Cervical ripening and induction of labor by prostaglandin E2: a comparison between intracervical gel and vaginal pessary.

OBJECTIVE: To compare the effectiveness and safety of two formulations of prostaglandin (PG) E2 (gel and pessary) for induction of labor. Primary outcomes were cervical ripening, initiation/duration of labor, and type of delivery. STUDY DESIGN: A total of 115 women with singleton gestations were consecutively enrolled and assigned to receive intracervical PGE2 (dinoprostone 0.5 mg) by gel (n = 66) or PGE2 (dinoprostone 10 mg) by intravaginal pessary (n = 49). RESULTS: Independently from parity, the vaginal pessary induced successful cervical ripening with a slightly higher but not statistically significant occurrence of vaginal delivery with respect to gel induction. The mean time interval from induction to vaginal delivery did not differ between groups, despite being shorter for the pessary group in inducation-delivery intervals > 12 h. No significant differences were found between the groups with respect to patients who required a second course of PGE2 (9% vs. 2%), as well as oxytocin (11% vs. 13%) induction. No significant difference was found in the incidence of uterine hyperstimulation and other adverse reactions in nulliparas, or in fetal and neonatal outcome. CONCLUSION: Independently from parity, both PGE2 administration routes appeared to be effective in achieving cervical ripening, initiation of labor and optimal type of delivery, and showed the same incidence of side-effects.

Prophylactic therapy in a pregnant woman with severe factor VII deficiency.

This paper reports a case of factor VII deficiency, a very rare autosomal recessive disorder, in a primipara at 37 weeks of gestation in whom we administered prophylactic therapy with factor VII every 12 h until 24 h after delivery. The prophylactic use of factor VII enabled the woman to deliver without hemorrhagic complications.

Vitamin B12 levels in pregnancy influence erythropoietin response to anemia.

OBJECTIVE: to discover whether vitamin B12 levels influence erythropoietin (EPO) response during pregnancy. STUDY DESIGN: 117 pregnant women after the 27th week were divided into three groups according to log vitamin B12 concentrations. EPO (by enzyme-linked immunosorbent assay), Hemoglobin (Hb) and medium corpuscular Hb concentration (MCHC) were measured in these patients. The tests used were: calculation of simple statistic, regression coefficient and t-independent test with level of significance. An exclusive partitioned cluster method (K-means procedure) was used. RESULTS: For the lowest vitamin B12 levels there is an unexpected lack of difference in plasma EPO levels between anemic and nonanemic patients. In fact EPO levels were high even in nonanemic women. The only parameter of the blood count that seems to change in relation to vitamin B12 concentration is the MCHC. CONCLUSIONS: These results suggest that low vitamin B12 levels inhibit the suppression of EPO response in nonanemic pregnant women probably through MCHC modifications.

[Radioimmunologic assay of PRL, E2 and prosterone, before and after pregnancy termination by metergoline and sulpiride]. / Dosaggio radioimmunologico di PRL, E2, P dopo interruzione di gravidanza in relazione con il trattamento con metergolina e sulpiride.

PIP: The authors have assayed plasma prolactin, estradiol, and progesterone in 30 women undergoing voluntary termination of pregnancy by vacuum aspiration under general anesthesia, in order to study in more detail, the correlations between PRL and sexual steroid hormones during the 1st trimester of pregnancy. Results obtained in the various plasma samples taken at intervals until 5 hours following vacuum curettage show a marked increase in PRL in the control group, from 80 to 3000 ng/ml, with a progressive decrease at the 5th hour. A much slighter increase was found in patients treated with Metergoline, compared to that of the former group, with an increase from 90 to 180 ng/ml, while in those patients treated with Sulpiride, the maximum increase ranges between 160-340 ng/ml. The plasma level of E2 decreased significantly and progressively after the sample taken at 30 minutes, with a similar pattern in the 3 groups. The plasma progesterone concentrations showed a similar patern in the groups treated with Metergoline and Sulpiride, with a progessive decrease in comparison with basal levels. On the contrary, the increase was found in the control groups, in comparison with basal values, in samples taken at 30 minutes, with a slow, progressive decrease in subsequent samples. It can be concluded from these results that the stress caused by vacuum curettage under anesthesia causes a stronger stimulation of PRL than the inhibition of this hormone caused by the fall of E2 and P concentrations; the inhibitory effect of Metergoline on PRL did not completely annul the effect of anesthesia and vacuum curettage on PRL production. While E2 shows a progressive decrease compared to basal values, with a similar behavior in all 3 groups, P, which decreases in the 2 groups that have undergone pharmacological treatment, shows a peak increase in the sample taken at 30 minutes. THe significance of this observation is not yet clear, and will be the subject of further study. (author's modified)^ieng