Volume 16~ l':umber l. Part :!

579 "INTRACERVICAL DINOPROSTONE (PGE2): DOES IT ACTUALLY LOWER THE CESAREAN SECTION RATE?"

G. J. Gilson, M.D., L. B. Curet, M.D.; The University of New Mexico Hospital, Albuquerque, New Mexico

The effect of preinduction cervical ripening with intracervical dinoprostone (prostaglandin E2 gel 0.5 mg) on the outcome of induction of labor with intravenous oxytocin was investi­gated. Seventy-nine pregnant women were randomized to receive either intracervical application of dinoprostone 0.5 mg gel or placebo gel. Compared to control subjects, the group who received dinoprostone exhibited no difference in cervical Bishop scores, induction to delivery interval, or cesarean section rate. The dinoprostone group experienced fewer failed inductions, but there was no difference between the two groups in the number who eventually achieved spontaneous vaginal delivery.

CONCLUSION: Intracervical PGE2 gel does not appear to appreciably lower the cesarean section rate when used at this dose and route prior to the induction of labor.

580 A RANDOMIZED PROSPECfIVE TRIAL OF THE SLOW RELEASE PROSTAGLANDIN E2 (PGE2) VAGINAL PESSARY Gina DunstQn-

BQQne M p, MPH ~ Elene Tur7o, R N.x and Ronald J, Wapner, M,D, JeffersQn Medical CQllege Qf ThQmas JeffersQn University HQspltal, PhIladelphia, Pennsylvama

The efficacy of cerVIcal applIcatIOn of PGE2 for npening the cervix IS unproven The most effectIve dose and mode of administratIOn have not been defmed, A new sustamed release PGE2 vagmal pessary

(CO NT Rx ™ InfusclleT '1 V) wa, compdred with placebo 10 a randomIzed prospective tnal Ten mg of PGE2 IS released at Img/hr GravIdas at '237 weeks gc')tatlOTI with intact membranes, no pnar uterme surgery, reactIve NST, and Bishop score Qf ~6 were ehglhle Pattents with a BishQP SCQre Qf ~4 were blindly randQmlzed; those With scores;?:5 receIved active pcs.;;ary Vaginal exams were repeated at 6 and 12 hQurs, the pessary was then removed Maternal side effects, hypcrstlffiulatiOTI. fetal heart rate ..ibnormalitlcs or actIve labor prompted pessary rcmovJl Thirty-four women were randomized; 19 addItional patIents receIved actIve drug for a BIshop SCQre Qf ~, There were no sIgmficant differences In matcrnd-l age, gc~tatlOn. graVIty or parity 10 the tWQ groups

SROM < 05 Delivery .5.12 hrs p< 05

Increase ID BIshop score ~3 w"' not SIgnIfIcantly dIfferent between placebo (57%) and actIve (49%) therapy, Neonatal outcome dId not dIffer between groups 13% (5/39) Qf patients treated wah active pessary developed hyperstlmulatlon, tWQ of these required tQCQlytlc therapy 100% of post-dates patIents whQ received active pessary changed the IT BIshop SCQre by ~3, or dehvered withm 24 hours. Slow release PGE2 vagmal pessary appea" tQ be an efficacious means for IOductlon of labor wahou! ,mo", ,Ide effects

581

spa Abstracts 405

AN ANALYSIS OF THE FLEXURAL RIGIDITY OF UTERINE PRESSURE MONITORING CATHETERS. Charles J. Macri, CDR MC USN Kevin Andersonx , Michael Pytlinskix , Dept. OB/GYN, University of Southern California, School of Medicine and California Polytechnic Institute, Los Angeles, CA

The rigidity of four commonly used intrauterine catheters was measured and compared. stiffness was assessed by an accepted parameter flexural rigidity (EI). EI is calculated by the formula:

EI=(F)(L)3/(48)Ymax where F is force, L is length, Ymax is the maximum deflection. A higher EI value denotes greater rigidity.

Catheter Corometrics Laurel (without wire) Spectromed Laurel (with wire) Utah (IntranR )

Mean EI (lb)(in)2 147 251 273 651 829

The Corometrics catheter, which contains a liquid column, is less rigid than the solid-state catheters. Complications that may be catheter-related, e.g. perforation or abrupt ion , should be reported by specific catheter type in order to assess whether catheter stiffness has clinical significance.

582 CHANGING PATTERNS OF SUBSTANCE ABUSE DURING PREGNANCY

Copur H~ Khakoo H, Boafo A, Ayromlooi J. New York Medical College, Llncoln Hospital N.Y.

A retrospective study of 19,614 women who delivered in an inner city hospital from Jan.1, 1985 to Dec.31, 1988 was conducted to determine changing pattern of substance abuse during pre~ nancy. 733 women(3.7%) used cocaine, crack, heroin, methadone and marljuana. The findings are summarized in the following table: Yrs. COCalne& Heroin&Meth Marijuna Multiple

Crack(334) adone(119) (26) (263) 85 26(22%) 32(28%) 4(3%) 55(47%) 86 62(39%) 26(16%) 5(3%) 67(42%) 87 100(49%) 23(11%) 8(4%) 73(36%) 88 146(58%) 38(11%) 9(4%) 68(27%)

Conclusion: Overall substance abuse increased over a period of four years. The use of cocaine and crack increased dramatically(three fold), whereas opiate abuse decreased. The increase in use of cocaine and crack could be attributed to ease of administration, lower cost to the patient and absence of disfigurement.