RESUMO
The aim of this study is to further compare the efficacy of PGE2 suppository, the intracervical foley catheter and extra-amniotic saline infusion in nulliparous women referred for labor induction. Totally 368 nulliparous women with a Bishop score = 4 with singleton gestation, vertex presentation and intact membrane referred for labor induction were randomly assigned to 3 groups; Foley catheter alone, Extra-amniotic saline infusion [EASI] and PGE2 suppository. All women received concurrent dilute oxytocine infusion. The change in the Bishop Score, labor progress, various labor endpoints and outcomes of labor were assessed. From 363 women studied after exclusion of 5, 119 were assigned to EASI, 121 to Foley and 118 to PGE2. Patients' demographics did not differ significantly between three groups nor did indication for induction [P=0.0001]. The EASI group had a significant improvement in Bishop Score 6 hours after induction. The mean time to active phase was 357 +/- 135 min for EASI, 457 +/- 178 for Foley and 609 +/- 238 min for PGE2 group respectively [P<0.05]. Rate of spontaneous rupture of membranes was higher in the EASI group [P=0.0001] and the mean time from the start of induction up to spontaneous rupture of membranes in the EASI group was shorter than other group [P<0.05]. The mean time to vaginal delivery was 14.8 +/- 6.1 in EASI group, 11.4 +/- 4.8 in Foley and 18.9 +/- 6.4 in PGE2 group [P<0.05]. There were no differences in Apgar scores, mean neonatal birth weight and neonatal morbidity. Our study showed that pre-induction cervical ripening by EASI with concurrent oxytocin is better than Foley and PGE2 in Bishop score and various labor end point and outcomes
RESUMO
Acute urinary retention in children is a relatively rare entity. There are a variety of causes that are poorly defined in the literature. We review our cases of acute urinary retention in children at three major pediatrics centers in Iran. Between 1996 and 2003, children [up to 14 years old] who had been referred due to acute urinary retention were examined. Urinary retention was defined as inability to empty the bladder volitionally for more than 12 hours with a urine volume greater than expected for age or a palpably distended bladder. All data from the patients' past medical history, physical examination, and laboratory and radiographic assessments were collected. Also, cystourethroscopy and urodynamic procedures had been carried out according to patient's conditions. Patients with secondary urinary retention, including those with surgical history, immobility or chronic neurological disorders, mental retardation, and drugs or narcotics consumption were excluded from study. There were 86 patients meeting the inclusion criteria, consisting of 58 males with a median age of 4 years [range 1 month to 14 years] and 58 females with a median age of 4 years [range 4 month to 14 years]. Etiologies were lower urinary tract stone in 27.9%, neurological disorders in 10.4%, trauma in 10.4%, local inflammatory causes in 9.1%, urinary tract infection in 7.4%, ureterocele in 7.4%, benign obstructing lesions in 5.8%, iatrogenic in 5.8%, constipation in 4.6%, imperforated hymen in 3.5%, and large prostate utricle, urethral foreign body, and rhabdomyosarcoma each in 1 case [1.1%]. The most common cause of acute urinary retention was lower urinary tract stone in our pediatric cases. Ureterocele and stone were the main findings in girls and boys, respectively, and urinary retention in boys was twice as prevalent as that in girls