María del Mar Centeno

Is external cephalic version at term contraindicated in previous caesarean section? A prospective comparative cohort study.

To determine if external cephalic version (ECV) can be performed with safety and efficacy in women with previous caesarean section.

Induction at 41 weeks increases the risk of caesarean section in a hospital with a low rate of caesarean sections.

Objective: To analyse the impact of a change in the management of prolonged pregnancies from inducing labour at 42+0 to induction at 410–6. Design: Retrospective cohort study. Methods: Analysis of 3563 single pregnancies with cephalic presentation of ≥ 41 weeks of gestation delivered in Cruces University Hospital (Spain). Two cohorts were compared corresponding to before and after the change in the policy on induction. Main outcome measures: Induction rate, vaginal delivery rate, newborn morbidity and mortality. Results: The overall rate of caesarean sections in the patients included in the study was 12.8% (19.5% among those induced and 8.4% among those in whom the onset of labour has been spontaneous). The caesarean section rate in cohorts 410–6 and 42+0 were 14.1% and 11.4%, respectively (p = 0.01). Though there were more newborns with umbilical cord blood ph<7.10 in cohort 410–6 than in the other group (8.7% versus 4.5%; p < 0.01), no significant differences were found between cohorts in 5-min Apgar score < 7, number of admissions to the neonatal care unit or perinatal mortality. Conclusion: The induction of labour during week 41 in prolonged pregnancies may increase the rate of caesarean sections in hospitals with low rates of caesarean sections.

Chemotherapy-induced emesis : management of early and delayed emesis in milder emetogenic regimens

Abstract The objective of the present study was to examine the problem of the control of nausea and vomiting induced by non-cisplatin containing cyclophosphamide-based chemotherapy regimens in breast cancer patients. This was randomized, double-blind, parallel-group and placebo-controlled study comparing the efficacy of three antiemetic therapeutic regimens (ondansetron for 3 days, ondasetron plus metoclopramide, and ondansetron given in a single dose) in breast cancer patients receiving cyclophosphamide-based chemotherapy regimens on an outpatient basis. Both the primary and the secondary efficacy were measured. The primary efficacy variable was the number of emetic episodies (considering early and delayed emesis). The secondary efficacy variable measured was the quality of life. Two-by-two tables using the chi-square test and relative-risk concept were elaborated for statistical analysis. There was no difference between high-dose ondansetron and ondansetron plus metoclopramide among patients given CMF (cyclophosphamide, methotrexate, 5-fluorouracil). The single-dose ondansetron regimen showed the worst results. In patients given an FEC regimen (cyclophosphamide, epirubicin, 5-fluorouracil) the antiemetic efficacy was best for the high-dose ondansetron regimen, followed by the ondansetron plus metoclopramide regimen, and was worst for single-dose ondansetron administration. Despite the use of different antiemetic schedules, nausea and emesis are significant problems in patients receiving cyclophosphamide-based chemotherapy. Their adequate control should be the aim of any antiemetic approach.

Oxytocin versus dinoprostone vaginal insert for induction of labor after previous cesarean section: a retrospective comparative study

Abstract Objective: To compare the efficacy and safety of two methods for induction of labor after previous cesarean section. Methods: To compare 247 women with a previous cesarean section who were induced with a dinoprostone vaginal insert and 279 women with a previous cesarean section induced with oxytocin, between 2001 and 2008. We evaluated vaginal delivery rate, maternal morbidity and newborn morbidity and mortality. Results: The overall rate of vaginal delivery was 65.2%. We did not find significant differences between induction with dinoprostone vaginal insert and oxytocin in the rate of cesarean section performed (35.6% vs. 34.1%, P=0.71). There were nine cases of uterine rupture (rate of 1.7%), of which four occurred with dinoprostone vaginal insert and five when using oxytocin (P=0.89). We found no significant differences in neonatal outcomes. Conclusions: Both tested methods appear to be equally safe and effective for induction of labor in women with a previous cesarean section.

Increased pain relief with remifentanil does not improve the success rate of external cephalic version: a randomized controlled trial.

Our objective was to compare the effect of two pain relief methods (remifentanil vs. nitrous oxide) on the success rate of external cephalic version.

Atosiban vs. ritodrine as a tocolytic in external cephalic version at term: a prospective cohort study

Abstract Objective: To compare the success rate of external cephalic version (ECV) at term using ritodrine or atosiban as a tocolytic agent. Study design: Prospective cohort study with a sample of 236 pregnant women with a breech presentation at term, from November 2006 to March 2008. Data have been analyzed from the moment the cephalic version is performed until the time of delivery. Results: ECV success rate using ritodrine as a tocolytic agent was 56.8% compared to 31.4% with atosiban. Ritodrine increases the version success potential more significantly than atosiban (P<0.05). In both cases, the use of ECV reduced the rate of cesarean sections, although a higher number of versions are required with atosiban [numbers needed to treat (NNT)=9.08] to avoid a cesarean section compared to ritodrine (NNT=3.41). Conclusions: Ritodrine seems better than atosiban as tocolytic agent for ECVs.

Induction of labor in breech presentation at term: a retrospective cohort study.

Abstract Objective: To compare the outcome of two methods of labor induction and spontaneous onset of labor in breech presentation at term. Material: A retrospective study between 2003 and 2012. We compare obstetric (indication of induction, Bishop score, cesarean rate) and perinatal outcomes (Apgar score, umbilical artery pH, base excess ≤−12 mmol/L, admission to neonatal unit) between prostaglandins and oxytocin. We also compare labor induction versus spontaneous onset of labor. Results: Of the 1684 breech deliveries, we carried out labor induction in 221 cases (76% with prostaglandins, 24% with oxytocin). The prostaglandins group had significantly lower Bishop scores and the time for induction phase was significantly higher. There were no differences in cesarean rate between both methods of induction or spontaneous onset of labor. The prostaglandins group had higher rates of base excess ≤−12 mmol/L. Compared with spontaneous onset of labor in breech presentation, induction had significant lower rates of newborn weight and higher rates of admission to the neonatal unit. Conclusions: Induction of labor in breech presentation at term is a reasonable and effective option after a careful selection of cases. It was not associated with an increase of perinatal morbidity or cesarean rate compared with spontaneous onset of labor.

16 P Chemotherapy induced emesis. management of early and delayed emesis in milder emetogenic regimens

The objective of the study was to examine the problem of control of nausea and vomiting induced by non-cisplatin cyclophosphamide-based chemotherapic regimens in breast cancer patients. This was a randomized double-blind, parallel-group and placebo controlled study comparing the efficacy of four antiemetic therapeutic regimens (A:Ondansetron for 3 days; B:Ondasetron plus Metoclopramide; C:Granisetron given a single dosis and D:Ondansetron given in a single dosis) in breast cancer patients receiving Cyclophosphamide, Methotrexate and 5-Fluoracil (CMF) regimen (174 cycles) and Cyclophosphamide, 4-Epiadryamicin and 5-Fluoracil (FEC) regimen (132 cycles). Both, number of emetic episodies (early and delayed emesis) and quality of life were evaluated. In patients receiving CMF there were no differences between regimens A, B and C in controlling early emesis. The single dose Ondansetron regimen (D) showed the worst resuts (p=0.003). Delayed emesis was best controlled by the “3 days-regimens” (A and B). In patients administered a FEC treatment, the antiemetic efficacy was superior for the single Granisetron regimen (C) if early emesis was considered. Moreover, efficacy of single Granisetron dosis (C) was similar to the 3-days Ondansetron regimen (A) in controlling delayed emesis after FEC treatment. The single Ondansetron regimen showed again the worst results (p=0.007). Despite different antiemetic schedules, nausea and emesis are significant problems in patients receiving cyclophosphamide-based chemotherapy.