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Abstract
Pre-eclampsia occurs in 6-8 % of all pregnancies and carries clinically signficant morbidity and mortality for the mother and fetus . The etiology and the factors responsible for the progression of pre-eclampsia remain poorly understood . The only known cure is delivery of the fetus and placenta . Thus , Pre-eclampsia is one of the more common indications for induction of labor .
Many women have this disorder before the onset of spontanous labor , the cervix may be unfavorable , thus increase the risk of failed induction and cesarean section .
Originally magnesium sulfate was used in prevention and treatment of pre-eclampsia and eclampsia , however its use has expanded to include inhibition of preterm labor .
The purpose of this study is to evaluate the effect of magnesium sulfate therapy on the outcome of induction of labor in women with severe pre-eclampsia .
The patients for whom this work was done were forty four pregnant women admitted to the emergency unit of Obstetrics department of Suez Canal University Hospital during the period from March 2002 to April 2003 .
All patients were suffering from severe P.E. with singletone vertex pregnancy , gestational age ≥ 32 wk . and with unfavorable cervix
( cervical dilatation < 2 cm and effacement < 50 % ) .
These cases were divided into two groups
Study group :
Included 22 patients received magnesium sulfate through labor and 24 hours after delivery .
control group :
Included 22 patients who received ringer solution that is identical in appearance to MgSo4 .
Induction of labor with misoprostol 25 ug / 4 hrs for maximum four doses was done for all patients .
Augmentation of labor by ARM and oxytocin administration was done if adequate uterine contraction was not achieved .
There was no significant statistical difference in the two groups as regard clinical criteria (age , parity , Systolic and diastolic BIP , temperature ,pulse and proteinurea ) p > 0.05 .
Also both groups are matched regarding laboratory investigations
( PT, PTT , SGOT , SGPT , Creatinin and platelet count) P value > 0.05.
Most of the control group had a score of 2 or 3 (36.4 % each), while most of the study group had a Bishop score of 3. With a P value of 0.65.
There was no statistical significant difference between both groups as regard to the need of nifidipine as an antihypertensive treatment
p =0.75 .
The Study results showed that the induction delivery interval was slightly longer in study group ( 17.5 ± 3.7 hours ) than control group (16.1 ± 3.1 hours) but this difference was not statistically significant p = 0.17 . However significantly higher doses of misoprostol was needed in the study group (mean 72.7 ± 25.4 ug) than that in the control group (mean 50.9 ± 21.8 ug) with a P value of 0.003 .
Two patients needed 25 ug of misoprostol in the study group against 7 in the control group while 6 patients needed 50ug in study group against 9 in control group , 6 patients needed 75ug in study group against 5 in control group , and 8 patients needed 100 ug misoprostol versus one patient in control group .
As regard augmentation of labor, the number of patients who needed augmentation of labor by ARM and oxytocin was significantly higher in the study group [ 19 (86%) vs 12 ( 54% ) ] , P = 0.02 more over the mean dose of required oxytocin was higher in study group (10.7± 3.8 international units) than control group ( 7.5 ± 3.9 international units ) while there was no significance difference in duration of oxytocin administration between both groups (P = 0.32), also maximum rate of oxytocin administration (mU/ min ) was higher in study group ( 19.6 ±5.4 mU/ min) than that in control group ( 14.4 ±6.5 mU/ min ) p =0.01 .
There was no statistically significant difference between the study and control groups regarding the number of patients delivered either vaginally ( 54 % vs 63%) or by cesarean section ( 45% vs 36% ) p =0 .53 .
Also no statistical significant difference in rate of failure of induction , fetal distress and failure to progress between both groups with x2 = 0.4
Also there was no statistically significant difference between both groups as regard Apgar score one ( p = 0.83) and five ( p= 0.52) minutes.
We conclude that the use of magnesium sulfate for seizure prophylaxis in severe pre-eclampia does not affect induction delivery interval , mode of delivery and also neonatal outcome but did necessitate a higher dose of misoprostol and oxytocin.