Prostaglandin E2질정에 의한 유도분만의 효과 = Induction of Labour Using Prostaglandin E2 Pessaries

다국어 초록 (Multilingual Abstract)

In order to determine the clinical usefulness of Prostaglandin E2 vaginal pessary in the induction of labour a stable 3mgm Prostaglandin E2 pessary supplied by Korea Upjohn Ltd. was used in the induction of labour in 66 patients admitted to Il Sin Women`s Hospital, Busan, between November 1982 and February 1983. In 19 cases the maximum does of 6mgm was used, a second 3mgm pessarybeing inserted 8~15hrs after the first pessary. Results 1. PGE2 pessaryalone was successful in inducing labour in 32 patients, 48.5%, and was considered to be a definite aid in a further 19, 28.8%. 2. In addition to the 32 patients already delivered or in active labour the action of cervical ripending was seen in an additional 9 patients in that the Bishops score increased by 3 points within 15 hours after the insertion of one 3mgm pessary. 3. In cases successfully induced by PGE2 pessary the average interval between rupture of the membranes and delivery was very short. 2.7hrs, and the average duration of labour was 5.4hours. 4. The overall Cesarean section rate was 21.2% but none was done for failed induction. The main indication was C.P.D., 11 out of 14 patients. 5. The incidence of postpartum hemorrhage, that is a loss of 500cc or more, was slightly higher than the overall hospital incidence. 6. Side effects were minimal. One patient vomited but only 10mls and among 29 pre-eclamptic or eclamptic patients in only 10 was there a change in the blood pressure, an increase by 20mmHg in 7 and decrease by 20mmHg in 3, within 3 hours of insertion of the pessary. 7. There were no episodes of fetal distress that could be attributed to PGE2 administration. 8. The factors possibly affecting the success rate, Bishop`s score, parity, gestational age and indication for induction were analysed. The indication for induction and gestational age were significant factors but parity and Bishop`s score had no affect on the outcome. Among patients with hypertensive complications of pregnancy there was a high success rate but a very low success rate in patients with post mature pregnancies and in these cases apart from one patient there was no other obstetric indication for induction. The high success rate in preterm pregnancies was irrespective of parity of Bishops score but there was always a definite obstetric indication for induction in these cases and this is considered to be the more important factor. This study also shows that the PGE2 pessary is simple to use, acceptable to the patient, has almost no side effects and can be safely used in all cases in which vaginal delivery is possible with a high rate of success. It is planned to continue the use of PGE2 pessary when it is commercially available.