Intravaginal misoprostol vs. expectant management in premature rupture of membranes with low Bishop scores at term.

OBJECTIVES: To evaluate the efficacy of vaginal misoprostol for cervical ripening and labor induction in premature rupture of membranes (PROM) cases with low Bishop scores at term. METHODS: Sixty-two PROM cases who fulfilled the criteria of 36 weeks of completed gestation, not in active labor, singleton pregnancy with vertex presentation, normal fetal heart rate reactivity, amniotic fluid index >5 cm and Bishop score <5, consented to participate in the study. Thirty-one of the cases were included in study group and a 50-microg misoprostol tablet was placed in the posterior vaginal fornix. Another 31 cases were included in control group and managed expectantly. Treatment success was defined as an interval from membrane rupture to delivery of <24 h. RESULTS: The mean admittance-delivery interval was significantly shorter in the study group (8.68+/-4.40 h) compared with the control group (26.22+/-18.98 h, P=0.001) and the mean interval from membrane rupture to delivery were also significantly shorter in the study group (19.37+/-7.20 h) than the control group (33.05+/-20.85 h, P=0.001). Oxytocin necessity was significantly lower in the study group than the control group (45.2% vs. 100%, P=0.00051). Tachysystole occurred more frequently in the study group (8 cases, 25.8% vs. 2 cases, 6.5%, P=0.038). There were no difference between two groups with regard to birth weights, 1- and 5-min Apgar scores and the need for neonatal intensive care unit. CONCLUSIONS: It is effective, safe and economic to use misoprostol vaginally in PROM cases with low Bishop scores at term.

Evaluation of urethrovesical junction mobility by perineal ultrasonography in stress urinary incontinence.

Perineal ultrasonographic measurements of the cephalocaudal and the ventrodorsal components of urethro-vesical junction (UVJ) movement at rest and stress was performed in 35 patients of stress urinary incontinence (SUI) and 20 continent controls. The cephalocaudal distance of UVJ from the pubis at rest position was almost similar in both continent and incontinent groups, but there was significant difference during stress. The cephalocaudal mobility and the ventrodorsal distance from the pubis was markedly different between the two groups, both at rest and during stress. However, the ventrodorsal mobility was similar in both groups. It is concluded that the UVJ mobility of SUI cases was higher on the cephalocaudal axis than the vetrodorsal axis. The distance between UVJ and the pubis was more on the ventrodorsal axis as compared to the control group and UVJ passed down the pubic symphysis in 63% of SUI cases during stress.