Our study has demonstrated that there was no alteration in nitric oxide production in preeclampsia, thus contributing to the existing unresolved role of nitric oxide in the pathogenesis of preeclampsia. Further research is called for.

Objective To estimate the cost-effectiveness of prostaglandin E2 (dinoprostone) vaginal gel for the induction of labour at term from the perspective of the UK's National Health Service.Design Economic evaluation conducted as part of a randomised controlled trial.Setting Maternity department at a major teaching hospital in London, UK.Population A cohort of 165 pregnant women presenting as cephalic between 36 +6 and 41 +6 weeks of gestation, for whom induction of labour was deemed necessary.Methods Either 3-mg Prostin E2 vaginal tablets or 1-or 2-mg Prostin E2 vaginal gel were administered at 6-hourly intervals.Main outcome measures Incremental cost per hour prevented between induction and delivery. The nonparametric bootstrap method was used to construct cost-effectiveness acceptability curves and estimate net benefits at alternative cost-effectiveness thresholds.Results Women receiving the gel accrued nonsignificantly higher costs (incremental cost £630; bootstrap 95% CI )£353, £2320; P = 0.43), and experienced a significantly reduced interval between induction and delivery (median of 1400 versus 1780 minutes; mean of 1711 versus 2765 minutes; P = 0.03). The incremental cost per hour prevented from induction of labour to delivery was estimated at £36. At a cost-effectiveness threshold of £100 per hour of care prevented, the probability that the gel is cost-effective was estimated at 0.83, and the mean net benefit to the health services was estimated at £1121 (bootstrap 95% CI )£1133, £3379). The results were sensitive to the inclusion of neonatal costs in the analysis and the value of the cost-effectiveness threshold. Notably, excluding neonatal costs increased the probability that the gel is cost-effective at a costeffectiveness threshold of £100 per hour of care prevented to 0.99.Conclusions This study suggests that prostaglandin E2 gel is probably more cost-effective than prostaglandin E2 tablets for the induction of labour at term. Given that the results are applicable to the general obstetric population requiring induction of labour at term, decision-makers should consider the likely economic impacts of their implementation.

Objective To compare the effectiveness of prostaglandin E2 (dinopristone) vaginal gel versus vaginal tablets for the induction of labour at term.Design Randomised controlled clinical trial.Setting University maternity hospital in London.Population Pregnant women with cephalic presentation undergoing induction of labour after 37 weeks of gestation.Methods Prostaglandin E2 vaginal tablets (3 mg) or vaginal gel (1 mg/2 mg) was administered at 6-hourly intervals until the cervix was suitable for amniotomy.Main outcome measures Induction to delivery interval, in minutes; rate of failed induction of labour requiring caesarean delivery.Results Eighty-two women received prostaglandin gel; 83 women received vaginal tablets. There were significant differences between the two treatment groups in the primary outcomes. The mean induction to delivery interval was significantly shorter in women who received the gel (1400 minutes, 690-2280 minutes, versus 1780 minutes, 960-2640 minutes; P = 0.03). The rate of failed induction of labour was significantly higher in women who received tablets (10.84 versus 1.22%; P = 0.01). Subanalysis showed that these differences were only representative of differences in the groups of primigravid women. There were no significant differences in any of the secondary outcomes, including the number of women who required syntocinon augmentation, the rate of uterine hyperstimulation, the need for epidural analgesia, meconium staining of liquor, the need for fetal blood sampling, or delivery by caesarean section. There were no differences in adverse maternal and neonatal outcomes.Conclusion Prostaglandin E2 vaginal gel is superior to vaginal tablets for the induction of labour.