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A double-blind study evaluating two dose schedules of oral prostaglandin E2(PGE2) was conducted in 56 normal “unripe” multiparas at term. The effect of PGE2was evaluated by comparing the change in Bishop score of the cervix and patient's response to oxytocin induction of labor after the prostaglandin priming. In the two study groups (one group on a fixed PGE2dosage and the other on a variable drug regimen) an average change of more than three points in the Bishop score was observed. In the control group no significant change in cervical ripeness was observed. Nine of the 32 patients (28) receiving prostaglandin delivered during the priming phase of the study, whereas only 1 control patient (4.2) delivered during priming. Six of 24 control patients (25) failed to deliver, whereas only 3 of 32 study patients (9) failed. In the successfully induced patients, the response to oxytocin, as expressed by the time to active phase, total time of labor, and mean dose of oxytocin required, did not vary significantly when control and study groups were compared. It is concluded that PGE2at either dosage schedule is effective in changing the Bishop score of the cervix and that it is not feasible to titrate the PGE2dose in order to effectively ripen the cervix without a very high incidence of induction of labor. In those cases where priming was completed, without accidental deliver)', the induction phase was successful more than 90 of the time. No adverse effect to mother or baby was observed during this study.

The significance of fetal heart rate-uterine contraction (FHR-UC) monitoring as a means of predicting the condition of the fetus during labor was studied by correlating 460 fetal pH determinations obtained from 216 patients with the analysis of the 20-minute FHR-UC record preceding the fetal scalp blood sample. Both qualitative and quantitative analyses of the FHR-UC record were performed. The results indicate a less than 10 chance of fetal pH ≤7.250 with a normal baseline FHR and no periodic changes or with periodic accelerations, early decelerations, and uncomplicated baseline bradycardia or tachycardia. Variable or delayed decelerations with a total surface area (TSA) of 1–100 for the 20-min period were associated with a fetal pH ≤ 7.250 in 23 and 34 of cases, respectively. Variable or delayed decelerations with a TSA > 100 had a 35 or 47 chance of fetal pH ≤ 7.250. It is concluded that FHR-UC monitoring can be used to screen the innocuous from the ominous periodic change but that fetal scalp blood pH must be obtained to identify accurately the true from the false-positive ominous pattern.

Sixteen episodes of prolonged fetal bradycardia lasting more than 2½ minutes with a decrease in FHR of more than 30 b.p.m. were observed in the course of 15 monitored labors. The mean fetal pH during the 20 minutes following the bradycardia (early recovery) was significantly less than the mean pH obtained 30 minutes or more after the bradycardia (late recovery). Various types of periodic heart rate changes were observed during the early recovery period but few persisted into late recovery. Vaginal delivery occurred in 13 of 15 patients. Two cesarean sections were performed for indications unrelated to the prolonged bradycardia. The 5 minute apgar score of all 15 neonates was 7 or greater.

Mixtures of two amorphous alumina gels of different acid reactivity change physically and chemically upon aging until a constant state is reached. The gels, when individually aged, retain their initial properties. The end-point appearance, viscosity, X-ray diffraction pattern, DTA thermogram, acid-insoluble fraction, and acid reactivity of the mixture are identical to those of the gel having the lower acid reactivity. The change in properties appears to be due to the conversion of the gel having the higher reactivity into the less reactive form. The rate of conversion is first-order, temperature-dependent, and directly dependent on the initial concentration of the less reactive gel.