I n t r o d u c t i o n: Induction of labor is an intervention in the obstetrics, which aim is to achieve cervical ripening and stimulate contractions of uterus before beginning of labor. The purpose of our study was to evaluate efficacy of combinations of vaginal misoprostol, intracervical dinoprostone and Foley catheter at term with regard to mode of delivery and rate of emergency C-sections due to birth asphyxia.

Ma t e r i a l a n d Me t h o d s: 403 singleton pregnant women, who underwent pharmacological labor induction at term, were reviewed. Patients were divided into 2 main cohorts due to beginning of induction algorithm: vaginal misoprostol (66) or intracervical dinoprostone (337) consisting of 3 subgroups — PGE2 alone (184), PGE2+Foley catheter (125), PGE2+Foley catheter+PGE1 (28).

R e s u l t s: Comparison of maternal age, presence of cervical dilation and parity revealed no major differences between cohorts. Eff ectiveness of labor induction with misoprostol, dinoprostone and dinoprostone followed by Foley catheter were respectively 90.9%, 51.3%, and 82.8%. Addition of PGE1 was effective in 83% of patients with negative response to PGE2 followed by Foley catheter. There was no statistically significant diff erence in rate of C-sections between dinoprostone and misoprostol cohorts, C-section due to birth asphyxia were insignificantly more frequent in PGE1 than in PGE2 cohort. Efficacy in the subgroup administered only dinoprostone was significantly higher in 40th than in 41th (p = 0.016).

C o n c l u s i o n s: Intracervical dinoprostone seems to be safer, but less effective in labor induction than vaginal misoprostol. Following PGE2 by other methods increased efficacy of induction in this cohort.

Background: Preeclampsia (PE) is a condition characterized by high blood pressure and significant proteinuria in pregnant women. It affects about 7% pregnancies and can be cause of fetal and maternal morbidity and mortality. During pregnancy, a physiological overexpression of the Renin-An-giotensin System (RAS) components is observed, including increased plasma Ang II level. Dysregulation of RAS in placenta may contribute to preeclampsia and uterine growth retardation. The aim of the study was to evaluate the Ang I metabolism in human preeclamptic placentas and to compare to normal pregnancies condition.
Method: Fragments of placental tissues were collected right after ceasarian section from PE and phy-siological pregnancies. Tissues were incubated in Krebs buffer in the presence of Ang I. Evaluation of Ang I metabolites in incubating fluid was performed by LC/MS/MS method. mRNA expression of main RAS components was measured by RT-PCR.
Results: Pattern of angiotensin metabolites did not differ between groups. The main products were Ang 1–7 and Ang II. Comparing to control group, more than 3-fold lower production of Ang II and Ang 1–7 in preeclampsia was observed. mRNA expressions of ACE and AT1 were significantly decreased in pre-eclamptic placentas, whereas higher expression of mRNA of ACE2 and MAS receptor were observed.
Conclusions: Production of Ang 1–7 by PE placentas was significantly lower than in control group. Significantly decreased mRNA expression of ACE and AT1 receptor and lower production of Ang II in placentas of PE patients suggest that placental Ang II/ACE/AT1r pathway could be less important than Ang 1–7/ACE-2/MASr pathway in development of preeclampsia, but this requires further investigations.