摘要:

The efficacy and safety of different oral doses of PGE2in tablet form were evaluated in 30 women admitted to the hospital for labor induction at or near term. The aim was to select a recommendable dose schedule based on recording of uterine contractility, clinical outcome and measurement of the resulting plasma levels of the two prostaglandin metabolites 15‐keto‐13.14‐dihydro‐PGE, and 15‐keto‐13,14‐dihydro‐PGF, by gas‐chromatography‐mass spectrometry and by radio‐immunoassay.Measurements of uterine contractility and of plasma levels of the PGE2metabolite both showed that the preferable interval between oral doses of PGE2tablets is one hour. Following 1.0 mg PGE2, the plasma concentration peaked after 45 to 60 minutes and had returned to approximately pretreatment levels after 120 minutes. With a two‐hour interval between doses there was above all a decreased frequency of contractions in the last part of the interval. No such variation in the contractility pattern was seen when 1.0 mg PGE2was administered every hour. When the individual dose was increased to 2.0 mg, signs of overstimulation of uterine contractility were observed. The plasma concentration of the E2metabolite increased in accordance with the oral dose.A slow rise in the plasma concentrations of the E2and F2αmetabolites was found some hours following initiation of treatment, possibly indicating an increased endogenous prostaglandin biosynthesis, probably secondary to the stimulat

ISSN:0001-6349    

DOI:10.3109/00016348009156932

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

The efficacy and safety of oral PGE2or intravenous infusion of oxytocin, in both cases combined with early amniotomy, for induction of labor on medical grounds, were compared in a randomized study of 200 women. After an initial dose of 0.5 mg, 1.0 mg of PGE2was given at hourly intervals for up to 24 hours. Oxytocin was administered as an intravenous pump infusion, the dose being increased step wise up to 20 mIU/min. The two methods were equally effective. All patients went into labor and were delivered within approximately 24 hours. Of the total of 200 patients included in the study, 92 per cent were delivered vaginally and 8 per cent with Caesarean section. In 26 per cent the delivery was completed by vacuum extraction. The frequency of instrumental delivery was significantly lower in multiparous than in primiparous patients. If the patient was a multiparous woman and the modified Bishop score was 6 or more, the combined frequency of Caesarean section and instrumental delivery was for PGE22.5 per cent and for oxytocin 3.1 per cent.No difference was found in the health status of neonates following labor induction with PGE2and oxytocin respectively.At the end of the 24‐hour observation period five patients were still in labor. These patients were delivered either by vacuum extraction (three patients) or by Caesarean section (two patients).The duration of labor was slightly longer (mean 1.1 hour) following oral PGE2than following intravenous infusion of oxytocin, mainly due to a prolongation of stage I.The type of delivery following oral PGE2or intravenous infusion of oxytocin in combination with early amniotomy was compared with that following spontaneous labor and following labor induction by oxytocin alone. The frequency of Caesarean section was the same but the frequency of instrumental delivery was lower in the former two groups of patients. The difference could at least partly be explained by a higher frequency of patients who obtained epidural analgesia in the randomized trial. Oral PGE2or intravenous infusion of oxytocin combined with early amniotomy was obviously more effective than oxytocin alone for labor induction. With oxytocin alone, two days of infusion was required in 53.8 per cent and four or more days in 2.4 per cent of the patients.It may be concluded that oral PGE2therapy combined with amniotomy is a valuable alternative to intravenous infusion of oxytocin for labor induction at or near term. The method is generally well accepted by the patient. The main advantage is the ease and simplicity of the treatment. Complications are rare, particularly in multiparous patients with good prospects of inducibilit

ISSN:0001-6349    

DOI:10.3109/00016348009156933

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

Labor was induced for medical reasons at or near term in altogether 200 patients. The women were randomly assigned to low amniotomy and either oral PGE2or intravenous infusion of oxytocin. The initial PGE2dose was 0.5 mg, followed by 1.0 mg every hour for up to 24 hours. Oxytocin was given as an intravenous pump infusion, starting with 5 mIU/min and rising stepwise to 20 mIU/min. Uterine contractility and fetal heart rate (FHR) were recorded by cardiotocography in 61 women receiving oxytocin and in 63 given prostaglandin E2. A detailed analysis of the contractility pattern was performed in 16 women, eight from each group.Labor was established slightly earlier in the oxytocin group than in the prostaglandin group of patients. When in labor, frequency and amplitude of contractions as well as uterine contractility were the same in both treatment groups. The frequency of atypical contractility patterns was higher in labor induced with PGE2than with oxytocin. One period of hypertonus was observed in one patient treated with PGE2but it was not associated with alterations in FHR and disappeared without additional therapy. Both mild and more severe variations in FHR occurred but were equally common in both treatment groups. There was no perinatal mortality among the newborns and the Apgar score 5 minutes after delivery was 8 or more.

ISSN:0001-6349    

DOI:10.3109/00016348009156934

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

The hormonal changes in maternal serum during parturition induced by amniotomy and oxytocin (OXY) infusion or oral prostaglandin E2(PGE), medication have been compared in 68 patients (33 women in the PGE2group, 35 in the oxytocin group). The effect of PGE2differed from that of oxytocin. Thus the prostaglandin elicited increases in total estriol (p<0.001) and decreases in prolactin (p<0.01), TSH (p<0.05) and HPL (p<0.05) from the basal level to that immediately before parturition. Maternal serum cortisol levels rose to the same extent in both treatment groups (p<0.001). The significant (p<0.05) increase occurred earlier among women receiving PGE2(two hours into therapy), even though labor pain was experienced later in this group. The serum estriol elevation in these patients was significant three hours after start of therapy (p<0.05). A similar time course was noted for the decrease of serum prolactin in PGE2treated patients. The drop in maternal serum levels of HPL and TSH in the PGE2group was significant only immediately prior to partus. Neither PGE2nor oxytocin induced changes in maternal serum levels of HCG or a‐fetoprotein or estradiol. Oxytocin but not PGE2lead to a decrease in maternal serum progesterone concentrations; this was significant (p<0.05 ‐ p<0.01) only late in labor. Mixed umbilical serum levels of the hormones mentioned above were the same regardless of method of induction. Hence the increased maternal estriol concentrations during PGE2treatment were not reflected in fetal blood. It is suggested that increases in maternal estriol levels during PGE2medication are due to effects on the maternal enterohepatic circulation rather than on the fetoplacental unit. Irrespective of maternal treatment, umbilical serum from female newborns contained statistically higher (p<0.05) levels of estradiol and HCG than serum from male child

ISSN:0001-6349    

DOI:10.3109/00016348009156935

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY