[Artificial induction of labor at term for medical reasons. Comparison of 2 technics for labor induction, oxytocin + early artificial rupture of the membranes versus prostaglandin E2 vaginal gel. Open randomized controlled study]. / Déclenchement artificiel du travail à terme pour raisons médicales. Comparaison de deux techniques d'induction du travail, ocytocine + rupture artificielle des membranes précoce versus prostine E2 gel vaginal. Etude ouverte contrôlée randomisée.

Labor induction for medical reasons is a situation rather well-controlled by the combination: "oxytocin-amniotomy" when the cervix is favorably open. However, new induction techniques are currently under study, especially vaginal administration of PGE2 which presents the advantage of being simple to administer and better accepted by the patients. This study compared the classical technique, oxytocin perfusion and early artificial rupture of the membranes, with the vaginal administration of PGE2 gel (first dose: 1 mg, second dose 1 or 2 mg, six hours later). The success rate of both techniques is comparable, approximately 70 p. cent. Also, the times between amniotomy and delivery are identical, approximately 5 hours. On the contrary, the lapses of time between the onset of the induction and the delivery, vary significantly, being always longer in the PGE2 group. However, the dose of vaginal PGE2 gel as well as the time of artificial membrane rupture could be modified in order to decrease the delay of the effect.

[Triazolam 0.25 mg versus loprazolam 1 mg in the treatment of common insomnia treated in general practice. Double-blind cross-over randomized trial]. / Triazolam 0.25 mg versus loprazolam 1 mg dans le traitement des insomnies communes traitées en médecine praticienne de ville. Essai croisé randomisé en double aveugle.

In a double-blind cross over randomized study for the first two nights efficacy and safety of triazolam 0.25 mg and loprazolam 1 mg have been compared in 67 out-patients complaining of common insomnia and treated by general practitioners. After the second night patients had to choose one of the two treatments and were continuing a 3-week treatment period with the preferred one. In case of no preference they received one of the 2 drugs according to a new randomization. Cross over administration of the two drugs for the first two nights shows that with triazolam global help to get in sleep is greater (p = 0.016) and sleep latency is shorter (p = 0.07) than with loprazolam, and number of night awakenings is decreased (p = 0.02) compared to loprazolam. Patients felt more rested under triazolam (p = 0.015) than loprazolam. Triazolam (N = 31) is more frequently preferred than loprazolam (N = 19) p = 0.09. Preferred treatment continued to be effective during the following three weeks and quality of sleep improved drastically for all items compared to baseline data (p = 0.01). Both treatments are well tolerated (4 drop-outs for side-effects: 2 under each treatment). The one-week tapering period allows progressive withdrawal with rare reappearance of minimum sleep disorders (5 cases: 2 under triazolam, 3 under loprazolam).

[Cervical dilatation by use of a vaginal suppository of meteneprost before voluntary interruption of the pregnancy in the first trimester]. / Dilatation cervicale par ovule vaginal de Méténéprost avant les IVG du premier trimestre.

Instrumental dilatation of the cervix prior to first trimester absorption may be difficult and source of complications. Pharmacological dilatation is proposed in a prospective random study using vaginal suppository containing 10 mg of 9-deoxo, 16-16 dimethyl, 9 methylene PGE2 (Meteneprost). Mean cervical dilatation, 3 hours after treatment, was significantly higher in the treated group (8.1 vs 6 mm) and additional dilatation was facilitated by cervical softening. Side effects occurred in most of the treated patients (uterine pain) but on a minor scale. This procedure may be considered as effective, safe and easy.