A randomized, double-blind trial of prostaglandin E2 gel for cervical ripening and meta-analysis

Article Abstract:

When labor is induced, the ripening of the cervix (softening and dilation) is critical for success. Research evidence indicates that prostaglandin E2 (PGE2) gel facilitates cervical ripening, but it is not clear that the use of this substance reduces the rate of cesarean section. To learn more about the effectiveness of PGE2, a study was carried out with 100 pregnant women who underwent labor induction. The women were randomly assigned to receive either PGE2 gel (47 patients) or a placebo gel (53 patients), which was inserted into the cervical canal. The patients were monitored for 12 hours and the cervix was again examined. If labor had started, this second examination was omitted. If sufficient cervical change had not taken place, labor was induced with oxytocin, and a cesarean delivery performed if the induction failed (if contractions did not reach a satisfactory level within 12 hours). Three patients in each group experienced spontaneous, uncomplicated labor during the 12-hour waiting period. The rate of cesarean section was similar in each group (28 percent in the PGE2 group and 30 percent in the placebo group), and cesarean section were required for similar reasons in the two groups. A review of the medical literature concerning PGE2 included 18 reports that had used a randomized, controlled design and met certain other criteria. The studies involved 1,811 patients who had received PGE2. No decrease was seen in the cesarean section rate in these studies due to the use of PGE2. Thus, results from both the current study and the meta-analysis of the literature do not support the use of PGE2 for cervical ripening. Because this substance has side effects, it is not recommended for use before the induction of labor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Drug therapy, Labor, Induced (Obstetrics), Induced labor, Prostaglandins E

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A prospective randomized study of saline solution amnioinfusion

Article Abstract:

A decreased amount of fluid surrounding the fetus during pregnancy occurs in a variety of pregnancy complications. Amnioinfusion is a method of adding saline (salt) solution to the space surrounding the fetus. It is used to treat pregnancies complicated by premature rupture of the amniotic membrane containing the fluid, pregnancies lasting beyond 42 weeks, variable fetal heart rate decelerations and decreased amniotic fluid associated with fetal growth retardation. A decreased amount of amniotic fluid can cause fetal umbilical cord compression, which affects the fetal heart rate and results in fetal distress. The incidence of operative delivery caused by fetal distress in labor was studied among 43 patients receiving amnioinfusion and 57 not receiving amnioinfusion. Patients having amnioinfusion had a lower incidence of endometritis (swelling caused by infection of the uterus after delivery) and a lower cesarean section rate due to fetal distress than patients not having the saline infusion. The technique of infusing saline solution is easily accomplished, relatively inexpensive and safe in the laboring patient with a decreased amount of amniotic fluid. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Dosage and administration, Fetal distress, Amniotic fluid, Physiologic salines, Saline solution

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Management options in women with preterm uterine contractions: a randomized clinical trial

Article Abstract:

Fluid therapy does not appear to be any more effective than terbutaline treatment for women with premature contractions and is less cost-effective. Length of time in the hospital, later complications, and hospital costs were compared for 179 women with premature contractions but no evidence of advancing labor treated with either terbutaline, fluid therapy, or observation. Contractions stopped and women were released from the hospital 6.0 hours after fluid therapy, 5.2 hrs after observation alone, and 4.1 hrs after terbutaline therapy. Complications were similar for all groups. Costs were highest for fluid therapy.

Care and treatment, Premature labor, Fluid therapy, Terbutaline

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