Die medikamentöse Geburtseinleitung - Parameter für ein erfolgreiches Management

In den letzten Jahrzehnten konnte am Dietrich-Bonhoeffer-Klinikum Neubrandenburg ein Anstieg der Geburtseinleitungen mit dem Prostaglandin Dinoproston-Vaginalgel 1 mg/2 mg verzeichnet werden. Mit Zunahme der Geburtseinleitungen erfolgte ebenfalls ein erhöhtes Auftreten der operativen Geburtsbeendigu...

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Bibliographic Details
Main Author: Berg-Kralj, Mandy
Contributors: Sudik, R. (Prof. Dr.) (Thesis advisor)
Format: Dissertation
Published: Philipps-Universität Marburg 2014
Frauenheilkunde und Geburtshilfe
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Table of Contents: In the past decades the number of induced labor with prostaglandin Dinoprostone vaginal gel 1mg/2mg has increased at the Dietrich-Bonhoeffer-Clinic Neubrandenburg. With the ascent of medical labor induction the number of operative deliveries has risen accordingly. Object of this analysis was the evaluation of how to reduce operative delivery determined by the following parameters: Bishop-score, parity, BMI and fetal weight. In summary patients who show the characteristics of a Bishop-score > 5, a body-mass-index between 18.5 and 30 and at least one childbirth in their medical history are indicators for a successful labor management with short latency. Half of the 3rd gravida developed sufficient contractions after 7.5 hours of the Dinoprostone vaginal gel application. For women expecting their second child the median time to get into labor was 8 hours. Referring to the Bishop score a number of 5 and higher was associated with a median time of 7.5 hours and to the development of contractions. A rigid cervix (Bishop-Score < 5) needed 9 - 13.5 hours in median to induce sufficient contractions. The study showed that in 773 out of 1213 labor inductions Minprostin-E2 vaginal gel had to be applied several times, mostly twice (500) with a total amount of 3 mg. Referring to the estimated dosage of Minprostin-E2 vaginal gel it was found that a Bishop-score from 2 - 6 will most likely require repeated application, with a suggestion of 1 mg Minprostin-E2 vaginal gel in the first course of application. Considerably shorter terms of latency could be observed compared to the increased starting dose of 2 mg. In addition the birth mode of women with an exceeding expecting date and women with gestational diabetes were compared. The first group showed a much lower number of operative vaginal deliveries (24.69 % versus 38.89 %). Threatening intrauterine asphyxia was the most common reason for an operative ending of labor (15.99%) In contrast in only 3.61 % of the newborn a true asphyxia could be proved.