oxytocin and Fetal-Membranes--Premature-Rupture

Prelabour rupture of membranes (PROM) exposes both foetuses and mothers to the risk of infection. Induction of labour has been proposed to reduce this risk, but its neonatal and maternal risks and benefits must be balanced against those of expectant management (EM). Recent randomized studies of preterm PROM show that EM until 37 weeks of gestation is associated with lower overall neonatal morbidity. In term PROM, active management is associated with a shorter birth interval but not with lower rates of neonatal infection. Similar maternal and neonatal outcomes are reported regardless of whether induction uses oxytocin, PGE2, or oral misoprostol.

Topics: Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Misoprostol; Oxytocin; Pregnancy

This study aimed to evaluate the incidence of chorioamnionitis in women with singleton gestations with ≥36 weeks' prelabor rupture of membranes induced with oxytocin within or after 12 hours of prelabor rupture of membranes.. The search was conducted using MEDLINE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID, and Cochrane Library as electronic databases from their inception to May 2020.. Randomized controlled trials of women with singleton cephalic gestations and prelabor rupture of membranes at ≥36 weeks comparing induction of labor with oxytocin either ≤12 hours after prelabor rupture of membranes or >12 hours after prelabor rupture of membranes (expectant management group).. The risk of bias in each included study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. All analyses were done using an intention-to-treat approach, evaluating women according to the treatment group to which they were randomly allocated in the original trials. The primary outcome was the incidence of chorioamnionitis.. After exclusions, 9 randomized controlled trials including 3759 women were analyzed. Women with singleton cephalic gestations and prelabor rupture of membranes at ≥36 weeks who have induction of labor ≤12 hours after prelabor rupture of membranes have shorter time between prelabor rupture of membranes and delivery (-12.68 hours; 95% confidence interval, -16.15 to -9.21) and higher chance of delivering within 24 hours of prelabor rupture of membranes (91% vs 46%; relative risk, 1.93; 95% confidence interval, 1.59-2.35). Cesarean and operative vaginal deliveries were not significantly different between the groups. Induction of labor ≤12 hours after prelabor rupture of membranes was also associated with significantly fewer incidences of chorioamnionitis (5.3% vs 9.9%; relative risk, 0.62; 95% confidence interval, 0.40-0.97), endometritis (2.4% vs 4.2%; relative risk, 0.59; 95% confidence interval, 0.40-0.87), neonatal sepsis (6.1% vs 11.8%; relative risk, 0.46; 95% confidence interval, 0.27-0.79), and admission to neonatal intensive care unit (6.4% vs 12.0%; relative risk, 0.54; 95% confidence interval, 0.43-0.69) compared with women managed expectantly, usually at >24 hours. The subgroup analysis of 3323 women with induction of labor at ≤6 hours showed similar results, including similar significant reductions in chorioamnionitis, endometritis, neonatal sepsis, and admission to neonatal intensive care unit.. Women with symptoms of prelabor rupture of membranes at ≥36 weeks should be evaluated promptly, and if prelabor rupture of membranes is confirmed, they should have induction of labor within 12 hours and perhaps even within 6 hours since the first symptom of prelabor rupture of membranes. This management is associated with significantly less morbidity, especially in terms of infections, for both the mother and the baby, with no evidence of any harm.

Topics: Chorioamnionitis; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Oxytocin; Pregnancy; Randomized Controlled Trials as Topic

To assess the effect of immediate induction versus expectant management on maternal and neonatal outcomes in case of term prelabor rupture of membranes.. We searched Medline Database, Cochrane Library and consulted international guidelines.. In case of term prelabor rupture of membranes, induction of labor is associated with shorter rupture of membranes to delivery intervals when compared to expectant management, if induction is conducted with oxytocin (LE2), prostaglandin E2 (LE2) or misoprostol (LE2), but not when induction is conducted with Foley® catheter (LE2), osmotic dilatator (LE2) or acupuncture (LE2). The strongest evidence to date comes from a large international randomized study, the TERMPROM study, which included over 5000 women between 1992 and 1995. This study compared immediate induction with oxytocin or prostaglandin E2 to expectant management up to 96hours, followed by induction by oxytocin or prostaglandin E2. Immediate induction was not associated with a decreased neonatal infection rate (LE1), even among women with a positive streptococcus B vaginal swab (LE2). Thus, expectant management can be offered without increasing the neonatal infection risk (Grade B). Induction with oxytocin was associated with a decreased risk of intra-uterine infection and postpartum fever in the TERMPROM study (LE2), however, this study had significant limitations concerning this outcome (unknown streptococcus B status and low rate of prophylactic antibiotics), and this association was not found in other smaller studies. This decrease was not observed with induction by prostaglandin E2. In the TERMPROM study, induction was not associated with an increase or decrease in the rate of cesarean section (LE2), whatever the parity (LE2) or Bishop score at admission (LE3). Induction can thus be proposed without increasing the cesarean section risk (Grade B). There is no study evaluating expectant management over 4 days.. In case of term prelabor rupture of membranes, induction can be offered without increasing the cesarean section risk (Grade B). Expectant management can be offered without increasing the neonatal infection risk (Grade B), even among women with a positive streptococcus B vaginal swab (Professional consensus). The optimal moment of induction will therefore be guided by the maternity wards organization and women's preference after having informed them of the risks and benefits associated with induction and expectant management (Professional consensus). In case of meconial fluid or term prelabor rupture of membranes>4 days, induction must be offered (Professional consensus).

Topics: Delivery, Obstetric; Dinoprostone; Female; Fetal Membranes, Premature Rupture; France; Humans; Infant, Newborn; Labor, Induced; MEDLINE; Misoprostol; Obstetrics; Oxytocics; Oxytocin; Pregnancy; Streptococcal Infections; Streptococcus agalactiae; Time Factors; Vagina

Prelabour rupture of membranes (PROM) at term is managed expectantly or by planned early birth. It is not clear if waiting for birth to occur spontaneously is better than intervening, e.g. by inducing labour.. The objective of this review is to assess the effects of planned early birth (immediate intervention or intervention within 24 hours) when compared with expectant management (no planned intervention within 24 hours) for women with term PROM on maternal, fetal and neonatal outcomes.. We searched Cochrane Pregnancy and Childbirth's Trials Register (9 September 2016) and reference lists of retrieved studies.. Randomised or quasi-randomised controlled trials of planned early birth compared with expectant management (either in hospital or at home) in women with PROM at 37 weeks' gestation or later.. Two review authors independently assessed trials for inclusion, extracted the data, and assessed risk of bias of the included studies. Data were checked for accuracy.. Twenty-three trials involving 8615 women and their babies were included in the update of this review. Ten trials assessed intravenous oxytocin; 12 trials assessed prostaglandins (six trials in the form of vaginal prostaglandin E2 and six as oral, sublingual or vaginal misoprostol); and one trial each assessed Caulophyllum and acupuncture. Overall, three trials were judged to be at low risk of bias, while the other 20 were at unclear or high risk of bias.Primary outcomes: women who had planned early birth were at a reduced risk of maternal infectious morbidity (chorioamnionitis and/or endometritis) than women who had expectant management following term prelabour rupture of membranes (average risk ratio (RR) 0.49; 95% confidence interval (CI) 0.33 to 0.72; eight trials, 6864 women; Tau² = 0.19; I² = 72%; low-quality evidence), and their neonates were less likely to have definite or probable early-onset neonatal sepsis (RR 0.73; 95% CI 0.58 to 0.92; 16 trials, 7314 infants;low-quality evidence). No clear differences between the planned early birth and expectant management groups were seen for the risk of caesarean section (average RR 0.84; 95% CI 0.69 to 1.04; 23 trials, 8576 women; Tau² = 0.10; I² = 55%; low-quality evidence); serious maternal morbidity or mortality (no events; three trials; 425 women; very low-quality evidence); definite early-onset neonatal sepsis (RR 0.57; 95% CI 0.24 to 1.33; six trials, 1303 infants; very low-quality evidence); or perinatal mortality (RR 0.47; 95% CI 0.13 to 1.66; eight trials, 6392 infants; moderate-quality evidence).. women who had a planned early birth were at a reduced risk of chorioamnionitis (average RR 0.55; 95% CI 0.37 to 0.82; eight trials, 6874 women; Tau² = 0.19; I² = 73%), and postpartum septicaemia (RR 0.26; 95% CI 0.07 to 0.96; three trials, 263 women), and their neonates were less likely to receive antibiotics (average RR 0.61; 95% CI 0.44 to 0.84; 10 trials, 6427 infants; Tau² = 0.06; I² = 32%). Women in the planned early birth group were more likely to have their labour induced (average RR 3.41; 95% CI 2.87 to 4.06; 12 trials, 6945 women; Tau² = 0.05; I² = 71%), had a shorter time from rupture of membranes to birth (mean difference (MD) -10.10 hours; 95% CI -12.15 to -8.06; nine trials, 1484 women; Tau² = 5.81; I² = 60%), and their neonates had lower birthweights (MD -79.25 g; 95% CI -124.96 to -33.55; five trials, 1043 infants). Women who had a planned early birth had a shorter length of hospitalisation (MD -0.79 days; 95% CI -1.20 to -0.38; two trials, 748 women; Tau² = 0.05; I² = 59%), and their neonates were less likely to be admitted to the neonatal special or intensive care unit (RR 0.75; 95% CI 0.66 to 0.85; eight trials, 6179 infants), and had a shorter duration of hospital (-11.00 hours; 95% CI -21.96 to -0.04; one trial, 182 infants) or special or intensive care unit stay (RR 0.72; 95% CI 0.61 to 0.85; four trials, 5691 infants). Women in the planned early birth group had more positive experiences compared with women in the expectant management group.No clear differences between groups were observed for endometritis; postpartum pyrexia; postpartum antibiotic usage; caesarean for fetal distress; operative vaginal birth; uterine rupture; epidural analgesia; postpartum haemorrhage; adverse effects; cord prolapse; stillbirth; neonatal mortality; pneumonia; Apgar score less than seven at five minutes; use of mechanical ventilation; or abnormality on cerebral ultrasound (no events).None of the trials reported on breastfeeding; postnatal depression; gestational age at birth; meningitis; respiratory distress syndrome; necrotising enterocolitis; neonatal encephalopathy; or disability at childhood follow-up.In subgroup analyses, there were no clear patterns of differential effects for method of induction, parity, use of maternal antibiotic prophylaxis, or digital vaginal examination. Results of the sensitivity analyses based on trial quality were consistent with those of the main analysis, except for definite or probable early-onset neonatal sepsis where. There is low quality evidence to suggest that planned early birth (with induction methods such as oxytocin or prostaglandins) reduces the risk of maternal infectious morbidity compared with expectant management for PROM at 37 weeks' gestation or later, without an apparent increased risk of caesarean section. Evidence was mainly downgraded due to the majority of studies contributing data having some serious design limitations, and for most outcomes estimates were imprecise.Although the 23 included trials in this review involved a large number of women and babies, the quality of the trials and evidence was not high overall, and there was limited reporting for a number of important outcomes. Thus further evidence assessing the benefits or harms of planned early birth compared with expectant management, considering maternal, fetal, neonatal and longer-term childhood outcomes, and the use of health services, would be valuable. Any future trials should be adequately designed and powered to evaluate the effects on short- and long-term outcomes. Standardisation of outcomes and their definitions, including for the assessment of maternal and neonatal infection, would be beneficial.

Topics: Cesarean Section; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Obstetric Labor Complications; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Prostaglandins; Randomized Controlled Trials as Topic; Term Birth; Time Factors; Watchful Waiting

Guidance for postabortion care (PAC) is established for the first trimester but limited in the second trimester.. To establish evidence-based recommendations for PAC in the second trimester.. Medline, POPLINE, and the Cochrane Central Register of Controlled Trials were searched with terms related to second-trimester PAC, including fetal demise, ruptured membranes, and incomplete abortion. The reference lists of retrieved articles were also searched.. Clinical trials and comparative studies of women presenting in the second trimester (12-28weeks) were included if more than 50% of participants met PAC criteria or if outcomes for PAC were analyzed separately.. Data were extracted from included studies. When interventions in at least two articles were comparable, a meta-analysis was performed.. Overall, 17 studies of 1419 women met inclusion criteria. Misoprostol given vaginally, sublingually, or buccally was associated with shorter expulsion times than was oral misoprostol. Additionally, 200μg of misoprostol was more effective than lower doses. Pretreatment with mifepristone decreased expulsion time. Misoprostol was more effective than oxytocin.. Misoprostol with or without mifepristone is an effective treatment for second-trimester PAC. The minimum misoprostol dose is 200μg vaginally, sublingually, or buccally every 6-12hours.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Aftercare; Cohort Studies; Female; Fetal Death; Fetal Membranes, Premature Rupture; Humans; Mifepristone; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Randomized Controlled Trials as Topic

Mastocytosis is a rare disorder characterized by an accumulation of mastocytes in cutaneous and visceral tissues. In the presence of stimuli such as stress, pain, drug administration and cutaneous compression, it can ultimately lead to cardiovascular collapse. In women with mastocytosis, pregnancy monitoring and pain management in the peripartum period can be challenging and should involve a multidisciplinary approach. In this article, we discuss our ante partum care and intra partum management, as illustrated by three recent cases.

Topics: Adult; Analgesia, Obstetrical; Cardiovascular Diseases; Female; Fetal Membranes, Premature Rupture; Humans; Male; Mastocytosis; Mastocytosis, Cutaneous; Mastocytosis, Systemic; Oxytocics; Oxytocin; Pain Management; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Care

Induction of labour after prelabour rupture of membranes may reduce the risk of neonatal infection.. The objective of this review was to assess the effects of induction of labour with oxytocin versus expectant management for prelabour rupture of membranes at or near term (34 weeks or more).. We searched the Cochrane Pregnancy and Childbirth Group trials register.. Randomised and quasi-randomised trials of early use of oxytocin versus no early use of oxytocin for spontaneous rupture of membranes, before labour (34 weeks gestation or more).. Trials were assessed for quality and data were abstracted.. Eighteen studies were included. The trials were of variable quality with potential for significant bias. Compared to expectant management, induction of labour by oxytocin was associated with a decreased risk of maternal infection (odds ratio for chorioamnionitis of 0.63, 95% confidence interval 0.51 to 0.78, endometritis 0.72, 95% confidence interval 0.52 to 0.99). There was also a decreased risk of neonatal infection (odds ratio 0.64, 95% confidence interval 0.44 to 0.93). The size of this effect may have been biased in favour of oxytocin. Based on one trial, women were more likely to view their care positively if labour was induced with oxytocin. Caesarean section rates were not statistically different between groups, although the trend was towards fewer interventions with expectant management. Oxytocin was associated with more frequent use of pain relief and internal fetal heart rate monitoring. Perinatal mortality rates were low and not significantly different between groups, although the trend was towards fewer deaths with induction of labour by oxytocin.. Induction of labour by oxytocin may decrease the risk of maternal and neonatal infection compared to expectant management. Induction of labour with oxytocin does not appear to increase the rate of caesarean section, although it may increase use of pain relief and internal fetal heart rate monitoring.[This abstract has been prepared centrally.].

Topics: Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy

The conventional method of induction of labour is with intravenous oxytocin. More recently, induction with prostaglandins, followed by an infusion of oxytocin if necessary, has been used.. The objective of this review was to assess the effects of induction of labour with prostaglandins compared with oxytocin, at or near term.. We searched the Cochrane Pregnancy and Childbirth Group trials register.. Randomised and quasi-randomised trials of early stimulation of uterine contractions with prostaglandins (with or without oxytocin) versus with oxytocin alone (not combined with prostaglandins) in women with spontaneous rupture of membranes before labour (34 weeks or more gestation).. Two reviewers assessed trial quality and extracted data.. Seventeen trials were included. Most of the trials were of moderate to good quality. Based on six trials, prostaglandins compared with oxytocin were associated with increased chorioamnionitis (odds ratio of 1.49, 95% confidence interval 1.07 to 2.09) and maternal nausea/vomiting. Based on eight trials, prostaglandins were associated with a decrease in epidural analgesia, odds ratio of 0.85, 95% confidence interval 0.73 to 0.98 and internal fetal heart rate monitoring (based on one trial). Caesarean section, endometritis and perinatal mortality were not significantly different between the groups.. Women with prelabour rupture of membranes at or near term having their labour induced with prostaglandins appear to have a lower risk of epidural analgesia and fetal heart rate monitoring. However there appears to be an increased risk of chorioamnionitis and nausea/vomiting with prostaglandins compared to oxytocin.[This abstract has been prepared centrally.].

Topics: Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins

The conventional method of induction of labour is with intravenous oxytocin. More recently, induction with prostaglandins, followed by an infusion of oxytocin if necessary, has been used.. The objective of this review was to assess the effects of induction of labour with prostaglandins versus oxytocin for prelabour rupture of membranes at term.. We searched the Cochrane Pregnancy and Childbirth Group trials register.. Randomised and quasi-randomised trials of early stimulation of uterine contractions with prostaglandins (with or without oxytocin) versus with oxytocin alone (not combined with prostaglandins) in women with spontaneous rupture of membranes at term (37 weeks or more gestation).. Two reviewers assessed trial quality and extracted data.. Eight trials were included. Based on three trials, prostaglandins compared to oxytocin were associated with increased chorioamnionitis (odds ratio of 1.51, 95% confidence interval 1.07 to 2.12) and neonatal infections (odds ratio 1.63, 95% confidence interval 1.00 to 2.66). Based on four trials, prostaglandins were associated with a decrease in epidural analgesia (odds ratio of 0.86, 95% confidence interval 0.73 to 1.00) and internal fetal heart rate monitoring (based on one trial). Caesarean section, endometritis and perinatal mortality were not significantly different between the groups.. Women with prelabour rupture of membranes at term having their labour induced with prostaglandins appear to have a lower risk of epidural analgesia and fetal heart rate monitoring. However there appears to be an increased risk of chorioamnionitis and neonatal infections after prostaglandin induction compared to oxytocin.[This abstract has been prepared centrally.].

Topics: Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins

Topics: Dinoprostone; Evidence-Based Medicine; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Term Birth

The clinical management of premature rupture of membranes (PROM) at term has been a matter of considerable controversy. Management options have included expectant management or induction of labor with oxytocin, dinoprostone (PGE2), or misoprostol. Early studies suggested that immediate oxytocin induction of labor might reduce maternal and neonatal infections while increasing risk for cesarean section. The definitive TermPROM study found no difference in neonatal infections between immediate and delayed induction with oxytocin and PGE2. However, neither PGE2 nor delayed induction resulted in fewer cesarean sections than immediate oxytocin. Misoprostol offers several theoretical advantages over oxytocin in the setting of PROM at term. However, randomized trials to date have found no significant advantage for misoprostol administration compared with other agents for women with PROM.

Topics: Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Physical Examination; Pregnancy; Randomized Controlled Trials as Topic; Streptococcal Infections

To systematically review published data evaluating the comparative use of misoprostol with placebo/expectant management or oxytocin for labor induction in women with term (> or = 36 weeks of gestation) premature rupture of membranes.. PubMed (1966-2005), Ovid (1966-2005), CINAHL, The Cochrane Library, ACP Journal Club, OCLC, abstracts from scientific forums, and bibliographies of published articles were searched using the following keywords: premature rupture of membranes, misoprostol, labor induction, and cervical ripening. Primary authors were contacted directly if the data sought were unavailable or only published in abstract form.. Only randomized controlled trials evaluating the efficacy and safety of misoprostol in comparison with placebo or expectant management (n = 6) and oxytocin (n = 9) published in either article or abstract form were analyzed and included in the meta-analysis.. Studies were reviewed independently by all authors. Meta-analysis was performed, and the relative risks (RRs) were calculated and pooled for each study outcome. Misoprostol, compared with placebo, significantly increased vaginal delivery less than 12 hours (RR 2.71, 95% confidence interval [CI] 1.87-3.92, P < .001). Misoprostol was similar to oxytocin with respect to vaginal delivery less than 24 hours (RR 1.07, 95% CI 0.88-1.31, P = .50) and less than 12 hours (RR 0.98, 95% CI 0.71-1.35, P = .90). Misoprostol was not associated with an increased risk of tachysystole, hypertonus, or hyperstimulation syndrome when compared with oxytocin and had similar risks for adverse neonatal and maternal outcomes.. Misoprostol is an effective and safe agent for induction of labor in women with term premature rupture of membranes. When compared with oxytocin, the risk of contraction abnormalities and the rate of maternal and neonatal complications were similar among the 2 groups.

Topics: Adult; Cervical Ripening; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Publication Bias; Randomized Controlled Trials as Topic

Premature rupture of membranes (PROM) occurs in 8% of term deliveries. In this situation labour induction with prostaglandins, compared with expectant management, results in a reduced risk of chorioamnionitis, neonatal antibiotic therapy, neonatal intensive care (NICU) admission, and increased maternal satisfaction. The use of prostaglandin is associated with an increased rate of diarrhoea and use of analgesia/anaesthesia. Compared with oxytocin, prostaglandin induction results in a lower rate of epidural use and internal fetal heart rate monitoring but a greater risk of chorioamnionitis, nausea, vomiting, more vaginal examinations, neonatal antibiotic therapy, NICU admission and neonatal infection. Women should be informed of the risks and benefits of each method of induction.Misoprostol is gaining increasing interest as an alternative induction agent. It appears to be an effective method of labour induction with term PROM. Further research is needed to identify the preferred dosage, route and interval of administration, and to assess uncommon maternal and neonatal outcomes. There has been limited research on the use of prostaglandins, including misoprostol, for induction of labour with a favourable cervix and intact membranes. Compared with intravenous oxytocin (with and without amniotomy), labour induction using vaginal prostaglandins in women with a favourable cervix (with and without PROM) results in a higher rate of vaginal delivery within 24 hours and increased maternal satisfaction. In women with a favourable cervix, artificial rupture of membranes followed by oral misoprostol has similar time to vaginal delivery compared with artificial rupture of membranes followed by oxytocin. Further research with prostaglandins, including misoprostol, is needed to evaluate other maternal and neonatal outcomes in women being induced with a favourable cervix. No form of prostaglandin induction in women with PROM or favourable cervix has proven clearly superior to oxytocin infusion.

Topics: Administration, Intravaginal; Cervical Ripening; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy

Induction of labour after prelabour rupture of membranes may reduce the risk of neonatal infection.. The objective of this review was to assess the effects of induction of labour with oxytocin versus expectant management for prelabour rupture of membranes at or near term (34 weeks or more).. We searched the Cochrane Pregnancy and Childbirth Group trials register.. Randomised and quasi-randomised trials of early use of oxytocin versus no early use of oxytocin for spontaneous rupture of membranes, before labour (34 weeks gestation or more).. Trials were assessed for quality and data were abstracted.. Eighteen studies were included. The trials were of variable quality with potential for significant bias. Compared to expectant management, induction of labour by oxytocin was associated with a decreased risk of maternal infection (odds ratio for chorioamnionitis of 0.63, 95% confidence interval 0.51 to 0.78, endometritis 0.72, 95% confidence interval 0.52 to 0.99). There was also a decreased risk of neonatal infection (odds ratio 0.64, 95% confidence interval 0.44 to 0.93). The size of this effect may have been biased in favour of oxytocin. Based on one trial, women were more likely to view their care positively if labour was induced with oxytocin. Caesarean section rates were not statistically different between groups, although the trend was towards fewer interventions with expectant management. Oxytocin was associated with more frequent use of pain relief and internal fetal heart rate monitoring. Perinatal mortality rates were low and not significantly different between groups, although the trend was towards fewer deaths with induction of labour by oxytocin.. Induction of labour by oxytocin may decrease the risk of maternal and neonatal infection compared to expectant management. Induction of labour with oxytocin does not appear to increase the rate of caesarean section, although it may increase use of pain relief and internal fetal heart rate monitoring.

Topics: Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy

The conventional method of induction of labour is with intravenous oxytocin. More recently, induction with prostaglandins, followed by an infusion of oxytocin if necessary, has been used.. The objective of this review was to assess the effects of induction of labour with prostaglandins compared with oxytocin, at or near term.. We searched the Cochrane Pregnancy and Childbirth Group trials register.. Randomised and quasi-randomised trials of early stimulation of uterine contractions with prostaglandins (with or without oxytocin) versus with oxytocin alone (not combined with prostaglandins) in women with spontaneous rupture of membranes before labour (34 weeks or more gestation).. Two reviewers assessed trial quality and extracted data.. Seventeen trials were included. Most of the trials were of moderate to good quality. Based on six trials, prostaglandins compared with oxytocin were associated with increased chorioamnionitis (odds ratio of 1.49, 95% confidence interval 1.07 to 2.09) and maternal nausea/vomiting. Based on eight trials, prostaglandins were associated with a decrease in epidural analgesia, odds ratio of 0.85, 95% confidence interval 0.73 to 0.98 and internal fetal heart rate monitoring (based on one trial). Caesarean section, endometritis and perinatal mortality were not significantly different between the groups.. Women with prelabour rupture of membranes at or near term having their labour induced with prostaglandins appear to have a lower risk of epidural analgesia and fetal heart rate monitoring. However there appears to be an increased risk of chorioamnionitis and nausea/vomiting with prostaglandins compared to oxytocin.

Topics: Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins

The conventional method of induction of labour is with intravenous oxytocin. More recently, induction with prostaglandins, followed by an infusion of oxytocin if necessary, has been used.. The objective of this review was to assess the effects of induction of labour with prostaglandins versus oxytocin for prelabour rupture of membranes at term.. We searched the Cochrane Pregnancy and Childbirth Group trials register.. Randomised and quasi-randomised trials of early stimulation of uterine contractions with prostaglandins (with or without oxytocin) versus with oxytocin alone (not combined with prostaglandins) in women with spontaneous rupture of membranes at term (37 weeks or more gestation).. Two reviewers assessed trial quality and extracted data.. Eight trials were included. Based on three trials, prostaglandins compared to oxytocin were associated with increased chorioamnionitis (odds ratio of 1.51, 95% confidence interval 1.07 to 2.12) and neonatal infections (odds ratio 1.63, 95% confidence interval 1.00 to 2.66). Based on four trials, prostaglandins were associated with a decrease in epidural analgesia (odds ratio of 0.86, 95% confidence interval 0.73 to 1.00) and internal fetal heart rate monitoring (based on one trial). Caesarean section, endometritis and perinatal mortality were not significantly different between the groups.. Women with prelabour rupture of membranes at term having their labour induced with prostaglandins appear to have a lower risk of epidural analgesia and fetal heart rate monitoring. However there appears to be an increased risk of chorioamnionitis and neonatal infections after prostaglandin induction compared to oxytocin.

Topics: Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins

Topics: Evidence-Based Medicine; Female; Fetal Membranes, Premature Rupture; Humans; Meta-Analysis as Topic; Oxytocin; Pregnancy; Prostaglandins; Treatment Outcome

To compare immediate labor induction by vaginal prostaglandins to immediate labor induction by oxytocin or to expectant management in case of prelabor rupture of the membranes at term.. A meta-analysis of all randomized trials indexed in Medline or in the Cochrane Database of Systematic Reviews comparing labor induction by vaginal prostaglandins to labor induction by oxytocin or to expectant management. The statistical analysis was performed according to Peto and Yussuf's modified Mantel Haenszel method. The results were expressed as odds-ratios.. Ten published studies meeting the above criteria were found. These trials included 1004 patients. When comparing labor induction by prostaglandins to expectant management, we observed a reduction of the admission-to-delivery interval, a decreased maternal and neonatal infection rate, without difference in the cesarean section rate. When comparing labor induction by vaginal prostaglandins to labor induction by oxytocin, a decreased cesarean section rate was observed without difference in maternal or neonatal infection rates.. Immediate labor induction by vaginal prostaglandins provides better maternal and neonatal outcomes than labor induction by oxytocin or expectant management in case of prelabor rupture of the membranes at term.

Topics: Administration, Intravaginal; Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Odds Ratio; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third

Review of the controlled comparisons between induction of labor and expectant care after prelabor rupture of the membranes (PROM) at term indicates that they are not unhelpful for deciding which of the two options is best. This is, first, because there is a large potential for bias in the studies reported thus far. Second, the trials are rather heterogeneous and they are comparisons more between early and late induction than between induction and expectant care. Third, it is difficult to weigh an increased risk of operative delivery with the induction policy against an apparently clear, but almost certainly biased, reduction of neonatal infection. With expectant care about 70% of women will give birth within 24 hours and 85% within 48 hours. The majority of these women will derive little, if any, benefit from induction and a routine policy of induction of labor after PROM cannot be justified on the basis of the data that are available.

Topics: Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy

Results from randomised trials with formal randomisation indicate no evidence of benefits in terms of cesarean delivery of maternal/neonatal infectious morbidity by awaiting spontaneous onset of labor for more than 24 hours in women with term PROM. An overnight policy of management seems to be an attractive alternative to other management protocols. Women with prelabor rupture of membranes await stimulation of labor with oxytocin till next morning if admitted before midnight. A majority of the women may go into spontaneous labor with an excellent prospect of having a vaginal delivery. Particularly the nulliparous woman with poor cervical score could benefit from such an approach. Although prostaglandins in theory should be an useful adjunct agent to oxytocin, particularly in the nulliparous woman with unripe cervix, convincing evidence of the efficacy of the drug is still lacking. Well-conducted and randomised studies to evaluate the role of prostaglandins in nulliparous women with PROM are required.

Topics: Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy; Time Factors

Topics: Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Patient Selection; Pregnancy; Risk

The continuing search for improvements in the methods of labor induction has seen the development of techniques that are more efficient, more reliable, safer, and more acceptable to the patient. Ultimately, these objectives will be best served by striving to mimic the normal physiology of parturition as closely as possible. Attention must be paid to the control of cervical ripening as well as myometrial contractility. Refinements in the use of oxytocin and prostaglandins continue to produce better results and the dawning of the era of progesterone receptor blockers gives hope of further significant advances.

Topics: Cervix Uteri; Clinical Trials as Topic; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Mifepristone; Oxytocin; Pregnancy; Prostaglandins

Topics: Cervix Uteri; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy

In the last third of pregnancy the unspecific bacterial diseases of placenta, umbilical cord and membranes differ from those in earlier months [154; 155; 85]. There is a parallel change in the localization of fetal organs affected. Pathologic anatomical clarification of this led to the conceptual definition of the rare extra-amnial placental-fetal path of infection on the one hand and of primary intra-amnial infection with secondary chorion-amnionitis on the other hand and to identification of the amniotic infection syndrome as a typical entity at the end of pregnancy [19]. While the amnionic sac is closed, unspecific fetal inflammation is rare. Generally this happens only after rupture of the membranes. Since the amniotic infection syndrome often produces only minor clinical symptoms and since fetal infection probably starts early, one searched for means of assessing the risk of infection independently from symptoms. In comparative series of investigations of pregnancies with and without premature rupture of the membranes, cases of neonatal death from infection were preceded by signs of inflammation in placenta, umbilical cord and membranes. Together with the fetal and maternal infections they depended on the length of time between rupture and the onset of labor. pns. The data now available give a clear picture of the development of the inflammatory processes in mature and premature children and suffice for the assessment of fetal and maternal risks.

Topics: Abortion, Septic; Amnion; Anti-Bacterial Agents; Cesarean Section; Female; Fetal Death; Fetal Diseases; Fetal Membranes, Premature Rupture; Humans; Hysterectomy; Infant, Newborn; Infant, Newborn, Diseases; Obstetric Labor Complications; Obstetric Labor, Premature; Oxytocin; Placenta Diseases; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third; Time Factors

This study compares the effectiveness and safety of oxytocin infusion against oral misoprostol for inducing labour in pregnant women with term prelabor membrane rupture. We randomized 173 pregnant women presenting with term prelabor rupture of membranes (PROM) at Ain Shams University Maternity Hospital into Group A (underwent induction of labor (IOL) by 25μg misoprostol oral tablet every 4 h, for maximum 5 doses) and an identical Group B: (underwent IOL by oxytocin infusion according to the hospital protocol). Our primary outcome was rate of vaginal delivery within 24 h, while the secondary outcomes included the time till active phase, induction to delivery interval, maternal pyrexia, nausea and vomiting, fetal distress, Apgar score, birth weight, and neonatal intensive care unit admission. Both groups showed high rates of vaginal delivery (82.4% & 87.1% for misoprostol group and oxytocin group respectively) with no significant difference between the two groups (p=0.394). However, patients induced by misoprostol took significantly less time to reach active phase with a shorter induction to delivery interval as compared to patients induced with oxytocin. This difference was clear in multiparous women, but not observed in primiparous women when subgroup analysis was done. No significant difference was found as regards other outcomes. Our study showed that both oral misoprostol and oxytocin are effective and safe for IOL in patients with PROM, with shorter induction-delivery interval in patients induced by oral misoprostol, an effect that is clear in multiparous but not primiparous women. TRIAL REGISTRATION: NCT05215873, on 31/01/2022, "retrospectively registered".

Topics: Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnant Women

The aim of this study was to compare maternal and neonatal outcomes between sublingual misoprostol and oxytocin on stimulating labor in term premature rupture of membranes (PROM) in pregnant women.. A total of 170 women were enrolled and equally divided into study and control groups. Mean maternal age, body mass index, parity, gestational age, and bishop score of both groups were comparable. Induction time of the study group was statistically shorter than the control group (338 and 399 min, respectively). Duration of active phase (450/427 min) and the second stage (19/21 min) of labor between study and control groups were not significantly different. Cesarean section delivery rate of study was lower than the control group (13.3 and 28.8%,. Induction time and cesarean section rates of sublingual misoprostol group were significantly lower than the intravenous oxytocin group in full-term PROM pregnancy.

Topics: Administration, Intravenous; Administration, Sublingual; Adult; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Single-Blind Method; Thailand

Premature rupture of membranes (PROM) occurs at term in 8% of pregnancies. Several studies have demonstrated that the risk of chorioamnionitis and neonatal sepsis increases with duration of PROM. Decreasing the time interval between PROM and delivery is associated with lower rates of maternal infections. In case of an unfavourable cervix, the use of prostaglandin for cervical maturation demonstrates some advantages over oxytocin. The use of double balloon catheter in reduction of PROM duration has not been evaluated in the literature.. We are conducting a prospective, monocentric, randomised clinical trial on pregnant women with an unfavourable cervix showing PROM at term (RUBAPRO).After 12-24 hours of PROM, women are randomly assigned to one group treated with a double balloon catheter for 12 hours, with oxytocin administered after 6 hours or to the control group treated with 24 hours of vaginal prostaglandin followed by oxytocin infusion alone. Patients (n=80) are randomised at a 1:1 ratio with stratification on parity.The inclusion criteria are a Bishop score of <6, cephalic presentation at term and confirmed PROM. Women with suspected chorioamnionitis; group B streptococcus (GBS) carrier; a history of caesarean delivery or any contraindication for vaginal delivery are excluded.The time from induction to delivery is the primary outcome. Secondary outcomes were mode of delivery, maternofetal morbidity and the effect of parity on strategies for reduction of PROM duration.To sufficiently demonstrate a difference (10 hours) between groups-with a statistical power of 90% and a two-tailed α of 5%-40 patients per group will be required.. Written informed consent is required from participants.National Ethics Committee approval was obtained in August 2017. The results will be published in a peer-reviewed journal and presented at relevant conferences. Access to raw data will be available only to members of the research team.. NCT03310333.

Topics: Administration, Intravaginal; Catheters; Cervical Ripening; Cervix Uteri; Delayed-Action Preparations; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; France; Humans; Labor, Induced; Oxytocics; Oxytocin; Parity; Pregnancy; Prospective Studies; Prostaglandins; Randomized Controlled Trials as Topic

Premature rupture of the membranes (PROM) occurs in about 8-10% of pregnancies and its most important complication is chorioamnionitis, so labour induction has an important role in this situation. This study was performed to compare oxytocin and sublingual Misoprostol for labour induction in PROM cases with term pregnancy. A total of 270 pregnant women who had spontaneous rupture of membrane and unripe cervix were enrolled. The first group underwent Oxytocin infusion according to low-dose standard protocol and the second group received 25 μg sublingual Misoprostol every 4 h. Time interval from induction to the beginning of active phase of labour was similar in both groups. Second stage of labour was significantly shorter in misoprostol group (p < .05). Although, some maternal side-effects were significantly higher in misoprostol group (p < .001), but 5 minute Apgar score was significantly better in this group. In conclusion, sublingual misoprostol was associated with better neonatal outcomes was more effective than oxytocin for labour induction in PROM cases. Impact statement What is already known on this subject: PROM occurs in about 8-10% of pregnancies; about 60% of these cases are term pregnancies. Most experts recommend early induction of labour in term PROM cases with an eye towards avoiding increased morbidity and mortality. Oxytocin is the most frequently used agent that is administered intravenously for the purpose of labour induction. Misoprostol is an alternative to oxytocin and is simpler to use, as it is administered via the oral, buccal, sublingual, rectal and vaginal routes rather than intravenously. What do the results of this study add: Time interval from induction to the beginning of active phase of labour was similar in both groups. Second stage of labour was significantly shorter in the misoprostol group. Although, some maternal side-effects were significantly higher in misoprostol group, the 5 minute Apgar score was significantly better in this group. What are the implications of these finding for clinical practice and/or further research: Sublingual misoprostol for induction of labour in PROM cases is more effective than oxytocin and its neonatal outcomes are better. Due to its easy prescription and better labour outcomes, sub lingual misoprostol may be a better choice for labour induction in PROM cases.

Topics: Administration, Intravenous; Administration, Sublingual; Adult; Apgar Score; Female; Fetal Membranes, Premature Rupture; Humans; Labor Stage, Second; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Term Birth; Time Factors; Young Adult

To evaluate the use of a transcervical Foley catheter plus oxytocin infusion compared with oxytocin infusion alone for labor induction and cervical ripening in women 34 weeks of gestation or greater with prelabor rupture of membranes.. This is a randomized, multicenter trial of women with a live, singleton gestation at 34 weeks of gestation or greater with prelabor rupture of membranes, an unfavorable cervical examination (less than or equal to 2\ cm dilated and less than or equal to 80% effaced), and no contraindication to labor. Participants were randomly allocated to a transcervical Foley catheter inflated to 30 cc with concurrent oxytocin infusion or oxytocin infusion alone. Oxytocin administration was standardized across sites. The primary study outcome was interval from induction to delivery. To detect a 2.5-hour difference in the interval from induction to delivery, we required outcome data on 194 women, assuming 80% power and a two-tailed α of 5%. Analysis was by intent to treat.. We enrolled 201 women: 93 were allocated to Foley and 108 to oxytocin. Demographics were similar between the groups. Time to delivery was not significantly different between groups: in the Foley group, it was 13.9 hours (±6.9 SD) compared with 14.4 hours (±7.9 SD) in the oxytocin group (P=.69). There were more cases of clinical chorioamnionitis (8% compared with 0%, P<.01) in the Foley group compared with the oxytocin group. There were no differences for other infectious morbidities or any other variable studied.. In patients with prelabor rupture of membranes, the use of a transcervical Foley catheter in addition to oxytocin does not shorten the time to delivery compared with oxytocin alone, but may increase the incidence of intraamniotic infection.. ClinicalTrials.gov, NCT01973036.

Topics: Adult; Cervical Ripening; Combined Modality Therapy; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Infusions, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome; Risk Assessment; Urinary Catheterization; Young Adult

Pre-labour rupture of membranes (PROM) at term is a common event with early induction of labour reducing infectious morbidity without increasing the caesarean rate. Syntocinon is commonly used for induction but prostaglandins are also routinely used. Large studies have shown no difference in the maternal and neonatal outcomes with either method.. To assess the safety and efficacy of vaginal prostaglandin (PG) compared to syntocinon for induction of labour in term-PROM.. This was a single-centre randomised controlled trial at Ipswich Hospital of women presenting at ≥37 weeks gestation with PROM. Women were randomised and managed in labour as per local guidelines. Analysis was by intention to treat.. One hundred and eighty-four women were recruited, 90 in the PG group and 94 in the oxytocin group. Women in both arms were of similar demographics and 53% of women in the PG group did not require any oxytocin. There was a statistically significant lower incidence of fetal heart rate abnormality in the PG group, 4.4% versus 12.8%. There was no difference in epidural use, caesarean section, maternal infection, admission to special care nursery or neonatal sepsis. Time to onset of labour was significantly longer in the PG group, 25.7 h versus 19.7 h but with no difference in the length of first stage. Maternal satisfaction was high in both groups with no significant difference in breastfeeding rates.. Induction of labour with oxytocin or vaginal prostaglandins are safe and efficacious options for women in the context of PROM at term.

Topics: Adult; Anesthesia, Epidural; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Gels; Gestational Age; Heart Rate, Fetal; Humans; Labor, Induced; Labor, Obstetric; Oxytocics; Oxytocin; Patient Satisfaction; Pregnancy; Prostaglandins; Time Factors; Young Adult

In premature rupture of membranes (PROM), the risk of chorioamnionitis increases with increasing duration of membrane rupture. Decreasing the time from PROM to delivery is associated with lower rates of maternal infection. The American College of Obstetricians and Gynecologists suggests that all women with PROM who do not have a contraindication to vaginal delivery have their labor induced instead of being managed expectantly. Although the use of oxytocin for labor induction has been demonstrated to decrease the time to delivery compared with expectant management, no studies have evaluated the effectiveness of cervical ripening with a Foley bulb to additionally decrease the time to delivery.. To determine whether simultaneous use of an intracervical Foley bulb and oxytocin decreases time from induction start to delivery in nulliparous patients with PROM compared with the use of oxytocin alone.. A randomized trial was conducted from August 2014 to February 2016 that compared the use of concurrent Foley bulb/oxytocin vs oxytocin alone in nulliparous patients ≥34 weeks' gestational undergoing labor induction for PROM. Our primary outcome was time from induction to delivery. Secondary outcomes were mode of delivery, tachysystole, chorioamnionitis, postpartum hemorrhage, Apgar scores, and admission to the neonatal intensive care unit.. A total of 128 women were randomized. Baseline characteristics were similar between groups. We found no difference in induction-to-delivery time between women induced with concurrent Foley bulb/oxytocin vs oxytocin alone (median time 13.0 hours [interquartile 10.7, 16.1] compared with 10.8 hours [interquartile range 7.8, 16.6], respectively, P = .09). There were no significant differences in mode of delivery, rates of postpartum hemorrhage, chorioamnionitis, or epidural use. Both groups had similar rates of tachysystole as well as total oxytocin dose. There were no differences in neonatal birth weight, Apgar scores, cord gases, or admissions to the neonatal intensive care unit.. This is the first randomized trial to compare concurrent Foley bulb/oxytocin vs oxytocin alone in nulliparous patients undergoing induction of labor for PROM. We found no difference in time from induction to delivery in patients induced with concurrent Foley bulb/oxytocin vs oxytocin alone. In nulliparous patients with PROM, this study suggests that addition of a Foley bulb to oxytocin does not decrease the time from induction start to delivery.

Topics: Adult; Catheterization; Cervical Ripening; Combined Modality Therapy; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Middle Aged; Oxytocics; Oxytocin; Parity; Pregnancy; Young Adult

Pre-labour rupture of membranes (PROM) at term is a common event whose management varies from centre to centre. The practice at the Kenyatta National Hospital (KNH) for patients with PROM at term is to initiate delivery of the patient soon on admission with intravenous oxytocin, if there are no contraindications to vaginal delivery. However, in PROM at term, if the cervix is not ripe, vaginal administration of prostaglandin pessaries for cervical ripening is not possible when there is active draining of liquor, thus use of intravenous oxytocin may take a very long time or fail all together. Oral misoprostol at low doses has been found to be a safe and effective agent for labour induction in numerous studies carried out in the developed world, where there are better resources for monitoring of labour. None of the studies has been carried out in Kenya, a limited resource country. Therefore, there is a need to determine the effectiveness and safety of oral misoprostol solution at the KNH, a limited resource set up.. To determine the effectiveness and safety of 2-hourly 20 mcg oral misoprostol solution compared to the standard intravenous oxytocin in labour induction in mothers with pre-labour rupture of membranes at term at the Kenyatta National Hospital.. An unblinded randomised clinical trial.. Kenyatta National Hospital Labour Ward Unit.. Eighty three pregnant women with pre-labour rupture of membranes at term without an indication for Caeserian section were consented and randomised for labour induction with either oral misoprostol at a dose of 20mcg 2-hourly up to a maximum of 4-doses, or with intravenous oxytocin according to the WHO protocol.. Induction to delivery interval; maternal complications and early neonatal outcomes.. The overall induction success rates in the misoprostol arm was 81% versus 83% in the oxytocin arm (P = 0.447). The mean induction to vaginal delivery interval in the misoprostol arm was 8.4 hours as compared to 9.45 hours in the oxytocin arm (P = 0.116). The induction to active labour interval was similar in the two study arms. The mean induction to active labour in the misoprostol arm was 4.02 hours as versus 4.51 hours in the oxytocin arm (P = 0.223 ). Two women who had failed induction with misoprostol were augmented with oxytocin and delivered vaginally. The Caesarean section rates were 19% in the misoprostol arm and 17% in the oxytocin arm (P = 0.447), which was not statistically significant. The maternal outcomes were similar in the two study arms. Four women had tachysystole in the misoprostol arm, compared to three in the oxytocin arm (P = 0.253). In the misoprostol arm two women had hypertonus compared to three in the oxytocin arm (P = 0.322).There was one case of hyperstimulation in the misoprostol arm and two in in the oxytocin arm. There were no differences in the foetal/neonatal outcomes. No baby had an Apgar score of less than seven at one or five minutes. No baby was admitted to the New Born Unit in either of the two arms. There was no case of a still birth in either of the study arms. There was no significant difference in the passage of meconium between the two arms, 39% in the misoprostol arm and 35.7% in the oxytocin arm (P = 0.755). The passage of meconium did not impact on the neonatal outcomes.. Oral misoprostol solution 20mcg 2-hourly is as safe and effective as the standard intravenous oxytocin for labour induction in women presenting with prelabour rupture of membranes at term at the Kenyatta National Hospital.

Topics: Administration, Intravenous; Administration, Oral; Adult; Apgar Score; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Kenya; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Young Adult

This is a prospective randomized study conducted in Tribhuvan University Teaching Hospital from February 2008 to January 2009. Total 72 women with Premature rupture of membranes (PROM) were included. Thirty-six women received PGE2 vaginal gel and thirty-six received iv oxytocin. Induction was successful in majority of cases in both the groups; 88.8% in PGE2 and 83.3% in oxytocin group (p value = 0.063). Time duration from induction to active stage was comparable (p value = 0.273). Induction to delivery interval was significantly low in oxytocin group (p value = 0.002) but leaking to delivery interval was similar in both the groups (p value = 0.083). PGE2 had slightly higher side effect than oxytocin. PGE2 and oxytocin were both effective and safe for induction of labour in women with PROM at term. There was no significant difference in maternal and fetal outcome, hospital stay, leaking to delivery interval, maternal and neonatal side effects, though induction to delivery interval was significantly less with oxytocin.

Topics: Administration, Intravaginal; Adult; Cesarean Section; Delivery, Obstetric; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome

The aim of this randomized study was to compare 2 protocols for inducing labor in women with premature rupture of membranes (PROM) at term.. Women with PROM and a Bishop score ≤5 were randomly assigned to receive either an intravenous oxytocin infusion (n = 223) or a dinoprostone pessary followed 6 hours later by an intravenous oxytocin infusion (n = 227).. Vaginal delivery within 24 hours of labor induction increased significantly with sustained-released dinoprostone followed by oxytocin infusion (78.5% vs 63.3%; relative risk, 1.23; 95% confidence interval, 1.09-1.39; P = .001). Maternal and neonatal outcomes were similar between the groups.. Sustained-released dinoprostone followed 6 hours later by an oxytocin infusion in term women with PROM was associated with a higher rate of vaginal delivery within 24 hours, and no difference in maternal-neonatal complications was observed compared with oxytocin infusion alone.

Topics: Adult; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Young Adult

The aim of this study was to compare the efficacy and safety of a prostaglandin E(2) (PGE(2)) vaginal insert with those of oxytocin for labor induction. The present study also examined whether its use reduces the rate of cesarean delivery in term pregnancies with premature rupture of membranes (PROM) and low Bishop scores.. A total of 240 women with singleton pregnancies at >or= 37 weeks, no prior uterine scar, vertex presentations, reactive nonstress tests, PROM for >or= 12 hours and Bishop scores of

Topics: Administration, Intravaginal; Adult; Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Oxytocics; Oxytocin; Pregnancy; Time Factors

: To estimate the effect of concurrent vaginal dinoprostone and oxytocin infusion against oxytocin infusion for labor induction in premature rupture of membranes (PROM) on vaginal delivery within 12 hours and patient satisfaction.. : Nulliparas with uncomplicated PROM at term, a Bishop score less than or equal to 6, and who required labor induction were recruited for a double-blind randomized trial. Participants were randomly assigned to 3-mg dinoprostone pessary and oxytocin infusion or placebo and oxytocin infusion. A cardiotocogram was performed before induction and maintained to delivery. Dinoprostone pessary or placebo was placed in the posterior vaginal fornix. Oxytocin intravenous infusion was commenced at 2 milliunits/min and doubled every 30 minutes to a maximum of 32 milliunits/min. Oxytocin infusion rate was titrated to achieve four contractions every 10 minutes. Primary outcomes were vaginal delivery within 12 hours and maternal satisfaction with the birth process using a visual analog scale (VAS) from 0 to 10 (higher score, greater satisfaction).. : One hundred fourteen women were available for analysis. Vaginal delivery rates within 12 hours were 25 of 57 (43.9%) for concurrent treatment compared with 27/57 (47.4%) (relative risk 0.9, 95% confidence interval 0.6-1.4, P=.85) for oxytocin only; median VAS was 8 (interquartile range [IQR] 2) compared with 8 (IQR 2), P=.38. Uterine hyperstimulation was 14% compared with 5.3%, P=.20; overall vaginal delivery rates were 59.6% compared with 64.9%, P=.70; and induction to vaginal delivery interval 9.7 hours compared with 9.4 hours P=.75 for concurrent treatment compared with oxytocin, respectively. There was no significant difference for any other outcome.. : Concurrent vaginal dinoprostone and intravenous oxytocin for labor induction of term PROM did not expedite delivery or improve patient satisfaction.. : Current Controlled Trials, www.controlled-trials.com, ISRCTN74376345. : I.

Topics: Administration, Intravaginal; Adult; Dinoprostone; Double-Blind Method; Drug Therapy, Combination; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Intravenous; Labor, Induced; Oxytocics; Oxytocin; Patient Satisfaction; Pessaries; Pregnancy; Pregnancy Outcome; Young Adult

The aim of this randomized trial was to compare the efficacy and safety of vaginal misoprostol and oxytocin for cervical ripening and labor induction in patients with premature rupture of membrane (PROM) at term.. Ninety-seven women with PROM at term were assigned randomly to receive intravaginal misoprostol or oxytocin. The primary outcome measure was the induction-delivery interval. Secondary outcomes included the number of women who delivered vaginally within 12 hours of the start of the induction in the two groups, the cesarean, hyperstimulation, and failed induction rates, the mode of delivery, and the neonatal outcome.. Forty-eight women were assigned to intravaginal misoprostol and 49 to oxytocin administration. The mean interval from induction to delivery was 10.61 +/- 2.45 hours in the misoprostol group and 11.57 +/- 1.91 hours in the oxytocin group (p = 0.063). The rates of vaginal delivery were 83.3% and 87.7% and cesarean delivery were 16.7% and 8.2% in the misoprostol and oxytocin groups, respectively. Neonatal outcomes were not significantly different. Of the cases, 8.3% in the misoprostol group and 8.2% in the oxytocin group revealed uterine contraction abnormalities.. Our study demonstrates that, intravaginally, misoprostol results in a similar interval from induction of labor to delivery when compared to oxytocin.

Topics: Administration, Intravaginal; Adult; Cesarean Section; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Prospective Studies; Time Factors

Topics: Administration, Intravaginal; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Oxytocin; Pregnancy; Pregnancy Outcome

The objective was to investigate whether acupuncture could be a reasonable option for augmentation in labor after spontaneous rupture of membranes at term and to look for possible effects on the progress of labor.. In a randomized controlled trial 100 healthy parturients, with spontaneous rupture of membranes at term, were assigned to receive either acupuncture or no acupuncture. The main response variables were the duration of active labor, the amount of oxytocin given, and number of inductions.. Duration of labor was significantly reduced (mean difference 1.7 h, p=0.03) and there was significant reduction in the need for oxytocin infusion to augment labor in the study group compared to the control group (odds ratio 2.0, p=0.018). We also discovered that the participants in the acupuncture group who needed labor induction had a significantly shorter duration of active phase than the ones induced in the control group (mean difference 3.6 h, p=0.002). These findings remained significant also when multiple regression was performed, controlling for potentially confounding factors like parity, epidural analgesia, and birth weight.. Acupuncture may be a good alternative or complement to pharmacological methods in the effort to facilitate birth and provide normal delivery for women with prelabor rupture of membranes.

Topics: Acupuncture Therapy; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Labor, Obstetric; Oxytocics; Oxytocin; Pregnancy; Term Birth

This study was undertaken to compare the use of oral mifepristone with intravenous oxytocin for labor induction in women with prelabor rupture of membranes (PROM) at 36 weeks' or greater gestational age.. Sixty-five women with spontaneous PROM were randomly assigned to receive orally administered mifepristone or oxytocin infusion. Two hundred milligrams of mifepristone was administered, and subjects were observed for 18 hours, or intravenous oxytocin was administered.. Thirty-three women received mifepristone and 32 received oxytocin. The average interval from start of induction to delivery was 1194.1 +/- 568.7 minutes for mifepristone-treated subjects and 770.8 +/- 519.9 minutes for oxytocin-treated subjects ( P = .001, log-transformed data). Of 33 mifepristone-treated subjects and 32 oxytocin-treated subjects, 25 (78.1%) and 17 (51.5%), respectively, achieved successful induction (defined as vaginal delivery within 24 hours) (relative risk [RR] 0.66, 95% CI 0.45-0.96, P = .01). There was more fetal distress in the mifepristone-treated group (9 vs 2, RR 4.36, 95% CI 1.02-18.66, P = .02), and a trend toward more cesarean births (7 vs 3, RR 2.26, 95% CI 0.64-7.99, P = .19). Eleven infants of mifepristone-treated women (33.3%) and 3 infants of oxytocin-treated women (9.4%) were admitted to the neonatal intensive care unit (RR 3.56, 95% CI 1.09-11.58, P = .02).. Oral mifepristone administration 18 hours before oxytocin infusion did not improve labor stimulation in women with PROM near term, and was associated with more adverse fetal outcomes.

Topics: Administration, Oral; Adult; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Infusions, Intravenous; Intensive Care Units, Neonatal; Labor, Induced; Mifepristone; Oxytocin; Pregnancy

To determine if oral misoprostol can replace oxytocin for labor stimulation in women with ruptured membranes at term and without evidence of labor.. Nulliparous women at 36 to 41 weeks with a singleton, cephalic-presenting fetus and ruptured membranes without evidence of labor were randomized to receive oral misoprostol (100 microg) or a placebo every 4 hours for a maximum of two doses. Intravenous oxytocin was initiated if active labor had not ensued within 8 hours of the initial study drug dose.. Fifty-one women were randomized to oral misoprostol and 51 women to the placebo. Misoprostol reduced the use of oxytocin stimulation of labor from 90% to 37% (P <.001) and was associated with approximately a 7-hour shorter elapsed time in the labor unit. Uterine hyperactivity, defined as six or more contractions in 10 minutes without fetal heart rate decelerations, occurred in 25% of women randomized to misoprostol. However, uterine hyperactivity associated with fetal heart rate decelerations occurred in only three (6%) women, none of whom required emergency cesarean delivery. Route of delivery and infant outcomes were not related to misoprostol use.. Oral misoprostol (100 microg) given in a maximum of two doses 4 hours apart significantly reduced the use of oxytocin in the management of women with ruptured membranes without labor at term.

Topics: Administration, Oral; Adolescent; Adult; Delivery, Obstetric; Double-Blind Method; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Intravenous; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Treatment Outcome; Uterine Contraction

Topics: Administration, Oral; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Intravenous; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Time Factors; Treatment Outcome

The study was undertaken to compare the efficacy, safety, and maternal satisfaction of oral misoprostol and intravenous oxytocin for labor induction in women with premature rupture of membranes at term.. One hundred five women were stratified by parity and randomly assigned to oral misoprostol 75 microg every 4 hours as needed to establish labor or to intravenous oxytocin.. The induction to vaginal delivery time with oral misoprostol was 737 (+/-426) minutes compared with 573 (+/-318) minutes with oxytocin (P=.04). The incidence of hyperstimulation was lower in the misoprostol group (6.0% vs 27.1%, P=.005). Women were more likely to be very satisfied with their care in the misoprostol group (86.0% vs 63.4%, P=.02).. In women at term with premature rupture of membranes, oral misoprostol resulted in a longer induction to vaginal delivery interval but increased maternal satisfaction and less hyperstimulation compared with intravenous oxytocin. Further research is needed to assess uncommon neonatal and maternal outcomes.

Topics: Adult; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Logistic Models; Misoprostol; Oxytocics; Oxytocin; Patient Satisfaction; Pregnancy; Time Factors

This study was undertaken to determine whether induction of labor with oral misoprostol will result in fewer cesarean deliveries than intravenous oxytocin in nulliparous women with premature rupture of membranes at term.. Three hundred five women at 10 centers were randomly assigned to receive oral misoprostol, 100 microg every 6 hours to a maximum of two doses or intravenous oxytocin. The primary outcome measure was cesarean deliveries. Secondary outcomes were time from induction to vaginal delivery and measures of maternal and neonatal safety.. The study was stopped prematurely because of recruitment difficulties. We present the results for the 305 enrolled women. There was no difference in the proportion of women who underwent cesarean delivery (20.1% in the misoprostol group, 19.9% in the oxytocin group). The time interval from induction to vaginal delivery was also similar (11.9 hours for the misoprostol group, and 11.8 hours for the oxytocin group). Maternal and neonatal safety outcomes were similar for the two treatments. More infants born to women in the misoprostol group received intravenous antibiotics in the neonatal period (16.4% vs 6.9%, P=.01), although there were no differences in chorioamnionitis or in proven neonatal infections. Women receiving misoprostol were less likely to have postpartum hemorrhage than those receiving oxytocin (1.9% vs 6.2%, P=.05).. Oral misoprostol does not offer any advantage in time from induction to vaginal delivery or risk of cesarean section.

Topics: Administration, Oral; Alprostadil; Cervical Ripening; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Humans; Injections, Intravenous; Labor, Induced; Misoprostol; Oxytocin; Parity; Pregnancy

To compare the active management of term prelabour rupture of membranes with oral misoprostol with conservative management for 24 hours followed by induction with oxytocin or prostaglandin E(2) (PGE(2)) gel.. A non-blinded randomised controlled trial.. Induction and labour wards, Aberdeen Maternity Hospital.. Sixty-one women with confirmed prelabour rupture of the membranes at > or =36 weeks of gestation.. The women were randomised to 50 microg of oral misoprostol repeated every 4 hours, if required, to a maximum of five doses (active group), or to induction of labour with PGE(2) gel or oxytocin only if not in spontaneous labour 24 hours after prelabour rupture of membranes (conservative group).. Number of women in active labour within 24 hours of the prelabour rupture of membranes, preference of women for any one particular method of management in any subsequent pregnancy with prelabour rupture of membranes.. 93.3% of the active group and 54.8% of the conservative group were in spontaneous labour within 24 hours of the prelabour rupture of membranes (RR 1.7, 95% CI 1.2 to 2.4). Of those achieving a vaginal delivery, 72% of the active group did so within 24 hours of the prelabour rupture of membranes as compared with 26.9% of the conservative group (RR 2.7, 95% CI 1.4 to 5.3, P = 0.002). There were no significant differences in the neonatal or maternal outcomes. In the active group, 78% felt they would have the same method of induction as compared with 40% in the conservative group (RR 1.9, 95% CI 1.1 to 3.3, P = 0.03).. Active management with oral misoprostol resulted in more women going into labour and delivering within 24 hours of the prelabour rupture of membranes with no increase in maternal or neonatal complications. Women tended to view active management of prelabour rupture of membranes more positively. Oral misoprostol might be an option to consider in those wishing active management.

Topics: Administration, Oral; Adult; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; Gels; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Prostaglandins E

To evaluate the effect of the concurrent administration of intravaginal misoprostol and oxytocin for cervical ripening and labor induction on length labor, mode of delivery and perinatal outcomes.. One hundred seven patients with singleton pregnancy at term, vertex presentations, premature rupture of membranes and Bishop scores of < or = 4 were randomly assigned to receive one of three treatments: Group I: Intravenous oxytocin plus intravaginal misoprostol (n = 36); Group II: Intravenous oxytocin plus placebo intravaginal (n = 34); Group III: Intravaginal misoprostol plus intravenous placebo. The time interval from induction to beginning of the labor, from induction to delivery, mode of delivery and perinatal outcomes were measured.. The mean time from induction to beginning of labor was different between the groups: Group I: 48.75 minutes, Group II: 107.50 minutes, Group III: 95.94 minutes (p = 0.0024). The mean time in minutes from induction to delivery was different between the groups: Group I: 359.83; Group II: 537.05; Group III: 474.54 (p < 0.05). The frequency of tachysystole, mode of delivery and perinatal outcomes were similar among the three groups.. Oxytocin that is administered simultaneously with intravaginal misoprostol for cervical ripening and labor induction in patients with pregnancies at term, premature rupture of membranes and Bishop scores < 4 make the labor beginning quickly, significantly shortens induction to delivery times without affecting the mode of delivery and with no apparent adverse maternal and perinatal effects.

Topics: Adult; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy

To compare the labour pattern and uterine activity of oral misoprostol with oxytocin for labour induction in women presenting with prelabour rupture of membranes at term.. Prospective randomised study.. Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong.. Eighty women presenting with prelabour rupture of membranes at term.. The women were randomised to receive either 100 microg misoprostol orally every 4 hours to a maximum of three doses, or intravenous oxytocin infusion according to the hospital protocol. Intrauterine pressure transducers were inserted one hour before induction of labour in both groups of women. We compared the pattern of uterine activity, the induction-to-delivery interval, duration of labour, mode of delivery and neonatal outcome between the two groups.. Both oxytocin and oral misoprostol caused an increase in uterine activity within one hour of labour induction. Peak uterine activity was reached 6-8 h after oral misoprostol, with persistent effects, and 8-10 h after oxytocin, requiring continuous titration of medication. The duration of labour was significantly reduced in nulliparous women, but not in those who were multiparous in the misoprostol group. The induction-to-delivery interval, the mode of delivery and the perinatal outcome were similar for the two groups.. Oral misoprostol caused earlier peak uterine activity, compared with oxytocin (6-8 h vs 8-10 h). Oral misoprostol was not only as effective as oxytocin in inducing labour in women at term with prelabour rupture of the membranes, but it reduced significantly the duration of labour in nulliparous women.

Topics: Administration, Oral; Adult; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Parity; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prospective Studies; Uterine Contraction

The null hypothesis was that the use of intrapartum amnioinfusion to induce term labor because of premature rupture of membranes when labor was complicated by low amniotic fluid volume due to vaginal loss would not improve fetal heart rate patterns, decrease the incidence of operative delivery, or improve neonatal acid-base status.. 200 term pregnancies with low amniotic fluid due to vaginal loss were randomly chosen to receive intrapartum amnioinfusion or standard obstetric care without amnioinfusion. Fetal heart rate pattern, method of delivery and neonatal acid-base status were compared with Student's t test, chi-squared analysis, Mann-Whitney U- or Fisher's exact test.. When amnioinfusion was used, the fetuses had lower rates of variable (74 vs. 91%, P<0.01) or late (26 vs. 58%, P<0.001) decelerations. Spontaneous deliveries were more frequent (77 vs. 59%, P<0.01) and cesarean sections less frequent (3 vs. 10%, P<0.05). Mean umbilical arterial (7.24+/-0.07 vs. 7.21+/-0.08, P<0.01) and venous (7.31+/-0.06 vs. 7.28+/-0.08, P<0.01) pH were significantly higher in newborns with amnioinfusion, and babies in this group had lower rates of neonatal acidemia of arterial (22 vs. 36%, P<0.005) or venous (13 vs. 26%, P<0.005) origin.. Amnioinfusion improved fetal heart rate pattern, lowered the incidence of operative delivery, and improved neonatal acid-base status in term labor complicated by low amniotic fluid due to vaginal loss.

Topics: Adult; Amniotic Fluid; Apgar Score; Birth Weight; Cesarean Section; Female; Fetal Blood; Fetal Membranes, Premature Rupture; Fluid Therapy; Gestational Age; Heart Rate, Fetal; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Prospective Studies; Water-Electrolyte Balance

We performed a prospective randomized study to compare maternal and fetal outcomes in pregnancies with prelabour rupture of the membranes (PROM) at term with early induction of labour or expectant management, 126 women with singleton pregnancy, cephalic presentation and gestational duration > or = 37 weeks, were randomized either to immediate induction of labour with oxytocin (Group 1) (n=52), or conservative management (Group 2) (n=74). Women who constituted Group 2 were divided into 2 groups. The first group (Group 2A) (n=25) included women in whom spontaneous labour did not begin after a waiting period of 24 hours, in which case labour was induced with oxytocin i.e. expectant management. The second group consisted of women (Group 2B) (n=49) in whom labour began spontaneously within 24 hours. The base Caesarean section rate was significantly higher in Group 2 (28.4%) (p<0.05). The rates of Caesarean section in the Groups 1-2A-2B were 19.2%, 60%, and 12.2%, respectively for nulliparous and parous women together. The rate of fetal distress was significantly higher in Group 2 (p<0.05). For determining maternal outcomes, the other parameters such as clinical chorioamnionitis, fever before or during labour, receiving antibiotics before or during labour, postpartum fever, analgesia, anaesthesia did not differ in Groups 1 and 2. Women in Group 1 went into active labour sooner, had fewer digital vaginal examinations, had a shorter interval between membrane rupture and delivery, and spent less time in the hospital before delivery than those in Group 2 (p<0.05). Babies in Group 2 were more likely to receive antibiotics, and more likely to stay in an intensive care nursery for more than 24 hours, and more likely to receive ventilation after initial resuscitation than those babies in Group 1. For developing apnoea and hypotonia, there was no significant difference between Groups 1 and 2. However, for babies in Group 2A there was a significant difference. We conclude that immediate induction of labour with oxytocin does not increase the risk of Caesarean section, compared with a practice of expectant management. Women at term with prelabour rupture of the membranes should therefore be reassured that immediate induction with oxytocin currently appears to be the best policy with respect to maternal and neonatal morbidity.

Topics: Adult; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Prospective Studies; Time Factors

To compare labor induction intervals between oral misoprostol and intravenous oxytocin in women who present at term with premature rupture of membranes.. One hundred eight women were randomly assigned to misoprostol 50 microg orally every 4 hours as needed or intravenous oxytocin. The primary outcome measure was time from induction to vaginal delivery. Sample size was calculated using a two-tailed alpha of 0.05 and power of 80%.. Baseline demographic data, including maternal age, gestation, parity, Bishop score, birth weight, and group B streptococcal status, were similar. The mean time +/-standard deviation to vaginal birth with oral misoprostol was 720+/-382 minutes compared with 501+/-389 minutes with oxytocin (P = .007). The durations of the first, second, and third stages of labor were similar. There were no differences in maternal secondary outcomes, including cesarean birth (eight and seven, respectively), infection, maternal satisfaction with labor, epidural use, perineal trauma, manual placental removal, or gastrointestinal side effects. Neonatal outcomes including cord pH, Apgar scores, infection, and admission to neonatal intensive care unit were not different.. Although labor induction with oral misoprostol was effective, oxytocin resulted in a shorter induction-to-delivery interval. Active labor intervals and other maternal and neonatal outcomes were similar.

Topics: Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Treatment Outcome

It was accomplished a random comparative study to evaluate the effects of dinoprostone in the Hospital de Gineco Obstetricia No. 60 of the Mexican Institute of the Social Security, from June of 1997 to December of the same year, in relationship to the inducement cervical repening and vaginal delivery in patients with score less than or equal Bishop to 4. They were studied a total of 156 patients split into two groups: 78 patients who were administered by intracervical gel of Dinoprostone and to the remainders 78 were administered oxitocin with the same purpose, being this last the control group. We found that the duration time of induction with dinoprostone is 2 hours in average less than the inducement with oxitocin (p > 0.05). The were achieved 67 deliveries with dinoprostone and 65 deliveries with oxitocina, being not significantly. (p < 0.05) The percentage of inducement defect was considered in relationship to the absence of cervical modifications in 12 hours of administration of dinoprostone or oxitocin, being only 3 patients in each group in these conditions. The observed complications were the same in both groups and the conditions of the newborn were better in the Dinoprostone group. The septic complications of mothers were smaller in Dinoprostone group than Oxitocin group and were significantly (p > 0.05). We can conclude that the dinoprostone intracervical application reduce the induction and expulsion time, with better conditions of the new born, and less percent of infectious complications, in relationship to the Oxitocin control group.

Topics: Adult; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Pregnancy Trimester, Third

Our purpose was to compare induction of labor with preterm rupture of membranes between 34 and 37 weeks' gestation with expectant management.. In this prospective investigation 120 gravid women at > or = 34 weeks 0 days and < 36 weeks 6 days of gestation were randomized to receive oxytocin induction (n = 57) or observation (n = 63).. Estimated gestational age at rupture of membranes (34.3 +/- 1.4 weeks vs 34.5 +/- 1.4 weeks) and ultrasonographically estimated fetal weight (2230 +/- 321 gm vs 2297 +/- 365 gm) were equivalent between groups (not significant). Chorioamnionitis occurred more often (16% vs 2%, p = 0.007), and maternal hospital stay (5.2 +/- 6.8 days vs 2.6 +/- 1.6 days, p = 0.006) was significantly longer in the control group. Neonatal sepsis was also more common in the observation group (n = 3) than among induction patients (n = 0), but the difference was not statistically significant.. Aggressive management of preterm premature rupture of the membranes at > or = 34 weeks 0 days of gestation by induction of labor is safe for the infant in our population and avoids maternal-neonatal infectious complications.

Topics: Adolescent; Adult; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Length of Stay; Morbidity; Oxytocics; Oxytocin; Patient Care Management; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Prospective Studies; Ultrasonography, Prenatal; Uterine Contraction

Our purpose was to compare vaginally administered misoprostol (Cytotec) with intravenous oxytocin for labor induction in women with premature rupture of membranes beyond 36 weeks' gestation.. Two hundred subjects with rupture of membranes without labor were randomly assigned to receive vaginally administered misoprostol or intravenous oxytocin. Twenty-five micrograms of misoprostol (Cytotec) was placed in the posterior vaginal fornix. If cervical ripening (Bishop score of > or = 8 or cervical dilatation of > or = 3 cm) or active labor did not occur, a single repeat dose of misoprostol was given 6 hours later. Oxytocin was administered intravenously by a standardized incremental infusion protocol to a maximum dose of 22 mU per minute.. Of the 197 subjects evaluated, 98 received misoprostol and 99 oxytocin. The average interval from start of induction to vaginal delivery was about 1 hour longer in the misoprostol group (811.5 +/- 511.4 minutes) than in the oxytocin group (747.0 +/- 448.0 minutes) (P = .65, log transformed data). Oxytocin administration was necessary in 37 of 98 (37.8%) of misoprostol-treated subjects. Vaginal delivery occurred in 85 misoprostol-treated subjects (86.7%) and 82 (85.9%) oxytocin-treated subjects (relative risk 1.17, 95% confidence interval 0.78 to 1.78, P = .45) with the remainder undergoing cesarean birth. There was no difference in the incidence of tachysystole (six or more uterine contractions in a 10-minute window for two consecutive 10-minute periods) or hypertonus between the two groups. There was no significant difference in frequency of abnormal fetal heart rate tracings between the two groups (29.6% in the misoprostol group and 28.9% in the oxytocin group, P = .91). Chorioamnionitis was diagnosed in 28 (28.6%) misoprostol-treated subjects and 26 (26.3%) oxytocin-treated subjects (P = .72, relative risk 1.06, 95% confidence interval 0.78 to 1.45). No significant differences were found in the incidence of fetal meconium (8.1% and 9.1%), 1- or 5-minute Apgar scores < 7 (11.0% and 10.2% of 1-minute Apgar scores, and 2.0% and 2.0% of 5-minute Apgar scores), neonatal resuscitation (24.5% and 27.6%), or admission to the neonatal intensive care unit (25.5% and 32.3%) between the two groups.. Vaginal administration of misoprostol (Cytotec) is an effective alternative to oxytocin infusion for labor induction in women with premature rupture of the membranes near term. The incidence of untoward effects is similar with use of the two agents.. 197 of the 214 women who presented to a Los Angeles, California (US), hospital in 1995-97 with spontaneous rupture of the membranes beyond 36 weeks' gestation (mean, 38 weeks) volunteered for a comparative study of the effectiveness of vaginally administered misoprostol and oxytocin infusion. Induction was started a minimum of 6 hours after the spontaneous rupture of membranes. In 98 women, 25 mcg of misoprostol (Cytotec) was placed in the posterior vaginal fornix and, if uterine contraction frequency was deemed inadequate, the dose was repeated once in the next 6 hours (average, 1.3 dose). In the remaining 99 women, oxytocin was administered by infusion pump according to standard protocol, for a maximum dose of 22 mU/minute. 75 (75.8%) of misoprostol-treated women and 73 (74.5%) of oxytocin-treated subjects were delivered vaginally within 24 hours of induction initiation. The mean time from start of induction to vaginal delivery was 811.5 +or- 511.4 minutes in the misoprostol group and 747.0 +or- 448.0 minutes in oxytocin-treated subjects. 85 (85.9%) misoprostol-treated women and 82 (83.7%) oxytocin-treated subjects delivered vaginally. There were no significant differences between treatment groups in terms of tachysystole or hypertonus incidence or in the frequency of abnormal fetal heart rate tracings. Chorioamnionitis was diagnosed in 28 (28.6%) misoprostol-treated and 26 (26.3%) oxytocin-treated subjects. Neonatal outcomes were similar in both groups. Although misoprostol administration did not reduce the cesarean section delivery rate, its efficacy and safety were similar to oxytocin's, indicating this is a suitable regimen in women with premature rupture of membranes beyond 36 weeks' gestation.

Topics: Administration, Intravaginal; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third

In order to compare the efficacy of immediate intravenous oxytocin administration and intracervical prostaglandin E2 gel application in premature rupture of membranes with unfavorable cervices at term, 45 term pregnant patients with premature rupture of membranes were randomized into two groups. Twenty women received immediate intravenous oxytocin after cleansing enema while the rest were treated with intracervical prostaglandin E2 gel. Means of maternal age, gestational age, Bishop score at admission and the rates of nulliparity did not show any significant differences between the two groups (p > 0.05). The mean rupture to delivery time was 12.6 +/- 4.4 hours in the oxytocin group and 16.5 +/- 4.5 hours in the prostaglandin group (p < 0.01). Mean birth weights and Apgar scores were insignificant. Cesarean section rates were 24% in the oxytocin group and 5% in the other (p < 0.05). No infectious morbidity was seen in any case. In conclusion, although delivery is delayed with the intracervical prostaglandin approach, cesarean section rate is lowered without an increase in infectious morbidity.

Topics: Administration, Topical; Adult; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Gels; Humans; Injections, Intravenous; Oxytocics; Oxytocin; Pregnancy; Treatment Outcome

To evaluate the safety and clinical effectiveness of intravaginal misoprostol, a synthetic prostaglandin E1 analogue, for labor induction in gravidas with premature rupture of membranes (PROM) at term.. One hundred forty-one pregnant women with term PROM were assigned randomly to one of two induction groups: 1) intravaginal misoprostol or 2) intravenous oxytocin by continuous infusion.. Seventy subjects were allocated to the misoprostol group and 71 to the oxytocin group. The mean (+/- standard deviation) interval from induction to delivery was significantly shorter in the misoprostol group (416 +/- 276 compared with 539 +/- 372 minutes; P = .04). In 85.7% of patients in the misoprostol group, only one dose was required. Intrapartum complication rates, mode of delivery, and neonatal or maternal adverse event rates were similar in the two treatment groups. Uterine tachysystole occurred more frequently with misoprostol than with oxytocin (28.6% compared with 14.0%; P < .04).. Intravaginal administration of misoprostol induces labor safely and effectively in patients with PROM at term.

Topics: Administration, Intravaginal; Adult; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Intravenous; Misoprostol; Oxytocics; Oxytocin; Pregnancy

Our purpose was to determine the effect of induction of labor on neonatal infection if mothers are group B streptococci positive and have prelabor rupture of membranes at term.. In the TermPROM study 5041 women were randomized to induction with intravenous oxytocin, induction with vaginal prostaglandin E2 gel, or expectant management with induction, if needed. Of these, 4834 women had vaginal or introital swabs for group B streptococci taken at entry. We used logistic regression to test for effects of treatment within group B streptococci subgroups.. Group B streptococci were predictive of neonatal infection for the induction with vaginal prostaglandin E2 gel and expectant groups but not for the induction with oxytocin group. For women positive for group B streptococci the rates of neonatal infection were 2.5% for the induction with oxytocin group and > 8% for all other groups.. Induction of labor with intravenous oxytocin may be preferable for group B streptococci-positive women with prelabor rupture of membranes at term.

Topics: Administration, Intravaginal; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Labor, Induced; Logistic Models; Oxytocin; Pregnancy; Streptococcal Infections; Streptococcus agalactiae; Vagina

As the interval between rupture of the fetal membranes at term and delivery increases, so may the risk of fetal and maternal infection. Recently the TERMPROM (Term Prelabor Rupture of the Membranes) Study Group reported the results of a randomized controlled trial comparing 4 management strategies: induction with oxytocin (IwO), induction with prostaglandin (IwP), and expectant management and induction with either oxytocin (EM-O) or prostaglandin (EM-P) if complications developed. The study found no statistically significant differences in neonatal infection and cesarean section rates between any of the 4 groups.. To conduct an economic evaluation comparing the cost of (a) IwO and EM-O, (b) IwP and EM-P and (c) IwO and IwP.. An economic analysis, conducted alongside the clinical trial, using a third-party payer perspective. Analysis included all treatment costs incurred for both the mother and the baby. Information on health care utilization and outcomes was collected for all study participants. Three countries (Canada, the United Kingdom and Australia), corresponding to the largest study recruitment, were chosen for calculation of unit costs. For each country, the base, low and high estimates of unit cost for each service item were generated. Intention-to-treat analysis. Extensive statistical and sensitivity analyses were performed.. The median cost of IwO per patient was significantly lower statistically than that of EM-O and IwP. This result held in all 3 countries compared -$114 and -$46 in Canada, -113 Pounds and -63 Pounds in the UK, and -A$30 and -A$49 in Australia) and after an extensive sensitivity analysis. There was no statistically significant difference in median cost per patient between IwP and EM-P.. Although the clinical results of the TERMPROM study did not find IwO to be preferable to the other treatment alternatives, the economic evaluation found it to be less costly. However, these cost differences, even though statistically significant, are not likely to be important in many countries. When this is the case, the authors recommend that women be offered a choice between management strategies.

Topics: Australia; Canada; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Health Care Costs; Humans; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Pregnancy Trimester, Third; Statistics, Nonparametric; United Kingdom

Our objective was to determine the best treatment for parturients at term with an unfavorable cervix and premature rupture of membranes (PROM).. In this prospective study, 96 women with PROM and an unfavorable cervix were randomized into one of three treatment groups: oxytocin induction, vaginal prostaglandin E2 gel followed by oxytocin, or expectant management.. Length of labor, cesarean section rate, and maternal/neonatal morbidity were not significantly different. In contrast, the interval from PROM until delivery and length of hospital stay were significantly longer in the expectantly managed group than in the other groups. Four of the patients who received expectant management required delivery because of nonreassuring fetal assessments.. Expectant management of PROM at term significantly prolongs hospital stay without decreasing the incidence of abdominal delivery or infectious morbidity. There appears to be potential for cord compression in patients managed expectantly without continuous electronic fetal surveillance.

Topics: Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Obstetric; Length of Stay; Oxytocics; Oxytocin; Pregnancy; Prospective Studies; Time Factors

A retrospective randomized paired study was performed of 200 electively induced labor by means of artificial rupture of membranes and oxytocin infusion and 200 spontaneous labor. It was found that labor length was significantly shorter (p < 0.5) in the study group tan the control group (2.02 +/- 3 h and 6.2 +/- 3 h respectively). Delivery was accomplished in the majority of the induced group (50.2%) between 12:00 and 17:59 h (p < 0.001), while in the control group it occurred randomly during the 24 hours (p > 0.05).

Topics: Adult; Extraembryonic Membranes; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy; Retrospective Studies; Time Factors

Induction of labor has become common practice in many Western countries, but few studies have assessed women's views.. A randomized, controlled trial was conducted at 72 hospitals in six countries. Five thousand forty-one women meeting eligibility criteria, with no contraindications for induction of labor or expectant management, were randomly assigned to four groups: induction with intravenous oxytocin, induction with vaginal prostaglandin E2 gel, or expectant management followed by induction with either oxytocin or with prostaglandin E2 gel if complications developed. The three main outcome measures were evaluations of the treatment received, perceived control during childbirth, and evaluations of the experience of trial participation.. Questionnaires were completed by 81.9 percent of the sample. No significant differences occurred between the two induction groups. Compared with the expectant management groups, induced women were less likely to report there was nothing they liked about their treatment and less likely to report that the treatment caused additional worry. No between-group differences occurred in experienced control during childbirth. Women in the induction groups were more likely to be willing to participate in the study again and to feel reassured.. Women's preferences should be considered when making decisions about their method of management when membranes rupture before labor. Obtaining participants' views is both feasible and worthwhile when evaluating forms of medical care.

Topics: Adult; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocics; Oxytocin; Patient Satisfaction; Pregnancy

The rate of Cesarean Section for failed induction of labor and maternal and fetal compilations are high when labor is induced in a nulliparas women with an unripe cervix by amniotomy and oxytocin infusion. Prostaglandins (PG) in different forms have been used for ripening the cervix with an aim of reducing these problems. A prospective randomized trial was performed on one hundred primigravid women between 37 and 42 weeks of gestation with singleton pregnancy, cephalic presentation and unfavorable cervix (Modified Bishop Score < or = 5) in the department of Obstetrics & Gynaecology of Institute of Postgraduate Medicine & Research from 1st May 1996 to 30th April 1997. In this study the efficiency of prostaglandin E2 intracervical (PGE2 IC) gel in induction of labor in a group of primigravid women with unripe cervix was assessed and compared with another group with similar characteristics using oxytocin infusion and artificial rupture of membrane (ARM). The Modified Bishop Score (MBS), interval between IOL and onset of labor and the duration of labor after insertion of PGE2 gel was significantly different from those of oxytocin infusion group. But the Apgar Score at 1 & 5 min had shown no statistically significant difference. Any significant difference could also not be detected in the mode of delivery between the two induction group. The proportion of emergency Cesarean Section (CS) was high in the oxytocin infusion group than that of in the prostaglandin group. There was also no significant difference regarding the acceptability of both the induction methods.

Topics: Adult; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Gels; Gestational Age; Humans; Infusions, Intravenous; Labor, Induced; Oxytocin; Parity; Pregnancy; Prostaglandins

To compare maternal and neonatal outcomes after 12 or 24 hours of expectant management in healthy nulliparous women with a ripe cervix and PROM at term.. A prospective, randomized study.. Karolinska Hospital, Stockholm, Sweden.. Two hundred and five healthy nulliparous women with singleton pregnancies, cephalic presentation, gestational duration 36 to 42 weeks, randomized to 12 or 24 hours of expectant management after evaluation of the cervical score (> 5). If spontaneous labor did not occur, induction was performed with oxytocin after 12 or 24 hours, respectively. MAIN PARAMETERS: Maternal early morbidity and neonatal infections, obstetric intervention rate (cesarean section or instrumental delivery).. The cesarean section rate was 4% in each group. The vacuum extraction rate was 21% in each group. Induction of labor was performed in 47% of the women allocated to 12 hours of expectant management vs 17% of the women allocated to 24 hours of expectant management (p < 0.05). The maternal morbidity rate was almost negligible. Only a few fetal infections occurred and no difference was noted between the groups.. In healthy nulliparous women at term with a ripe cervix, expectant management over 24 hours vs 12 hours resulted in fewer inductions of labor and no increase in instrumental deliveries, without any increase in neonatal or maternal morbidity.

Topics: Adult; Cervix Uteri; Cesarean Section; Chi-Square Distribution; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Labor, Induced; Oxytocin; Parity; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Vacuum Extraction, Obstetrical

As the interval between rupture of the fetal membranes at term and delivery increases, so may the risk of fetal and maternal infection. It is not known whether inducing labor will reduce this risk or whether one method of induction is better then another.. We studied 5041 women with prelabor rupture of the membranes at term. The women were randomly assigned to induction of labor with intravenous oxytocin; induction of labor with vaginal prostaglandin E2 gel; or expectant management for up to four days, with labor induced with either intravenous oxytocin or vaginal prostaglandin E2 gel if complications developed. The primary outcome was neonatal infection. Secondary outcomes were the need for cesarean section and women's evaluations of their treatment.. The rates of neonatal infection and cesarean section were not significantly different among the study groups. The rates of neonatal infection were 2.0 percent for the induction-with-oxytocin group, 3.0 percent for the induction-with-prostaglandin group, 2.8 percent for the expectant-management (oxytocin) group, and 2.7 percent for the expectant-management (prostaglandin) group. The rates of cesarean section ranged from 9.6 to 10.9 percent. Clinical chorioamnionitis was less likely to develop in the women in the induction-with-oxytocin group than in those in the expectant-management (oxytocin) group (4.0 percent vs. 8.6 percent, P<0.001), as was postpartum fever (1.9 percent vs. 3.6 percent, P=0.008). Women in the induction groups were less likely to say they liked "nothing" about their treatment than those in the expectant-management groups.. In women with prelabor rupture of the membranes at term, induction of labor with oxytocin or prostaglandin E2 and expectant management result in similar rates of neonatal infection and cesarean section. Induction of labor with intravenous oxytocin results in a lower risk of maternal infection than does expectant management. Women view induction of labor more positively than expectant management.

Topics: Adult; Anti-Bacterial Agents; Cesarean Section; Chorioamnionitis; Dinoprostone; Female; Fetal Death; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infections; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome

To investigate the effectiveness of oral misoprostol as a cervical priming agent for patients presenting with pre-labor rupture of membranes at term.. Eighty patients presenting with pre-labor rupture of membranes at term were randomized to receive either 200 micrograms of misoprostol or 50 mg of vitamin B6 orally 1 hour after admission. Labor was induced with intravenous oxytocin infusion 12 hours after oral medication if the patient did not go into labor. We compared the induction rate, duration of labor, mode of delivery, and leaking-to-delivery interval in the two groups.. The cervical score was significantly improved and the induction rate was also reduced in the misoprostol group when compared with the control group. The interval from recruitment to onset of labor, duration of labor, and the interval from recruitment to delivery were significantly shorter in the misoprostol group. The mode of delivery and the perinatal outcome were similar for the two groups.. Oral misoprostol is an effective agent for cervical priming and labor induction in patients with pre-labor rupture of membranes at term.

Topics: Administration, Oral; Adult; Cervix Uteri; Delivery, Obstetric; Double-Blind Method; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pyridoxine; Time Factors

Topics: Female; Fetal Membranes, Premature Rupture; Gels; Humans; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Prostaglandins; Reproducibility of Results

To compare obstetric and perinatal outcome between two different expectant managements in women with prelabour rupture of the membranes (PROM).. A randomised study.. One thousand three hundred and eighty-five women with rupture of the membranes at 34 to 42 weeks without contractions.. Women without contractions 2 h after admission were randomised to early induction the following morning after PROM (early induction group) or induction two days later (late induction group). Women with contractions starting within 2 h after admission were included in the calculations as a short latency group. Digital examinations of the cervix were avoided until onset of active labour. Labour was induced with oxytocin in both groups if no spontaneous contractions occurred or if chorioamnionitis or fetal distress was detected.. The frequency of spontaneous deliveries, operative deliveries, maternal and neonatal infections.. In nulliparous women, a higher rate of spontaneous deliveries was found in the late induction group (89%) compared with the early induction group (81%) (P < 0.05). The ventouse extraction rate was 7% and 14% respectively (P < 0.05). A low (2-4%) caesarean section rate was recorded and did not differ between the groups. Endometritis was detected in six women after delivery. Sixty-one children were treated with antibiotics, and no difference could be detected between the groups.. A higher rate of spontaneous deliveries was found among nulliparous women with prolonged latency as compared with brief latency prior to induction. A protocol of no digital examination before labour was associated with infrequent maternal and fetal morbidity, regardless of latency.

Topics: Adult; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Gestational Age; Heart Rate, Fetal; Humans; Labor, Induced; Oxytocin; Parity; Pregnancy; Pregnancy Outcome; Time Factors

To compare the rates of clinical amnionitis and endometritis in patients with premature rupture of membranes (PROM), using endocervical prostaglandin E2 (PGE2) gel for induction of labor versus immediate oxytocin induction of labor.. We randomized 118 patients to receive either endocervical 0.5 mg of PGE2 gel (study group) or immediate oxytocin induction of labor (control group). If labor was not established in the group receiving PGE2 gel in 24 hours, intravenous oxytocin was given in incremental doses. The rates of clinical amnionitis and endometritis in the two groups were analyzed. Also compared were hours of labor, duration of rupture of membranes and number of vaginal examinations. Student t test, chi 2, or Wilcoxon rank-sum test were used for statistical analysis, as appropriate. P < .05 was considered significant.. The rates of clinical amnionitis were 5.3% in the PGE2 group and 8% in the control group. Endometritis developed in 1.7% of PGE2 patients and 3.2% of controls. These differences in maternal infection rates were not statistically significant. The two groups were comparable with respect to age, parity, and antepartum group B streptococcal colonization. No significant differences in hours of labor, duration of ruptured membranes, or vaginal examinations were observed. Neonatal outcome data (mean birth weight, Apgar scores at 1 and 5 minutes, Apgar score less than 7 at 5 minutes) were not statistically significant.. Endocervical placement of 0.5 mg of PGE2 gel does not increase the incidence of clinical amnionitis and endometritis in patients with PROM at term when compared with immediate induction of labor with oxytocin.

Topics: Administration, Topical; Adult; Cervix Uteri; Chorioamnionitis; Dinoprostone; Endometritis; Female; Fetal Membranes, Premature Rupture; Gels; Humans; Infusions, Intravenous; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Prospective Studies; Risk Factors

To compare expectant management with early induction of labour in pregnant patients with prelabour rupture of membranes at term and unfavourable cervix.. A prospective, randomised study of 154 women with prelabour rupture of membranes at term of whom 80 had been managed expectantly, and 74 had undergone oxytocin induction at a rate of 2.5 mU/min. Digital examination was not performed before oxytocin infusion, and the first was delayed until 4 h (nulliparae), or 2 h (multiparae) of regular uterine contractions.. The mean period from rupture of membranes to delivery was significantly shorter in the induction group. The mean duration of labour was significantly shorter in the expectant group. Operative vaginal deliveries were more common in the induction group, and fetal distress was the most common cause of operative vaginal deliveries. The caesarean rates were low and similar in both groups. Maternal and neonatal infectious morbidity was similar and no difference was found in the length of hospitalisation.. Expectant management in patients with ruptured membranes at term is safe and reduces the frequency of operative vaginal deliveries.

Topics: Adult; Cesarean Section; Female; Fetal Distress; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome; Prospective Studies

Topics: Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome

To compare conservative management of pre-labor spontaneous rupture of membranes (SROM) with the use of prostaglandin (PG) E2 in healthy parous women at term (gestational age at least 37 weeks).. An open randomized study was conducted with 100 parous women; 50 were treated conservatively for 24 hours, and 50 were managed actively using PGE2 gel (1 mg), administered at admission and repeated 6 hours later if labor was not established. Both groups received intravenous oxytocin if labor did not start within 24 hours after admission.. The use of PGE2 gel led to a significant reduction in the mean interval (+/- standard error of the mean) from SROM to onset of labor: 17.26 +/- 1.51 hours in the conservative group versus 6.50 +/- 1.23 in the PGE2 group. A significantly smaller proportion of subjects required oxytocin in the PGE2 group (12 versus 38%, P < .02). The two groups were comparable with respect to analgesic requirements. Within 24 hours of SROM, 80% of the women in the PG group and 56% in the conservative group had delivered (P < .02). Most women delivered vaginally, 96% of those managed conservatively and 100% of those managed actively with PGE2.. Active management using PGE2 gel in parous women with pre-labor SROM significantly improves the time to delivery without influencing the cesarean rate or fetal-maternal infective morbidity.

Topics: Administration, Intravaginal; Adult; Anti-Bacterial Agents; Apgar Score; Delivery, Obstetric; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Gels; Humans; Labor Onset; Oxytocin; Parity; Pregnancy; Puerperal Disorders; Time Factors

The efficacy and safety of intracervical prostaglandin E2 (PGE2) gel for induction of labor in patients with premature rupture of the membranes (PROM) at term and with an unripe cervix were evaluated. Fifty-two patients who did not start labor 6 to 12 hours after PROM and who had an unripe cervix were randomized to one of two management protocols. Patients randomized to PGE2 received a single intracervical application of 0.5 mg PGE2. Patients randomized to the conservative protocol were managed expectantly for 24 hours. If labor was not established 6 hours after randomization in patients receiving PGE2 or 24 hours after PROM in patients managed expectantly, labor was induced with intravenous oxytocin. Of the patients receiving PGE2, 93% began labor after a single application, and the mean interval between prostaglandin application and delivery was 6.6 hours. In the conservative group, only 57% began labor within 24 hours, and more than half of them required augmentation with oxytocin. The mean latency between PROM and delivery was 15 hours in patients managed with PGE2 and 30 hours in patients managed conservatively (P < 0.01). There were no complications and pregnancy outcome was similar in the two groups. Intracervical PGE2 is safe and effective for inducing labor in patients with PROM and an unfavorable cervix.

Topics: Adult; Cervix Uteri; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy

Topics: Cardiotocography; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infusion Pumps; Labor, Induced; Oxytocin; Pregnancy; Prospective Studies; Pulsatile Flow

Prostaglandin E2 is often used for induction of labour. A procedure appropriate for obstetrical condition of the cervix uteri is recommended. 1,472 births with a medical indication were induced in a multicenter-study. With a bishopscore < 5 prostaglandin E2 gel intracervical and with a score between 5 and 8 vaginal tablets were used for induction. Appropriate for the condition of cervix it was allowed to continue the induction. With a bishopscore > 8 an infusion of oxytocin was given. The fetal outcome was evaluated appropriate for the condition of cervix before and during induction of labour. The APGAR-score one minute post partum was < 8 in 10.8 per cent of all neonates. This part was near the same in the gel- and in the tablet group (p > 5%). By continuation of induction, the part with pathological findings was at all times not in relation to the different groups of cervical condition. It's the same by APGAR-scores 5 and 10 minutes after delivery. The acidotic morbidity at all was 10.7%. Also in this connection it was only an unimportant (p > 5%) increasing to observe then the induction was continued. There is no relation between the different groups of cervical condition and the acidotic morbidity. Under observation of mother and child the to cervical condition appropriated used method of induction of labour does not expect a bad neonatal outcome. The longer the cervix is unripen, the higher is the rate of delivery by caesarean section. The exploitation of the possibilities of induction by drugs can be recommended.

Topics: Acid-Base Equilibrium; Administration, Intravaginal; Apgar Score; Cervix Uteri; Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged

Our objective was to compare maternal and perinatal outcomes between two management schemes for women with preterm premature rupture of the membranes and documented fetal pulmonary maturity.. Of 164 women with preterm premature rupture of the membranes at 32 weeks to 36 weeks 6 days' gestation, 93 eligible and consenting women were randomly selected for either induction of labor (n = 46) or expectant management (n = 47). Expectant management included hospitalization, assessment for fetal heart rate abnormalities, chorioamnionitis, and labor. Digital cervical examinations were prohibited until progressive labor occurred. Follow-up was also done for the 71 women who did not participate.. The women in the induction of labor and expectant management groups had similar demographic characteristics and gestational ages (34.1 vs 34.3 weeks). Expectant management was associated with prolonged latencies to labor, delivery, and maternal hospitalization (p < 0.001), as well as increased hospitalization of infants at 2 to 5 days after delivery (p < 0.05). These patients had increased chorioamnionitis and fetal heart rate abnormalities before labor (p = 0.01, 0.03). Infants received more frequent (p < 0.001) and prolonged antimicrobial therapy after expectant management (p = 0.003) with no reduction in proven sepsis (6.8% vs 4.4%). These latter differences were influenced by the neonatologist's concern over potential neonatal infection.. Among women with preterm premature rupture of the membranes at 32 to 36 weeks with mature surfactant profiles, immediate induction of labor reduces the duration of hospitalization and infection in both mothers and neonates.

Topics: Adult; Chorioamnionitis; Female; Fetal Death; Fetal Membranes, Premature Rupture; Fetal Monitoring; Fetal Organ Maturity; Follow-Up Studies; Humans; Incidence; Infusions, Intravenous; Labor, Induced; Length of Stay; Lung; Morbidity; Oxytocin; Physical Examination; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Trimester, Third; Prospective Studies; Tocolysis

To compare the rate of obstetric interventions, length of labor, and maternal morbidity in pregnancies with prelabor rupture of membranes at term after either early or late induction of labor in both primiparous and pluriparous women.. Prospective, randomized study.. 362 women with singleton pregnancies, cephalic presentations, gestational age of 36 completed weeks or more were allocated at random to induction with oxytocin either 6 hours after PROM (n = 62) (early) or 24 hours (n = 62) (late). Those eligible, but not participating in the study, totalled 238 women. MAIN OBSTETRIC MEASURES: Time of spontaneous labor in the late induction group, length of labor, obstetric intervention rate, maternal morbidity, and the degree of histologic chorioamnionitis.. The length of labor was longer in the late induction group than in the early induction group in both primiparous and pluriparous (p < 0.05). There were no overall differences in the rate of obstetric interventions or maternal morbidity, but there were marked differences between primiparous and pluriparous women. Increasing time span between the period from rupture of membranes to delivery increased the degree of histologic chorioamnionitis.. If a woman wants a short labor, she will benefit from early induction. We did not find statistical differences in the rate of obstetric intervention or in the maternal morbidity, but there was a tendency towards adverse effects of late induction.

Topics: Adult; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Parity; Pregnancy; Prospective Studies; Time Factors

To compare a conservative and an active policy (immediate oxytocin infusion) of management of prelabour rupture of the membranes in term primigravidae.. Randomized trial involving 444 women.. District maternity hospital.. Caesarean section rate in each group; also the rate of forceps deliveries, spontaneous deliveries, length of labour, number of vaginal examinations, type of analgesia, pyrexia in labour or the puerperium and antibiotic use in the mother and the infant in each group. The caesarean section rate for the whole trial where the latent period was greater than 12 h was compared to that where the latent period was less than or equal to 12 h.. There were fewer caesarean sections in the conservative group (odds ratio (OR) 0.60, 95% confidence interval (CI) 0.35 to 1.02; P = 0.06). There was a similar number of forceps deliveries (OR 0.79; 95% CI 0.52 to 1.19; P = 0.26) but more spontaneous deliveries (OR 1.57; 95% CI 1.08 to 2.29; P = 0.02) in the conservative group. More women managed conservatively required inhalational analgesia only for pain relief in labour (OR 2.88; 95% CI 1.46 to 5.68; P = 0.003), a similar number required pethidine (OR 1.29; 95% CI 0.85 to 1.94; P = 0.23), and fewer required epidural analgesia (OR 0.57; 95% CI 0.39 to 0.84; P = 0.005). The number of vaginal examinations was less in the conservative group (difference between mean 0.53; 95% CI 0.25 to 0.80; P less than 0.001). Fewer women managed conservatively experienced four or more vaginal examinations in labour (OR 0.58; 95% CI 0.39 to 0.86; P = 0.007). There were no differences in the lengths of labour, the proportions of women who developed pyrexia in labour or the puerperium or who required antibiotics or in the proportions of infants who required antibiotics.. These results argue in favour of a conservative policy in managing primigravidae at term with prelabour rupture of the membranes.

Topics: Adult; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Prospective Studies; Time Factors; Treatment Outcome

A prospective study comparing three management schemes for patients at term with premature rupture of membranes was performed.. One hundred forty patients were randomized to one of three study groups: prostaglandin E2, placebo, or oxytocin. Patients randomized to prostaglandin E2 and placebo received vaginal suppositories containing 3 mg prostaglandin E2 or glycerin only, respectively; suppositories were administered in a double-blind fashion, on one or two occasions, 6 hours apart. Oxytocin was given only if labor was not established after 12 hours or to augment inadequate labor. In patients randomized to oxytocin labor was induced with intravenous oxytocin. The time interval to delivery, delivery outcome, and complications were analyzed.. Patients receiving prostaglandin E2 were more likely to be in labor after one suppository and to be delivered without the addition of oxytocin when compared with placebo. The time interval to delivery was shorter with prostaglandin E2 and oxytocin induction versus placebo ("expectant management"). The incidence of maternal infection was lowest in patients with labor induced by prostaglandin E2. Although the overall cesarean section rate was low, there was a trend toward a lower rate with prostaglandin E2 induction. No adverse effects were observed with prostaglandin E2.. Prostaglandin E2 can be used successfully to induce labor after premature rupture of membranes at term with greater ease of administration when compared with oxytocin.

Topics: Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Labor, Obstetric; Oxytocin; Parity; Pessaries; Pregnancy; Prospective Studies

The purpose of this prospective investigation was to evaluate a protocol for management of term patients with premature rupture of membranes (PROM) and a cervix unfavorable for induction of labor (Bishop score 4 or less). Patients initially were observed for 24 to 36 hours for the spontaneous onset of labor. If spontaneous contractions did not commence, labor was induced with oxytocin. Patients subsequently were divided into three groups: 44 who had spontaneous labor, 29 who had spontaneous labor but required oxytocin augmentation, and 39 women who had oxytocin induction. Patients who entered labor spontaneously had a significantly shorter mean latent period between rupture of membranes and onset of labor (16.0 versus 26.8 and 40.7 hours), shorter mean duration of labor (7.6 versus 12.1 and 13.1 hours), and shorter mean duration of rupture of membranes (23.6 versus 39.0 and 53.8 hours). These women also had a significant decrease in the frequency of chorioamnionitis (7 versus 14 and 33%), and their infants had fewer evaluations for sepsis (25.0 versus 34.5 and 53.8%). We conclude that term patients with PROM and an unfavorable cervix who require oxytocin augmentation or induction of labor are at increased risk for intrapartum and neonatal infection compared with those who progress through labor spontaneously.

Topics: Cervix Uteri; Chorioamnionitis; Endometritis; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome; Prospective Studies; Risk Factors; Time Factors

To compare conservative versus prostaglandin management of prelabour rupture of the membranes (PROM) in healthy primigravid women at term.. A prospective randomized study.. Labour Ward, Aberdeen Maternity Hospital.. 230 primigravidae at terms with PROM, 115 allocated to be treated conservatively and 115 to be managed with prostaglandin treatment.. In the conservatively managed group the women were observed for up to 24 h after hospital admission with PROM. The actively managed group had PGE2 gel (2 mg) instilled into the posterior fornix and if contractions had not commenced, a further dose of PGE2 gel (1 mg) was instilled 6 h later. In both groups, if labour had not established 24 h after admission, intravenous oxytocin was given in escalating doses.. PROM to delivery interval, oxytocin augmentation, mode of delivery, maternal and neonatal infective morbidity.. There was a significant reduction in the PROM to delivery interval in the women managed actively with PGE2 gel and fewer women in the PGE2 group required oxytocin augmentation (31% vs 51%). The two managements groups were comparable for intrapartum analgesia, antibiotic treatment, babies requiring admission to the special care nursery unit and delivery by caesarean section.. The early use of prostaglandin is associated with a significant reduction in PROM to delivery interval without a significant increase in infective morbidity or caesarean section rate. However, the advantages of the conservative approach should not be overlooked. More work is still needed in the management of those women where uterine activity fails to establish within 24 h after PROM.

Topics: Administration, Intravaginal; Adult; Apgar Score; Bacterial Infections; Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Fever; Humans; Infant, Newborn; Injections, Intravenous; Labor Stage, Second; Oxytocin; Pregnancy; Prospective Studies; Uterine Contraction

In a prospective randomized trial of 106 patients who had spontaneously ruptured their membranes greater than or equal to 4 hours in the absence of labour, vaginal prostaglandin E2 pessaries and intravenous Syntocinon were compared. There was no significant difference in the treatment to delivery times between the 2 groups. The number of operative deliveries in each group were comparable. No untoward side-effects were noted. The use of vaginal prostaglandin E2 tablets appears to be a safe alternative to Syntocinon for induction of labour when spontaneous rupture of membranes has occurred in the absence of uterine contractions.

Topics: Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Intravenous; Labor, Induced; Oxytocin; Pessaries; Pregnancy; Prospective Studies

The purpose of this study was to assess rates of endometritis, clinical chorioamnionitis, cesarean delivery, and neonatal sepsis from the records of patients with premature rupture of the membranes (PROM) and an unfavorable cervix treated with vaginal prostaglandin (PG) E2 in comparison with those in the literature.. Using a computer data base at Denver General Hospital, we identified 146 women with PROM and cervical dilatation of 2 cm or less at term who were treated with PGE2 gel or suppositories. The records were reviewed to identify rates of maternal and neonatal infection and complications, as well as cesarean delivery.. The cesarean rate was 12%. Chorioamnionitis developed in 6.8% of the study group and endometritis in 2%. Neonatal complications were limited to two with low Apgar scores (less than 7 at 5 minutes), one with microbiologically confirmed sepsis, and two with positive urine counterimmunoelectrophoresis for group B streptococcus. The only instance of neonatal sepsis occurred in a patient with rupture of membranes longer than 24 hours.. The use of vaginal PGE2 suppositories for induction of labor and cervical ripening in term patients with PROM was accompanied by a high rate of vaginal delivery and a low rate of maternal and neonatal complications in a city hospital setting.

Topics: Administration, Intravaginal; Adult; Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Obstetric Labor Complications; Oxytocics; Oxytocin; Pregnancy; Retrospective Studies

Intrauterine prostaglandin (PG) F2 alpha infusion and intravenous (IV) oxytocin infusion were compared to evaluate the effectiveness of the two methods for termination of pregnancies with second-trimester rupture of membranes. Twenty-two women with this complication were randomly allocated to receive either 20 mg PGF2 alpha, diluted in 500 mL of NaCl 0.9% and administered through a Foley catheter inserted through the cervix, or IV oxytocin infusion in increasing doses. All subjects in the PGF2 alpha group aborted after the first administration. Repeat infusion was necessary in three oxytocin-treated subjects. The mean (+/- SD) induction-abortion interval was significantly shorter in those receiving PGF2 alpha (6.7 +/- 1.2 hours) than in those receiving oxytocin (8.8 +/- 2.7 hours). Minor side effects, such as nausea and vomiting, were observed in three women during PGF2 alpha infusion and were treated symptomatically and by temporary interruption of the infusion. Uterine hypertonus, observed in one subject in each group, was treated by temporary cessation of the infusion. We conclude that intrauterine PGF2 alpha infusion seems more effective than IV oxytocin for termination of pregnancies with second-trimester rupture of membranes.

Topics: Abortion, Therapeutic; Dinoprost; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Intravenous; Infusions, Parenteral; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Random Allocation; Uterus

Forty-seven nulliparous term pregnant women with PROM and unfavorable cervix, were randomly divided into 23 patients who were observed for four hours then followed by intravenous oxytocin, and 24 patients who were given 3 mg PGE2 gel intravaginally then followed by intravenous oxytocin four hours later. No statistically significant difference was observed between the two treatment groups with regard to Bishop score four hours after observation, intravenous oxytocin to delivery time, Apgar score at 1 and 5 minutes and maternal puerperal complications in both groups. It can be concluded that PGE2 did not significantly improve Bishop score or shorten the induction to delivery time in cases of PROM with unfavorable cervix. Intravenous oxytocin is still preferable both in terms of cost and effectiveness.

Topics: Administration, Intravaginal; Adult; Apgar Score; Cesarean Section; Drug Therapy, Combination; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infusions, Intravenous; Oxytocin; Pregnancy; Prospective Studies; Prostaglandins E

Ninety-four nulliparous women with a poor cervical score (less than 6) who had premature rupture of membranes at term were randomized by sealed envelope into two groups. One group received immediate stimulation of labor with oxytocin infusion. The second group received two prostaglandin E2 (PGE2) 3-mg pessaries 4 hours apart, followed by oxytocin infusion, if necessary. The interval between initiation of therapy to onset of labor was significantly longer in the PG group, but the length of labor was similar in both groups. The maximum dose of oxytocin needed was significantly higher in the oxytocin group. The cesarean delivery rate in the oxytocin group was 14.9%, compared with 19.1% in the PG group (not significantly different). All seven cesareans in the oxytocin group and seven of nine in the PG group were for failed stimulation of labor. Neonatal Apgar scores at 1 and 5 minutes and admission to the neonatal intensive care unit were similar in the two groups. The incidence of maternal and neonatal infection was small and was not different in the two groups. The use of PGE2 3-mg pessaries 4 hours apart, followed by oxytocin infusion if necessary, did not confer any benefit over the use of intravenous oxytocin in obstetric or neonatal outcome when both agents were started a few hours after admission.

Topics: Administration, Intravaginal; Apgar Score; Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infusions, Intravenous; Labor, Induced; Oxytocin; Parity; Pregnancy; Pregnancy Outcome

In a randomized prospective study, we compared the use of intravenous oxytocin with oral PGE2 tablets for stimulation of labor in cases of premature rupture of membranes (PROM) before term, where the onset of spontaneous labor did not occur within the first 3 h. This study represents the first of its kind in which oral PGE2 and oxytocin have been directly compared as oxytocic agents for PROM before 37 weeks. Labor induction was successful in 96% of patients in the PGE2 group compared with 84% in the oxytocin group. The incidence of cesarean section (CS) was 5% and 16% in the PGE2 and the oxytocin groups, respectively. While 10% of the CS were performed due to fetal bradycardia in the oxytocin group, none was performed in the PGE2 group despite the fact that the latter group had relatively lower Bishop scores. The data presented indicate that oral PGE2 is safe and effective in initiating active labor in healthy women at pre-term with PROM. Thus we recommend its use to induce labor 3 h after rupture of membranes before 37 weeks gestation.

Topics: Administration, Oral; Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Heart Rate, Fetal; Humans; Infusions, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Prospective Studies; Tablets

In a material of 88 patients with premature rupture of the membranes and unripe cervix, a comparative investigation was undertaken to compare the effects of prostaglandin E2 (PGE2) vaginal tablets and intravenous oxytocin on induction of labour. The patients were subdivided at random into two groups: 42 patients treatment with PGE2 and 46 treatment with intravenous oxytocin. The results did not reveal any significant differences in the numbers of successful inductions regardless of the Bishop score at the commencement of stimulation but the duration of induction was found to be briefer in the oxytocin group. No significant differences were observed in the numbers of instrumental interventions in the two groups nor in the frequencies of side effects and in the employment of analgesics. Treatment with PGE2 vaginal tablets is considered to be more acceptable by the patients and easier for the staff to use. The tablets were just as safe and reliable in use as intravenous oxytocin for induction of labour in cases of premature rupture of the membranes and Bishop scores less than 6, but the duration of induction was significantly longer.

Topics: Administration, Intravaginal; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Tablets; Uterine Cervical Incompetence

In a material of 88 patients with premature rupture of the membranes and unripe cervix, a comparative investigation was undertaken to compare the effects of prostaglandin E2 (PGE2) vaginal tablets and intravenous oxytocin on induction of labour. The patients were subdivided at random into two groups: 42 patients treatment with PGE2 and 46 treatment with intravenous oxytocin. The results did not reveal any significant differences in the numbers of successful inductions regardless of the Bishop score at the commencement of stimulation but the duration of induction was found to be briefer in the oxytocin group. No significant differences were observed in the numbers of instrumental interventions in the two groups nor in the frequencies of side effects and in the employment of analgesics. Treatment with PGE2 vaginal tablets is considered to be more acceptable by the patients and easier for the staff to use. The tablets were just as safe and reliable in use as intravenous oxytocin for induction of labour in cases of premature rupture of the membranes and Bishop scores less than 6, but the duration of induction was significantly longer.

Topics: Adult; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pilot Projects; Pregnancy; Risk Factors; Uterine Cervical Incompetence; Uterine Contraction

Premature rupture of the membranes (PROM) in otherwise uncomplicated full-term single pregnancies was studied in a prospective randomized study. Ninety-three women were randomized to either induction with oxytocin infusion (n = 43) or expectant management (n = 50). Twenty-four and 26 respectively were nulliparas. In the induction group, all but 3 were delivered within 24 h from PROM. There were 3 vacuum extractions (VE), all in nulliparous women. No cesarean section (CS) was performed. In the expectancy group, 23 of 50 were delivered within 24 h. There were 5 VE and 3 CS in nulliparas and 1 VE and 1 CS in paras. The instrumental actions were mainly due to arrest of 1st or 2nd stage labor. The only clinical infections occurred in nulliparas in the expectancy group. Our conclusion is that parous women with PROM can be treated by either induction or expectancy while in nulliparas, induction after some hours' expectation seems preferable.

Topics: Adult; Bacterial Infections; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Middle Aged; Oxytocin; Pregnancy; Pregnancy Outcome; Prospective Studies

We have studied the influence of endocervical application of 0.4 mg prostaglandin E2 (PGE2) in gel on the clinical outcome of pregnancies of at least 36 weeks' duration complicated with premature rupture of the membranes (PROM) and unripe cervix, (modified Bishop score of 7 or less). There were 579 women in the study. The PGE2 gel was applied within the first 12 hours after PROM. The first 60 women were randomly divided into controls given oxytocin infusions and experimental subjects given PGE2 gel. All others were given PGE2 gel, and the results were compared with those obtained in patients with similar criteria who were treated with oxytocin infusions during the preceding year. The clinical outcome was significantly better in the PGE2-treated patients than oxytocin-infused patients. PROM to delivery interval and the incidence of operative deliveries were significantly reduced. No adverse effects on the neonates were observed and the incidence of neonatal infection declined. It is concluded that cervical ripening with PGE2 gel in patients with PROM and unripe cervix near term significantly improves the outcome for both mother and child.

Topics: Adult; Cervix Uteri; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy; Random Allocation; Time Factors

Sixty pregnant patients at term, who had premature rupture of the membranes and an unfavourable cervix were randomised to compare expectant management with oxytocin induction and with the use of prostaglandin E2 vaginal tablets for cervical ripening/induction of labour. Patients treated expectantly were placed on bed rest and observed for labour and infection. Patients managed by intervention were given intravenous oxytocin or 2 prostaglandin E2 tablets (0.5 mg) intravaginally every 6 hours. Between the three groups the duration of labour was longer in the oxytocin group and all 6 caesarean sections were performed on patients in this group. There was only 1 case of proven neonatal sepsis; this occurred in the oxytocin group. Patients with prostaglandin cervical ripening had a shorter hospital stay compared with patients treated expectantly. It is concluded that prostaglandin-induced cervical ripening is the method of choice in handling term patients with premature rupture of the membranes and an unfavourable cervix.

Topics: Adult; Cervix Uteri; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Obstetric Labor Complications; Oxytocin; Pregnancy; Pregnancy Outcome; Time Factors

Sixty-nine patients (48 primigravidae and 21 multigravidae) with 12 hours of spontaneous premature rupture of membranes (PROM) after 36 weeks gestation were randomly allocated to receive either prostaglandin E2 (PGE2) oral tablets or intravenous oxytocin to stimulate labor. The two treatments were compared regarding stimulation - delivery interval (SDI), analgesic requirements, maternal and fetal side effects, and patient acceptability. The mean SDI was shorter in the oxytocin group, but without statistical significance. Analgesic requirements and fetal side effects were similar in the two groups, but there was a higher incidence of nausea and vomiting in those patients receiving the maximum dose (1 mg hourly) of PGE2. On subjective assessment, clinicians considered oxytocin to be more effective (p less than 0.05), while midwives felt both regimes to be equally helpful. PGE2 oral tablets were significantly (p less than 0.05) more acceptable to the patients, who preferred the convenience of oral dosing, the absence of an i.v. line and the increased mobility. It is concluded that PGE2 tablets are a safe and effective method of stimulating labor following PROM, and highly acceptable to parturients. In those women in whom labor has not been established within 8 h of initiating PGE2 therapy, or in whom gastric side effects are troublesome, intravenous oxytocin should be substituted.

Topics: Adolescent; Adult; Analgesics; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Injections, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome; Tablets

One hundred consecutive women with singleton pregnancies and primary rupture of membranes (PROM) after 36 weeks of gestation were included in a prospective, randomized trial of intravenous infusion of oxytocin (up to 30 mIU/min) versus low-dose prostaglandin F2 alpha(PGF2 alpha, up to 6.0 micrograms/min). Cesarean section was performed in 12 patients because of suspected disproportion or intra-uterine asphyxia. Effective contractions or labor progress failed to become established within 8 hours in another 4 women stimulated with PGF2 alpha and 2 stimulated by oxytocin. The stimulation delivery time (hours) for the remaining 82 women treated with PGF2 alpha or oxytocin, respectively was 8.7 against 12.1 for initial Bishop score less than 5 (p less than 0.01), (Mann-Whitney test), 7.2 vs. 7.1 for Bishop score 5-8 and 5.7 vs. 4.2 for Bishop score greater than 8. Patients with initial Bishop score less than 5 seemed to need analgetics less often when treated with PGF2 alpha than with oxytocin. Frequencies of side effects and instrumental deliveries as well as the fetal outcome were similar for the two treatment schedules. The results of the study suggest that low-dose PGF2 alpha infusion may be the more appropriate treatment for women with an unfavorable initial Bishop score.

Topics: Adolescent; Adult; Clinical Trials as Topic; Dinoprost; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Prospective Studies; Prostaglandins F; Random Allocation

We conducted a prospective randomized study involving 317 patients with term gestations (greater than 36 weeks) and premature rupture of membranes (PROM). Eighty-five percent of the 167 patients managed conservatively began labor within 48 hours. The cesarean section rate in this group was 7% as opposed to 21% in the group managed by oxytocin induction. There were no neonatal infections, and the maternal intrauterine infection rate was lower in the group managed expectantly, 4% vs 12%. There was no difference in the average time of hospitalization for the two groups. Conservative management of patients with PROM at term will significantly reduce the incidence of cesarean section without placing the mother or infant at a higher risk of infection.

Topics: Cesarean Section; Endometritis; Female; Fetal Diseases; Fetal Distress; Fetal Membranes, Premature Rupture; Fetal Monitoring; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Prospective Studies; Random Allocation; Streptococcal Infections; Streptococcus agalactiae; Time Factors

To induce cervical priming and labor, 20 nulliparous term pregnant women with premature rupture of the membranes and unfavorable cervical states were randomly given either oxytocin intravenously or 4 mg prostaglandin E2 in gel intravaginally. One of ten women receiving oxytocin had a favorable cervical state within five hours and vaginal delivery within 24 hours after the start of the infusion compared with six of ten women after prostaglandin E2 gel application. This difference is statistically significant (P less than .01). The number of instrumental deliveries was nine (four cesarean sections and five vacuum extractions) in the oxytocin-treated patients compared with only two vacuum extractions in women who received prostaglandin E2 gel. This difference is also statistically significant (P less than .01, Fischer exact test). In a subsequent open study, 4 mg prostaglandin E2 gel was applied vaginally to 17 term pregnant women of mixed parity with premature rupture of the membranes and unfavorable cervixes. In 12 women a favorable cervical state was achieved within five hours after gel application, and all these women were delivered within 24 hours. None of the women required cesarean section but two required delivery by vacuum extraction. There were no perinatal losses, but two infants in the oxytocin-treated group had Apgar scores less than 7 at five minutes. At pediatric follow-up after two and six months, all infants were normal. In both obstetric and perinatal outcome prostaglandin E2 gel thus seems to be superior to oxytocin for labor induction in term pregnant patients with premature rupture of the membranes and unfavorable cervixes.

Topics: Administration, Topical; Adult; Cervix Uteri; Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Gels; Humans; Infusions, Parenteral; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins E; Vacuum Extraction, Obstetrical

One hundred thirty-four indigent patients at term who had premature rupture of membranes and a cervix unfavorable for induction of labor (80% effacement or less, 2 cm dilation or less) were randomized to compare expectant with intervention management. Women with any medical or obstetric condition warranting immediate intervention were excluded from the study. Patients treated expectantly were placed at bed rest and observed for labor or infection. Patients managed by intervention were given oxytocin if labor did not ensue within 12 hours of rupture of the membranes. Patients in the intervention protocol had longer labor (P less than .02) and a higher incidence of both cesarean delivery (P less than .05) and intraamniotic infection (P less than .05). There was only one case of proven neonatal sepsis, and this occurred in a patient managed by induction of labor. There was no statistically significant difference between groups in mean length of maternal hospitalization.

Topics: Adult; Bacterial Infections; Cervix Uteri; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy; Prospective Studies; Random Allocation

The efficacy of oral PGE2 tablets and buccal demoxytocin (resoriblets) for the induction of labor in cases of premature rupture of the membranes (PROM) after the 37th week of gestation has been evaluated in a prospective, randomized investigation of 193 women. PGE2 tablets (Prostin) were given to 109 parturients and demoxytocin resoriblets (Sandopart) to 84. The former were given in increasing doses from an initial 0.5 mg to a maximum of 1.5 mg every hour. The demoxytocin was administered at a constant dosage of 50 I.U. every 30 min. The treatment was unsuccessful in 10 of the women treated with PGE2 tablets and in 19 women receiving demoxytocin resoriblets. In addition, the treatment had to be discontinued in 5 women in the PGE2 group due to gastrointestinal side effects. This gives a total success rate of 86.3% for treatment with PGE2 against 77.4% in respect of demoxytocin. This difference is not significant. No difference was observed between the two treatment groups as regards: the stimulation-delivery interval, duration of the various stages of labor, efficacy in primiparae and multiparae, efficacy in patients with a high/low Bishop score. A significantly higher frequency of gastro-intestinal side effects was seen in those treated with PGE2 (21.7%) as compared with demoxytocin (3.6%). The frequency of surgical intervention was 17% in the PGE2 group and 10% in the demoxytocin group. In 4 cases where the stimulation was successful, cesarean section was carried out for reasons unrelated to the drug therapy. Despite the fact that demoxytocin treatment results in fewer side effects than PGE2, the efficacy of the drug is not superior. Based on experience from previous investigations carried out in this department, where intravenous oxytocin was found to be clearly better than oral PGE2 for the induction of labor in cases of PROM, intravenous oxytocin will remain the method of choice due to the shorter period of treatment, which must take priority.

Topics: Administration, Oral; Adult; Dinoprostone; Drug Evaluation; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Prostaglandins E; Random Allocation; Tablets

In a prospective randomized study, 36 patients with spontaneous rupture of the membranes of greater than or equal to 4 h duration were stimulated with 3 mg vaginal prostaglandin E2 pessaries or intravenous oxytocin. Oxytocin stimulation was associated with shorter labours and a lower incidence of abnormal cervimetric progress. Of the patients given prostaglandin pessaries, 40% required a second dose after 4 h for slow progress; 45% of the primigravidae subsequently developed abnormal labour which was corrected by augmentation with oxytocin in all cases. One caesarean section was carried out for disproportion, and the remaining 35 patients were delivered vaginally. Prostaglandin pessaries were not associated with an increased incidence of hyperstimulation or sepsis. In conclusion, although PGE2 pessaries are safe in spontaneous rupture of the membranes, intravenous oxytocin is more efficient in stimulating labour.

Topics: Adolescent; Adult; Apgar Score; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infusions, Parenteral; Labor, Induced; Oxytocin; Pessaries; Pregnancy; Prostaglandins E; Time Factors; Vagina

Prostaglandin E2-tablets were compared to intravenous oxytocin for the stimulation of labor in 201 patients at or near term, with premature spontaneous rupture of the membranes without labor activity for 6 hours after the escape of fluid. The patients were randomly allocated; 99 were treated with PGE2-tablets (0.5-1.5 mg/hr) and 102 with intravenous oxytocin (7.5-45 mIU/min). The treatment was ineffective in the PGE2 group in 3 cases; these were treated successfully with intravenous oxytocin. In the oxytocin group, 3 patients were delivered by cesarean section for reasons not associated with the drug. A significant difference was found in the stimulation-delivery time, in favor of intravenous oxytocin. Although PGE2 tablets are a safe and convenient alternative to intravenous oxytocin, the investigation showed that intravenous oxytocin is preferable in cases of premature rupture of the membranes with more than 6 hours without labor activity.

Topics: Adult; Clinical Trials as Topic; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins E; Random Allocation; Time Factors

The effect on labour of 50 mg intravaginal PG F2 alpha or a standard intravenous oxytocin regimen was compared in 2 randomised trials involving a total of 83 patients, 23 of whom had experienced spontaneous rupture of the membranes (S.R.O.M.) and 60 of whom had artificial rupture of the membranes (A.R.M.) to induce labour. In each trial, labour had not been initiated by membrane rupture alone. In both trials only 20% of the patients receiving PG F2 alpha required further augmentation of labour with intravenous oxytocin. The mean length of labour in patients receiving PG F2 alpha was 2.5 hours shorter in the A.R.M. trial and 3.0 hours shorter in the S.R.O.M. trial than the mean length of labour in patients receiving intravenous oxytocin (P < 0.01). In the A.R.M. trial, the PG F2 alpha-treated group had significantly less analgesic requirements (P < 0.001). Although more normal deliveries occurred in the patients treated with PG F2 alpha than oxytocin in both trials, the numbers did not reach statistical significance. No side effects occurred in the PG F2 alpha-treated patients or their babies and this method was much preferred by patients and nursing staff alike.

Topics: Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Prostaglandins F

Topics: Carbachol; Castor Oil; Clinical Trials as Topic; Drug Evaluation; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Obstetric Labor Complications; Oxytocin; Pregnancy; Prostaglandins F; Quinine; Time Factors

To determine the management of patients with term prelabor rupture of membranes.. Synthesis of the literature from the PubMed and Cochrane databases and the recommendations of French and foreign societies and colleges.. Term prelabor rupture of membranes is considered a physiological process until 12 h have passed since rupture (professional consensus). In cases of expectant management and with a low rate of antibiotic prophylaxis, home care may be associated with an increase in neonatal infections (LE3), compared with hospitalization, especially for women with group B streptococcus (GBS) colonization (LE3). Home care is therefore not recommended (grade C). In the absence of spontaneous labor within 12 h of rupture, antibiotic prophylaxis may reduce the risk of maternal intrauterine infection but not of neonatal infection (LE3). Its use after 12 h of rupture in term prelabor rupture of the membranes is therefore recommended (grade C). When antibiotic prophylaxis is indicated, intravenous beta-lactams are recommended (grade C). Induction of labor with oxytocin (LE1), prostaglandin E2 (LE1), or misoprostol (LE1) is associated with shorter rupture-to-delivery intervals than expectant management; immediate induction is not, however, associated with lower rates of neonatal infection (LE1), even among women with a positive GBS vaginal swab (LE2). Thus, expectant management can be offered without increasing the risk of neonatal infection (grade B). Induction of labor is not associated with either an increase or decrease in the cesarean rate (LE2), regardless of parity (LE2) or Bishop score at admission (LE3). Induction can thus be proposed without increasing the risk of cesarean delivery (grade B). No induction method (oxytocin, dinoprostone, misoprostol, or Foley catheter) has demonstrated superiority over any another method for reducing rates of intrauterine or neonatal infection or of cesarean delivery or for shortening the rupture-to-delivery intervals, regardless of parity or the Bishop score.. Term prelabor rupture of membranes is a frequent event. A 12-hour interval without onset of spontaneous labor was chosen to differentiate a physiological condition from a potentially unsafe situation that justifies antibiotic prophylaxis. Expectant management or induction of labor can each be proposed, even in case of positive screening for group streptococcus. The decision should depend on the woman's wishes and maternity unit organization (professional consensus).

Topics: Dinoprostone; Female; Fetal Membranes, Premature Rupture; Gynecology; Humans; Infant, Newborn; Labor, Induced; Misoprostol; Oxytocin; Pregnancy; Streptococcus agalactiae

This study was aimed to determine if admission-to-delivery times vary between term nulliparous women with prelabor rupture of membranes (PROM) who initially receive oxytocin compared with buccal misoprostol for labor induction.. This is a retrospective cohort of 130 term, nulliparous women with PROM and cervical dilation of ≤2 cm who underwent induction of labor with intravenous oxytocin or buccal misoprostol. The primary outcome was time from admission to delivery. Linear regressions with log transformation were used to estimate the effect of induction agent on time to delivery.. Women receiving oxytocin had faster admission-to-delivery times than women receiving misoprostol (16.9 vs. 19.9 hours,. In term nulliparous patients with PROM, intravenous oxytocin is associated with faster admission-to-delivery times than buccal misoprostol.

Topics: Administration, Intravenous; Adult; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Labor, Obstetric; Linear Models; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Retrospective Studies; Time Factors

Induction of labor usually within 24 hours is recommended for term prelabor rupture of membranes. It is still unclear when within the 24 hours induction of labor for term prelabor rupture of membranes should be initiated. Antibiotic prophylaxis for group B Streptococcus is usually recommended for prolonged prelabor rupture of membranes.. The aim of our study was to evaluate whether induction of labor at ≤6 hours from prelabor rupture of membranes with intravenous oxytocin in singleton pregnancies at ≥37 weeks' gestation without regular uterine contractions reduces the administration of intravenous antibiotic agents.. This was a retrospective cohort study including all women with prelabor rupture of membranes at ≥37 weeks' gestation and without regular uterine contractions in which labor was induced using intravenous oxytocin. Women were divided into 2 groups according to the timing of induction (≤6 hours vs >6 hours after prelabor rupture of membranes).. A total of 166 women with term prelabor rupture of membranes were included, 53 of whom (31.9%) were induced within 6 hours of prelabor rupture of membranes and 113 (68.1%) were induced after 6 hours. There were no differences in demographic characteristics and risk factors for term prelabor rupture of membranes between the 2 groups. Women who underwent induction of labor at ≤6 hours were significantly less exposed to intravenous antibiotic prophylaxis compared with women induced at >6 hours (36% vs 80.5%, respectively; odds ratio, 0.14; 95% confidence interval, 0.07-0.28). Furthermore, for women induced within 6 hours after prelabor rupture of membranes, the chances of delivering at <12 or <24 hours were increased, nonreassuring cardiotocogram significantly less common, and hospital stay significantly shorter. No differences were found in regard to neonatal outcomes.. Induction of labor at ≤6 hours with intravenous oxytocin after term prelabor rupture of membranes is significantly associated with lesser use of antibiotic agents, shorter latency to delivery, lower incidence of nonreassuring cardiotocogram, and shorter hospital stay than induction of labor at >6 hours after prelabor rupture of membranes.

Topics: Anti-Bacterial Agents; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Oxytocin; Pregnancy; Retrospective Studies; Streptococcus agalactiae

To assess the risk of chorioamnionitis in nulliparous, term, singleton, vertex (NTSV) pregnancies with premature rupture of membranes (PROM) and an unfavorable cervix undergoing labor induction with either prostaglandin E2 (PGE2) or oxytocin only.. Retrospective cohort of NTSV pregnancies presenting with PROM who underwent labor induction with either PGE2 (n=94) or oxytocin (n=181) between October 2015 and March 2019. The primary outcome of chorioamnionitis was compared between the two groups. Statistical analysis included Chi-squared and Wilcoxon rank-sum tests, as well as logistic regression. For time to delivery, a Cox proportional hazard regression was used to determine the hazard ratio (HR) and adjusted HR (aHR).. Baseline characteristics were similar between the two groups. Cervical ripening with PGE2 was associated with an increased rate of chorioamnionitis (18.1 vs. 6.1%; aOR 4.14, p=0.001), increased neonatal intensive care unit admissions (20.2 vs. 9.9%; aOR 2.4, p=0.02), longer time interval from PROM to delivery (24.4 vs. 17.9 h; aHR 0.56, p=<0.0001), and lower incidence of meconium (7.4 vs. 14.4%; aOR 0.26, p=0.01), compared to the oxytocin group.. Based on our data, the use of oxytocin appears both superior and safer compared to PGE2 in NTSV pregnancies with PROM undergoing labor induction.

Topics: Adult; Cervical Ripening; Chorioamnionitis; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Outcome and Process Assessment, Health Care; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Prognosis; Retrospective Studies; Risk Assessment; United States

To determine the management of patients with term prelabor rupture of membranes.. Synthesis of the literature from the PubMed and Cochrane databases and the recommendations of French and foreign societies and colleges.. Term prelabor rupture of membranes is considered a physiological process up to 12hours of rupture (Professional consensus). In case of expectant management and with a low rate of antibiotic prophylaxis, home care compared to hospitalization could be associated with an increase in neonatal infections (LE3), especially in case of group B streptococcus colonization (LE3). Home care is therefore not recommended (Grade C). In the absence of spontaneous labor within 12hours of rupture, antibiotic prophylaxis could reduce the risk of maternal intrauterine infection but not of neonatal infection (LE3). Its use after 12hours of rupture in term prelabor rupture of the membranes is therefore recommended (Grade C). When antibiotic prophylaxis is indicated, intravenous beta-lactams are recommended (Grade C). Induction of labor with oxytocin (LE1), prostaglandin E2 (LE1) or misoprostol (LE1), is associated with shorter rupture of membranes to delivery intervals when compared to expectant management. Compared with expectant management, immediate induction of labor is not associated with lower rates of neonatal infection (LE1), even among women with a positive streptococcus B vaginal swab (LE2). Thus, expectant management can be offered without increasing the risk of neonatal infection (Grade B). Induction of labor is not associated with an increase or decrease in the cesarean delivery rate (LE2), whatever parity (LE2) or Bishop score at admission (LE3). Induction can thus be proposed without increasing the risk of cesarean delivery (Grade B). No induction method (oxytocin, dinoprostone, misoprostol or Foley® catheter) has demonstrated superiority over another, whether to reduce rate of intrauterine or neonatal infection, rate of cesarean delivery or to shorten rupture of membranes to delivery intervals regardless of Bishop's score and parity.. Term prelabor rupture of membranes is a frequent event. A 12-hour delay without onset of spontaneous labor was chosen to differentiate a physiological condition from a potentially unsafe situation justifying an antibiotic prophylaxis. Expectant management or induction of labor can both be proposed, even in case of positive screening for streptococcus B, depending on the patient's wishes and maternity units' organization (Professional consensus).

Topics: Antibiotic Prophylaxis; beta-Lactams; Dinoprostone; Female; Fetal Membranes, Premature Rupture; France; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Streptococcal Infections; Streptococcus agalactiae

To assess the studies comparing induction methods in women with term prelabor rupture of the membranes and establish if one is superior to the others.. The MedLine database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.. The included studies compared medical induction methods: oxytocin (intravenous), dinoprostone (vaginal gel, pessary or intracervical gel), and misoprostol (oral or vaginal route); and a mechanical induction method: the Foley catheter. The primary outcome measures were: labor induction to delivery interval, number of women delivered within 12 or 24hours of initiation of induction and cesarean delivery rate. The small sample size of the included studies as well as the limited number of reported complications does not provide a reasonable basis for concluding on the secondary outcome measures: pyrexia, chorioamnionitis, uterine tachysystole, Apgar scores of<7 at 5minutes. Induction of labor with misoprostol (oral and vaginal) reduced the labor induction to delivery interval compared with dinoprostone (LE2). This interval was unchanged when comparing induction with oxytocin and Foley catheter (LE2). The data comparing this interval in women induced with dinoprostone versus oxytocin and misoprostol versus oxytocin is limited or inconsistent. The cesarean delivery rate was comparable in women induced with dinoprostone (vaginal gel) versus oxytocin (LE2), misoprostol (oral and vaginal route) versus oxytocin (LE2), Foley catheter versus oxytocin (LE2), misoprostol versus dinoprostone (LE2) and misoprostol versus Foley catheter (LE2). The number of women delivered within 24hours of initiation of induction was comparable when induced with oral misoprostol versus oxytocin (LE2) and Foley catheter versus oxytocin (LE2). There is a lack of data for this outcome when comparing dinoprostone versus oxytocin, vaginal misoprotsol versus oxytocin, and misoprostol (oral and vaginal) versus dinoprostone. No induction method is superior to another for nulliparous women or women with unfavorable cervix (LE2).. The superiority of an induction method, in terms of effectiveness or safety, could not be established with the current available data for women with term prelabor rupture of the membranes. An increased risk of chorioamnionitis due to induction using Foley catheter could not be ruled out by the available data. All medical methods are suitable for inducing women with term prelabor rupture of the membranes (Grade B).

Topics: Cesarean Section; Delivery, Obstetric; Dinoprostone; Female; Fetal Membranes, Premature Rupture; France; Humans; Labor, Induced; MEDLINE; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Time Factors; Treatment Outcome

To evaluate the use of the intracervical balloon compared with locally applied prostaglandins for cervical ripening for induction in patients with preterm premature rupture of membranes.. Monocentric, retrospective (from 2002 to 2017) observational cohort study of singleton pregnancies complicated by preterm premature rupture of membranes and induced between 34 and 37 weeks. The primary outcome measure was balloon catheter efficiency evaluated by Cesarean section rate. Secondary outcomes were : interval from induction to delivery, labor duration, oxytocin use, intrauterine infection rate, maternal complications (i.e., postpartum hemorrhage and endometritis), and neonatal complications.. 60 patients had cervical ripening with prostaglandins alone and 58 had balloon catheter. Demographic characteristics were similar between the groups, except for induction term and neonatal weight. There was not a significant difference in occurrence of Cesarean section rate (p = 0.14). Nor were there significant differences in time from induction to birth (p = 0.32) or in intrauterine infection rate (p = 0.95). Labor duration was shorter (p = 0.006) and total oxytocin dose lower (p = 0.005) in patients induced by prostaglandins alone. Concerning neonatal outcomes, there were more transfers to intensive care (p = 0.008) and more respiratory distress (p = 0.005) among newborns induced by prostaglandins.. Compared with locally applied prostaglandins, balloon catheter induction is not associated with an increase of Cesarean section rate in patients with preterm premature rupture of membranes.

Topics: Adult; Catheterization; Cervical Ripening; Cesarean Section; Cohort Studies; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins; Reproductive Tract Infections; Retrospective Studies; Uterine Diseases

Topics: Adult; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Hysterectomy; Labor, Induced; Lupus Erythematosus, Systemic; Oxytocin; Placenta Accreta; Prednisolone; Pregnancy; Pregnancy Complications; Sjogren's Syndrome; Uterine Contraction; Uterine Inertia; Uterus

Topics: Cervical Ripening; Female; Fetal Membranes, Premature Rupture; Humans; Oxytocics; Oxytocin; Pregnancy

To identify the ideal gestational age at delivery for preterm premature rupture of membranes and modalities of birth.. To identify studies, research was conducted using Pub-Med, Embase and Cochrane databases.. Prolonged latency duration after pPROM does not worsen neonatal prognosis (NP3). Therefore, it is recommended not to deliver before 34 weeks of gestation for patient with uncomplicated preterm rupture of membranes (pPROM) (Grade C). After 34 weeks of gestation, expectant management for pPROM is not associated with neonatal sepsis (NP1) but is associated to intra-uterine infection (NP2). Early delivery is associated with higher risk of respiratory distress syndrome (NP2), higher risk of cesarean section (NP2) and longer duration of NICU hospitalization (NP2). Before 37 weeks of gestation, expectant management is recommended for uncomplicated pPROM (Grade A), even if vaginal group B streptococcus is positive, as long as antibiotics are used at the time of membranes rupture (Professional consensus). Elective cesarean section is reserved for usual obstetrical indications. Oxytocin and prostaglandins are reasonable options for inducing labor (Professional consensus). Data are too scarce to establish recommendation regarding intra-cervical balloons in case of pPROM (Professional consensus).. Expectant management is recommended for uncomplicated pPROM before 37 weeks of gestation.

Topics: Anti-Bacterial Agents; Cesarean Section; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; France; Gestational Age; Humans; Infant, Newborn; Infections; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications, Infectious; Premature Birth; Prognosis; Prostaglandins; Uterine Diseases

Topics: Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Labor, Obstetric; Oxytocics; Oxytocin; Pregnancy

Data evaluating the accuracy of ICD9-CM codes in identifying inductions are limited. Our objective was to examine the test characteristics of ICD9-CM coding for induction of labor and to identify differences between those captured by coding and those not.. We performed a retrospective cohort study of ICD9-CM codes in identifying charts of induced women at our institution from 2005 to 2009. Review of the medical record was the gold standard. Characteristics of the charts were compared using Mann-Whitney U tests and chi-square tests where appropriate.. A total of 3,263 women were included, 708 with ICD9-CM coding for induction (screen positive). A total of 422 women were randomly sampled from those not coded as induction (screen negative). The sensitivity of ICD9-CM coding for induction was 51.4%, specificity 98.8%, positive predictive value 96.6%, negative predictive value 74.7%. False negative charts (25%) were more likely to be women induced for premature rupture of membranes (40% versus 8%, p < 0.001) or with oxytocin (51% versus 33%, p < 0.001) when compared with screen positive charts.. It is reassuring that 97% of charts coded for induction by ICD9-CM codes are, in fact, patients that were induced. With this degree of accuracy, we can be confident that charts coded as induction are unlikely to be miscoded.

Topics: Adult; Clinical Coding; Female; Fetal Membranes, Premature Rupture; Humans; International Classification of Diseases; Labor, Induced; Oxytocin; Pregnancy; Prognosis; Retrospective Studies; Sensitivity and Specificity; Young Adult

The authors evaluated the effectiveness and safety of "neo-metoro" or 'mini-metoro" metreurynters plus oxytocin for labor induction and assessed differences in parturition outcomes, according to the metreurynter used at induction initiation.. The authors retrospectively reviewed 146 consecutive women with live singleton pregnancies, and who underwent induction. Parturition outcomes were vaginal delivery achieved within the planned schedule (VDPS), vaginal delivery finally achieved (VDF), and induction-to-delivery interval (IDI). Women were divided into neo-metoro, mini-metoro, and without metreurynter groups based on metreurynter use at induction initiation. The authors examined the relationships of metreurynter groups with factors, parturition outcomes, and adverse events. In 113 women who underwent two-day induction, the authors calculated IDI and adjusted odds ratio (AOR) for achieving delivery per unit time.. VDPS rates were 65% in nulliparous and 81% in multiparous women. VDF rates were 78% in nulliparous and 96% in multiparous women. AORs for VDPS were 0.30 in nulliparous women and 0.18 in Bishop score (BS) 1-3 class. AORs for VDF were 0.04 in BS1-3 class and 0.14 in BS4-5 class. In 113 women undergoing two-day induction, AORs for achieving delivery per unit time were 0.45 in nulliparous women, 0.46 in obese women, and 0.48 in BS1-3 class. Neo-metoro use at induction initiation tended to reduce IDI.. Labor induction using these metreurynters plus oxytocin is safe and effective. The advantages of neo-metoro over mini-metoro use at induction initiation remain unclear; neo-metoro use at induction initiation may reduce IDI.

Topics: Administration, Intravaginal; Adult; Catheters; Combined Modality Therapy; Equipment Design; Female; Fetal Membranes, Premature Rupture; Humans; Japan; Labor, Induced; Oxytocics; Oxytocin; Parity; Pregnancy; Pregnancy Outcome; Proportional Hazards Models; Retrospective Studies

To determine the best management for women with premature rupture of membranes at term.. In 2008, 579 women admitted to Peking University First Hospital for premature rupture of membranes (PROM) at term were allocated to one of 3 groups. Group 1 (n=292) consisted of those whose labor began spontaneously within 12 hours of PROM; group 2 (n=234), of those whose labor did not begin within 12 hours of PROM and were induced with oxytocin; and group 3 (n=53), of those who accepted a cesarean delivery immediately after PROM was diagnosed. The χ(2) test was used to compare the rates of intrauterine and neonatal infection in these 3 groups.. Compared with the intrauterine and neonatal infection rates for group 1 (3.4% and 13.7%) and group 3 (1.9% and 3.8%), the corresponding rates were higher for group 2 (10.7% and 21.8%) (P<0.05). In group 2, 76.5% of the women began labor within 24 hours of induction and 92.7% of these within 12 hours.. In women at term, induction should be performed immediately after PROM is diagnosed, as it is likely to fail when labor does not begin within 12 hours of oxytocin administration.

Topics: Adult; Cesarean Section; China; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Middle Aged; Oxytocics; Oxytocin; Pregnancy; Pregnancy Complications, Infectious; Retrospective Studies; Time Factors; Young Adult

Topics: Analgesia, Epidural; Analgesia, Obstetrical; Anesthesia, Inhalation; Anesthetics, Local; Bupivacaine; Charcot-Marie-Tooth Disease; Contraindications; Female; Fentanyl; Fetal Membranes, Premature Rupture; Humans; Neural Conduction; Oxytocin; Pregnancy; Pregnancy Complications

The objective of this study was to examine if patients with "early rupture of membranes (ROM)" after spontaneous onset of labor are at increased risk of cesarean section.. The rate of cesarean section was examined in 447 term singleton nulliparas who were admitted after the spontaneous onset of labor. The cases were divided into 2 groups: (1) "early ROM", defined as ROM at a cervical dilatation <4 cm (n=109); and (2) "late ROM", ROM at a cervical dilatation >or=4 cm (n=338).. (1) "Early ROM" occurred in 24.4% of the cases and the overall cesarean section rate was 5.6%; (2) there were no significant differences in the clinical characteristics including prepregnancy BMI, proportion of complicated pregnancies, total duration of labor, proportion of regional anesthesia, gestational age at delivery, and birthweight between the two groups of cases. However gravidas with "early ROM" were of advanced maternal age and had less cervical dilation on admission, shorter duration of 1st stage of labor, and more frequent use of oxytocin augmentation; (3) patients with "early ROM" had a threefold higher rate (11.9% vs. 3.6%) of cesarean section and a fourfold higher rate (11.9% vs. 3.0%) of cesarean section due to failure of progress than did those with "late ROM" (p<0.005 for each); (3) 92% (23/25) of cesarean sections were performed due to failure to progress; and (4) there was no significant difference in the rate of histologic chorioamnionitis between the two groups of cases.. "Early ROM" after the spontaneous onset of labor is a risk factor for cesarean section in term singleton nulliparas.

Topics: Adult; Cesarean Section; Cohort Studies; Female; Fetal Membranes, Premature Rupture; Humans; Labor Onset; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Republic of Korea; Retrospective Studies; Risk Factors

Women with pre-labour rupture of membranes at term (Term-PROM) commonly choose to have early induction of labour with the use of oxytocin. Although there is evidence of efficacy and safety of induction by the use of prostaglandin, it is used infrequently in Australia.. To identify current practice and views of obstetricians in Australia, on Term-PROM.. A postal survey among all obstetricians in Australia in April 2009. Fellows no longer practising obstetrics or who were non-practising were asked to return the survey without completing it.. Of the 1319 surveys posted, 720 (54.6%) were returned, 23.8% of whom were practising only gynaecology or non-practising, leaving 548 respondents practising obstetrics (41.5%). The most common management of Term-PROM is induction of labour (IOL) within 24 h at the next convenient opportunity (75%). More than 96% would use intravenous oxytocin at some stage as their method of induction. Prostaglandin gel (PGE₂) was utilised by 15% of respondents regularly, mainly for ripening of an unfavourable cervix in a primigravida, but nearly 40% would consider the use of PGE₂ indicating that it would produce a more 'natural' labour, that women could ambulate more and that there would be reduced impact on midwifery staff. For those who would not consider PGE₂, the most common reasons were concerns of hyperstimulation, increased infection rate and precautions of use based on product information..   Oxytocin is the most widely used induction agent for women with term-PROM. PGE₂ is an important alternative method of induction and nearly 40% would consider using it. Clarification from RANZCOG and further studies on whether PGE₂ offers a safe and effective option are now required.

Topics: Australia; Data Collection; Female; Fetal Membranes, Premature Rupture; Health Knowledge, Attitudes, Practice; Humans; Labor, Induced; Obstetrics; Oxytocics; Oxytocin; Practice Guidelines as Topic; Practice Patterns, Physicians'; Pregnancy; Prostaglandins; Surveys and Questionnaires

Spontaneous pre-labour rupture of membranes (SPROM) at term is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality, particularly because it is associated with a latency period from membrane rupture to delivery.. To compare the outcome of labour in women who had immediate induction of labour, with those who had delayed induction following SPROM at term.. A prospective case control study of 200 women who had either immediate induction of labour with intravaginal misoprostol tablets, or delayed induction with intravenous oxytocin infusion after an expectant period of 12 hours, at Aminu Kano Teaching Hospital, Kano, Nigeria. The outcome of labour was compared in the two groups using the Z test and Chi square test, while, p-value of less than 0.05 was taken as significant. The odds ratio (OR) and 95% confidence interval were also determined where appropriate.. Immediate induction of labour with intravaginal misoprotol resulted in lower rates of caesarean section and operative vaginal delivery, with a higher rate of spontaneous vaginal delivery. The duration of latent phase of labour and hospital stay before delivery was statistically significantly shorter in the immediate induction group. Neonatal and maternal morbidity were insignificant and comparable between the two groups.. Immediate induction of labour with intravaginal misoprotol resulted in significantly lower rates of intervention without compromising fetomaternal outcome. We recommend the immediate induction of labour with proper use of intravaginal misoprotol in women with SPROM at term.

Topics: Administration, Intravaginal; Adolescent; Adult; Case-Control Studies; Cervical Ripening; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; Hospitals, Teaching; Humans; Labor, Induced; Length of Stay; Misoprostol; Nigeria; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Prospective Studies; Rupture, Spontaneous; Time Factors; Young Adult

Topics: Adult; Cesarean Section; Complementary Therapies; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infection Control; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Risk Factors; Time Factors

Retrospective study of 744 women at the Virgen del Camino Hospital in Pamplona concerning two variants for the active treatment of premature rupture of the membranes (PROM). The main purpose of the study was to assess the differences between two variants for the active treatment of PROM at term in pregnant women with negative vaginal-rectal culture screening for Group B Streptococci, and a Bishop test of 4 or less on admission.. Retrospective study of 744 patients with single pregnancy at term, PROM, and Bishop test <4. The patients, who were not randomised, were treated with dinoprostone (Propess) or expectant therapy, according to the physician's choice. Induction with oxytocin was started 12 h after PROM. Qualitative data were analysed using the chi(2) test, while quantitative data were analysed using the Student's t-test or the Mann-Whitney U-test according to the distribution of the variables. Regression models were applied to correct the biases caused by confounding variables.. Of the 744 patients, the cervix of 13% was maturated with pericervical dinoprostone, while 87% were subject to expectant management until 12 h after rupture of the membranes. The time of dilation and the time until labour were significantly shorter in the dinoprostone group (p=0.0). The rate of caesarean sections was also lower in the dinoprostone group at 9.3% compared to 17.6% in the expectant management group, reaching statistical significance (p=0.04). There were no differences in the parameters of fetal well being (Apgar and pH).. The use of therapy with dinoprostone in patients with PROM could be a safe method and more effective than expectant management.

Topics: Administration, Intravaginal; Adult; Anti-Bacterial Agents; Cesarean Section; Delayed-Action Preparations; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Fever; Humans; Labor Stage, First; Labor, Induced; Linear Models; Oxytocics; Oxytocin; Parity; Pregnancy; Retrospective Studies; Time Factors

A failed induction usually refers to failure to progress to the active phase of labour; however, there is no consensus regarding when an induction has failed.. To investigate the factors (particularly length of latent phase) that may influence mode of birth for women undergoing Syntocinon induction of labour.. A retrospective analysis of 978 nulliparous women undergoing Syntocinon induction of labour following artificial or spontaneous rupture of membranes was performed.. As the length of the latent phase increased, the likelihood of birth by caesarean section increased significantly (P < 0.001). After ten hours of Syntocinon administration, the 8% of women not in the active phase of labour had approximately a 75% chance of being delivered by emergency caesarean section and after 12 h the chance was almost 90%. Multivariate analysis also suggested an association between birth by caesarean section and use of prostaglandin gel (P < 0.001) or mechanical methods of cervical priming (P = 0.004), maternal height < 155 cm (P = 0.020) and cervical dilation prior to commencement of Syntocinon (P = 0.018).. It would seem reasonable to continue a Syntocinon infusion for at least ten hours in women undergoing induction who have yet to reach the active phase of labour ( 4 cm), and unclear benefit in continuing an induction beyond 12 h. The duration of latent phase is a helpful predictor of subsequent mode of birth.

Topics: Cervical Ripening; Female; Fetal Membranes, Premature Rupture; Humans; Labor Stage, First; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Time Factors; Treatment Failure

Topics: Administration, Oral; Confounding Factors, Epidemiologic; Female; Fetal Membranes, Premature Rupture; Humans; Injections, Intravenous; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy

Topics: Bias; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy

To evaluate the effect of early amniotomy in term gestation on the mode of delivery and pregnancy outcome in comparison with premature rupture of membranes (PROM) and oxytocin induction.. The study population consisted of 60 consecutive parturients induced by early amniotomy. The two comparison groups were 147 women admitted with term PROM and 65 patients induced by oxytocin. All study participants were evaluated prospectively and had unfavorable cervical scores.. The duration of the first stage of labor was significantly longer in the PROM group (987.8 +/- 572.3 min) as compared with the early amniotomy group (615.0 +/- 389.6 min) and the oxytocin induction group (650.9 +/- 349.5 min, P<0.001). Higher rates of CS were found in the study group (26.7%) as compared to the controls (11.6% in the PROM and 16.9% in the oxytocin groups, p=0.012). Neonatal outcome was similar in all groups. A stratified analysis comparing the risk of CS while controlling for a previous one did not show a significant difference between the early amniotomy and the oxytocin administration groups.. Early amniotomy is associated with a higher rate of CS. While controlling for a previous CS, both ways of induction were comparable. In order to decrease the CS rates, induction should probably start with cervical ripening techniques in order to improve the Bishop scores.

Topics: Adult; Amnion; Cesarean Section; Delivery, Obstetric; Diabetes, Gestational; Female; Fetal Membranes, Premature Rupture; Fetal Monitoring; Fetal Movement; Gestational Age; Heart Rate, Fetal; Humans; Hypertension; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Prospective Studies

The aim of this case control study was to evaluate the thus far controversially discussed influence of acupuncture (AP) on the duration of labor. Fifty-seven women with AP treatment (group A) were included in our study after spontaneous vaginal full-term delivery. The control group included 63 women (group B). Median duration of the first stage of labor was 196 min in group A and 321 min in group B (Wilcoxon 2-sample test, p < 0.0001). Median duration of the second stage of labor was 57 min in group A and 57 min in group B (Wilcoxon 2-sample test, p = 0.82). Thirty women had a premature rupture of the membranes (PROM), in group A 66.7% and in group B 33.3% (chi2 test, p = 0.02). Women without AP (group B) received significantly more often oxytocin during the first stage of labor compared with group A women (85 and 15%, respectively, chi2 test, p = 0.01) as well as during the second stage of labor (72 and 28%, respectively, chi2 test, p = 0.03). Our study suggests that AP treatment is a recommendable form of childbirth preparation due to its positive effect on the duration of labor, namely by shortening the first stage of labor.

Topics: Acupuncture Analgesia; Chi-Square Distribution; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; Humans; Labor Stage, First; Labor Stage, Second; Labor, Obstetric; Oxytocin; Pregnancy; Statistics, Nonparametric; Time Factors

Topics: Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Meta-Analysis as Topic; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Reproducibility of Results

To test an effective method of terminating second-trimester pregnancy with ruptured membranes in women who fail to abort from an oxytocin infusion.. Five patients with rupture of membranes during the second trimester of pregnancy and failed to abort using the traditional method of intravenous oxytocin infusion were treated with intrauterine instillation of prostaglandin E2 (PGE2) solution through a double-balloon device.. All five patients aborted within 8.8 +/- 4.5 hours from the beginning of PGE2 instillation. No major complications occurred. The only side effect was short-duration pyrexia (less than 48 hours).. Use of the double-balloon device and intrauterine instillation of PGE2 was effective for termination of pregnancy in patients with rupture of membranes who do not respond to oxytocin.

Topics: Abortifacient Agents; Abortion, Induced; Adult; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Treatment Failure; Uterus

Topics: Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome

Topics: Arteriosclerosis; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infant, Premature; Obstetric Labor, Premature; Oxytocin; Placenta; Pregnancy; Pregnancy Complications, Infectious; Vascular Diseases

Topics: Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome

To compare 12-hour and 72-hour expectant management of premature rupture of membranes (PROM) in singleton term pregnancies.. In a prospective, nonrandomized study, 566 low-risk women with singleton term pregnancies presenting with PROM were assigned to either 12-hour or 72-hour expectant management. Patients who had not entered labor at the end of the assigned period were induced with oxytocin. The pregnancy outcome of both methods was compared with regard to infectious complications and method of delivery.. There was no statistical difference in the rate of chorioamnionitis between the 12-hour and 72-hour expectant management groups (11.7 versus 12.7%; relative risk [RR] 0.9, 95% confidence interval [CI] 0.6-1.5; P = .83). Cesareans were performed to a similar degree in both groups (4.7 versus 6.7%; RR 0.7, 95% CI 0.3-1.4; P = .39). Fifty-five percent of the 12-hour group underwent oxytocin induction, compared with 17.5% of those in the 72-hour group (RR 5.8, 95% CI 3.9-8.5; P < .001). Women undergoing induction after 72-hour expectant management had an increased risk of cesarean delivery compared with those after a 12-hour wait (RR 5.9, 95% CI 2.3-15.1; P < .001). Overall, women in the 12-hour group had shorter admission-to-discharge times than the 72-hour group (5 versus 6 days, 95% CI of the difference 0.6-1.3; P < .01).. Regimens of 12-hour and 72-hour expectant management of PROM are comparable regarding infectious complications and pregnancy outcome. However, the longer wait prolongs the interval to delivery and increases hospitalization costs.

Topics: Adolescent; Adult; Cesarean Section; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Length of Stay; Oxytocin; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Prospective Studies; Time Factors

Topics: Cesarean Section; Female; Fetal Membranes, Premature Rupture; Humans; Incidence; Oxytocin; Pregnancy; Prostaglandins; Risk Factors

Topics: Administration, Intravaginal; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Vacuum Extraction, Obstetrical

Rupture of membranes at term, whether spontaneous or artificial, causes rapid and sustained increase in prostaglandin F2 alpha (PGF2 alpha) metabolite (PGFM) levels and is associated with augmentation of uterine contractions. To investigate why premature rupture of membranes (PROM) often fails to initiate uterine contractions, we measured plasma concentrations of PGFM and oxytocin (OT) in patients with PROM near term. Serial blood samples were taken before and after PROM as well as before and after local PGE2 gel application for cervical ripening. For comparison, patients with similar criteria with intact membranes were also studied, as were patients in spontaneous labor at term with and without spontaneous rupture of membranes. PROM was always associated with an initial, marked increase in plasma PGFM. Whether or not this increased PGF2 alpha production was maintained was related to the cervical status at the time of PROM. In patients with unripe cervix PGFM levels returned to initial levels within 2 hours and no contractions were elicited; when the cervix was 3 cm or more dilated, PGFM levels remained high and contractions began within 1 to 3 hours. PROM had no significant effect on plasma OT levels. When PGE2 gel was applied to ripen the cervix, PGFM levels increased moderately within 30 minutes in all patients regardless of the status of the membranes. In patients with intact membranes the concentration of PGFM in plasma declined to initial levels within 4 hours, whereas in patients with PROM, PGFM levels remained increased throughout the study period.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Cervix Uteri; Dinoprost; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor Onset; Labor, Obstetric; Oxytocin; Pregnancy; Uterine Contraction

Premature rupture of the membranes was diagnosed in a 27-year-old nullipara at 24 weeks' gestation. Medical induction of abortion (because of sepsis) was attempted and failed. The products of conception were removed surgically per vagina; that procedure was followed by an intractable hemorrhage. Subtotal hysterectomy and repair of the left common iliac artery and vein were performed to stop the bleeding. In retrospect the case was diagnosed as a left ligamentary ectopic pregnancy with uterine rupture and erosion of the left common iliac vessels.. A case report of a ligamentary ectopic pregnancy that failed to respond to prostaglandin E2 for induced abortion for sepsis at 24 weeks is presented. The 27-year-old nullipara had normal ultrasound findings for gestational age up to 21 weeks gestation. She had consulted at 5 weeks for abdominal pain and bleeding, at 14 weeks again for abdominal pain, shoulder pain and vaginal bleeding, although both times the pain and bleeding resolved spontaneously. She was seen again at 16 and 21 weeks gestation, when ultrasound scans were normal for dates. At 24 weeks, she experienced vaginal discharge of blood and tissue, and was managed as premature rupture of membranes. She became septic 12 days later. She was treated with transcervical PGE2 and iv oxytocin without response for 3 days. Surgical evacuation was successful, but bleeding persisted. During laparotomy she had a large left broad ligament hematoma, a left ruptured uterus, and open left internal iliac artery and vein. These were repaired, and she received 40 units of blood, 8 platelets and 14 of plasma. Only after histology was the diagnosis of ligamentary pregnancy made. The lack of response to PG for abortion should raise suspicion of ectopic pregnancy, although preoperative diagnosis of ligamentary pregnancy is extremely rare.

Topics: Abortion, Therapeutic; Adult; Female; Fetal Membranes, Premature Rupture; Humans; Oxytocin; Pregnancy; Pregnancy, Ectopic; Prostaglandins E

Topics: Female; Fetal Membranes, Premature Rupture; Humans; Injections, Intravenous; Labor, Induced; Oxytocin; Pregnancy

The obstetric outcome in women with premature rupture of the membranes (PROM) at term (greater than 36 weeks gestation) without spontaneous onset of labor (within 2 h after admission) was evaluated prospectively in a joint study at the University Hospital of Lund, Sweden and Kandang Kerbau Hospital, National University of Singapore. After 2 h of observation without uterine contractions, labor was stimulated with oxytocin infusion. 303 patients participated and were classified according to parity (nulliparae-multiparae) and cervical dilatation at admission (less than 2 cm dilated; greater than or equal to 2 cm dilated). No significant race-related differences could be found, except for birthweight. Nulliparae with unfavorable cervix at admission had a high rate of ominous fetal heart rate findings in labor and a high cesarean section rate (19.4%), particularly for failed stimulation of labor. The high cesarean section rate after routine stimulation of labor in nulliparae with unfavorable cervix suggests that a non-intervention approach may be justified in this group. In contrast, the cesarean section rate after stimulation of labor was 3.6% in nulliparae with the cervix dilated 2 cm or more at admission and 4.2% in multiparae and ominous fetal heart rate changes were much less common.

Topics: Adult; Apgar Score; Cervix Uteri; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Heart Rate, Fetal; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Parity; Pregnancy; Prognosis; Prospective Studies; Uterine Contraction

The authors describe 4 cases of falsely recorded fetal heart rate pattern due to technical failure. Interaction of a fetal monitor and an infusion pump may lead to a 'false' fetal heart rate tracing, suggesting fetal compromise and masking the actual cardiac activity. The limits of indirect fetal monitoring are stressed.

Topics: Adult; Diagnostic Errors; Female; Fetal Heart; Fetal Membranes, Premature Rupture; Fetal Monitoring; Heart Rate; Humans; Infusions, Parenteral; Labor, Induced; Oxytocin; Pre-Eclampsia; Pregnancy

Premature rupture (= PR) of the amnion is a serious complication even for the mature child if it occurs earlier than 24 hours before birth. To keep the interval as short as possible, the authors induce labour from week 35/0 in case of PR, provided the Bishop score is greater than 7. If the bishop score is lower, they conduct intracervical priming of the cervix with 0.4 mg PGE2 gel before induction of labour. This has proved clinically superior to intravenous procedures. In the study presented here, the authors attempted to find out whether intracervical administration of PGE2 gel would result in changes in the maternal and foetal plasma concentrations of oxytocin, PGFM, or PGEM when comparing conditions in case of ruptured amnion with those if the amnion remained intact. If the amnion is intact and the cervix immature (less than 2 cm), intracervical administration of 0.4 mg PGE2 gel produces a significant OT increase within 30 minutes. From a cervical width of 2 cm onwards, the OT levels are already primarily enhanced and will hardly change even after PGE2 gel administration. Similar conditions obtain in PR. PGFM plasma levels will rise only slightly within an hour after intracervical PGE2 gel administration, independent of whether there has been a rupture or not, or whether the cervix is dilated less than 2 cm or 2 cm and more.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Topical; Cervix Uteri; Dinoprost; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Maternal-Fetal Exchange; Oxytocin; Pregnancy; Prostaglandins E; Prostaglandins F

The plasma concentrations of oxytocin and 13,14-dihydro-15-keto-prostaglandin F2 alpha (PGFM) were measured in serial samples collected during the first stage of spontaneous and oxytocin-induced labor in 17 and 15 women, respectively. Four women in late pregnancy served as control subjects, with serial samples collected at similar intervals as during labor. During spontaneous labor, mean plasma oxytocin levels were consistently raised over the levels observed 1 to 2 weeks before the onset of labor and were higher than the levels in the control patients (mean, 19.9 +/- 3.1 pg/ml) and the initial levels in the oxytocin-induced group of women (mean, 17.4 +/- 4.8 pg/ml). The mean plasma oxytocin levels during spontaneous labor (45 +/- 3.9 pg/ml) were similar to those observed during infusion of 4 to 6 mU/min of synthetic oxytocin (49.1 +/- 10.9 pg/ml). Plasma oxytocin levels increased progressively with stepwise increments of the infusion. Plasma PGFM levels also rose during labor, but, in contrast to the oxytocin levels which increased in early labor, plasma PGFM levels did not increase significantly until relatively late in labor, provided the membranes were intact. The state of the membranes had a marked influence on plasma PGFM; patients with spontaneous rupture of membranes had significantly increased PGFM levels when admitted early in labor or when membranes ruptured during labor. This increase in prostaglandin F2 alpha (PGF2 alpha) production does not by itself suffice to initiate labor, as evidenced by the failure of premature rupture of the membranes to initiate labor in a number of patients with elevated PGFM levels in whom labor was then induced with oxytocin. Conversely, oxytocin induction was successful only when PGFM levels increased during the infusion of oxytocin; in the absence of a rise in plasma PGFM, oxytocin induction failed. These data add support to the view that both oxytocin and PGF2 alpha are required for adequate stimulation of the human uterus during labor. In addition, the data suggest that oxytocin rather than PGF2 alpha may be the major stimulus that initiates labor, whereas PGF2 alpha appears responsible for the progress of labor.

Topics: Cervix Uteri; Dinoprost; Extraembryonic Membranes; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Parenteral; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Prostaglandins F; Time Factors

Topics: Cervix Uteri; Drug Evaluation; Female; Fetal Membranes, Premature Rupture; Humans; Hyaluronoglucosaminidase; Infusions, Parenteral; Labor, Induced; Oxytocin; Pregnancy

Topics: Aspirin; Bed Rest; Betamethasone; Estrogens; Ethanol; Female; Fetal Membranes, Premature Rupture; Glucocorticoids; Humans; Hydroxyprogesterones; Indomethacin; Infant, Low Birth Weight; Infant, Newborn; Isoxsuprine; Magnesium Sulfate; Obstetric Labor, Premature; Oxytocin; Pregnancy; Progesterone; Prostaglandins; Respiratory Distress Syndrome, Newborn

Two groups of healthy women at term, who were not in labor 3 hours after premature rupture of the membranes, were studied. In one group labor induction with oral prostaglandin E2 (PGE2) was begun 3 hours after rupture, and in the other group intravenous oxytocin induction was begun 12 hours after rupture. PGE2 was successful in initiating active labor in 88% of women treated. Of the women who were observed for 12 hours, one-half began labor spontaneously during that time. Women in whom labor was induced with PGE2 given 3 hours after rupture of the membranes had a shorter interval of rupture to delivery, a lower cesarean section rate, and shorter postpartum hospitalization. Although significant bradycardia did not occur in fetuses of those women given PGE2, 10% of infants whose mothers were receiving oxytocin were delivered by cesarean section for this reason. It is concluded that oral PGE2 is safe and effective for induction of labor in women with premature membrane rupture. The benefits, to both mother and fetus, of a shorter latent period are discussed.

Topics: Adult; Extraembryonic Membranes; Female; Fetal Death; Fetal Heart; Fetal Membranes, Premature Rupture; Heart Rate; Humans; Labor, Induced; Labor, Obstetric; Maternal Mortality; Monitoring, Physiologic; Oxytocin; Pregnancy; Prostaglandins E; Puerperal Infection; Time Factors

Topics: Adrenergic beta-Antagonists; Amnion; Female; Fetal Diseases; Fetal Membranes, Premature Rupture; Humans; Oxytocin; Parasympatholytics; Pregnancy; Uterine Contraction

Chorioamnionitis is an inflammatory reaction occurring in the fetal membranes of the placenta. It is usually associated with premature rupture of the membranes, whether spontaneous or artificial. Rupture of the fetal membranes sets off a time bomb that threatens both maternal and fetal welfare. The seriousness of this threat is dependent upon several variables: the length of gestation, economic status of the patient and the duration of the rupture. There is a controversy about the relative importance of these variables and about the proper degree of aggressiveness necessary to achieve optimum fetal salvage. When chorioamnionitis occurs, most obstetricians agree that the uterus should be evacuated by the most expeditious route. Usually oxytocic induction will accomplish delivery without difficulty, but should it fail to effect cervical ripening and dilatation within a reasonable time, cesarean section should be performed without further delay. If cesarean section is necessary in the presence of gross infection, hysterectomy is advocated by some.

Topics: Abortion, Therapeutic; Amnion; Chorion; Extraembryonic Membranes; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Inflammation; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications; Sepsis

Authors report about 504 oxytocin infusions after amniotomy or spontaneous rupture of membranes without possibility of cardiotokography. The rate of success by a 12-hour-limit is 91,9 per cent, by a 24-hour-limit 95,2 per cent. It was observed a superior rate of obstetric operations, post-partum haemorrhages and 3 cases of uterus rupture following hypersensitivity. Intravenous oxytocin infusion reduced the time of delivery. After combinating induction of labour childrens have an acceptable general condition, recorded by Apgar-score. Simultaneous induction of labour by oxytocin infusion is a high-risk proceeding in obstetric hospitals without possibility of cardiotokography. However, a renunciation of this method in default of alternatives is not accept.

Topics: Female; Fetal Heart; Fetal Membranes, Premature Rupture; Hospitals, Community; Humans; Infusions, Parenteral; Labor, Induced; Oxytocin; Pregnancy