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Kagwisage J, Balandya BS, Pembe AB, Mujinja PGM. Health Related Quality of Life Post Labour Induction with Misoprostol Versus Dinoprostone At Muhimbili National Hospital in Dar Es Salaam, Tanzania: A cross Sectional Study. East Afr Health Res J 2020; 4:58-64. [PMID: 34308221 PMCID: PMC8279179 DOI: 10.24248/eahrj.v4i1.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 05/26/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Labour induction using Misoprostol or Dinoprostone results to similar maternal and foetal clinical outcomes. However, the clinical outcome measures have rarely been combined with effects of interventions on patients' health related quality of life. This study aimed to assess postpartum health related quality of life of parturient after labour induction with vaginal administration of misoprostol versus dinoprostone. METHODS This was a comparative cross sectional study in which pregnant women who underwent labour induction with misoprostol and dinoprostone during the study period were included. Data were collected within 24 hours post-delivery using the 36 item short form health survey questionnaire which consists of 24 attributes distributed in five domains including bodily pains and physical performance three attributes each, mental health seven attributes, general health two attributes, social functioning six attributes and three attributes for labour induction satisfaction. We first estimated scores of all attributes in each domain using Likert scales and then the domain scores were converted into a 0 to 100 scales to express in percentage of total scores. Quality of life was compared in the two study groups using the independent samples T Test. Multivariate regression analysis was performed to control for marital status, gravidity, parity, baseline cervical status, time interval from induction to delivery and mode of delivery. RESULTS Women who received misoprostol reported better health related quality of life compared to those who received dinoprostone (mean score 92.89 vs. 87.25;P<.00). Misoprostol group had significantly higher scores in all domains of health related quality of life; reduced bodily pain (93.76 vs. 84.19;P<.00), physical performance (83.64 vs. 73.58;P<.00), mental health (96.40 vs. 93.55; P<.00), general health (93.78 vs. 90.23;P=.01), social functioning (94.81 vs. 91.25;P<.00) and satisfaction perceptions (94.96 vs. 90.71;P<.00). CONCLUSION Health related quality of life information is of particular value in routine care of natal and postnatal mothers. Current and updated guidelines should address the impacts of labour induction interventions on maternal health related quality of life, and encourage the use of quality of life information in provision of holistic natal and postnatal care services. Clinical trials are recommended to determine the effectiveness of labour induction with either of the two methods and address the historical adverse outcomes associated to the use of misoprostol.
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Affiliation(s)
- Jonas Kagwisage
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Belinda S Balandya
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Phares GM Mujinja
- Department of Behavioral Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Lapuente-Ocamica O, Ugarte L, Lopez-Picado A, Sanchez-Refoyo F, Lasa IL, Echevarria O, Álvarez-Sala J, Fariñas A, Bilbao I, Barbero L, Vicarregui J, Hernanz Chaves R, Paz Corral D, Lopez-Lopez JA. Efficacy and safety of administering oral misoprostol by titration compared to vaginal misoprostol and dinoprostone for cervical ripening and induction of labour: study protocol for a randomised clinical trial. BMC Pregnancy Childbirth 2019; 19:14. [PMID: 30621614 PMCID: PMC6325751 DOI: 10.1186/s12884-018-2132-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 12/03/2018] [Indexed: 11/25/2022] Open
Abstract
Background Among the various methods available, the administration of prostaglandins is the most effective for inducing labour in women with an unfavourable cervix. Recent studies have compared treatment with various titrated doses of oral misoprostol with vaginal misoprostol or dinoprostone, indicating that the use of an escalating dose of an oral misoprostol solution is associated with a lower rate of caesarean sections and a better safety profile. The objective of this study is to assess which of these three therapeutic options (oral or vaginal misoprostol or vaginal dinoprostone) achieves the highest rate of vaginal delivery within the first 24 h of drug administration. Methods An open-label randomised controlled trial will be conducted in Araba University Hospital (Spain). Women at ≥41 weeks of pregnancy requiring elective induction of labour who meet the selection criteria will be randomly allocated to one of three groups: 1) vaginal dinoprostone (delivered via a controlled-release vaginal insert containing 10 mg of dinoprostone, for up to 24 h); 2) vaginal misoprostol (25 μg of vaginal misoprostol every 4 h up to a maximum of 24 h); and 3) oral misoprostol (titrated doses of 20 to 60 μg of misoprostol following a 3 h on + 1 h off regimen up to a maximum of 24 h). Both intention-to-treat analysis and per-protocol analysis will be performed. Discussion The proposed study seeks to gather evidence on which of these three therapeutic options achieves the highest rate of vaginal delivery with the best safety profile, to enable obstetricians to use the most effective and safe option for their patients. Trial registration NCT02902653 Available at: https://clinicaltrials.gov/show/NCT02902653 (7th September 2016). Electronic supplementary material The online version of this article (10.1186/s12884-018-2132-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- O Lapuente-Ocamica
- Department of Obstetrics and Gynecology, Araba University Hospital, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain
| | - L Ugarte
- Department of Obstetrics and Gynecology, Araba University Hospital, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain
| | - A Lopez-Picado
- Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Araba Research Unit, University Hospital Araba, c/ Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Clinical Research and Clinical Trials Unit, Hospital Clínico San Carlos. Instituto de Investigacion Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain
| | - F Sanchez-Refoyo
- Department of Obstetrics and Gynecology, Araba University Hospital, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain
| | - Iñaki Lete Lasa
- Department of Obstetrics and Gynecology, Araba University Hospital, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain. .,Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.
| | - O Echevarria
- Department of Obstetrics and Gynecology, Araba University Hospital, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain
| | - J Álvarez-Sala
- Department of Obstetrics and Gynecology, Araba University Hospital, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain
| | - A Fariñas
- Department of Obstetrics and Gynecology, Araba University Hospital, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain
| | - I Bilbao
- Department of Obstetrics and Gynecology, Araba University Hospital, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain
| | - L Barbero
- Department of Obstetrics and Gynecology, Araba University Hospital, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain
| | - J Vicarregui
- Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Department of Pediatrics, Araba University Hospital, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain
| | - R Hernanz Chaves
- Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Pharmacy Department, Araba University Hospital, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain
| | - D Paz Corral
- Department of Obstetrics and Gynecology, Araba University Hospital, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain
| | - J A Lopez-Lopez
- Department of Obstetrics and Gynecology, Araba University Hospital, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain.,Bioaraba Research Unit, Jose Atxotegui s/n, 01009, Vitoria-Gasteiz, Spain
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Torkzahrani S, Ghobadi K, Heshmat R, Shakeri N, Jalali Aria K. Effect of Acupressure on Cervical Ripening. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e28691. [PMID: 26430530 PMCID: PMC4586896 DOI: 10.5812/ircmj.28691] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/22/2015] [Accepted: 06/17/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cervical ripening is one of the main stages of initiation labor. Acupressure in Chinese medicine is considered as an invasive technique, which through reliving oxytocin ripens the cervix. Acupoint Sanyinjiao (SP6) was selected in this study because it is the acupoint selected in gynecology and it is easy for women to locate and apply pressure without medical assistance. OBJECTIVES The aim of this study was to determine the effect of acupressure on cervical ripening. PATIENTS AND METHODS In this randomized clinical trial, 150 primigravida with term pregnancy who had referred to Deziani hospital in Gorgan were chosen and divided to three groups: in the first group acupressure was done by the researcher while in the second groups this was performed by the mother her self, and the third group served as a control and only received routine care. For both intervention groups the pressure was applied on Sp6 for about 20 minutes during one to five days. Elements were checked from cervical ripening at 48 and 96 hours after intervention and at the time of hospitalization. The tools for gathering information included demographic characteristics and midwifery history questionnaire, daily records and follow up forms. Content validity was used for validity of tools. Reliability of the observation check-list and physical examination was confirmed by inter-rater scores (inter observer), and daily records by test-re-test. Data was analyzed by analysis of variance (ANOVA), Kruskal-Wallis and Chi-squared tests (P ≤ 0.05). RESULTS There was a significant difference between mothers' educations in the three groups. Most of the mothers (59.5%) in the researcher-performed acupressure group had secondary education. Cervical ripening was significantly different between the three groups after 48 hours (P ≤ 0.05), yet there was no significant difference after 96 hours and at the time of admission. Mean Bishop score was enhanced after 48 hours in the researcher-performed acupressure group (P ≤ 0.021) and the self-performed acupressure group (P ≤ 0.007) in comparison to the control group. CONCLUSIONS The results showed that acupressure is a safe technique and leads to cervical ripening. Thus, regarding the desired results that were achieved when mothers applied acupressure themselves, it could be suggested that it is beneficial for mothers to be trained to apply this method at home.
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Affiliation(s)
- Shahnaz Torkzahrani
- Department of Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Khadighe Ghobadi
- Counseling and Reproductive Health Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
- Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Reza Heshmat
- Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Acupuncture Medicine Association, Tehran, IR Iran
| | - Nezhat Shakeri
- Acupuncture Medicine Association, Tehran, IR Iran
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Katayoun Jalali Aria
- Counseling and Reproductive Health Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
- Department of Midwifery, Faculty of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, IR Iran
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