Objective: To compare labor induction with transcervical catheter to oral misoprostol treatment in primiparous women and women with an unripe cervix, who are at high risk for unsuccessful labor induction. Study Design...Objective: To compare labor induction with transcervical catheter to oral misoprostol treatment in primiparous women and women with an unripe cervix, who are at high risk for unsuccessful labor induction. Study Design: A retrospective study was carried out in a university hospital in Sweden. Primary outcomes were vaginal birth within 24 hours and the cesarean section rate. Secondary outcomes were the induction to vaginal delivery interval, chorioamnionitis and neonatal asphyxia. Results: Vaginal birth within 24 hours was obtained more frequently after catheter compared with misoprostol in primiparous women (p < 0.001) and women with Bishop scores 3 - 4 (p < 0.001), but not in women with Bishop scores 0 - 2 (p = 0.07). The cesarean section rates were comparable in all groups (p > 0.05). The induction to vaginal delivery interval was 8 - 12 hours shorter after catheter (p < 0.001). The rates of chorioamnionitis and newborns with an Apgar score 0.05). Conclusion: Labor induction with transcervical catheter resulted in a higher rate of vaginal birth within 24 hours and an 8 - 12 hour shorter induction to vaginal delivery interval compared to treatment with oral misoprostol. This was obtained without increasing the rates of cesarean section, chorioamnionitis or neonatal asphyxia.展开更多
Prostaglandins (PGs) mediate cervical ripening leading to parturition. PGs are used successfully to induce cervical ripening. However, the cell type specific expression of PG receptor subtypes and various stromal fact...Prostaglandins (PGs) mediate cervical ripening leading to parturition. PGs are used successfully to induce cervical ripening. However, the cell type specific expression of PG receptor subtypes and various stromal factors important for cervical ripening in human cervix is not known. Our objective was to investigate the expression and localization of PG receptors EP1-4 and FP and localization of stromal factors CTGF (connective tissue growth factor), furin, calgranulin ?B, ALOX12 (arachidonate 12-lipooxy-genase) and ALOX15 in human cervical tissue from pregnant and non-pregnant women. Cervical biopsies were obtained from non-pregnant (NP), term pregnant (TP) and post-partum (PP) women. The mRNA expression was determined with real-time PCR, protein expression and localization with immunohistochemistry. Our results show that the EP2 mRNA level was higher in the PP group as compared to TP, whereas the EP4 mRNA level was lower in the TP group as compared to NP. Concomitantly stromal EP2 and epithelial EP3 immunoreactivity was higher in the TP as compared to the NP group, while the EP4 immunostaining in glands was lower in the TP as compared to the PP group. Immunostaining of endothelial CTGF, smooth muscle furin and ALOX12, were all lower in the TP group as compared to NP, for CTGF also the PP group was lower than NP. Endothelial calgranulin B immunoreactivity was higher in the PP group than the NP group. PG receptors and stromal factors exhibit differential expression in the cervix from women in non-pregnant and pregnant states, implying their involvement in the process of cervical ripening.展开更多
文摘Objective: To compare labor induction with transcervical catheter to oral misoprostol treatment in primiparous women and women with an unripe cervix, who are at high risk for unsuccessful labor induction. Study Design: A retrospective study was carried out in a university hospital in Sweden. Primary outcomes were vaginal birth within 24 hours and the cesarean section rate. Secondary outcomes were the induction to vaginal delivery interval, chorioamnionitis and neonatal asphyxia. Results: Vaginal birth within 24 hours was obtained more frequently after catheter compared with misoprostol in primiparous women (p < 0.001) and women with Bishop scores 3 - 4 (p < 0.001), but not in women with Bishop scores 0 - 2 (p = 0.07). The cesarean section rates were comparable in all groups (p > 0.05). The induction to vaginal delivery interval was 8 - 12 hours shorter after catheter (p < 0.001). The rates of chorioamnionitis and newborns with an Apgar score 0.05). Conclusion: Labor induction with transcervical catheter resulted in a higher rate of vaginal birth within 24 hours and an 8 - 12 hour shorter induction to vaginal delivery interval compared to treatment with oral misoprostol. This was obtained without increasing the rates of cesarean section, chorioamnionitis or neonatal asphyxia.
文摘Prostaglandins (PGs) mediate cervical ripening leading to parturition. PGs are used successfully to induce cervical ripening. However, the cell type specific expression of PG receptor subtypes and various stromal factors important for cervical ripening in human cervix is not known. Our objective was to investigate the expression and localization of PG receptors EP1-4 and FP and localization of stromal factors CTGF (connective tissue growth factor), furin, calgranulin ?B, ALOX12 (arachidonate 12-lipooxy-genase) and ALOX15 in human cervical tissue from pregnant and non-pregnant women. Cervical biopsies were obtained from non-pregnant (NP), term pregnant (TP) and post-partum (PP) women. The mRNA expression was determined with real-time PCR, protein expression and localization with immunohistochemistry. Our results show that the EP2 mRNA level was higher in the PP group as compared to TP, whereas the EP4 mRNA level was lower in the TP group as compared to NP. Concomitantly stromal EP2 and epithelial EP3 immunoreactivity was higher in the TP as compared to the NP group, while the EP4 immunostaining in glands was lower in the TP as compared to the PP group. Immunostaining of endothelial CTGF, smooth muscle furin and ALOX12, were all lower in the TP group as compared to NP, for CTGF also the PP group was lower than NP. Endothelial calgranulin B immunoreactivity was higher in the PP group than the NP group. PG receptors and stromal factors exhibit differential expression in the cervix from women in non-pregnant and pregnant states, implying their involvement in the process of cervical ripening.
