1
|
Pergialiotis V, Papadatou K, Panagiotopoulos M, Bellos I, Papapanagiotou A, Rodolakis A, Daskalakis G. The impact of vaginal pH on induction of labour outcomes: a meta-analysis of observational studies. J OBSTET GYNAECOL 2022; 42:2558-2565. [PMID: 35775477 DOI: 10.1080/01443615.2022.2091433] [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: 01/06/2023]
Abstract
The present meta-analysis evaluates the impact of an acidic vaginal pH on the progress of labour induction with dinoprostone and misoprostol. We searched Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, Clinicaltrials.gov and Google Scholar databases for relevant studies. Meta-analysis was performed with Rstudio using the meta function and trial sequential analysis was used to evaluate the adequacy of sample size. Nine studies were retrieved that involved 809 patients. An acidic vaginal pH did not influence the efficacy of misoprostol or dinoprostone in terms of accomplishing a successful vaginal delivery (OR 0.62, 95% CI 0.29, 1.30). The interval to delivery was unaffected by the acidity of vaginal pH (Mean Difference 4.18 h, 95% CI -2.09, 10.45). In conclusion, vaginal pH does not seem to affect the potency of vaginally administered prostaglandins; therefore, moistening of vaginal tables with acetic acid does not seem reasonable until further evidence becomes available.
Collapse
Affiliation(s)
- Vasilios Pergialiotis
- 1st department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Papadatou
- 1st department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Panagiotopoulos
- 1st department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Angeliki Papapanagiotou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Rodolakis
- 1st department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Daskalakis
- 1st department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
2
|
Supraventricular Tachycardia in Infants With Congenital Diaphragmatic Hernia: Prevalence, Associations, and Outcomes. Pediatr Crit Care Med 2022; 23:e329-e337. [PMID: 35353075 DOI: 10.1097/pcc.0000000000002952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To characterize the prevalence, associations, management, and outcomes of supraventricular tachycardia (SVT) in neonates with congenital diaphragmatic hernia (CDH). DESIGN Retrospective chart and cardiology code review within a cohort of patients with CDH was used to define a subpopulation with atrial arrhythmia. SVT mechanisms were confirmed by electrocardiogram analysis. Cox proportional hazard regression identified risk factors for SVT and association with clinical outcomes. SETTING Medical Surgical ICU in a single, tertiary center, Boston Children's Hospital. PATIENTS Eligible patients included neonates presenting with classic Bochdalek posterolateral CDH between 2005 and 2017, excluding newborns with Morgagni hernia or late diagnoses of CDH (>28 d). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS SVT arose in 25 of 232 neonates with CDH, (11%); 14 of 25 infants (56%) had recurrent SVT; atrioventricular node-dependent tachycardia was the most frequent mechanism (32%). The majority (71%) of SVT episodes received intervention. Nine patients (36%) received preventative antiarrhythmic medications. SVT was associated with lower Apgar score at 1 min, structural heart disease, larger defect size, extracorporeal membrane oxygenation (ECMO) support, and prostaglandin therapy for ductal patency as well as hospital stay greater than or equal to 8 weeks and use of supplemental oxygen at discharge. CONCLUSIONS SVT can occur in neonates with CDH and frequently requires treatment. Odds of occurrence are increased with greater CDH disease severity, ECMO, and prostaglandin use. In unadjusted logistic regression analysis, SVT was associated with adverse hospital outcomes, underscoring the importance of recognition and management in this vulnerable population.
Collapse
|
3
|
Kashanian M, Bahasadri S, Nejat Dehkordy A, Sheikhansari N, Eshraghi N. A comparison between induction of labor with 3 methods of titrated oral misoprostol, constant dose of oral misoprostol and Foley catheter with extra amniotic saline infusion (EASI), in women with unfavorable cervix. Med J Islam Repub Iran 2019; 33:115. [PMID: 31934574 PMCID: PMC6946922 DOI: 10.34171/mjiri.33.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Different methods of cervical ripening and induction of labor have been used in the cases of unfavorable cervix with different levels of success, but no method has been found to be the best option. The purpose of the present study was to find the effects and side effects of three different methods of cervical ripening and induction of labor. These three methods were oral titrated misoprostol, constant dose of oral misoprostol and Foley catheter with extra-amniotic saline infusion. Methods: This clinical trial was performed on women with unfavorable cervix who had been admitted in Akbarabadi Teaching Hospital for induction of labor and had bishop score of less than six; between March 2014- March 2015. The eligible women were assigned into three groups. In titrated oral misoprostol group (n=33), titrated solution of misoprostol, and in oral misoprostol group (n=33), 50µg oral misoprostol every four hours and in Foley catheter group (n=50), Foley catheter with extra-amniotic saline infusion were administered. The main outcome was the number of vaginal deliveries during the first 24 hours. In addition, number of cesarean deliveries and adverse effects were compared between the three groups. The obtained data were analyzed using SPSS 18 software. Data analysis was performed according to the intention to treat principle. Chi-square test, Fisher Exact test, Student ttest, and Mann-Whitney U test, were used for comparing data. P-value≤0.05 was considered statistically significant. Results: The three groups did not have any significant difference according to maternal age, gestational age at the time of admission, gravidity, parity, and primary Bishop Score. There was no significant difference between the three groups for the main outcome, which was vaginal delivery during the first 24 hours (p=0.887). There was no significant difference between the three groups according to hypertonicity, uterine hyperstimulation, meconium passage, non-reassuring fetal heart rate, neonatal Apgar score in minutes one and 5, and mean duration of beginning the intervention up to delivery. However, uterine tachysystole and NICU admission were more in the group to whom the titrated solution of misoprostol was administered (p=0.002 and p=0.037 respectively). The number of cesarean deliveries due to failure to progress was higher in the EASI group. However, EASI group showed the least number of none-reassuring fetal heart rate between the three groups. Meconium passage was more in the titrated misoprostol group, but the difference was not significant. Conclusion: All three methods are appropriate methods for induction of labor in the cases of unfavorable cervix; and choosing each method depends on the expertise of labor staff, accessibility to the medications, cost, and taking care for monitoring the patients and adverse effects.
Collapse
Affiliation(s)
- Maryam Kashanian
- Department of Obstetrics & Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran.,National Association of Iranian Obstetricians & Gynecologists (NAIGO), Tehran, Iran
| | - Shohreh Bahasadri
- Department of Obstetrics & Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Ashraf Nejat Dehkordy
- Department of Obstetrics & Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | | | - Noushin Eshraghi
- Department of Obstetrics & Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran.,National Association of Iranian Obstetricians & Gynecologists (NAIGO), Tehran, Iran
| |
Collapse
|
4
|
Zhao L, Lin Y, Jiang T, Wang L, Li M, Wang Y, Sun G, Xiao M. Prediction of the induction to delivery time interval in vaginal dinoprostone-induced labor: a retrospective study in a Chinese tertiary maternity hospital. J Int Med Res 2019; 47:2647-2654. [PMID: 31096809 PMCID: PMC6567707 DOI: 10.1177/0300060519845780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study aimed to investigate the potential factors that affect the induction to delivery time interval in women undergoing induction of labor with a controlled-release dinoprostone vaginal insert. Methods Pregnant women who presented for delivery at Hubei Maternal and Child Health Hospital from January 2016 to August 2016 were recruited. Finally, 1265 women who underwent labor induction with a vaginal dinoprostone (PGE2) insert were analyzed. Univariate and multivariate linear regression analyses were used to estimate the relevant risks for delivery time. Results Among the1265 subjects, the mean delivery time was 18.92 ± 12.50 hours. Univariate and multivariate analyses showed that fetal weight, an obstetric complication (premature rupture of the membranes), and the delivery history were significantly associated with the induction to delivery time. Biparietal diameter was related to the vaginal delivery time in univariate analysis, but there was no significant difference after adjustment in multivariate analysis. Conclusions Vaginal dinoprostone is an effective method for successful induction of labor. Gestational age, parity, and fetal weight are major factors that predict the induction to delivery time interval.
Collapse
Affiliation(s)
- Lei Zhao
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Hongshan District, Wuhan, China
| | - Ying Lin
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Hongshan District, Wuhan, China
| | - Tingting Jiang
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Hongshan District, Wuhan, China
| | - Ling Wang
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Hongshan District, Wuhan, China
| | - Min Li
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Hongshan District, Wuhan, China
| | - Ying Wang
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Hongshan District, Wuhan, China
| | - Guoqiang Sun
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Hongshan District, Wuhan, China
| | - Mei Xiao
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Hongshan District, Wuhan, China
| |
Collapse
|
5
|
Wallström T, Strandberg M, Gemzell-Danielsson K, Pilo C, Jarnbert-Pettersson H, Friman-Mathiasson M, Wiberg-Itzel E. Slow-release vaginal insert of misoprostol versus orally administrated solution of misoprostol for the induction of labour in primiparous term pregnant women: a randomised controlled trial. BJOG 2019; 126:1148-1155. [PMID: 30989788 DOI: 10.1111/1471-0528.15796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the World Health Organization (WHO) recommended orally administrated dosage of misoprostol (25 μg) with a vaginal slow-release (7 μg/hour) insert of misoprostol regarding time from induction to delivery and safety of the method. DESIGN Open label, Randomised controlled trial (RCT). SETTING Delivery ward at a secondary referral hospital in Stockholm, Sweden, from 1 October 2016 to 21 February 2018. POPULATION One hundred and ninety-six primiparous women with singletons in cephalic presentation at ≥37 weeks of gestation and with a Bishop score of ≤4. METHODS Women were randomised to an oral solution of misoprostol (Cytotec® n = 99) or vaginal slow-release misoprostol (Misodel® [MVI] n = 97). MAIN OUTCOME MEASURES Primary outcome: time from induction to vaginal delivery. SECONDARY OUTCOMES mode of delivery; proportion of vaginal deliveries within 24 hours (VD24); neonates with an Apgar score of <7 at 5 minutes; pH < 7.10; postpartum haemorrhage (PPH) of >1000 ml; hyperstimulation; and women's delivery experience (VAS). RESULTS There was no difference in the time to delivery [corrected] (median 21.1 hours in the MVI group and 23.2 hours in the oral group; Kaplan-Mayer log rank P = 0.31). There was no difference regarding the proportion of VD24 (50.5 versus 55.7%, P = 0.16). Hyperstimulation with non-reassuring cardiotocography (CTG) was more common in the MVI group (14.4 versus 3.0%, P < 0.01). Terbutaline (Bricanyl® ) was used more often for hyperstimulation in the MVI group (22.7 versus 4.0%, P < 0.01). There was no difference in the numbers of children admitted to the neonatal intensive care unit (NICU). CONCLUSIONS Vaginal delivery after induction of labour (IOL) with slow-release misoprostol did not result in a shorter time from induction to vaginal delivery, compared with oral misoprostol solution, but was associated with a higher risk for hyperstimulation and fetal distress. There were no differences in mode of delivery or neonatal outcome. TWEETABLE ABSTRACT IOL with MVI was similar to oral solution of misoprostol but hyperstimulation and fetal distress were more common.
Collapse
Affiliation(s)
- T Wallström
- Department of Clinical Science and Education, Department of Obstetrics and Gynaecology, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden
| | - M Strandberg
- Department of Clinical Science and Education, Department of Obstetrics and Gynaecology, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden
| | - K Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - C Pilo
- Department of Clinical Science and Education, Department of Obstetrics and Gynaecology, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden
| | - H Jarnbert-Pettersson
- Department of Clinical Science and Education, Department of Obstetrics and Gynaecology, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden
| | | | - E Wiberg-Itzel
- Department of Clinical Science and Education, Department of Obstetrics and Gynaecology, Karolinska Institute, Sodersjukhuset, Stockholm, Sweden
| |
Collapse
|
6
|
Labor Induction with Orally Administrated Misoprostol: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6840592. [PMID: 29124067 PMCID: PMC5624161 DOI: 10.1155/2017/6840592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/11/2017] [Accepted: 07/25/2017] [Indexed: 11/20/2022]
Abstract
Introduction One great challenge in obstetric care is labor inductions. Misoprostol has advantages in being cheap and stable at room temperature and available in resource-poor settings. Material and Methods Retrospective cohort study of 4002 singleton pregnancies with a gestational age ≥34 w at Sodersjukhuset, Stockholm, during 2009-2010 and 2012-2013. Previously used methods of labor induction were compared with misoprostol given as a solution to drink, every second hour. Main outcome is as follows: Cesarean Section (CS) rate, acid-base status in cord blood, Apgar score < 7,5′, active time of labor, and blood loss > 1500 ml (PPH). Results The proportion of CS decreased from 26% to 17% when orally given solution of misoprostol was introduced at the clinic (p < 0.001). No significant difference in the frequency of low Apgar score (p = 0.3), low aPh in cord blood (p = 0.1), or PPH (p = 0.4) between the different methods of induction was studied. After adjustment for different risk factor for CS the only method of induction which was associated with CS was dinoproston⁎⁎ (Propess®) (aor = 2.9 (1.6–5.2)). Conclusion Induction of labor with misoprostol, given as an oral solution to drink every second hour, gives a low rate of CS, without affecting maternal or fetal outcome.
Collapse
|
7
|
The role of prostaglandins E1 and E2, dinoprostone, and misoprostol in cervical ripening and the induction of labor: a mechanistic approach. Arch Gynecol Obstet 2017; 296:167-179. [DOI: 10.1007/s00404-017-4418-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 05/30/2017] [Indexed: 12/23/2022]
|
8
|
Yellon SM. Contributions to the dynamics of cervix remodeling prior to term and preterm birth. Biol Reprod 2017; 96:13-23. [PMID: 28395330 PMCID: PMC5803764 DOI: 10.1095/biolreprod.116.142844] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/01/2016] [Accepted: 11/28/2016] [Indexed: 01/05/2023] Open
Abstract
Major clinical challenges for obstetricians and neonatologists result from early cervix remodeling and preterm birth. Complications related to cervix remodeling or delivery account for significant morbidity in newborns and peripartum mothers. Understanding morphology and structure of the cervix in pregnant women is limited mostly to the period soon before and after birth. However, evidence in rodent models supports a working hypothesis that a convergence of factors promotes a physiological inflammatory process that degrades the extracellular collagen matrix and enhances biomechanical distensibility of the cervix well before the uterus develops the contractile capabilities for labor. Contributing factors to this remodeling process include innervation, mechanical stretch, hypoxia, and proinflammatory mediators. Importantly, the softening and shift to ripening occurs while progesterone is near peak concentrations in circulation across species. Since progesterone is required to maintain pregnancy, the premise of this review is that loss of responsiveness to progesterone constitutes a common final mechanism for remodeling the mammalian cervix in preparation for birth at term. Various inputs are suggested to promote signaling between stromal cells and resident macrophages to drive proinflammatory processes that advance the soft cervix into ripening. With infection, pathophysiological processes may prematurely drive components of this remodeling mechanism and lead to preterm birth. Identification of critical molecules and pathways from studies in various rodent models hold promise for novel endpoints to assess risk and provide innovative approaches to treat preterm birth or promote the progress of ripening at term.
Collapse
Affiliation(s)
- Steven M. Yellon
- Longo Center for Perinatal Biology, Departments of Basic Sciences Division of Physiology and Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| |
Collapse
|
9
|
Zhang Y, Zhu HP, Fan JX, Yu H, Sun LZ, Chen L, Chang Q, Zhao NQ, Di W. Intravaginal Misoprostol for Cervical Ripening and Labor Induction in Nulliparous Women: A Double-blinded, Prospective Randomized Controlled Study. Chin Med J (Engl) 2016; 128:2736-42. [PMID: 26481739 PMCID: PMC4736884 DOI: 10.4103/0366-6999.167299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: In China, no multicenter double-blinded prospective randomized controlled study on labor induction has been conducted till now. This study is to evaluate the efficacy and safety of intravaginal accurate 25-μg misoprostol tablets for cervical ripening and labor induction in term pregnancy in nulliparous women. Methods: This was a double-blinded, prospective randomized controlled study including nulliparous women from 6 university hospitals across China. Subjects were randomized into misoprostol or placebo group with the sample size ratio set to 7:2. Intravaginal 25-μg misoprostol or placebo was applied at an interval of 4 h (repeated up to 3 times) for labor induction. Primary outcome measures were the incidence of cumulative Bishop score increases ≥3 within 12 h or vaginal delivery within 24 h. Safety assessments included the incidences of maternal morbidity and adverse fetal/neonatal outcomes. Results: A total of 173 women for misoprostol group and 49 women for placebo were analyzed. The incidence of cumulative Bishop score increases ≥3 within 12 h or vaginal delivery within 24 h was higher in the misoprostol group than in the placebo (64.2% vs. 22.5%, relative risk [RR]: 2.9, 95% confidence interval [CI]: 1.4–6.0). The incidence of onset of labor within 24 h was significantly higher in the misoprostol group than in the placebo group (48.0% vs. 18.4%, RR: 2.6, 95% CI: 1.2–5.7); and the induction-onset of labor interval was significantly shorter in the misoprostol group (P = 0.0003). However, there were no significant differences in the median process time of vaginal labor (6.4 vs. 6.8 h; P = 0.695), incidence (39.3% vs. 49.0%, RR: 0.8, 95% CI: 0.4–1.5) and indications (P = 0.683) of cesarean section deliveries, and frequencies of maternal, fetal/neonatal adverse events between the groups. Conclusion: Intravaginal misoprostol 25 μg every 4 h is efficacious and safe in labor induction and cervical ripening.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Wen Di
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| |
Collapse
|
10
|
Tsikouras P, Koukouli Z, Manav B, Soilemetzidis M, Liberis A, Csorba R, Trypsianis G, Galazios G. Induction of Labor in Post-Term Nulliparous and Parous Women - Potential Advantages of Misoprostol over Dinoprostone. Geburtshilfe Frauenheilkd 2016; 76:785-792. [PMID: 27582576 PMCID: PMC5001574 DOI: 10.1055/s-0042-105287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/19/2016] [Accepted: 03/20/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION We undertook a prospective cohort study to compare the effectiveness and safety of 50 µg misoprostol versus 3 mg dinoprostone in two vaginal doses 6 hours apart, followed if necessary by oxytocin for labor induction in low-risk post-term (> 40 weeks) pregnancies with unfavorable cervix (Bishop score ≤ 6). METHODS Labor induction and subsequent management were conducted using a standardized protocol. The primary outcome of the study was labor induction rate. Secondary outcomes included mode of delivery, time interval from induction to delivery, maternal complications and neonatal outcome. RESULTS 107 patients received misoprostol (Group A) and 99 patients received dinoprostone (Group B). Compared with group A, more women in Group B needed a second vaginal dose of prostaglandin or oxytocin infusion in order to proceed to labor (21.5 vs. 43.4 %; p = 0.01). Misoprostol alone as a single or double vaginal dose was more effective than dinoprostone alone in inducing labor without oxytocin administration (85.0 vs. 50.4 %; p = 0.04). Overall, the rate of successful induction of labor did not differ between groups (91.6 vs. 85.8 %; p = 0.75). Vaginal delivery, operative vaginal delivery and Caesarean section rates were not significantly different. Time interval from induction to delivery however, was shorter for Group A (median 11 hours vs. 14.1 hours; p < 0.001). Though emergency Caesarean section due to fetal distress was more frequent in Group A (16.8 vs. 4.0 %; p = 0.007), low Apgar scores < 7 and NICU admissions did not differ significantly. Maternal complications, mostly not serious, were higher in Group A (31.8 vs. 2.0, p < 0.001). CONCLUSION Misoprostol is a more effective agent than dinoprost in post-term pregnancy for labor induction with few maternal adverse effects.
Collapse
Affiliation(s)
- P. Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace,
Greece
| | - Z. Koukouli
- Department of Obstetrics and Gynecology, Democritus University of Thrace,
Greece
| | - B. Manav
- Department of Obstetrics and Gynecology, Democritus University of Thrace,
Greece
| | - M. Soilemetzidis
- Department of Obstetrics and Gynecology, Democritus University of Thrace,
Greece
| | - A. Liberis
- Department of Obstetrics and Gynecology, Democritus University of Thrace,
Greece
| | - R. Csorba
- Department of Obstetrics and Gynecology, Clinicum Aschaffenburg, Teaching
Hospital of University Würzburg, Germany
| | - G. Trypsianis
- Department of Medical Statistic, Democritus University of Thrace,
Greece
| | - G. Galazios
- Department of Obstetrics and Gynecology, Democritus University of Thrace,
Greece
| |
Collapse
|
11
|
Sadi R, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Javadzadeh Y, Ahmadi-Bonabi A. Effect of Saffron (Fan Hong Hua) On the Readiness of The Uterine Cervix In Term Pregnancy: A Placebo-Controlled Randomized Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e27241. [PMID: 28180016 PMCID: PMC5285732 DOI: 10.5812/ircmj.27241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 02/03/2015] [Indexed: 01/01/2023]
Abstract
Background Readiness of the cervix is required for successful induction of labor, and there are a number of ways in which this can be achieved. Objectives The aim of the present study was to assess whether taking saffron orally could have an effect on the cervical readiness (primary outcome) and some delivery and neonatal outcomes (secondary outcomes) in women in the stage of term pregnancy. Patients and Methods In this double-blind trial, 50 women with a gestational age of 39 to 41 weeks, no indication of cesarean section, a Bishop’s score of less than 4, who had plan to have vaginal delivery at Shohada hospital of Bonab, Iran were randomized into two groups receiving three 250mg saffron or placebo pills in 24 hours. The readiness of the cervix was assessed using the Bishop’s score. The Mann-Whitney U test was used to compare the scores between the groups. Results There were no significant differences between the groups in terms of the Bishop’s score at the baseline (P = 0.792) and 10-12 hours after starting the intervention (P = 0.159). The Bishop’s score was significantly higher in the saffron group 20 - 24 hours after the intervention was started (P = 0.029) and just after onset of active uterine contractions (P = 0.003). In the saffron group, there was no cesarean section and 1 meconium staining of the fetus, but 3 and 4, respectively, in the placebo group. There was no statistically significant difference between the groups in terms of the timing of the onset of spontaneous active uterine contractions, the duration of the first and second stages of labor, the need for delivery augmentation, and the first and fifth minutes of neonatal Apgar (P > 0.05). No adverse event was reported in any of the groups. Conclusions Saffron can increase the readiness of the cervix in term pregnancies. However, the study limitations do not allow for any definite conclusions for its use in clinical practice, and more research is needed to assess its effect on delivery and neonatal outcomes.
Collapse
Affiliation(s)
- Roghaieh Sadi
- Students’ Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Sakineh Mohammad-Alizadeh-Charandabi
- Department of Midwifery, Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding Author: Sakineh Mohammad-Alizadeh-Charandabi, Associate Professor, PhD in Reproductive Health, Department of Midwifery, Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-09143136276, Fax: +98-4134796969, E-mail: ,
| | - Mojgan Mirghafourvand
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Yousef Javadzadeh
- Pharmaceutics Department, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | | |
Collapse
|
12
|
Yenuberi H, Abraham A, Sebastian A, Benjamin SJ, Jeyaseelan V, Mathews JE. A randomised double-blind placebo-controlled trial comparing stepwise oral misoprostol with vaginal misoprostol for induction of labour. Trop Doct 2016; 46:198-205. [PMID: 26787644 DOI: 10.1177/0049475515624856] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A comparison of induction of labour (IOL) using three doses of 25 µg vaginal misoprostol inserted at intervals of 4 h or more with a stepwise oral regime starting with 50 µg followed by two doses of 100 µg was studied in a double-blind placebo-controlled trial in a tertiary centre in South India. Primary outcome was vaginal delivery in 24 h. Significantly more women in the first group required oxytocin augmentation and a third dose of the drug than women in the second group. Uterine tachysystole and other maternal and neonatal complications were similar. Thus it is concluded that women induced with oral, as compared to vaginal misoprostol are more likely to labour without oxytocin.
Collapse
Affiliation(s)
- Hilda Yenuberi
- Registrar, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anuja Abraham
- Assistant Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajit Sebastian
- Assistant Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh J Benjamin
- Associate Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Visalakshi Jeyaseelan
- Lecturer, Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jiji E Mathews
- Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
13
|
Stenson D, Wallstrom T, Sjostrand M, Akerud H, Gemzell-Danielsson K, Wiberg-Itzel E. Induction of labor in women with a uterine scar. J Matern Fetal Neonatal Med 2015; 29:3286-91. [PMID: 26699657 DOI: 10.3109/14767058.2015.1123242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the frequency of uterine rupture following induction of labor in women with a previous cesarean section. Misoprostol was compared to other methods of induction. METHODS A retrospective cohort study of 208 women attempting induction of labor after one previous cesarean section. Delivery data were collected retrospectively and compared. Group 1(2009-2010) was compared with Group 2 (2012-2013). In Group 1, the main method of induction was vaginal PGE2 (prostaglandin-E2), amniotomy, oxytocin or a balloon catheter. In Group 2, the dominant method of induction was an oral solution of misoprostol. MAIN OUTCOME MEASURES frequency of uterine rupture in the two groups. RESULTS Nine cases (4.3%) of uterine rupture occurred. There was no significant difference in the frequency of uterine rupture following the change of method of induction from PGE2, amniotomy, oxytocin or mechanical dilatation with a balloon catheter to orally administered misoprostol (4.1 versus 4.6%, p = 0.9). All ruptures occurred in women with no prior vaginal delivery. CONCLUSION The shift to oral misoprostol as the primary method of induction in women with a previous cesarean section did not increase the frequency of uterine rupture in the cohort studied.
Collapse
Affiliation(s)
- David Stenson
- a Department of Clinical Science and Education , Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital , Sweden
| | - Tove Wallstrom
- a Department of Clinical Science and Education , Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital , Sweden
| | - Maria Sjostrand
- a Department of Clinical Science and Education , Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital , Sweden
| | - Helena Akerud
- b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden , and
| | - Kristina Gemzell-Danielsson
- c Department of Women's and Children's Health , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Eva Wiberg-Itzel
- a Department of Clinical Science and Education , Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital , Sweden
| |
Collapse
|
14
|
van der Tuuk K, van Pampus MG, Koopmans CM, Aarnoudse JG, van den Berg PP, van Beek JJ, Copraij FJ, Kleiverda G, Porath M, Rijnders RJ, van der Salm PC, Morssink LP, Stigter RH, Mol BW, Groen H. Prediction of cesarean section risk in women with gestational hypertension or mild preeclampsia at term. Eur J Obstet Gynecol Reprod Biol 2015; 191:23-7. [DOI: 10.1016/j.ejogrb.2015.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/04/2015] [Accepted: 05/19/2015] [Indexed: 11/15/2022]
|
15
|
Fang D, Shi SQ, Shi L, Yang J, Liu H, Xia H, Garfield RE. Direct electrical stimulation softens the cervix in pregnant and nonpregnant rats. Am J Obstet Gynecol 2015; 212:786.e1-9. [PMID: 25640046 DOI: 10.1016/j.ajog.2015.01.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/04/2014] [Accepted: 01/27/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the study was to determine the effects of electrical stimulation (ES) on cervical ripening in pregnant and nonpregnant rats. STUDY DESIGN Timed pregnant and nonpregnant Sprague-Dawley rats (n = 6-7/group) were used. Cervical ES for pregnant rats was performed in vivo on day 15 of gestation by inserting an electrical probe into the vagina in contact with the cervix. Parameters of ES varied from 0.1 to 0.2 mA, 10 pulses per second, 20 milliseconds pulse duration, and repeating pulses for 15, 30, 60, and 120 minutes for pregnant ES groups and similar times for sham control groups with electrode but without ES. Nonpregnant ES groups were stimulated with only 0.2 mA for 30 minutes. Cervical collagen was measured in controls and following ES at various times using light-induced fluorescence (LIF) of collagen. Photographs were taken following ES, and some rats were killed, the cervices were isolated, and cervical extensibility was estimated. RESULTS LIF values of pregnant rats are significantly lower (P < .001) and extensibility greater (P < .05) in the ES treatment groups compared with the control groups on days 16 and 17 of pregnancy. Similarly LIF is lower (P < .05) and extensibility values greater (P < .05) in nonpregnant rats treated with ES. No adverse effects, including altered delivery time, pup weights, or damage to cervix, were produced by low current levels of ES needed to soften the cervix. CONCLUSION The following conclusions were reached: (1) application of ES rapidly produces softening and ripening of the cervix in pregnant and nonpregnant rats; (2) ES treatment does not produce early delivery; (3) the exact mechanism for ES ripening is not yet known; and (4) ES might be used clinically to ripen the cervix when needed.
Collapse
|
16
|
Voigt F, Goecke T, Najjari L, Pecks U, Maass N, Rath W. Off-label use of misoprostol for labor induction in Germany: a national survey. Eur J Obstet Gynecol Reprod Biol 2015; 187:85-9. [DOI: 10.1016/j.ejogrb.2014.11.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/25/2014] [Accepted: 11/21/2014] [Indexed: 01/08/2023]
|
17
|
Zeng X, Zhang Y, Tian Q, Xue Y, Sun R, Zheng W, An R. Efficiency of dinoprostone insert for cervical ripening and induction of labor in women of full-term pregnancy compared with dinoprostone gel: A meta-analysis. Drug Discov Ther 2015; 9:165-72. [DOI: 10.5582/ddt.2015.01033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Xianling Zeng
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Xi'an Jiao Tong University
| | - Yafei Zhang
- Department of General Surgery, the Second Affiliated Hospital, Xi'an Jiao Tong University
| | - Quan Tian
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Xi'an Jiao Tong University
| | - Yan Xue
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Xi'an Jiao Tong University
| | - Rong Sun
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Xi'an Jiao Tong University
| | - Wei Zheng
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Xi'an Jiao Tong University
| | - Ruifang An
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Xi'an Jiao Tong University
| |
Collapse
|
18
|
Madaan M, Agrawal S, Puri M, Nigam A, Kaur H, Trivedi SS. Is low dose vaginal misoprostol better than dinoprostone gel for induction of labor: a randomized controlled trial. J Clin Diagn Res 2014; 8:OC31-4. [PMID: 25386492 PMCID: PMC4225944 DOI: 10.7860/jcdr/2014/8101.4906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 05/08/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the efficacy and safety profile of low dose vaginal misoprostol with dinoprostone gel for induction of labor in term pregnancies. METHODS The study was conducted at Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital on 100 pregnant women with term pregnancy after application of inclusion and exclusion criteria. The women were randomized in 2 groups of 50 women each. Group I received misoprostol 25μg at every six hour vaginally for a maximum of five doses for induction of labor; while group II received dinoprostone gel 0.5 mg every six hourly for a maximum of three doses. Maternal outcomes such as mode of delivery and induction delivery interval; and fetal outcomes such as APGAR score and incidence of NICU admission were assessed in both the groups. Statistical analysis was done using student t-test and chi-square test. RESULTS There was no significant difference in the mean induction to delivery interval in both the groups (14.32±0.13 hours in Group I and 14.92±0.18 hours in Group II, p=0.75), mode of delivery, indication of cesarean section and perinatal outcome. However, significant difference was observed in requirement of oxytocin augmentation in both the groups (32% in Group I and 68% in Group II, p=0.005). CONCLUSION Vaginal misoprostol in low doses is similar in efficacy and safety to dinoprostone gel for cervical ripening and labor induction in term pregnancy.
Collapse
Affiliation(s)
- Monika Madaan
- Ex Assistant Professor, Department of Obstetrics and Gynecology, LHMC & SSKH (Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital), New Delhi, India
| | - Swati Agrawal
- Assistant Professor, Department of Obstetrics and Gynecology, LHMC & SSKH, New Delhi, India
| | - Manju Puri
- Professor, Department of Obstetrics and Gynecology, LHMC & SSKH, New Delhi, India
| | - Aruna Nigam
- Ex. Assistant Professor, Department of Obstetrics and Gynecology, LHMC & SSKH, New Delhi, India
| | - Harvinder Kaur
- GDMO, Department of Obstetrics and Gynecology, LHMC & SSKH, New Delhi, India
| | - Shubha Sagar Trivedi
- Director Professor, Department of Obstetrics and Gynecology, LHMC & SSKH, New Delhi, India
| |
Collapse
|
19
|
Abstract
OBJECTIVE To review the most current literature in order to provide evidence-based recommendations to obstetrical care providers on induction of labour. OPTIONS Intervention in a pregnancy with induction of labour. OUTCOMES Appropriate timing and method of induction, appropriate mode of delivery, and optimal maternal and perinatal outcomes. EVIDENCE Published literature was retrieved through searches of PubMed, CINAHL, and The Cochrane Library in 2010 using appropriate controlled vocabulary (e.g., labour, induced, labour induction, cervical ripening) and key words (e.g., induce, induction, augmentation). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to the end of 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The evidence in this document was rated using criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table 1). SUMMARY STATEMENTS: 1. Prostaglandins E(2) (cervical and vaginal) are effective agents of cervical ripening and induction of labour for an unfavourable cervix. (I) 2. Intravaginal prostaglandins E(2) are preferred to intracervical prostaglandins E(2) because they results in more timely vaginal deliveries. (I).
Collapse
|
20
|
Abstract
INTRODUCTION Labor induction is now reported to occur in up to 30 - 40% of obstetrical patients. There are a number of pharmacological options available to facilitate labor induction, including oxytocin and analogues of prostaglandins E1 and E2, which have particular utility when labor induction necessitates cervical ripening, as when labor induction occurs in the context of an unfavorable cervix. AREAS COVERED This paper reviews acceptable pharmacological options for labor induction, especially when cervical ripening is required. These options include oxytocin and a number of prostaglandin formulations using dinoprostone and misoprostol. It also covers several analyses of published clinical trials (Phase-III) describing evidence of effectiveness. EXPERT OPINION Oxytocin is best used when labor needs to be induced in the context of a favorable cervix. When the cervix is not favorable, cervical ripening using prostaglandins should precede labor induction. Either dinoprostone or misoprostol are superior to oxytocin alone for cervical ripening. However, judicious, careful considerations need to be made at the outset of labor induction so as to balance maternal and fetal risks, and these should be guided by institutional policies that reflect the evidence-base.
Collapse
Affiliation(s)
- J Seth Hawkins
- University of Texas Southwestern School of Medicine, Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, 5323 Harry Hines Boulevard, Dallas, TX 75390-9032, USA
| | | |
Collapse
|
21
|
|
22
|
Ande AB, Ezeanochie CM, Olagbuji NB. Induction of labor in prolonged pregnancy with unfavorable cervix: comparison of sequential intracervical Foley catheter-intravaginal misoprostol and intravaginal misoprostol alone. Arch Gynecol Obstet 2011; 285:967-71. [PMID: 22012248 DOI: 10.1007/s00404-011-2094-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 09/21/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the outcome of induced labor at term using sequential intracervical Foley catheter with intravaginal misoprostol versus intravaginal misoprostol alone. METHODS A prospective matched case control study among parturient with prolonged pregnancy and unfavorable cervix at a tertiary hospital in Nigeria. RESULTS The study population was 100 with a mean age of 29.46 ± 3.88 years. Parturient with prior cervical priming using intracervical Foley catheter had significantly lower oxytocin augmentation of uterine contractions in labor (44 vs. 64%, P = 0.045), shorter mean insertion to active phase labor duration (233 ± 98 vs. 354 ± 154 min, P = 0.0001), shorter insertion to delivery interval (514 ± 175 vs. 627 ± 268, P = 0.014), more vaginal delivery <12 h (92.5 vs. 60%, P = 0.001) and less delivery by caesarean section (20 vs. 40%, P = 0.029). CONCLUSIONS The sequential combination of intracervical Foley catheter and intravaginal misoprostol for cervical ripening and induction of labor appears to be a safe and more effective method compared to intravaginal misoprostol in parturient at term with unfavorable cervices.
Collapse
Affiliation(s)
- A Babatunde Ande
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
| | | | | |
Collapse
|
23
|
Tan TC, Yan SY, Chua TM, Biswas A, Chong YS. A randomised controlled trial of low-dose misoprostol and dinoprostone vaginal pessaries for cervical priming. BJOG 2010; 117:1270-7. [PMID: 20722643 DOI: 10.1111/j.1471-0528.2010.02602.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We studied the efficacy of 25-microg misoprostol pessaries as either single or double dose compared with a 3-mg dinoprostone pessary for cervical priming. DESIGN AND SETTING A randomised controlled trial in Singapore. POPULATION One hundred and seventy-one women with term pregnancies and modified Bishop scores (mBS) < or =6 from 2003 to 2004. METHOD Patients were randomised to single misoprostol dose, double misoprostol dose or the current dinoprostone regimen. MAIN OUTCOME MEASURES Primary outcome was number of women who achieved favourable mBS >6 or active labour by day 2. Secondary outcomes were time interval from insertion to delivery, cardiotocographic abnormalities, delivery and neonatal outcome. RESULTS More women in the misoprostol double-dose group (96.6%) and dinoprostone group (93%) achieved the primary outcome compared with the single-dose group (77.8%) (P = 0.003 and P = 0.03, respectively). There was no difference in secondary outcomes. More multiparous women achieve primary outcome compared with nulliparous women (odds ratio 0.21, 95% confidence interval 0.06-0.77). CONCLUSION Double-dose misoprostol 25 microg is as effective as dinoprostone 3 mg inserts for cervical priming; both are more efficacious than a single-dose misoprostol pessary. Parity prognosticates the success of induction.
Collapse
Affiliation(s)
- T-C Tan
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, University Hospital, Singapore
| | | | | | | | | |
Collapse
|
24
|
Oral misoprostol versus intracervical prostaglandin E2 gel for active management of premature rupture of membranes at term. Int J Gynaecol Obstet 2009; 106:23-6. [DOI: 10.1016/j.ijgo.2009.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Revised: 02/09/2009] [Accepted: 03/12/2009] [Indexed: 11/30/2022]
|
25
|
Szczesny W, Sandvik L. Pre-induction cervical ripening with 25 microg and 50 microg vaginal misoprostol in 181 nulliparous parturients. J Matern Fetal Neonatal Med 2009; 22:265-8. [PMID: 19330712 DOI: 10.1080/14767050902763142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the effect of intravaginally misoprostol at start dosages of 25 microg and 50 microg when used for pre-induction cervical ripening among nulliparous parturients. METHODS Our observational study involves all cases of partus induction consecutively registered in a Norwegian hospital between September 2002 and August 2006, with the following inclusion criteria: nulliparous, singleton pregnancies >or=37 weeks, an unfavourable cervix (Bishop score <or=6), viable fetus >2499 g, received misoprostol vaginally every 6 h upto four times. Seventy-six women started with 25 microg (25 microg-group) and 105 started with 50 microg (50 microg-group). All continued with 25 microg. Primary outcome was vaginal delivery within 48 h after the first misoprostol dose. Secondary outcome was caesarean section performed within 96. RESULTS Vaginal delivery within 48 h after the initial dose occurred more often in the 25 microg-group than in the 50 microg-group (75 vs. 58%, p = 0.018). The rate of caesarean section was lower in the 25 microg-group than in the 50 microg-group (19 vs. 33%, p = 0.043). These differences remained significant after adjusting for confounders. CONCLUSION Our findings support the notion that the dose of 25 microg misoprostol is as at least as efficient as 50 microg in nulliparous parturients.
Collapse
Affiliation(s)
- Witold Szczesny
- Department of Obstetrics and Gynecology, Sykehuset Innlandet Hospital Trust, Elverum, Norway.
| | | |
Collapse
|
26
|
Kundodyiwa TW, Alfirevic Z, Weeks AD. Low-dose oral misoprostol for induction of labor: a systematic review. Obstet Gynecol 2009; 113:374-83. [PMID: 19155909 DOI: 10.1097/aog.0b013e3181945859] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the efficacy and safety of low-dose oral misoprostol compared with dinoprostone (PGE2), vaginal misoprostol, and oxytocin for labor induction in women with a viable fetus. DATA SOURCES We conducted electronic database searches of PubMed, MEDLINE, EMBASE, and the Cochrane Library for articles published before January 2008 using the keywords misoprostol, labor, induction, randomized controlled trials, dinoprostone, oxytocin, pregnancy, and maternal and fetal side effects. METHODS OF STUDY SELECTION We included randomized controlled trials comparing 20-25 micrograms oral misoprostol with vaginal misoprostol, dinoprostone or oxytocin given to women at 32-42 weeks of gestation for labor induction. From 401 citations identified, results from nine studies were finally analyzed using the Review Manager software. Relative risk (RR) and 95% confidence intervals (CIs) were calculated using fixed and random-effects models. TABULATION, INTEGRATION, AND RESULTS Nine articles with 2,937 women met the inclusion criteria. The five trials comparing oral misoprostol and dinoprostone showed significantly fewer women requiring cesarean delivery in the misoprostol group (20% compared with 26%; RR 0.82, 95% CI 0.71-0.96). There were no statistically significant differences in risks of uterine hyperstimulation or need for oxytocin augmentation. Two trials compared oral with vaginal low-dose misoprostol. Women using oral misoprostol were significantly less likely to experience uterine hyperstimulation with fetal heart rate changes (2% compared with 13%; RR 0.19, 95% CI 0.08-0.46), but there were no significant differences in other outcomes. CONCLUSION Low-dose oral misoprostol solution (20 micrograms) administered every 2 hours seems at least as effective as both vaginal dinoprostone and vaginal misoprostol, with lower rates of cesarean delivery and uterine hyperstimulation, respectively.
Collapse
|
27
|
Souza ASR, Amorim MMR, Feitosa FEL. Comparison of sublingual versus vaginal misoprostol for the induction of labour: a systematic review. BJOG 2008; 115:1340-9. [DOI: 10.1111/j.1471-0528.2008.01872.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
28
|
Calder AA, Loughney AD, Weir CJ, Barber JW. Induction of labour in nulliparous and multiparous women: a UK, multicentre, open-label study of intravaginal misoprostol in comparison with dinoprostone. BJOG 2008; 115:1279-88. [DOI: 10.1111/j.1471-0528.2008.01829.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
29
|
Prager M, Eneroth-Grimfors E, Edlund M, Marions L. A randomised controlled trial of intravaginal dinoprostone, intravaginal misoprostol and transcervical balloon catheter for labour induction. BJOG 2008; 115:1443-50. [PMID: 18715244 DOI: 10.1111/j.1471-0528.2008.01843.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of induction of labour by vaginal application of dinoprostone or misoprostol or transcervical insertion of a balloon (Bard) catheter. DESIGN A non-blinded, randomised, controlled trial. SETTING A tertiary level Swedish hospital. POPULATION A total of 592 women who had undergone full-term pregnancies, not previously been subjected to a caesarean section, and required induction of labour for common, routine indications. METHODS Women were randomly assigned to induction of labour using intravaginal dinoprostone (2 mg once every 6 hours) or misoprostol (25 micrograms once every 4 hours) or a transcervical balloon catheter. MAIN OUTCOME MEASURES The time interval between induction to delivery in general and vaginal delivery in particular, the mode of delivery, maternal and neonatal parameters of outcome. RESULTS Of the 588 subjects included in the final intention-to-treat analysis, 191 were assigned to treatment with dinoprostone, 199 with misoprostol and 198 with the balloon catheter. The shortest mean induction-to-delivery interval was obtained with the catheter (12.9 hours versus 16.8 and 17.3 hours for dinoprostone and misoprostol, respectively). The efficacies of the two prostaglandins were similar. The maternal and neonatal outcomes associated with each of the three procedures were similar. CONCLUSIONS Induction of labour with a transcervical balloon catheter is effective and safe and can be recommended as the first choice. The two prostaglandins, dinoprostone and misoprostol, were shown to be equally effective and safe, while misoprostol costs significantly less and is easier to store.
Collapse
Affiliation(s)
- M Prager
- Division of Obstetrics and Gynaecology, Department of Woman and Child Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | | | | |
Collapse
|
30
|
Fawole AO, Adegbola O, Adeyemi AS, Oladapo OT, Alao MO. Misoprostol for induction of labour: a survey of attitude and practice in southwestern Nigeria. Arch Gynecol Obstet 2008; 278:353-8. [DOI: 10.1007/s00404-008-0584-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
|
31
|
Xu H, Platt RW, Luo ZC, Wei S, Fraser WD. Exploring heterogeneity in meta-analyses: needs, resources and challenges. Paediatr Perinat Epidemiol 2008; 22 Suppl 1:18-28. [PMID: 18237348 DOI: 10.1111/j.1365-3016.2007.00908.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The investigation of heterogeneity remains an essential but difficult issue in the conduct of meta-analysis. We reviewed standard and graphical methods used to explore heterogeneity in meta-analysis and publications from January 2005 to April 2007 regarding meta-analyses that focused on perinatal health topics. We assessed their approaches to the investigation of heterogeneity, including: (1) whether statistical testing for heterogeneity was performed and, if so, which test was used, (2) how a finding of statistically significant heterogeneity was handled, and (3) how the analyses were conducted in the presence of heterogeneity.
Collapse
Affiliation(s)
- Hairong Xu
- Department of Obstetrics and Gynecology, Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | | | | | | | | |
Collapse
|
32
|
Viswanathan M. Tailoring systematic reviews to meet critical priorities in maternal health in the intrapartum period. Paediatr Perinat Epidemiol 2008; 22 Suppl 1:10-7. [PMID: 18237347 DOI: 10.1111/j.1365-3016.2007.00907.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Health care practitioners and researchers commonly call for greater reliance on evidence as a means to achieve improvement in quality of care. Systematic reviews provide a means to accelerate the use of evidence-based clinical interventions and public health practices. The extent to which these time- and resource-intensive systematic reviews currently address critical maternal health priorities in the intrapartum period is unclear. This analysis summarises key maternal health and research priorities, maps these priorities to existing reviews, identifies gaps in the literature that can be addressed with systematic reviews, and highlights key methodological concerns in conducting systematic reviews. The analysis draws on published data on maternal morbidities and an overview of 108 systematic reviews in Medline in the past 5 years using the MeSH terms 'Delivery, Obstetric,' to draw the links between health priorities, research priorities, existing evidence and missing evidence. Key causes of morbidity during labour and delivery in the United States include haemorrhage, pre-eclampsia and eclampsia, obstetric trauma and infection. Analyses of maternal morbidity and mortality suggest that key concerns include racial and ethnic disparities in health outcomes and the prevention of adverse events. Systematic reviews, however, generally tend to focus on the reduction of harms associated with interventions, are frequently limited to randomised designs, and do not address issues of health disparities. The results suggest that advances in evidence-based care in maternal health require that systematic reviews address issues of prevention of adverse events, include a larger variety of study designs when necessary and pay closer attention to health disparities.
Collapse
Affiliation(s)
- Meera Viswanathan
- Research Triangle Institute International, Research Triangle Park, NC 27709-2194, USA.
| |
Collapse
|
33
|
|