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Aim: To evaluate the efficacy and safety of oral misoprostol for labor induction in women with term premature rupture of membranes (PROM) and an unfavorable cervix. Methods: We randomized 130 women with PROM of ≤4 h to either oral misoprostol, 50 μg, or a placebo given every 4 h for up to three doses. Intravenous oxytocin was initiated if active labor did not begin within 12 h. Results: Sixty-four women received oral misoprostol and 66 received placebo. The PROM-to-delivery interval was shorter with misoprostol than with placebo (13.7±5.8 vs. 20.3±6.8 h, respectively, P<0.05). Misoprostol significantly reduced the need for oxytocin (28.1 vs. 72.7%, P<0.001) and antibiotics (25 vs. 69.7%, P<0.001). No significant differences in cesarean section or hyperstimulation rate were noted. Conclusion: Oral misoprostol given to women with unfavorable cervix soon after term PROM significantly reduces the induction-to-delivery time and the need for oxytocin and antibiotics. [ABSTRACT FROM AUTHOR]

: ObjectivesRipening of the cervix with a Foley catheter commonly results in cervical dilatation without contractions. We examined the outcome of labour in women who underwent induction of labour using a Foley catheter, followed by either 1. early amniotomy, or 2. augmentation of labour by oxytocin and late amniotomy: DesignProspective randomised clinical trial: SettingLabour and delivery ward of a university teaching hospital: ParticipantsPregnant women ≥38 weeks of a singleton gestation, who had had no prior caesarean section: MethodsAll women underwent cervical ripening using a Foley catheter. Following removal of the catheter, women were randomly assigned to either early (n = 80) or late amniotomy (n = 88).Main outcome measures Comparison of mode of delivery and duration of labour between the two groups: ResultsThe rate of caesarean section was significantly higher in the early amniotomy group compared with the late amniotomy group (25% vs 7.9%; relative risk 1.74; 95% CI 1.3 – 2.34). The increase in caesarean section rate was due primarily to dystocia (15% vs 3.3%; relative risk 1.8; 95% CI 1.32 – 2.45). When excluding caesarean deliveries, no significant difference was found in duration of labour between the groups (8.3 hours (3.8) vs 7.7 hours (2.9)): ConclusionsIn women who undergo cervical ripening with a Foley catheter, augmentation of labour by oxytocin followed by amniotomy during active labour results in a lower rate of caesarean delivery for dystocia [ABSTRACT FROM AUTHOR]

Abstract: Objective:: To compare maternal and neonatal morbidity associated with two methods to extract the impacted fetal head during Cesarean delivery. Study design:: We retrospectively analyzed cases with difficult extraction of the impacted fetal head during Cesarean section. We compared maternal and neonatal outcomes between cases that were delivered by head extraction following pushing through the vagina (‘push’ method) and those that were delivered by the reverse breech technique (‘pull’ method). Results:: We reviewed 3105 Cesarean section reports. Difficult extraction necessitating the ‘push’ or ‘pull’ methods was noted in 48 (1.5%) instances. Women that were delivered by the ‘pull’ method had significantly lower rate of postpartum fever (5% versus 46%; odds ratios, 0.06; 95% confidence intervals, 0.007–0.51) and extensions of the uterine incision (15% versus 50%; odds ratio, 0.17; 95% CI, 0.04–0.74) compared to those that were delivered by the ‘push’ method. Neonatal outcomes were good in all cases. Conclusions:: In cases with difficult extraction of the impacted fetal head during Cesarean section, ‘pull’ method may result in lower maternal morbidity compared to the traditional ‘push’ method. [Copyright &y& Elsevier]

No Abstract available [ABSTRACT FROM AUTHOR]