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- W2022376676 abstract "Oral prostaglandin E2 (PGE2) is now widely used in conjunction with amniotomy for induction of labor, especially in the parous patient and the primigravida with a favorable cervix. It has been highly successful and the oral tablets now on trial seem to have a low incidence of side effects. The main concern in using a swallowed drink or a tablet was the possible development of uterine hyperstimulation after the longacting dose of uterine stimulant had been given. However, only a few cases have been reported with a wide variety of regimens of PGE2; thus this complication seems rare except with higher intravenous doses. The following case is reported wherein severe uterine hypertonus after induction of labor with low-dose oral PGE2 tablets developed. A 32 year old woman, para 2 had had 2 previous spontaneous vertex deliveries of healthy infants weighing 7 pounds (3.2 kg) and 8 pounds 4 ounces (3.6 kg), after 7 hours and 5 hours of labor. The pregnancy had been uneventful and induction of labor was carried to term plus 9 days by low amniotomy and oral PGE2. The cervix was given an inducibility rating of 6. Within the 1st hour a high baseline intraamniotic pressure was noted (up to 30 mmHg) but this fell spontaneously to under 15 mm. The 4th hourly dose was omitted since the patient was in very good labor and a rise in baseline pressure to 25 mm had again occurred with 80 mm contractions every 2 minutes. 80 minutes after the 3rd dose the patient began to have increasing abdominal pain and prolonged contractions. An intraamniotic baseline pressure showed a rise to over 60 mm for periods of 4, 4, 8, and 10 minutes, with only brief falls to 30 mm in between. The patient was in continuous severe pain unrelieved by 50 mg intravenous pethidine and nursing on her side. The fetal heart fell progressively from a baseline of 125/minute to 60 just prior to delivery. The cervical dilatation was only 5 cm with the vertex 1 cm above the ischial spines 20 minutes before delivery. Labor was clearly progressing rapidly. When the head had entered the pelvic region, preparations were made to expedite delivery with the ventouse, but full dilatation was reached quickly and delivery was achieved with Haig Ferguson forceps. A healthy male child weighing 7 pounds, 4 ounces (3.3 kg) was delivered with an Apgar of 5 but he rapidly responded to simple resuscitation with mucus extraction and oxygen. In spite of the total low dose of PG and the rarity of significant hypertonus reported with PGs, it is clear that the severe hypertonus was due to PG stimulation. It is also unusual since the condition occurred long after the last PG administration. In such a severe case, it might be wise to consider a rapid intravenous infusion of ethyl alcohol." @default.
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- W2022376676 date "1974-07-01" @default.
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- W2022376676 title "UTERINE HYPERTONUS AFTER ORAL PROSTAGLANDIN E2" @default.
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- W2022376676 doi "https://doi.org/10.1016/s0140-6736(74)91591-8" @default.
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