, amniotic fluid index, biophysical profile and placental location. Indications included previous Cesarean section, postdate pregnancy, pregnancy-induced hypertension, diabetic pregnancy, suspected large-for-gestational age (LGA) infants, suspected fetal growth restriction (FGR), oligohydramnios, decreased fetal movements, premature rupture of membranes at or before term. EFW was calculated after measuring fetal abdominal circumference and femur length. The EFW was compared with the weight at delivery, 1-3 days later. RESULTS: There was a high correlation between EFW and birth weight (R(2) = 0.775, P < 0.001). The mean birth weight was 3207 +/- 561 g, and mean absolute weight difference was 227 +/- 197 g; (absolute range, 0-1700 g; actual range, - 986 to + 1700 g). The mean weight difference was significantly different between the patients with LGA infants, FGR infants and preterm premature rupture of membranes (PPROM) (- 110 +/- 281 g, + 113 +/- 195 g and + 115 +/- 307 g, respectively, P < 0.01). Stepwise linear regression analysis of the effects of maternal and pregnancy characteristics on the weight difference yielded lower gestational age, higher birth weight, anterior placenta, higher gravidity, and younger maternal age as independent and significant variables associated with greater actual weight difference inaccuracy (R(2) = 0.099, P < 0.001), and higher birth weight as the only independent and significant variable associated with greater absolute weight difference (R(2) = 0.09, P = 0.018). CONCLUSIONS: The sonographic EFW is highly correlated with birth weight. However, clinicians should be aware of the risk of overestimation in pregnancies with suspected LGA and underestimation in pregnancies with PPROM and suspected FGR.

Adult↗
PubMed2004

Maternal self-administered fetal heart rate monitoring and transmission from home in high-risk pregnancies.

OBJECTIVES: To evaluate the feasibility of high-risk pregnancy surveillance by patient-directed fetal heart rate monitoring and transmission, and to assess patient satisfaction with this technology. METHODS: Thirty-six women with high-risk pregnancies performed daily non-stress tests at home and transmitted the data to our perinatal care center by telephone. At each transmission, patients were asked by a physician about perceived fetal movements and uterine contractions and given the results. If the tracing was unsatisfactory, further evaluation was performed. In addition, patients completed a questionnaire on quality of life and anxiety state before and after the study. RESULTS: All patients were able to perform the tests and transmissions. The quality of recorded data was significantly correlated with maternal body mass index, but not with gestational age at the time of monitoring or birth weight. Thirty-nine of the total 562 tracings (6.9%) were inconclusive or non-reassuring. After repeated testing, 32 of them (82%) were considered normal, and seven patients (18%) were referred for additional in-hospital evaluation. Of this group, four were discharged for further surveillance with routine home monitoring and the remaining three were hospitalized for continued evaluation. There were no significant immediate adverse maternal or neonatal outcomes as a result of the monitoring. Patient satisfaction was high. CONCLUSIONS: Daily home FHR monitoring in high-risk patients is safe and feasible at all gestational ages, based on this initial pilot evaluation. It is easily and reliably performed and accepted by patients with a high level of satisfaction.

Adult↗
PubMed2004

Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes.

Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. Although it is a well-known cause of pregnancy complications, its epidemiology has not been studied systematically. Our aim was to review the recent data on the epidemiology of GDM, and to describe the close relationship of GDM to prediabetic states, in addition to the risk of future deterioration in insulin resistance and development of overt Type 2 diabetes. We found that differences in screening programmes and diagnostic criteria make it difficult to compare frequencies of GDM among various populations. Nevertheless, ethnicity has been proven to be an independent risk factor for GDM, which varies in prevalence in direct proportion to the prevalence of Type 2 diabetes in a given population or ethnic group. There are several identifiable predisposing factors for GDM, and in the absence of risk factors, the incidence of GDM is low. Therefore, some authors suggest that selective screening may be cost-effective. Importantly, women with an early diagnosis of GDM, in the first half of pregnancy, represent a high-risk subgroup, with an increased incidence of obstetric complications, recurrent GDM in subsequent pregnancies, and future development of Type 2 diabetes. Other factors that place women with GDM at increased risk of Type 2 diabetes are obesity and need for insulin for glycaemic control. Furthermore, hypertensive disorders in pregnancy and afterwards may be more prevalent in women with GDM. We conclude that the epidemiological data suggest an association between several high-risk prediabetic states, GDM, and Type 2 diabetes. Insulin resistance is suggested as a pathogenic linkage. It is possible that improving insulin sensitivity with diet, exercise and drugs such as metformin may reduce the risk of diabetes in individuals at high risk, such as women with polycystic ovary syndrome, impaired glucose tolerance, and a history of GDM. Large controlled studies are needed to clarify this issue and to develop appropriate diabetic prevention strategies that address the potentially modifiable risk factors.

Congenital Abnormalities↗
PubMed2004

Attitudes of Israeli gynecologists towards the levonorgestrel-releasing intrauterine system: a questionnaire survey.

OBJECTIVES: The aim of the study was to examine the current attitudes and practices of gynecologists regarding the use of the levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena, Schering AG, Germany) as a contraceptive device and for the treatment of menorrhagia in the premenopausal period. In addition, physician knowledge of patient satisfaction with the device was evaluated. METHODS: A written, self-administered questionnaire was given to 300 gynecologists actively employed in gynecological departments and outpatient clinics in urban centers in Israel. The items covered the indications for which the LNG-IUS was prescribed, the estimated rate of use of the LNG-IUS compared to copper intrauterine devices (IUDs), patient satisfaction with the LNG-IUS and previous knowledge about it, and demographic characteristics of the population using IUDs. All forms were completed on an anonymous basis. RESULTS: The questionnaire was returned, properly completed, by 298 physicians, yielding a response rate of 99.3%. Almost one-half of the physicians (n = 147, 49.3%) used the LNG-IUS only as a contraceptive device, 17.4% only as treatment for menorrhagia, and 33.2% for both indications. The vast majority of gynecologists (82.2%) reported a patient satisfaction rate of 70% or more. Among the gynecologists using the LNG-IUS as treatment for menorrhagia, the estimated overall patient satisfaction rate was more than 50%. Although most physicians expressed greater patient satisfaction with the LNG-IUS than with copper-releasing IUDs (p < 0.004), the majority of gynecologists still used the copper-releasing IUDs more frequently. Most considered the LNG-IUS as an appropriate method for endometrial protection in postmenopausal women using estrogen replacement therapy. CONCLUSIONS: Physicians should be made aware of the beneficial health effects of the LNG-IUS, particularly in premenopausal women with menorrhagia and for endometrial protection during hormone replacement.

Adult↗
PubMed2004

Pre-eclampsia and gestational diabetes mellitus: does a correlation exist early in pregnancy?

OBJECTIVE: We investigated whether blood pressure profile early in pregnancy was associated with the development of pre-eclampsia in patients with gestational diabetes mellitus (GDM). METHODS: A retrospective longitudinal database study of 1664 GDM subjects was performed. Systolic and diastolic blood pressure measurements were taken bi-weekly during the first and second trimesters. GDM patients who developed pre-eclampsia were compared to GDM patients who did not. Subjects were further stratified by maternal age, parity, race, prepregnancy body mass index (BMI) and weight gain during pregnancy. Logistic regression was performed to identify the net effect of each factor on the development of pre-eclampsia. RESULTS: Overall, 167/1664 (10%) GDM patients developed pre-eclampsia. GDM patients who developed pre-eclampsia were more obese, gained more weight during pregnancy and had more severe GDM in comparison to GDM patients who did not. Although all mean blood pressure measurements were within the normal range, significantly higher systolic and diastolic values were recorded in the GDM patients who developed pre-eclampsia throughout the first and the second trimesters of pregnancy. Logistic regression revealed that higher parity (p = 0.04), maternal age (p = 0.03) and pre-pregnancy BMI (p = 0.03) were all contributing factors to pre-eclampsia. In contrast, weight gain during pregnancy and race were not related. CONCLUSION: In GDM patients, higher blood pressure readings early in pregnancy, even prior to GDM diagnosis, were associated with the subsequent development of pre-eclampsia.

Adult↗
PubMed2004

Recurrence of gestational diabetes: pregnancy outcome and birth weight diversity.

OBJECTIVE: We sought to evaluate birth weight diversity and pregnancy outcome in women with two consecutive pregnancies complicated with gestational diabetes mellitus (GDM). METHODS: A retrospective longitudinal study of 389 patients with two consecutive GDM pregnancies was assessed for pregnancy outcome and fetal weight diversity. Since there is a tendency towards repetition or moderate increase in fetal weight in subsequent non-diabetic pregnancies, consecutive GDM pregnancies were stratified into three categories. They consisted of: an increase in birth weight of more than 250 g between GDM pregnancies for the same gestational age at delivery, and considered significant; an increase in birth weight of more than 100 g but less than 250 g; and a decrease in birth weight in the second GDM pregnancy compared to the index pregnancy. Any change in birth weight of up to 100 g between the two pregnancies was considered comparable. RESULTS: The mean interval between the two diabetic pregnancies was 3 years. The change in weight above the biologically expected weight was evaluated. In 181/389 (46%), an elevation in birth weight between pregnancies was recorded and from this group only 125/181 (69%) had significant increases in birth weight (> 250 g) with a mean of 531 +/- 49 g. Furthermore, 130/389 (33.4%) had decreased fetal weight between the two pregnancies (mean 373 +/- 31 g). In 78/389 (20.1%), birth weight changes were considered similar (< 100 g). Fasting plasma glucose (FBG) and pre-pregnancy body mass index (BMI) were significantly elevated in the second pregnancy (FBG 97 +/- 15 vs. 102 +/- 4.7 mg/dl; BMI 25.9 +/- 4.7 vs. 27 +/- 6.7 kg/m2, respectively; p = 0.02). No difference was found in the mean maternal weight gain during pregnancy, gestational age at delivery, mean blood glucose, macrosomia or large-for-gestational-age rates. No difference in neonatal outcome (neonatal intensive care unit admission, the need for respiratory support, stillbirth rate or shoulder dystocia) was found between the two pregnancies. CONCLUSION: In GDM patients, owing to the role of glycemic control and environmental factors, an expected increase in birth weight between pregnancies cannot be predicted.

Adult↗
PubMed2004

The importance of diagnostic work-up in the management of candidal vulvovaginitis. A prospective study.

OBJECTIVE: To assess the accuracy of the diagnostic work-up in identifying vaginal candidal infection, and to determine the safety, efficacy and speed of action of clotrimazole vaginal tablets. PARTICIPANTS: Two hundred and twenty-three patients with symptoms and signs of candidal infection, a presence of vaginal pH < or = 4.5 and positive 10% KOH examination. METHODS: After vaginal culture was taken, the eligible patients were treated with clotrimazole 200 mg vaginal tabs (manufactured by Teva or Agis). RESULTS: Cultures grew Candida albicans in 189 cases (85%), and Candida non-albicans in five (2.2%); 29 patients (13%) did not have any candidal infection. Of the 189 C. albicans-positive patients, 174 were reassessed for effects of clotrimazole treatment by self-reports and objective measures. Ninety-four percent of the patients reported improvement after treatment, rated moderate to high by 87%. The physician evaluation was similar: some improvement in 96%, and moderate or high improvement in 91%. At the second examination, 7.5% of the treated patients still had a positive culture for Candida albicans, and they remained positive on KOH microscopic examination, although vaginal pH was significantly higher. Maximal improvement was recorded three to four days after starting treatment. CONCLUSION: It is important that the diagnostic work-up for suspected candidal infections consist of at least vaginal pH measurement and microscopy study with KOH. We encourage the use of vaginal cultures, especially in recurrent cases. Clotrimazole is a safe and effective treatment.

Adult↗
PubMed2004

Efficacy and safety of standard versus low-dose Femarelle (DT56a) for the treatment of menopausal symptoms.

OBJECTIVE: In a previous study treatment with a daily standard dose of Femarelle (644 mg/day) resulted in a significant elevation in bone mineral density (BMD) while a reduced dose resulted in a decrease in BMD. The aim of the current study was to examine the efficacy and safety of the two doses of Femarelle in the treatment of menopausal symptoms. MATERIALS AND METHODS: Eighty healthy postmenopausal women were randomly allocated to receive either the standard dose (SD) or low dose (LD) of Femarelle (644 mg/day vs 344 mg/day). A detailed medical history was taken on enrollment, followed by a physical examination, pelvic ultrasound, and sex hormone and lipid profiles. A detailed Kupperman index for each patient was completed. These measures were repeated every three months for 12 months. RESULTS: In both groups there was a significant reduction in the Kupperman index following 12 weeks of treatment, which was sustained throughout the 12 months of treatment (p < 0.01). Seventy-six percent of the patients in the SD group reported a decrease in vasomotor symptoms and seventy eight % in the LD group (NS). This decrease was sustained following 12 months of treatment. There was no change in TSH and sex hormone levels or endometrial thickness during the study period. CONCLUSIONS: In the current study we found that menopausal symptoms were reduced similarly by LD and SD, however for the combined treatment of menopausal symptoms and osteoporosis the standard dosage of 644 mg/day of Femarelle is needed.

Bone Density↗
PubMed2004

Effect of the WHI study on the attitude of Israeli gynecologists to hormonal therapy during menopause.

OBJECTIVE: To evaluate the attitude of Israeli gynecologists to the use of hormonal therapy (HT) during menopause consequent to the recent publication of the Women's Health Initiative (WHI) study. DESIGN: Gynecologists present at the annual convention of the Israeli Society of Obstetrics and Gynecology in the community were asked to complete a 5-item questionnaire on their opinions regarding hormone therapy (HT) use in light of the WHI study. RESULTS: Ninety-five percent of the physicians believed that HT is still a legitimate treatment modality during menopause, although almost 40% would now limit it to the management of climacteric symptoms. As a result of the WHI study, 65% of the physicians recommended cessation of HT use in up to 30% of their treated postmenopausal patients. The responders estimated that about 40% of their patients using HT ceased treatment on their own initiative following publication of the WHI study. CONCLUSIONS: Both physicians and patients were clearly influenced by the WHI study. Today, HT is being reserved by most gynecologists in Israel for the treatment of menopausal symptoms and is not being used as a preventive measure against future complications of heart disease and osteoporosis.

Attitude of Health Personnel↗
PubMed2004

Social aspects of the new assisted reproduction technologies: attitudes of Israeli gynecologists.

AIM: To evaluate attitudes of gynecologists as to the social aspects of assisted reproduction technologies. METHODS: The survey was sent electronically to 600 gynecologists covering their opinions on impact of reproductive technologies, the role of gynecologists in reshaping social reality, their definition of family, concern for the unborn child, accessibility to the new technologies, and potential partners in the decision-making process. RESULTS: One hundred fifty-five gynecologists completed the questionnaire. The majority agreed that the new reproduction technologies have major social consequences (90.3%); that gynecologists, by putting these technologies to use, play a major role in changing social reality; and that the interests of the unborn child should be taken into consideration (84.5%). More than half included single parents and same-sex couples in the definition of a "family" and believed that fertility treatments should be available to everyone. As to sharing responsibility, 65.2% (n = 101) felt the gynecologist should not be the sole decision-maker regarding the necessity of treatment; among them, 49.7% preferred that social workers or psychologists be involved--rather than jurists. CONCLUSIONS: The gynecologists in the present survey seemed to be well aware of the importance of the social revolution initiated by the development of assisted reproduction technologies. While they accepted a broader definition of the family, they have not lost sight of the rights of the unborn child and as such, the need for related professionals to take a greater part in the decision-making process. These findings have important implications for educational programs in the health care professions and for future legislation regarding public accessibility to these procedures.

Attitude of Health Personnel↗
PubMed2003

Cervical length evaluation by transvaginal sonography in nongravid women with a history of preterm delivery.

OBJECTIVE: To evaluate cervical length in the nongravid period in women with a past history of preterm delivery. METHODS: The study population comprised 54 women who had delivered spontaneously before 34 weeks of gestation. Etiology of preterm delivery was suspected to be related to cervical incompetence, defined as a painless and progressive dilatation of the cervix in the absence of other causes. Patients with pre-eclampsia, intrauterine growth restriction, uterine anomalies, fetal anomalies, multiple gestation and similar complications were excluded. Shortening of the cervix was recorded during pregnancy in all study patients. One hundred and four women matched for age, parity and body mass index who had given birth at term served as the control group. Cervical length was evaluated in all women at least 12 weeks after delivery by transvaginal sonography in the mid-sagittal plane. RESULTS: The mean gestational age at delivery was 30.8 +/- 1.2 weeks in the study group and 38.8 +/- 2.1 weeks in the control group (P = 0.03). The mean cervical length in the two groups was 36 +/- 6 and 38 +/- 4 mm, respectively. This difference was not statistically significant (P = 0.9). CONCLUSIONS: In nongravid women with unexplained preterm delivery there is no difference in cervical length compared to patients who deliver at term. Shortening of the cervix is most probably a reversible phenomenon that occurs during pregnancy and represents a failure of the competence mechanism to adapt to pregnancy.

Adult↗
PubMed2003

Isolated fetal ascites caused by Wolman disease.

Wolman disease is a rare autosomal-recessive disorder caused by reduced levels of lysosomal acid lipase. It occurs in infancy and is fatal in most cases before the age of 1 year. Affected infants show signs of lipid storage in most tissues, including hepatosplenomegaly, abdominal distension, vomiting, steatorrhea, failure to thrive, and adrenal calcifications. We present a case of isolated fetal ascites diagnosed at 32 weeks of gestation, with negative work-up for immune and non-immune hydrops fetalis and congenital infections and malformations. After delivery, the diagnosis of Wolman disease was established. Although rare, storage diseases such as Wolman disease should be considered in cases of isolated fetal ascites.

Adult↗
PubMed2003

PGE2 induction of labor for consistent decreased perception of fetal movements at term.

OBJECTIVES: To determine the effects of labor induction with vaginal prostaglandin E2 (PGE2) on mode of delivery and immediate neonatal outcome in women with consistent decreased perception of fetal movements at term. METHODS: The study group consisted of 115 women with consistent perception of decreased fetal movements admitted for induction of labor at term. Findings were compared with those of 510 women with normal spontaneous onset of labor. Women with previous cesarean section (CS) were excluded from both the study and control groups. RESULTS: The rate of CS was higher in the study group (14.8%) than in the control group (9%) (not significant). The rates of low 5-min Apgar score (<or=7) and CS performed for non-reassuring fetal heart rate were two-fold higher in the study group than in the control group (2.6% vs. 1.2%, and 6.1% vs. 3.1%, respectively, not significant in both). CONCLUSION: Induction of labor with PGE2 is successful in approximately 85% of the patients with decreased perception of fetal movements at term and apparently with no serious maternal or fetal complications. However, these pregnancies might be at higher risk of perinatal complications. We suggest that active labor induction may be currently considered as the preferred strategy in these pregnancies. Large prospective randomized studies on maternal and neonatal outcome are needed to clarify this issue.

Adult↗
PubMed2003

Continuous glucose monitoring for treatment adjustment in diabetic pregnancies--a pilot study.

AIMS: To examine the efficacy of a continuous glucose monitoring (CGM) system for treatment adjustment in patients with diabetic pregnancy treated with insulin. METHODS: The study sample consisted of eight women with diabetic pregnancy, six with pre-pregnancy Type 1 diabetes mellitus and two with gestational diabetes (GDM), all being treated with multiple daily insulin injections. Gestational age ranged from 24 to 32 weeks. Data derived from the Continuous Glucose Monitoring System (MiniMed) for 72 h were compared with fingerstick glucose measurements (six to eight times a day), and treatment was adjusted on the basis of the findings. Two to four weeks later, the patients were re-evaluated with CGM. RESULTS: In the first part of the study, an average of 744+/-33 glucose measurements was recorded for each patient with CGM. The mean total time of hyperglycaemia (glucose level >7.7 mmol/l) undetected by the fingerstick method was 152+/-33 min/day. Nocturnal hypoglycaemic events (glucose level <2.7 mmol/l) were recorded in seven patients. Based on the additional information obtained by continuous monitoring, the insulin regimen was changed in all patients. CGM re-evaluation after treatment adjustment showed a reduction in undetected hyperglycaemia to 89+/-17 min/day and in nocturnal hypoglycaemic events, which were recorded in only one patient. CONCLUSIONS: Continuous glucose monitoring may diagnose high blood glucose levels and nocturnal hypoglycaemic events that are unrecognized by intermittent blood glucose monitoring and could serve as a useful tool for the long-term management of diabetic pregnancies. A large prospective study is needed to determine the clinical implications of this new monitoring technique.

Adult↗
PubMed2003

A mobile aerosol cryotherapy device (Histofreezer) for treatment of cervical contact bleeding: a pilot study.

This study aims to evaluate the efficacy of the Histofreezer (a mobile aerosol cryotherapy device) treatment for women with cervical contact bleeding. Ten healthy women aged 22-50 years referred to our outpatient colposcopy clinic for recurrent postcoital or contact bleeding, and who suffered from mild to wide ectropion with bleeding on contact were studied. All women had a normal pelvic examination and ultrasound and a normal colposcopy and PAP smear. They were treated with the Histofreezer, which freezes the tissue to a temperature of -55 degrees C. A picture of the cervix was taken by a cervical camera before, after the procedure and during follow-up visits 4 and 8 weeks afterwards. There was a complete resolution of bleeding ectropion with a good healing of squamous metaplasia in seven patients. Two women showed partial improvement. Based on this initial study, this short and simple ambulatory treatment shows good results, both subjectively and on follow-up colposcopy.

Adult↗
PubMed2003

Induction of labor with vaginal prostaglandin E2.

OBJECTIVE: To determine the effects of labor induction with vaginal prostaglandin E2 (PGE2) on mode of delivery in post-term pregnancies and to identify possible predictors of successful vaginal delivery. METHODS: The study group consisted of 211 women with post-term pregnancy (gestational age more than a full 41 weeks) admitted for induction of labor with vaginal applications of PGE2. Findings were compared with women with spontaneous onset of labor (group 2, n = 510). Women with previous Cesarean section were excluded from both study and control groups. RESULTS: The rate of Cesarean section was significantly higher in the study group (19.4%) than in the control group (9%). A logistic regression model was used to control for maternal and gestational age, gravidity, parity, nulliparity rate, number of used PGE2 tablets, oligohydramnios and delivery weight as possible predictors of Cesarean section (R2 = 0.56, p < 0.001). On stepwise analysis, nulliparity (OR 45.2, 95% CI 2.93-695.5), number of PGE2 applications (OR 2.79, 95% CI 1.04-7.52) and maternal age (OR 1.23, 95% CI 1.01-1.50) were independently and significantly associated with increased risk of Cesarean section. PGE2 induction was a significant independent predictor of Cesarean section (OR 2.3, 95% CI 1.3-3.9). CONCLUSION: PGE2 induction of labor was successful in approximately 80% of patients with post-term pregnancy, with apparently no serious maternal or fetal complications. Risk factors intrinsic to the patient, and labor induction itself, were the reasons for excess Cesarean deliveries in women with prolonged pregnancies.

Administration, Intravaginal↗