A comparison of sublingual and vaginal misoprostol for induction of labour: a randomized controlled trial

Tyrimo tikslas — palyginti gimdymui sužadinti po liežuviu dedamos 50 µg misoprostolio ir į makštį dedamos 25 µg misoprostolio dozių veiksmingumą ir saugumą. Metodika. Klinikinis atsitiktinių imčių dvigubai aklas tyrimas. Iš viso 140 moterų gimdymui sužadinti kas 4 val. buvo dedama arba 50 µg misoprostolio po liežuviu ir placebo į makštį (n = 70, sublingvalinė grupė), arba placebo po liežuviu ir 25 µg misoprostolio į makštį (n = 70, vagininė grupė) (didžiausias dozių skaičius — 6). Pagrindiniu vertinimo kriterijumi buvo pasirinktas laikas nuo sužadinimo pradžios iki gimdymo natūraliais takais. Papildomai vertintas per 12 ir 24 val. nuo sužadinimo pradžios pagimdžiusių moterų skaičius, misoprostolio dozių skaičius, skatinimo oksitocinu ir gimdos perstimuliavimo dažnumas, gimdymo būdas ir naujagimių būklė po gimdymo. Rezultatai. Laikas nuo sužadinimo pradžios iki gimdymo natūraliais takais sublingvalinėje grupėje buvo statistiškai reikšmingai trumpesnis (902,9 ± 224,4, palyginti su 999,3 ± 246,4 min., p = 0,03), o po vienos vaisto dozės natūraliais takais pagimdžiusių moterų skaičius didesnis (53,4 proc., palyginti su 25,0 proc., p = 0,002) nei vagininėje grupėje. Tachisistolijų dažnumas buvo daugiau kaip 3 kartus didesnis sublingvalinio nei vagininio misoprostolio grupėje, atitinkamai 14,7 proc. ir 4,3 proc. (p = 0,04). Hipertonuso ir gimdos perstimuliavimo sindromo dažnumas, gimdymo būdas ir procedūrų dėl vaisiaus hipoksijos dažnumas, naujagimių būklė po gimdymo grupėse statistiškai reikšmingai nesiskyrė. Išvados. Palyginti su 25 µg į makštį dedamo misoprostolio doze, 50 µg po liežuviu kas 4 val. vartojamo misoprostolio veiksmingumas yra didesnis. Nepaisant dažnesnių tachisistolijų vartojant 50 μg po liežuviu, naujagimių būklė po gimdymo abiejose tyrimo grupėse buvo vienodaObjective. To compare the efficacy and safety of 50 µg of sublingual misoprostol with 25 µg of vaginal misoprostol administered for labour induction at term. Methods. Double-blinded randomised controlled trial. A total of 140 women were randomised to receive either 50 µg of sublingual misoprostol with vaginal placebo (n=70) or sublingual placebo with 25 µg of vaginal misoprostol (n=70) every 4 hours (maximum 6 doses). The primary outcome measure was the interval from the start of induction to vaginal delivery. Women having a vaginal delivery within 12 and within 24 hours, the number of misoprostol doses given, oxytocin augmentation, excessive uterine activity, mode of delivery and neonatal outcomes were other outcome measures. Results. The induction to vaginal delivery time was significantly shorter (902,9±224,4 vs 999,3±246,4 min, P=0,03) and significantly more women were delivered vaginally after single dose of misoprostol (53,4% vs 25,0%, P=0,002) in the sublingual group compared with the vaginal group. The incidence of tachysystole was more than 3-fold higher in the sublingual than in the vaginal group (14,7% versus 4,3%, P=0,04). There were no significant differences in the incidence of hypertonus or hyperstimulation syndrome, mode of delivery, interventions for fetal distress or neonatal outcomes between two groups. Conclusion. Fifty micrograms of sublingual misoprostol four hourly seems to have better efficacy than 25 µg of vaginal misoprostol. Despite more frequent tachysystole with 50 µg of sublingual misoprostol, neonatal outcomes were similarKauno medicinos universitetasVytauto Didžiojo universiteta

Sensitivity and Specificity of Biochemical Tests for Diagnosis of Intrahepatic Cholestasis of Pregnancy

Background and aim: Intrahepatic cholestasis of pregnancy (ICP) is linked with increased risk of fetal complications. An accurate diagnostic test is needed to diagnose this disorder on time. We aimed to assess sensitivity and specificity of laboratory tests used for diagnosis of intrahepatic cholestasis of pregnancy and determine more reliable cut-off values of transaminases. Material and methods: Sixty one symptomatic patients with ICP and 29 healthy pregnant women were included in the retrospective analysis. Results: ICP patients had higher total bile acids (TBA) levels than healthy women (32 vs. 6; P < 0.0001) due to increase in cholic acid (CA) and chenodeoxycholic acid (CDCA). CA/CDCA ratio was significantly higher in ICP patients compared to healthy pregnant women (1.13 vs. 0.68; P < 0.00002). TBA, CA, CDCA and CA/CDCA ratio demonstrate the following sensitivity (94%, 96%, 89%, 71.9%) and specificity (63%, 63%, 59%, 79.3%, respectively) for ICP diagnosis. Lowering cut-off values for ALT (31 U/ L) and AST (30 U/L) resulted only in minimal increase of sensitivity to 92.2% vs. 90.1% for ALT and to 92.2%, vs. 90.6% for AST. Conclusion: The present study did not reveal any single specific and sensitive marker for reliable diagnosis of ICP. Establishment of lower cut-off values for transaminases activity might only minimally increase the accuracy of diagnosing ICP

Sublingual compared with vaginal misoprostol for labour induction at term : a randomised controlled trial

Objective To compare the efficacy and safety of 50 μg of sublingual misoprostol with 25 μg of vaginal misoprostol administered for labour induction at term. Design Double-blinded, randomised controlled trial. Setting University Hospital, Kaunas, Lithuania. Sample A total of 140 women at term with indications for labour induction. Methods Women were randomised to receive either 50 μg of sublingual misoprostol with vaginal placebo (n = 70) or sublingual placebo with 25 μg of vaginal misoprostol (n = 70) every 4 hours (maximum six doses). Main outcome measures The number of women delivering vaginally within 24 hours of labour induction. Results Fifty-eight women (83%) in the sublingual misoprostol group and 53 (76%) in the vaginal misoprostol group delivered vaginally within 24 hours [relative risk (RR) 1.1, 95% confidential interval (CI) 0.9–1.3]. However, the induction to vaginal delivery time was significantly shorter in the sublingual group (15.0 ± 3.7 hours) compared with the vaginal group (16.7 ± 4.1 hours, P = 0.03). The incidence of tachysystole was more than three-fold higher in the sublingual than in the vaginal group (14 versus 4.3%; RR 3.3, 95% CI 0.9–11.6), but this was not statistically significant. There were no significant differences in the incidence of hypertonus or hyperstimulation syndrome, mode of delivery, interventions for fetal distress or neonatal outcomes between the two groups. Conclusion A 50 μg of sublingual misoprostol 4 hourly for labour induction at term seems to have similar efficacy as 25 μg of vaginal misoprostol. Further studies on safety with larger numbers of women need to be conducted before routine sublingual misoprostol use in this settingKauno medicinos universitetasVytauto Didžiojo universiteta

Resolution of fetal hydrops dependent on sustained fetal supraventricular tachycardia after digoxin therapy

We present a special case of fetal supraventricular tachycardia detected at 34 weeks gestation. Fetal hydrops was noted on ultrasound upon admission. Normal fetal heart rate was maintained for three weeks by maternal administration of digoxin. A live infant was delivered via caesarian section at 37 weeks gestation. This clinical case demonstrated that pharmacological treatment can be effective and helps to prolong pregnancy safely

Проекты ЦИК и ЛУНЗ 2010–2012 г.: путешествие по Шёлковому пути к более безопасному и современному здравоохранению

Подготавливая это издание, мы хотели сами осознать масштаб проделанной за три года работы, поделиться накопленным опытом сотрудничества, оставить для истории страницы о дружбе, взаимопонимании, доверии, стремлении к улучшению здравоохра- нения в наших странах

Проекты ЦИК и ЛУНЗ 2010–2012 г.: путешествие по Шёлковому пути к более безопасному и современному здравоохранению

Подготавливая это издание, мы хотели сами осознать масштаб проделанной за три года работы, поделиться накопленным опытом сотрудничества, оставить для истории страницы о дружбе, взаимопонимании, доверии, стремлении к улучшению здравоохра- нения в наших странах

Предпринимательская среда в новых странах ЕС

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