Is high-dose misoprostol able to lower the incidence of cesarean section? A randomized controlled trial.

OBJECTIVE: To determine whether high-dose (100 microg) misoprostol was able to increase the rate of successful labor induction and lower the incidence of Cesarean section without adverse fetal effects. METHODS: A total of 360 women were randomized to receive either oxytocin (n = 192) by intravenous infusion, or misoprostol (n = 168) 100 microg intravaginally every 4 h. The Cesarean section rate was the primary end-point. Incidences of uterine and fetal heart rate abnormalities during labor and adverse neonatal outcomes were assessed as secondary end-points. RESULTS: Compared with those women receiving oxytocin, patients given misoprostol had a significantly shortened labor (10.7+/-6.0 vs. 15.4+/-10.4 h, p < 0.001). The Cesarean section rate did not differ between patients receiving misoprostol or oxytocin (36 (21.4%) vs. 38 (19.8%), p = 0.79) despite a sample size adequate to detect a 13 percentage point difference in this outcome. Patients receiving misoprostol had a higher incidence of the hyperstimulation syndrome (27 (16.1%) vs. 9 (4.7%), p < 0.001), and of fetal intolerance of labor as an indication for Cesarean delivery (23 (63.9%) vs. 15 (39.5%), p = 0.06), and had a greater number of umbilical artery cord blood pH findings of< 7.20 (20 (43.5%) vs. 6 (17.1%), p = 0.02). These worrisome trends on interim analysis resulted in our prematurely terminating the study. CONCLUSION: High-dose intravaginal misoprostol did not reduce the Cesarean section rate and was associated with a greater hazard of fetal intolerance of labor.

Short forms of the Benton Judgment of Line Orientation Test: development and psychometric properties.

The Benton Judgment of Line Orientation Test (BJLOT) is a widely used neuropsychological test measuring visuospatial judgment. The present study developed two 15-item short forms using data from 100 neurologic patients. The new short forms are equivalent in test construction and retain the stimulus properties of the original test. Correlational analyses revealed that each short form score related significantly to the original BJLOT (p <.001). The short forms were found to be internally consistent, with alpha reliability coefficients exceeding .82. Although kappa coefficient analyses found the short forms to lack sufficient accuracy in categorizing the cases via the BJLOT diagnostic classifications, the short forms were accurate in detecting the presence of impairment. These results suggest that the two short forms can be utilized as screening instruments for detecting the presence or absence of visuospatial impairment.