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Induction of Labor With Misoprostol
cians perform some type of assisted vaginal delivery. Although only 57% of the respondents in this study were trained in vacuum use during residency, 75% perform the procedure. Instruction in forceps delivery is important because those who do not master the skill during residency are not likely to become proficient in this technique in private practice.
Operative Vaginal Delivery Bofill JA, Rust OA, Perry KG, Roberts WE, Martin RW, Morrison JC. Operative vaginal delivery: A survey of Fellows ofACOG. Obstet Gynecol 1996;88:1007-10.
Induction of labor With Misoprostol
Synopsis: To document operative vaginal delivery rates and determine patterns with regard to midpelvic delivery and deep transverse arrest stratified by time elapsed since residency training, the authors sampled 1600 ACOG Fellows from all states. The resultant study group, which comprised 558 respondents who still practice obstetrics, was divided into three subgroups based on time since residency training: recent (5 10 years), intermediate (1 l-20 years), and remote (>20 years). The majority of respondents (61%) had an operative vaginal delivery rate of 5 15%. Of these, 25% use only the obstetric forceps, whereas 14% use vacuum exclusively for their operative vaginal deliveries. Overall, 5 1% of the respondents use forceps more often than vacuum; the remainder use vacuum more frequently than forceps. Of the 41% of Fellows who reported they still perform midpelvic deliveries, 52% prefer forceps and 48% use vacuum extraction. With regard to deep transverse arrest, there was no consensus on management, but the largest proportion of respondents, 42%, would attempt delivery with vacuum assistance. Twenty-six percent would attempt a forceps delivery, and 25% would proceed directly to cesarean delivery. For midpelvic delivery, the most recently trained physicians prefer the vacuum, whereas the more remotely trained Fellows use forceps more often.
Young D, Bennett K, Butt K, Mundle W, Windrim R. Induction of labour with misoprostol-A review. J !hc Obstet Gynaecol Can 1996;18:1153-7.
. . .
Commentary: Misoprostol, marketed in the U.S. for prevention and treatment of gastric and duodenal ulcers, has been used in combination with mifepristone or methotrexate for
Commentary: Operative vaginal delivery is an important part of modern obstetric practice, and most obstetri-
Synopsis: The authors reviewed articles reporting on the use of misoprosto1 for induction of labor at term. In their own randomized clinical trial of 222 patients in which they compared vaginal misoprostol, 50 Fg every 4 hours, with a standard induction protocol, they found the misoprostol group had a 3-hour decrease in time to vaginal delivery and less need for oxytocin augmentation, with no differences in cesarean delivery rates, maternal interventions, or neonatal adverse outcomes. In a subsequent meta-analysis of published randomized trials involving >6OO women, misoprostol was associated with more frequent vaginal births within 12 hours (relative risk [RR]= 1.60) and within 24 hours (RR= 1.36). Oxytocin use was reduced with misoprostol (RR=0.53), and no significant changes in low 5-minute Apgar scores or rate of neonatal acidosis was found with misoprostol. In another randomized trial of 275 women that compared misoprosto1 and intracervical or vaginal dinoprostone for labor induction, there was no difference in the time from induction to vaginal birth using either drug.
. . .
first-trimester pregnancy termination and as single-agent therapy for second-trimester pregnancy termination. A number of studies support the use of vaginal misoprostol as an effective, safe, and less-expensive alternative to approved prostaglandin agents for induction of labor. An issue raised in several reports using vaginal misoprostol for labor induction has been the incidence of uterine hyperstimulation. Although the authors claim that substantive worrisome newborn outcomes have been rare, acceptable, and not different between misoprostol and control groups, the use of vaginal misoprostol warrants further clinical investigation before becoming standard practice.
Seat-Belt Use During Pregnancy Pearlman MD, Phillips ME. during pregnancy. Obstet 88:1026-9.
Safety belt use
Gynecol 1996;
Synopsis: In this study, 350 pregnant women at the first prenatal visit were asked to complete a survey about seatbelt use during pregnancy. Attitude toward and usage of lap and shoulder belts were assessed. The survey was repeated at 28-32 weeks’ gestation. Both surveys were completed by 298 women (85.1%). The frequency of seat-belt use reported during pregnancy was always (44.6%), usually (22.5%), sometimes (lO.l%), rarely (13.1%), and never (9.7%). Of 68 women who rarely or never used seat belts, discomfort or inconvenience (48.5%), habit of never using seat belts (29.4%), and fear of hurting the baby (16.2%) were cited as the main reasons. Proper seat-belt placement was used by 68% of the women at the second survey, significantly more than at the first survey (53%). Of the women completing both surveys, 55% stated that they had received some information on seat-belt use in pregnancy. These women were more likely to use seat belts than those who received no information (X.001) and were more likely to identify proper seat-belt position (Pc.001).
Operative Vaginal Delivery Bofill JA, Rust OA, Perry KG, Roberts WE, Martin RW, Morrison JC. Operative vaginal delivery: A survey of Fellows ofACOG. Obstet Gynecol 1996;88:1007-10.
Induction of labor With Misoprostol
Synopsis: To document operative vaginal delivery rates and determine patterns with regard to midpelvic delivery and deep transverse arrest stratified by time elapsed since residency training, the authors sampled 1600 ACOG Fellows from all states. The resultant study group, which comprised 558 respondents who still practice obstetrics, was divided into three subgroups based on time since residency training: recent (5 10 years), intermediate (1 l-20 years), and remote (>20 years). The majority of respondents (61%) had an operative vaginal delivery rate of 5 15%. Of these, 25% use only the obstetric forceps, whereas 14% use vacuum exclusively for their operative vaginal deliveries. Overall, 5 1% of the respondents use forceps more often than vacuum; the remainder use vacuum more frequently than forceps. Of the 41% of Fellows who reported they still perform midpelvic deliveries, 52% prefer forceps and 48% use vacuum extraction. With regard to deep transverse arrest, there was no consensus on management, but the largest proportion of respondents, 42%, would attempt delivery with vacuum assistance. Twenty-six percent would attempt a forceps delivery, and 25% would proceed directly to cesarean delivery. For midpelvic delivery, the most recently trained physicians prefer the vacuum, whereas the more remotely trained Fellows use forceps more often.
Young D, Bennett K, Butt K, Mundle W, Windrim R. Induction of labour with misoprostol-A review. J !hc Obstet Gynaecol Can 1996;18:1153-7.
. . .
Commentary: Misoprostol, marketed in the U.S. for prevention and treatment of gastric and duodenal ulcers, has been used in combination with mifepristone or methotrexate for
Commentary: Operative vaginal delivery is an important part of modern obstetric practice, and most obstetri-
Synopsis: The authors reviewed articles reporting on the use of misoprosto1 for induction of labor at term. In their own randomized clinical trial of 222 patients in which they compared vaginal misoprostol, 50 Fg every 4 hours, with a standard induction protocol, they found the misoprostol group had a 3-hour decrease in time to vaginal delivery and less need for oxytocin augmentation, with no differences in cesarean delivery rates, maternal interventions, or neonatal adverse outcomes. In a subsequent meta-analysis of published randomized trials involving >6OO women, misoprostol was associated with more frequent vaginal births within 12 hours (relative risk [RR]= 1.60) and within 24 hours (RR= 1.36). Oxytocin use was reduced with misoprostol (RR=0.53), and no significant changes in low 5-minute Apgar scores or rate of neonatal acidosis was found with misoprostol. In another randomized trial of 275 women that compared misoprosto1 and intracervical or vaginal dinoprostone for labor induction, there was no difference in the time from induction to vaginal birth using either drug.
. . .
first-trimester pregnancy termination and as single-agent therapy for second-trimester pregnancy termination. A number of studies support the use of vaginal misoprostol as an effective, safe, and less-expensive alternative to approved prostaglandin agents for induction of labor. An issue raised in several reports using vaginal misoprostol for labor induction has been the incidence of uterine hyperstimulation. Although the authors claim that substantive worrisome newborn outcomes have been rare, acceptable, and not different between misoprostol and control groups, the use of vaginal misoprostol warrants further clinical investigation before becoming standard practice.
Seat-Belt Use During Pregnancy Pearlman MD, Phillips ME. during pregnancy. Obstet 88:1026-9.
Safety belt use
Gynecol 1996;
Synopsis: In this study, 350 pregnant women at the first prenatal visit were asked to complete a survey about seatbelt use during pregnancy. Attitude toward and usage of lap and shoulder belts were assessed. The survey was repeated at 28-32 weeks’ gestation. Both surveys were completed by 298 women (85.1%). The frequency of seat-belt use reported during pregnancy was always (44.6%), usually (22.5%), sometimes (lO.l%), rarely (13.1%), and never (9.7%). Of 68 women who rarely or never used seat belts, discomfort or inconvenience (48.5%), habit of never using seat belts (29.4%), and fear of hurting the baby (16.2%) were cited as the main reasons. Proper seat-belt placement was used by 68% of the women at the second survey, significantly more than at the first survey (53%). Of the women completing both surveys, 55% stated that they had received some information on seat-belt use in pregnancy. These women were more likely to use seat belts than those who received no information (X.001) and were more likely to identify proper seat-belt position (Pc.001).