Obstetrics and gynecology
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Obstetrics and gynecology · May 1991
Randomized Controlled Trial Comparative Study Clinical TrialLabor induction with continuous low-dose oxytocin infusion: a randomized trial.
One hundred twenty-three women were randomized to receive either of two regimens of oxytocin for labor induction. Sixty-one received a low-dose regimen, with oxytocin increases at intervals of not less than 60 minutes. Patients with unripe cervices received prolonged low-dose oxytocin priming before membrane rupture. ⋯ Cesarean delivery and cesareans for fetal distress were more frequent in the traditional protocol group. This study demonstrates that a continuous low-dose protocol for oxytocin induction of labor is effective in establishing active labor and achieving vaginal delivery in women with both ripe and unripe cervices. It is also associated with fewer episodes of uterine hyperstimulation requiring adjustments of oxytocin infusion than is the traditional protocol of this institution.
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Obstetrics and gynecology · Mar 1991
Randomized Controlled Trial Clinical TrialNifedipine in the treatment of severe preeclampsia.
We conducted a randomized clinical trial in which patients with severe preeclampsia between 26-36 weeks of gestation received either nifedipine (10-30 mg sublingually, then 40-120 mg/day orally; N = 24) or hydralazine (6.25-12.5 mg intravenously, then 80-120 mg/day orally; N = 25). Effective control of blood pressure was achieved with nifedipine in 95.8% of subjects and with hydralazine in 68%, a statistically significant difference (P less than .05). Maternal side effects were minor in both groups. ⋯ Infants born to women treated with nifedipine were delivered at more advanced gestational ages (34.6 +/- 2.3 versus 33.6 +/- 2.4 weeks; statistically not significant), weighed more (1826 +/- 456 versus 1580 +/- 499 g; statistically not significant), and tended to have fewer, mainly minor, complications. The average number of days spent in the neonatal intensive care unit was significantly lower in the nifedipine group (15.1 versus 32.7 days; P less than .005), leading to an average 31% reduction in total (maternal and neonatal) hospitalization-related charges for each nifedipine-treated pregnancy. We conclude that nifedipine is an effective, convenient, and low-cost treatment for patients with severe preeclampsia, and is not associated with undesirable side effects.
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Obstetrics and gynecology · Mar 1991
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled epidural analgesia during labor.
This study compared the safety, efficacy, local anesthetic usage, patient satisfaction, and anesthesia manpower demands of patient-controlled epidural analgesia and continuous epidural infusion during labor. After establishment of epidural analgesia, 88 parturients with vertex presentation were assigned randomly to receive either patient-controlled epidural analgesia or continuous epidural infusion, using 0.125% bupivacaine containing 1 microgram/mL of fentanyl. Inadequate analgesia was treated in both groups with a 10-mL "top-up" of 0.25% bupivacaine. ⋯ Use of local anesthetic solution was examined with respect to cervical dilatation and did not increase late in labor. Patients generally viewed infusion technology favorably. These findings suggest that patient-controlled epidural analgesia is safe and effective, reduces anesthesia manpower needs, and is well accepted.
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Obstetrics and gynecology · May 1990
Randomized Controlled Trial Comparative Study Clinical TrialAnesthesia for neonatal circumcision: local anesthesia is better than dorsal penile nerve block.
Several studies document the benefit of dorsal penile nerve block for neonatal circumcision, but the literature does not address the use of local anesthesia. A randomized, controlled, prospective study was conducted to compare the efficacy of dorsal penile nerve block versus local anesthesia. Thirty infants were randomly divided into three equal groups (N = 10): an unanesthetized control group, a group given dorsal penile nerve block, and a group given local anesthesia. ⋯ Dorsal penile nerve block had no effect on postoperative cortisol levels. No complications occurred. Although both types of anesthesia attenuated the physiologic responses to circumcision, local anesthesia demonstrated greater efficacy than dorsal penile nerve block while being simpler to perform.
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Obstetrics and gynecology · May 1990
Randomized Controlled Trial Comparative Study Clinical TrialA randomized comparison of gentamicin-clindamycin and cefoxitin-doxycycline in the treatment of acute pelvic inflammatory disease.
In this prospective trial, 130 hospitalized patients with acute pelvic inflammatory disease based on clinical criteria were randomly treated with intravenous gentamicin plus clindamycin (N = 63) or cefoxitin plus doxycycline (N = 67) for at least 4 days, followed by oral clindamycin or doxycycline, respectively, for a total of 14 days. Pre-treatment cultures were obtained for endocervical Neisseria gonorrhoeae and Chlamydia trachomatis, and for endometrial C trachomatis and aerobic and anaerobic bacteria. Overall, 46 subjects (35%) had endocervical cultures positive for N gonorrhoeae. ⋯ Post-treatment cultures for N gonorrhoeae were negative in all cases tested. Post-treatment endocervical and endometrial C trachomatis cultures were negative in ten of 11 subjects treated with gentamicin-clindamycin and in eight of nine treated with cefoxitin-doxycycline, a nonsignificant difference. We conclude that gentamicin-clindamycin and cefoxitin-doxycycline have similar clinical cure rates for acute pelvic inflammatory disease and are equivalent in eradicating genital N gonorrhoeae and C trachomatis.