Risk factors associated with uterine rupture during trial of labor after cesarean delivery: a case-control study

Article Abstract:

Several different factors can increase the risk of uterine rupture during labor in women who have had a prior cesarean section. Patients who attempt a vaginal delivery after a prior cesarean section should be monitored closely during labor. A study compared 70 patients with uterine rupture during labor after a prior cesarean section to 70 patients who had a successful vaginal delivery after a prior cesarean section (control group). Thirty-three percent of the patients with uterine rupture had two or more prior cesarean sections, compared with 16% of the control group patients. Seventy-seven percent of the women with uterine rupture were treated with oxytocin, compared with 56% of those in the control group. Oxytocin is a drug used for labor induction and augmentation. Dysfunctional labor occurred in 44% of the patients with uterine rupture, compared with 10% of the control group patients.

Complications and side effects, Labor (Obstetrics), Uterus, Vaginal birth after cesarean, Uterine perforation

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Misoprostol: an effective agent for cervical ripening and labor induction

Article Abstract:

The drug misoprostol may be as effective and safe as dinoprostone at ripening the cervix in preparation for induction of labor. Researchers compared the effectiveness of 25 micrograms of misoprostol vaginally administered every three hours for up to eight doses with 0.5 milligrams of dinoprostone (prostaglandin E2) gel applied to the cervix every six hours for up to three doses in 276 patients. More women receiving misoprostol (65.5%) accomplished vaginal delivery than did those receiving dinoprostone (41.4%). Patients receiving misoprostol had a shorter interval from the start of induction to delivery and used less oxytocin. The dosage of misoprostol produced rapid rates of uterine contractions in 24 cases; this rate was considered acceptable.

Physiological aspects, Cervix uteri, Labor, Induced (Obstetrics), Induced labor, Misoprostol, Prostaglandins E, Incompetent cervix

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Management of the symptomatic placenta previa: a randomized, controlled trial of inpatient versus outpatient expectant management

Article Abstract:

Selected patients experiencing bleeding from placenta previa may not need hospitalization. In placenta previa, the placenta lies over the cervix. Researchers randomly assigned half a group of 39 women admitted to the hospital at 24 to 36 weeks gestation with vaginal bleeding due to placenta previa to hospital care and monitoring and half to home care and outpatient monitoring. Over 60% had subsequent bleeding and 26 women had emergency cesareans. No differences were seen in maternal or newborn outcomes. However, while outpatient care saved money, the study comprised so few women that conclusions about safety cannot be drawn.

Care and treatment, Innovations, Prenatal care, Ambulatory medical care, Ambulatory care, Placenta praevia, Placenta previa

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