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PubMed1993

[Induced labor: conditions for success and causes of failure. A prospective study of 162 cases].

The authors report the results of a prospective study of 162 cases of induced labour collected between 30 October 1990 and 31 December 1991 in the maternity unit of the Yaounde teaching hospital group. There were 1,640 deliveries during this period. Premature rupture of the membranes in 72 cases (44.4 per cent) and postmaturity in 42 cases (27.2 per cent) were the chief indications for the induction of labour in this study. There were 138 cases (85.2 per cent) of spontaneous delivery, 20 cases (12.3 per cent) of cesarean section and 4 cases (2.5 per cent) of vacuum extraction. Failure of induction occurred in 16 cases (9.8 per cent). Repeat induction of labour after a rest period led to spontaneous delivery in 6 cases. There were 6 fetal deaths, i.e. a perinatal mortality of 3.7 per cent. Postmaturity (3 cases) and premature rupture of the membranes (2 cases) were the risk factors in these six fetal deaths. Analysis of cases of failed induction and of fetal deaths in this study leads the authors to conclude that ripening of the cervix is an essential parameter for success of the artificial induction of labour. Premature rupture of the membranes, and postmaturity associated with an unripe cervix are unfavourable risk factors for the induction of labour and are potential indications for preventive cesarean section in order to avoid fetal death.

Cesarean Section↗
PubMed2002

Intrauterine bacterial inoculation induces labor in the mouse by mechanisms other than progesterone withdrawal.

We tested the hypothesis that progesterone (P(4)) withdrawal is the primary mechanism by which intrauterine bacteria induce preterm labor in mice. CD-1 mice on Day 14.5 of a 19- to 20-day gestation were subjected to one of four treatments: 1) intrauterine injection of sterile medium, 2) intrauterine injection of 10(6) heat-killed Escherichia coli bacteria, 3) intrauterine injection of 10(9) heat-killed E. coli, or 4) ovariectomy. Mice were then killed at four time points from 0.75 to 11 h after surgery for serum collection. Separately, animals were pretreated either with s.c. P(4) or with vehicle 2 h before ovariectomy or high-dose bacterial inoculation. Ovariectomy led to a rapid fall in serum P(4) levels of 60% by 1 h and 81% by 8 h compared with levels in controls (P < 0.001). In contrast, intrauterine inoculation with 10(9) bacteria led to a more modest decline in P(4) of only 28% by 8 h (P = 0.24, which was no different from that of 10(6) bacteria, an inoculum below the threshold for preterm delivery). Despite significantly lower levels of P(4) in the ovariectomy group, time to delivery was significantly shorter with 10(9) bacteria intrauterine (24 +/- 5.6 h vs. 19 +/- 3.6 h, P = 0.03). Pretreatment with 1.5 mg P(4) per mouse prolonged the interval to delivery following both ovariectomy and high-dose bacteria, in association with pharmacologically elevated serum P(4) levels. In contrast, physiologic P(4) supplementation (0.375 mg/mouse) prolonged gestation only in the ovariectomy group. We conclude that withdrawal of endogenous P(4) is not the primary cause of labor following intrauterine bacterial inoculation in mice.

Animals↗
PubMed1987

[Gap junction formation in the myometrial muscle cells of ovariectomized mid-pregnant rats during premature labor induced by estradiol].

In order to obtain a better understanding of gap junction (GJ) formation in the myometrial muscle cells of rats during the time of premature delivery, the myometrial GJs and nuclear estradiol receptor (nE2R) levels, as well as serum estradiol (E2) and progesterone (P) levels were simultaneously determined in mid-pregnant ovariectomized (OVX) rats both with and without E2 administration. Artificial premature deliveries were not induced in either the rats which were OVX on day 15 of gestation with the E2 treatment, or which were OVX on day 16 with the vehicle treatment. However, there were significant decreases in serum P and significant increases in the number of myometrial GIs in these rats compared to the levels of the non-OVX pregnant rats treated with the vehicle. These results suggest that serum P withdrawal and GJ formation are not sufficient to induce premature delivery, and that other factors are involved. Artificial premature delivery was induced in the rats which were OVX on day 16 with the E2 treatment. They were given 2.5 micrograms E2 twice daily, for two days. A significant decrease in serum P, a marked increase in the number of GJ and a significant correlation between the myometrial GJs and serum E2 levels were found in both the "premature" delivery rats and the "prior to" delivery rats. A significant difference between the nE2R levels of the two groups was found, however. These profiles closely resembled those of the full-term rats during spontaneous delivery as we reported earlier.

Animals↗
PubMed1994

[PgE2 gel and PgE2 vaginal tablets for induced labor--a prospective randomized study].

In a prospective randomised study, the effects of an intracervical gel containing 0.5 mg PgE2 and an intravaginal tablet containing 3 mg PgE2 were compared in their efficiency to induce delivery at term. When only gel was used, induction failed in 45% of the cases, especially with an initially immature cervix score. However, these patients did show significant improvement of the Bishop score. The vaginal tablet was more effective with regard to the induction of delivery. When using the vaginal tablet alone, induction failed in only 5% of cases (p < 0.001). Best results, however, were obtained with a combination of both application forms. In this group there were no failures. Tablet application induced delivery within 24 hours in 56% of the cases, gel application in only 27% (p < 0.001). There were no significant differences observed in these groups during the course of labour. The length of the latency period was identical, whether a tablet or a gel was used in initiating labour. In 29% of the cases, beta-sympathicomimetics had to be used because of tetanic contractions or polysystolia. No significant differences in the occurrence of these contractions were seen in either the gel or the tablet group. Even in a high-risk collective with 25% pathological Doppler-flow findings, no higher rate of operative deliveries or fetal acidoses was observed after prostaglandin induction, if careful surveillance of the patients and early use of tocolytics in experienced hands were administered. Our results further confirm the concept of a differential induction of labour with prostaglandins.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intravaginal↗
PubMed1990

[Induced labor for gravidae with low Bishop's scores (with report of 242 cases)].

In planned/selective delivery, gravidae with Bishop's score 5 or below 5 are deal with lower position water sac, the aim of which is to induce regular uterine contraction and complete physiological latent period of cervical dilation. From Oct 1986 to Dec 1988, 242 cases of primiparae by this method and the latent period in physiological limit. This is a great breakthrough in induced labour for gravidae with low Bishop's scores. We found that this method is simple, effective, safe, and economic. It not only alleviates pain of the gravidae, but also helps to prevent the rise of caesarean section rate.

Cervix Uteri↗