Prostaglandin gel versus oxytocin – prelabour rupture of membranes at term – A randomised controlled trial

[Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Methods for Inducing Labor]

OBJECTIVES

To assess the studies comparing induction methods in women with term prelabor rupture of the membranes and establish if one is superior to the others.

METHODS

The MedLine database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.

RESULTS

The included studies compared medical induction methods: oxytocin (intravenous), dinoprostone (vaginal gel, pessary or intracervical gel), and misoprostol (oral or vaginal route); and a mechanical induction method: the Foley catheter. The primary outcome measures were: labor induction to delivery interval, number of women delivered within 12 or 24hours of initiation of induction and cesarean delivery rate. The small sample size of the included studies as well as the limited number of reported complications does not provide a reasonable basis for concluding on the secondary outcome measures: pyrexia, chorioamnionitis, uterine tachysystole, Apgar scores of<7 at 5minutes. Induction of labor with misoprostol (oral and vaginal) reduced the labor induction to delivery interval compared with dinoprostone (LE2). This interval was unchanged when comparing induction with oxytocin and Foley catheter (LE2). The data comparing this interval in women induced with dinoprostone versus oxytocin and misoprostol versus oxytocin is limited or inconsistent. The cesarean delivery rate was comparable in women induced with dinoprostone (vaginal gel) versus oxytocin (LE2), misoprostol (oral and vaginal route) versus oxytocin (LE2), Foley catheter versus oxytocin (LE2), misoprostol versus dinoprostone (LE2) and misoprostol versus Foley catheter (LE2). The number of women delivered within 24hours of initiation of induction was comparable when induced with oral misoprostol versus oxytocin (LE2) and Foley catheter versus oxytocin (LE2). There is a lack of data for this outcome when comparing dinoprostone versus oxytocin, vaginal misoprotsol versus oxytocin, and misoprostol (oral and vaginal) versus dinoprostone. No induction method is superior to another for nulliparous women or women with unfavorable cervix (LE2).

CONCLUSION

The superiority of an induction method, in terms of effectiveness or safety, could not be established with the current available data for women with term prelabor rupture of the membranes. An increased risk of chorioamnionitis due to induction using Foley catheter could not be ruled out by the available data. All medical methods are suitable for inducing women with term prelabor rupture of the membranes (Grade B).

Therapeutic Potential of Oxytocin in Atherosclerotic Cardiovascular Disease: Mechanisms and Signaling Pathways

Coronary artery disease (CAD) is a major cardiovascular disease responsible for high morbidity and mortality worldwide. The major pathophysiological basis of CAD is atherosclerosis in association with varieties of immunometabolic disorders that can suppress oxytocin (OT) receptor (OTR) signaling in the cardiovascular system (CVS). By contrast, OT not only maintains cardiovascular integrity but also has the potential to suppress and even reverse atherosclerotic alterations and CAD. These protective effects of OT are associated with its protection of the heart and blood vessels from immunometabolic injuries and the resultant inflammation and apoptosis through both peripheral and central approaches. As a result, OT can decelerate the progression of atherosclerosis and facilitate the recovery of CVS from these injuries. At the cellular level, the protective effect of OT on CVS involves a broad array of OTR signaling events. These signals mainly belong to the reperfusion injury salvage kinase pathway that is composed of phosphatidylinositol 3-kinase-Akt-endothelial nitric oxide synthase cascades and extracellular signal-regulated protein kinase 1/2. Additionally, AMP-activated protein kinase, Ca²⁺/calmodulin-dependent protein kinase signaling and many others are also implicated in OTR signaling in the CVS protection. These signaling events interact coordinately at many levels to suppress the production of inflammatory cytokines and the activation of apoptotic pathways. A particular target of these signaling events is endoplasmic reticulum (ER) stress and mitochondrial oxidative stress that interact through mitochondria-associated ER membrane. In contrast to these protective effects and machineries, rare but serious cardiovascular disturbances were also reported in labor induction and animal studies including hypotension, reflexive tachycardia, coronary spasm or thrombosis and allergy. Here, we review our current understanding of the protective effect of OT against varieties of atherosclerotic etiologies as well as the approaches and underlying mechanisms of these effects. Moreover, potential cardiovascular disturbances following OT application are also discussed to avoid unwanted effects in clinical trials of OT usages.