Cervical ripening and induction of delivery by local administration of prostaglandin E2 gel or vaginal tablets is equally effective.

BACKGROUND: Prostaglandin E2 for local application has been widely used for preinduction cervical ripening in cases presenting with an unfavorable cervical state. The optimal way of administering prostaglandin E2, however, remains unclear. The aim of this study was to compare the effect of multiple application of 0.5 mg Minprostin intracervical Gel to the effect of 3 mg Minprostin vaginal tablets in priming the uterine cervix and inducing labor in an open, prospective, randomised study. METHODS: PGE2 was applied up to three times a day for two days until ripening was obtained or labor induced. In case no progress took place amniotomy was performed and i.v. oxytocin stimulation one hour later if necessary. A total of 208 pregnant women, consecutively admitted for induction of delivery, with Bishop Scores 0-5, were included. RESULTS: Minprostin gel (group I) and Minprostin tablets (group II) were equally effective in ripening the cervix. Delivery within 48 hours was achieved in 59% and 63% respectively. The mean number of applications was 2.6 (s.d. 1.6) and 2.7 (s.d. 1.3) respectively. In case more than four doses were required no further effect was seen on delivery rates. Rates of cesarean section (performed in 15% and 18% respectively), labor induction (3%/1%), drop outs (14%/12%) and failed inductions (10%/5%) were comparable. Patients in group I had a significantly lower demand for analgesia. A significantly shorter induction-delivery interval in group II was seen in patients with preinduction Bishop scores 3-5 compared to patients with Bishop scores 0-2. Side effects were few. Both procedures appear safe. CONCLUSIONS: Cervical ripening and induction of delivery by local administration of prostaglandin E2 gel or vaginal tablets in cases presenting with an unfavorable cervical state is equally effective.

Prognostic factors and adjuvant treatment in early epithelial ovarian cancer.

Four hundred and ten patients with epithelial ovarian cancer FIGO stages I and II were registered by a Danish multicenter study group (The Danish Ovarian Cancer Group - DACOVA). Two-thirds were stage I, the most frequent substage was Iai which was the classification in 27%. Five-year survival for stage I was 72%, and 38% for stage II. Multivariate analysis showed that age, stage, residual tumor, histologic grade and adjuvant treatment had prognostic value. For stage, three significantly different groups could be identified: (1) stage Iai, (2) stage Iaii-Ic, and (3) stage II. Histologic grade showed a significant survival difference between all grades. Adjuvant treatment had a moderate but significant impact on survival. Patients in stage Iai had a good survival with surgery alone and will probably not benefit from adjuvant therapy. Adjuvant treatment improved survival for the remaining patients in stages I and II without residual tumor. A difference between treatment modalities was not observed. However, the data need to be confirmed by a randomized trial. Patients in stage II with residual tumor should be treated as stage III.

[Induction of labor. Prostaglandin E2 vaginal tablets compared with intravenous oxytocin for induction of labor in premature rupture of the membranes and immature cervix]. / Fødselsinduktion. Prostaglandin E2 vaginaltabletter sammenlignet med intravenøs oxytocin til igangsaetning af fødsel ved primaer vandafgang og umodne cervikale forhold.

In a material of 88 patients with premature rupture of the membranes and unripe cervix, a comparative investigation was undertaken to compare the effects of prostaglandin E2 (PGE2) vaginal tablets and intravenous oxytocin on induction of labour. The patients were subdivided at random into two groups: 42 patients treatment with PGE2 and 46 treatment with intravenous oxytocin. The results did not reveal any significant differences in the numbers of successful inductions regardless of the Bishop score at the commencement of stimulation but the duration of induction was found to be briefer in the oxytocin group. No significant differences were observed in the numbers of instrumental interventions in the two groups nor in the frequencies of side effects and in the employment of analgesics. Treatment with PGE2 vaginal tablets is considered to be more acceptable by the patients and easier for the staff to use. The tablets were just as safe and reliable in use as intravenous oxytocin for induction of labour in cases of premature rupture of the membranes and Bishop scores less than 6, but the duration of induction was significantly longer.

Apgar scores in low birth weight infants delivered vaginally and by cesarean section.

A retrospective investigation of 641 live infants weighing less than 2500 g showed that the frequency of a low Apgar score (less than or equal to 7, five minutes after birth) was significantly correlated to the birth weight of the infant and independent of the mode of delivery and the presentation of the fetus at birth.

Infections with Neisseria gonorrhoeae and Chlamydia trachomatis in women with acute salpingitis.

The value of cultural and serological procedures in diagnosing gonococcal and chlamydial infections was investigated in 85 women who had provisional diagnoses of pelvic inflammatory disease. The correlation between certain clinical variables and the absence or presence of such infections was also studied. In 46 the diagnosis of acute salpingitis was verified by laparoscopy. The laboratory and clinical findings in the patients with acute salpingitis were compared with those in the remaining 39 women in whom laparoscopy did not show signs of inflammation. Salpingitis was considered to be gonococcal if Neisseria gonorrhoeae was isolated or a fourfold or more change in titre of antibodies to gonococcus pilus antigen was found. The diagnosis of chlamydial salpingitis was based on the isolation of Chlamydia trachomatis, a fourfold or more change in titre of IgG antibodies to or from a titre of greater than or equal to 1/256, or the presence of IgG antibodies at a titre of greater than or equal to 1/512. Patients with chlamydial salpingitis had less severe symptoms but a more protracted course of disease than patients with gonococcal salpingitis or with acute salpingitis not associated with the two pathogens.

Importance of Mycoplasma hominis in acute salpingitis assessed by culture and serological tests.

In 95 women with a provisional diagnosis of pelvic inflammatory disease, a final diagnosis of acute salpingitis was confirmed by laparoscopy in 46 and 10 had strong clinical evidence of acute salpingitis. The findings in the remaining 39 patients without signs of acute salpingitis by laparoscopy were used as a standard of reference. Criteria for the diagnosis of possible mycoplasmal salpingitis were tentatively defined as the isolation of Mycoplasma hominis from the cervix together with positive test results for M hominis antibodies (a titre of greater than or equal to 1/1280 or a change in titre, or both); these criteria were fulfilled in 12 patients with acute salpingitis. A positive correlation between mycoplasmal salpingitis and chlamydial salpingitis or gonococcal salpingitis, or both, was significant. Mycoplasmal salpingitis was not associated with any characteristic clinical feature different from those of patients with non-mycoplasmal salpingitis. Our findings do not support the view that M hominis is an important primary pathogen in acute salpingitis.

A comparison of two IUDs: Multiload Cu 250 and Copper T 200.

PIP: A prospective, randomized single-blind comparison of the Multiload Cu 250 (ML) with the Copper T 200 (Cu T) disclosed no significant difference between the 2 IUDs. The 124 women fitted with the ML did not differ significantly from the 116 fitted with the Cu T in age, parity, day of insertion, or bleeding pattern prior to IUD insertion. 15 of the ML group and 16 of the Cu T group had prior experience with IUDs. Follow-up examinations occurred at 6 weeks and 6 and 12 months. After 12 months 6 women using ML and 3 using Cu Ts could not be reached. In the ML group the duration of menstruation was significantly longer after insertion than in the Cu T group, but the difference was less than 1 day. 1 woman from each group became pregnant. The rates of termination per 100 women 12 months after insertion were .9 and .8 for pregnancy, 2.6 and 7.5 for expulsion, 4.4 and 1.6 for bleeding, 7.8 and 5.8 for pain, 4.3 and 1.6 for infection, 3.5 and 1.7 for planning pregnancy, and 3.5 and 4.2 for other personal reasons for the Cu T and ML respectively. Total rates of termination were 27.0 for the Cu T and 23.3 for the ML. The ML was expelled by 8 of 64 nulliparas and the Cu T by 1 of the 56 nulliparas, a significant difference. The continuation rate for ML is consistently higher than that of the Cu T for multiparas, but among nulliparas in the ML group there is a pronounced decline after 6 months because of expulsion. The continuation rate after 12 months is identical among nulliparas for the 2 IUDs. The ML is as effective as the Cu T and has the same frequency of side effects, but is easier to insert.^ieng

Comparison between two IUDs: Progestasert and CuT 200.

PIP: A prospective, randomized clinical trial was conducted to determine the efficacy, side effects, and bleeding patterns of 2 T-formed IUDs, the Progestasert and a copper containing IUD (CuT 200). 196 women were fitted with Progestasert (96 nulli- and 100 multi-parae) and 186 with CuT 200 (99 nulli- and 87 multiparae). Mean age in the Progestasert group was 24.3 years (range 15-44) and mean parity 1.0 (range 0-4). In the CuT 200 group, corresponding figures were 23.7 years (range 15-44) and parity 0.9 (range 0-6). The women were told to keep a menstrual diary card indicating duration and frequency of menstrual bleeding, spotting, and pain. Follow-up clinic visits and gynecological examinations were scheduled at 6 weeks, 6 months, and 12 months after insertion, or earlier if necessary. The Chi-Square test and Student's T-test were used in statistical analysis. 8 women became pregnant, 4 in the Progestasert group (1 nulli- and 3 multiparae), and 4 in the CuT group (1 nulli- and 3 multiparae). In the Progestasert group, 1 pregnancy was ectopic. 9 women were lost to follow-up. No significant differences were observed between the groups in terms of duration or number of intermenstrual bleeding and spotting. There was no significant difference in menstrual pattern between the groups prior to IUD insertions. 12 months postinsertion, duration and heaviness of menstrual bleeding had increased in all groups. In the Progestasert group, duration of menstrual bleeding (mean, 6.80) was significantly longer than in the CuT 200 group (mean, 6.05, p0.05). In the nullipara group, the difference in duration of menstrual bleeding was significant (Progestasert, mean 6.91; CuT 200, mean 6.09 p0.05). No significant difference in duration of menstruation was seen in the para group of women. The heaviness of menstrual bleeding was significantly higher in the CuT 200 group as a whole (p0.05) and in the group of nulliparae with CuT 200 (p0.05). The findings show that CuT 200 is more useful in practice but Progestasert is preferable for women who bleed heavily.^ieng

[Multiload and copper-T200. A prospective study of 2 types of coils]. / Multiload og kobber-T200. En prospektiv undersøgelse af to spiraltyper.

PIP: In a prospective, randomized single-blind investigation, 124 women with the Multiload 250 (MLCU-250) and 116 women with the Copper-T-200 (CU-T200) were compared. After a 12 month observation period, the pregnancy risks were 0.9 and 0.8 respectively. No relevant differences were found between the 2 types of IUDs with regard to discontinuation rate or frequency of side effects; however, insertion of the MCLU-250 was found to be easier. (author's)^ieng

Follicular stimulating hormone, luteinizing hormone and estrogen levels before and after female sterilization.

A prospective pilot investigation of 14 women subjected to sterilization via laparoscopy, using bipolar electrocoagulation of the Fallopian tubes, did not reveal any significant change in the levels of follicular stimulating hormone (FSH), luteinizing hormone (LH) or estradiol either before or 3 months after the operation. However, the investigation gave evidence of a slight decrease in estradiol levels in the first 3 months after sterilization.

[Progestasert and copper-T. A prospective, randomized clinical study of 2 coil types]. / Progestasert og kobber-T. En prospektiv, randomiseret klinisk undersøgelse af to spiraltyper.

PIP: In a prospective, randomized clinical trial of 2 IUDs, the Progestasert (1963 women) and the Cu T200 (186 women), there were no significant differences observed after a period of 12 months of observation, particularly with regard to efficacy. The Progestasert, however, must be changed at most 18 months after insertion; thus, this IUD is less practical than the Cu T200. (author's)^ieng

A pregnancy with a hydatidiform mole, thyreotoxicosis and live-born infant.

A 26-year-old woman, pregnant for the 3rd time, was admitted in the 2nd trimester with bleeding and slight signs of thyreotoxicosis. The free thyroxin, total thyroxin and TRH-test confirmed the diagnosis. The patient was delivered 8 weeks before term of a living boy of 1680 g. Immediately after the child, a 300 g normal placenta was born, followed by 650 g of molar tissue. Four weeks after birth and evacuation of the molar tissue, the patient was euthyreoid, with normal thyreoid parameters. It is presumed to have been a twin pregnancy, in which the part transformed to molar tissue has secreted a thyroid stimulating factor.