Résumé
OBJECTIVE: To compare the safety and efficacy of two dose regimens of intravaginally administered misoprostol (PGE1) for cervical ripening and labor induction. METHODS: One hundred patients with unfavorable cervix (including PROM) for labor induction were randomly assigned to group A and group B. Group A patients received 25 g of vaginal misoprostol every 4 hours with maximum of 6 doses and group B patients received 25 g, 50 g, 100 g, 100 g of misoprostol every 4 hours with maximum of 4 doses. Misoprostol was inserted to the posterior vaginal fornix. Successful induction was defined when Bishop score was increased to greater than 9 or regular uterine contractions were developed. The rates of successful induction, vaginal delivery, mean time from induction to delivery, drug side effects, and neonatal outcomes were compared. RESULTS: The average interval from start of induction to vaginal delivery was shorter in group B (780.1+/-313.0 minutes) than group A (1108.9+/-485.9 minutes) (p<0.01). The rate of vaginal delivery was higher in group B (42/50, 84.0%) than group A (35/50, 70.0%) although statistically not significant. The incidences of tachysystole, abnormal fetal heart rate tracing, meconium passage, low 1-min and 5-min Apgar scores, and admission to the neonatal intensive care unit were not different between two groups. CONCLUSIONS: Induction with misoprostol using dose-increasing schedule showed shorter time from induction to delivery and higher rate of successful induction than using same dose schedule without increase of side effects and adverse neonatal outcomes.
Sujets)
Femelle , Humains , Nouveau-né , Grossesse , Rendez-vous et plannings , Maturation du col utérin , Col de l'utérus , Rythme cardiaque foetal , Incidence , Soins intensifs néonatals , Méconium , Misoprostol , Contraction utérineRésumé
OBJECTIVE: To evaluate the efficacy of sonohysterography on exact submucosal myoma. methods: Transvaginal sonohysterography was performed on 45 patients who diagnosed as submucosal myoma and 29 patients who diagnosed as endometrial polyp by classic abdominal or vaginal sonogram, and then they received the diagnostic hysteroscopy at all. RESULTS: In 24 of 45 patients on sonohysterogram, submucosal myoma was diagnosed that was protruded to uterine cavity more than 2/3 of mass. Nine patients had intramural myoma and 12 patients had myoma that protruded only lesser than 1/3 of mass on sonohysterogram. These 21 patients revealed the same finding on hysteroscopy. On hysteroscopy, submucosal myomas were in 20 of 24 patients and polyps were in 3 patients and synechia was in one patients. In 8 of 29 patients on sonohysterogram, endometrial hyperplasia was found and confirmed by hysteroscopy. In 16 of 21 patients whose finding was polyp on sonohsyterogram, polyp was confirmed by hysteroscopy. However hysteroscopic findings were myomas in 3 of 21 patients and synechia in one patients. Therefore in 29 of 74 patients (39.2%), further hysteroscopy was not needed by sonohysterogram. In 65 of 74 patients (87.8%), sonohysterographic findings were same as hysteroscopic findings. CONCLUSION: Sonohysterogram for diagnosis of submucosal myoma and polyp is essential procedure in order to avoid unnecessary hysteroscopy. However differentiation between polyp and submucosal myoma has still some difficulty.