ABSTRACT
OBJECTIVE: To compare the effectiveness of prostaglandin E2 (dinopristone) vaginal gel versus vaginal tablets for the induction of labour at term. DESIGN: Randomised controlled clinical trial. SETTING: University maternity hospital in London. POPULATION: Pregnant women with cephalic presentation undergoing induction of labour after 37 weeks of gestation. METHODS: Prostaglandin E2 vaginal tablets (3 mg) or vaginal gel (1 mg/ 2 mg) was administered at 6-hourly intervals until the cervix was suitable for amniotomy. MAIN OUTCOME MEASURES: Induction to delivery interval, in minutes; rate of failed induction of labour requiring caesarean delivery. RESULTS: Eighty-two women received prostaglandin gel; 83 women received vaginal tablets. There were significant differences between the two treatment groups in the primary outcomes. The mean induction to delivery interval was significantly shorter in women who received the gel (1400 minutes, 690-2280 minutes, versus 1780 minutes, 960-2640 minutes; P = 0.03). The rate of failed induction of labour was significantly higher in women who received tablets (10.84 versus 1.22%; P = 0.01). Subanalysis showed that these differences were only representative of differences in the groups of primigravid women. There were no significant differences in any of the secondary outcomes, including the number of women who required syntocinon augmentation, the rate of uterine hyperstimulation, the need for epidural analgesia, meconium staining of liquor, the need for fetal blood sampling, or delivery by caesarean section. There were no differences in adverse maternal and neonatal outcomes. CONCLUSION: Prostaglandin E2 vaginal gel is superior to vaginal tablets for the induction of labour.
Subject(s)
Dinoprostone , Labor, Induced/methods , Oxytocics , Administration, Intravaginal , Adult , Cesarean Section/statistics & numerical data , Female , Humans , Obstetric Labor Complications/etiology , Parity , Pregnancy , Pregnancy Outcome , Tablets , Term Birth , Vaginal Creams, Foams, and JelliesABSTRACT
Clinical and physiological effects of pressure-regulated ventilation of the lungs using the inverse rate of inhalation to exhalation (PCV-IR) were studied in two groups of patients. No appreciable advantages of this mode of pulmonary ventilation in comparison with common ("volumic") method were observed in group 1 patients (following open-heart surgery) with moderately expressed respiratory disorders (PaO2/FIO2 = 340c13 and index of lung comprometation 0.7c0.04). At the same time, the level of the peak inhalation pressure in the airways at PCV-IR was reliably lower than during common artificial ventilation of the lungs (AVL). In patients with grave respiratory disturbances (PaO2/FIO2 = 93c10 and index of lung comprometation 6.88c0.56) application of this scheme brought about an improvement of pulmonary biomechanics and gas exchange, but the hemodynamics was virtually the same. It is noteworthy that the process of PCV-IR adaptation required a thorough preliminary "adjustment" of the ventilation parameters and took rather a long time in the majority of patients. Positive effects of PCV-IR may be due to several mechanisms: a slowing down (ramp-like) flow, limitation of the upper pressure during inhalation, prolongation of exhalation in comparison with inhalation, and a regulated level of internal positive end expiratory pressure. PCV-IR is recommended as a variant of respiratory support in the treatment of patients with severe involvement of the lungs, when the potentialities of common AVL are exhausted.
