Randomized controlled trial of vaginal misoprostol versus dinoprostone vaginal insert for labor induction

OBJECTIVE

To compare the safety and efficacy of vaginal misoprostol versus dinoprostone vaginal inserts for cervical ripening and labor induction.

METHODS

Two hundred singleton gestations with an indication for cervical ripening and induction of labor were randomized to receive either 50 microg of misoprostol intravaginally every 3 h or a 10-mg dinoprostone vaginal insert every 12 h for a maximum of 24 h. Statistical analysis included Student's t test, the Mann-Whitney U test, chi2 analysis and Fisher's exact test.

RESULTS

Ninety-seven women received vaginal misoprostol while 89 women received the dinoprostone vaginal insert. Fourteen women were removed from the study after randomization. The interval from start of induction to vaginal delivery (794.5 +/-408 min vs. 1005.3 +/- 523 min; p < 0.02) was significantly shorter in the misoprostol group. Women receiving misoprostol were more likely to deliver vaginally both in < 12 h (44% vs. 12%; p < 0.0001) and < 24 h (68% vs. 38%; p < 0.001). A non-reassuring fetal heart rate tracing was the indication for 71.4% (20/28) of Cesarean deliveries in the misoprostol group compared to 40% (14/35) in the dinoprostone group (p = 0.03). There were no significant differences in neonatal outcomes.

CONCLUSION

Intravaginal misoprostol and dinoprostone are safe and effective medications for use in cervical ripening before labor induction. Misoprostol results in a shorter interval from induction to delivery. However, Cesarean delivery for a non-reassuring fetal heart rate tracing was more common with misoprostol.

Pancreatic adenocarcinoma in the pregnant patient: case report and review of the literature

BACKGROUND

In this case report, the authors discuss the presentation and treatment of pancreatic adenocarcinoma in a pregnant woman. Pancreatic adenocarcinoma is extremely rare in the pregnant patient. Only three cases of pancreatic adenocarcinoma diagnosed antepartum have been reported.

METHODS

A case report and a review of the literature are reported.

RESULTS

The authors report a case of pancreatic adenocarcinoma in a pregnant woman at 17 weeks' gestation. Endoscopic retrograde cholangiopancreatography with stent placement and a pancreaticoduodenectomy were performed successfully.

CONCLUSIONS

Pancreatic adenocarcinoma is very rare in the pregnant patient. However, pancreaticoduodenectomy can be performed successfully. To the authors' knowledge, this is the first report of a pregnant woman treated with pancreaticoduodenectomy for pancreatic adenocarcinoma.

Temperature-dependent symptoms in a patient with esophageal motor disease

Patients with esophageal motor disease have been known to develop symptoms (chest pain, or dysphagia, or both) upon ingestion of warm or cold beverages. A patient with an esophageal motor disorder is described from whom a history of marked symptoms related to bolus temperature was elicited. Manometric monitoring during the administration of wet swallows with cold and warm water boluses reproducibly altered primary swallows from normal amplitude (74 +/- 7 mmHg) peristaltic contractions (warm boluses) to low amplitude (9 +/- 1.0 mmHg) aperistaltic contractions (cold boluses). The striking correlation between clinical history and manometric findings supports altered peristalsis as one mechanism for the development of symptoms related to bolus temperature in patients with esophageal motor disease.

Dapsone hypersensitivity. The sulfone syndrome revisited

A hypersensitivity reaction to low-dose (50-mg), short-term dapsone administration developed in a 16-year-old girl. The reaction included fever, malaise, dermatitis, jaundice with hepatic dysfunction, lymphadenopathy, and hemolytic anemia. Physicians should be familiar with this "sulfone syndrome," an uncommon, potentially serious, side effect of dapsone therapy.