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Objective To compare the efficacy of low dose vaginal misoprostol and dinoprostone vaginal gel for induction of labour at term. Design A single-blind randomised controlled trial.Setting Antenatal and labour ward of a UK district general hospital.Participants Two hundred and sixty-eight women requiring induction of labour at term (>37 weeks of gestation) with no significant fetal or medical condition, no previous uterine surgery and no contraindication to prostaglandin. Methods Misoprostol 25 Ag (one-quarter of a 100 Ag tablet) was inserted into the posterior vaginal fornix every 4 hours (to a maximum of six doses) or dinoprostone vaginal gel 1 -2 mg 6 hourly (maximum of 3 mg in 24 hours). Main outcome measure Induction-to-vaginal delivery interval.Secondary outcome measures Requirements for oxytocin, mode of delivery, number of women delivering <24 hours, incidence of uterine contraction abnormalities, incidence of abnormal cardiotocograph (CTG) recordings, 5-minute Apgar scores, umbilical cord pH recordings, analgesia requirements, admission to NICU and blood loss at delivery. Results There were no significant differences between the two groups in induction-to-vaginal delivery interval, mode of delivery, number of women delivering within 24 hours and neonatal outcomes. The incidence of uterine contraction abnormalities (tachysystole and hyperstimulation) and the incidence of abnormal CTG recordings were also similar for both groups. Conclusion Low dose vaginal misoprostol is as effective as dinoprostone gel for inducing labour at term.There would be substantial cost savings, estimated at around £3.9 million per annum, for maternity services if low dose misoprostol became the agent of choice for inducing labour in the UK.

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Objective: To determine whether kangaroo care (skin-to-skin contact) between mother and baby in the operating theatre can affect breastfeeding outcomes following an elective caesarean section. Method: A randomised controlled trial recruited 366 women (182 in study group, 187 in control) having an elective caesarean section at term (≥37 completed weeks of pregnancy) who chose to breastfeed their baby at birth. Babies in the study group had immediate skin-to-skin contact in the operating theatre. The control group had standard care (skin-to-skin following the operation). Results: There was a 5% increase in breastfeeding rates at 48 hours (88% vs 83%) and 7% at 6 weeks (53% vs 46%); however, these differences were not statistically significant (P = 0.25 and 0.44). There was a significant correlation between the length of time for which skin-to-skin was performed and continuing to breastfeed at 48 hours (P = 0.04). Conclusion: Skin-to-skin contact in the operating theatre following an elective caesarean section is a simple intervention associated with a trend towards an increase in breastfeeding rates at 48 hours and 6 weeks. There is a correlation between length of time for which skin-to-skin is performed during the first 24 hours and the continuation of breastfeeding at 48 hours (P = 0.04).

Objective: To compare the efficacy of Kangaroo care (skin-to-skin contact with mother) with standard care (next to the mother in a cot) for premature, low birth weight and babies of diabetic mothers in a transitional care ward setting. Method: This was a cohort study undertaken in a transitional care/postnatal ward of a UK district general hospital. The study involved 214 babies (107 in the study group, 107 in the control group) with a gestation 34-36+6 weeks, small for gestational age and babies of diabetic mothers. Babies in the study group had Kangaroo care following birth up to 6 weeks of age. Control group had standard care (in the cot next to the mother). The main outcome measure was the length of hospital stay. The secondary outcome measures were breastfeeding at discharge from hospital and at 6 weeks, admission to neonatal intensive care unit (NICU) and parent satisfaction. Results: There was a significant reduction in mean length of stay (4.33 vs. 5.01 days, P = 0.017, 95% CI 3.93-4.73 and 4.58-5.44) in the study group compared to the control. There was also an increase in exclusive breastfeeding rates on discharge from hospital in the study group (72% vs. 55% P = 0.01, OR 2.09, 95% CI 1.18-3.69). There were no differences in feeding outcomes at 6 weeks, or in admission to NICU. Conclusions: Kangaroo care is a simple intervention that reduces length of hospital stay and improves breastfeeding rates on discharge from hospital for babies cared for in a transitional care/postnatal ward setting. Parents rate Kangaroo care highly, especially in the first 2 weeks following birth.