Does prostaglandin confer significant advantage over oxytocin infusion for nulliparas with pre-labor rupture of membranes at term?

Article Abstract:

A delay in delivery after premature rupture of the fetal membranes (PROM) has been associated with disability or death of the mother or infant. The pituitary hormone oxytocin, which causes the uterus to contract, thereby stimulating childbirth, is used to induce labor in women with PROM. However, oxytocin may not be as effective in nulliparous women with an unripe cervix. These are women who have not been pregnant before and do not show any sign, as indicated by the condition of the cervix, of impending labor. Such patients may experience longer and more difficult labor, require greater amounts of oxytocin, and have an increased incidence of cesarean section. Studies show that application of prostaglandin E2 (PGE2) preparations directly to the vagina is effective in inducing labor, and consequently reducing incidence of cesarean deliveries in women with unfavorable cervix without increasing the risk of infection. The effects of PGE2 and oxytocin on rates of cesarean section and the incidence of infection were compared in 94 nulliparous women with unfavorable cervices and PROM. The duration between start of treatment and onset of labor was longer for PGE2-treated patients than for oxytocin-treated women. The duration of labor, rates of cesarean section, physical condition of the infant, admission to newborn intensive care units, and incidence of infection in the mother and child were similar for both groups. Patients treated with oxytocin required higher doses of drug than those treated with PGE2. Cesarean sections were required due to inability to induce labor in seven oxytocin-treated patients and seven PGE2-treated patients. The incidence of infection was low. These findings show that PGE2 treatment to induce labor did not produce any additional benefit over oxytocin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Prostaglandins

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Oxytocin augmentation in dysfunctional labour after previous caesarean section

Article Abstract:

Patients having had a cesarean delivery are now offered a trial of labor for a potential vaginal delivery at their next pregnancy, but this effort is generally stopped when labor fails to progress. In patients without a history of cesarean section labor can be induced artificially by administration of a synthetic form of the hormone oxytocin which is responsible for uterine muscle contractions during labor. However, caution has surrounded the use of oxytocin during a trial of labor because of the possibility of scar rupture, i.e., uterine rupture. Measurements of uterine activity were made before and after oxytocin induction in 63 women with cesarean uterine scars whose labors were progressing slowly (dysfunctional labor). Prior to administering oxytocin, the amplitude of uterine activity was lower than that found in other women who had cesarean scars but normally progressing labor. Twenty- two percent of the 63 patients ultimately required repeat cesarean section because of cephalopelvic disproportion (the mother's pelvis can not accommodate the size of the baby's head). These patients required longer durations and higher doses of oxytocin, their babies were larger by weight and the amount of cervical dilatation achieved was much less than the 78 per cent of patients who, after induction with oxytocin, had good labor progress as measured by cervical dilatation (cervical opening to accommodate the fetus). Researchers conclude that a favorable outcome can be predicted by effective cervical dilatation with satisfactory uterine activity when oxytocin is used for patients who have dysfunctional labor after a cesarean birth.

Causes of

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Uterine activity during spontaneous labour after previous lower- segment caesarean section

Article Abstract:

It was previously assumed that once a woman had a cesarean section (surgical incision through the abdominal wall and the uterine muscle) she would need to have all subsequent births in the same manner. Recent studies prove that vaginal deliveries after a cesarean section are successful and safe. It is suggested that the amount and strength of uterine activity during labor contractions may influence the integrity of a cesarean scar and help to determine patients who will be good candidates for a trial of labor and vaginal delivery. Uterine activity was measured and compared in women during first and subsequent pregnancies with and without a history of cesarean section. It was found that if the previous pregnancy advanced into the later active stage of labor prior to cesarean section (as opposed to having the section performed early in labor), the uterine activity and force on the surgical scar were reduced in the subsequent pregnancy. In patients who had a vaginal delivery in a pregnancy before or after the cesarean delivery, uterine activity measurements were similar to those of the control patients who had more than one pregnancy but no cesarean births, i.e., no uterine scar. It is suggested that an intact uterine scar does not effect uterine function if the previous delivery was a vaginal delivery.

Care and treatment, Complications and side effects, Labor (Obstetrics)

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