Use of misoprostol for cervical ripening.

BACKGROUND: Misoprostol, the prostaglandin E1 analog, is increasingly used for cervical ripening and induction of labor. We evaluated our experience with misoprostol in an open-label setting. METHODS: Patients were selected for cervical ripening based on clinical profile. At 3 cm cervical dilation, misoprostol was discontinued and other means of labor augmentation were used. Over 13 months, 470 inductions of labor occurred, and 455 charts were available; 254 patients (56%) received misoprostol for cervical ripening, and 144 (32%) received dinoprostone (prostaglandin E2). RESULTS: With misoprostol, mean time from beginning of contractions until delivery was 7 hours, 30 minutes; vaginal birth occurred in 85% of cases, and spontaneous labor occurred in 38%. Hyperstimulation occurred in 4 cases (1.6%) and precipitate labor in 7 (3%). All infants were discharged in excellent condition; one had a 5-minute Apgar score <7, and 33 (13%) had meconium, none with aspiration. Twenty-three patients who had had a previous cesarean section received misoprostol and delivered vaginally. CONCLUSION: Misoprostol was found to be a safe and effective agent for cervical ripening as part of labor induction.

Hypnotic susceptibility, mood state, and cardiovascular reactivity.

In this study we explored the relationship between hypnotic susceptibility measured with the Harvard Group Scale of Hypnotic Susceptibility (HGSHS) and cardiovascular parameters. After assessing their degree of hypnotic susceptibility, we induced 21 female students into happy mood states and into sad mood states. During the mood state induction we monitored blood pressure, heart rate, and cardiac vagal tone continuously. The study demonstrated a strong relationship between hypnotic susceptibility and both cardiac vagal tone and heart rate reactivity. Subjects with lower heart rate and greater vagal tone during baseline and greater heart rate increases during mood induction were more susceptible to hypnosis. Multiple regression analyses indicated that approximately 40% of the individual difference variance of hypnotic susceptibility was accounted for by baseline cardiac vagal tone and heart rate reactivity during mood state. The data demonstrate that autonomic tone, assessed by cardiac vagal tone and heart rate reactivity, are related to hypnotic susceptibility as measured by the HGSHS.

Effects of lateral recumbency and sitting on the first stage of labor.

We compared uterine activity in lateral recumbency and the sitting position during the first stage of labor in a group of nulliparas. Lateral recumbency was accompanied by more intense, less frequent and more efficient uterine contractions than sitting. Patients preferred sitting for the first half of labor and lateral recumbency for the second. No adverse fetal reaction was noticed in either position, judging from the fetal heart rate. An increase in maternal pulse rate during sitting could have indirectly indicated some compression of the prevertebral vessels. Maternal position clearly affects several parameters of labor, and its selection should be based upon maternal comfort, uterine contractility and efficiency, and hemodynamic repercussions.