OBJECTIVE: To compare the efficacy, side effects, and complications of high-dose vaginal misoprostol with concentrated intravenous oxytocin plus low-dose vaginal prostaglandin (PGE2) for second-trimester labor inducti...OBJECTIVE: To compare the efficacy, side effects, and complications of high-dose vaginal misoprostol with concentrated intravenous oxytocin plus low-dose vaginal prostaglandin (PGE2) for second-trimester labor induction. METHODS: One hundred twenty-six consenting women with maternal or fetal indications for pregnancy termination and no prior cesarean delivery were randomly assigned to receive either vaginal misoprostol 600 μg1 ×, 400 μg every 4 hours 5×.(misoprostol group, n = 60) or escalating-dose concentrated oxytocin infusions (277-1,667 mU/min) plus vaginal PGE2 10 mg every 6 hours 4×. (oxytocin group, n = 66). Both groups received concurrent extra-amniotic saline infusion for cervical ripening. Women who failed their assigned regimen received 20 mg of PGE2 suppositories every 4 hours until delivery. Analysis was by intent to treat. RESULTS: Demographic characteristics were similar between study groups. Median induction-to-delivery interval was significantly shorter in the misoprostol group (12 hours) than in the oxytocin group (17 hours; P < .001). There was a higher induction success rate at 24 hours in the misoprostol group (95%) than in the oxytocin group (85%; P = .06), although this difference did not reach statistical significance. The incidence of live birth (25%versus 17%), chorioamnionitis (5%versus 2%), and postpartum hemorrhage greater than 500 mL (3%versus 3%) were similar between the misoprostol and oxytocin groups, respectively. Diarrhea (2%versus 11%; P = .04), nausea/emesis (25%versus 42%; P = .04), and retained placenta requiring curettage (2%versus 15%; P = .008) were significantly less common in the misoprostol group when compared with the oxytocin group, respectively. Isolated intrapartum fever, however, was more frequent in the misoprostol group (67%) than in the oxytocin group (21%; P < .001). CONCLUSION: Compared with concentrated oxytocin plus low-dose vaginal PGE2, high-dose vaginal misoprostol is associated with significantly shorter induction-to-delivery intervals, fewer side effects, a lower incidence of retained placenta, and comparable incidence of live birth.展开更多
We sought to determine whether midtrimester amniotic fluid levels of matrix metalloproteinase- 8 were associated with subsequent preterm premature rupture of membranes. We conducted a case- control study examining 57 ...We sought to determine whether midtrimester amniotic fluid levels of matrix metalloproteinase- 8 were associated with subsequent preterm premature rupture of membranes. We conducted a case- control study examining 57 asymptomatic women who underwent genetic amniocentesis from 14 to 21 weeks’ gestation and subsequently had preterm premature rupture of membranes (< 35 wk) and 58 women with subsequent term delivery. Measurement of total matrix metalloproteinase- 8 level in amniotic fluid was conducted using a commercially available enzyme- linked immunosorbent assay and association with preterm birth due to preterm premature rupture of membranes was assessed. The overall distribution of matrix metalloproteinase- 8 concentrations was similar in women who had preterm premature rupture of membranes and term controls (median 2.39 ng/mL, 25th to 75th percentile 1.1- 10.1 vs 2.37 ng/mL, 25th to 75th percentile 1.5- 4.7, P =. 94). However, 26% of women who had preterm premature rupture of membranes had a matrix me- talloproteinase- 8 concentration above the 90th percentile (8.7 ng/mL), compared with only 10% of term controls (odds ratio 3.1, 95% CI 1.1- 8.7; P =. 03). Elevated matrix metallopro- teinase- 8 remained associated with preterm premature rupture of membranes after adjustment for maternal age, race, parity, gestational age, and year of amniocentesis (odds ratio 3.4, 95% CI 1.2- 9.9; P =. 03). The overall distribution of midtrimester amniotic fluid matrix metalloproteinase- 8 levels did not differ between women who had preterm premature rupture of membranes and those delivered at term. However, marked elevations of midtrimester amniotic fluid matrix metalloproteinase- 8 were highly associated with subsequent preterm premature rupture of membranes, suggesting that the pathophysiologic processes that contribute to preterm premature rupture of membranes may begin in early pregnancy.展开更多
文摘OBJECTIVE: To compare the efficacy, side effects, and complications of high-dose vaginal misoprostol with concentrated intravenous oxytocin plus low-dose vaginal prostaglandin (PGE2) for second-trimester labor induction. METHODS: One hundred twenty-six consenting women with maternal or fetal indications for pregnancy termination and no prior cesarean delivery were randomly assigned to receive either vaginal misoprostol 600 μg1 ×, 400 μg every 4 hours 5×.(misoprostol group, n = 60) or escalating-dose concentrated oxytocin infusions (277-1,667 mU/min) plus vaginal PGE2 10 mg every 6 hours 4×. (oxytocin group, n = 66). Both groups received concurrent extra-amniotic saline infusion for cervical ripening. Women who failed their assigned regimen received 20 mg of PGE2 suppositories every 4 hours until delivery. Analysis was by intent to treat. RESULTS: Demographic characteristics were similar between study groups. Median induction-to-delivery interval was significantly shorter in the misoprostol group (12 hours) than in the oxytocin group (17 hours; P < .001). There was a higher induction success rate at 24 hours in the misoprostol group (95%) than in the oxytocin group (85%; P = .06), although this difference did not reach statistical significance. The incidence of live birth (25%versus 17%), chorioamnionitis (5%versus 2%), and postpartum hemorrhage greater than 500 mL (3%versus 3%) were similar between the misoprostol and oxytocin groups, respectively. Diarrhea (2%versus 11%; P = .04), nausea/emesis (25%versus 42%; P = .04), and retained placenta requiring curettage (2%versus 15%; P = .008) were significantly less common in the misoprostol group when compared with the oxytocin group, respectively. Isolated intrapartum fever, however, was more frequent in the misoprostol group (67%) than in the oxytocin group (21%; P < .001). CONCLUSION: Compared with concentrated oxytocin plus low-dose vaginal PGE2, high-dose vaginal misoprostol is associated with significantly shorter induction-to-delivery intervals, fewer side effects, a lower incidence of retained placenta, and comparable incidence of live birth.
文摘We sought to determine whether midtrimester amniotic fluid levels of matrix metalloproteinase- 8 were associated with subsequent preterm premature rupture of membranes. We conducted a case- control study examining 57 asymptomatic women who underwent genetic amniocentesis from 14 to 21 weeks’ gestation and subsequently had preterm premature rupture of membranes (< 35 wk) and 58 women with subsequent term delivery. Measurement of total matrix metalloproteinase- 8 level in amniotic fluid was conducted using a commercially available enzyme- linked immunosorbent assay and association with preterm birth due to preterm premature rupture of membranes was assessed. The overall distribution of matrix metalloproteinase- 8 concentrations was similar in women who had preterm premature rupture of membranes and term controls (median 2.39 ng/mL, 25th to 75th percentile 1.1- 10.1 vs 2.37 ng/mL, 25th to 75th percentile 1.5- 4.7, P =. 94). However, 26% of women who had preterm premature rupture of membranes had a matrix me- talloproteinase- 8 concentration above the 90th percentile (8.7 ng/mL), compared with only 10% of term controls (odds ratio 3.1, 95% CI 1.1- 8.7; P =. 03). Elevated matrix metallopro- teinase- 8 remained associated with preterm premature rupture of membranes after adjustment for maternal age, race, parity, gestational age, and year of amniocentesis (odds ratio 3.4, 95% CI 1.2- 9.9; P =. 03). The overall distribution of midtrimester amniotic fluid matrix metalloproteinase- 8 levels did not differ between women who had preterm premature rupture of membranes and those delivered at term. However, marked elevations of midtrimester amniotic fluid matrix metalloproteinase- 8 were highly associated with subsequent preterm premature rupture of membranes, suggesting that the pathophysiologic processes that contribute to preterm premature rupture of membranes may begin in early pregnancy.