Selective induction of labour.

In a prospective study of 1000 consecutive primigravidae labour was induced on 95 occasions. None of 16 perinatal deaths and none of 4 cases of suspected brain damage occurred after prolonged pregnancy or pre-eclampsia. It is concluded that a low incidence of induction is compatible with good results and that enthusiasm for the statistical concept of high risk in obstetric practice should be reviewed in the interest of mothers and children as individuals.     

Perinatal deaths: analysis by clinical cause to assess value of induction of labour.

Over the 10 years 1966-75 the rate of induction of labour in the Glasgow Royal Maternity Hospital has increased from 16-3% of all births. During the same period perinatal mortality fell from 33 to 22 per 1000, mainly because of significantly fewer deaths due to antepartum haemorrhage; trauma; maternal diseases; and unknown causes in mature babies. The reduction in the number of deaths of unknown causes in mature fetuses was achieved by preventing deaths occurring after 40 weeks and was recorded in all age and parity groups. The results suggested that increased use of induction of labour has contributed to the improved perinatal mortality rate.     

Pathogenesis of neonatal hyperbilirubinaemia after induction of labour with oxytocin.

To determine the pathogenesis of neonatal hyperbilirubinaemia after oxytocin-induced labour venous cord blood from 95 healthy newborn infants was examined. Of these, 15 were delivered by elective caesarean section, 40 after spontaneous labour, and 40 after oxytocin-induced labour. There was no significant difference in any haematological or biochemical variable between the first two groups. Infants born after oxytocin-induced labour, however, showed clear evidence of increased haemolysis associated with significantly decreased erythrocyte deformability (P less than 0.001). In-vitro studies showed a time- and dose-related reduction in erythrocyte deformability in response to oxytocin. The findings suggest that the vasopressin-like action of oxytocin causes osmotic swelling of erythrocytes leading to decreased deformability and hence more rapid destruction with resultant hyperbilirubinaemia in the neonate.     

Comparison of natural and synthetic prostaglandin E2 tablets in labour induction.

A multicentre, randomized, double-blind trial compared the efficacy and safety of and tolerance to natural and synthetically produced prostaglandin E2 tablets in the induction of labour in 202 women. The compounds were similarly effective, inducing labour in approximately 66% of patients. The total dose required and the interval between induction and delivery were similar in the two groups, as were the Apgar scores at 1 and 5 minutes and the incidence of maternal and fetal side effects.     

Prostaglandin E2 tablets compared with intravenous oxytocin in induction of labour.

Stimulation of uterine activity after amniotomy has been carried out with prostaglandin E2 (PGE2) tablets in two dosage regimens and with intravenous oxytocin. Oxytocin stimulation was the most successful. The difference in success rate was most marked in nulliparous patients and those with low Bishop score.     

Randomised comparison of early versus late induction of labour in post-term pregnancy.

In a prospective randomised study of mothers referred for prolonged pregnancy (around the 42nd week) 214 (group 1) were submitted to attempted induction of labour and 195 (group 2) assigned to continue for a further week without intervention. Strict selection criteria were used for the certainty of term. Mothers in group 2 were given regular non-stress tests to ensure fetal wellbeing, as were those in group 1 in whom induction failed. In group 1, 48 (23%) out of 210 first attempted inductions failed. In group 2, 135 (69%) of the births started spontaneously as compared with 38 (18%) in group 1. The mean duration of labour was 7.5 hours in each group. There was no significant difference in incidence of operative delivery, use of analgesics, or signs of perinatal asphyxia. Significantly more children in group 1 needed phototherapy for hyperbilirubinaemia. There was a clustering of births in the late afternoon and evening, which was most pronounced in group 1. A policy of vigilant non-intervention up to the 44th completed week of pregnancy does not appear to jeopardize mother or fetus.     

Scottish attitudes to blood donation and AIDS.

OBJECTIVE--To see whether the issue of AIDS has influenced the observed decline in blood donation in Scotland. DESIGN--Two methods: a quantitative survey using personal interviews based on a questionnaire and a qualitative survey based on group discussions. SETTING--Interviews based on the questionnaire were conducted in the respondents'' homes. The group discussions were held in the homes of professional market research interviewers. PARTICIPANTS--For the quantitative survey a representative sample of 976 Scottish adults was selected by multistage sampling. In the qualitative survey 16 groups of five to eight respondents assigned according to donating experience and sociodemographic criteria took part. MAIN RESULTS--AIDS was not mentioned as a discouraging factor in donation, and off putting aspects identified before AIDS became a public issue remained salient--for example, fear of needles. Many (75%) thought it unlikely that donation entailed a risk of developing AIDS. Nevertheless, respondents were reluctant to consider the AIDS issue personally. Being asked to do so, as in the routine screening of donors, aroused fears and resentment. CONCLUSIONS--The issue of AIDS, including fear of infection, has not directly influenced the declining numbers of donors, but the unpleasant associations of AIDS have had an indirect effect, particularly in undermining the emotional benefits of giving blood. For example, the screening process, which requires potential donors to consider their personal risk from AIDS, had had the effect of discouraging donors in general. Redressing the balance is difficult as screening must be universally applied. Rather than minimising the issue of AIDS, publicity needs urgently to reassert the positive benefits of and rewards from giving blood.     

Patients' prerogatives and perceptions of benefit.

Patients today demand more information about their treatment. Doctors, however, seem reluctant to cast aside ingrained habits of paternalism, believing they can best interpret therapeutic choices for their patients. Whether doctors can be more objective and effective than patients in interpreting the "probabilities" of medical evidence is open to question. On the other hand, the exercise of choice by patients may itself have a bearing on the probabilities of outcome. Involving patients more in making therapeutic choices is justified if doctors can present options in an unbiased and effective manner and if the process improves the outcome of the care delivered.