Safety and Efficacy of Oral Mifepristone in Pre-induction Cervical Ripening and Induction of Labour in Prolonged Pregnancy

Objective(S)

To study the safety and efficacy of oral mifepristone in pre-induction cervical ripening and induction of labour in prolonged pregnancy.

Method(S)

This is a single blind randomized control trial. 100 women with prolonged pregnancy beyond 40 weeks and Bishop score <6 were recruited, and randomly allocated into two groups. Women who received Tab. Mifepristone 200 mg orally were assigned in Study Group (n = 50) and who received placebo orally were assigned in Control Group (n = 50) At the end of 24 h, change in the Bishop’s score was assessed and Tab. Misoprostol 25 μg was administered intravaginally every 4 h, maximum 6 doses for induction/augmentation of labour. Analysis regarding safety and efficacy of the drug was done with regards to maternal and perinatal outcome.

Result(S)

Among 100 subjects, 50 received mifepristone and 50 received placebo. Mean induction to delivery interval was 1,907 ± 368.4 min for Study Group versus 2,079 ± 231.6 min for Control Group. The improvement in mean Bishop score was 5.0408 ± 1.90 for Study Group compared with 3.26 ± 1.15 was for Control Group after 24 h. Mean dose of misoprostol in Study Group was 40 ± 27.2, while the same in Control Group was 52 ± 19.46. Eight (16 %) women in Study Group and two (4 %) women in Control Group delivered vaginally within 24 h without any need of augmentation. There were 6 (12 %) cesareans and 2 (4 %) instrumental deliveries in Study Group and 8 (16 %) cesareans and 5 (10 %) instrumental deliveries in the Control Group. There was no statistically significant difference in perinatal outcomes between two groups.

Conclusion(S)

Mifepristone had a modest effect on cervical ripening when given 24 h prior to labour induction and appearing to reduce need for misoprostol compared with placebo.     

Vaginal Misoprostol vs Vaginal Misoprostol With Estradiol for Labor Induction: A Prospective Double Blind Study

Objective

To compare the safety and effectiveness of vaginal misoprostol with combined vaginal misoprostol and estradiol for induction of labor in unfavorable cervix.

Method

A prospective study was carried out from Jan 2008 to Jul 2008 on total of 90 women with unfavorable cervix (Bishop’s score was <5) and gestation >36 weeks with clinical indication for induction of labor. They were randomly assigned to receive either vaginal misoprostol 25 μg alone or vaginal misoprostol 25 μg with vaginal estradiol 50 μg. Misoprostol alone was repeated every 3 h in both groups till ripening of cervix (Bishop’s score was = 8) and establishment of active labor.

Results

Main indications were post dated pregnancies (period of gestation >41 weeks) and pregnancy induced hypertension. Age, parity and mode of delivery were not significantly different. No significant difference was found in pre induction Bishop’s score, fetal outcome and maternal complications. However, doses of misoprostol required for cervical ripening (p = 0.017), time required for cervical ripening (p = 0.042), time required for starting of active labor (p = 0.017) and time required for delivery in vaginal delivery cases (p = 0.047) were found significantly less in combined estradiol and misoprostol group.

Conclusion

Estradiol acts synergistically with misoprostol vaginally and significantly hastens the process of cervical ripening, initiation of active labor and vaginal delivery.     

Comparison Between Use of Oral Misoprostol Versus Vaginal Misoprostol for Induction of Labour at Term

Background and Objective

In modern obstetrics, around 30% of cases require induction of labour for various reasons. Misoprostol is gaining popularity as pharmacological inducing agent, though the route and dosage of administration are not standardised. The objective of the study is to compare the safety and efficacy of the two routes of misoprostol administration—oral (100 μg 4th hourly) and vaginal (25 μg 4th hourly), for induction of labour at term.

Methods

In this randomised trial, 104 women having crossed the expected date of delivery without going into spontaneous labour and cases which had premature rupture of membranes <12 h were considered for labour induction and were divided into two equal groups. Group A received 100 μg misoprostol orally 4th hourly, and group B received 25 μg misoprostol vaginally 4th hourly. Labour characteristics and maternal and foetal outcome were compared.

Results

In terms of maternal outcome, mean number of doses for oral group is 2.73 and vaginal group is 3.04. In oral group, mean induction to vaginal delivery interval was 13 h 43 min and in vaginal group interval is 13 h 26 min which was statistically not significant. The need for oxytocin augmentation was also statistically not significant. Both groups had equal number of failed inductions. Emergency LSCS done for foetal distress was more in vaginal group 2.9% compared to oral group which is 1%, but difference was not statistically significant (p value ?0.55). Number of thick MSL in oral group was 3.2% as compared to vaginal group which is 10.7% which was statistically significant (p value ?0.04). APGAR score at 5 min 7/10 was seen in 7.7% in vaginal group as compared to 0% in oral group which was also statistically significant (0.004). Number of NICU admissions was also more in vaginal group compared to oral group.

Conclusion

Misoprostol in either oral or vaginal route has proven to be equally effective for inducing labour in women at term pregnancy. However, occurrence of lesser incidence of meconium-stained liquor and NICU admissions and fewer caesareans with better neonatal outcome in women induced with oral misoprostol outweighs its advantages over the vaginal misoprostol.

     

To Study the Maternal and Neonatal Outcome in Postdated Women Undergoing Induction of Labour Versus Spontaneous Labour

IntroductionEnsuring safety of the mother along with the delivery of a healthy baby is the ultimate objective of all obstetricians. Labour induction is increasingly becoming one of the most common obstetric interventions in India. The aim of the study is to compare the feto-maternal outcome of induction of labour versus spontaneous labour in postdated women.MethodThis was a prospective observational comparative study. A total of 100 patients were selected, 50 who had induction of labour (study group) and 50 who had spontaneous labour (control). A structured proforma and partographs were used to obtain data.Result42% nulliparous women had induction of labour as compared to 29% multiparous women. The rate of cesarean section (58%) was substantially higher in those who had been induced. Non-progression of labour or failure of induction was the commonest indication for cesarean section. Post-partum haemorrhage was a complication found more commonly in the study group. Perineal tears were found more commonly in the control group.The mean birth weight of babies born to mothers who had been induced was significantly higher than that of those born to women who went into spontaneous labour. The APGAR scores were comparable in both groups. There was a higher incidence of hyperbilirubinemia in the study group.ConclusionAlthough induction of labour is a relatively safe procedure, some foetal and maternal risks were found to be higher in induced group than in those with spontaneous labour. Induction must be carried out only when necessary and not as a routine elective procedure.     

Buccal Versus Vaginal Misoprostol Administration for the Induction of First and Second Trimester Abortions

Objectives

To compare the effectiveness, side effects, and patient satisfaction of buccal versus vaginal misoprostol administration in first and second trimester induced abortions.

Methods

In first trimester, women received oral mifepristone followed by misoprostol either by buccal or vaginal route. In second trimester, women received oral mifepristone followed by repeated doses of misoprostol either by buccal or vaginal route. A comparative analysis using SPSS was done.

Results

In first trimester, success rate of medical abortion was 96 % in buccal group and 88 % in vaginal group. Nausea was the most common adverse effect which was similar in both groups. In second trimester, success rate was 96 % in buccal group and 80 % in vaginal group. A statistically higher incidence of nausea was noticed in buccal group. Patient satisfaction level was almost similar in both the groups in both trimesters.

Conclusions

Buccal and vaginal routes of misoprostol administration have similar efficacy and patient satisfaction level for first and second trimester induced abortions. Hence, buccal route may serve as an alternative to vaginal misoprostol.     

Prospective Comparative Study of Oral Versus Vaginal Misoprostol for Second-Trimester Termination of Pregnancy

Background

Various medical methods for second-trimester medical termination of pregnancy (MTP) exist. Misoprostol alone has been used with myriad variations in route and dosage. Comparison between oral and vaginal routes of misoprostol forms the basis of this study.

Methods

This was a prospective comparative study of misoprostol for second-trimester (14–20 weeks) MTP, comparing oral versus vaginal routes. Sixty patients were randomly allotted to two groups; 30 received oral misoprostol 400 µg 4 h up to a maximum of five doses (2000 µg), and 30 received vaginal misoprostol in the same dose and duration. In both groups, oxytocin infusion was started if abortion did not occur. Efficacy of oral versus vaginal misoprostol, induction–abortion interval (AI) and need for surgical intervention were analyzed.

Results

Both groups were well matched in terms of age, parity, previous LSCS, mean gestational age and indication for MTP. Overall mean induction–abortion interval was 19.59 h (21.66 vs. 18.57 h, oral vs. vaginal, respectively), with vaginal group taking lesser time (p 0.09). Sixty percentage in oral group required five doses, while 70% in vaginal group required 3–4 doses of misoprostol (p 0.010). 23.7 versus 6.7% in oral versus vaginal group required check curettage (p 0.038). There were no major complications, and there was only one failure in oral group.

Conclusions

Though both oral and vaginal misoprostol are safe, vaginal route appears to be more efficacious for second-trimester MTP.

     

Misoprostol for induction of labour: a survey of attitude and practice in southwestern Nigeria

BACKGROUND: Although supported by research evidence, misoprostol for induction of labour remains contentious. OBJECTIVE: To assess perception and practice of obstetricians regarding use of misoprostol for labour induction. METHODOLOGY: Cross-sectional questionnaire-based survey of Senior Registrars and Consultant Obstetricians in southwestern Nigeria. RESULTS: One hundred and six questionnaires were completed (52.8% Consultants; 47.2% Senior Registrars). Most respondents (96, 90.6%) employ misoprostol for induction in both live and dead fetuses with majority having personally prescribed misoprostol for cervical ripening or induction of labour (97.2 and 79.3%, respectively). Fetal tachycardia, hyperstimulation and ruptured uterus were the commonly reported complications. Twenty-six respondents (24.5%) reported being aware of maternal death in relation to misoprostol use. Only 52.9% of the respondents have protocols guiding misoprostol use in their hospitals. More than half of respondents administer misoprostol 50 mug or higher 6 hourly. Most (92, 87.6%) believe that research evidence backs use of misoprostol for the indication; 89.5% of respondents support use of misoprostol. Most respondents (90, 86.5%) disagree with the notion that misoprostol is too dangerous for induction; only 26 respondents (25.1%) considered oxytocin a better choice for induction; 93 respondents (88.6%) agreed that, given cautious use, misoprostol is safe for induction, while 86 respondents (81.9%) considered misoprostol a cost-effective intervention for labour induction in developing countries. Though senior registrars and younger consultants tended to report side effects more frequently than older consultants, they were more likely to support misoprostol for induction of labour than older consultants. This differences were however not statistically significant (P > 0.05). CONCLUSION: Misoprostol is widely utilized by obstetricians for induction of labour in southwestern Nigeria. Fetal and maternal side effects are commonly experienced. We recommend urgent adoption of evidence-based guidelines in every unit using the drug to prevent complications.     

Oral Misoprostol Solution for Induction of Labour

Objective

To determine the effects of oral misoprostol solution for induction of labour.

Study Design

This is a prospective observational study.

Setting

This study was conducted in Government Medical College, Aurangabad.

Method

Patients undergoing induction of labour after 36 weeks of pregnancy were allocated by randomization to induction of labour with oral misoprostol solution administered 2 h apart. Delivery within 24 h after induction with oral misoprostol solution was the primary outcome on which the sample size was based. The data were analysed by Statistical Software for Social Sciences software.

Result

Two hundred patients were randomly selected for induction with oral misoprostol solution. There were no significant differences in substantive outcomes. Vaginal delivery within 24 h was achieved in 80.5 % of patients. The caesarean section rate was 19.5 %. Uterine hyperactivity occurred in 4 % of patients. The response to induction of labour in women with unfavourable cervices (modified Bishop’s score <2) was somewhat slower with misoprostol, induction to delivery interval was more, oxytocin requirement was more, and vaginal delivery rate was less.

Conclusion

This new approach to oral misoprostol solution administration was successful in achieving vaginal delivery rate in 24 h in 80.5 % of patients; rate of LSCS was less 19.5 %.

     

Comparative Study of Misoprostol in First and Second Trimester Abortions by Oral,Sublingual, and Vaginal Routes

Objective

To identify an effective misoprostol-only regimen for termination of pregnancy between 12 and 20 weeks of gestation, a prospective randomized study comparing sublingual, vaginal, and oral routes of administration of misoprostol was done.

Methods

One hundred and fifty women (12–20 weeks gestation) were randomly divided into three groups and given 400 mcg misoprostol sublingually, vaginally, and orally every 4 h up to a maximum of four doses. Primary outcome was the success rate at 24 h. Secondary outcomes were failure rate, induction–abortion interval, and need for surgical intervention. Various side effects and patients’ subjective assessment of comfort with the route of administration were also studied.

Results

Success rate at 24 h of sublingual (86 %) group was higher compared to oral (64 %) group (P = 0.011). Complete abortion rate of sublingual (76 %) group was higher than that of oral (48 %) group (P = 0.004). There was no significant difference in the failure rate and need for surgical intervention in the three groups. Induction–abortion interval in sublingual (9.8 ± 3.6 h) and vaginal (10.6 ± 2.9 h) groups was shorter than that in oral group (14.3 ± 3.3). Diarrhea occurred significantly more in the oral group (28 %) and sublingual (22 %) compared to vaginal group (6 %). Fever was significantly higher in vaginal (36 %) than that in the oral group (12 %). Oral route of administration was most comfortable.

Conclusion

Sublingual route results in significantly higher abortion rate compared to oral route. Vaginal route has efficacy similar to sublingual route.     

Oral misoprostol versus intracervical dinoprostone for induction of labor.

OBJECTIVES: To compare oral misoprostol with dinoprostone for induction of labor and their effects on the fetal heart rate patterns. METHODS: In a randomized controlled trial, 200 patients received either misoprostol 50 mug orally for every 4 h, or dinoprostone 0.5 mg intracervically for every 6 h. Cardiotocographic recordings, in 10-min windows 30, 60, and 80 min after prostaglandin administration during induction and continuously during labor, were compared between the two groups. Primary outcome for effectiveness and safety was assessed in terms of the number of vaginal deliveries within 24 h and fetal heart rate abnormalities during induction and labor respectively. RESULTS: Data from 96 patients in the misoprostol group and 95 in the dinoprostone group were analyzed. There were no significant differences in respect of the number of vaginal deliveries within 24 h (RR 1.12; 95% CI 0.88-1.42). The frequency of suspicious and pathological fetal heart rate patterns did not differ significantly but significantly more cardiotocographs in the dinoprostone group had non-reassuring baseline variability 60 min after dose administration (RR 0.33; 95% CI 0.14-0.77). Maternal and neonatal outcomes did not differ significantly. CONCLUSION: Oral misoprostol is as effective as intracervical dinoprostone for induction of labor with no difference in the frequency of fetal heart rate abnormalities.     

Induction of Labor at Term with Oral Misoprostol or as a Vaginal Insert and Dinoprostone Vaginal Insert – A Multicenter Prospective Cohort Study

Introduction The efficacy, safety, and perinatal outcome of oral misoprostol (OM), a misoprostol vaginal insert (MVI), and a dinoprostone vaginal insert (DVI) for induction of labor at term was examined in a prospective multicenter cohort study (ethics committee vote 4154–07/14). The primary aims of the study were the induction-birth interval (IBI), the cumulative delivery rates after 12 h, 24 h, and 48 h as well as the mode of delivery. Method 322 pregnant women were included in four German tertiary perinatal centers (MVI 110, DVI 64, OM 148). They did not vary in age or BMI. Statistical analysis was carried out using a multivariate linear regression analysis and binary logistic regression analysis. Results With regards to the median IBI, MVI and OM were equally effective and superior to the DVI (MVI 823 min [202, 5587]; DVI 1226 min [209, 4909]; OM 847 min [105, 5201]; p = 0.006). Within 24 hours, 64% were able to deliver with DVI, 85.5% with MVI and 87.5% with OM (p < 0.01). The rates of secondary Caesarean sections (MVI 24.5%; DVI 26.6%; OM 18.9%) did not differ significantly. Uterine tachysystole was found in 20% with MVI, 4.7% with DVI and 1.4% with OM (p < 0.001). A uterine rupture did not occur in any of the cases. Perinatal acidosis occurred (umbilical cord arterial pH < 7.10) in 8.3% with MVI, 4.7 with DVI and 1% with OM (p = 0.32). Neonatal condition was only impaired in three cases (5-minute Apgar score < 5). Summary Induction of labor at term using the prostaglandins misoprostol and dinoprostone is an effective intervention that is safe for the mother and child. Oral application of misoprostol demonstrated the highest efficacy while maintaining a favorable safety profile.     

米索前列醇促宫颈成熟的效果及安全性评价

目的：评价米索前列醇用于晚期妊娠促宫颈成熟的有效性及安全性。方法：采用随机双盲临床对照试验。宫颈Ｂｉｓｈｏｐ评分＜７分、有引产指征的单胎、头位妊娠８５例，分为试验组４３例（阴道给米索前列醇１００μｇ），对照组４２例（给予安慰剂）。用药前及用药１２小时后进行宫颈Ｂｉｓｈｏｐ评分，胎心电子监护，脐动脉、胎儿大脑中动脉和肾动脉收缩期最大血流速度（Ｓ）与舒张末期血流速度（Ｄ）的比值（Ｓ／Ｄ值）测定。如１２小时不临产，按常规行催产素引产。产后留取胎盘及蜕膜组织进行组织学观察。结果：用药１２小时后，试验组宫颈Ｂｉｓｈｏｐ评分升高平均为４．４±２．２分，明显高于对照组的１．０±０．９分。试验组用药后１２小时内自然临产发生率为６７．４％（２９／４３），显著高于对照组的１４．３％（６／４２）。两组用药前后脐动脉、大脑中动脉及肾动脉Ｓ／Ｄ值差异均无显著性（Ｐ＞０．０５）。两组胎心率监护异常发生率、胎儿窘迫发生率及新生儿Ａｐｇａｒ评分差异均无显著性。组织学观察除绒毛干及绒毛内血管呈不同程度扩张外，试验组胎盘及蜕膜组织学改变与对照组无其它不同。结论：米索前列醇（１００μｇ）用于晚期妊娠促宫颈成熟，安全、有效、用药方便。     

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.     

Comparison of Induction of Labour and Expectant Management in Postterm Pregnancy: A Matched Cohort Study

Randomized clinical trials have shown that induction of labour does not result in higher caesarean delivery rates in women who are postterm. Despite this evidence, the policy of inducing women who are postterm is not generally applied in the Netherlands. This provides us with the opportunity to assess whether the findings from randomized studies can also be observed in nonrandomized studies and to validate these findings in the Dutch obstetric population. We performed a retrospective matched cohort study (1:1 ratios for both age and parity) in women with uncomplicated pregnancies of 42 weeks' duration and compared induction of labour with a policy of serial antenatal monitoring. Analyses were made by the intention to treat principle. We studied 674 women. Among the 337 women in the expectant management group, 42 (12.5%) underwent caesarean delivery, compared to 46 (13.6%) of the 337 women in the induction group (relative risk [RR], 0.9; 95% confidence interval [CI], 0.6–1.4). However, the incidence of shoulder dystocia (RR, 4.3; 95% CI, 1.3–15) and meconium‐stained amniotic fluid (RR, 1.8; 95% CI, 1.4–2.3) were higher in the expectant management group. Induction of labour does not result in an increased risk of caesarean delivery in women who are postterm. Because epidemiologic studies suggest an increased risk of perinatal death and birth injury beyond 42 weeks' gestation, induction of labour should be offered to all women who are postterm.     

Oral Misoprostol for Induction of Labour in Term PROM: A Systematic Review

ObjectiveTo assess the efficacy of oral misoprostol for induction of labour (IOL) in the context of term pre-labour rupture of membranes (TPROM), and to assess pregnancy outcomes following the administration of oral misoprostol.Data SourcesA systematic literature search was performed using Ovid Medline, Embase, PubMed, and the Cochrane Database of Systematic Reviews.Study SelectionEligible studies were quasi-experimental trials or randomized controlled trials involving the use of oral misoprostol in singleton cephalic term pregnancies with confirmed rupture of membranes and no spontaneous labour at the time of membranes rupture, in mothers with no contraindications to vaginal delivery. Studies were excluded if they utilized vaginal misoprostol, excluded primigravid participants, or if the full text of the article was not accessible in English.Data ExtractionData were extracted by two reviewers using a standardized data extraction form. Study quality was assessed using the modified Jadad score.Data SynthesisTwelve randomized controlled trials that included 1489 singleton pregnancies were included. Doses of oral misoprostol ranged from 20 to 200 μg. The incidence of vaginal birth ranged from 73.0%–95.0% in the oral misoprostol group compared with 52.4%–94% in the control group. Hyperstimulation was infrequent, ranging from 0% to 13.8% in the oral misoprostol group compared with 0%–24% in the control group. Two trials, involving a total of 144 women that compared 50 μg of oral misoprostol every 4 hours versus expectant management followed by PGE₂ gel showed a higher incidence of vaginal birth with misoprostol (pooled risk ratio 1.33, 95% confidence interval 1.10–1.61).ConclusionOral misoprostol appears to be a safe and effective for IOL in TPROM. However, the varying administration, dose, and frequency reported in the literature highlights the need to develop a standardized protocol for use in Canadian obstetrical practice.     

Comparative Efficacy of Vaginal Misoprostol vs Vaginal Dinoprostone Administered 3 Hours Prior to Copper T380A Intrauterine Device Insertion in Nulliparous Women: A Randomized Controlled Trial

Study ObjectiveTo compare the effectiveness of misoprostol and dinoprostone tablets administered vaginally 3 hours before copper intrauterine device (IUD) insertion vs placebo in reducing pain and increasing ease of insertion among nulliparous women.DesignRandomized controlled trial.SettingTertiary referral hospital.ParticipantsA total of 129 nulliparous women requesting a Copper T380A IUD insertion.InterventionsWomen were randomized to receive 200 μg misoprostol or 3 mg dinoprostone or placebo 3 hours before IUD insertion.Main Outcome Measure(s)Primary outcome was patient-reported pain during IUD insertion using a 10-cm visual analog scale (VAS). Secondary outcomes include provider ease of insertion, women satisfaction level, and side effects.ResultsParticipants' baseline characteristics were comparable between the study groups. Mean pain score during IUD insertion was lower with misoprostol than placebo (3.1 ± 2.3 vs 4.4 ± 2.2; P = .02) and dinoprostone compared to placebo (2.4 ± 1.8 vs 4.4 ± 2.2; P < .001). Clinicians reported easier IUD insertion with misoprostol than placebo (2.4 ± 1.7 vs 4.0 ± 2.4; P = .001) and dinoprostone compared to placebo (2.0 ± 1.5 vs 4.0 ± 2.4; P < .001). Women's satisfaction levels were higher with both misoprostol and dinoprostone than placebo (P < .001). Side effects did not differ among the 3 study groups.ConclusionsPremedication with vaginal misoprostol or dinoprostone effectively lowered pain during copper IUD insertion. However, the reduction in pain scores was clinically significant only in women who received dinoprostone. In both the misoprostol and dinoprostone groups, clinicians found the procedure easier, and women were more satisfied with IUD insertion. Side effects and complications were similar in all groups.     

Trends in obstetric interventions in the Dutch obstetrical care system in the period 1993-2002

OBJECTIVE: To determine trends in induction of labour-, instrumental vaginal delivery- and caesarean section rates in the Netherlands in the period 1993-2002. STUDY DESIGN: Data derived from The Netherlands Perinatal Registry and Statistics Netherlands were used to calculate annual rates for induction of labour, instrumental vaginal delivery and caesarean section. Regarding caesarean section, rates were also calculated for different subgroups with respect to parity, presentation of the fetus, gestational age and multiple pregnancies. In the subgroup of women with a singleton fetus in vertex presentation between 37 and 42 weeks of gestation instrumental delivery rates were compared for women with induced labours and women in spontaneous labour. RESULTS: The overall CS rate rose from 8.1 to 13.6%. Proportionally the rise was greatest for breech presentation (+37.7%), multiple gestations (+12.7%) and women delivering between 24 and 28 weeks (+9.5%). However, in absolute numbers the rise was most impressive in the group of women with a singleton fetus in vertex presentation between 37 and 42 weeks of gestation. Rate of induction of labour and instrumental vaginal delivery remained constant (approximately 15% respectively 10% of all deliveries). In nulliparous term women with singletons in vertex presentation the CS rate increased with 8.0% to a rate of 20.7% when labour was induced versus an increase of 3.4% to a rate of 7.5% in spontaneous labour. CONCLUSION: In absolute numbers the rise in CS was most extensive in the group of women with a singleton fetus in vertex presentation between 37 and 42 weeks of gestation. Induction of labour rates and instrumental vaginal delivery rates remained constant during the past decade.     

米索前列醇后穹窿给药用于足月妊娠引产

目的探讨足月妊娠应用米索前列醇引产的安全性和效果.方法选择正常单胎头位足月妊娠具有引产指征,而无禁忌症100例,随机分成两组,米索组用米索前列醇50μg放置阴道后穹窿,每3h服1次,共3次,缩宫素组用缩宫素2.5IU加入5%葡萄糖500ml内.结果米索组引产的有效率为95.46%,缩宫素组为80.85%,P＜0.05,有显著差异,低宫颈评分引产成功率,米索组84.09%,缩宫素组48.94%,P＜0.05,有显著差异,总产程时间米索组短于缩宫素组,二组分娩方式、产后出血、以及新生儿情况比较无显著差异.结论米索前列醇应用于足月妊娠引产既能促宫颈成熟,又能于短时间内发动规律宫缩,两者同步化,是一种使用方便、安全有效、价格便宜的引产方法,但需严密监护.     

Vaginal Dinoprostone Versus Oral Misoprostol for Predilatation of the Cervix in First Trimester Surgical Abortion

Summary: Prostaglandins are effective in predilatation of the cervix prior to first trimester surgical termination of pregnancy under local analgesia. A randomized open comparative trial was devised to compare the effectiveness and acceptability of vaginal dinoprostone with oral misoprostol. Two groups were randomized to control for age, parity and ethnicity. The operation was easier and less painful in older, parous, and Polynesian women. Both methods were effective with respect to ease of dilatation. Both were acceptable and equal with respect to the level of pain experienced by the woman during the operation. Vaginal dinoprostone is more gradual in its action, but it is more expensive, has to be refrigerated and self-insertion may sometimes cause problems. Oral misoprostol is considerably cheaper and does not require refrigeration, but it was associated with more preoperative nausea, cramping and occasional heavy bleeding.     

Vaginal Dinoprostone Versus Oral Misoprostol for Predilatation of the Cervix in First Trimester Surgical Abortion

Summary: Prostaglandins are effective in predilatation of the cervix prior to first trimester surgical termination of pregnancy under local analgesia. A randomized open comparative trial was devised to compare the effectiveness and acceptability of vaginal dinoprostone with oral misoprostol. Two groups were randomized to control for age, parity and ethnicity. The operation was easier and less painful in older, parous, and Polynesian women. Both methods were effective with respect to ease of dilatation. Both were acceptable and equal with respect to the level of pain experienced by the woman during the operation. Vaginal dinoprostone is more gradual in its action, but it is more expensive, has to be refrigerated and self-insertion may sometimes cause problems. Oral misoprostol is considerably cheaper and does not require refrigeration, but it was associated with more preoperative nausea, cramping and occasional heavy bleeding.