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In recent years, both at home and abroad have been in preparation for advanced prostate induced labor reports, but the results vary [1 ~ 3]. Since the author from January 1997 to January 1998 of misoprostol (SR misoprostol), cards forefront of lipid A suppository (PG 05), late pregnancy induced labor, and oxytocin were compared, the results are reported.

A clinical data

General information on the induction of labor with 1.1 indications (including hypamnion pregnancy expired, mild to moderate PIH) required hospitalization for the first induction of single pregnancies, early maternal 120, gestational age 37 weeks to 41 6, aged 22 to 32, cervical Bishop score ≤ 7 pm without labor contraindications and application of prostaglandin drug contraindications were randomly divided into three groups, each with 40 cases, respectively, with misoprostol, PG 05 and oxytocin induced abortions. The average age among the three groups, the pregnancy, gestational age, labor induction and cervical score indications distribution, the difference was not significant.

1.2 Methods

1.2.1 misoprostol group before conventional obstetric labor inspection, OK Bishop score, not by any drug cervical ripening. Conventional genital complex iodine strict disinfection, dry vaginal secretions. Will misoprostol 50 μ g (by the Shanghai Hualian Pharmaceutical Factory production per unit 200 μ g) placed after vaginal fornix, sits flat for 30 minutes every three to four hours a repeat treatment until a law contractions (5 ~ 6 min each time, sustained over 30 s) to stop medication , the largest dose of 300 ug.

Section 1.2.2 PG 05 Ibid. Genital disinfection method, dry vaginal secretions, PG 05 0.25 mg Suppository (from Northeast Pharmaceutical Factory production, each 1 mg) after placing vaginal fornix. 30 min sits flat.

1.2.3 oxytocin group 5% glucose injection 2.5 u intravenous oxytocin, eight drops per minute, 30 min without contractions drops increase, the biggest drop to a few drops every 30 minutes, until the law contractions.

1.3 Effect judge within 24 h after administration labor, and the mouth opening of the Palace ≥ 2 cm for the successful induction; Labor and mouth Palace expansion for the effective pre-cm 2; Within 24 h after administration of labor or cervical score of <2 hours, invalid, successful and effective together for the total effective.

1.4 indicators of the three groups before treatment by hand to obstetric examination, cervical Bishop score, NST, ultrasound examination, the process of medication to patients on blood pressure, heart rate, fetal heart rate, body temperature, contractions, and so on, record production, post-partum hemorrhage.

1.5 statistically using chi-square test and analysis of variance.

Two Results

2.1 induction results in table 1. Misoprostol group and the group of 05 PG success rate and the total labor efficiency, there was no significant difference (χ 2 0.86,1.52, respectively, P> 0.05), misoprostol group and the oxytocin group, and the success rate of labor efficiency differences were statistically significant (χ 2 respectively 35.5,29.01, all P <0.05).

Table 1 Comparison of the effects of labor group (cases,%, n = 40)

Successful groups effectively void total efficiency

Misoprostol Section 36 (90.0) 3 (7.5) 1 (2.5) 97.5

GAA 32 (80.0) 3 (7.5) 5 (12.5) 87.5

Oxytocin Section 10 (25.0) 8 (20.0) 22 (55.0) 45.0

2.2 induction cervical score relations with the successful induction of misoprostol group cervical score in the low (less than 4 hours) the total labor efficient than oxytocin group, the difference was significant (χ 2 = 31.02, P <0.05), misoprostol group and no significant difference acetic the (χ 2 = 0.98, P> 0.05), as shown in table 2.

Table 2 cervical score and the success rate of labor relations

Group 2 ~ 4 ~ 7 at 5 pm

Misoprostol Section 20 (95.2) 19 (100.0)

GAA Group 16 (80.0) 19 (95.0)

Oxytocin Group 2 (10.0) 16 (70.0)

Section 2.3 of the total labor and labor outcome comparison see table 3, three groups of middle-time close, the difference was not significant. Misoprostol trigger contractions time was significantly shorter in group and PG 05 oxytocin group, the difference was significant (P <0.05). The group rate of cesarean section and vaginal delivery rate surgery, fetal distress and neonatal Apgar score, postpartum hemorrhage no significant difference in volume. Section 22 cases oxytocin induction invalid, the next day induction using misoprostol vaginal delivery are 20 cases, two cases of fetal distress, maternal fatigue, and uterine atony OK cesarean section.

Table 3 group induced contractions of labor time and comparison (h)

Group n induced contractions of labor time

Misoprostol group ± 2.1 39 3.25 8.02 2.2 ±

6.01 GAA group of 35 ± 2.2 8.8 ± 3.0 *

Oxytocin Group 18 10.08 ± 3.23 * 8.68 ± 3.6

* Misoprostol group: P <0.05

Side effects of a 2.4 ① contractions stronger than the frequency: misoprostol group in the case of oxygen and left lying remission after vaginal delivery and neonatal asphyxia no. GAA group four cases, the oxygen, and lying to the left of contractions inhibitor after two cases mitigation, another two cases of fetal distress in mitigation and emergency cesarean section OK, oxytocin No cases occurred. ② gastrointestinal symptoms: nausea and vomiting misoprostol group 1, group interrupting two cases of nausea and vomiting, diarrhea four cases are better without special treatment, oxytocin group without any symptoms. ③ blood pressure changes: misoprostol and oxytocin group had no obvious change the blood pressure, interrupting 12 cases mildly elevated blood pressure, but the difference between before and after the medication was not significant.

Three discussion

Cervical maturity is an important condition for the success of labor induction, the more easily the more mature labor successful, will lead to premature labor and birth spacing extended forceps delivery rate and the rate of increase in Caesarean sections [4]. Misoprostol is prostaglandin E1 (PGE1) derivatives, can cervical degradation of collagen in the connective tissue will be stored in the cells and collagen-elastase release by the prostate or hormone receptor activator of collagen fibers cervix, cervical softening in a short period of time [5]. The data show that misoprostol induction and the success rate is significantly higher than the efficiency of oxytocin group and acetic group, misoprostol and oxytocin group compared the difference was significant. The labor groups were not statistically different, but induced contractions, misoprostol group was significantly shorter than the oxytocin group and acetic group. The misoprostol for induction of advanced cervical ripening role there.

Prostaglandins and oxytocin induction of labor in the major side effect is too strong or too contraction frequency, resulting fetal heart rate changes, fetal distress. This information, in addition to oxytocin group, the other two groups have different levels of contractions increased, misoprostol group in 1 case (2.5%) than Wang Zehua, reported a low of 9.3% [6], its causes and possible misoprostol single small dose of the drug.

The results show that small doses of misoprostol vaginal delivery points for the induction effect of late pregnancy, the role fast, safe, especially applicable to cervical immature late pregnancy. The drug is cheap, stable, the use of simpler, more GAA and oxytocin has obvious advantages in promoting the use of grassroots hospitals. Although the labor group acetic good effect of fast, but the safety of misoprostol and oxytocin than poor, and expensive, to cryopreservation. Oxytocin cervical ripening right of pregnant women, labor could be effective, but right cervical immature effect of late pregnancy is not ideal.

Author units: Hunan Provincial People's Hospital in Loudi (Loudi 417000)

References

A Ravburn WF, Wapner RJ, Barss VA, et al.An intravaginal controlled-release prostaglandin E2 pessary for cervical ripening and initiation of labor at term.Obstet YORK, 1992,19 (3): 374-379

Two Varaklis K, R Gumina, Stubblefiled PG.Randomized controlled trial of vaginal misoprostol and intracervical prostaglandin E2 gel for induction of labor at term.Obstet YORK, 1995,86 (pt1 4): 541 - 554

3 Wang Lin, Shi Chang example, the sun-zhen, and others. Misoprostol for full-term pregnancy induction of clinical observation. China journal Obstetrics and Gynecology, 1997,32 (1): 666

Four Li Qiang, single-family rule. Cervical ripening and cervical ripening. China journal Obstetrics and Gynecology, 1993,28 (6): 369

Five Korean characters Institute. Abortion and drug-related physiological problems early pregnancy. Practical Obstetrics and Gynecology magazine, 1994,10 (1): 3

6 Wang Zehua, Li Wei-chi, Ouyang for phase, and others. Misoprostol cervical ripening in effect and safety evaluation. China journal Obstetrics and Gynecology, 1997,32 (5): 326

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Hunan Medical

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1999 16 No. 2 Vol No. 1999

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