Uterine Hyperstimulation Research Articles

Oral misoprostol for induction of labour.

Misoprostol is an orally active prostaglandin. In most countries misoprostol is not licensed for labour induction, but its use is common because it is cheap and heat stable. To assess the use of oral misoprostol for labour induction in women with a viable fetus. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 January 2014). Randomised trials comparing oral misoprostol versus placebo or other methods, given to women with a viable fetus for labour induction. Two review authors independently assessed trial data, using centrally-designed data sheets. Overall there were 76 trials (14,412) women) which were of mixed quality.In nine trials comparing oral misoprostol with placebo (1109 women), women using oral misoprostol were more likely to give birth vaginally within 24 hours (risk ratio (RR) 0.16, 95% confidence interval (CI) 0.05 to 0.49; one trial; 96 women), need less oxytocin (RR 0.42, 95% CI 0.37 to 0.49; seven trials; 933 women) and have a lower caesarean section rate (RR 0.72, 95% CI 0.54 to 0.95; eight trials; 1029 women).In 12 trials comparing oral misoprostol with vaginal dinoprostone (3859 women), women given oral misoprostol were less likely to need a caesarean section (RR 0.88, 95% CI 0.78 to 0.99; 11 trials; 3592 women). There was some evidence that they had slower inductions, but there were no other statistically significant differences.Nine trials (1282 women) compared oral misoprostol with intravenous oxytocin. The caesarean section rate was significantly lower in women who received oral misoprostol (RR 0.77, 95% CI 0.60 to 0.98; nine trials; 1282 women), but they had increased rates of meconium-stained liquor (RR 1.65, 95% CI 1.04 to 2.60; seven trials; 1172 women).Thirty-seven trials (6417 women) compared oral and vaginal misoprostol and found no statistically significant difference in the primary outcomes of serious neonatal morbidity/death or serious maternal morbidity or death. The results for vaginal birth not achieved in 24 hours, uterine hyperstimulation with fetal heart rate (FHR) changes, and caesarean section were highly heterogenous - for uterine hyperstimulation with FHR changes this was related to dosage with lower rates in those with lower doses of oral misoprostol. However, there were fewer babies born with a low Apgar score in the oral group (RR 0.60, 95% CI 0.44 to 0.82; 19 trials; 4009 babies) and a decrease in postpartum haemorrhage (RR 0.57, 95% CI 0.34 to 0.95; 10 trials; 1478 women). However, the oral misoprostol group had an increase in meconium-stained liquor (RR 1.22, 95% CI 1.03 to 1.44; 24 trials; 3634 women). Oral misoprostol as an induction agent is effective at achieving vaginal birth. It is more effective than placebo, as effective as vaginal misoprostol and results in fewer caesarean sections than vaginal dinoprostone or oxytocin.Where misoprostol remains unlicensed for the induction of labour, many practitioners will prefer to use a licensed product like dinoprostone. If using oral misoprostol, the evidence suggests that the dose should be 20 to 25 mcg in solution. Given that safety is the primary concern, the evidence supports the use of oral regimens over vaginal regimens. This is especially important in situations where the risk of ascending infection is high and the lack of staff means that women cannot be intensely monitored.

Comparison on efficacy and safety of seven different methods for labor induction: a network meta-analysis

Objective With a network meta-analysis,to compare the effects and safety of seven clinically common-used induction methods.Methods Publications of randomized controlled trials between January 1,1980 and November 20,2011 were searched on Medline,Embase and Cochrane Central Register of Controlled Trials with the following terms including dinoprostone,misoprostol,Foley catheter,oxytocin and labor induction.A network meta analysis with both direct and indirect comparison was applied for 48 randomized controlled trials (19 819 participants) recruited,and the following seven induction methods applied in the publications were compared:oxytocin (intravenous,Ⅳ),vaginal dinoprostone,intracervical dinoprostone,oral misoprostol,vaginal misoprostol,sublingual misoprostol and foley catheter.The main outcomes were the proportion of vaginal delivery within 24 hours,cesarean section rate,uterine hyperstimulation rate and Apgar score＜7 at 5 min after birth.Medline,Embase and Cochrane Central Register of Controlled Trials were searched between January 1,1980 and November 20,2011.Results Foley catheter methods had the lowest cesarean section rate and the lowest uterine hyperstimulation rate.Vaginal misoprostol method had the highest number of vaginal delivery within 24 hours,but the highest uterine hyperstimulation rate.The lowest rate of neonatal Apgar score＜7 at 5 min was found in women using sublingual misoprostol,while the highest in those using vaginal Dinoprostone.Oxytocin (Ⅳ) method had the lowest number of vaginal delivery within 24 hours and the highest cesarean section rate.Conclusion Foley catheter method is the best available option for labor induction in terms of efficacy and safety,while the induction effect of oxytocin (Ⅳ) was not good enough.Vaginal misoprostol and vaginal dinoprostone methods had relative good induction effect but with obvious adverse effects. Key words: Labor, induced; Meta-analysis; Treatment outcome

Labor Induction with 50μg Vaginal Misoprostol: Can We Reduce Induction-Delivery Intervals Safely?

To compare the efficacy and safety profile of two methods of labor induction i.e., intracervical dinoprostone gel (0.5mg 8h) and misoprostol (50μg 4h) for induction of labor in women with a poor Bishop's score. Observational study. January 1st, 2009 to December 31st, 2010. A total of 329 women with unfavorable cervices induced at or near term. Two cervical ripening agent study arms were used: dinoprostone gel (193 women) and misoprostol (137 women). Induction to delivery interval, cesarean section, incidence of meconium stained liquor, FHR pattern, incidence of uterine hyperstimulation, and neonatal outcomes. The induction to delivery interval was significantly shorter in the misoprostol group as compared to the dinoprostone group (p<0.001). There was no difference in cesarean section rates between the two groups (dinoprostone gel 43%; misoprostol 33%; p=0.144). The incidence of non-reassuring fetal heart rate pattern, meconium stained liquor, and uterine hyperstimulation were equivalent in both the groups (p=0.529; 0.733; and 0.321, respectively). The neonatal outcomes in both the groups were comparable in terms of Apgar scores at birth (p=0.160) and NICU admissions (p=0.951). Labor induction in women with unfavorable cervices results in high caesarean section rates. However, the use of misoprostol significantly reduces the induction to delivery interval, without adversely affecting the caesarean section rates and neonatal outcomes. Hence it may become a cost-effective alternative to dinoprostone gel in resource-poor settings like India.

Efficacy and safety of intravaginal misoprostol versus intracervical dinoprostone for labor induction at term: A systematic review and meta‐analysis

Recent studies suggest that misoprostol may be more effective than dinoprostone in pregnant women with unfavorable cervix. The objective here is to investigate and compare the efficacy and safety of intravaginal misoprostol and intracervical dinoprostone for labor induction, including incidence of cesarean section, vaginal delivery rate within 24 h, uterine hyperstimulation, tachysystole, oxytocin augmentation, neonatal intensive care unit (NICU) admissions, and Apgar score of less than 7 at 1 and 5 min. Databases searched were MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, up to July 2013. Randomized controlled trials comparing intravaginal misoprostol with intracervical dinoprostone in women with singleton pregnancy, intact membranes and unfavorable cervix (Bishop's <6) were included. Pooled relative risk, mean difference and 95% confidence intervals were calculated. The use of misoprostol was significantly effective in increasing the rate of vaginal delivery within 24 h and less oxytocin augmentation when compared with dinoprostone. However, the incidents of uterine hyperstimulation and tachysystole were significantly higher under the misoprostol protocol than dinoprostone protocol. Furthermore, we found similar efficiency in the rate of cesarean delivery, NICU admission and Apgar score at 1 and 5 min among the study groups. Intravaginal misoprostol appears to be more efficient for labor induction than intracervical dinoprostone; however, dinoprostone has been demonstrated to be safer because of the lower incidence of uterine hyperstimulation and tachysystole. Further high-quality studies assessing the possible effectiveness of misoprostol and dinoprostone in selected groups of patients are warranted.

Pre-induction cervical ripening: comparing between two vaginal preparations of dinoprostone in women with an unfavorable cervix

Objective: Prostaglandin E2 (PGE2-Dinoprostone) is accepted for both ripening of the cervix and induction of labor. As conflicting data exist concerning the efficiency and safety of different treatment modalities, we aimed to compare slow-release vaginal insert PGE2 with serial vaginal tablets of PGE2 for cervical ripening and induction of labor.Methods: A retrospective cohort study comparing all pregnancies who underwent induction of labor by either a single slow-release vaginal insert of 10 mg PGE2 (study group) to a historical control group of women who were treated with serial administration of 3 mg vaginal PGE2 tablets in a 2:1 ratio, matched by parity.Results: Overall, 639 women were enrolled (213 treated with PGE2 tablets and 426 with slow-release vaginal inserts). Vaginal insert was associated with shorter initiation-to-ripening interval (12.4 ± 7.7 versus 18.6 ± 15.2 h, p < 0.001) and a higher rate of delivery within 24 h (61.5 versus 51.6%, p = 0.018). Vaginal insert was associated with an increased rate of tachysystole (8.0 versus 3.1%, p < 0.01); however, the rates of cesarean section or operative delivery due to non-reassuring fetal heart rate (NRFHR) were similar. On multivariable analysis, slow-release vaginal insert was independently associated with a higher rate of delivery within 24 h (OR 1.50, 95% CI 1.04–2.18).Conclusion: Slow-release PGE2 vaginal insert achieves cervical ripening and subsequently delivery over a shorter time period than PGE2 tablets, without increasing uterine hyperstimulation rate.

Titrated oral misoprostol solution versus vaginal misoprostol for labor induction

ObjectiveTo determine the efficacy and safety of a titrated oral misoprostol solution compared with vaginal misoprostol tablets for labor induction. MethodsA randomized, triple-blind, multicenter clinical trial was conducted between March 2010 and June 2011. Women with a single gestation (n=200) were randomized to receive a titrated oral misoprostol solution (initial misoprostol dose 20μg/hour; dose increased by 20μg/hour every 6hours up to 80μg/hour for a maximum of 48 doses) or vaginal misoprostol tablets (25μg of misoprostol every 6hours for a maximum of 8 doses). Risk ratios (RR) and 95% confidence intervals (CIs) were calculated for maternal and perinatal outcomes. ResultsThe frequencies of vaginal delivery not achieved within 12hours (RR 0.87; 95% CI, 0.62–1.22) and within 24hours (RR 1.11; 95% CI, 0.83–1.49) were similar in the 2 groups. No differences were found in terms of uterine hyperstimulation, unfavorable cervix at 12 and 24hours, oxytocin augmentation, tachysystole, epidural analgesia, adverse effects, and perinatal outcome. Approximately 70% of the women preferred the oral solution. ConclusionA titrated oral misoprostol solution was as effective and safe for labor induction as vaginal misoprostol tablets.ClinicalTrial.gov: NCT00 992524

Oxytocin augmentation of labour in women with epidural analgesia for reducing operative deliveries

The rate of operative deliveries (both caesarean sections, vacuum extractions and forceps), continues to rise throughout the world. These are associated with significant maternal and neonatal morbidity. The most common reasons for operative births in nulliparous women are labour dystocia (failure to progress), and non-reassuring fetal status. Epidural analgesia has been shown to slow the progress of labour, as well as increase the rate of instrumental deliveries. However, it is unclear whether the use of oxytocin in women with epidural analgesia results in a reduction in operative deliveries, and thereby reduces both maternal and fetal morbidity. To determine whether augmentation of women using epidural analgesia with oxytocin will decrease the incidence of operative deliveries and thereby reduce fetal and maternal morbidity. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2013). All published and unpublished randomised and quasi-randomised trials that compared augmentation with oxytocin of women in spontaneous labour with epidural analgesia versus intent to manage expectantly were included. Cluster-randomised trials were eligible for inclusion but none were identified.Cross-over study designs were unlikely to be relevant for this intervention, and we planned to exclude them if any were identified. We did not include results that were only available in published abstracts. The two review authors independently assessed for inclusion the 16 studies identified as a result of the search strategy. Both review authors independently assessed the risk of bias for each included study. Both review authors independently extracted data. Data were checked for accuracy. We included two studies, involving 319 women. There was no statistically significant difference between the two groups in either of the primary outcomes of caesarean section (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.42 to 2.12) or instrumental delivery (RR 0.88, 95% CI 0.72 to 1.08). Similarly, there were no statistically significant differences between the two groups in any of the secondary outcomes for which data were available. This included Apgar score less than seven at five minutes (RR 3.06, 0.13 to 73.33), admission to neonatal intensive care unit (RR 1.07, 95% CI 0.29 to 3.93), uterine hyperstimulation (RR 1.32, 95% CI 0.97 to 1.80) and postpartum haemorrhage (RR 0.96, 95% CI 0.58, 1.59). There was no statistically significant difference identified between women in spontaneous labour with epidural analgesia who were augmented with oxytocin, compared with those who received placebo. However, due to the limited number of women included in the studies, further research in the form of randomised controlled trials are required.

Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labour

Slow progress in the first stage of spontaneous labour is associated with an increased caesarean section rate and fetal and maternal morbidity. Oxytocin has long been advocated as a treatment for slow progress in labour but it is unclear to what extent it improves the outcomes for that labour and whether it actually reduces the caesarean section rate or maternal and fetal morbidity. This review will address the use of oxytocin and whether it improves the outcomes for women who are progressing slowly in labour compared to situations where it is not used or where its administration is delayed. To determine if the use of oxytocin for the treatment of slow progress in the first stage of spontaneous labour is associated with a reduction in the incidence of caesarean sections, or maternal and fetal morbidity compared to situations where it is not used or where its administration is delayed. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (23 February 2013) and bibliographies of relevant papers. Randomised controlled trials which compared oxytocin with either placebo, no treatment or delayed oxytocin in the active stage of spontaneous labour in low-risk women at term. Two authors independently assessed studies for inclusion, assessed risk of bias and extracted data. We sought additional information from trial authors. We included eight studies in the review involving a total of 1338 low-risk women in the first stage of spontaneous labour at term. Two comparisons were made; 1) the use of oxytocin versus placebo or no treatment (three trials); 2) the early use of oxytocin versus its delayed use (five trials). There were no significant differences in the rates of caesarean section or instrumental vaginal delivery in either comparison. Early use of oxytocin resulted in an increase in uterine hyperstimulation associated with fetal heart changes. However, the early use of oxytocin versus its delayed use resulted in no significant differences in a range of neonatal and maternal outcomes. Use of early oxytocin resulted in a statistically significant reduction in the mean duration in labour of approximately two hours but did not increase the normal delivery rate. There was significant heterogeneity for this analysis and we carried out a random-effects meta-analysis; however, all of the trials are strongly in the same direction so it is reasonable to conclude that this is the true effect. We also performed a random-effects meta-analysis for the four other analyses which showed substantial heterogeneity in the review. For women making slow progress in spontaneous labour, treatment with oxytocin as compared with no treatment or delayed oxytocin treatment did not result in any discernable difference in the number of caesarean sections performed. In addition there were no detectable adverse effects for mother or baby. The use of oxytocin was associated with a reduction in the time to delivery of approximately two hours which might be important to some women. However, if the primary goal of this treatment is to reduce caesarean section rates, then doctors and midwives may have to look for alternative options.

A Randomized Clinical Trial on the Need of Continuing Oxytocin Infusion in Active Phase of Induced Labour

Objective : To evaluate the effect of continuation and discontinuation of oxytocin infusion on maternal and neonatal outcome once the active phase of labour is established. Methods: This is a prospective randomized clinical trial on 100 pregnant women in whom labour was induced on obstetric ground in our institute. Patients were randomly divided in two groups. In the first group oxytocin infusion continued throughout labour and in the second group oxytocin infusion discontinued after establishment of active phase of labour. Result: Consumption of total oxytocin dose, induction-delivery interval, uterine hyperstimulation, caesarean section rate were significantly less in oxytocin discontinued group. Concurrently in oxytocin-continued group rate of postpartum hemorrhage (PPH), neonatal asphyxia, hyperbillirubinemia were higher in comparison to oxytocindiscontinued group. Conclusion : Continuous oxytocin infusion during active phase of labour increases chance of caesarean section, PPH and also of neonatal asphyxia, hyperbillirubenemia. Discontinuation of oxytocin infusion reduces labour risk and gives good neonatal outcome. DOI: http://dx.doi.org/10.11566/cmoshmcj.v12i2.35 Chatt Maa Shi Hosp Med Coll J 2013; 12(2): 23-30

Comparative Evaluation of 50 Microgram Oral Misoprostol and 25 Microgram Intravaginal Misoprostol for Induction of Labour at Term: A Randomized Trial

ObjectivesTo assess and compare the efficacy and safety of 50 μg oral misoprostol and 25 μg intravaginal misoprostol for induction of labour at term. MethodsThis non-blinded, randomized clinical trial included 228 pregnant women at term with obstetric or medical indications for induction of labour. Women either took 50 μg misoprostol orally (two 25 μg tablets) or had one 25 μg tablet of misoprostol inserted in the posterior vaginal fornix. In each group, misoprostol administration was repeated every four hours in the same dose until regular uterine contractions were established or to a maximum of five doses. Time to delivery and outcome data for each group were compared. ResultsOf the 228 women, eight (3.5%) were excluded from the analysis as they withdrew their consent after randomization. Mean induction-to-delivery interval was similar in both groups (21.22 hours in the oral group vs. 20.15 hours in the vaginal group; P = 0.58). There was no significant difference between the groups with respect to the number of women who delivered within 24 hours or who required oxytocin augmentation of labour, the mode of delivery, and neonatal outcomes (P > 0.05). Uterine hyperstimulation occurred in two women who received misoprostol vaginally, but not in any of the women in the oral misoprostol group. ConclusionOral misoprostol in a dose of 50 μg every four hours, to a maximum of five doses, has the potential to induce labour as safely and effectively as 25 μg misoprostol administered vaginally every four hours.

PL.88 Syntocinon Infusion: A Prospective Audit at St John’s Hospital (Nov 2010 – April 2011)

IntroductionThe use of oxytocin infusion in the induction and augmentation of labour is an essential component of intra-partum care in obstetrics worldwide but can be associated with potentially serious complications....

PL.44 Repeat Use of Dinoprostone Pessary after Failed Induction of Labour

IntroductionThere is no guideline advising on the management of women in whom induction of labour with first dinoprostone pessary has failed. Repeat cervical ripening with a second pessary is a...

Induction of labour with a Foley catheter or oral misoprostol at term: the PROBAAT-II study, a multicentre randomised controlled trial

BackgroundInduction of labour is a common obstetric procedure. At present, different methods are used for induction of labour in women with an unfavourable cervix. Recently, we showed that in term women with an unfavorable cervix the use of a Foley catheter in comparison with vaginal Prostaglandin E2 gel, results in a comparable vaginal delivery rate. A meta-analysis on the subject indicated lower rates of hyperstimulation, and probably as a sequel fewer cases of postpartum haemorrhage. Misoprostol (PgE1) is another type of prostaglandin frequently used for labour induction, recommended by the international federation of gynaecology and obstetrics (FIGO). Misoprostol can be administered by vaginal, rectal and oral route. There is evidence that oral administration results in less asphyxia and hyperstimulation than vaginal administration. At present, valid comparisons between oral misoprostol and Foley catheter are lacking. Therefore, we propose a randomised controlled trial comparing Foley catheter to oral misoprostol in order to assess safety and cost-effectiveness.Methods/DesignWe plan a multicentre, randomised, controlled, open-label clinical trial among term pregnant women with a vital singleton in cephalic presentation, unfavorable cervix, intact membranes and an indication for induction of labour. After informed consent, women will be randomly allocated by a webbased randomisation system to transcervical Foley catheter or oral misoprostol (50 mcg every 4 hours). The primary outcome will be a composite of complications of uterine hyperstimulation, i.e. post partum haemorrhage and asphyxia. Secondary outcomes are mode of delivery, maternal and neonatal morbidity, costs and women’s preference. Serious adverse events such as severe maternal or neonatal morbitity or mortality will be monitored and reported to an independent data safety monitory board. With a sample size of 1860 women we will be able to demonstrate a 5% non-inferiority of the Foley catheter as compared to misoprostol for the composite outcome.DiscussionWorldwide, various methods are being used for labour induction. Results of the proposed trial will contribute to the answer which method of induction of labour is most safe, cost-effective, and patient friendly and will help to construct evidence based guidelines.Trial registrationThe Netherlands Trial Register NTR3466

The tocography variants of uterine activity hyperstimulation

We performed an analysis of 85 histories of labor. Depending on perinatal outcome and application of uterotonics all stories of labor were divided into 3 groups. We present typical signs and shapes of uterine activity hyperstimulation in the application of uterotonic in labor. We established that with the appearance of any signs of hyperstimulation, it is necessary to limit or suspend the infusion of drug or to revise the plan of labor conduction in favor of the Cesarean section.

The transcervical foley catheter versus the vaginal prostaglandin e2 gel in the induction of labour in a previous one caesarean section - a clinical study.

To compare the effectiveness and the safety of the transcervical Foley catheter and the prostaglandin E2 (PGE2) gel for the induction of labour in women with a previous one caesarean section with an unfavourable cervix at term. This study was conducted in the Department of Obstetrics and Gynaecology, J.N. Medical College, Aligarh, (U.P),India. Seventy women with singleton pregnancies at term, with previous one lower segment caesarean sections with a cephalic presentation and a Bishop's score of ≤ 6, who required induction at term were included in the study. Group A had 35 women in whom the transcervical Foley catheter was inserted and Group B included 35 women in whom the PGE2 gel was inserted vaginally for the induction of labour.The Bishop's score after 12 hours of induction, the oxytocin requirement, the induction to delivery interval, the mode of delivery, the maternal complications and the neonatal outcome were compared. The Foley catheter and the PGE2 gel had a comparable effect on the Bishop's score after 12 hours and the induction to the delivery interval was slightly shorter with the Foley catheter (18.15 hours) as compared to 21.06 hours with the PGE2 gel. There was no case of uterine rupture or scar dehiscence. In this study, both the modes of induction in women with previous one caesarean sections were safe, simple and effective. The main advantages of the cervical ripening with the Foley catheter over the Prostaglandin E2 gel are the low cost, reversibility and the lower risk of systemic and serious side effects like uterine hyperstimulation and rupture, as well as it induces a significant ripening and dilatation of the cervix and a shorter induction to the delivery interval. So, the cervical ripening effect of the Foley catheter is as good as that of the Prostaglandin E2 gel in women with previous one caesarean sections.

Efficacy and safety of oral solution dosed misoprostol versus misoprostol vaginally in labour induction

Background: Labour induction is one of the most common medical procedures in obstetrics. The aim is to end the pregnancy when continuity is a risk to mother or fetus. Its main side effect is the increase in the cesarean rate, compared to spontaneous onset deliveries. On the other hand, mortality and morbidity in cesareans are higher. The most common pharmacological drugs used for induction are prostaglandins: dinoprostone and misoprostol. The “gold standard” for labour induction is vaginal misoprostol. The oral route is also effective and also has several benefits like faster onset and easear administration. In recent years several publications state that the administration of misoprostol oral solution, given in doses gradually, is associated with a lower cesarean and hyperstimulation rate than the cases where vaginal misoprostol has been used in pregnant women with unripe cervix. Furthermore, being its half life shorter, it may be very useful in case of uterine hyperstimulation and, probably, a high percentage of women prefer this oral administration to the vaginal one. The objective of this study is to compare the efficacy, safety and side effects on mother and fetus on use of oral versus vaginal administration for induction of labour for prolonged gestation (41 weeks) and premature rupture of membranes, both with live fetus. Methods/Design: Design: double blind controlled trial. Study population: Pregnant women whose labour will be induced due to premature rupture of membranes or prolonged gestation. Inclusion Criteria: 1) Bishop Test equal to or less than 7; 2) Single pregnancy; 3) Pregnancy at term (37 - 42 weeks); 4) No history of uterine surgery; 5) Cephalic presentation; 6) Live fetus; 7) No prostaglandins contraindications. Discussion: Nowadays induction rates are very high, ranging from 25% to 30% approximately. In these cases caesarean rates are higher than when the delivery starts spontaneously. That is one of the main reasons why caesareans have increased, mainly in the cases of nuliparous women with immature cervix. If we can prove the hypothetical good results obtained through the use of dosed oral misoprotol, we will be able to reduce the number of induced deliveries by cesarean, and so improve the levels of security for the mother and the foetus, and, as a consequence, provide a higher quality of medical attention to the newborn and the mother.

Sudden persistent fetal bradycardia after spinal analgesia for labor pain

Sudden persistent fetal bradycardia after spinal analgesia for labor pain

Rose of Jericho: A Word of Caution

The wide consumption of this herb by Omani women may have not raised alertness to any negative outcomes during previous times. However, with the introduction of modern drugs for labor induction, and insulin for mothers with gestational diabetes, safety concerns regarding the possibility of uterine hyperstimulation, over induction of labor, or even hypoglycemia in the mother or the fetus, dictate that this herb should be used with caution. Until proven safe, Rose of Jericho consumption during pregnancy aught to be carefully monitored by doctors and caregivers. Pregnant women need to be aware about possible risks and acknowledge their usage of this herbal tea especially upon admission for delivery. Meanwhile, the consumption of this herb among pregnant women and its clinical relevance require further evaluation.

Isosorbide Mononitrate versus Misoprostol for Cervical Ripening

Objective: To compare the efficacy and safety of isosorbide mononitrate (IMN) versus misoprostol used to induce labour for overdue pregnancy.Setting: A prospective randomized clinical study conducted at AL-Elwiya Maternity Teaching Hospital in Baghdad from Jan. 2008 to Dec. 2008.Method: One hundred and fifty women with over due pregnancy (past date and posterm pregnancy) referred for induction of labour with Bishop scores &lt;_ 5 were randomly allocated to receive either forty mg isosorbide mononitrate (IMN) tablet as a single vaginal dose (n=75) or fifty mcg misoprostol vaginally (n=75) every six hrs for a maximum of three doses. Amniotomy and/or oxytocin infusion is considered when Bishop scores frankly progressed (augmentation) or used when no improvement achieved after 24 hour (induction). Adverse effects of medications, induction - delivery interval, mode of delivery and neonatal outcome were recorded and subjected to statistical analysis.Results: Isosorbide mononitrate was associated with less adverse effects than misoprostol especially regarding uterine tachysystol (0 with isosorbide mononitrate vs 12% with misoprostol, P&lt;0.01) and hyperstimulation (0 with isosorbide mononitrate vs 16% with misoprostol, p&lt;0.01) but the induction - delivery interval with isosorbide mononitrate group was significantly longer compared with misoprostol (26.3±7.3hrs vs 15.4±5.4 hrs , p&lt;0.01). Oxytocin was added to 70 women (93.3%) used isosorbide mononitrate while to 15 women (20%) used misoprostol (p&lt;0.001). Caesarean rate was not significantly different between the two groups, but the indications were different, dystocia is the major cause (73.3%) with isosorbide mononitrate while persistent non-assuring fetal heart rate pattern (64%) in the misoprostol group.Conclusion: Cervical ripening and induction of labour using isosorbide mononitrate resulted in fewer adverse effects but it was less effective than misoprostol.

Assimilating evidence quality at a glance using graphic display: research synthesis on labor induction

Evidence profiled in the World Health Organization induction of labor guideline extended to 84 tables and 116 pages, which is hard to assimilate. Summarizing this evidence graphically can present information on key outcomes succinctly, illustrating where the gaps, strengths and weaknesses lie. For induction of labor, graphic representation clearly showed that evidence was lacking on maternal complications when comparing oxytocin with other agents, evidence was strong on birth within 24 h when comparing vaginal prostaglandins with placebo or no treatment, but again it was weak on uterine hyperstimulation when comparing oxytocin with vaginal prostaglandins. These graphs/plots allow readers to capture the essence of the information gathered at a glance. The use of graphical displays when interpreting and publishing data on several comparisons and outcomes is encouraged.