Intravenous Dexamethasone Versus Vaginal Misoprostol in Enhancing Cervical Ripening and Labor Induction

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Mahmoud Salman ◽  
Fekria Ahmed Salama ◽  
Mina Yacoub
Keyword(s):  
Total Duration ◽  
Active Phase ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Control Group ◽  
P Value ◽  
Time Interval ◽  
Vaginal Misoprostol ◽  
Mean Time

Abstract Background Induction of labor is one of the most common procedures performed in the world of Obstetrics. Traditionally, labor induction is performed using prostaglandin and oxytocin. However, usage of corticosteroids nowadays is gaining a lot of interest regarding its effects on cervical ripening and shortening the physiological process of labor. Aim of work to evaluate the efficacy of intravenous dexamethasone versus vaginal misoprostol in enhancing cervical ripening and labor induction. Patients and Methods A randomized controlled clinical trial was carried out at Ain Shams University Maternity Hospital on (60) full term pregnant women between 39 – 42 weeks undergoing induction of labor, during a period from April 01, 2019 to November 30, 2019. Pregnant women were divided into two groups; vaginal misoprostol (control) group and intravenous dexamethasone (experimental) group (30 cases each). Results Our study showed that the mean time interval (hours) from initiation of labor induction to initiation of active phase was statistically significantly shorter among the dexamethasone (experimental) group 7.36 ± 2.23 versus 12.20 ± 4.92 hours among the vaginal misoprostol (control) group (p value < 0.001). Also, the mean time interval of the total duration between the induction of labor to successful vaginal delivery was statistically significantly shorter among the dexamethasone group 10.90 ± 4.17 versus 19.20 ± 5.62 hours among the vaginal misoprostol group (p value < 0.001). The results of this study showed the rate of initiation of active phase and rate of successful vaginal delivery were more in the experimental dexamethasone group than the control vaginal misoprostol control group. Conclusion Intravenous injection of 8 mg of dexamethasone before induction of labor is found to shorten the duration of labor induction by reducing the time interval between the initiation of labor induction and onset of active phase and the total duration from initiation of labor induction to delivery with no marked maternal or fetal complications. Recommendations Intravenous Dexamethasone can help cervical ripening and accelerate induction of labor. Further research should be taken in consideration with more population for more global evaluation.

Titrated oral misoprostol solution versus vaginal misoprostol for labor induction in primi gravid ladies

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
I M Abdalfattah ◽  
W E Mohammed ◽  
A A El-gaml
Keyword(s):  
Safety Profile ◽  
Tap Water ◽  
Maternity Hospital ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Controlled Clinical Trial ◽  
Solution Versus ◽  
Oral Misoprostol ◽  
Vaginal Misoprostol

Abstract Background It is now generally accepted that the uterine cervix plays an important role during pregnancy and labor and that it depends on an active ripening process within the cervix; which is necessary for successful labor induction. Aim of the Work to test the safety and efficacy of titrated oral misoprostol compared to vaginal misoprostol for labor induction in term gravid ladies. Patients and Methods This prospective, single-blinded randomized controlled clinical trial was conducted at Ain-Shams University Maternity Hospital during the period between August 2017 and August 2018. 120 pregnant women planned for induction of labor were recruited in the study according to the inclusion / exclusion criteria. Subjects included in the study were randomized into two groups: patients who received oral 200 ug misoprostol in 200 ml water titrated over 24 hours and placebo tablets vaginally which resemble vagiprost tablets (25 microgram misoprostol) and the second group contained pients who received vaginal misoprostol 25microg maximum four doses, and placebo solution of 200 ml of tap water. Results titrated oral misoprostol is as effective in promoting cervical ripening and inducing labor as intravaginal misoprostol, oral Misoprostol has a similar maternal and perinatal safety profile to vaginal misoprostol. Conclusion This new approach to oral misoprostol administration was successful in minimizing the risk of uterine hyper-stimulation, which has been a feature of misoprostol use for induction of labor, at the expense of a somewhat slower response. Oral Misoprostol has a similar maternal and perinatal safety profile compared to vaginal misoprostol.

scholarly journals Comparative study of intra vaginal misoprostol (PGE1) with intracervical dinoprostone (PGE2) gel for induction of labour

2018 ◽  
Vol 7 (9) ◽  
pp. 3769
Author(s):  
Bina M. Raval ◽  
Nainesh S. Zalavadiya ◽  
Pushpa A. Yadava ◽  
Shital T. Mehta
Keyword(s):  
Caesarean Section Rate ◽  
Cost Effective ◽  
Active Phase ◽  
Cross Sectional Study ◽  
Cervical Ripening ◽  
Cross Sectional ◽  
Misoprostol Group ◽  
The Mean ◽  
Vaginal Misoprostol ◽  
Mean Time

Background: Labour is a final consequence of Pregnancy and is inevitable. The timing of labour may vary widely but it will happen sooner or later. The aim of the present research was to study the safety, efficacy and effect of intra vaginal Misoprostol and intra cervical Dinoprostone gel for induction of labour.Methods: 100 patients who required labour of induction were included in this prospective cross-sectional study from September 2017- March 2018. 50 patients of them received 25mcg tablet misoprostol intravaginal and 50 patients of them required 0.5mg intracervical dinoprostone gel and doses were repeated every 6 hourly for up to maximum 6 doses for Misoprostol and 3 doses for Dinoprostone gel.Results: The majority of patients had gestational age above 40 weeks and between 37-40 weeks in PGE2 and PGE1 group respectively. The mean time taken for the onset of labour was less in Misoprostol than in Dinoprostone group (43.22min v/s 1 hr40 min). The mean time taken for induction to active phase of labour (1hr 42min v/s 4hr 10min) and active phase to delivery (3hr 6min v/s 4hr54min) was less in Misoprostol than Dinoprostone group. The mean time required for induction to delivery was less in Misoprostol group (5hr 2min v/s 11hrs). Requirement of oxytocin for augmentation of labour was almost equal in both groups. Caesarean section rate was less in Misoprostol group (10% v/s 22%). Maternal side effects were minimal in either groups and neonatal outcome was good in both the groups.Conclusions: Both Misoprostol and Dinoprostone gel are safe, effective for cervical ripening and induction but Misoprostol is more cost effective and stable at room temperature.

scholarly journals Efficacy and safety of oral mifepristone for cervical priming and induction of labor in term pregnancy

2018 ◽  
Vol 7 (7) ◽  
pp. 2766 ◽  
Author(s):  
Abhilasha Gupta ◽  
Aruna Verma ◽  
Iti Madan ◽  
Monika Kashyap
Keyword(s):  
Controlled Trial ◽  
Group Versus ◽  
Perinatal Outcomes ◽  
Active Phase ◽  
Cervical Ripening ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Bishop Score ◽  
Term Pregnancy

Background: The objectives of the study was to assess the efficacy of mifepristone in priming the cervix/inducing labor over next 96 hrs in term pregnancy.Methods: In this single blind randomized controlled trial 200 women with term pregnancy beyond 39 weeks and Bishop’ score <6 were randomly allocated into two groups. Tab Mifepristone 400 mg orally was given to women in study group (n=100) and no intervention in control group (n=100). On follow up one case was lost in control group. All women were observed for change in the bishop’s score or onset of labor in next 96 hrs. If Bishop’s score was <6, the choice of induction was left on the clinician/patient.Results: Mean induction to delivery interval, duration of active phase and improved Bishop score were 79.35±53.43 hr, 2.47±1.23 hr, 6.68±1.69 for study group versus 148±65.66 hr, 3.09±1.45 hr, 5.8±2.15  for control group (p value is <0.001) respectively.  Seventy one (71%) women in study group and 39 (39.3%) women in control group delivered vaginally within 96 hrs without any need of augmentation. There were 9 (9%) caesareans in study group and 24 (24.2%) caesareans in control group but no instrumental delivery in both groups. There was no statistically difference in perinatal outcomes between two groups.Conclusions: Mifepristone is an effective drug for cervical ripening and initiation of labor when given in term pregnancy beyond 39 weeks with poor Bishop’s score (<6) and appearing to reduce need for other agent for augmentation of labor.

Intravaginal isosorbide mononitrate in addition to misoprostol versus misoprostol only for induction of labor: a randomized controlled trial

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H M Harb ◽  
D Y Mansour ◽  
Y M A M E Abouahmed
Keyword(s):  
Nitric Oxide ◽  
Clinical Trial ◽  
Active Phase ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Isosorbide Mononitrate ◽  
Nitric Oxide Donors ◽  
P Value ◽  
Delivery Time ◽  
Whole Process

Abstract Background Induction of labor is still a controversial obstetric procedure. The need to shorten delivery time has been recognized and practiced for centuries. Although the indications have clearly changed during the past decades from a need to expel a dead fetus to an effective solution to reduce the threat to the mother and her precious fetus, effective and safe methods of achieving delivery must always have been the primary objectives. Induction is indicated when the benefits to either mother or fetus outweigh those of pregnancy continuation. Nitric oxide donors(NO donors) such as isosorbide mononitrate could be of a great use for cervical ripening because of their effect on release of prostaglandins and vasodilation while having no or little effect on uterine activity ; since they are relatively safe and has low number of non-vital adverse effect if used with caution, they could be added to misoprostol to shorten to time needed for cervical ripening thus accelerating the whole process of induction of labor. The Aim of this study was to evaluate safety & efficacy of nitric oxide donors such as intravaginal isosorbide mononitrate in addition to misoprostol versus misoprostol only for the whole process of induction of labor. Patients and Methods in a prospective randomized double-blind placebo-controlled clinical trial which was conducted at Ain Shams Maternity University Hospital in Cairo from January 2018 to June 2018, 50 women were included in induction of labor, they were randomly divided into 2 group: Group I consisted of 25 patients, each patient was given 1 tablet of isosorbide mononitrate 40mg vaginally once and one tablet of misoprostol 25mcg vaginally; Group II consisted of 25 patients, each patient was given 1 tablet of misoprostol 25mcg vaginally. Misoprostol were given for a maximum of 5 doses (one 25mcg vaginal tablet) with interval of 6 hours between each tablet. This clinical trial was registered in clinicaltrial.gov registry with number: NCT03523754. Results there was a statistically significant difference between Isosorbide mononitrate & Misoprostol group versus Misoprostol only group regarding induction to delivery time ( mean 19.55 ± 1.41 to 22.94 ± 1.44 hours respectively, P-value &lt;0.001) , induction to active phase interval (mean 10.67 ± 1.83 to 13.81 ± 0.52 hours respectively, P-value &lt;0.001), maternal headache (36% to 12% respectively, P-value =0.047). Conclusion Isosorbide mononitrate appears to be a safe agent when used with misoprostol for induction of labor. It decreases induction to delivery time and induction to active phase time.

scholarly journals Comparison between Sublingual and Vaginal Misoprostol for Induction of Labour in Primigravida

2018 ◽  
Vol 13 (3) ◽  
pp. 51-55
Author(s):  
Sailaja Ghimire ◽  
Deepanjali Sharma ◽  
Samjhana Dhakal ◽  
Gehanath Baral
Keyword(s):  
Fetal Distress ◽  
Fetal Outcome ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
P Value ◽  
Time Interval ◽  
Vaginal Route ◽  
Sublingual Misoprostol ◽  
The Mean ◽  
Vaginal Misoprostol

Aims: To compare the outcome and side effects of administration of sublingual misoprostol with vaginal misoprostol for induction of labour and cervical ripening. Methods: It was a hospital based comparative study which was carried out in 120 patients in each group of sublingual and vaginal route of misoprostol induction from August 2016 to February 2017 at Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu. Patients with Bishops score <6 were subjected for Misoprostol 25 μg (for maximum 2 doses) 6 hours apart. Results were analyzed using SPSS 21 taking p-value <0.05 as statistically significant. Results: The mean change in Bishops score after 6 hours of misoprostol was statistically signifi cantly (p=0.001) in sublingual group in comparison to vaginal group. The diff erence in augmentation rate was not statistically signifi cant (p= 0.811). The mean time interval from drug administration to delivery was almost similar in both groups. The indications for cesarean section were similar in both the groups, the most common being fetal distress, (67.33% in sublingual and 58.065% in vaginal group). In terms of maternal and neonatal outcome there was no difference. Conclusions: Sublingual route results in significant changes of Bishop’s score as compared to vaginal route. It was also significantly better in terms of fetal outcome. However, both routes appeared similar in terms of maternal outcome.

scholarly journals A study comparing vaginal misoprostol alone with vaginal misoprostol in combination with Foley catheter for cervical ripening and labour induction

2017 ◽  
Vol 6 (2) ◽  
pp. 485 ◽  
Author(s):  
Binti R. Bhatiyani ◽  
Manisha R. Gandhewar ◽  
Swati Kapsikar ◽  
Pradip Gaikwad
Keyword(s):  
Foley Catheter ◽  
Active Phase ◽  
Fetal Distress ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Combination Group ◽  
Maternal Complications ◽  
Misoprostol Group ◽  
Vaginal Misoprostol

Background: Induction of labor is a commonly practised intervention in modern obstetrics. The objective of this study was to compare the efficacy of vaginal misoprostol alone with vaginal misoprostol in combination with Foley catheter for labour induction. It aims to assess the induction delivery interval, the outcome of labour, the incidence of instrumental delivery and Cesarean section. The neonatal outcomes and maternal complications would also be assessed.Methods: 105 women with singleton viable pregnancies of 28 weeks or more gestation with cephalic presentation, intact membranes and an unfavorable cervix (Bishops score less than 6) were randomly assigned to induction of labor using vaginal misoprostol or Foley catheter in combination with vaginal misoprostol. Women in the misoprostol only group received 25 micrograms of misoprostol per vagina every 4 hours for a maximum of six doses. Whereas women in the combination group received vaginal misoprostol and in addition Foley catheter was introduced through the cervix for 12 hours. Interruption of the trial was done in case of failure to enter the active phase of labour after 24 hours of induction, fetal distress, hyperstimulation, hypersensitivity to drugs.Results: The induction to delivery time was shorter in misoprostol group as compared to the Foley with misoprostol group by 3 hours. There was no significant change in Bishops score after induction with Foley in combination with misoprostol as compared to misoprostol alone. There was no increase in the maternal and fetal complications in the misoprostol group as compared to Foley with misoprostol.Conclusions: Misoprostol alone was more efficacious for ripening and inducing agent as compared to Foley in combination with misoprostol.

scholarly journals Role of Dexamethasone in Induction of Labor: (A Randomized Clinical Trial)

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H M Elsayed ◽  
A M Bahaa ◽  
A A Alanwar ◽  
K M Mohamed
Keyword(s):  
Pregnant Women ◽  
Statistical Difference ◽  
Active Phase ◽  
Maternity Hospital ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Control Group ◽  
Significant Statistical Difference ◽  
Phase Interval ◽  
Group D

Abstract Background Labor induction is a common obstetric procedure which is done for many indications. Ripening of the cervix is a complex process involving hormonal, vasodilatory and inflammatory changes. There are broad range of methods for cervical ripening and induction of labor. Aim of the study: to assess the efficacy of intramuscular administration of dexamethasone on the induction delivery-interval in full term women undergoing induction of labor. Patients and Methods This study was carried out between July 2018 and January 2019, at the labor ward of Ain Shams university maternity hospital, a double bind randomized control trial of 80 pregnant women undergoing induction of labor after obtaining the approval of the local ethical committee and a fully-informed written consent. They were randomized into two groups: group D (Dexamethasone group n = 40) and group C (control group n = 40). Results Of 80 pregnant women undergoing induction of labor there were no statistically significant differences between the two groups as regard their age, body mass index, gestational age and bishop score at time of intervention. There was significant statistical difference between the two groups as regard induction-active phase interval (P &lt; 0.05), mean induction-active phase interval in group D was (4.91±.85 hours) while in group C was (5.44±.83 hours). There was no significant statistical difference between the two groups as regard duration of active phase of labor, mean duration of active phase in group D was (4.10±.97 hours) and in group C (4.47±1.20 hours). There was significant statistical difference between the two groups as regard induction-delivery interval (P &lt; 0.05), mean induction-delivery interval in group D was (9.73±.1.52hours) while in group C was (10.70±1.87 hours). There were no statistically significant differences between the two groups as regard duration of 2nd and 3rd stages of labor. Conclusion Single intramuscular injections of 2 ml. (8mg) of dexamethasone before induction of labor seems to shorten induction-delivery interval by shortening the induction-active phase interval.

Factors associated with delayed onset of active labor following administration of vaginal Misoprostol among women at Mbarara Regional referral hospital, Uganda: A prospective cohort study

2019 ◽  
Author(s):  
Rogers Kajabwangu ◽  
Francis Bajunirwe ◽  
Henry Lukabwe ◽  
Esther Atukunda ◽  
Baraka Munyanderu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gestational Age ◽  
Labor Induction ◽  
Induction Of Labor ◽  
P Value ◽  
Regional Referral Hospital ◽  
Factors Associated ◽  
Delayed Onset ◽  
Active Labor ◽  
Vaginal Misoprostol

Abstract Background Vaginal misoprostol has been recommended by the World Health Organization as one of the effective methods for induction of labor. Globally 9.6% of all deliveries follow induction of labor. Although the goal of labor induction is to initiate active labor with subsequent vaginal delivery, some mothers undergoing labor induction delay to get into active labor and some fail completely. The factors associated with delayed onset of active labor following labor induction with vaginal misoprostol have not been sufficiently explored in resource limited settings.Methods We conducted a prospective cohort study over a period of 6 months on the antenatal ward and labor suit of Mbarara Regional Referral Hospital, southwestern Uganda. We enrolled mothers of gestational age at least 28 weeks, with indication for labor induction. They received 50 micrograms of vaginal misoprostol every 6 hours with a maximum of 4 doses and were followed up until onset of active labor. Onset of active labor was considered delayed if it occurred at more than 12 hours after administration of the first dose of vaginal misoprostol. Bivariate and multivariate analysis was done to determine the factors associated with delayed onset of active labor.Results Eighty-eight mothers underwent induction of labor, 22.7% had delayed onset of active labor. After adjusting for potential confounders, low/no parity (Relative Risk or RR 2.67, p-value=0.01), low gestational age (RR 3.1, p-value=0.006) and higher BMI (RR 0.36, p-value=0.005), were associated with delayed onset of active labor following vaginal misoprostol administration.Conclusion Nulliparity, gestational age less than 37weeks are associated with delayed onset of active labor following labor induction with vaginal misoprostol while BMI of 26 and above is protective from delayed onset of labor.

scholarly journals Use of Intravenous Dexamethasone for Cervical Ripening and Labor Induction in Term Pregnancies with Pre-labour Rupture of Membranes: Randomized control trial

2021 ◽  
Vol 4 (2) ◽  
pp. 01-08
Author(s):  
Sarah safwat
Keyword(s):  
Vaginal Delivery ◽  
Intravenous Administration ◽  
Randomized Control Trial ◽  
Active Phase ◽  
Maternity Hospital ◽  
Labor Induction ◽  
Cervical Ripening ◽  
Control Group ◽  
Dexamethasone Group ◽  
Randomized Control

Abstract Background: During the first 36 to 38 weeks of normal gestation, the myometrium is in a preparatory yet unresponsive state. Concurrently, the cervix begins an early stage of remodeling yet maintains structural integrity. Induction of labour is a complex process involving cervical ripening which undergo extensive remodeling and dynamic changes controlled by hormonal, inflammatory changes, and other biological processes. Aim of the Work: to assess the effect of intravenous administration of dexamethasone on the induction delivery interval in term patients with prelabour rupture of membranes undergoing induction of labor. Patients and Methods: This randomized control trial was conducted at department of Obstetrics and Gynecology at Ain Shams University Maternity Hospital (ASUMH) in the period between August 2020 and January 2021. Participants of this study were 80 full term pregnant women with pre-labor rupture of membranes attended the labor ward in El Demerdash Maternity Hospital and scheduled for induction of labor by 8 mg dexamethasone IV before starting induction by PGE1, after 4 hours oxytocin was added by 1 IU/hr with the dose increasing by 1 IU every 30 minutes till optimal contractions were reached which were three uterine contractions in 10 minutes and each lasting for 40-50 seconds. Results: Fetal distress, arrest of delivery and indications of CS delivery were non-significantly less frequent among Dexamethasone group. Induction-active phase and active phase durations were significantly shorter among dexamethasone group than among control group. Second and third stages durations were non-significantly shorter among dexamethasone group than among control group. Total induction-delivery duration was significantly shorter and rate of vaginal delivery was significantly higher among dexamethasone group than among control group. Postpartum hemorrhage (PPH), postpartum endometritis, chorioamnionitis were not reported among the studied groups. No significant difference between Dexamaethasone and Control groups regarding neonatal condition Conclusion: Intravenous administration of dexamethasone in addition to labor induction protocol shortened the induction - active phase and active phase durations. It shortened the total induction-delivery duration and increased the rate of successful vaginal delivery. It has no effect on second and third stages durations with no increase in incidence of intrapartum, postpartum nor neonatal complications.

scholarly journals Comparison of Oral and Vaginal Administration of Low-dose Misoprostol for Labor Induction

2012 ◽  
Vol 4 (3) ◽  
pp. 137-140
Author(s):  
Ragweshwar Jyoti ◽  
Mamta Mahajan ◽  
Kumud Bala Gupta ◽  
Renu Sharma
Keyword(s):  
Low Dose ◽  
Neonatal Outcome ◽  
Oral Route ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Comparable Efficacy ◽  
Control Group ◽  
Study Group ◽  
Vaginal Administration ◽  
Vaginal Misoprostol

ABSTRACT Objective Comparison of oral and vaginal administration of lowdose misoprostol for induction of labor at term. Materials and methods Two hundred pregnant women after 37 weeks of gestation with an indication for induction were given 25 μg of misoprostol orally (study group) or vaginally (control group), every 3 hours to a maximum of 8 doses. The induction to delivery interval, requirement of oxytocin, dose of misoprostol used, maternal and neonatal outcome were analyzed statistically. Results The median induction to delivery interval was significantly shorter in those induced with vaginal misoprostol (p = 0.06). The median induction to delivery interval was 21.35 ± 7.44 hours in study group and 14.64 ± 5.49 hours in control group. Eighty-two percent women in study group and 84% women in control group had vaginal delivery. Cesarean section rate was lower in control group, 16% vs 18% in study group, but the difference was not statistically significant (p = 0.790). Oxytocin augmentation was needed for 80% cases in the study group and 54% cases in control group, which was statistically significant (p = 0.006). The incidence of abnormal FHR was more in control group as compared to study group (30 vs 14%). Hyperstimulation syndrome was observed in 4% cases in control group and 2% cases in study group. Neonatal outcome was found to be similar in both groups. Conclusion Vaginal misoprostol achieved higher success rate within a short induction interval but was associated with increase in abnormal FHR pattern and abnormal uterine activity as compared to the oral route. Oral route had comparable efficacy, was safe and well-tolerated route of misoprostol administration for induction of labor at term. How to cite this article Mahajan M, Gupta KB, Sharma R, Jyoti R. Comparison of Oral and Vaginal Administration of Low-dose Misoprostol for Labor Induction. J South Asian Feder Obst Gynae 2012;4(3):137-140.

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