Comparison of the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter in term nulliparous women with borderline oligohydramnios / 中华医学杂志(英文版)

BACKGROUNDS@#At present, there is no consensus on the induction methods in term pregnancy with borderline oligohydramnios. This study aimed to compare the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter (SBC) in term nulliparous women with borderline oligohydramnios.@*METHODS@#We conducted a retrospective cohort study from January 2016 to November 2018. During the study period, a total of 244 cases were enrolled. Of these, 103 cases were selected for induction using dinoprostone and 141 cases were selected for induction with SBC. The pregnancy outcomes between the two groups were compared. Primary outcomes were successful vaginal delivery rates. Secondary outcomes were maternal and neonatal adverse events. Multivariate logistic regression was used to assess the risk factors for vaginal delivery failure in the two groups.@*RESULTS@#The successful vaginal delivery rates were similar between the dinoprostone group and the SBC group (64.1% [66/103] vs. 59.6%, [84/141] P = 0.475), even after adjustment for potential confounding factors (adjusted odds ratio [aOR]: 1.07, 95% confidence interval [CI]: 0.57-2.00, P = 0.835). The incidence of intra-amniotic infection was lower in the dinoprostone group than in the SBC group (1.9% [2/103] vs. 7.8%, [11/141] P < 0.001), but the presence of non-reassuring fetal heart rate was higher in the dinoprostone group than in the SBC group (12.6% [13/103] vs. 0.7%, [1/141] P < 0.001). Multivariate logistic regression showed that nuchal cord was a risk factor for vaginal delivery failure after induction with dinoprostone (aOR: 6.71, 95% CI: 1.96-22.95). There were three factors related to vaginal delivery failure after induction with SBC, namely gestational age (aOR: 1.51, 95% CI: 1.07-2.14), body mass index (BMI) >30 kg/m2 (aOR: 2.98, 95% CI: 1.10-8.02), and fetal weight >3500 g (aOR: 2.49, 95% CI: 1.12-5.50).@*CONCLUSIONS@#Term nulliparous women with borderline oligohydramnios have similar successful vaginal delivery rates after induction with dinoprostone or SBC, with their advantages and disadvantages. In women with nuchal cord, the risk of vaginal delivery failure is increased if dinoprostone is used in the induction of labor. BMI >30 kg/m2, large gestational age, and estimated fetal weight >3500 g are risk factors for vaginal delivery failure after induction with SBC.

Efecto oxitócico del decocto de la flor sagrada de los incas (Cantua buxifolia) sobre útero aislado de rata estrogenizada / Oxytocic effect of the deck of the sacred flower of the incas (Cantua buxifolia) on the isolated uterus of a strogenized rat

Objetivo. El objetivo de este estudio fue investigar el efecto del decocto de la flor sagrada de los incas (Cantua buxifolia) sobre útero aislado de rata estrogenizada. Materiales y métodos. La planta entera fue utilizada para preparar el decocto, obteniendo concentraciones finales 4 mg/mL. Se utilizaron seis ratas hembras procedentes del Instituto Nacional de Salud; posteriormente, se les estrogenizó con valerato de estradiol (solución 0,3%) durante tres días previos al experimento. Luego se sacrificaron mediante dislocamiento cervical y se aislaron los segmentos uterinos de las ratas; finalmente, se fijó en los baños de órgano aislado, determinándose la amplitud, frecuencia de contracción y actividad uterina en los grupos problema (Cantua buxifolia) y oxitocina. Resultados. El decocto de Cantua buxifolia 4 mg/mL evidenció incremento de la amplitud, frecuencia de la contracción y actividad uterina similar a oxitocina en concentración de 2X10-5 UI, (p=0,829; p=1,00 y p=0,762, respectivamente). Conclusión. El decocto de Cantua buxifolia tiene efecto oxitócico en útero aislado de rata estrogenizada.

Objective. The objective of this study was to investigate the effect of the decoct of the sacred flower of the Incas (Cantua buxifolia) on the isolated uterus of estrogenized rats. Materials and methods. The whole plant was used to prepare the decoct, obtaining final concentrations of 4 mg/mL. Six female rats from the National Institute of Health were used, subsequently they were estrogenized with estradiol valerate (0.3% solution) for three days prior to the experiment. Then, they were sacrificed by cervical dislocation and the uterine segments of the rats were isolated, finally it was fixed in the isolated organ baths, determining the amplitude, frequency of contraction and uterine activity in the problem groups (Cantua buxifolia) and oxytocin. Results. The decoct of Cantua buxifolia 4 mg/mL showed an increase in amplitude, frequency of contraction and uterine activity similar to oxytocin at a concentration of 2X10-5 IU, (p = 0.829; p = 1.00 and p = 0.762, respectively). Conclusion. Cantua buxifolia decoct has an oxytocic effect in the isolated uterus of estrogenized rats.

Use of misoprostol in the treatment of postpartum hemorrhage: a pharmacoepidemiological approach / Uso do misoprostol no tratamento da hemorragia pós-parto: uma abordagem farmacoepidemiológica

ABSTRACT Objective To characterize the use of the drug misoprostol for treatment of postpartum hemorrhage in pregnant women. Methods A descriptive observational study was carried out with secondary data from pregnant women who used misoprostol to treat postpartum hemorrhage in a reference public maternity, from July 2015 to June 2017. Clinical and sociodemographic profiles of pregnant women, how misoprostol was used and success rate in controling postpartum hemorrhage were characterized. Results A total of 717 prescriptions of misoprostol were identified. Of these, 10% were for treatment of postpartum hemorrhage. The majority of pregnant women were young adults, married, with complete high school education, white, residing in urban areas, multiparous (68.1%) and 25% had previous cesarean sections. The mean gestational age was 39 weeks and 51.4% had a cesarean section. There was prophylactic use of oxytocin in 47.2% of women. Treatment of postpartum hemorrhage was successful in 84.7% of women. Of these, 79.2% also used oxytocin and 54.2% methylergonovine. Only 13.5% of pregnant women had less than five prenatal visits, and the main cause of postpartum hemorrhage was uterine atony. There were 13 complications after hemorrhage, 15.3% required blood transfusion and there was one case of maternal death. Conclusion Misoprostol showed to be effective and safe for treating postpartum hemorrhage.

RESUMO Objetivo Caracterizar o uso do medicamento misoprostol para o tratamento da hemorragia pós-parto em gestantes. Métodos Estudo observacional descritivo realizado por meio de dados secundários de gestantes que fizeram uso do misoprostol para tratamento da hemorragia pós-parto em maternidade pública de referência, no período de julho de 2015 a junho de 2017. Caracterizaram-se os perfis clínico e sociodemográfico das gestantes, o padrão de utilização do misoprostol e sua taxa de sucesso no controle da hemorragia pós-parto. Resultados Foram identificadas 717 prescrições do misoprostol. Destas, 10% foram para tratamento da hemorragia pós-parto. Predominaram gestantes adultas jovens, casadas, com Ensino Médio completo, raça branca, da região urbana, multíparas (68,1%) e 25% apresentavam cesáreas prévias. A idade gestacional média foi 39 semanas e 51,4% das gestantes tiveram parto cesárea. Houve uso profilático de ocitocina em 47,2% das mulheres. O tratamento da hemorragia pós-parto eve sucesso em 84,7% das gestantes que usaram misoprostol. Destas, 79,2% também usaram ocitocina e 54,2% metilergometrina. Apenas 13,5% das gestantes tiveram menos de cinco consultas de pré-natal, e a principal causa da hemorragia pós-parto foi atonia uterina. Foram registrados 13 casos de complicações após a hemorragia, 15,3% necessitaram de hemotransfusão e houve um caso de óbito materno. Conclusão O misoprostol demonstrou ser efetivo e seguro para o tratamento da hemorragia pós-parto.

Guía de práctica clínica para el uso de uterotónicos en la prevención de la hemorragia posparto / Clinical practice guide for the use of uterotonics in postpartum hemorrhage prevention

Objetivo: Proveer recomendaciones para mejorar la calidad del cuidado y desenlaces para mujeres que reciben atención del parto, en relación a la prevención de la hemorragia posparto (HPP) por atonía uterina en El Salvador. Métodos: La presente guía fue desarrollada siguiendo los lineamientos del Manual para la elaboración de guías de la Organización Mundial de la Salud1. De forma general, se creó un grupo para la elaboración con enfoque multidisciplinario compuesto por expertos sobre el tema, epidemiólogos, metodólogos y pacientes. Con base en la evidencia proveniente de la guía para el uso de uterotónicos para la prevención de hemorragia posparto, se desarrolló una adaptación para el contexto del sistema de salud de El Salvador2. Se realizó inclusión de evidencia local y la contextualización de sus recomendaciones. Las recomendaciones fueron graduadas en un panel de expertos conformado por profesionales en estadística, enfermería, materno infantil, médicos generales y especialistas en ginecología y obstetricia, perinatología, anestesiología, medicina familiar, economía de la salud, epidemiología, además se incluyó la participación de pacientes siguiendo el enfoque GRADE. Adicionalmente, la guía fue evaluada por pares temáticos y metodológicos. Todos los participantes del panel y del grupo desarrollador firmaron un formato de conflicto de intereses que analizaron los coordinadores de la guía.

Exploring obstetrical interventions and stratified cesarean section rates using the Robson classification in tertiary Care hospitals in the united arab emirates

Abstract Objective The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system. Methods Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE). Results The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson's classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS.The rate of vaginal birth after cesarean was 261(6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section. Conclusion The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.

Tecnologias de cuidado para prevenção e controle da hemorragia no terceiro estágio do parto: revisão sistemática / Care technologies to prevent and control hemorrhage in the third stage of labor: a systematic review / Tecnologías de cuidado para prevención y control de la hemorragia en la tercera etapa del parto: revisión sistemática

Objetivo identificar evidências acerca das contribuições das tecnologias de cuidado usadas para prevenção e controle da hemorragia no terceiro estágio do parto. Método revisão sistemática com busca em bases de dados. Dois investigadores selecionaram os textos de forma independente na primeira etapa e, na segunda, em reunião de conciliação. Para avaliação da concordância, aplicou-se o coeficiente Kappa; para avaliação do risco de viés e classificação dos níveis de evidência, adotou-se o Grading of Recommendations, Assessment, Development and Evaluation. Resultados incluíram-se 42 artigos; desses, 34 classificados como tecnologias de produto, sendo a maioria produtos farmacológicos; dois referentes ao uso do saco plástico transparente para a coleta de sangue e contribuição do intervalo de nascimento e dos cuidados pré-natais. Os oito artigos classificados como tecnologias de processo se referiam a manejo ativo do terceiro estágio do parto, tração controlada de cordão, massagem uterina e intervenções educacionais. Conclusão as tecnologias de produto e de processo apresentaram evidência alta e moderada confirmada em 61,90% dos artigos. Os níveis de evidência demonstram contribuições das tecnologias para prevenção e controle da hemorragia. Na prática clínica, o enfermeiro deve oferecer cuidados à mulher fundamentados em evidências científicas e construir protocolos sobre as ações de cuidado da enfermagem.

Objective to identify evidence concerning the contribution of health technologies used to prevent and control hemorrhaging in the third stage of labor. Method systematic review with database searches. First, two researchers independently selected the papers and, at a second point in time, held a reconciliation meeting. The Kappa coefficient was used to assess agreement, while the Grading of Recommendations, Assessment, Development and Evaluation was adopted to assess risk of bias and classify level of evidence. Results in this review, 42 papers were included, 34 of which addressed product technologies, most referred to pharmacological products, while two papers addressed the use of blood transparent plastic bags collector and the contribution of birth spacing and prenatal care. The eight papers addressing process technologies included the active management of the third stage of labor, controlled cord traction, uterine massage, and educational interventions. Conclusion product and process technologies presented high and moderate evidence confirmed in 61.90% of the papers. The levels of evidence confirm the contribution of technologies to prevent and control hemorrhaging. Clinical nurses should provide scientific-based care and develop protocols addressing nursing care actions.

Objetivo identificar las evidencias acerca de las contribuciones de las tecnologías de cuidado usadas para la prevención y el control de la hemorragia en la tercera etapa del parto. Método revisión sistemática con búsqueda en bases de datos. Dos investigadores seleccionaron los textos, de forma independiente, en la primera etapa; y, en la segunda en reunión de conciliación. Para evaluación de la concordancia fue aplicado el coeficiente Kappa; para evaluación del riesgo de sesgo y clasificación de los niveles de evidencia, se adoptó el Grading of Recommendations, Assessment, Development and Evaluation. Resultados fueron incluidos 42 artículos; de estos, 34 fueron clasificados como: tecnologías de producto (siendo la mayoría productos farmacológicos), dos referentes a la contribución del saco plástico transparente recolector de sangre y del intervalo de nacimiento y de los cuidados prenatales. Los ocho artículos clasificados como tecnologías de proceso se referían al manejo activo de la tercera etapa del parto, a la tracción controlada del cordón, al masaje uterino y a intervenciones educacionales. Conclusión las tecnologías de producto y de proceso presentaron evidencia alta y moderada, lo que fue confirmado en 61,90% de los artículos. Los niveles de evidencia demuestran las contribuciones de las tecnologías para la prevención y el control de la hemorragia. En la práctica clínica, el enfermero debe ofrecer cuidados a la mujer fundamentados en evidencias científicas y construir protocolos sobre las acciones de cuidado de la enfermería.

The effect of oxytocin on fear responses: bidirectional regulation or methodological issues? / 生理学报

One of the core symptoms in anxiety disorders is dysregulated fear response. It is crucial for psychologists and neuroscientists to understand how fear responses are enhanced and inhibited. Although oxytocin (OXT) was initially conceived as a prosocial molecule and mammalian neuropeptide that enhances cooperation and trust, later studies showed that it produces modulatory influence on fear responses. Therefore, OXT is now regarded as a promising pharmacological agent to boost treatment response in anxiety disorders. However, the effect of OXT on fear responses have been somewhat complex, and there are some contradictions among animal experiments and human studies. In this article, we summarize recent studies that employed animal models, brain region-specific manipulations and preclinical studies to explore the role of OXT in the acquisition and processing of fear response. We also discuss the methodological differences among these studies and review the potential factors that may contribute to the complicated effect of OXT on fear response. This review will help to promote the potential clinical application of OXT.

Ocitocina sintética e a aceleração do parto: reflexões sobre a síntese e o início do uso da ocitocina em obstetrícia no Brasil / Synthetic oxytocin and hastening labor: reflections on the synthesis and early use of oxytocin in Brazilian obstetrics

Resumo O artigo reflete sobre o processo de medicalização do parto, tendo como foco específico o desenvolvimento da ocitocina sintética em 1953. Investiga a vida social da ocitocina, isto é, sua sintetização, estabilização e uso em obstetrícia para acelerar o trabalho de parto. Por meio do levantamento em dois periódicos brasileiros de obstetrícia da época, é analisado o início do uso da ocitocina sintética no Brasil, a partir do final da década de 1950, e os argumentos dos obstetras acerca da recomendação ou não desse uso. É observada, nesse período, a centralidade cada vez maior do obstetra no parto, bem como a recomendação do uso encadeado de diferentes intervenções - com destaque para a ocitocina - visando menor tempo de trabalho de parto.

Abstract This article reflects on the medicalization of childbirth, focusing on the development of synthetic oxytocin in 1953. Specifically addressed is the social life of oxytocin; in other words, its synthesis, stabilization, and use in obstetrics to hasten labor. Two Brazilian obstetrics journals of this era were surveyed to analyze the early use of synthetic oxytocin in Brazil in the late 1950s, along with obstetric arguments for or against its use. Notable in this period is the increasingly central role of the obstetrician in childbirth, as well as the recommendation to use different interventions linked together (particularly oxytocin) to shorten labor.

Efecto de la oxitocina en los niveles de malondialdehído, óxido nítrico y proteína s100b en el recién nacido / Effect of oxytocin on the levels of malondialdehyde, nitric oxide, and s100b protein in newborns

RESUMEN Objetivos. Evaluar los efectos de la administración de oxitocina en la conducción del parto en los niveles de malondialdehído (MDA), óxido nítrico (ON) y proteína S100B en el recién nacido. Material y Métodos. Se seleccionó a 80 gestantes a término sin patología obstétrica y fetal, formando dos grupos: Gestantes con parto normal y conducidas con oxitocina. Se extrajo sangre inmediatamente después del parto de la vena de cordón umbilical para medir MDA, ON y de la arteria para la proteína S100B. Se cuantificó la concentración de MDA y ON por métodos espectroscópicos y la proteína S100B por ELISA. Resultados. Se tuvo valores de 3,4 uMol/L y 3,6 uMol/L de MDA y 1,4 uMol/Ly 1,8 uMol/L de ON en el grupo conducido con oxitocina y control respectivamente sin diferencia significativa, los niveles de S100B fueron mayores en el grupo conducido con oxitocina, con una mediana de 1,36 μg/L comparado con el grupo de parto normal 1,11 μg/L (p=0,03). No hubo relación entre la dosis de oxitocina administrada y los niveles de MDA, ON y S100B. Conclusiones. No hay diferencia entre los niveles de MDA y ON entre las gestantes con parto normal y conducidas. Hay diferencia significativa en los niveles de proteína S100B en recién nacidos de parto con oxitocina. No hay relación entre la dosis de oxitocina y los niveles de estrés oxidativo y proteína S100B.

ABSTRACT Objectives. To assess the effects of the administration of oxytocin during labor management on the levels of malondialdehyde (MDA), nitric oxide (NO), and S100B protein in newborns. Materials and Methods. We selected 80 term pregnant women without obstetric and fetal pathology, forming two groups: pregnant women with normal delivery and pregnant women conducted with oxytocin. Blood was collected immediately after delivery from the umbilical cord vein to measure MDA, ON and from the artery for protein S100B. The concentration of MDA and ON was quantified by spectroscopic methods and the protein S100B by ELISA. Results. Values of 3.4 uMol/L and 3.6 uMol/L of MDA and 1.4 uMol/L and 1.8 uMol/L of NO were obtained in the oxytocin and control group, respectively, without significant difference; S100B levels were higher in the oxytocin managed group, with a median of 1.36 μg/L compared to the normal delivery group 1.11 μg/L (p=0.03). There was no relationship between the dose of oxytocin administered and the levels of MDA, ON, and S100B. Conclusions. There is no difference between MDA and NO levels between pregnant women undergoing a normal or managed birth. There is a significant difference in S100B protein levels in newborns born via an oxytocin-managed delivery. There is no relationship between oxytocin dose and levels of oxidative stress and S100B protein

Cost-effectiveness of carbetocin versus oxytocin for prevention of postpartum hemorrhage resulting from uterine atony in women at high-risk for bleeding in Colombia / Rendimento da carbetocina versus oxitocina para a prevenção da hemorragia pós-parto resultante da atonia uterina em mulheres com alto risco de sangramento na Colômbia

Abstract Objective To assess the cost-effectiveness of carbetocin versus oxytocin for prevention of postpartum hemorrhage (PPH) due to uterine atony after vaginal delivery/ cesarean section in women with risk factors for bleeding. Methods A decision treewas developed for vaginal delivery andanother one for cesarean, in which a sequential analysis of the results was obtained with the use of carbetocin and oxytocin for prevention of PPH and related consequences. A third-party payer perspective was used; only directmedical costs were considered. Incremental costs and effectiveness in terms of quality-adjusted life years (QALYs) were evaluated for a one-year timehorizon. The costs were expressed in 2016 Colombian pesos (1 USD = 3,051 Col$). Results In the vaginal delivery model, the average cost of care for a patient receiving prophylaxis with uterotonic agents was Col$ 347,750 with carbetocin and Col$ 262,491 with oxytocin,while theQALYs were 0.9980 and 0.9979, respectively. The incremental costeffectiveness ratio is above the cost-effectiveness threshold adopted by Colombia. In the model developed for cesarean section, the average cost of a patient receiving prophylaxis with uterotonics was Col$ 461,750 with carbetocin, and Col$ 481,866 with oxytocin, and the QALYs were 0.9959 and 0.9926, respectively. Carbetocin has lower cost and is more effective, with a saving of Col$ 94,887 per avoided hemorrhagic event. Conclusion In case of elective cesarean delivery, carbetocin is a dominant alternative in the prevention of PPH compared with oxytocin; however, it presents higher costs than oxytocin, with similar effectiveness, in cases of vaginal delivery.

Resumo Objetivo Avaliar a relação custo-eficácia da carbetocina versus oxitocina para prevenção de hemorragia pós-parto (HPP) vaginal e cesariana devido à atonia uterina em mulheres com fatores de risco para desenvolver sangramento. Métodos Foram desenvolvidos protocolos de manejo para parto vaginal e outra para parto por cesárea e analisados resultados obtidos com carbetocina e oxitocina na prevenção de HPP, assim como, consequências relacionadas à ocorrência do evento hemorrágico. A perspectiva utilizada foi a do terceiro pagador, portanto, apenas os custos médicos diretos foram levados em consideração. Os custos incrementais e a eficácia em termos de anos de vida ajustados pela qualidade (QALY) foram avaliados para um horizonte de tempo de um ano. Os custos foram expressos em pesos colombianos de 2016 (1 USD = 3.051 Col$). Resultados No modelo de parto vaginal, o customédio de cuidados para um paciente que recebeu profilaxia com agentes uterotônicos foi de Col$ 347.750 com carbetocina e Col$ 262.491 com oxitocina, enquanto os QALYs foram 0,9980 e 0,9979, respectivamente. O índice incremental de custo-efetividade está acima do limite de custoefetividade adotado pela Colômbia. No modelo desenvolvido para parto por cesárea, o custo médio do paciente que recebeu profilaxia com terapia uterotônica foi de Col$ 461.750 com carbetocina e Col$ 481.866 com oxitocina e os QALYs foram 0,9959 e 0,9926, respectivamente. A carbetocina foi a alternativa com menor custo e maior efetividade com uma economia de $94.887 por evento hemorrágico evitado. Conclusão A carbetocina no parto eletivo por cesárea é uma alternativa dominante na prevenção da PPH em relação à oxitocina; porém representa custos mais altos com uma eficácia similar à da oxitocina no caso de parto vaginal.

El Balón de Bakri como herramienta en el manejo de la hemorragia post parto / THE BAKRI´S BALLOON AS AN IMPORTANT TOOL FOR THE MANAGEMENT OF POST PARTUM HEMORRHAGE

Introducción La hemorragia post parto es una de las complicaciones más graves del puerperio y una de las principales causas de mortalidad materna a nivel mundial. Dentro del esquema del manejo de la misma se encuentra el uso del balón de Bakri para evitar la histerectomía post parto. Objetivo: presentar la experiencia en la utilización del Balón de Bakri en un trabajo colaborativo entre los Servicios de Obstetricia del Hospital Nacional Posadas y de la Madre y el Niño de Formosa Capital entre enero de 2015 a junio de 2016. Método: Estudio transversal y descriptivo que incluyó a 25 pacientes con hemorragia post parto sin respuesta al tratamiento con Ocitócicos y que requirieron colocación del Balón de Bakri. Resultados: El balón de Bakri fue aplicado a 25 mujeres con hemorragia refractaria. La mediana de insuflación del Balón de Bakri fue de 300 (240/ 600 mL). La hemostasia se consiguió en 23 (92 %) de estas mujeres. Dos mujeres debieron ser histerectomizadas por continuar sangrando luego de la colocación del balón. Conclusión: El balón de Bakri es una herramienta eficaz para el manejo de la hemorragia post parto refractaria a carbetocina, evitando la histerectomía en el 92% de los casos.

Postpartum hemorrhage is one of the most serious complications of puerperium and one of the leading causes of maternal mortality worldwide. Within the framework of the management of it is the use of Bakri balloon to prevent puerperal hysterectomy. The aim of this study is to present the experience in the use of Bakri balloon in a collaborative work between the Obstetrics Departments of the Posadas National Hospital and the Madre y el Niño Hospital of Formosa Capital, Argentina, from January 2015 to June 2016. Methods: Cross-sectional descriptive study that included 25 patients with postpartum bleeding with uterine atony refractory to treatment with uterotonics and required Bakri balloon placement. Results: The Bakri ballon was applied to 25 women with refractory bleeding Oxytocics after vaginal delivery. The median Bakri balloon inflation was 300 (240/600 mL). Hemostasis was achieved in 23 (92%) of these women. Two women (8%) had to be undergone hysterectomy for bleeding continue after placement of the ball. Conclusion: The Bakri balloon is an effective tool for the management of post partum hemorrhage refractory to Carbetocin avoiding hysterectomy in 92% of cases.

Can the Induction of Labor with Misoprostol Increase Maternal Blood Loss? / Pode a indução do parto com misoprostol aumentar a perda de sangue materna?

Abstract Purpose To evaluate blood loss during misoprostol-induced vaginal births and during cesarean sections after attempted misoprostol induction. Methods We conducted a prospective observational study in 101 pregnant women indicated for labor induction; pre- and postpartum hemoglobin levels were measured to estimate blood loss during delivery. Labor was induced by administering 25 μg vaginal misoprostol every 6 hours (with a maximum of 6 doses). The control group included 30 patients who spontaneously entered labor, and 30 patients who underwent elective cesarean section. Pre- and postpartum hemoglobin levels were evaluated using the analysis of variance for repeated measurements, showing the effects of time (pre- and postpartum) and of the group (with and withoutmisoprostol administration). Results Therewere significant differences between pre- and postpartum hemoglobin levels (p < 0.0001) with regard to misoprostol-induced vaginal deliveries (1.6 ± 1.4 mg/dL), non-induced vaginal deliveries (1.4 ± 1.0 mg/dL), cesarean sections after attempted misoprostol induction (1.5 ± 1.0 mg/dL), and elective cesarean deliveries (1.8 ± 1.1 mg/dL). However, the differences were proportional between the groups with and without misoprostol administration, for both cesarean (p = 0.6845) and vaginal deliveries (p = 0.2694). Conclusions Labor induction using misoprostol did not affect blood loss during delivery.

Resumo Objetivo Avaliar a perda sanguínea em partos vaginais induzidos com misoprostol, e em cesáreas com tentativa prévia de indução do parto com misoprostol. Métodos Realizou-se estudo prospectivo observacional com 101 gestantes com indicação para indução do trabalho de parto, as quais foram avaliadas pela dosagem de hemoglobina pré e pós-parto para estimativa da perda sanguínea no parto. Procedeu-se à indução do trabalho de parto com misoprostol 25 μg, via vaginal, a cada 6 horas, em um número máximo de 6 doses. O grupo controle foi composto por 30 pacientes que entraram emtrabalho de parto espontaneamente, e por 30 pacientes que se submeteram a cesárea eletiva. O estudo da hemoglobina, antes e depois do parto, foi avaliado por ANOVA paramedidas repetidas, no qual foi verificado o efeito do tempo (pré e pós-parto) e o efeito do grupo (com e sem uso do misoprostol). Resultados Existem diferenças significativas entre os níveis de hemoglobina pré e pós-parto (p < 0,0001) nos partos vaginais induzidos pelo misoprostol (1,6 ± 1,4 mg/ dL), nos partos vaginais não induzidos (1,4 ± 1,0 mg/dL), nas cesáreas com tentativa prévia de indução (1,5 ± 1,0mg/dL), e nas cesáreas eletivas (1,8 ± 1,1mg/dL). Porém, as diferenças foram proporcionais em ambos os grupos, ou seja, ocorreu diferença tanto no grupo que fez uso do misoprostol quanto no grupo que não fez uso do medicamento, tanto na cesárea (p = 0,6845) quanto no parto vaginal (p = 0,2694). Conclusões A indução do parto com misoprostol não alterou a perda sanguínea durante o parto.

Complicaciones en el trabajo de parto por la ingesta de infusión oxitócica en gestantes del centro de Salud de Huando de enero a junio, 2016 / Complications in labor for the intake of oxytocic infusion in pregnant women from the Huando Health Center from January to June, 2016

Objetivo: Determinar las complicaciones que se presentan durante el trabajo de parto debido a la ingesta de infusiones oxitócicas en gestantes atendidas en el Centro de Salud de Huando de enero a junio, 2016. Métodos y Materiales: Para esta investigación se utilizó la investigación sustantiva con enfoque cuali-cuantitativa y nivel descriptivo, el cual permitió determinar las complicaciones que se presentan durante el trabajo de parto por la ingesta de infusiones oxitócicas en gestantes atendidas en el Centro de Salud de Huando de enero a junio, 2016. La población estuvo constituida por 95, de ellas se seleccionaron mediante los criterios de inclusión; resultando solo 46 gestantes como muestra. La técnica utilizada fue la entrevista y su instrumento fue el cuestionario de entrevista "INFOX" que constituida de 18 preguntas estructuradas acerca de infusión oxitócica, como segunda técnica se utilizó el análisis documentario y se empleó el instrumento guía de análisis documentario el cual nos permitió recolectar los datos mediante la revisión de historias clínicas con la finalidad de identificar las complicaciones en el trabajo de parto de aquellas gestantes que refirieron haber ingerido la infusión oxitócica. Resultados: Son datos recopilados en el distrito de Huando mediante el cuestionario de entrevista que se realizó a las gestantes que fueron atendidas de enero a junio en el Centro de Salud de Huando y la revisión de historias clínicas de las que refirieron haber ingerido infusión oxitócica, dando como resultado, el 58.7% presentaron alguna complicación en el trabajo de parto, la mayoría que refirió haber ingerido se encontraban entre 16 a 20 años de edad (34.8%), seguido de 21 a 25, de 26 a 30, de 31 a 35 años de edad (17.4%) y solo fueron pocas que tenían de 36 a 45 y de 31 a 35 años de edad (6.5%). Entre las complicaciones maternas que se presentaron fueron ruptura prematura de membranas (37%), parto precipitado (21.7%), y en las complicaciones perinatales se presentó sufrimiento fetal agudo (17.4%), síndrome de aspiración meconial (6.5%) y distrés respiratorio (10%). El tipo de infusiones que se ingiere comúnmente por la población son la congona (47.8%), ruda (17.4%), canela (13%), orejano (8.7%) y entre otras combinaciones (13%), de las cuales la congona fue la infusión más consumida y el que fue más preferido por la usuarias. Conclusiones: La ingesta de infusión oxitócica se relaciona al tipo de complicación en el trabajo de parto tanto en la madre como en la del bebe, entre las complicaciones maternas que se encontraron por la infusión oxitócica fueron ruptura prematura de membranas (37%) y parto precipitado (21.7%), y las complicaciones perinatales fueron sufrimiento fetal agudo (17.4%), síndrome de aspiración meconial (6.5%) y distrés respiratorio (101%). El tipo de infusión oxitócica más consumida fue la congona (47.8%) y el 21.7% produjo complicaciones en el trabajo de parto. La utilización de infusiones oxitócicas debe ser permitida por parte del personal de salud, si bien entre las composiciones químicas de las plantas medicinales hay sustancias que puedan mejorar las contracciones uterinas sin alterar el bienestar fetal para así poder brindarles una atención con calidad, humanizada e intercultural poniendo en uso las prácticas tradicionales, así como también hay sustancias tóxicas que puedan alteran la fisiología normal del trabajo de parto ocasionando complicaciones materno perinatales más aún si se ingirieron en altas cantidades y repetidas veces, ante ello se debe supervisar estrictamente el progreso del parto evaluando e identificando precozmente cualquier cambio desfavorable en la salud materna perinatal.

Labor stimulation with oxytocin: effects on obstetrical and neonatal outcomes / Estimulação do parto com oxitocina: efeitos nos resultados obstétricos e neonatais / Estimulación del parto con oxitocina: efectos en los resultados obstétricos y neonatales

Abstract Objective: to evaluate the effects of labor stimulation with oxytocin on maternal and neonatal outcomes. Method: descriptive and analytical study with 338 women who gave birth at a tertiary hospital. Obstetric and neonatal variables were measured and compared in women submitted and non-submitted to stimulation with oxytocin. Statistics were performed using Chi-square test, Fisher exact test, Student t-test; and crude Odds Ratio with 95% confidence interval were calculated. A p < 0.05 was considered statistically significant. Results: stimulation with oxytocin increases the rates of cesarean sections, epidural anesthesia and intrapartum maternal fever in primiparous and multiparous women. It has also been associated with low pH values of umbilical cord blood and with a shorter duration of the first stage of labor in primiparous women. However, it did not affect the rates of 3rd and 4th degree perineal lacerations, episiotomies, advanced neonatal resuscitation, 5-minute Apgar scores and meconium. Conclusion: stimulation with oxytocin should not be used systematically, but only in specific cases. These findings provide further evidence to health professionals and midwives on the use of oxytocin during labor. Under normal conditions, women should be informed of the possible effects of labor stimulation with oxytocin.

Resumo Objetivo: avaliar os efeitos da estimulação do parto com oxitocina nos resultados maternos e neonatais. Método: estudo descritivo e analítico, com 338 mulheres que deram à luz em um hospital de nível terciário. Variáveis obstétricas e neonatais foram medidas e comparadas em mulheres com e sem estimulação com oxitocina. Estatísticas foram feitas utilizando-se o teste Qui-quadrado, teste exato de Fisher e o teste t-Student; e as Odds Ratio brutas com intervalo de confiança de 95% foram calculadas. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: a estimulação com oxitocina aumentou as taxas de cesarianas, anestesia peridural, febre materna intraparto em primíparas e multíparas. Ela também foi associada com baixos valores de pH do cordão umbilical e com uma menor duração da primeira fase do parto em primíparas. No entanto, ela não afetou as taxas de laceração perineal de terceiro e quarto graus, a episiotomia, a reanimação neonatal avançada, o teste de Apgar de 5 minutos e o mecônio. Conclusão: a estimulação com oxitocina não deveria ser utilizada de maneira sistemática, mas apenas em casos muito específicos. Estes resultados fornecem evidências adicionais aos profissionais de saúde e às parteiras sobre o uso de oxitocina durante o parto. Em condições normais, as mulheres deveriam ser informadas sobre os possíveis efeitos da estimulação com oxitocina.

Resumen Objetivo: valorar los efectos de la estimulación del parto con oxitocina en los resultados maternos y neonatales. Método: estudio descriptivo y analítico con 338 mujeres que parieron en un hospital de tercer nivel. Variables obstétricas y neonatales fueron medidas y comparadas en mujeres con y sin estimulación con oxitocina. Estadísticos Chi-cuadrado, test exacto de Fisher, test t-Student, Odd Ratio cruda y un intervalo de confianza del 95% fueron calculados. Un valor p < 0,05 se consideró estadísticamente significativo. Resultados: la estimulación con oxitocina incrementó el ratio de cesáreas, analgesia epidural, fiebre materna intraparto en primíparas y multíparas; también se relacionó con bajos valores de pH de cordón umbilical, y menor duración de la primera fase del parto en primíparas. Sin embargo no afectó la tasa de desgarros de 3-4 grado, episiotomías, reanimación neonatal avanzada, test de Apgar a los 5 minutos o meconio. Conclusión: la estimulación con oxitocina no debería emplearse de forma sistemática, sino solo en casos muy indicados. Estos hallazgos proporcionan mayor evidencia a los profesionales y matronas a cerca del uso de oxitocina durante el parto. En condiciones normales, las mujeres deberían estar informadas de los posibles efectos de la estimulación con oxitocina.

Abdominal alterations in disseminated paracoccidioidomycosis: computed tomography findings / Alterações abdominais da paracoccidioidomicose disseminada: achados por tomografia computadorizada

Objective: To evaluate the incidence and spectrum of abdominal computed tomography imaging findings in patients with paracoccidioidomycosis. Materials and Methods: Retrospective analysis of abdominal computed tomography images of 26 patients with disseminated paracoccidioidomycosis. Results: Abnormal abdominal tomographic findings were observed in 18 patients (69.2%), while no significant finding was observed in the other 8 (30.8%) patients. Conclusion: Computed tomography has demonstrated to play a relevant role in the screening and detection of abdominal abnormalities in patients with disseminated paracoccidioidomycosis. .

Objetivo: Avaliar a frequência e variedade de achados de imagem por exames de tomografia computadorizada de abdome em indivíduos com paracoccidioidomicose disseminada. Materiais e Métodos: Estudo retrospectivo dos exames de tomografia computadorizada de abdome de 26 pacientes com paracoccidioidomicose disseminada. Resultados: Foram encontradas alterações tomográficas abdominais em 18 pacientes (69,2%) dos casos analisados e 8 pacientes (30,8%) apresentaram exames normais. Conclusão: A tomografia computadorizada de abdome mostrou grande importância no rastreamento e identificação de alterações abdominais nos pacientes com paracoccidioidomicose disseminada. .

Clinical management of the induction of labor in intrauterine fetal death: evaluation of incidence of cesarean section and related conditions / Manejo clínico na indução de parto de feto morto: avaliação da incidência e condições associadas à cesariana

OBJECTIVE: To assess the incidence and conditions associated with cesarean section in a cohort of pregnant women with intrauterine fetal death (IUFD), and clinical management to anticipate the childbirth. METHODS: It was a retrospective cohort study with 163 mothers with IUFD, at the second half of pregnancy, who were managed to anticipate childbirth using pharmacological preparations and/or a mechanical method (Foley catheter) in a teaching hospital in Rio de Janeiro State, Brazil. Cox regression was used to evaluate the effect of the clinical methods on the kind of delivery. RESULTS: The Subgroups A (misoprostol or Oxytocin), B (misoprostol and Oxytocin), and C (Foley catheter alone or combined with misoprostol and/or Oxytocin) were formed according to the applied methods. Nine out of 163 cases ended with cesarean section. The incidence of cesarean section was 3.5 per 1,000 people-hours, meaning that a pregnant woman with IUFD had a 15.6% risk of cesarean section during the first 48 hours of clinical management to anticipate childbirth. The conditions significantly associated with the mode of delivery were placental abruption (HR: 44.97), having two or more previous cesarean deliveries (HR: 10.03), and mechanical method with Foley catheter (HR: 5.01). CONCLUSION: Cesarean section was an essential conduct in this cohort and followed previous cesarean delivery and placental abruption. The effect of the mechanical method on the abdominal route suggests that the Foley catheter method was used in the most difficult cases and that the surgery was performed to ensure maternal health. .

OBJETIVO: Verificar a incidência e as condições associadas à cesariana em coorte de gestantes com feto morto e manejo clínico para antecipar o parto. MÉTODOS: Estudo de coorte retrospectivo com 163 mães de feto morto intraútero, na segunda metade da gestação, que tiveram manejo clínico para antecipar o parto com administração de medicamentos e/ou por método mecânico com cateter de Foley, em um hospital escola do Estado do Rio de Janeiro, Brasil. A regressão de Cox foi empregada para avaliar o efeito entre os métodos clínicos e o modo de parto. RESULTADOS: Os subgrupos A (misoprostol ou ocitocina), B (misoprostol e ocitocina) e C (cateter de Foley isolado ou combinado com misoprostol e/ou ocitocina) foram formados de acordo com os métodos administrados. Nove dos 163 casos terminaram em cesariana. A incidência de cesariana foi de 3,5 por 1000 pessoas-hora, significando que uma gestante com óbito fetal teve um risco de 15,6% de parto por cesárea durante as primeiras 48 horas de manejo clínico para antecipar o parto. As condições significativamente associadas ao modo de parto foram duas ou mais cesáreas prévias (HR: 10,03), descolamento da placenta durante a indução (HR: 44,97) e o método mecânico com cateter de Foley (HR: 5,01). CONCLUSÃO: Os fatores associados ao parto por cesárea foram a cesárea prévia e a ocorrência de descolamento da placenta. O efeito do método mecânico sugere que ele foi usado nos casos mais difíceis e a cirurgia foi realizada para assegurar a saúde materna. .

In vivo and in vitro anti-inflammatory activity of Cryptostegia grandiflora Roxb. ex R. Br. leaves

BACKGROUND: Despite Cryptostegia grandiflora Roxb. ex R. Br. (Apocynaceae) leaves are widely used in folk Caribbean Colombian medicine for their anti-inflammatory effects, there are no studies that support this traditional use. Therefore, this work aimed to evaluate the effect of the total extract and primary fractions obtained from Cryptostegia grandiflora leaves, using in vivo and in vitromodels of inflammation, and further get new insights on the mechanisms involved in this activity. RESULTS: Ethanolic extract of Cryptostegia grandiflora leaves, and its corresponding ether and dichloromethane fractions, significantly reduced inflammation and myeloperoxidase activity (MPO) in ear tissue of mice treated with 12-O-tetradecanoyl-phorbol-13-acetate (TPA). Histological analysis revealed a reduction of edema and leukocyte infiltration. Complementarily, we demonstrated that extract and fractions reduced nitric oxide (NO•) and prostaglandin E2 (PGE2) production in LPS-stimulated RAW 264.7 macrophages, as well as scavenging activity on DPPH and ABTS radicals. CONCLUSIONS: Our results demonstrated for the first time the anti-inflammatory activity of Cryptostegia grandiflora leaves, supporting its traditional use. This activity was related to inhibition of MPO activity, and PGE2 and NO• production. These mechanisms and its antioxidant activity could contribute, at least in part, to the anti-inflammatory effect showed by this plant.

Violencia obstétrica: percepción de las usuarias / Obstetric violence: perceptions of users

OBJETIVO: Evaluar la percepción de las usuarias sobre la atención recibida en relación con prácticas consideradas como violencia obstétrica. MÉTODOS: Estudio prospectivo, descriptivo, exploratorio, de corte transversal por medio de una encuesta anónima a 425 puérperas atendidas en la Maternidad “Concepción Palacios” entre mayo y agosto de 2011, sobre aspectos relativos a violencia obstétrica. RESULTADOS: El 66,8 % manifestó la realización de procedimientos médicos sin consentimiento informado, 49,4 % fue objeto de algún tipo de trato deshumanizante, solo 20,5 % percibió trato no violento. Entre los reportes de trato deshumanizante predominó el obstaculizar el apego precoz (23,8 %). El trato deshumanizante fue percibido con más frecuencia por las gestantes tardías y las adolescentes (P<0,0001). Los principales perpetradores señalados son las enfermeras y los médicos. Entre los procedimientos sin consentimiento el más frecuentemente reportado fue la realización de múltiples tactos (37,2 %) y la administración de oxitócicos (31,3 %). Este tipo de violencia fue percibido con más frecuencia por las adolescentes (P<0,0002). A más alto nivel de educación se observó menor percepción de violencia (P<0,0059). Una de cada 4 usuarias conoce el término violencia obstétrica, y 1 de cada 5 sabe donde denunciarla. Solo 12 % recibió información sobre el consentimiento informado y 17 % firmó un formulario. CONCLUSIONES: Existe una elevada percepción de violencia en la atención obstétrica dada por la realización de procedimientos médicos sin consentimiento informado y trato deshumanizante por parte del personal de salud. No se aplica de manera sistemática la obtención del consentimiento informado.

OBJECTIVE: To evaluate the perception of the users on the attention received in relation to considered practices obstetric violence. METHOD: Prospective, descriptive, exploratory, transverse- court study by means of an anonymous opinion poll to 425 women in postpartum period attended in Concepción Palacios Maternity between May and August 2011, on relative aspects to obstetric violence. RESULTS: 66.8 % manifested the realization of medical procedures without informed consent, 49.4 % it was some kind of dehumanizing deal’s object, only 20.5 % perceived deal I do not force. The reports of dehumanizing deal predominated to obstruct the precocious attachment (23.8 %). The dehumanizing deal was perceived with more frequency by the overdue pregnant and teens (P 0.0001). The principal marked perpetrators are nurses and doctors. In the procedures without consent the more frequently reported was the realization of multiple vaginal touches (37.2 % ) and oxytocin administration (31.3 % ). This type of violence was perceived with more frequency by the teens (P 0.0002). Minor perception of violence was observed to higher level of education (P 0.0059). One out of every 4 users knows the term obstetric violence, and 1 out of every 5 knows where to denounce her. Only 12 % received information on the informed consent and 17 % signed a fill-out form. CONCLUSIONS: There is an elevated perception of violence in the obstetric attention given the realization of medical procedures without informed consent and dehumanizing deal for part of the staff of health. The obtaining of the informed consent is not applicable of systematic way.

Induction of labor with titrated oral misoprostol solution versus oxytocin in term pregnancy: randomized controlled trial / Indução do trabalho de parto por meio de solução oral titulada de misoprostol versus oxitocina em gestação a termo: estudo controlado randomizado

PURPOSE: To evaluate the effectiveness and the safety of orally administered misoprostol in comparison to intravenously infused oxytocin for labor induction in term pregnant women. METHODS: Between 2008 and 2010, a total of 285 term pregnant women whom were candidate for vaginal delivery were assessed for eligibility to enter the study. Twenty five patients were excluded for different reasons; and 260 included women were randomly assigned to one of the two groups according to the method of treatment, misoprostol or oxytocin. The misoprostol group received 25 µg every 2 hours for up to 24 hours for induction. The oxytocin group received an infusion of 10 IU which was gradually increased. The time from induction to delivery and induction to the beginning of the active phase and successful inductions within 12, 18, and 24 hours were recorded. The trial is registered at irct.ir, number IRCT2012061910068N1. RESULTS: Failure of induction, leading to caesarean section was around 38.3% in the oxytocin group and significantly higher than that of the misoprostol group (20.3%) (p<0.001). Despite the more prevalent failure in the oxytocin group, the mean time intervals from induction to active phase and labor of this group were both significantly less than the misoprostol group (10.1±6.1 and 13.2±7.7 versus 12.9±5.4 and 15.6±5.1 hours respectively, both p-values were <0.05). Maternal and fetal complications were comparable between groups except gastrointestinal symptoms which were encountered more frequently in the misoprostol (10.9 versus 3.9%, p=0.03). CONCLUSIONS: Misoprostol is a safe and effective drug with low complications for the induction of labor. Failure is seen less with misoprostol and caesarean sections are less frequently indicated as compared to oxytocin.

OBJETIVO: Avaliar a eficácia e segurança do misoprostol administrado por via oral em comparação à infusão de oxitocina para a indução do trabalho de parto em gestantes a termo. MÉTODOS: Entre 2008 e 2010, um total de 285 gestantes a termo candidatas para parto vaginal foram avaliadas quanto à eligibilidade para inclusão no estudo. Vinte e cinco pacientes foram excluídas por várias razões, e as 260 mulheres incluídas foram divididas aleatoriamente em dois grupos de acordo com o método de tratamento, misoprostol ou oxitocina. O grupo tratado com o misoprostol recebeu 25 µg cada 2 horas durante um máximo de 24 horas para indução. O grupo tratado com oxitocina recebeu infusão de 10 UI, que foi aumentada gradativamente. O tempo a partir da indução até o início da fase ativa e as induções bem-sucedidas dentro de 12, 18 e 24 horas foram registrados. O ensaio foi registrado em irct.ir, número IRCT2012061910068N1. RESULTADOS: A falha de indução levando à necessidade de cesariana foi de aproximadamente 38.3% no grupo tratado com oxitocina, sendo significativamente maior em relação ao grupo tratado com misoprostol (20,3%) (p<0,001). Apesar da falha mais prevalente no grupo tratado com oxitocina, os intervalos médios entre indução e fase ativa e trabalho de parto nesse grupo foram ambos significativamente menores em relação ao grupo tratado com misoprostol (10,1±6,1 e 13,2±7,7 versus 12,9±5,4 and 15,6±5,1 horas, respectivamente, sendo ambos os p-valores <0,05). Complicações maternas e fetais foram comparáveis entre grupos, com exceção dos sintomas gastrointestinais, que foram encontrados mais frequentemente no grupo tratado com misoprostol (10,9 versus 3,9%, p=0,03). CONCLUSÕES: O misoprostol é droga segura e eficaz para a indução do parto, com poucas complicações. Falhas são menos observadas e cesáreas são indicadas menos frequentemente com o misoprostol em relação à oxitocina.

Maternal serum progesterone, estradiol and estriol levels in successful dinoprostone-induced labor

Hormone-mediated quiescence involves the maintenance of a decreased inflammatory responsiveness. However, no study has investigated whether labor induction with prostanoids is associated with changes in the levels of maternal serum hormones. The objective of this study was to determine whether labor induction with dinoprostone is associated with changes in maternal serum progesterone, estradiol, and estriol levels. Blood samples were obtained from 81 pregnant women at term. Sixteen patients had vaginal birth after spontaneous labor, 12 required cesarean section after spontaneous labor and 16 underwent elective cesarean. Thirty-seven patients had labor induction with dinoprostone. Eligible patients received a vaginal insert of dinoprostone (10 mg) and were followed until delivery. Serum progesterone (P4), estradiol (E2) and estriol (E3) levels and changes in P4/E2, P4/E3 and E3/E2 ratios were monitored from admission to immediately before birth, and the association of these measures with the resulting clinical classification outcome (route of delivery and induction responsiveness) was assessed. Progesterone levels decreased from admission to birth in patients who underwent successful labor induction with dinoprostone [vaginal and cesarean birth after induced labor: 23% (P < 0.001) and 18% (P < 0.025) decrease, respectively], but not in those whose induction failed (6.4% decrease, P > 0.05). Estriol and estradiol levels, P4/E2, P4/E3 and E3/E2 ratios did not differ between groups. Successful dinoprostone-induced labor was associated with reduced maternal progesterone levels from induction to birth. While a causal relationship between progesterone decrease and effective dinoprostone-induced labor cannot be established, it is tempting to propose that dinoprostone may contribute to progesterone withdrawal and favor labor induction in humans.