Unwanted pregnancy. A failure of contraceptive education.

One thousand consecutive women presenting for first-trimester abortion at a free-standing clinic were interviewed with respect to contraceptive education and use. The vast majority had had some exposure to contraceptive information, yet more than half had not been using any form of contraception when conception occurred. More energy should be given to increasing women's motivation for using contraception.

Infant outcome following labor induction.

A matched control study was undertaken in which 156 children were examined between ages 23 and 62 months after births associated with spontaneous labor, oxytocin-induced labor, or prostaglandin E2 (PGE2)--induced labor. Physical development was not adversely affected by labor induction based on height and weight percentiles. The frequency of neurologic or developmental abnormalities not attributable to postdelivery events was the same overall in induced and spontaneous labors (19.2 per 1,000), but those abnormalities occurring after labor induction all followed use of oxytocin. None followed PGE2 despite case-selection criteria which specifically chose PGE2 cases from among those with documented adverse drug-related reactions.

Comparison of women seeking early and late abortion.

The differential characteristics of 697 women desiring induced abortion were studied according to when in pregnancy they presented. Age, marriage, and level of formal education were inversely related, those with greatest delay tending to be young, unmarried, and minimally educated. Religion was relevant, but generally was not. Nulliparity was only a weak correlate of delay. Contributory factors of denial, ambivalence, fear, and preceding menstrual irregularity accounted for two thirds of cases; they were uniformly distributed over the range of gestational age, but constituted the greatest proportion of reasons among those delaying decision longest. Physician delay and laboratory error accounted for all but one tenth of the remainder; they were concentrated particularly among gravidas presenting for care in the early part of the midtrimester. Fear characterized the young, poorly informed noncontraceptors, and had the greatest relative impact in protracted delays; denial was more likely to be found among older and ostensibly better informed women.

Effect of oxytocin and oral prostaglandin E2 on uterine contractility and fetal heart rate patterns.

The incidnce of uterine contractility and of abnormalities of fetal heart rate (FHR) pattern was determined in a series of 2,834 monitored gravid women with singleton pregnancies producing mature infants in vertex presentation. Those subjected to uterotonic agents for induction or augmentation of lbaor had significantly more tetanic contractions, baseline hypertonus, and coupling of contractions. Similarly, significantly more variable and late FHR decelerations occurred in stimulated labors, and these were concentrated primarily in those receiving oxytocin. The overall incidence of FHR decelerations associated with the use of prostaglandin E2 (PGE2) was comparable to that encountered in unstimulated labor. The similarity between the contractions of spontaineous labor and those labors produced by PGE2 is noted.

PIP: Of the 3700 gravid women with singleton pregnancies producing mature infants in vertex presentation, 2834 had routine uterine contractility (UC) and fetal heart rate (FHR) monitoring, producing records sufficient enough for data analysis. The monitoring was done using Corometrics Models 101, 101A, and 101B FHR monitors and a Hewlett-Packard Model 8020A cardiotocograph. Tetanic contractions were observed in 10.4% of labors overall, and in 8.3% of unstimulated labors; these were observed significantly more often when a uterotonic agent was used, totaling 14% of 1047 cases (t=4.54; p0.001). The increase was statistically significant only in oxytocin-stimulated labors. Baseline hypertonus was seen in 9.9% of unstimulated labors and in 13.5% of those labors subjected to stimulation (t=2.83; p0.01). Again, statistical significance was achieved only with oxytocin administration. Coupling was observed in 15.4% of unstimulated labors, but fewer (14.2%) stimulated labors. The findings also showed that both tetanic and coupled contractions occurred more often with prostaglandin E2 (PGE2) than with oxytocin induction or oxytocin stimulation; a finding, however, which needs further investigation. Significantly, more variable and late FHR decelerations were also noted in stimulated labors, particularly in those receiving oxytocin. Use of oral PGE2 did not affect the incidence of either variety of moderate-plus-severe FHR decelerations. These findings clinically support the reported similarity between spontaneous and PGE2--induced contractions, and their inherent dissimilarity from those produced by oxytocin.

Relative birthweights of twins.

In a series of 182 twin gestations second-born twins were more often heavier than first-born twins (55%), but overall they weighed less by an average of 21 g. This paradox was shown to be due to the skewed distribution of weight differences favoring the first-born twin, most apparent among pairs in which one or both weighed at least 3000 g. The larger the difference between birthweights, the greater the likelihood that the heavier twin would be delivered first.

Dysfunctional labor XII. Long-term effects on infant.

Developmental studies were done at 3 and 4 years of age in a series of 656 children and the results were correlated with the preceding labor pattern and the type of delivery. It was determined that there were significant adverse effects among offspring delivered by midforceps procedures or born following labors characterized by prolonged deceleration, secondary arrest of dilatation, or arrest of descent.

Station of the fetal presenting part. VI. Arrest of descent in nulliparas.

The specific labor aberration of arrest of descent was investigated in 253 nulliparas. It was found to be associated with fetopelvic disproportion in 52%. Delivery outcome was adversely affected by such factors as high fetal station at time of arrest and long duration of arrest. Arrest of descent occurring during the administration of oxytocin infusion was particularly ominous, no patient subsequently delivering vaginally. The best delivery prognosis was seen in those cases in which apparently causative inhibitory agents, including peridural anesthesia and sedation, were allowed to abate expectantly. Neither immediate operative delivery nor expectancy (other than in the specific abatement cases) was determined to be an appropriate approach to resolving this problem. Postarrest progression, especially if at a rate that was the same as or greater than prearrest descent, proved to be a favorable sign for delivery outcome. Neonatal depression and birth trauma were closely correlated with midforceps procedures, especially when done in conjunction with forceps rotation. Cephalopelvic disproportion yielded poor perinatal results, particularly among those delivered vaginally by instrumental means. Uterotonic stimulation of labor to correct the arrest problem therapeutically also had an adverse effect on the fetus when followed by operative delivery. Based on these observations a program of management was evolved for treating patients with arrest of descent.

Oral prostaglandin E2 for induction of labor at term. II. Comparison of two low-dosage regimens.

Prostaglandin E2 was administered orally for induction of labor in 100 normal term gravidas with two dosage regimens. The data derived were compared with comparable data from gravidas matched with study patients according to prelabor cervical preparation and other relevant obstetric and actuarial features. Analysis of patterns of cervical dilatation and station vs. time was carried out. A dose of 0.5 mg. hourly was found to be effective in inducing labor of good quality with minimal side effects, providing a better balance between efficacy and adverse reactions than the higher dosage level.

Preinduction priming with oral prostaglandin E2.

A double-blind study was undertaken to determine the effectiveness of prostaglandin E2 as a means for improving the prelabor pelvic conditions preparatory to induction of labor at term in 30 patients with unfavorable Bishop scores of less than 6. An interval of priming was followed after 8 to 12 hours by induction with oxytocin infusion. No meaningful differences were found in index cases as compared with controls to verify that PGE2 has any priming or enhancing effect under the conditions of the investigation.

PIP: A clinical experiment was undertaken to assess the usefulness of PG(prostaglandin)E2 in priming cervixes with unfavorable Bishop scores prior to induction of term delivery. The study, which used 30 pregnant woman at term, was a double-blind study employing placebo or .5 mg PGE2 tablets in a dosage schedule of 2 tablets at 3-hourly intervals for 3 doses. During the priming, vital signs, fetal heart rate, and uterine contractility were monitored. Between 8-12 hours following the last dose of medication or placebo, intravenous oxytocin infusion was begin for labor induction. Oxytocin infusion failed to induce labor in 3 of the primed and 4 of the unprimed patients. Fetal heart rates were altered in 1 baby from each group; otherwise, all babies in both groups did well. There was no difference between the 2 groups as to the dosage of oxytocin required to induce active labor or to effect delivery. The duration of oxytocin stimulation and the interval from onset of priming to delivery were also comparable in the 2 groups. The study results show that PGE2 does not have appreciable priming benefits when unfavorable prelabor pelvic conditions prevail.