scholarly journals Oral mifepristone as adjuvant to prostaglandin E2 (PGE2) gel for preinduction cervical ripening and induction of labour in third trimester

2017 ◽  
Vol 6 (9) ◽  
pp. 3952
Author(s):  
Jitendra D. Mane ◽  
Sanjay Singh ◽  
Anil Kumar Singh
Keyword(s):  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Control Group ◽  
Study Group ◽  
Third Trimester ◽  
Safety And Efficacy ◽  
Vaginal Deliveries ◽  
Spontaneous Labour ◽  
Unfavourable Cervix

Background: Whenever the intrauterine milieu is not conducive for the foetus and continuation of pregnancy may affect adversely to mother and the fetus, termination of the pregnancy is planned. Objective of this work was to study the safety and efficacy of oral mifepristone as adjuvant to PGE2 gel in pre-induction cervical ripening and induction of labour in third trimester.Methods: 150 patients in third trimester were recruited in this single blind randomized control trial that were planned for delivery with unfavourable cervix. They were randomly allocated into two groups i.e. study group (n = 75) who received Tab. Mifepristone 200 mg orally and control group (n = 75) who received placebo orally. At the end of 48 hours (h), change in the Bishop’s Score was assessed and those with unfavourable cervix or not in labour, were administered PGE2 gel intracervically every 6h, for maximum of 3 doses for pre-induction cervical ripening of cervix. Analysis regarding safety and efficacy of the drug was done with regards to maternal and perinatal outcome.Results: Out of 150 patients, 75 received mifepristone and 75 received placebo. Mean Bishop’s Score showed significant improvement after 48h in study group (R R 5.135, 95% CI 4.78 to 5.48) compared to control group (RR 3.43, 95% CI 3.21 to 3.65). Significant number of women went in spontaneous labour in study group (39 v/s 20) (p - 0.035) in each dose category of PGE2 application. The opportunity to induce labour (with oxytocin) was better in study group in each dose category of intracervical PGE2 gel application. Moreover, lesser number of PGE2 gel was used in study group comparing control group. However, there were no statistical differences in both the groups as far as number of vaginal deliveries and caesearean sections are concerned. Duration of labour in both the groups was same. Neonatal and maternal morbidity was comparable in both the groups.Conclusions: Mifepristone improves Bishops score when given 48 h prior to labour induction along with increased number of spontaneous labour and reduced need for PGE2 gel applications, without increasing maternal or neonatal morbidity.

scholarly journals A comparative study of safety and efficacy of vaginal isosorbide mononitrate (40mg) with dinoprostone gel (0.5mg)

2018 ◽  
Vol 7 (10) ◽  
pp. 4197
Author(s):  
Malathi T. M. ◽  
Kanchanamalai K.
Keyword(s):  
Side Effects ◽  
Cost Effective ◽  
Labor Induction ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Controlled Study ◽  
Isosorbide Mononitrate ◽  
Control Group ◽  
Study Group ◽  
Safety And Efficacy

Background: It is essential to intervene pregnancy for safety of mother, fetus or both. Successful labor induction is clearly related to the state of the cervix. Women with an unfavorable cervix who have not experienced cervical ripening phase before labor present the greatest challenge with regard to labor induction. Therefore, it is necessary to use optimal technique for cervical ripening and safe confinement. One of the common methods includes use of PGE2 gel for cervical ripening. The rationale of this study is to compare the safety and efficacy of Iso-sorbide mononitrate as pre-induction cervical ripening with PGE2 gel induction.Methods: After attaining ethics approval [PSG IHEC], a prospective randomised, case-controlled study was conducted on 182 women undergoing elective induction of labour. They were allocated to either Study or Control group by computer generated random number table method. ISMN was used vaginally prior to labour induction in the study group whereas PGE2 gel induction was used in the control group. Change in bishop score and Induction to delivery interval was assessed in both the groups.Results: There was a significant reduction in induction to delivery interval in the study group (ISMN) 15.2 hours when compared to 23.2 hours in the control group (PGE2 gel) with p=0.000. Need for augmentation of labour was reduced in the study group significantly with p=0.003. Cost of induction was less when compared to the control group. ISMN had less side effects hence can be used as OP basis.Conclusions: Vaginal Isosorbide mononitrate when used as a cervical ripening agent significantly reduces induction to delivery interval. Use of Isosorbide mononitrate was associated with very less side effects and it is a cost-effective drug. Thus, ISMN can be used safely and effectively in term patients for pre-induction cervical ripening when compared to PGE2 gel.

scholarly journals COMPARATIVE STUDY BETWEEN FOLEY CATHETER AND DINOPROSTONE GEL FOR CERVICAL RIPENING AND INDUCTION OF LABOUR IN PATIENTS AT TERM WITH UNFAVOURABLE CERVIX (BISHOP'S SCORE<4)

2019 ◽  
pp. 1-4
Author(s):  
Shrikant Warade ◽  
Anshul Pahwa ◽  
Savita Dhongade
Keyword(s):  
Foley Catheter ◽  
Mode Of Delivery ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Time Interval ◽  
Vaginal Deliveries ◽  
Unfavourable Cervix ◽  
Group B ◽  
Singleton Pregnancies

BACKGROUND- Since ancient times, labour inducton is a well established obstetric concept. In the past few decades, rate of labour induction has increased dramatically. The primary objective of this study was to compare the efcacy of transcervical foley catheter with intracervical dinoprostone gel for cervical ripening and labour induction in term singleton pregnancies with unfavourable cervix. METHODS- Term singleton pregnancies fullling inclusion criteria were randomized by chit box system to receive intracervical dinoprostone or transcervical foley catheter. Progress of labour was monitored with the help of partogram. Labour augmentation was done by oxytocin. RESULTS- 110 patients in each group were enrolled. Group A was induced with transcervical Foley catheter and group B with dinoprostone gel. Baseline characteristics like maternal age, parity, gestational age were comparable in each group. There was a signicant difference in the Bishop's score (<.0.05) at the end of 12 hours, Group B showing a greater improvement than A. A signicant difference was also observed in the requirement of augmentation with Pitocin, 77.27% in foley group and 63.63% in dinoprostone group . Although, there was no signicant difference observed in the mode of delivery (p>0.05) and induction to delivery time interval (p>0.05) , maternal and neonatal morbidity between the groups. CONCLUSION- To conclude, Dinoprostone is associated with rapid cervical ripening . Although, mean induction to delivery interval and number of vaginal deliveries were comparable between the groups. Moreover, cost and safety prole of foley catheter makes it comparable or even superior to dinoprostone gel for cervical ripening and induction of labour, especially in developing countries.

117 IN VIVO EVALUATION OF THE CERVICAL STIFFNESS EVOLUTION DURING INDUCED LABOR IN EWES USING ELASTOGRAPHY

2015 ◽  
Vol 27 (1) ◽  
pp. 150 ◽  
Author(s):  
L. Peralta ◽  
E. Mourier ◽  
C. Richard ◽  
P. Chavette-Palmer ◽  
M. Muller ◽  
...  
Keyword(s):  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Control Group ◽  
Maturation Process ◽  
In Vivo Evaluation ◽  
Perinatal Medicine ◽  
Successful Induction ◽  
Cervical Maturation

Despite numerous advances and intensive research in perinatal medicine, spontaneous preterm birth (PTB) is the leading global cause of neonatal mortality and morbidity. On the other hand, labour has to be induced in ~23% of pregnancies worldwide. Both issues may be related to the distensibility of the cervical tissue. Quantitative and objective monitoring of the cervix ripening may provide a complementary method to identify cases at risk of PTB and assess the likelihood of successful induction of labour. Currently, however, no reliable clinical tools for such a quantitative and objective evaluation exist. Elastography aims at imaging tissue stiffness. All elastography techniques rely on the same basics: an external force is applied to the tissue and the resulting movements are then followed. Supersonic shear imaging (SSI) is a dynamic method that uses the propagation of mechanical waves to excite the tissue. Its speed is tracked then by ultrafast imaging, allowing characterisation of stiffness [Bercoff et al. 2004 IEEE Trans. Ultrason. Ferroelect. Freq. Contr. 51, 396–409]. Understanding the mechanisms that take place in normal pregnancy will allow a better comprehension of the cervical remodelling and lead to better methods of diagnosis of PTB and successful induction of labour. In this work, we propose a preliminary assessment of the evolution of stiffness during the cervical maturation process in the sheep. The main goal was to study the feasibility of elastography using SSI to quantify cervical stiffness during the maturation process and to assess the potential of this technique for diagnosis of preterm labour and for labour induction success. Cervical stiffness was quantified, by 2 different operators, in 9 pregnant ewes in vivo by using SSI. The cervical ripening was induced by a dexamethasone injection in 5 animals, and 4 animals constituted the control group. The stiffness of the second ring of the cervix was quantified over a circular region of interest of 5 mm of diameter during vaginal ultrasound examination. Images were acquired every 4 h during 24 h to monitor the cervical maturation induced by the dexamethasone injection. Cervical stiffness was found to decrease significantly throughout the cervical ripening (from 9.5 ± 0.9 kPa to 5.0 ± 0.8 kPa; P = 2.7e–5). The intraobserver and interobserver repeatability of measurements were assessed using Bland-Altman analysis with 95% CI. The principal findings of the study were that elastography measurements using SSI technique were highly reproducible in all cases. Second, stiffness of the uterine cervix decreases throughout the maturation process induced by the dexamethasone injection. Finally, it was possible to quantify the decrease of stiffness through the cervical maturation process. Elastography may be a valuable method to quantify objectively and noninvasively the cervical stiffness in vivo, and ultimately could be a useful tool for the diagnosis of PTB and the assessment of labour induction success.

scholarly journals Mifepristone safety and efficacy in preinduction of labor: an observational study

2021 ◽  
Vol 10 (3) ◽  
pp. 1027
Author(s):  
Thota Sai Tejaswi ◽  
Shailaja R. Bidri
Keyword(s):  
Randomized Study ◽  
Late Pregnancy ◽  
Active Phase ◽  
Cervical Ripening ◽  
Control Group ◽  
Study Group ◽  
Uterine Contractility ◽  
Time Duration ◽  
Unfavourable Cervix ◽  
Phase Interval

Background: When the continuation of pregnancy adversely affecting the mother and fetus, termination of pregnancy is planned. Mifepristone as a method of pre-inducing agent in late pregnancy by increasing sensitivity of the uterus to the actions of prostaglandins and increasing uterine contractility. Objective of this study is to know the efficacy of mifepristone as a preinduction cervical ripening and induction of labor.Methods: In this prospective randomized study, 130 pregnant women are included and divided into two groups i.e. study group(n=65), has received tab mifepristone 200 mg and control group (n=65) has not received any drug.  After the end of 24 hours, Bishops score in both the groups are assessed and those not in labor or with unfavourable cervix are administered with intracervical dinoprostone gel every 6 hourlies for maximum of 3 doses or until pregnant woman entered into active labor. Statistical analysis regarding improvement in Bishops score, induction active phase interval, induction delivery interval is observed.Results: After 24 hours, observation in the mean Bishops score has showed significant improvement in the study group (72.33%), when compared to control group (54.58%). % woman has gone into spontaneous labor in study group (61.5%), and in control group (75.4%). Induction to active phase time duration is less in study group with mean (10.53), and in control group (17.4). Induction to delivery time duration is also less in study group with mean (15.100) when compared to control group (22.100). 67.7% of patients has delivered by vaginally in study group, and in control group 41%.Conclusions: Tab. mifepristone 200 mg has a pre inducing agent for cervical ripening, shown better improvement in Bishops score within 24-48 hours and decreases time duration from induction to active phase and induction to delivery.

scholarly journals Knowledge, Perception and Women's Experience on Induction of Labour – A Questionnaire-based   observational study in South India

2021 ◽  
Author(s):  
Rajeshwari G Bhat ◽  
vinutha vinod ◽  
Parvati V Bhat ◽  
Nida Zahoor
Keyword(s):  
Adverse Effects ◽  
Unmet Need ◽  
Induction Of Labour ◽  
Labour Induction ◽  
Control Group ◽  
P Value ◽  
Negative Experience ◽  
Spontaneous Labour ◽  
Women's Experience ◽  
Realistic Information

Abstract Background Induction of labour is an indispensable obstetric procedure.Very few studies have concentrated on women;s experience of induction of labour. Its been reported that women generally have a negative experience with Induction...There is a lack of data regarding the experience of labour induction among Indian women. .We carried out this study womens experience on the induction of labour in this part of South Asia. This study highlights the unmet need of women undergoing induction of labour and changes obstetricians can implement in their day to day practice to make childbirth a positive experienceMethods The aim was to study the Knowledge, Perception and Women’s experience on Induction of labour and to compare this labour experience with women who have come in spontaneous labour. During the study period 300 women who were induced, formed the study group, every consecutive women who came in spontaneous labour formed the control group. Validated. Questionnaires were given after delivery for both induced and to women who delivered spontaneously. Ethical clearance was obtained by the institution (MUEC/13/2015-2016) Data were analysed using SPSS 16. Percentage was used to summarize the categorical data, Chi-square test for associations and Independent t test to compare visual analogue scoresResults Out of 300 women who were induced 65%(196) were aware of induction .84% (249) women knew the reason for their induction.57%(170/300) were aware of benefits of induction of labour, whereas only 15% (45/300) were informed about adverse effects .54% (162/300) of women felt analgesia given was not satisfactory.61 %(177) of women had positive, and 14 %(40) had negative attitude towards induction.32 %(94)spontaneously labouring women felt labour unbearable compared to 45% (126) induced women which is statistically significant (p value 0.001). While comparing the two groups, induced women felt more sad (p<0.001) and tired (p=0.01) compared to women in spontaneous group.Discussion Induced women were not well informed about adverse effects and felt labour was unbearable .Induced women were more tired and sad at the end of labour..Women should be provided with realistic information,and better analgesia in labor Conclusion Induced women were not well informed about adverse effects and felt labour was unbearable .Induced women were more tired and sad at the end of labour. Women should be offered better analgesia in labour. Good counselling and compassionate care from healthcare workers may increase the satisfaction levels of induced women.

To compare the efficacy and safety of intravaginal misoprostol and intracervica lcervigel for induction of labour

2017 ◽  
Vol 6 (10) ◽  
pp. 4447
Author(s):  
Nivedita Malik
Keyword(s):  
Induction Of Labour ◽  
Cervical Ripening ◽  
Research Centre ◽  
Efficacy And Safety ◽  
Safety And Efficacy ◽  
Obstetrics And Gynaecology ◽  
Vaginal Deliveries ◽  
Misoprostol Group ◽  
Favourable Change ◽  
The Mean

Background: This randomized prospective study was conducted in the department of obstetrics and Gynaecology Batra Hospital and Medical Research centre from 1st March to 30th April 2008 to compare the safety and efficacy of intravaginal misoprostol and intracervical dinoprostone gel (cervigel) for cervical ripening and induction of labour.Methods: 80 women were recruited in the study. 40 women were administered misoprostol tablet 25ug vaginally while the other 40 were given intracervical cervigel.Results: A total of 85.1% (68 patients) delivered vaginally (33 in the misoprostol group and 35 in the cervigel group) i.e. spontaneous vaginal and assisted vaginal deliveries. The mean interval from start of induction to vaginal delivery was 707.63+146.511 minutes in the misoprostol group and 833.13 +144.36 minutes in the cervigel group with p=0.001 which was significant statistically. Though both the groups showed a favourable change in Bishop’s score after induction but this was not statistically significant. However, the number of doses required in both the groups to produce an effect on cervical ripening and dilation was statistically significant p=0.001, cervigel group requiring lesser dose (42.5% in cervigel vesus 7.5% in the misoprostol group after administration of 1st dose).Conclusions: Both 25ug misoprostol intravaginal and dinoprostone gel intracervical are equally effective and safe for cervical ripening and induction of labour.

COMPARISON OF SAFETY AND EFFICACY OF INTRACERVICAL DINOPROSTONE GEL AND EXTRA-AMNIOTIC FOLEY'S CATHETER FOR INDUCTION OF LABOUR

2021 ◽  
pp. 13-15
Author(s):  
Radha Garg ◽  
Bharti Saxena ◽  
Neha Dhingra ◽  
Madhu Meena
Keyword(s):  
Mode Of Delivery ◽  
Full Term ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Vaginal Deliveries ◽  
Before And After ◽  
The Difference ◽  
Foley’S Catheter ◽  
Group B

BACKGROUND: The uterus remains quiescent throughout 9 months and begins to act on its own when full term is approached. Almost 50% women deliver in the duration of one week before and after the calculated EDD; and induction of labour is needed in about 20% of women: to increase the success of labour induction, to reduce the duration and complications of labour and to diminish the rate of caesarean sections. Cervical ripening is needed before induction of labour. There are many methods for induction of labour; however till date, none of them can claimed to be the best. To compare the AIM OF PRESENT STUDY: safety and efcacy of Dinoprostone gel versus intracervical foley's catheter for ripening of cervix and induction of labour. Compara MATERIAL AND METHODS: tive prospective study was conducted on 400 full term uncomplicated primigravida women needing induction of labour between January 2019 to June 2020 in department of obstetrics & gynecology at GMC Kota in Rajasthan.Group A: 200 women induced with Dinoprostone gel and Group B: 200 women induced with extra-amniotic Foley's catheter. Baseline characteristics like maternal age, gestational age, indication for induction were comparable in both the groups. The mean induction to delivery interval was shorter in RESULT: group A (12.69 ± 3.64 hours) as compared to Group B (18.17 ± 3.17 hours) and this difference was statistically highly signicant (P = 0.0001). There was no signicant difference observed in mode of delivery, labour progress at 18 hours, indication for caesarean section, maternal side effects, mean birth weight, Apgar score at 5 mins, number of NICU admissions between the two groups. The number of vaginal deliveries we CONCLUSION: re similar in both the groups but mean induction to delivery interval was signicantly shorter with Dinoprostone gel. However, the maternal and fetal outcomes were better in Foley's catheter group although the difference was not statistically signicant

scholarly journals Comparative study of induction of labour with dinoprostone gel versus mechanical dilatation in unfavorable cervix (low Bishops Score)

2017 ◽  
Vol 6 (10) ◽  
pp. 4363 ◽  
Author(s):  
Gayatri Mathuriya ◽  
Sharad Pratap Singh Kushwaha ◽  
Shweta Pradhan
Keyword(s):  
Vaginal Delivery ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
P Value ◽  
Common Procedure ◽  
Vaginal Deliveries ◽  
Group A ◽  
The Mean ◽  
Mean Time

Background: Induction of labour is a common procedure in obstetrics, occurring in upto 30% of pregnancies. Objective of present study was to compare the efficacy of double balloon transcervical catheter to that of a PG vaginal insert among women undergoing labour induction in terms of singleton pregnancies of both nulliparous and multiparous women with an unfavorable cervix.Methods: Patient admitted for induction of labour were randomized to receive intravaginal dinoprostone or intracervical Foley’s catheter. Patient not entering active labour and having rupture membranes or arrest of dilatation received IV oxytocin.Results: 150 patients received dinoprostone gel (group A) and 150 patients received Foleys catheter no.18 (group B). The mean time until cervix ripening was less in group A group (0.0001-p value). The mean time until vaginal delivery was less in the Group A group (p value-0.010) among vaginal deliveries more patients in the Group A group delivered within 24 hours (0.0001-P value.). There was significant differences in cesarean delivery rates (8% vs 20.66%, P value-0.0001, sig). Oxytocins is required in both groups (73.33% vs. 78.66%).Conclusions: Group A was associated with more rapid cervical ripening, shorten induction to vaginal delivery interval and greater no. of vaginal deliveries within 24 hours.

scholarly journals Induction of labour in mid-trimester pregnancy using double-balloon catheter placement within 12 h versus within 12–24 h

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jing Peng ◽  
Ruobing Li ◽  
Shuguo Du ◽  
Heng Yin ◽  
Min Li ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Balloon Catheter ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Efficacy And Safety ◽  
Research Subjects ◽  
Cervical Dilation ◽  
Double Balloon ◽  
Trimester Pregnancy ◽  
Vaginal Deliveries

Abstract Background This study aims to evaluate the efficacy and safety of the induction of labour in mid-trimester pregnancy using a double-balloon catheter (DBC) within 12 h versus within 12–24 h. Methods In this retrospective study, a total of 58 pregnant women at 14 + 0 weeks to 27 + 6 weeks of gestation were enrolled as research subjects, and they underwent the intended termination of pregnancy at our birth centre from January 1, 2017, to June 31, 2019. Based on the duration of DBC, the patients were divided into two groups, namely, the DBC group within 12 h and the DBC group within 12–24 h. Results All 58 cases were successful vaginal deliveries, and no one chose to undergo caesarean section. The success rate of induction (successful abortion of the foetus and placenta without the implementation of dilation and evacuation) was higher in the DBC group within 12–24 h (96.3%, 29/31) than in the DBC group within 12 h (71.0%, 18/27) (p < 0.05). Additionally, the time from DBC removal to delivery in the DBC group within 12–24 h was significantly shorter than that in the DBC group within 12 h (3.0 h versus 17.8 h) (p < 0.05), and the degree of cervical dilation after DBC removal in the DBC group within 12–24 h was larger than that in the DBC group within 12 h (p < 0.05). Conclusion In the clinic, the placement time of DBC generally lasts for approximately 12 h. However, considering that the cervical condition is immature in the mid-trimester, properly extending the placement time of DBC to 24 h will benefit cervical ripening and reduce the chance of dilation and evacuation.

Safety and Efficacy of Single-Dose Ketorolac for Postoperative Pain Management After Primary Palatoplasty: A Prospective Cohort Study With Historical Controls

2021 ◽  
pp. 105566562110128
Author(s):  
Jason R. Stein ◽  
Esperanza Mantilla-Rivas ◽  
Marudeen Aivaz ◽  
Md Sohel Rana ◽  
Ishwarya Shradha Mamidi ◽  
...  
Keyword(s):  
Single Dose ◽  
Postoperative Pain Management ◽  
Postoperative Hemorrhage ◽  
Bleeding Complications ◽  
Control Group ◽  
Study Group ◽  
Safety And Efficacy ◽  
Opioid Dose ◽  
Historical Controls

Objective: To analyze safety and efficacy of single-dose ketorolac after primary palatoplasty (PP). Design: Consecutive cohort of patients undergoing PP, comparing to historical controls. Setting: A large academic children’s hospital. Patients, Participants: A consecutive cohort of 111 patients undergoing PP (study n = 47) compared to historical controls (n = 64). Interventions: All patients received intraoperative acetaminophen, dexmedetomidine, and opioids while the study group received an additional single dose of ketorolac (0.5 mg/kg) at the conclusion of PP. Main Outcome Measures: Safety of ketorolac was measured by significant bleeding complications and need for supplementary oxygen. Efficacy was assessed through bleeding, Face Legs Activity Cry Consolability (FLACC) scale, and opioid dose. Results: Length of stay was similar for both groups (control group 38.5 hours [95% CI: 3.6-43.3] versus study group 37.6 hours [95% CI: 31.3-44.0], P = .84). There were no significant differences in all postoperative FLACC scales. The mean dose of opioid rescue medication measured as morphine milligram equivalents did not differ between groups ( P = .56). Significant postoperative hemorrhage was not observed. Conclusions: This is the first prospective study to evaluate the safety and efficacy of single-dose ketorolac after PP. Although lack of standardization between study and historical control groups may have precluded observation of an analgesic benefit, analysis demonstrated a single dose of ketorolac after PP is safe. Further investigations with more patients and different postoperative regimens may clarify the role of ketorolac in improving pain after PP.

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