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Erhardt D, Radan A, Mathis J, Surbek D. Vaginal dinoprostone insert compared with two different oral misoprostol regimens for labor induction in nulliparous and multiparous women. Acta Obstet Gynecol Scand 2024. [PMID: 39223038 DOI: 10.1111/aogs.14956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/23/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Labor induction exhibits considerable variations in protocols and medication regimens. Limited studies compare vaginal dinoprostone inserts with different oral misoprostol dosages, considering parity influence. This study explores the distinctions among 10 mg vaginal dinoprostone inserts and oral misoprostol 25 μg every 2 and every 4 h for labor induction, stratified by parity. MATERIAL AND METHODS This retrospective cohort study involved 607 participants across two hospitals. The primary outcome, time from induction to delivery, and secondary outcomes, including mode of delivery and maternal and fetal safety, were assessed. RESULTS Patient characteristics revealed differences in indication for labor induction, with the dinoprostone cohort having fewer post-term and premature rupture of membranes cases but more intrauterine growth restriction/small-for-gestational age. Both oral misoprostol regimens showed a shorter time to delivery interval compared to the dinoprostone cohort (median: 1380 min [IQR 1381.0] and 1127.0 min [IQR 1214.0] versus 1631.5 [IQR 1736.2], p < 0.001 and p = 0.014). Only the difference between oral misoprostol q2h and vaginal dinoprostone remained significant for nulliparous but not multiparous women, losing significance over all the population after adjusting for confounding factors. The proportion of women giving birth within 24 h did not significantly differ between misoprostol q2h and dinoprostone after adjusting for confounders. When comparing misoprostol q4h with dinoprostone after confounder adjustment, an increased time to delivery interval for misoprostol q4h was found (p = 0.001). Both oral misoprostol regimens exhibited fewer meconium-stained liquor (miso q4h: OR 0.44, miso q2h: OR 0.34) and cesarean sections (miso q4h: OR 0.48, miso q2h: OR 0.53) compared to dinoprostone, even after adjustment for confounders. CONCLUSIONS Our study suggests that oral misoprostol 25 μg q4h is less effective than 10 mg vaginal dinoprostone for labor induction if parity and indication for induction are adjusted for, particularly in multiparous women. In terms of side effects, oral misoprostol regimens seem superior to vaginal dinoprostone. Our data support the individualized use of different agents for labor induction according to parity, indication for induction, bishop score, and women's preference.
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Affiliation(s)
- Damaris Erhardt
- Department of Obstetrics and Feto-maternal Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Anda Radan
- Department of Obstetrics and Feto-maternal Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jérôme Mathis
- Department of Obstetrics and Gynecology, Centre Hospitalier Bienne, Bienne, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Feto-maternal Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland
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Wasim AU, Khan MM, Aneela F, Khan H, Solís MDD, Shabir I, Hassan SSU, Tariq UB. A Comparative Study of the Efficacy and Safety of Oral Misoprostol, Intravenous Oxytocin, and Intravaginal Dinoprostone for Labor Induction in Pakistani Women. Cureus 2023; 15:e39768. [PMID: 37398821 PMCID: PMC10312116 DOI: 10.7759/cureus.39768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION A frequent medical procedure to accelerate labor is the induction of labor. There are different methods of labor induction, including the use of medications such as misoprostol, oxytocin, and dinoprostone. OBJECTIVE This research compared the effectiveness and safety of oral misoprostol, intravenous oxytocin, and intravaginal dinoprostone for labor induction in Pakistani women. METHODOLOGY A study was conducted in the Department of Obstetrics and Gynaecology, Hayatabad Medical Complex-Medical Teaching Institute (MTI) and Lady Reading Hospital-MTI, Peshawar, Pakistan, over two years. It included 378 women between 38 and 42 gestational weeks, divided into three groups of 126 women each. The oral misoprostol group was given a maximum of six doses of a 25 μg oral misoprostol solution (oral misoprostol tablet of 200 μg dissolved in 200 ml) at intervals of two hours. The drip rate for the intravenous oxytocin group ranged from 6 mIU/minute to 37 mIU/minute. The intravaginal dinoprostone group received a controlled-release vaginal insert containing 10mg of intravaginal dinoprostone, which was left in place for 12 hours. RESULTS More women in the oral misoprostol group (n=94; 74.6%) had successful inductions when compared to the intravaginal dinoprostone (n=83; 65.9%) and intravenous oxytocin (n = 77; 64.71%) groups. Oral misoprostol had the greatest proportion of normal vaginal deliveries (n=62; 65.95%), followed by intravaginal dinoprostone (n=47; 56.63%), and intravenous oxytocin had the lowest rate (n=33; 42.85%). Cesarean section rates were greatest in the intravenous oxytocin group (n=31; 40.26%), followed by the intravaginal dinoprostone group (n=29; 34.94%), and lowest in the oral misoprostol group (n=24; 25.53%). CONCLUSION Oral misoprostol induces labor in women safely and effectively, resulting in the lowest percentage of cesarean deliveries and the highest percentage of normal vaginal deliveries, respectively. Intravaginal dinoprostone showed the lowest rate of side effects, followed by oral misoprostol while intravenous oxytocin had the highest rate of side effects.
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Affiliation(s)
- Asad Ullah Wasim
- Medicine, Fazaia Medical College, Islamabad, PAK
- Clinical and Translational Research, Larkin Community Hospital, South Miami, USA
| | | | - Fnu Aneela
- Medicine and Surgery, Liaquat University of Medical and Health Science, Jamshoro, PAK
| | - Haris Khan
- Medicine and Surgery, Jinnah Medical College, Peshawar, PAK
| | | | - Insha Shabir
- Medicine and Surgery, Fatima Jinnah Medical University, Lahore, PAK
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Abstract
PURPOSE OF REVIEW Recent evidence supports elective induction of labor after 39 weeks; however, labor induction in patients with an unfavorable cervix, a Bishop score less than 6, may take several days. In this review, we focus on the efficacy and safety of methods of labor induction for the unfavorable cervix. RECENT FINDINGS Recent evidence on the use of mechanical cervical preparation with transcervical balloons suggests balloons are the most effective option for decreasing time to delivery in the nulliparous patient. Single and double balloons are equally effective, with a volume of more 30 ml being more effective. The addition of misoprostol or oxytocin concurrently with a balloon further expedites time to delivery. SUMMARY Mechanical dilation should be considered when available and technically possible for labor induction in patients with an unfavorable cervix. Misoprostol is an effective adjunct to trans-cervical balloons, further decreasing time to delivery as compared with balloon alone. When misoprostol is contraindicated, oxytocin is a safe, effective, alternative adjunct to trans-cervical balloons. More research is needed to evaluate safe outpatient options, induction methods in the setting of prior cesarean with an unfavorable cervix, and to directly compare misoprostol with oxytocin as adjuncts to transcervical balloons.
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Win ST, Tan PC, Balchin I, Khong SY, Si Lay K, Omar SZ. Vaginal assessment and expedited amniotomy in oral misoprostol labor induction in nulliparas: a randomized trial. Am J Obstet Gynecol 2019; 220:387.e1-387.e12. [PMID: 30633917 DOI: 10.1016/j.ajog.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/12/2018] [Accepted: 01/02/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Labor is induced in 20-30% of maternities, with an increasing trend of use. Labor induction with oral misoprostol is associated with reduced risk of cesarean deliveries and has a safety and effectiveness profile comparable to those of mechanical methods such as Foley catheter use. Labor induction in nulliparous women continues to be challenging, with the process often quite protracted. The eventual cesarean delivery rate is high, particularly when the cervix is unfavorable and ripening is required. Vaginal examination can cause discomfort and emotional distress particularly to nulliparous women, and plausibly can affect patient satisfaction with the induction and birth process. OBJECTIVE The aim of this study was to evaluate regular (4-hourly prior to each oral misoprostol dose with amniotomy when feasible) compared with restricted (only if indicated) vaginal assessments during labor induction with oral misoprostol in term nulliparous women MATERIALS AND METHODS: We performed a randomized trial between November 2016 and September 2017 in a university hospital in Malaysia. Our oral misoprostol labor induction regimen comprised 50 μg of misoprostol administered 4 hourly for up to 3 doses in the first 24 hours. Participants assigned to regular assessment had vaginal examinations before each 4-hourly misoprostol dose with a view to amniotomy as soon as it was feasible. Participants in the restricted arm had vaginal examinations only if indicated. Primary outcomes were patient satisfaction with the birth process (using an 11-point visual numerical rating scale), induction to vaginal delivery interval, and vaginal delivery rate at 24 hours. RESULTS Data from 204 participants (101 regular, 103 restricted) were analyzed. The patient satisfaction score with the birth process was as follows (median [interquartile range]): 7 [6-9] vs 8 [6-10], P = .15. The interval of induction to vaginal delivery (mean ± standard deviation) was 24.3 ± 12.8 vs 31.1 ± 15.0 hours (P = .013). The vaginal delivery rate at 24 hours was 27.7% vs 20.4%; (relative risk [RR], 1.4; 95% confidence interval [CI], 0.8-2.3; P = .14) for the regular vs restricted arms, respectively. The cesarean delivery rate was 50% vs 43% (RR, 1.1; 95% CI, 0.9-1.5; P = .36). When assessed after delivery, participants' fidelity to their assigned vaginal examination schedule in a future labor induction was 45% vs 88% (RR, 0.5; 95% CI, 0.4-0.7; P < .001), and they would recommend their assigned schedule to a friend (47% vs 87%; RR, 0.6; 95% CI, 0.5-0.7; P < .001) in the regular compared with the restricted arms, respectively. CONCLUSION Despite a shorter induction to vaginal delivery interval with regular vaginal examination and a similar vaginal delivery rate at 24 hours and birth process satisfaction score, women expressed a higher preference for the restricted examination schedule and were more likely to recommend such a schedule to a friend.
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Affiliation(s)
- Sandar Tin Win
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Peng Chiong Tan
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia.
| | - Imelda Balchin
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Su Yen Khong
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Khaing Si Lay
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Siti Zawiah Omar
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Jonker L, Memon F. Influence of maternal factors and mode of induction on labour outcomes: a pragmatic retrospective cohort study. J OBSTET GYNAECOL 2018; 38:946-949. [PMID: 29565195 DOI: 10.1080/01443615.2018.1441814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Since recent research indicates that other modalities are at a minimum non-inferior to the NICE-recommended hormonal agent prostaglandin E2 (PGE2), a retrospective cohort study was conducted on 1971 consecutively induced singleton pregnancies. Multinominal regression analysis showed that the odds ratio (OR) for vaginal delivery with balloon-mediated labour induction (84% vaginal deliveries; OR 1.6; 95% CI 0.7-3.5) is similar to the PGE2 agents propess (81%; OR 1.2; 95% CI 0.68-1.98) and prostin (79%; OR 0.99; 95% CI 0.55-1.79) when using a triple multi-agent induction as a reference. On the other hand, combining the propess and prostin (60% vaginal deliveries; OR 0.45; 95% CI 0.21-0.96) and attempting quadruple combinations of the induction modalities (56%; OR 0.37; 95% CI 0.16-0.85) yields significantly poorer outcomes. However, compared to the known factors associated with increased caesarean section rates, such as an increased maternal age, nulliparous pregnancies and a history of caesarean section, the differential impact of different induction modalities appear less pronounced. Impact statement What is already known on this subject? Recent published data from controlled clinical trials have shown that other labour-inducing agents, including balloon catheters, are as effective as prostaglandin E2 (PGE2) in achieving a vaginal delivery. What do the results of this study add? The data from this pragmatic retrospective cohort study supports the findings of others that the use of a balloon is as effective as PGE2. It also demonstrates that regular clinical practice can differ from an experimental environment, with patients receiving multiple induction modalities in a daily practice. Both the combination of different PGE2 medications and a quadruple labour induction approach are associated with poorer results, as measured by the vaginal delivery rate. The data presented here also confirms that a nulliparous status, a maternal age and a history of caesarean section are associated with reduced odds of achieving a vaginal delivery. What are the implications of these findings for clinical practice and/or further research? The body of evidence showing favourable results with a balloon induction is growing. Furthermore, there are limits to the effectiveness of combining the different induction modalities. Maternal and perinatal factors associated with a risk of caesarean section further complicate labour induction management.
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Affiliation(s)
- L Jonker
- a Research and Development Department , Cumbria Partnership NHS Foundation Trust , Carlisle , UK
| | - F Memon
- b Obstetrics and Gynaecology Department , North Cumbria University Hospitals NHS Trust , Carlisle , UK
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Wang X, Yang A, Ma Q, Li X, Qin L, He T. Comparative study of titrated oral misoprostol solution and vaginal dinoprostone for labor induction at term pregnancy. Arch Gynecol Obstet 2016; 294:495-503. [PMID: 26746850 PMCID: PMC4981622 DOI: 10.1007/s00404-015-4000-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/18/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate effectiveness and safety of titrated oral misoprostol solution (OMS) in comparison with vaginal dinoprostone for cervix ripening and labor induction in term pregnant women. METHODS A multicenter randomized controlled trial of women with term singleton pregnancy with indications for labor induction; 481 participants were allocated to receive titrated OMS with different doses by hourly administration according to the procedure or insert vaginal dinoprostone for cervix ripening and labor induction to compare maternal outcomes including indication of labor induction, mode of outcome of delivery, maternal morbidity, and neonatal outcomes between two groups for evaluating the efficacy and safety of titrated oral misoprostol induction. RESULT Proportion of delivery within 12 h of titrated oral misoprostol is significantly less than vaginal dinoprostone (p = 0.03), but no difference of total vaginal delivery rate (p = 0.93); the mean time of first treatment to vaginal delivery was longer in OMS group (21.3 ± 14.5 h) compared with the vaginal dinoprostone group (15.7 ± 9.6 h). Although the proportion of cesarean section between the two groups showed no statistically significant difference, OMS group showed significantly lower frequency of uterine hyperstimulation, hypertonus, partus precipitatus and non-reassuring fetal heart rate than dinoprostone group. Neonatal outcomes were similar evaluating from Apgar score and NICU admission. Our study also showed that labor induction of women with cervix Bishop score ≤3 needed increased dosage of misoprostol solution. CONCLUSION Titrated OMS is as effective as vaginal dinoprostone in labor induction for term pregnant women, with safer effect for its lower rate of adverse effect for women.
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Affiliation(s)
- Xiu Wang
- Department of Gynecology and Obstetrics, Affiliated Guangren Hospital of Xi’an Jiaotong University, No. 21, Jiefang Road, Xi’an, 710004 Shaanxi China
| | - Aijun Yang
- Department of Gynecology and Obstetrics, Affiliated Guangren Hospital of Xi’an Jiaotong University, No. 21, Jiefang Road, Xi’an, 710004 Shaanxi China
| | - Qingyong Ma
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi’an Jiaotong University, No. 61, Jiankang Road, Xi’an, 710061 Shaanxi China
| | - Xuelan Li
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Medical College, Xi’an Jiaotong University, No. 61, Jiankang Road, Xi’an, 710061 Shaanxi China
| | - Li Qin
- Obstetric Department of Shannxi Province People Hospital, No. 42, Friendship Road, Xi’an, 710068 Shaanxi China
| | - Tongqiang He
- Obstetric Department of Maternal and Child Care Service Center of Northwest, No. 1616, Yanxiang Road, Xi’an, 710008 Shaanxi China
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Drakopoulos P, Duyck C, Gayet-Ageron A, Fernandez S, Irion O, Martinez de Tejada B. What is the optimal duration of oral misoprostol treatment for cervical ripening? J Matern Fetal Neonatal Med 2016; 30:1494-1499. [PMID: 27493019 DOI: 10.1080/14767058.2016.1220520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the number of misoprostol tablets needed to obtain a Bishop score (BS) ≥ 6 or a significant cervical change (≥2 points in BS) during cervical ripening. METHODS Retrospective study of women with term singleton pregnancies and a BS < 6 taking oral misoprostol (20 μg first 2 doses followed by 40 μg every 2 h) for cervical ripening. RESULTS We included 400 women, 72% nulliparous, mean age of 31.3 ± 5.9 years and 70% with a baseline BS ≤ 2. During cervical ripening, 61 (15.3%) achieved a BS ≥ 6 and 205 (51.3%) a significant change in BS. The incremental risk to achieve a BS ≥ 6 after 4 tablets was low (+3.25%) with an incremental probability of +12.75% for painful uterine contractions and +0.5% for abnormal fetal tracing (AFT). The incremental probability to achieve a significant change in BS after 7 tablets was low (+2.0%). 24.3% women delivered by cesarean section which likelihood significantly increased with maternal age <35 years, BMI ≥ 30, nulliparity, AFT, and baseline BS ≤ 2. CONCLUSIONS The marginal benefit of giving more than 7 misoprostol tablets (14 h) during cervical ripening is very low.
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Affiliation(s)
- Panagiotis Drakopoulos
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland.,b Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium , and
| | - Céline Duyck
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland
| | - Angèle Gayet-Ageron
- c Department of Community Health and Medicine , Clinical Research Center and Division of Clinical Epidemiology, Geneva University Hospitals, University of Geneva , Geneva , Switzerland
| | - Sonia Fernandez
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland
| | - Olivier Irion
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland
| | - Begoña Martinez de Tejada
- a Department of Obstetrics and Gynecology , Faculty of Medicine, Geneva University Hospitals , Geneva , Switzerland
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Veena B, Samal R, Inbaraj LR, George CE. Sublingual Misoprostol (PGE1) Versus Intracervical Dinoprostone (PGE2) Gel for Induction of Labour: A Randomized Control Trail. J Obstet Gynaecol India 2015; 66:122-8. [PMID: 27651590 DOI: 10.1007/s13224-015-0820-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/23/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Prostaglandins are popular agents for induction of labour, owing to their dual action of cervical ripening and inducing uterine contractions. Sublingual misoprostol offers high efficacy as it bypasses first-pass metabolism. Researchers have proved that intracervical PGE1 is as effective as PGE2 except for increased caesarean rate and hyperstimulation. Limited knowledge is available on the efficacy of sublingual PGE1 and intracervical PGE2. This study was designed to compare the effectiveness of sublingual PGE1 with intracervical PGE2. METHODS A randomized control trial was conducted in Bangalore Baptist Hospital, Bangalore. One hundred and ninety women with singleton, term pregnancy were equally divided into PGE1 and PGE2 groups, and primary outcome was measured. RESULTS Post-induction mean Bishop's score in PGE1 group was statistically significant (t = 6.57, p < 0.05). Failed induction rate (1 vs 13.6 %) and need for augmentation (46.3 vs 62.1 %) were lower with PGE1 than those with PGE2 (p < 0.05). Significant (p < 0.05) maternal and foetal outcomes like higher rate of NVD (35.8 vs 26 %), lower LSCS rate (15.8 vs 32.6 %), lower incidence of foetal complications (7.3 vs 21 %) were noted with PGE1. APGAR scores at 1 and 5 min were not significant. Mean cost of induction with PGE1 was 12.55+/4.15 INR and with PGE2 470.65+/126.5. CONCLUSION Sublingual PGE1 is a better cervical ripening agent, faster and more effective, with a shorter induction-to-delivery interval as compared to intracervical PGE2. We also noted lower incidence of caesarean section and foetal distress with sublingual PGE1 compared to oral or vaginally administered PGE1.
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Affiliation(s)
- Braganza Veena
- Obstertics and Gynaecology, Bosio Hospital, Candolim, Goa India
| | - Rajinish Samal
- Department of Obstetrics and Gynaecology, Bangalore Baptist Hospital, Bangalore, India
| | - Leeberk R Inbaraj
- Department of Community Health, Bangalore Baptist Hospital, Bellary Road, Hebbal, 560024 Bangalore, India
| | - Carolin Elizabeth George
- Department of Community Health, Bangalore Baptist Hospital, Bellary Road, Hebbal, 560024 Bangalore, India
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Wang L, Zheng J, Wang W, Fu J, Hou L. Efficacy and safety of misoprostol compared with the dinoprostone for labor induction at term: a meta-analysis. J Matern Fetal Neonatal Med 2015; 29:1297-307. [DOI: 10.3109/14767058.2015.1046828] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Huber G, Schütz H, Seelbach-Göbel B. Induction of labor in twin pregnancies with oral misoprostol versus vaginal dinoprostone--is it effective and safe? J Matern Fetal Neonatal Med 2014; 28:1043-6. [PMID: 25001425 DOI: 10.3109/14767058.2014.942629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the effectiveness and safety of oral misoprostol versus vaginal dinoprostone for the induction of labor in twin pregnancies. METHODS All twin pregnancies ≥ 34 weeks 0 days that were induced with either misoprostol or dinoprostone in St. Hedwig Hospital between 2002 and 2013 were included in this retrospective study. Length of induction, mode of delivery, maternal and neonatal outcomes were compared between the two groups. RESULTS After identifying 186 twin mothers matching the inclusion criteria, 154 women were induced with misoprostol (group A) and 32 with dinoprostone (group B). There were no differences in demographic data between the groups. Rates of successful vaginal delivery (53.9% versus 56.3%) and length of induction to delivery (30.2 h versus 26.9 h) were also similar. There were slightly higher rates of postpartum hemorrhage in group B (16.6% versus 10.8%), but without reaching statistical significance. Neonatal outcomes regarding umbilical artery pH <7.20 and one minute Apgar also were without significant differences. CONCLUSIONS Study data indicate that oral misoprostol and vaginal dinoprostone are similarly effective and safe for the induction of labor in twin gestations. Further trials with larger series are needed to confirm these results.
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Affiliation(s)
- Georgine Huber
- Department of Obstetrics and Gynecology, University Regensburg, St. Hedwig Hospital , Regensburg , Germany
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