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Okafor CG, Eleje GU, Adinma JI, Ikechebelu JI, Umeh EO, Okafor CO, Ugwu EO, Ugboaja JO, Nwosu BO, Ezeama CO, Udigwe GO, Okoro CC, Egeonu RO, Ezema EC, Umeononihu OS, Okpala BC, Okafor CC, Ofojebe CJ, Ilika CP, Oguejiofor CB, Ogabido CA, Umeokafor CC, James JE, Obiagwu HI, Okafor LU, Obidike AB, Okam PC, Okeke KN, Inya AO, Njoku TK, Eleje LI. A randomized clinical trial of Premaquick biomarkers versus transvaginal cervical length for pre-induction cervical assessment at term among pregnant women. SAGE Open Med 2023; 11:20503121231158220. [PMID: 36923111 PMCID: PMC10009056 DOI: 10.1177/20503121231158220] [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: 09/20/2022] [Accepted: 02/01/2023] [Indexed: 03/13/2023] Open
Abstract
Objectives To compare Premaquick biomarkers (combined insulin-like growth-factor binding protein 1 and interleukin-6) and cervical length measurement via transvaginal ultrasound for pre-induction cervical evaluation at term among pregnant women. Methods A randomized clinical trial of consenting pregnant women at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. The women were randomized equally into Premaquick group (n = 36) and transvaginal ultrasound group (n = 36). The cervix was adjudged 'ripe' if the Premaquick test was positive or if the trans-vaginal measured cervical length was less than 28 mm. The primary outcome measures were the proportions of women who needed prostaglandin analogue for cervical ripening and the proportion that achieved vaginal delivery after induction of labour. The trial was registered in Pan African clinical trial registry (PACTR) registry with approval number PACTR202001579275333. Results The baseline characteristics were similar between the two groups (p > 0.05). There was no statistically significant difference between the two groups in terms of proportion of women that required prostaglandins for pre-induction cervical ripening (41.7 versus 47.2%, p = 0.427), vaginal delivery (77.8 versus 80.6%, p = 0.783), mean induction to delivery interval (22.9 ± 2.81 h versus 24.04 ± 3.20 h, p = 0.211), caesarean delivery (22.2 versus 19.4%, p = 0.783), proportion of neonate with birth asphyxia (8.30 versus 8.30%, p = 1.00) and proportion of neonate admitted into special care baby unit (16.7 versus 13.9%, p = 0.872). Subgroup analysis of participants with 'ripe' cervix at initial pre-induction assessment showed that the mean induction to active phase of labour interval and mean induction to delivery interval were significantly shorter in Premaquick than transvaginal ultrasound group. Conclusion Pre-induction cervical assessment at term with either Premaquick biomarkers or transvaginal ultrasound for cervical length is effective, objective and safe with similar and comparable outcome. However, when compared with women with positive transvaginal ultrasound at initial assessment, women with positive Premaquick test at initial assessment showed a significantly shorter duration of onset of active phase of labour and delivery of baby following induction of labour.
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Affiliation(s)
- Chigozie G Okafor
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - George U Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria.,Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Nnewi Campus, Awka, Nigeria
| | - Joseph I Adinma
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Joseph I Ikechebelu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria.,Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Nnewi Campus, Awka, Nigeria
| | - Eric O Umeh
- Department of Radiology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Chisolum O Okafor
- Department of Radiology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Emmanuel O Ugwu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Teaching Hospital, Enugu Campus, Enugu State, Nigeria
| | - Joseph O Ugboaja
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Betrand O Nwosu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Chukwuemeka O Ezeama
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Gerald O Udigwe
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria.,Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Nnewi Campus, Awka, Nigeria
| | - Chukwuemeka C Okoro
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Richard O Egeonu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | | | - Osita S Umeononihu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Boniface C Okpala
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | | | - Chukwuemeka J Ofojebe
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Chito P Ilika
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Charlotte B Oguejiofor
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Chukwudi A Ogabido
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Chijioke C Umeokafor
- Department of Radiology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - John E James
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Hillary I Obiagwu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Lazarus U Okafor
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Afam B Obidike
- Department of Anaesthesia, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Princeston C Okam
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Kenneth N Okeke
- Department of Paediatrics, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Anselem O Inya
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Tobechi K Njoku
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Anambra State, Nigeria
| | - Lydia I Eleje
- Evaluation, Research and Statistics Unit, Department of Educational Foundations, Faculty of Education, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
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Wang X, Zhang C, Li X, Qi H, Liu Q, Lei J. Safety and efficacy of titrated oral misoprostol solution versus vaginal dinoprostone for induction of labor: A single-center randomized control trial. Int J Gynaecol Obstet 2021; 154:436-443. [PMID: 33336360 PMCID: PMC8451767 DOI: 10.1002/ijgo.13546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/09/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022]
Abstract
Objective To compare the efficacy and safety of the hourly administration of titrated oral misoprostol solution (OMS) and vaginal dinoprostone for induction of labor. Methods Titrated OMS was administrated hourly for induction of labor, starting with a dose of 20 µg and terminating at a dose of 50 µg. The safety and efficacy of OMS were compared with that of vaginal dinoprostone for induction of labor. Results From June 2016 to October 2019, 2280 (78.3%) and 2115 (72.9%) women who received titrated OMS and vaginal dinoprostone, respectively, had a vaginal delivery (P = 0.005). Cesarean delivery was performed in 632 (21.7%) and 783 (27.0%) women who received titrated OMS and vaginal dinoprostone, respectively (P = 0.008). Tachysystole with changes in fetal heart rate (FHR) was seen in 104 (3.6%) and 249 (8.6%) women in the OMS and dinoprostone groups, respectively (P = 0.007). The frequency of non‐reassuring FHR was lower in the OMS group compared to the dinoprostone group (P = 0.006). Conclusion The titrated OMS has an efficacy comparable to vaginal dinoprostone. Moreover, it causes a lower incidence of cesarean delivery, lower frequency of tachysystole with changes in FHR, and non‐reassuring FHR. Titrated oral misoprostol has a similar efficacy to dinoprostone, but with a lower incidence of cesarean delivery and lower frequency of non‐reassuring fetal heart rate.
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Affiliation(s)
- Xiu Wang
- Department of Gynecology and Obstetrics, Affiliated Guangren Hostpial of Xi'an Jiaotong University, Xi'an, China
| | - Chao Zhang
- Department of Gynecology and Obstetrics, Affiliated Guangren Hostpial of Xi'an Jiaotong University, Xi'an, China
| | - Xia Li
- Department of Gynecology and Obstetrics, Affiliated Guangren Hostpial of Xi'an Jiaotong University, Xi'an, China
| | - Hongyan Qi
- Department of Gynecology and Obstetrics, Affiliated Guangren Hostpial of Xi'an Jiaotong University, Xi'an, China
| | - Qing Liu
- Department of Gynecology and Obstetrics, Affiliated Guangren Hostpial of Xi'an Jiaotong University, Xi'an, China
| | - Jing Lei
- Department of Gynecology and Obstetrics, Affiliated Guangren Hostpial of Xi'an Jiaotong University, Xi'an, China
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