Induction of labor with intravaginal administration of misoprostol

Objective: The purpose of this study was to evaluate the efficacy and safety of intravaginal misoprostol for labor induction. Methods: 110 singleton term pregnancies with or without rupture of membranes were enrolled. Fractionated doses of misoprostol were applied (50–100 μg), every 6 h until a maximum of three doses or beginning of labor. Results: The average interval (±S.D.) from vaginal application to the beginning of active labor and to delivery were, respectively, 9.5±5.7 h and 14.8±9.5 h. Failed labor induction was observed in two cases (2%). Cesarean section rate was 14%. The incidence of tachysystole was 18% and hypersystole 4%, but these situations were associated with abnormal fetal heart rate pattern (hyperstimulation) in only 3%. No maternal side effects and neonatal adverse effects were noted. Conclusions: Intravaginal misoprostol administration with low doses is an effective and safe method for labor induction in term pregnancies, with or without rupture of membranes.     

Intravaginal misoprostol 600 μg and 800 μg for the treatment of early pregnancy failure

Objective: To compare the respective effectiveness and safety of 600 μg and 800 μg of intravaginal misoprostol for complete abortion in cases of early pregnancy failure (occurring in the first 12 weeks). Method: A total of 114 women with a diagnosis of early pregnancy failure made by transvaginal ultrasonography at Rajavithi Hospital between November 25, 2002 and July 31, 2003, were assigned randomly to 2 groups of equal size. In one group the women received 600 μg of misoprostol and in the other 800 μg of misoprostol intravaginally. Results: The rate of complete abortion within 24 h was significantly higher in the group that received 800 μg of misoprostol (68.4%) than in the other group (45.6%) (P < 0.05). There were no significant differences between the 2 groups regarding time interval between misoprostol insertion and complete abortion or side effects. Conclusion: Intravaginal misoprostol 800 μg is significantly more effective than vaginal misoprostol 600 μg for the termination of an early pregnancy failure, with no significant differences in side effects.     

Prediction of adverse outcome associated with vaginal misoprostol for labor induction

Objective: To identify predictors of adverse outcome in pregnant women at term receiving 50 μg of intravaginal misoprostol for labor induction. Study design: A prospective observational study was conducted of 720 pregnant women at term with an unfavorable cervix and a medical or obstetric indication for labor induction. All patients received 50 μg of intravaginal misoprostol every 4 h up to three doses. The primary outcome measure was “adverse outcome” defined as: neonatal death, fetal acidemia and emergent cesarean delivery performed for non-reassuring fetal heart rate tracings. A stepwise logistic regression analysis was used to identify predictors of adverse outcome. Results: Tachysystole (frequent uterine contractions) (odds ratio (OR), 3.7; 95% confidence interval (CI), 1.2–10.8) and fetal tachycardia (OR, 4.8; 95% CI, 1.4–16.2) were determined as significant predictors of adverse outcome. The specificity of the model was 94.2%, whereas the sensitivity was 20.4%. Conclusion: In the absence of tachysystole and fetal tachycardia, an uneventful delivery might be expected for women receiving 50 μg of intravaginal misoprostol.     

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.     

Two different regimens of preinduction ripening of the uterine cervix with prostaglandin E2: a randomized clinical study

A randomized clinical study was designed to test the relative efficacy of preinduction cervical ripening with 0.25 mg prostaglandin E₂ (PGE₂), repeated if necessary (group 1) compared to a single maturation with 0.50 mg PGE₂ (group 2). In group 1 (n = 42), the ripening process was repeated every day until spontaneous onset of labor occurred or induction with oxytocin was decided (for improved Bishop score above 5, or maternal or fetal distress). In group 2 (n = 42) the patients who had not labored 12 h after the maturation procedure had labor induced with oxytocin, irrespective of their cervical status. In group 1, 28 patients experienced repeated maturations (from 2 to 9). Thirty patients had an induction of labor with oxytocin in group 2 and only 12 in group 1 (P < 0.0001). There were four failures of induction of labor in group 2 and none in group 1 (P < 0.05). Three episodes of myometrial hyperstimulation requiring an emergency cesarean section for acute fetal distress occurred in group 2 and none in group 1. There were 13 cesarean sections in group 2 and eight in group 1. The outcome of pregnancy was otherwise similar in both groups. In order to avoid failure of induction of labor, pre-induction cervical ripening with 0.25 mg PGE₂, repeated daily if necessary, is therefore recommended in high risk pregnancy unless a severe maternal or a fetal distress call for a prompt delivery irrespective of the cervical status.     

Endometrial T-lymphocyte subset infiltration during the ovine estrous cycle and early pregnancy

T-lymphocytes were quantitated within luminal, stromal and glandular areas of ovine endometrium. In experiment 1, ovariectomized (OVX), estrus (E) and day 13 (D13) ewes (six/group) received 500 μg of phytohemagglutinin (PHA) or vehicle in ligated right and left uterine horns, respectively. At 48 h, uteri were removed for the immunohistochemical evaluation of T-lymphocyte subsets. In experiment 2, T-lymphocytes were quantitated within non-pregnant and pregnant uterine horns on day 19. For experiment 1, mean numbers of T₄ and T₈ lymphocytes within luminal and stromal areas of PHA-treated horns were greatest (P < 0.05) for D13 ewes and least (P < 0.05) for E ewes. Numbers of T₆ lymphocytes for these same areas were greatest (P < 0.05) for PHA-treated horns of OVX ewes. Overall, the T₄/T₈ ratio (P < 0.004) and mean number of T₁₉ cells (P < 0.009) were increased by PHA. Numbers of CD45R lymphocytes were not affected by PHA but were greater (P < 0.05) in glandular and luminal than stromal areas. For experiment 2, mean numbers of endometrial T₄, T₆, T₈ and T₁₉ lymphocytes were similar (P> 0.05) between non-pregnant and pregnant horns; however, the number of CD45R lymphocytes was greater (P < 0.05) in endometrial tissue of pregnant than non-pregnant horns. The data indicate that the in vivo response of specific ovine T-lymphocytes to PHA was generally dependent upon reproductive stage and the presence of conceptus tissue influenced the infiltration of CD45R lymphocytes.     

Effect of angiotensin-converting enzyme inhibitor on renal function in ovarian hyperstimulation syndrome in the rabbit

Objective: To investigate renal function and whether captopril prevents alterations in the handling of sodium and water in the ovarian hyperstimulation syndrome (OHSS) in the rabbit.

Design: Experimental study

Setting: Physiology laboratory.

Animal(s): Six female New Zealand white rabbits were used as controls, and 13 were hyperstimulated with gonadotropins.

Intervention(s): Saline or captopril.

Main Outcome Measure(s): Renal excretory and hemodynamic variables.

Result(s): The 3% extracellular volume expansion in OHSS animals induced a significant elevation in mean arterial pressure by 27%, although increments in natriuresis and diuresis were similar to those observed in controls. The OHSS group had impaired pressure-natriuresis sensitivity compared with controls (0.36 ± 0.07 μEq/min/g of Na excreted per mm Hg vs. 1.74 ± 0.45 μEq/min/g of Na excreted per mm Hg; P<.05. Captopril significantly reduced mean arterial pressure (P<.05) and shifted the pressure-natriuresis response to the left by 0.85 ± 0.17 μEq/min/g of Na excreted per mm Hg (P<.05).

Conclusion(s): In OHSS in the rabbit model, pressure-natriuresis sensitivity is impaired. Angiotensin II may play a significant role in this phenomenon, since angiotensin-converting enzyme inhibition normalized the pressure-natriuresis relationship.     

Comparison of oral and vaginal misoprostol for induction of labor at term: a randomized controlled trial

OBJECTIVE: To compare the efficacy of oral with vaginal misoprostol for induction of labor at term. METHODS: One hundred and fifty-three pregnant women at term with indications for induction of labor and Bishop score < or = 6 were randomly assigned to receive misoprostol either 100 microg orally or 50 microg vaginally every 6 h for 48 h. Repeated doses were given until Bishop score > or = 8 was achieved or spontaneous rupture of membranes occurred. Those who were not in labor after 48 h had labor induced with amniotomy and oxytocin. The main outcome measure was induction to delivery time. RESULTS: The median induction to vaginal delivery time in the oral group (14.3 h) was not significantly different from that of the vaginal group (15.8 h). The median number of doses was also not significantly different in the oral group compared with the vaginal group. There was a significant higher incidence of uterine tachysystole in the vaginal group compared to the oral group (17.1% vs 5.3%, P = 0.032). There was no hyperstimulation in either group. There were no significant differences between the groups with respect to oxytocin augmentation, cesarean section rate, analgesic requirement, and neonatal outcomes. CONCLUSION: Oral administration of 100 microg misoprostol has similar efficacy to intravaginal administration of 50 microg misoprostol for labor induction with less frequent abnormal uterine contractility. 100 microg of misoprostol orally can be used as an alternative to the vaginal route for labor induction.     

Comparison of 25 and 50 microg vaginally administered misoprostol for preinduction of cervical ripening and labor induction.

Our purpose was to compare the efficacy of 25 microg and 50 microg intravaginally administered misoprostol tablets for cervical ripening and labor induction. Either 25-microg (n: 58) or 50-microg (n: 56) misoprostol tablets were randomly administered intravaginally to 114 subjects with an unripe cervix for labor induction. The physician was blinded to the medication. Intravaginal misoprostol was given every 4 h until the onset of labor. The mean Bishop score before misoprostol administration was 2.1 +/- 1.6 in the 25-microg group and 2.0 +/- 1.4 in the 50-microg group (p > 0.05). With the 25-microg dose the time until delivery was significantly longer (991.2 +/- 514.4 min vs. 703.12 +/- 432.6 min in the 50-microg group). The use of oxytocin augmentation was significantly higher in the 25-microg group (63.8%) than the 50-microg group (32.1%; p < 0.05). The proportions of patients with tachysystoles and hypersystoles were not significantly different between the two groups (19 and 6.9%, respectively, in the 25-microg group and 25 and 17.8%, respectively, in 50-microg group; p > 0.05). Overall, in the 25-microg group more women achieved vaginal delivery (79.3 vs. 60.7%; p < 0.05). The rate of cesarean sections due to non-reassuring fetal status was higher in the 50-microg misoprostol group (28.6 vs. 10.3%; p < 0.05). The number of neonates with a low 1-min Apgar score (<7) was significantly higher in the 50-microg misoprostol group (26.8 vs. 8.6%; p < 0.05), but 5-min Apgar scores and umbilical artery blood gas values at the time of delivery were not significantly different between the groups (p > 0.05). One patient in the 25-microg group suffered a ruptured uterus. Intravaginal administration of 25 microg of misoprostol is a clinically effective labor induction regimen and has the least adverse effects and complications.     

The effect of oxytocin infusion and misoprostol on neonatal bilirubin levels

Purpose

To investigate the association of neonatal bilirubin levels with oxytocin and misoprostol use for labour induction.

Methods

A total of 100 neonates were included in the study. The first group consisted of 50 healthy babies of women who had received oxytocin infusion, and the second group consisted of 50 healthy babies of women who had received 25 μg misoprostol every 4 h placed in the posterior fornix for labour induction. Bilirubin and haematocrit levels were measured in all on days 1 and 4 of the neonatal period.

Results

The levels of bilirubin in the oxytocin group were significantly higher than those in the misoprostol group on day 1 [4.42 ± 0.27 vs. 3.55 ± 0.28 mg/dl (P = 0.035)] while they were higher also on day 4 but not significantly so [7.47 ± 0.63 vs. 6.86 ± 0.65 mg/dl (P = 0.525)]. The mean haematocrit levels on day 1 were 50.62 ± 1.23 and 58.04 ± 1.30 in groups 1 and 2, respectively, with a significant difference between them. The levels were 52.31 ± 1.27 and 58.96 ± 1.14 on day 4 and the difference was again significant. P < 0.05 indicated statistical significance.

Conclusions

Labour induction with misoprostol and oxytocin does not seem to have harmful effects on bilirubin levels in the neonate.     

Randomized controlled trial of 50 and 100 mcg of misoprostol for induction of labor at term

To compare the safety and efficacy of two different regimens of misoprostol for labor induction at term, we conducted a randomized controlled trial on women presenting for induction of labor at >37 weeks’ gestation. Eligible women were randomized to receive intra-vaginal misoprostol 50 μg every 4 h or 100 μg every 6 h until any of the following: 1) adequate contraction pattern (3 contractions/10 min); 2) dilatation >3 cm; 3) artificial rupture of membranes; or 4) signs of uterine hyperstimulation. Use of oxytocin during labor was at the discretion of the managing clinician. The main outcome variable considered for analysis was cesarean section rate. Secondary outcome measures were induction to delivery interval and neonatal outcome (Apgar scores, meconium staining, and umbilical artery pH). A total of 58 women were randomized to receive either misoprostol 100 μg (n=26) or 50 μg (n=32). The 100 and 50 μg groups had similar mean Bishop’s scores at induction (4.0±2.3 vs 4.1±2.2, p=0.87), rates of nulliparity, use of epidural anesthesia, and oxytocin augmentation. The number of doses of misoprostol used was similar in the two groups (1.4±0.6 vs 1.8±1.2). The mean±standard deviation time to delivery (hours) (11.9± 7.3 vs 14.3±9.6 h, p=0.30) and cesarean section rate (35% vs 19%, p=0.30, relative risk: 1.8, 95% confidence interval 0.7–5.4) were not different in the 100 vs 50 μg group. Power analysis demonstrated that 132 women would be required in each group to achieve statistical significance in the primary outcome measure (α=0.05, β=0.80). Similarly, rates of 5-minute Apgar scores <7 (4% vs 3%, p=1.0), and of meconium passage (17% vs 25%, p=0.73) were not significantly different between the two groups. Received: 20 January 2001 / Accepted: 7 March 2001     

Misoprostol is more efficacious for labor induction than prostaglandin E2 , but is it associated with more risk?

Objective: Our purpose was to compare the efficacy and safety of misoprostol with dinoprostone (Prepidil) for labor induction. Study Design: In a randomized, controlled trial of labor induction, patients were randomly assigned to receive either 50 μg of intravaginal misoprostol every 4 hours or 0.5 mg of intracervical prostaglandin E₂ every 6 hours. Eligibility criteria included gestation of ≥31 weeks, Bishop score <6, and fewer than 12 contractions per hour. Primary outcomes were cesarean section, induction to delivery time, oxytocin use, and fetal distress requiring delivery. Results: One hundred fifty-nine women were randomly assigned to receive misoprostol (n = 81) or Prepidil (n = 78). There were no differences in the indication for induction, preinduction Bishop score, epidural use, or cesarean section rate. Mean time to delivery was significantly shorter in the misoprostol group (19 hours 50 minutes) than in the Prepidil group (28 hours 52 minutes) (P = .005). Only 58% of women in the misoprostol group required oxytocin augmentation, in comparison with 88% of women receiving Prepidil (P = .00002). However, 41% of women receiving misoprostol and 17% receiving Prepidil had late decelerations or bradycardias (P = .001), and 20% of the misoprostol group and 5% of the Prepidil group had deliveries for fetal distress (P = .05). Conclusions: Misoprostol is more efficacious than Prepidil for labor induction. However, the significantly increased incidence of abnormal fetal heart rate tracings and the trend in increased deliveries for fetal distress with misoprostol dosing of 50 μg every 4 hours are of concern. These data suggest that either a lower dose of misoprostol or less frequent dosing of misoprostol should be considered. (Am J Obstet Gynecol 1999;180:1543-50.)     

A Comparison of Vaginal vs. Oral Misoprostol for Induction of Labor–Double Blind Randomized Trial

Objective

To compare efficacy and safety of 50 μgm misoprostol vaginal with oral for labor induction.

Methods

110 women at term gestation, Bishop score ≤4, with various indications for labor induction were randomized and double blinded. After decoding 51 women had received misoprostol orally and 52 vaginally, four hourly (maximum six doses) or till woman went into active labor.

Results

Statistical analysis was done with SPSS 11.0. In vaginal misoprostol group induction delivery interval was significantly less (9.79 vs. 16.47 h) and successful induction was significantly higher (90.38 vs. 74.51%) than oral group, with in 24 h of induction. As for as dose required is concerned in vaginal group 40.38% women needed two doses for delivery, in contrast 35.29% in oral group maximum six doses were required.

Conclusion

Vaginal route of misoprostol is more effective labor inducing agent than oral.     

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

Objective

To compare the efficacy and safety profile of two methods of labor induction i.e., intracervical dinoprostone gel (0.5 mg 8 h) and misoprostol (50 μg 4 h) for induction of labor in women with a poor Bishop’s score.

Design

Observational study.

Study Period

January 1st, 2009 to December 31st, 2010.

Population

A total of 329 women with unfavorable cervices induced at or near term.

Methods

Two cervical ripening agent study arms were used: dinoprostone gel (193 women) and misoprostol (137 women).

Main Outcome Measures

Induction to delivery interval, cesarean section, incidence of meconium stained liquor, FHR pattern, incidence of uterine hyperstimulation, and neonatal outcomes.

Results

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).

Conclusions

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.     

Dexamethasone compared with betamethasone for glucocorticoid treatment of postpartum HELLP syndrome

Objectives: To compare the efficacy of dexamethasone and betamethasone to ameliorate the course of postpartum hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. Methods: A prospective, mixed randomized/non-randomized clinical investigation of patients with postpartum HELLP syndrome. Treatment with either dexamethasone or betamethasone was continued until there was evidence of disease recovery. Results: Baseline characteristics of both the dexamethasone (n=18) and betamethasone (n=18) groups were similar. Although the time to discharge from the obstetrical recovery room was not statistically significant between groups, reduction in mean arterial blood pressure was more pronounced in the dexamethasone group as compared with the betamethasone group (−15.3±1.4 mmHg vs. −7.5±1.4 mmHg, respectively, P<0.01). Patients in the dexamethasone group required less antihypertensive treatment than the betamethasone group (6% vs. 50%, P=0.01) and also had a decreased need for readmission to the obstetrical recovery room (0% vs. 22%, P=0.03). Conclusion: This investigation supports the use of dexamethasone as the superior glucocorticoid to use for patients with postpartum HELLP syndrome.     

Vascular endothelial growth factor, nitric oxide, and leptin follicular fluid levels correlate negatively with embryo quality in IVF patients

Objective(s): To measure vascular endothelial growth factor (VEGF), nitric oxide (NO) and leptin levels in individual ovarian follicles and to examine their relationships with perifollicular blood flow, follicular metabolic indices, and the developmental potential of the corresponding oocyte and embryo.

Design: Prospective study.

Setting: Academic, tertiary care institution.

Patient(s): Unselected IVF patients.

Intervention(s): Color-pulsed Doppler analysis of perifollicular blood flow; determination of partial pressure of oxygen (pO₂), partial pressure of carbon dioxide (pCO₂), and pH and VEGF, leptin and NO levels in follicular fluid.

Main Outcome Measure(s): Fertilization and day 3 embryo morphology and cleavage.

Result(s): Fifty-five follicular fluid samples from 16 patients were studied. Mean follicular fluid levels were as follows: VEGF, 1,046 ± 863.7 pg/mL (range, <63–3,332.7 pg/mL); NO₃/NO₂, 34.2 ± 12 μM (range, 16.4–76.1 μM); and leptin, 20.1 ± 12.1 ng/mL (range, 3.3–52.2 ng/mL). Vascular endothelial growth factor had a negative correlation with embryo morphology (r = −0.28, P=.01). Leptin demonstrated a negative correlation with follicular pO₂ (r = −0.42, P=.005) and a positive correlation with follicular pCO₂ (r = 0.36, P=.02). Follicular leptin levels correlated positively with VEGF levels (r = 0.46, P=.008) and with NO₃/NO₂ levels (r = 0.39, P=.006).

Conclusion(s): Vascular endothelial growth factor, NO and leptin appear to be markers of follicular hypoxia and suboptimal embryo development. Whether fluctuations of these regulatory factors determine or reflect changes in the follicular microenvironment affecting oocyte developmental potential remains to be elucidated.     

Comparative evaluation of 25 μg and 50 μg of intravaginal misoprostol for induction of labor

Objectives

To compare the efficacy and safety of 25 μg vs 50 μg of intravaginal misoprostol for induction of labor

Methods

One hundred forty eight pregnant females requiring induction were randomly assigned to receive either 25 μg (80 cases-group A) or 50 μg (68 cases — group B) of intravaginal misoprostol every 4 hours till adequate contractions were achieved or maximum dose of the drug up to 200 μg was used.

Results

The onset of contraction was earlier in group B (3.40± 1.88) as compared to group A (4.56±2.25); 81.2% of the cases in group A and 83.8% of the cases in group B delivered vaginally. Induction to delivery interval was shorter in group B(43.9%) cases; while 29% cases in group A delivered within 12 hours. Mean dose for successful induction in group A was high compared to group B. Requirement for oxytocin infusion was higher in group A (25% vs 16.2%) (p=0.189). Abnormal contractility pattern was seen in 14.7% cases in group B as compared to 6.25% cases in group A (p=0.765). GIT side effects were common in group B (38.2%) as compared to group A (28.75%) (p=0.22). Rupture uterus did not occur in any group. In group B 34.7% neonates had apgar score <7 at 1 min. and required NICU admission as compared to only 14.9% in group A.

Conclusion

50 μg dose though more efficacious than 25 μg dose, appears to be less safe both for mother and baby due to the high incidence of tachysystole, hyperstimulation and intrauterine passage of meconium.     

Timed intercourse after intrauterine insemination for treatment of infertility

Objective: To compare the pregnancy rates, between intrauterine insemination (IUI) followed by timed intercourse and IUI only for treatment of the infertile couples. Study design: A prospective study of two different protocols of intrauterine insemination in two hundred and one infertile couples with a normal spermiogram was carried out. Of these, 101 couples were treated with IUI alone and 100 couples had both IUI and timed intercourse within a 12-18 h period. The pregnancy rates were compared between groups. Results: The characteristics of the two groups were similar in terms of the mean age, as well as the duration and causes of infertility. The cycle characteristics following follicular stimulation were also similar between two groups. The pregnancy rate per cycle increased with increasing numbers of total motile sperm per insemination in the IUI alone group (P=0.045). Timed intercourse increased pregnancy rate in patients with lower motile sperm number (<40×10⁶) (27.7% versus 10.5%, P=0.023), but not in patients with higher sperm number (≥40×10⁶) (25.7% versus 22.7%, P=0.671). Conclusions: In IUI with low number of motile sperm inseminated, timed intercourse significantly increases the pregnancy rates over IUI alone in infertile couples with a normal sperminogram. This alternative treatment appears to be a practical, simple, and inexpensive addition that improves the pregnancy rate in patients receiving ovulation induction and intrauterine insemination program.     

米非司酮配伍米索前列醇足月妊娠引产对胎盘及母婴血生化的影响

目的 :了解小剂量米非司酮配伍小剂量米索前列醇用于足月妊娠引产时胎盘形态、功能及母婴血生化的变化。方法 :将 80例妊娠期无明显并发症及合并症 ,因孕期延长而引产的初产妇随机分成两组 ,A组 36例 ,口服米非司酮 10 0mg ,36h后将米索前列醇 50 μg置于阴道后穹窿 ,间隔 3h如无宫缩再置 ,2 4h内使用米索前列醇不超过 3次 ;B组4 4例单用米索前列醇引产 ,用法同上 ;C组配对 4 0例自然临产者。 3组临产后均取母血检测胎盘功能 ;分娩后取母血及脐血测定肝、肾功能及皮质醇 ;取胎盘行形态学检查并进行定量分析。结果 :A组需用米索前列醇的次数较B组明显减少。 3组产妇肝、肾功能及胎盘功能均正常 ,皮质醇组间无明显差异 ,脐血T -BI增高但组间无明显差异。胎盘绒毛合体细胞结节、纤维素样坏死、血管合体细胞膜形成的发生率 ,3组间无明显差异。结论 :未发现足月孕妇口服米非司酮 10 0mg配伍小剂量米索前列醇引产对胎盘形态及功能产生影响 ,亦未发现母婴血生化指标因此而改变     

Labor induction in preeclampsia: is misoprostol more effective than dinoprostone?

OBJECTIVE: To compare the efficacy of vaginal misoprostol versus dinoprostone for induction of labor (IOL) in patients with preeclampsia according to the WHO criteria. STUDY DESIGN: Ninety-eight patients were retrospectively analyzed. A total of 47 patients received 3 mg dinoprostone suppositories every 6 h (max. 6 mg/24 h) whereas 51 patients in the misoprostol group received either 50 mug misoprostol vaginally every 12 h, or 25 mug every 6 h (max. 100 mug/24 h). Primary outcomes were vaginal delivery within 24 and 48 h, respectively. RESULTS: The probability of delivering within 48 h was more than three-fold higher in the misoprostol than in the dinoprostone group: odds ratio (OR)=3.48; 95% confidence interval (CI) 1.24, 10.30, whereas no significant difference was observed within 24 h (P=0.34). No correlation was seen between a ripe cervix prior to IOL and delivery within 24/48 h (P=0.33 and P=1.0, respectively). More cesarean sections were performed in the dinoprostone group due to failed IOL (P=0.0009). No significant differences in adverse maternal outcome were observed between both study groups, whereas more neonates (12 vs. 6) of the dinoprostone group were admitted to the NICU (P=0.068). CONCLUSION: This study suggests that misoprostol may have some advantages compared to dinoprostone, including improved efficacy and lower cost of the drug, even in cases of preeclampsia.