[Pharmacological induction of labour: benefits and risks]. / Induzione farmacologica del travaglio di parto: vantaggi e rischi.

AIM: Induction of labour is a very common practice in modern obstetrics. The most used method is based on the use of topical prostaglandins. In this study we aimed to analyse the results of pharmacological induction of labour through the use of dinoprostone, comparing the intracervical gel (Prepidil 0.5 mg) and the vaginal insert (Propess 10 mg). METHODS: An observational longitudinal study was conducted, in which all patients treated with prostaglandins from January 1, 2003 to June 30, 2006 were included, for a total of 852 cases. The intracervical gel was applied on 32.5% of pregnant women (277 patients) while the vaginal insert to 56.2% (479 patients); in 11.3% of the cases (96 patients) both preparations were administered, one after the other. RESULTS: In 2/3 of the total (568 patients), the induction led to vaginal delivery, in contrast to 284 cases in which the practice showed negative results: in 270 women (31.7%) a cesarean section was practiced. Adverse events occurred only in 1.8% of cases (16 patients); the most frequent adverse reaction was uterine hypertonus in 1.8% of cases, which was in any case resolved with removal of the vaginal insert or injection of a tocolytic drug (atosiban). CONCLUSION: Induction through prostaglandins is an effective and safe method to get cervical maturation. Its success is influenced by Bishop score. In the case of unfit cervix, vaginal insert seems to get better results than intracervical gel. The relation between risks and benefits is certainly better in the latter.

Prenatal diagnosis of vasa previa presenting as amniotic band. 'A not so innocent amniotic band'.

We describe a case in which the early antepartum diagnosis of vasa previa was made in an asymptomatic patient by means of color Doppler ultrasonography. A woman, gravida 3 para 1 at 22 weeks' gestation, was diagnosed as having an anterior low-lying placenta, a velamentous cord insertion and an amniotic band with vessels traversing the internal cervical os towards a succenturiate lobe. At the 39th week, a Cesarean section was performed and a healthy female baby was born. Transvaginal color Doppler flow imaging facilitated the accurate diagnosis of this condition.