A low dose oxytocin regime for induction and augmentation of labour

A low dose oxytocin regime was used in Labour Ward, Alexandra Hospital for the induction and augmentation of labour. It utilised an oxytocin infusion administered in an arithmetic progression from 1 to 16 mU in a peristaltic infusion pump. A total of 100 patients (67 for augmentation and 33 for induction of labour) classified according to parity were studied. An overall vaginal delivery rate of 87% was obtained. The overall mean durations of labour for nulliparous and multiparous patients were 6.6 hours (S.D. +/- 2.9 hours) and 4.9 hours (S.D. +/- 2.8 hours) respectively. The mean induction delivery time for nulliparous patients was 6.4 hours (S.D. +/- 3.2 hours) and for multiparous patients it was 4.0 hours (S.D. +/- 2.2 hours). About 69% of the nulliparae and 94% of the multiparae who were induced delivered within 9 hours. All the induced patients delivered within 12 hours. Neonatal outcome was good as assessed by Apgar score.     

Thyrotoxic crisis following eclampsia and induction of labour

A patient was diagnosed to be thyrotoxic and commenced on medications, but it was not known that she was 13 weeks pregnant at the time. She failed to take the medications and presented at 25 weeks with eclampsia and thyrotoxic crisis. Her management is discussed.     

Comparison of natural and synthetic prostaglandin E2 tablets in labour induction

A multicentre, randomized, double-blind trial compared the efficacy and safety of and tolerance to natural and synthetically produced prostaglandin E2 tablets in the induction of labour in 202 women. The compounds were similarly effective, inducing labour in approximately 66% of patients. The total dose required and the interval between induction and delivery were similar in the two groups, as were the Apgar scores at 1 and 5 minutes and the incidence of maternal and fetal side effects.     

Intra-vaginal use of misoprostol for induction of labour in intrauterine death

This prospective study was done in the Department of Obstetric & Gynaecology in Mymensingh Medical College & Hospital during the period of February 2006 to January 2007, to assess the efficacy of vaginal misoprostol for induction of labour in intrauterine foetal death cases and to detect any intrapartum or postpartum complications. For this study, 50 cases of IUD were selected among admitted patients who were diagnosed by detailed history, clinical examination and by USG. Fifty microgram of misoprostol was given per vaginally, which was repeated 4 hours interval upto effective uterine contraction to a maximum six doses. All the informations were recorded in a predesigned structured data collection sheet and data had been interpreted through appropriate statistical analysis. In this study, 46% patients were within 18-25 years of age and gestational age between 28-37 weeks was 80%. Regarding causes of IUD, commonest was idiopathic (52%), next was gestational hypertension, pre-eclampsia, impending eclampsia (28%). Most of the patients (80%) had no history of antenatal checkup and belongs to below average socioeconomic status. Most case (64%) had less Bishop's score (<3) & all cases had unfavourable cervix, score <6. Vaginal delivery was 98% and 2% needed caesarean section. Mean induction delivery interval was 11.8 hours. Induction delivery interval was within 6-23 hours and 66% cases needed 2-3 doses of vaginal misoprostol. Complications were found in a minor group of patients. Nausea, vomiting, occurred in 12% of cases. Others were fever (2%), shivering (6%), PPH (4%), chorioamniotitis (2%) etc. Vaginal misoprostol for cervical ripening and labour induction is very effective and shorten the time of induction delivery interval. On the other hand, misoprostol is quite cheap, easy to administer, well tolerability and less side effects.     

低位水囊联合缩宫素静滴用于足月产妇引产的分析

目的分析低位水囊联合缩宫素静滴在足月产妇引产中的应用。方法选择我院于2016年1月～2017年12月收治的362例需接受引产的足月产妇为研究对象。给予产妇低位水囊联合缩宫素静滴引产。根据产妇产次分组,分为初产妇组和经产妇组。评估患者的引产成功率、阴道分娩率,对比两组产程分布。结果本组362例足月产妇,13例因拒绝阴道试产等因素而终止妊娠,剔除研究;剩余349例产妇经低位水囊联合缩宫素静滴引产后,10例引产失败,339例引产成功(97.13%),阴道分娩率85.25%。经产妇组第一产程、第二产程时间均短于初产妇组,组间差异显著(P0.05)。结论低位水囊联合缩宫素静滴用于足月产妇,可提高产妇引产成功率及阴道分娩率。     

脑电双频指数在老年患者异氟烷复合诱导中的应用

目的探讨比较在异氟烷复合诱导的老年病人中不同脑电双频指数（BIS）下行插管时的血流动力学变化。方法选择ASAⅠ～Ⅲ级择期全麻病人60例,年龄65-77岁。随机分为3组,每组20例。诱导时先给予咪达唑仑0．04mg／kg,芬太尼1μg／kg同时给予异氟烷自主吸入,并调节异氟烷吸入浓度,使BIS 3～5min达到设定的不同目标值（A组50-60,B组40-50,C组30-40）后,立即给予芬太尼2μg／kg,琥珀胆碱1mg／kg。45s后行气管插管。麻醉监测心率（HR）、平均动脉压（MAP）、BIS、呼气末异氟烷浓度（EtISO）。结果各组插管后BIS均明显升高（P〈0．05）,A组BIS值甚至超过60以上。C组MAP下降最明显,且一直持续到插管后5min,其MAP与A、B组相应时间相比仍有显著差异（P〈0．05）。结论以BIS监测对老年人的异氟烷复合诱导有一定的指导作用,但过深的麻醉将对老年患者的循环产生明显抑制。     

A retrospective review of pregnancy outcome after misoprostol (prostaglandin E1) induction of labour

This retrospective study looked at the outcome of using 50-100 micrograms misoprostol once daily to induce labour compared to the outcome of the overall patient population delivered during the same period (1994-1996). During that period 11,255 patients were delivered and 1037 (9.2%) were induced with misoprostol. Results showed a significantly lower mean Caesarean section rate: 9.3% for the misoprostol group versus 13.3% for the overall population (p = 0.002, Odds Ratio (OR) 0.67, 95% CI 0.53, 0.83). The abruption rates were not significantly different: 0.8% for misoprostol versus 0.4% (p = 0.09, OR 1.86, 95% CI 0.81, 4.09). There was more postpartum haemorrhage in the misoprostol group: 5.6% versus 3.5% (p = 0.0006, OR 1.63, 95% CI 1.22, 2.19); a higher incidence of Apgar scores less than 6 at one minute 10.2% versus 7.9% (p = 0.0093, OR 1.33, CI 1.06, 1.65) but not at five minutes 2.9% versus 2.4% (p = 0.674, OR 1.09, CI 0.73, 1.61) and a higher perinatal mortality rate 55/1000 versus 16.3/1000 (p = 0.00, OR 3.5, 95% CI 2.55, 4.80). The rate remained higher but not significantly so when a correction was made to eliminate the high number of intrauterine deaths induced with misoprostol 18/1000 versus 16.3/1000 (p = 0.69, OR 1.11, 95% CI 0.66, 1.84). There were no cases of uterine rupture in either group. In conclusion, there was a significantly lower Caesarean section rate among patients who had once daily misoprostol induction of labour. Close monitoring of the foetus, in patients with misoprostol induction, is needed to detect foetal distress and prophylaxis against postpartum haemorrhage is still mandatory.     

Clinical trial comparing artificial rupture of membranes plus oral PGE2 tablets versus artificial rupture of membranes plus intravenous oxytocin for induction of labour in primigravid patients at term.

We report the results of a pilot study conducted to compare the efficacy of oral prostaglandin E2 versus intravenous oxytocin in inducing labour after lower amniotomy in 20 primigravid patients at term. The results suggest no significant differences in the performance of each group for the induction to delivery interval, the mode of delivery, the Apgar score at five minutes or for third stage abnormalities. However, the use of oral PGE2 allows the patient unrestricted mobility and avoids the discomfort of i.v. infusions.     

An evaluation of the Bishop scoring system in relation to a method of induction of labour by intra-vaginal prostaglandin

This paper is a prospective study of the outcome of labour in 109 patients with favourable and unfavourable cervices in whom labour was induced by intravaginal prostaglandin, with supplementary syntocinon infusion where necessary. There were 61 primigravidae and 48 multigravidae. The rate of operative intervention was virtually no higher than in those labours of spontaneous onset. The length of labour varied inversely with the Bishop score of the cervix before induction, with a coefficient of correlation of -0·995 for primigravidae and of -0·929 for multigravidae. Bishop score was shown to be a poor indicator of the number of doses of prostaglandin needed for successful induction.