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PubMed1981

Fatal amniotic fluid embolism during legally induced abortion, United States, 1972 to 1978.

Amniotic fluid embolism (AFE) has emerged as an important cause of death from legally induced abortion. In the period 1972-1978, 12 probably and three autopsy-confirmed cases of fatal AFE during legally induced abortion were identified in the United States (12% of all deaths from legal abortion). Fourteen deaths from AFE were associated with labor-inducing techniques, and one with hysterotomy. The risk of death appears to be related to gestational age: the death-to-case rate for AFE increases progressively from nil at less than or equal to 12 weeks' gestation to 7.2 deaths per 100,000 abortions at greater than or equal to 21 weeks' gestation. Because treatment is frequently ineffective, prevention of AFE is critical. Performing abortions early in pregnancy and using curettage techniques whenever feasible should reduce the risk of death from this obstetric accident during legally induced abortion.

Abortion, Legal↗
PubMed1979

Induction of labor following intrauterine death with intra-amniotic hyperosmolar urea and prostaglandin F2alpha: evaluation of placental endocrine function and changes in coagulation parameters.

A practicable and reliable method for inducing labor in patients whose pregnancies are complicated by intrauterine death of the fetus is described. The method involves the intra-amniotic instillation of 30 mg of prostaglandin F2alpha with 60 gm of urea. Twenty patients had pregnancies ranging between 22 and 41 weeks and the estimated duration of fetal death ranged between two and eight weeks. Delivery was achieved within 24 hours in all cases. Side effects and complications were minimal. Plasma human placental lactogen (hPL) and progesterone concentrations, as well as several blood coagulation parameters (i.e., plasma fibrinogen, blood platelet count, and serum fibrin degradation products (FDP) concentrations), were measured immediately prior to induction of labor. The latter (i.e., coagulation factors) were repeated at parturition. The presence of residual viable placenta prior to induction did not influence the induction-delivery interval. No statistically significant alterations in blood coagulation parameters that could be attributed to the specific method of induction employed were noted.

Amniotic Fluid↗
PubMed2006

[Trial of labor after previous cesarean delivery: review of the literature].

OBJECTIVE: The aim of this review was to relate the evolution of obstetrical management of delivery in women who had previously undergone cesarean delivery and to search the studies supporting the choice of the mode of delivery. MATERIAL AND METHOD: We identified relevant studies through a computer search in the Medline database. RESULTS: After a period from 1980 to 2000 when the vaginal delivery had been increasingly recommended, a growth in the use of the planned cesarean delivery was observed. Recent studies report more evidence that uterine rupture is the result of trial of labor and that adverse perinatal outcomes are associated with uterine rupture. The risk of uterine rupture is increased with labor induction. The use of prostaglandins appears to be implicated in a significant increase of uterine rupture, and subsequently might be contraindicated in this situation. The use of oxytocin induced labor appears to increase the risk of uterine rupture. However, the level of adverse perinatal outcomes is low. The choice of the mode of delivery should take into account the likelihood of a further pregnancy, due to the increased risk of placental pathologic conditions depending on the number of repeated cesarean sections. CONCLUSION: An optimal decision for the mode of delivery should be shared with the pregnant women and all these factors should be taken into consideration.

Cesarean Section↗
PubMed1992

Management of premature rupture of membranes at term.

Although prelabor rupture of membranes at term is common, in most cases, the spontaneous onset of labor relieves the obstetrician of the need for making management decisions. The standard practice in the United States has been to induce labor with intravenous oxytocin in that minority of patients who fail to labor spontaneously. Controlled trials suggest that this practice is associated with higher rates of both chorioamnionitis and the need for cesarean delivery than is expectancy. Expectancy, however, has not been demonstrated to be safer for the perinate.

Chorioamnionitis↗
PubMed1992

Metoclopramide-enhanced analgesia for prostaglandin-induced termination of pregnancy.

We previously determined that a single dose of metoclopramide could significantly reduce the patient-controlled analgesia (PCA) morphine requirements of women undergoing prostaglandin-induced termination of pregnancy. In the present study, we evaluated whether repeated doses of metoclopramide would further reduce pain and accelerate expulsion of the fetus. After intraamnionic injection of prostaglandin, patients were randomly allocated to receive either 10 mg of intravenous metoclopramide (n = 17) or saline (n = 15), concurrent with the initiation of PCA. A second, identical dose was administered 4 h later. Data included visual analogue scale scores for pain 45 min after each administration of metoclopramide or saline and visual analogue scale and sedation scores every 2 h for the first 10 h, amount of morphine delivered by PCA pump, time of fetal and placental passage, and hospital discharge. Metoclopramide-treated patients experienced significantly earlier fetal and placental passage (P < 0.05). This was associated with a 66% reduction in PCA morphine received by the time of fetal delivery (P < 0.05). In addition, patients in the metoclopramide group were discharged from the hospital significantly sooner (P < 0.05). This difference included fewer second-day hospital stays (P < 0.05). Visual analogue scale scores measured 45 min after each infusion of the study agent were reduced from baseline in the metoclopramide group only (P < 0.05). No significant intergroup differences were noted with respect to pain or interval morphine usage. We conclude that repeated doses of metoclopramide significantly reduce the duration of induced labor and therefore the total PCA morphine requirements.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗
PubMed1998

[PGF2 and the induction of the trial of labor. The prognostic value of uterine contractions].

BACKGROUND: Uterine contractions during the first hour following intracervical application of dinoprostone would show the myometrial sensitivity to prostaglandins E2 (PGE2) and could be a good practical marker of the real prospects of success of an attempt to induce labor according to the above mentioned modalities. The verification of such an hypothesis is the principal aim of this work. METHODS: The study was carried out on a group of 90 cardiotocograms recorded soon after a sample of pregnant women at term underwent labor induction by intracervical application of a gel containing 0.5 mg of PGE2 (dinoprostone). Special attention was paid to some characteristics of the cardiotocograms obtained during the first hour following administration of the gel: regularity of uterine contractions, total number of contractions, number of contractions having an intensity equal or superior to 50 mmHg, mean number of contractions during a period of 10 minutes, mean number of "effective" contractions during a period of 10 minutes, presence or absence of "excessive uterine activity" (tachysystole and/or hypersystole). RESULTS: Some cardiotocographic patterns were associated with a higher percentage of successful inductions, but the observed differences, not statistically significant, do not seem to be clinically interesting. CONCLUSIONS: However, it's not possible to exclude that a longer period of uterine contractions monitoring, perhaps lasting 2 hours instead of only 60 minutes, could lead to more useful information for the management choices.

Dinoprostone↗
PubMed1999

A randomized comparison of oral misoprostol versus Foley catheter and oxytocin for induction of labor at term.

OBJECTIVE: We sought to compare the efficacy and safety of oral misoprostol administered to patients with the efficacy and safety in a control group treated with a Foley catheter and oxytocin for induction of labor. STUDY DESIGN: Two hundred patients requiring induction of labor at term with a Bishop score of </=5 were randomized to receive oral misoprostol or a cervical Foley catheter plus oxytocin. Patients in the misoprostol group received 50 microg at 4-hour intervals for a maximum of 6 doses or until an adequate contraction pattern developed. Those in the control group had a Foley catheter inserted in the cervix, whereas oxytocin was administered intravenously by a standard incremental infusion protocol to a maximum dose of 36 mU/min. RESULTS: In multiparous patients the percentage delivered of their neonates within 24 hours and the median induction-to-delivery times were similar in the 2 groups. In nulliparous patients, however, delivery within 24 hours was significantly less likely in the misoprostol group (53.4% vs 82. 5%; P <.001), and the median induction-to-delivery time was longer (23.3 hours vs 17.2 hours; P <.01). There were no differences in the incidence of meconium, chorioamnionitis, low Apgar scores, or cesarean delivery. The incidence of hyperstimulation was higher in the oxytocin-Foley group (4.1% vs 13.1%; P =.02). CONCLUSION: Oral misoprostol is as effective as oxytocin-Foley catheter for inducing labor in multiparous women. Misoprostol appears less efficacious in nulliparous patients.

Administration, Oral↗
PubMed1997

Eligibility criteria for labor induction with prostaglandins.

Particular conditions exist at the end of some pregnancies which cause an increase in maternal and fetal risk. A valid alternative for these pregnancies is represented by the administration of prostaglandins, in order to obtain labor induction. The goal of our study was to define the eligibility criteria and the epidemiological characteristics that correlate most with a favorable obstetrical outcome. The study was conducted on 133 informed, consenting patients subjected to labor-induced delivery with prostaglandins E2. The mode of delivery in relationship to parity demonstrated that the pluriparous patients had fewer difficulties in labor and in its induction: of the 43 pluriparous cases, none had a cesarean section for failed induction and 95.3% delivered vaginally. One hundred percent of the patients with a Bishop score of more than 4 went into labor, as opposed to 81% of the patients with a score of less than 4. Therefore, taking into consideration the cost of the method, we retain that choosing an active position is valid, respecting the eligibility criteria for the induction of labor described above.

Adult↗
PubMed2001

Induction of labor in women with previous cesarean section using the double balloon device.

BACKGROUND AND METHODS: To evaluate the efficacy and safety of labor induction by the double balloon device in women with previous cesarean section. Induction of labor was carried out in 37 women with previous cesarean section for various indications. All the inductions of labor were performed using the Atad double balloon device (ARD). RESULTS: Cervical ripening (Bishop scores above 5) was achieved in 82.3% of the induced women with subsequent vaginal delivery in 78.6% and repeat cesarean section in 22.3%. An important observation of the results was the chances to achieve a vaginal delivery according to the second Bishop score that was recorded 12 hours following the insertion of the device. When the second was above 5 the chances for vaginal delivery were 79.4%. The mean time from removal of the device to delivery was 10.8 hours. No complications were noted using the device. CONCLUSIONS: The double balloon device appears to be a safe and effective method of inducing labor in women with a previous lower segment cesarean section. Wide scale studies and further use of the device for induction of labor in women who have had previous cesarean sections are warranted.

Adult↗
PubMed1988

Prostaglandin E2 suppositories as a second-trimester abortifacient.

Despite the large number of second-trimester abortions performed each year in the United States through labor induction, the optimal method of inducing labor has not been developed. This study was performed to evaluate the efficacy and safety of vaginal prostaglandin E2 suppositories as an abortifacient. We analyzed the abortions at 14-24 menstrual weeks' gestation performed at Women's Hospital, Los Angeles, in 1985 and 1986. The abortion rate at 24 hours was 90.4%, with a mean induction-to-abortion time of 13.8 hours. Although gastrointestinal side effects were frequent, hemorrhage, infection and live births were infrequent. Prostaglandin E2 suppositories are a simple, effective and safe means of effecting second-trimester abortion that requires little surgical skill.

Abortion, Induced↗
PubMed1991

Maternal serum cortisol and prolactin variations during labor.

Maternal serum cortisol (F) and prolactin (PRL) levels were measured during labor in 20 uncomplicated pregnancies. Four pregnant women were admitted with ruptured membranes (RM group) and 16 were admitted with intact membranes (IM group), ten with spontaneous onset of labor (SL group) and 10 with induced labor (IL group), five with a prolonged for duration labor (PL group) and 15 with a normal for duration labor (NL group). Before the inset of labor F levels were statistically higher (p less than 0.05) in the RM group (x = 975 ng/ml), than in the IM group (x = 664 ng/ml), and also in the SL group (x = 783 ng/ml), than in the IL group (x = 679 ng/ml). During labor, in all twenty pregnant women a marked rise of F (from x = 726 ng/ml before the onset of labor, to x = 911 ng/ml) and a marked fall of PRL (from x = 161 ng/ml to x = 122 ng/ml) were observed (p less than 0.05). In the PL group the F elevation and the PRL drop were more pronounced (p less than 0.001). After placental separation, PRL levels increased slightly while F values remained unchanged. These changes in hormone levels before and during labor could be attributed to the emotional and physical stress of labor.

Female↗
PubMed1981

[Alterations of oxytocin and prostaglandin E1, E2, F2 alpha levels in human plasma during labor (author's transl)].

In order to investigate the role of oxytocin (OT) and prostaglandins (PGs) in the mechanism of labor onset, changes of OT and PGs levels in human plasma were evaluated before labor, soon after the labor onset, and at the time of established labor in the following three groups. Group 1 consisted of 6 cases with spontaneous labor, group 2, of 6 cases with induced labor with PGF2 alpha drip infusion, and group 3, of 5 cases with induced with PGE2 vaginal suppository. OT concentrations were measured by RIA, PGE1, PGE2, and PGF2 alpha were extracted and determined by Inagawa's method. Levels of OT in group 1 were divided into two subgroups: subgroup 1 with high OT levels (24.0-116.2 microunits/ml) and subgroup 2 with low OT levels (below 7.2 microunits/ml) throughout labor. Changes of PGs level in subgroup 1 showed no definite tendency during labor, suggesting that OT appears to play the leading role in spontaneous labor. Those in subgroup 2 showed a particular behavioral pattern during labor, suggesting an important role played by PGs for the onset of labor following rupture of the membranes. The results of groups 2 and 3 are fully discussed in terms of labor process.

Female↗
PubMedDate not supplied

[Prostaglandin E2 gel for ripening the cervix and/or labor induction in the unripe cervix at the end of pregnancy].

Endocervical instillation of a Prostaglandin-E2-containing-gel is a well accepted method to ripen the cervix before induction or to induce labor directly. Until now the main problem of this method were difficulties with the preparation of the Prostaglandin-gel-mixture. In the present study a prefabricated 0.5 mg PGE2 containing gel was tested with relation to its safety and efficacy. During the period of one year no gel-specific difficulties e.g. stability, homogeneity or sterility occurred. 57% of the nulliparas and 71% of the multiparas with a modified Bishop-score of smaller or equal to 5 could be delivered within 12 hours of the first gel-application. In most of the remaining women no substantial cervical ripening could be detected. In only 12% of nulliparas and 6% of multiparas labor could not be induced by means of the second gel-application. The rate of operative deliveries in this group of low risk patients was low (4.1% in nulliparas and 1.9% in multiparas). The fetal outcome was excellent in all instances. Maternal side effects could be detected in 5 women. Based on our experience endocervical PGE2-gel-instillation can be considered a safe and very efficacious method of induction of labor in unfavorable cervical-score.

Cervix Uteri↗
PubMed1978

Studies on platelet function during different modes of administration of PgF2alpha in obstetrics and gynecology.

Platelet function has been studied during intravenous, intraamniotic, and extraamniotic administration of prostaglandin F2alpha (PgF2alpha) for termination of missed abortion and missed labor, for therapeutic abortion, and for induction of term labor. The controls received oxytocin i.v. (missed labor and term labor). Our investigations have shown that there was a normalization of the increased spontaneous platelet aggregation and a significant reduction of ADP- and collagen-induced platelet aggregation in the groups given PgF2alpha i.v. The desaggregation in these groups was increased. The other groups given PgF2alpha showed no significant changes in platelet function. Inducing labor by oxytocin we found a tendency to increased platelet aggregation and decreased desaggregation. The clinical importance of these findings and the consequences for hemostasis are discussed.

Abortion, Missed↗
PubMed1992

Prolonged pregnancy: the management dilemma.

In a prospective randomized study, pregnancies with unfavorable cervix and well established gestational age of at least 42 weeks were selected for management by either antepartum fetal testing or prostaglandin gel induction of labor. Of the 108 pregnancies studied, 57 (53%) had labor induced and 51 (47%) continued without intervention. Comparison of the two groups showed no difference in meconium staining, fetal distress, length of first stage of labor, the need for intervention, or the mode of delivery. In terms of Apgar score the neonatal outcome was not significantly different but a greater proportion of the babies (7.8% versus 1.8%) in the noninduced group required intubation. Our data show that there is no particular advantage in letting the pregnancy go beyond 42 completed weeks of gestation especially if prostaglandin is available for induction of labor.

Female↗
PubMed2001

Vaginal misoprostol for induction of labor: 25 vs. 50 microg dose regimen.

OBJECTIVE: To compare the efficacy and safety of two regimens of vaginal misoprostol for induction of labor. METHOD: In a randomized study, 185 women undergoing induction of labor were allocated to Group A (n=93), to be given 25 microg misoprostol and Group B (n=92), to be given 50 microg misoprostol. Intravaginal misoprostol was given every 4 h until the onset of labor. A maximum of six doses was administered. RESULTS: Abnormal uterine contractions were more common in Group B compared to Group A: 33 (35.86%) vs. 10 (10.75%) cases, and significantly more women in Group B required tocolysis (9.78 vs. 3.23%). The induction-delivery interval (mean+/-S.D.) was 17.18+/-8.48 h in Group A and 9.37+/-5.87 h in Group B (P<0.05). Oxytocin infusion was used in 37.63% of women in Group A and 26.08% in Group B (P>0.05). The cesarean section rate was 17.20% in Group A and 14.13% in Group B (P>0.05). Cesarean for failed IOL was more common in Group A: 7 of 16 (43.8%) vs. 3 of 13 (23.1%) cesarean deliveries (P<0.05). Postpartum hemorrhage occurred in 9.78% of women in Group B compared to 2.15% in Group A (P<0.05). There was a trend for more neonatal complications in Group B, but this did not reach significance. CONCLUSIONS: Although a dose of 50 microg of misoprostol results in a significantly shorter induction-delivery interval with less need for labor augmentation, there was an increased risk of uterine contractile abnormalities and postpartum hemorrhage. A regime using 25 microg of misoprostol every 4 h can induce labor safely and effectively.

Administration, Intravaginal↗
PubMed1992

[Induction of labor by using PGE2 and oxytocin in high risk pregnancies].

The study group consisted of 82 primigravid and 55 multiparous women with post term pregnancy, preeclampsia, intrauterine growth retardation, insufficiency of placenta and diabetes mellitus have induced labor. Prepidil (Upjohn) in dosage 0.5 mg was given into uterine cervix of 46 patients (PG group) and oxytocin was infused to 42 patients in dosage ranged from 5 mU/min to 30 mU/min (Ox group). Induction of labor has been considered as successful, if after 12 hours of drug administration, regular contractions of uterus and dilation of cervix more than 3 cm were obtained. Significant improvement of cervix state, measured by Bishop score has been observed only in PG group, even if the induction of labor failed. Similar rates of caesarean sections and the same occurrences of late and variable decelerations have been observed in both study groups. Results obtained in both these groups suggest that induction of labor in such pregnancies after prostaglandins administration is more effective than oxytocin infusion.

Adult↗