N. J. Secher

Haemodynamic Effects of Oxytocin (Syntocinon®) and Methyl Ergometrine (Methergin®) on the Systemic and Pulmonary Circulations of Pregnant Anaesthetized Women

Abstract. The haemodynamic effects of oxytocin (Syntocinon®) and methyl ergometrin (Methergin®) were studied in 9 healthy females in the first trimester of pregnancy. The patients were anaesthetized with sodium thiomebumal, pethidine and pancuronium bromide and ventilated on a Manley respirator. 10 i.u. oxytocin given as an i.v. bolus brought about a fall in femoral arterial pressure of 40%, systemic resistance 59% and pulmonary resistance 44% 30 sec after injection. However, the heart rate increased 31% and stroke volume 17%, so that the cardiac output increased by 54%. The pulmonary arterial pressure and wedge pressure were increased by 33% and 35%, respectively 150 sec after injection. No changes were seen in the haemodynamic parameters during infusion of 80 mU oxytocin for 10 min. 0.2 mg Methergin brought about an increase in the femoral arterial pressure of 11 %, pulmonary arterial pressure 27% and wedge pressure 31%, with no changes in the other measured parameters. The use of oxytocic drugs in patients with compromised circulation is discussed.

Use of Oral Oxytocics for Stimulation of Labor in Cases of Premature Rupture of the Membranes at Term: A randomized comparative study of prostaglandin E2 tablets and demoxytocin resoriblets

Abstract. The efficacy of oral PGE2 tablets and buccal demoxytocin (resoriblets) for the induction of labor in cases of premature rupture of the membranes (PROM) after the 37th week of gestation has been evaluated in a prospective, randomized investigation of 193 women. PGE2 tablets (Pro‐stinR) were given to 109 parturients and demoxytocin resoriblets (SandopartR) to 84. The former were given in increasing doses from an initial 0.5 mg to a maximum of 1.5 mg every hour. The demoxytocin was administered at a constant dosage of 50 I.U. every 30 min.

CHANGES IN SERUM LIPIDS DURING TREATMENT WITH NORGESTREL, OESTRADIOL-VALERATE AND CYCLOPROGYNON@

Abstract. The serum concentrations of triglycerides, cholesterol, and free glycerol were determined in 23 climacteric women, before and after the administration of three different steroid drugs. Each drug was given within a period of 12 weeks (3 cycles). Period I: Norgestrel, 0.5 mg daily from the 12th to 21st day of each cycle. Period II: Oestradiol‐valerate (Progynon®) 2 mg daily from the 2nd to 21st day of each cycle. Period III: Oestradiol‐valerate 2 mg from the 1st to 11th day followed by oestradiol‐valerate 2 mg+0.5 mg dl‐norgestrel from day 12 to 21 of each cycle (Cycloprogynon®). A significant decrease in triglycerides was observed following the administration of norgestrel and Cycloprogynon®, whereas oestradiol‐valerate had no effect on the triglyceride levels. On the other hand, oestradiol‐valerate, following a period of norgestrel, produced an increase in serum cholesterol levels.

Induction of Labor with and without Primary Amniotomy: A Randomized Study of Prostaglandin E2 Tablets and Intravenous Oxytocin

Abstract. A comparative study of labor induction has been performed on 471 consecutive patients. Primary amniotomy was performed in 227 cases, and 103 of these patients were stimulated, 57 patients with PGE2 tablets and 46 with oxytocin. In the remaining 124 cases labor was induced within 4 hours without medical stimulation. Primary amniotomy was omitted in 244 cases, as the head was not engaged and the cervix was unripe. After random allocation to the treatment groups 125 patients received PGE2 tablets (ProstinR), and 119 patients received oxytocin intravenously. After 2 days of stimulation without primary amniotomy, delivery was induced in 83 per cent of the patients receiving PGE2 and in 84 per cent of the patients receiving oxytocin. All patients on whom primary amniotomy had been performed were delivered on the first day. There was no difference in the success rate between PGE2 and oxytocin treatments in patients with the same Bishop score. The performance of amniotomy at the beginning of induction led to a significantly lower total dose as well as a lower maximal dose of PGE2 and oxytocin. There was no difference in the duration of active labor in patients receiving PGE2 or oxytocin.

Oral Oxytocics for Induction of Labor: A Randomized study of prostaglandin E2 tablets and demoxytocin resoriblets

Abstract. A randomized comparative study of 387 consecutive patients admitted for induction of labor was carried out using two orally administered oxytocics (prostaglandin E2 tablets (ProstinR) or Demoxytocin resoriblets for buccal administration (SandopartR)), the results of which are reported here.

Induction of therapeutic abortion using either extra-amniotic prostaglandin F2α or hypertonic saline followed by oxytocin: A clinical comparison of the two methods

160 women with uteri at 10-20 weeks gestation were treated with either PG(prostaglandin)F2alpha or saline solution followed by oxytocin to effect an abortion. 80 women were in each treatment group. The distribution of the patients according to age, parity, and gestation duration is tabulated. PGF2alpha was administered extraovularly in a concentration of .1 mg/ml with .7 mg being injected in the operating theater and nurses administering the rest based on response to previous injections. Administration continued for up to 30 hours. Saline was given in a volume in ml dependent on the duration of pregnancy multiplied by a factor of 10. Subcutaneous injections of oxytocin were given on subsequent days to speed the abortion. 85% of the PG patients successfully aborted without surgical dilatation of the cervix. The average dosage of PG required was 7.5 mg in 11 instillations. Side effects and complications in the PG group were minimal. 1 instillation of saline followed by 2 days of oxytocin were required to effect a 79% abortion rate in the saline group. Although the number of patients requiring surgical dilatation was the same for both groups, the procedure was much less time-consuming for the PG group. The complication rate was 26% for the saline group as compared to 14% for the PG group. The PG group required a shorter hospital stay.

LABOR INDUCTION WITH PROSTAGLANDINS

Prostaglandins E2 and F2 alpha have been used for labor induction for more than 10 years. Many investigations have shown that these prostaglandins are effective, and within certain dosage schedules, safe oxytocics, even though the systemic administration is accompanied by side effects, mainly from the gastro-intestinal tract. Oral PGF2 appears to be the prostaglandin favored in recent years. It gives few side effects when administered in this manner. It is concluded from the present investigation and a study of the literature that oral PGE2 has certain advantages in comparison with other oxytocics for induction of labor at term, although it cannot entirely replace intravenous oxytocin. This, together with the relatively high cost of oral PGE2, will limit its use in the future for labor induction at term in normal cases.

Termination of pregnancy in cases of fetal death in utero by intravenous prostaglandin F2α

Delivery was induced by an intravenous infusion of prostaglandin F2alpha (PGF2alpha) in gradually increasing doses in 30 consecutive cases of fetal death in utero after the 28th week of gestation. Twenty patients delivered during the first day of prostaglandin administration, 9 on the second day, and 1 patient not until the third day of infusion. It is concluded, that intravenous PGF2alpha appears to be superior to oxytocin in termination of pregnancy under these conditions.

Therapeutic Abortion with Extra-Amniotic PGF2α: A clincal comparison with extra-amniotic PGF2α, 0.9 per cent salinendashand 20 per cent saline followed by oxytocin

Women with a duration of pregnancy from the loth to the lS th week were treated in different ways. In group a comprising 80 women repeated instillations of PGF,a were performed through a Foley catheter. Within 30 hours abortion occurred or evacuation of the uterus was performed without dilatation of the cervix in 85 per cent of the women. Slight side-effects were noted in 47 of the women. The most frequent was nausea and vomiting, while in 6 cases alone flushing was noted. In group b comprising only 8 women, a Foley catheter was introduced to the extra-amniotic space and repeated instillations of 0.9 per cent saline was performed. After 30 hours no abortion had occurred, in 2 cases evacuation was performed without surgical dilatation of the cervix, * while in the remaining 6 cases the cervix was closed. I n group c comprising 80 women, a single dose of 20 per cent of saline in a volume of 10 ml/week of gestation was introduced to the extraamniotic space. After this repeated injections of oxytocin were given subcutaneously. After a single instillation of hypertonic saline foliowed by oxytocin for one day abortion occurred in 64 per cent of the women. The number of complications was higher in group c, treated with hypertonic saline and oxytocin compared with group a, with PGF,a. The average stay in hospital was longer ( 4 3 days) in the hypertonic saline group than (3,4 days) in the PGF,a-group.