Induction of labor with pulsatile oxytocin

Article Abstract:

Oxytocin, the pituitary hormone which causes uterine contraction, is often given as a continuous intravenous treatment to induce or augment labor. Complications associated with this treatment have included uterine hyperstimulation, fetal distress, and increased neonatal bilirubin levels, and these apparently are related to dosage. Oxytocin is secreted by the pituitary in pulses, and administering the substance in this way may provide for a better response and outcome. The effectiveness and safety of pulsatile intravenous oxytocin therapy in 50 women was compared with continuous intravenous administration in 56 women, all of whom needed induction of labor. The induction-to-delivery time was similar in both groups, with no difference noted in uterine hyperstimulation, use of pain medication, or epidural anesthesia. Six percent of the infants in the pulsed group and 12.5 percent of those in the continuous group were delivered by cesarean section. There were no differences among newborns in birth weight, Apgar score (an index of fetal well-being), or blood acidity. Among infants with hyperbilirubinemia, those in the continuous group were an average of two weeks older in terms of gestational age and tended to have a significantly higher birth weight and level of bilirubin. The pulsed group received less oxytocin, independent of the induction-to-delivery time. The study suggests that pulsed oxytocin is as safe and effective as continuously administered oxytocin and may provide a better margin of safety in high-risk conditions, since lower doses were needed. In addition, pulsed oxytocin may be less likely to result in hyperbilirubinemia among term infants, but more research on these effects are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration, Oxytocin

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Induction of labor with mifepristone (RU 486) in intrauterine fetal death

Article Abstract:

Intrauterine death of the fetus is a common and serious complication of pregnancy, which causes psychological distress and adverse physiological effects as well. Hence, clinicians try to expel the fetus from the uterus by inducing labor with prostaglandins. However, these naturally occurring substances have adverse side effects and cannot be used under certain conditions. Mifepristone, also known as RU 486, is a steroid drug that prevents the actions of the female hormone progesterone and the adrenal glucocorticoid hormones. This drug has been used to induce abortion in the first trimester of pregnancy, and can induce labor after fetal death. The effectiveness of and tolerance to mifepristone in inducing labor was assessed in patients with intrauterine fetal deaths; 46 women were given mifepristone and 48 women (controls) were given an inert placebo. The drug was considered effective if the fetus was expelled from the uterus within 72 hours after starting treatment with mifepristone at a dose of 600 milligrams per day for two days. Treatment with mifepristone was effective in 29 of 46 patients (63 percent), whereas spontaneous labor occurred in only eight of 48 patients (17 percent) given a placebo. Mifepristone was well tolerated. One woman who was given a placebo developed widespread coagulation (clotting) within the blood vessels. These findings show that mifepristone may be a useful alternative to prostaglandins in the management of intrauterine fetal death. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Mifepristone, Fetal death

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A randomized clinical trial comparing misoprostol with prostaglandin E2 gel for preinduction cervical ripening

Article Abstract:

A single dose of misoprostol may be more efficient in inducing and shortening the length of labor than a dose of prostaglandin E2 (PGE2) gel. Seventy-five women requiring softening and thinning of the cervix before labor inducement were treated with either misoprostol or PGE2. Average labor time in misoprostol-treated women was 14.7 hours compared with 20.4 hours in the group treated with PGE2. Only 58% of the women using misoprostol required further labor inducement with oxytocin, contrasted with 81% using PGE2. Misoprostol, a synthetic prostaglandin, costs far less than PGE2.

Health aspects, Misoprostol, Prostaglandins E

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