Iz MacKenzie

THE INFLUENCE OF PRE‐INDUCTION VAGINAL PROSTAGLANDIN E2 GEL UPON SUBSEQUENT LABOUR

Eight hundred and three patients with singleton viable pregnancies and fetal cephalic presentation were given prostaglandin E, in viscous gel by intravaginal instillation the evening before planned surgical induction. When the cervix was ‘ripe’, surgical induction was avoided in 65·9 per cent of primigravidae and 87 5 per cent of multigravidae; the administration of epidural analgesia was less frequent, the rate of spontaneous vaginal delivery greater, the Caesarean section rate lower, and the state of the newborn at delivery better than in those patients who required surgical induction. Side effects attributable to the prostaglandin gel were rare as were complications.

Routine antenatal Rhesus D immunoglobulin prophylaxis: the results of a prospective 10 year study

Objective To assess the clinical and financial impact, and identify the problems, of providing routine antenatal RhD immunoglobulin prophylaxis for Rhesus D negative nulliparae.

Recombinant human relaxin as a cervical ripening agent

Objective The aim of this study was to investigate the efficacy and safety of recombinant human relaxin (rhRIx) as a cervical ripening agent in women with an unfavourable cervix before induction of labour at term.

The physiological and clinical effects of progesterone inhibition with mifepristone (RU 486) in the second trimester

Summary. A double‐blind placebo‐controlled trial was performed in 20 primigravidae to assess the physiological and clinical effects of oral mifepristone on myometrial contractility and sensitivity in the second trimester. Ten women received 600 mg of oral mifepristone and 10 women a placebo 24 h before abortion was induced in both groups, with extra‐amniotic PGE2 instillation. Intrauterine pressure recordings demonstrated increased spontaneous uterine activity and increased sensitivity to PGE2 and ergometrine, but no change in oxytocin sensitivity after mifepristone treatment. There were no significant differences in PGE or PGF metabolite concentrations in peripheral maternal plasma over the 24‐h study period after treatment between the mifepristone and placebo groups. The mean induction abortion interval in the mifepristone group was 512 (SD 321) min compared with 1128 (SD 606) min in the placebo group (P≤0.02). The mechanism whereby mifepristone provokes enhanced uterine contractility and sensitivity to prostaglandins, with a reduction in abortion times, does not appear to be through endogenous production of PGE or PGF.

Acupuncture for pain relief during induced labour in nulliparae: a randomised controlled study.

Please cite this paper as: MacKenzie I, Xu J, Cusick C, Midwinter‐Morten H, Meacher H, Mollison J, Brock M. Acupuncture for pain relief during induced labour in nulliparae: a randomised controlled study. BJOG 2011;118:440–447.

General obstetrics: The kinetics of routine antenatal prophylactic intramuscular injections of polyclonal anti-D immunoglobulin

Objectiveu2002 To observe the pharmacokinetics of intramuscular anti‐D immunoglobulin (IgG) given for routine antenatal prophylaxis.

Reducing hospital stay after abdominal hysterectomy

potential anaphylactic hazards in delivery wards, and also to insist that all patients booked for delivery should be specifically asked about latex allergy. If a personal history exists, appropriate specific tests before any further obstetric management can prevent serious anaphylactic episodes complicating delivery. For patients with positive tests, suitable alternative latex free rubber material is available.

Factors that influence the incision-delivery interval at caesarean section and the impact on the neonate: a prospective cohort study

OBJECTIVEnTo determine the range of, and influences on, the incision-delivery interval (IDI) and the impact on neonatal condition at delivery.nnnSTUDY DESIGNnAnalysis of prospectively collected cohort data from all women delivered by caesarean section over 12 months in an obstetric unit delivering 6000 women per year. Prospective data were collected from clinical records, with factors that influence IDI and relationship to neonatal condition at birth as the main outcome measures.nnnRESULTSnIDI was recorded for 1379 (93%) caesarean sections and ranged between 1 and 37min; median (IQR) was 6 (5-8)min, and for 3% the interval was longer than 15min. Category 1 and 2 caesarean sections had shorter IDI than categories 3 and 4 and intrapartum operations had significantly shorter IDI at 5 (3-8)min than antepartum at 7 (5-9)min (P<0.0001). Factors associated with longer IDI included previous delivery by caesarean section, increased maternal body mass index (BMI), regional anaesthesia, larger neonatal birthweight and technical problems including intraperitoneal adhesions, but did not include fetal malpresentation, multiple pregnancy, grade of surgeon or stage of labour. IDI had no impact on neonatal condition at birth.nnnCONCLUSIONSnProlonged IDI does not adversely affect neonatal outcome, but factors associated with prolonged IDI should be acknowledged when assessing decision-to-delivery interval target times.

Assessing the methods of a recently published study: four placebo groups?

JG. Early versus late epidural analgesia and the risk of instrumental delivery in nulliparous women: a systematic review. BJOG 2011;118:655–61. 3 Luxman D, Wolman I, Groutz A, Cohen JR, Lottan M, Pauzner D, et al. The effect of early epidural block administration on the progression and outcome of labor. Int J Obstet Anesth 1998;7:161–4. 4 Wong CA, Scavone BM, Peaceman AM, McCarthy RJ, Sullivan JT, Diaz NT, et al. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med 2005;352:655–65. 5 Ohel G, Gonen R, Vaida S, Barak S, Gaitini L, Ohel G, et al. Early versus late initiation of epidural analgesia in labor: does it increase the risk of cesarean section? A randomized trial. Am J Obstet Gynecol 2006;194:600–5. 6 Wang F, Shen X, Guo X, Peng Y, Gu X, Labor Analgesia Examining G, et al. Epidural analgesia in the latent phase of labor and the risk of cesarean delivery: a five-year randomized controlled trial. Anesthesiology 2009;111:871–80. 7 Wong CA, McCarthy RJ, Sullivan JT, Scavone BM, Gerber SE, Yaghmour EA, et al. Early compared with late neuraxial analgesia in nulliparous labor induction: a randomized controlled trial. Obstet Gynecol 2009;113:1066–74.