ABSTRACT
Hidradenitis suppurativa is a debilitating inflammatory skin disease with a chronic course and often disappointing response to treatment. Though a minority of persons (20%) reports symptom remission during pregnancy, the vast majority experiences no relief (72%), and few experience clinical deterioration (8%). Disease flares are also observed post-partum. The pathophysiological basis for pregnancy-associated fluctuations in clinical status is currently unknown. Because most women with HS require ongoing management throughout pregnancy, it is important to evaluate the suitability and safety of current treatment options for pregnant women. The following review will outline current management strategies for HS and their compatibility with pregnancy and lactation.
Subject(s)
Hidradenitis Suppurativa/therapy , Pregnancy Complications/therapy , Anti-Bacterial Agents/adverse effects , Biological Products/adverse effects , Contraindications , Cryotherapy , Female , Hidradenitis Suppurativa/drug therapy , Hidradenitis Suppurativa/surgery , Homeopathy , Humans , Immunosuppressive Agents/adverse effects , Lactation , Laser Therapy , Metformin/therapeutic use , Pain Management , Pregnancy , Pregnancy Complications/drug therapy , Pregnancy Complications/surgery , Smoking CessationABSTRACT
OBJECTIVES: Define methods of induction of labour for the population of pregnant women at the end of 41 SA and beyond, including membranes sweeping, mechanical and pharmacological procedures as oxytocin, prostaglandin E1 (misoprostol) and E2 (dinoprostone) and other methods as well for the scarred uterus. METHODS: Bibliographic research done by consulting databases PubMed, and Cochrane. RESULTS: Membrane sweeping reduces by 41% the need of induction of labour at 41 SA and 72% for postterm (42 SA). Membrane sweeping is a technique with some discomfort for the patient but has advantages. This procedure should not be imposed on patients in a systematic visit because it presents inconveniences (contractions, bleeding, pain). Oxytocin remains the gold standard used for labour induction and requires well-codified rationale protocols in maternity for increasing doses. Most of the trials show that this product is appropriate when the cervix is considered as favorable (Bishop ≥ 6). In the presence of intact membranes, induction by oxytocin must be associated with amniotomy for a significant reduction in "induction-delivery" period. The Foley catheter is a mechanically reliable, reproducible method for inducing labour with less uterine hyperstimulation without increasing the rate of caesarean sections. It is an interesting process but maternal and neonatal infectious morbidity appears to be possibly increased. The non-vaginal PGE2 (cervical) are no longer recommended. The PGE2 vaginal gel or pessary are comparable methods to induce labour. They can be used to successfully induce labour regardless of cervical Bishop score. In case of unfavorable cervical conditions, PGE2 can reduce the use of oxytocin and decrease the required doses. Misoprostol is a molecule that may be proposed for induction of labour provided to know the doses, risks and side effects and to adapt materno-fetal monitoring. The optimal route of administration remains yet to be assessed because of a higher risk of hyperstimulation or tachysystole. Initial doses should be 25 µg. However, misoprostol did not have the authorization in this indication and merit some caution when using it. Prostaglandin E1 is associated with a high risk of uterine rupture and should not be used after caesarean section. Acupuncture, homeopathy NO donors, breast stimulation or sexual intercourse are methods ineffective in all conditions or assessment is insufficient to conclude with evidence based medicine. CONCLUSION: In postterm, different procedures could be performed for induction of labour. Furthermore membrane sweeping, oxytocin is the drug of choice for induction on favourable cervix and one of the most commonly used drugs. Vaginal prostaglandins E2 are effective whatever the cervical conditions. Misoprostol is a very interesting pharmacological molecule without authorization in this indication but has real advantages on efficacy, cost, storage and administration. Other studies with high power have to remain on track and to focus on the optimal and route doses because of increased risk of tachysystole or hyperstimulation with effects on the FHR. Minimal doses at 25µg seem to be safe. The Foley catheter is a reliable method without any pharmacological effect and opening interesting perspectives but with caution about the possible increased infectious risks.