Apoptosis Compound Library br Methods This prospective study

Methods This prospective study was conducted at the Zekai Tahir Burak Woman\'s Health, Research and Education Hospital, Ankara, Turkey between April 2009 and August 2009. The study was approved by the local Ethics Committee of the hospital, and an informed consent was signed by all patients before treatment, as in all cases of labor induction at our institution. Forty consecutive women with term isolated oligohydramnios and Bishop score≤5 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (prostaglandin E2; Group A). Oligohydramnios was defined as an amniotic fluid index (AFI) of < 5 cm. The control group, Group B, consisted of 64 cases of pregnancy with normal amniotic fluid volume (AFI ≥ 5 cm) and Bishop score≤5, and was matched for patient\'s age and parity. The criteria of inclusion were women with a singleton live cephalic presentation between 37 weeks and 42 weeks, intact amniotic membranes, and reassuring fetal Apoptosis Compound Library rate (FHR). The exclusion criteria were multifetal gestation; noncephalic presentation; premature rupture of membranes; suspicious or ominous nonstress test result at admission; placenta previa; suspected macrosomia over 4000 g; a history of uterine scarring or pregnancies complicated by evidence of fetal congenital malformations, gestational diabetes, hypertension, intrauterin growth retardation, or chronic illness; and any other contraindication to vaginal delivery. Patients with contraindication to prostaglandins administration (allergy, severe asthma, or pre-existing cardiac or cardiovascular disease), renal or hepatic dysfunction, and parity > 5 were also excluded. None of the women in the study received epidural or other modes of analgesia. Gestational age was established by the last reported menstrual period and first-trimester ultrasound measurements. Ultrasonography was performed on all patients to assess presentation of fetus, estimated fetal weight, placental site, and amniotic fluid volume. The amniotic fluid volume was estimated according to the four-quadrant technique. The uterus was divided into four quadrants, by the umbilicus transversely (into upper and lower halves) and by the linea nigra (into right and left halves). The maximum vertical diameter of the largest pocket in each quadrant without an aggregate of cord or fetal extremities was measured in centimeters. The sum of the largest vertical pocket in the four quadrants was the AFI. A depth of 0–5 equated with oligohydramnios. The dinoprostone insert was left in situ for 12 hours, if possible, or removed at the onset of active labor. Active labor was considered to begin when cervical dilatation was 4 cm. All cases were followed by continuous electronic fetal monitoring. A partogram was drawn to follow the progress of labor. Artificial rupture of membranes was done at 5-cm dilatation, and color of amniotic fluid (liquor amnii) was noted. At the 12th hour from the start of treatment, the Bishop scores were re-evaluated. For patients whose Bishop score was still<5 (i.e., not exhibiting regular uterine contraction), a vaginal application of dinoprostone was performed and they were induced with low-dose oxytocin infusion. Oxytocin augmentation was applied in the second stage, if necessary. Tachysystole was defined as six or more than five contractions in 10 minutes, averaged over a 30-minute window. Hyperstimulation was described as a tachysystole with late FHR decelerations or fetal tachycardia (> 160 beats/min) or other worrying FHR changes. In the event of hyperstimulation, the vaginal dinoprostone insert was removed, and fetal resuscitation (and tocolysis, if needed) was done. Non-reassuring FHR patterns were defined as persistent or recurring episodes of severe variable decelerations, late decelerations, prolonged fetal bradycardia, or a combination of decreased beat-to-beat variability and a decelerative pattern.