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Prostaglandin E2 gel for cervical ripening and induction of labor: A critical analysis
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Citations from the Literature
eral prenatal clinic, and their infants. On the basis of either interviews or urine assays conducted prenatally or post partum, 27 percent of the subjects had used marijuana during pregnancy and 18 percent had used cocaine. When only positive urine assays were considered, the corresponding values were 16 percent and 9 percent, respectively. When potentially confounding variables were controlled for in the analysis, the infants whose mothers had positive urine assays for marijuana, as compared with the infants whose mothers were negative according to both interviews and urine assays, had a 79-g decreased in birth weight (P = 0.04) and a 0.5~cm decrement in length (P = 0.02). Women who had positive assays for cocaine, as compared with non-users, had infants with a 93-g decrease in birth weight (P = 0.07), and 0.7-cm decrement in length (P = O.Ol), and a 0.43-cm-smaller head circumference (P = 0.01). To compare our findings with those of other investigators who did not use urine assays, we repeated the analyses, considering only self-reported use of marijuana (23 percent) and cocaine (13 percent). There were no significant associations between such use as determined by interviews alone and any of the measures of outcome. We conclude that the use of marijuana or cocaine during pregnancy is associated with impaired fetal growth and the measuring a biologic marker of such use is important to demonstrate the association.
Socio-economic status and pregnancy outcome. An Australian study Morrison J; Najman JM; Williams GM; Keeping JD; Andersen MJ Department of Obstetrics and Gynaecology, University of Queensland, South Brisbane, QLD; Australia British Journal of Obstetrics and Gynaecology/%/3 (298307)/1989/ A prospective cohort of 8556 pregnant women attending the Mater Misericordiae Mothers’ Hospital in Brisbane was examined to consider the impact of socio-economic status on pregnancy outcome. The indicators of socio-economic status selected were family income, maternal education and paternal occupational status. Pregnancy outcomes considered were preterm delivery, low birthweight, low birthweight for gestational age, and perinatal death. Subsidiary analyses were also undertaken for Apgar scores, time to establish respiration, need for mechanical respiration and admission to intensive care. Before adjustment, the main consistent association was between the occupational status of the father and three measures of perinatal morbidity. Initial adjustment of the mother’s socio-demographic background and weight/height ratio reduced the strength and statistical significance of the above associations, while further adjustment for lifestyle variatibns between the three status groups further reduced the above associations to marginal statistical significance. The findings suggest that observed class differences in pregnancy outcome are attributable to the mother’s personal characteristics (height/weight2, parity) and her lifestyle. Int J Gynecol Obstet 30
C-reactive protein in preterm labour: Association with outcome of tocolysis and placental histology Cammy H; Goossens A; Derde MP; Temmerman M; Foulon W; Amy JJ Academish Ziekenhuis, Vrije Universiteit Brussel, Department of Gynaecology, Andrology and Obstetrics, B-1090 Brussels; Belgium British Journal of Obstetrics and Gynaecology/%/3 (314319)/1989/ Tocolytics were administered in 66 consecutive women in uncomplicated preterm labour with intact fetal membranes (53 singleton and 13 twin pregnancies). C-reactive protein (CRP), a marker of infection, was determined daily and use retrospectively to investigate the role of subclinical infection in preterm labour and to predict the efficacy of tocolysis and the development of a clinical perinatal infection. CRP was also determined in 66 women in uncomplicated labour at term (53 singleton and 13 twin pregnancies). The placenta was examined for histological evidence of infection in all patients who were delivered before 36 weeks (n = 21) and in all women in the control group (n = 66). Elevated CRP levels were more often found in patients who were refractory to tocolysis, suggesting and underlying infectious morbidity. Placental infection was found in 62% of the preterm delivery group and in 12% of the control group. There was an association between elevated CRP levels and histological evidence of placental infection. However, confounding factors such as urinary tract infections limit the usefulness of the CRP test. Because CRP cannot predict clinical perinantal infection accurately, its clinical relevance is very limited. Prostagiandin E, gel for cervical ripening and induction of labor: A critical analysis Rayburn WF Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, NE 68105; USA American Journal of Obstetrics and Gynecology/l60/3 (529534)/1989/ This report summarizes the cumulative experience of 3,313 pregnancies represented in 59 prospective clinical trials in which intracervical or intravaginal prostaglandin E, gel was used for cervical ripening before induction of labor. Results indicate that local prostaglandin E, is superior to placebo or no therapy in enhancing cervical effacement and dilation, reducing initial induction failures, shortening the induction-delivery interval, reducing oxytocin use, and lowering the rate of cesarean section because of failure to progress. Certain advantages also exist for labor induction in the presence of a favorable cervical state. Uterine hyperstimulation or pathologic fetal heart rate patterns before oxytocin administration occur in < 1% of reported cases and are usually dose related, self contained, and reversible with the use of beta-adrenergic tocolytic therapy. Maternal systemic effects in these low doses are negligible. Worldwide clinical experience has clearly demonstrated that prostaglandin E, gel administered before induction of labor is of major therapeutic benefit andshould become commercially available for more than investigational use.
Citations from the Literature
eral prenatal clinic, and their infants. On the basis of either interviews or urine assays conducted prenatally or post partum, 27 percent of the subjects had used marijuana during pregnancy and 18 percent had used cocaine. When only positive urine assays were considered, the corresponding values were 16 percent and 9 percent, respectively. When potentially confounding variables were controlled for in the analysis, the infants whose mothers had positive urine assays for marijuana, as compared with the infants whose mothers were negative according to both interviews and urine assays, had a 79-g decreased in birth weight (P = 0.04) and a 0.5~cm decrement in length (P = 0.02). Women who had positive assays for cocaine, as compared with non-users, had infants with a 93-g decrease in birth weight (P = 0.07), and 0.7-cm decrement in length (P = O.Ol), and a 0.43-cm-smaller head circumference (P = 0.01). To compare our findings with those of other investigators who did not use urine assays, we repeated the analyses, considering only self-reported use of marijuana (23 percent) and cocaine (13 percent). There were no significant associations between such use as determined by interviews alone and any of the measures of outcome. We conclude that the use of marijuana or cocaine during pregnancy is associated with impaired fetal growth and the measuring a biologic marker of such use is important to demonstrate the association.
Socio-economic status and pregnancy outcome. An Australian study Morrison J; Najman JM; Williams GM; Keeping JD; Andersen MJ Department of Obstetrics and Gynaecology, University of Queensland, South Brisbane, QLD; Australia British Journal of Obstetrics and Gynaecology/%/3 (298307)/1989/ A prospective cohort of 8556 pregnant women attending the Mater Misericordiae Mothers’ Hospital in Brisbane was examined to consider the impact of socio-economic status on pregnancy outcome. The indicators of socio-economic status selected were family income, maternal education and paternal occupational status. Pregnancy outcomes considered were preterm delivery, low birthweight, low birthweight for gestational age, and perinatal death. Subsidiary analyses were also undertaken for Apgar scores, time to establish respiration, need for mechanical respiration and admission to intensive care. Before adjustment, the main consistent association was between the occupational status of the father and three measures of perinatal morbidity. Initial adjustment of the mother’s socio-demographic background and weight/height ratio reduced the strength and statistical significance of the above associations, while further adjustment for lifestyle variatibns between the three status groups further reduced the above associations to marginal statistical significance. The findings suggest that observed class differences in pregnancy outcome are attributable to the mother’s personal characteristics (height/weight2, parity) and her lifestyle. Int J Gynecol Obstet 30
C-reactive protein in preterm labour: Association with outcome of tocolysis and placental histology Cammy H; Goossens A; Derde MP; Temmerman M; Foulon W; Amy JJ Academish Ziekenhuis, Vrije Universiteit Brussel, Department of Gynaecology, Andrology and Obstetrics, B-1090 Brussels; Belgium British Journal of Obstetrics and Gynaecology/%/3 (314319)/1989/ Tocolytics were administered in 66 consecutive women in uncomplicated preterm labour with intact fetal membranes (53 singleton and 13 twin pregnancies). C-reactive protein (CRP), a marker of infection, was determined daily and use retrospectively to investigate the role of subclinical infection in preterm labour and to predict the efficacy of tocolysis and the development of a clinical perinatal infection. CRP was also determined in 66 women in uncomplicated labour at term (53 singleton and 13 twin pregnancies). The placenta was examined for histological evidence of infection in all patients who were delivered before 36 weeks (n = 21) and in all women in the control group (n = 66). Elevated CRP levels were more often found in patients who were refractory to tocolysis, suggesting and underlying infectious morbidity. Placental infection was found in 62% of the preterm delivery group and in 12% of the control group. There was an association between elevated CRP levels and histological evidence of placental infection. However, confounding factors such as urinary tract infections limit the usefulness of the CRP test. Because CRP cannot predict clinical perinantal infection accurately, its clinical relevance is very limited. Prostagiandin E, gel for cervical ripening and induction of labor: A critical analysis Rayburn WF Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Nebraska Medical Center, Omaha, NE 68105; USA American Journal of Obstetrics and Gynecology/l60/3 (529534)/1989/ This report summarizes the cumulative experience of 3,313 pregnancies represented in 59 prospective clinical trials in which intracervical or intravaginal prostaglandin E, gel was used for cervical ripening before induction of labor. Results indicate that local prostaglandin E, is superior to placebo or no therapy in enhancing cervical effacement and dilation, reducing initial induction failures, shortening the induction-delivery interval, reducing oxytocin use, and lowering the rate of cesarean section because of failure to progress. Certain advantages also exist for labor induction in the presence of a favorable cervical state. Uterine hyperstimulation or pathologic fetal heart rate patterns before oxytocin administration occur in < 1% of reported cases and are usually dose related, self contained, and reversible with the use of beta-adrenergic tocolytic therapy. Maternal systemic effects in these low doses are negligible. Worldwide clinical experience has clearly demonstrated that prostaglandin E, gel administered before induction of labor is of major therapeutic benefit andshould become commercially available for more than investigational use.