Induction of labour in grandmultipara by intracervical prostaglandin E tablets

This is a prospective controlled study in which planned induction of labour was carried out in 100 grand multiparous patients between 37-43 week gestation by intracervical application of PGE tablets [induction group]. Another 100 grandmultiparous patients who went into spontaneous labour were considered as controls [control group] to determine the safety and efficacy of PGE2 tablets and to compare labour characteristics and its outcome. In the induction group, labor was successfully induced in 98 patients [98%], of whom 96% delivered vaginally. The mean duration of active labour was 2.5 + 0.63 hr. In the induction group compared to 4.6 + 1.8 hr. in the controls. The mean duration of the second and third stages were shorter in the induction group. The incidence of operative and instrumental deliveries was significantly less frequent among induction group patients [3.1% and 2.0%] respectively compared to 7.0% and 8.0% in control group patients. Similarly, they needed less oxytocin augmentation for their labour. No case of uterine rupture was reported in the study. There was no difference in fetal outcome between both groups. It is concluded that PGE intracervical tablet is a safe and effective for planned induction of labor in grandmultiparous patients

Intrapartum fetal heart rate patterns: correlation with apgar score and umbilical cord blood pH and gases in preterm labour

A prospective study of 106 preterm pregnancies [28-36 weeks gestational age] were admitted in active labor to the Labor Ward of Northern Area Armed Forces Hospital, KSA, during 15-month period starting March 1992. Continuos intrapartum fetal heart rate [FHR] records were analyzed and statistically compared to neonatal outcome as reflected by Apgar scores and umbilical cord blood pH and gases. Abnormal intrapartum fetal heart patterns were reported in 42 cases and correlated well with low 5-minutes Apgar scores and neonatal blood acidosis [cord blood pH < 7.25]. In this group, neonatal resuscitation and endotracheal intubations were significantly higher compared to cases with normal FHR patterns. Moreover, the cesarean section rate was significnatly higher compared to cases with normal FHR patterns. In the abnormal FHR group, there was no significant difference in the cord blood pH values between cases of vaginal and abdominal deliveries. Normal FHR patterns were associated with a good outcome as regard neonatal acidosis and Apgar scores. In conclusion, a normal intrapartum FHR patterns predicts a good fetal tolerance to the stress of preterm labor. With abnormal FHR patterns, neonatal asphyxia and low Apgar scores would be expected and prompt obstetric intervention is required including all measures necessary for neonatal resuscitation