scholarly journals Maternal and fetal outcomes with the use of prostaglandins E2 as a cervical ripening agent for induction of labour

2019 ◽  
Vol 9 (1) ◽  
pp. 44
Author(s):  
Shagun Gupta ◽  
Neha Kuntal ◽  
Virendra Kumar Gupta
Keyword(s):  
Neonatal Morbidity ◽  
Modern Medicine ◽  
Labor Induction ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
P Value ◽  
Bishop Score ◽  
Singleton Pregnancy ◽  
Group 2 ◽  
Group 1

Background: In modern medicine induction of labour is required in patients for a good feto-maternal outcome. PGE2 is a prostaglandin analogue which has been used as a cervical ripening agent to improve bishops score. Objective of this study was to evaluate the efficacy of intravaginal PGE2 gel as a cervical ripening agent in unfavourable cervix for induction of labor and any complications associated with its use.Methods: This study comprised of 90 women who required labor induction. Singleton pregnancy above 37 weeks, live intrauterine fetus, Cephalic presentation, Bishop score of 1-6, reactive FHR pattern were included. Women who required only single induction were categorized as Group 1. Those requiring more than one dose after reassessment of bishops scoring at 6, 12 and 18 hours belonged to Group 2.Results: Group1 had more of younger population below 30 years consisting more primigravidas with > 80% women having gestational age of > 39 weeks. Most common indication for induction of labour in both groups was post-dated pregnancy. 65 patients received one dose of cerviprime gel forming Group 1. In Group 2, 72% received 2 doses and 28%, 3 doses of gel. Initial bishops score mean was 4.2 in Group 1 and 4.1 in Group 2. Mean change in bishop score was analysed after 6, 12, and 18 hours of instillations of PGE2 gel. Significant p value was obtained in all groups requiring one, two and three doses of gel. In Group 1, 12.3% and in Group 2, 16% had LSCS. Maternal side effects were minimal and neonatal outcome was good.Conclusions: The study showed that intravaginal application of PGE2 is effective, safe and acceptable method as a cervical ripening agent for labor induction in women with poor bishops score. It reduces caesarean delivery rate without increasing maternal and neonatal morbidity.

scholarly journals Comparative study of mifepristone versus balloon catheter for cervical ripening and induction of labour in previous caesarean section

2020 ◽  
Vol 9 (6) ◽  
pp. 2504
Author(s):  
Krishna Dahiya ◽  
Nisha Yadav ◽  
Pushpa Dahiya ◽  
Isha Nandal
Keyword(s):  
Caesarean Section ◽  
Mode Of Delivery ◽  
Balloon Catheter ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Bishop Score ◽  
Catheter Group ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Background: The objective of this present study was to compare the efficacy of oral mifepristone and balloon catheter for cervical ripening and induction of labour in women with previous caesarean section.Methods: This prospective study was conducted on 130 pregnant women with previous 1 caesarean section and term singleton pregnancy admitted for induction of labour. Sixty-five patients were induced with oral mifepristone (Group 1) and in another 65 transcervical balloon catheter (Group 2) was inserted for induction of labour. Both groups were than compared with respect to change in bishop score, induction to active phase interval, induction to delivery interval, dose of oxytocin in milliunits, mode of delivery, maternal complication and fetal outcomes.Results: Change in bishop score after induction was more in mifepristone group than balloon catheter group (p=0.002). Favorable bishop score was more in Group 1 (83.07%) than Group 2 (66%), p=0.05. There was significant difference in mode of delivery between two groups, 61.53% in Group 1, and 32.3% in Group 2 delivered vaginally (p<0.001).Conclusions: Present study showed that mifepristone is an alternative to balloon catheter for induction of labour in women with previous one caesarean section with poor bishop score.

scholarly journals A retrospective comparative study to evaluate the efficacy and safety of mifepristone with misoprostol over misoprostol alone in induction in labor

2018 ◽  
Vol 7 (12) ◽  
pp. 5140
Author(s):  
Reena Sharma ◽  
B. R. Sharma ◽  
Poojan Dogra
Keyword(s):  
Comparative Study ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Efficacy And Safety ◽  
Group A ◽  
The Mean ◽  
Group 2 ◽  
Group B ◽  
Retrospective Comparative Study ◽  
Group 1

Background: The aim is to compare the improvement in pre-induction Bishop’s score, proportion of patients going in labor and induction–delivery interval after using the Misoprostol versus Mifepristone and Misoprostol as cervical ripening and labor inducing agent.Methods: It is retrospective comparative study conducted on 110 women. Women were randomized in group A and in group B of 55 patients in each group. Group A received tab Mifepristone 200 mg orally on day 1 followed by Misoprostol 25 ug after 48 hours and continued 6 hourly till maximum four tablets and group B patients received tablet Misoprostol 25ug and continued 25ug 6hrly maximum 4 doses. Women observed for improvement in Bishop‟s score, induction-delivery interval and requirement of subsequent doses of Misoprostol.Results: Present study concluded that tablet Mifepristone is an efficient cervical ripening and inducing agent of labor as pre-induction Bishop’s score was improved. 36.4%patients went into labor only with tablet Mifepristone. The mean induction-delivery interval was,19±12.2hrs in Group 1 as compare to 13.1±13.0 hrs in Group 2. Mean Bishop’s score observed in Group 1 were 2.5±1.78 and 1.67±1.25 in Group 2. It was observed that there was significant improvement in the Bishop’s score after giving Mifepristone to the patients; mean Bishop’s 24hrs after mifepristone were 4.03±1.80. Repeated dose of Misoprostol required in Group 1 was observed to be higher than group 2 as shown in table 8. Mean misoprostol doses required in group 1 was 2.56±1.15 as compared to 1.71±1.58 in group 2.Conclusions: Mifepristone with Misoprostol reduce the induction delivery interval and more potent in combination for induction of labour as compared to Misoprostol alone.

scholarly journals Bishop score versus transvaginal ultrasonographic measurement of cervical length in predicting successful labor induction in post-term pregnancy: prospective cohort study

2018 ◽  
Vol 7 (11) ◽  
pp. 4646
Author(s):  
Mansour A. Khalifa ◽  
Ahmed M. Abbas ◽  
Mohammed A. Gaber ◽  
Maher Salah
Keyword(s):  
Cervical Length ◽  
Labor Induction ◽  
Study Group ◽  
Bishop Score ◽  
Successful Induction ◽  
Unfavorable Cervix ◽  
Moderate Negative Correlation ◽  
Group 2 ◽  
Failed Induction ◽  
Group 1

Background: The current study aims to compare the efficacy of Bishop score assessment and transvaginal ultrasonographic measurement of the cervical length in prediction of the outcome of labor induction in post-term pregnancy.Methods: A comparative Prospective observational study conducted in Department of Obstetrics and Gynecology, Kom Ombo central hospital from January 2017 to October 2017. Pregnant women were classified into two groups of Bishop Score Group (1): ladies with (Bishop Score <5) = unfavorable cervix and Group (2): those with (Bishop Score >5) = favorable cervix. Also, they were classified into two groups of cervical lengths: Group (1): women with (cervical length <25mm, shorter cervix) and Group (2): those with (cervical length ≥25 mm, longer cervix). The Primary outcome was Bishop score by digital examination and Cervical length by TVS.Results: The study group was 100 women. Regarding sonographic assessment, 44 patients had cervical length <25 mm and the mean cervical length for the whole study group was 25.19±8.16 mm. Successful induction was achieved in 78 patients (78%), while CS was done in 22 patients due to failed induction.  No difference between both groups regarding the parity (p=0.063). When comparing women with successful VD versus those delivered by CS, we found significantly higher Bishop score in the first group 5.12 ± 1.93  vs 3.89 ± 1.71 in the second group (p=0.002). Additionally, VD group had significantly shorter cervix than CS group (22.31 ±7.14 vs. 35.37± 5.80 mm, p=0.007). The Bishop score showed significant moderate negative correlation with the cervical length (r=-0.589, p=0.001).Conclusions: Success of labor induction in women undergoing induction due to prolonged pregnancy can be highly predicted by cervical length as it is more objective and accurate than Bishop Score. The 25 mm cut-off point for cervical length was the best predictor of vaginal delivery.

scholarly journals A review of maternal and fetal outcome of induction of labour with Foley’s catheter and extra amniotic saline infusion in women with previous caesarean delivery

2018 ◽  
Vol 7 (9) ◽  
pp. 3551
Author(s):  
Sunil Kumar ◽  
Nishtha A. Mahabalshetti ◽  
Dinu Simon Dinu Simon
Keyword(s):  
Caesarean Section ◽  
Low Cost ◽  
Foley Catheter ◽  
Fetal Outcome ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
P Value ◽  
Time Interval ◽  
Singleton Pregnancy ◽  
Foley’S Catheter

Background: Incidence of induction of labour has increased in the recent past due to increased screening facilities like ante partum fetal surveillance. Vaginal birth after caesarean section (VBAC) is one of the strategies developed to control the rising rate of caesarean sections. Intracervical Foley’s catheter reduces the risk of uterus hyper tonicity and rupture in women with one caesarean section as it’s placement induces the cervical repining without inducing any uterine contractions.Methods: A prospective study of 35 women with one previous LCSs, term gestation and singleton pregnancy, were selected for trial of labour (TOL) considering inclusion and exclusion criteria.Results: Out of 35 cases studied 21 cases (60%) went for successful induction with Foleys and the remaining 40% underwent caesarean section. The mean time interval for Foley’s expulsion was 6.74 in the success group and 10.04 in the failed group (p value <0.05). In 4 cases there were meconium stained liquor, and they underwent emergency LSCS. One case (2.8%) had scar rupture which also underwent caesarean section.Conclusions: This study shows that the Foley catheter is an effective method of cervical ripening with additional benefit of low cost, reversibility, easy availability and lack of need for special storage. This method confers significant improvement in Bishop Score and vaginal delivery was achieved in majority of patients.

scholarly journals Comparison of Foley’s catheter with PGE2 gel and Foley’s catheter with PGE2 gel with extra amniotic saline infusion for labour induction

2018 ◽  
Vol 7 (5) ◽  
pp. 1782
Author(s):  
Shobha Bembalgi ◽  
Lavanya . ◽  
Vinutha M. B.
Keyword(s):  
Foley Catheter ◽  
Saline Infusion ◽  
Induction Of Labour ◽  
Labour Induction ◽  
Bishop Score ◽  
Significant Difference ◽  
The Mean ◽  
Group 2 ◽  
Foley’S Catheter ◽  
Group 1

Background: Induction of labour is initiation of uterine contractions before the onset in order to vaginally deliver the foetoplacental unit. Common reasons for induction of labour are post-term and hypertensive disorders of pregnancy. The purpose of this study was to compare the efficacy of Foley catheter with intra cervical PGE2 gel and Foley catheter with PGE2 gel with extra amniotic saline infusion for induction of labour.Methods: The clinical trial was conducted from November 2016 to April 2017 at Karnataka Institute of Medical Sciences, Hubballi. 80 pregnant women which included both primigravidae and multigravidae were alternatively divided into two groups. Group 1 received Foley’s and PGE2 gel and group 2 received Foley’s, PGE2 gel and extra amniotic saline infusion for induction of labour.Results: Both groups were comparable with respect to maternal age, gestational age and indication for induction. There was no significant difference in the mean pre-induction Bishop score between two groups. In both the groups there was significant improvement in the Bishop score after 6 hours of induction. But progress in group 2 was greater than group 1(P <0.05). The mean time from induction to delivery in group 2 was shorter and was statistically significant(P<0.05). There was no difference in mode of delivery, neonatal and maternal morbidity and mortality between 2 groups.Conclusions: The present study showed that Foley’s with PGE2 gel with extra amniotic saline infusion is better for labour induction though both groups appear to be effective agents.

scholarly journals Efficacy Study of Mifepristone in Pre-induction Cervical Ripening and Induction of Labour

2021 ◽  
Vol 23 (3) ◽  
pp. 259-263
Author(s):  
Sanita Kayastha ◽  
Sunima Mainali ◽  
Ritu Subedi
Keyword(s):  
Neonatal Outcome ◽  
College Teaching ◽  
Test Group ◽  
Patient Characteristics ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Control Group ◽  
P Value ◽  
Bishop Score ◽  
Normal Delivery

This study was carried out to see the safety and efficacy of mifepristine as pre-induction cervical ripening agent along with misoprostol in induction of labour. It was a study done from January to June 2020 in Department of Obstetrics and Gynecology, Nepal Medical College Teaching Hospital. Total 120 patients were included in this study. Out of which, 60 women were be kept in test group who were induced by mifepristone and misoprostol and 60 women were kept in control group induced by misoprostol only. Patient characteristics, improvement of bishop score, maternal and neonatal outcome was recorded. Chi- square and T- Test were used to compare the result. Patient characteristics and the Bishop score at zero-hour of both the groups were similar. The mean bishop score 48 hours after use of mifepristine in test group was significantly increased in test group vs control group (P<0.0001). There were total 12(20%) patient who went in to labour with mifepristone only without the use of misoprostol. Total number of normal delivery was more (p value=0.003) and cesarean was less (p=0.013) in test group than in control group. The instrumental delivery in both test and control group were same. The adverse effect and neonatal outcome was similar in both the regime. Thus mifepristone as pre-induction cervical ripening agent is a safe and efficient drug

scholarly journals P318 Left atrial dysfunction assessed by echocardiography in relation to left atrial fibrosis in patients undergoing ablation for atrial fibrillation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Pilichowska ◽  
J Baran ◽  
P Kulakowski ◽  
B Zaborska
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Systolic Function ◽  
Electrophysiological Study ◽  
Stiffness Index ◽  
P Value ◽  
Group 2 ◽  
Left Atrial Dysfunction ◽  
Left Atrial Fibrosis ◽  
Group 1

Abstract PURPOSE Left atrial (LA) fibrosis is the hallmark of LA remodeling in atrial fibrillation (AF), alters LA function and may predict poor catheter ablation (CA) outcome. LA fibrosis may be assessed invasively using electroanatomical mapping (EAM) during electrophysiological study. The aim was to assess LA function parameters in relation to degree of LA fibrosis derived from EAM in patients with AF. METHODS Patients (pts) n = 39 (79% males, mean age 56+/-10) with non-valvular AF were studied with TTE and TEE before first CA during sinus rhythm. LA strain (LAS) and strain rate (LASR) were analyzed in reservoir (r), conduit (cd) and contractile (ct) phases. The velocities of mitral A, E" and A" were measured with Doppler. E/E" and LA stiffness index - the ratio of E/E" to LASr were assessed. LA appendage flow velocity (LAAv) was measured in TEE. LA volume using biplane area-length method was calculated. The EAM of LA was build using Carto System before CA. Low amplitude potentials area (LAPA) was quantitatively analyzed and expressed as a percentage of LA surface using the cut-off &lt;0.5 mV to detect sites of fibrosis. LA parameters were compared between mild (LAPA &lt;10%) moderate (LAPA 10-40%) and extensive degree of LA fibrosis (LAPA &gt;40%) (table). RESULTS The mean LA volume was 35 ± 11 mL/m². The LAPA ranged from 2 to 78 % of LA surface. Reduced LA function was observed in the LAPA &gt;40% group. Extensive LAPA altered mainly LA compliance parameters. Traditional LA systolic function parameters did not differ in relation to degree of LAPA. CONCLUSION LA compliance is mostly affected by LA fibrosis, thus LA diastolic parameters may be useful in the noninvasive assessment of LA fibrosis. Whether these parameters should be a part of the proper selection of candidates for CA requires further studies. LA function parameters LA parameters Group 1 LAPA &lt;10% n = 13 Group 2 LAPA &gt;10% &lt;40% n = 13 Group 3 LAPA &gt;40% n = 13 P-value Group 1 + 2 vs 3 Mitral A 0.55 ± 0.10 0.55 ± 0.24 0.73 ± 0.32 0.077 A" 9.19 ± 1.74 7.85 ± 1.43 7.92 ± 2.40 0.376 LASr 31.48 ± 4.52 26.48 ± 8.79 19.63 ± 6.76 &lt;0.001 LAScd 17.30 ± 3.05 15.44 ± 6.93 10.91 ± 4.04 0.003 LASct 14.18 ± 5.36 11.05 ± 3.67 8.72 ± 4.78 0.024 LASRr 1.22 ± 0.19 1.24 ± 0.21 0.92 ± 0.20 &lt;0.001 LASRct -1.71 ± 0.46 -1.37 ± 0.34 -1.04 ± 0.33 &lt;0.001 LA stiffness 0.20 ± 0.07 0.34 ± 0.17 0.63 ± 0.29 &lt;0.001 LAAv 0.83 ± 0.18 0.55 ± 0.17 0.60 ± 0.16 0.178

Does Presurgical Nasoalveolar Molding Have a Long-Term Effect on Nasal and Upper Airway Dimensions?

2020 ◽  
pp. 105566562098023
Author(s):  
Ashwina S. Banari ◽  
Sanjeev Datana ◽  
Shiv Shankar Agarwal ◽  
Sujit Kumar Bhandari
Keyword(s):  
Upper Airway ◽  
P Value ◽  
Airway Patency ◽  
The Mean ◽  
Group 2 ◽  
Acoustic Pharyngometry ◽  
Nasoalveolar Molding ◽  
Area And Volume ◽  
Group 1

Objectives: To compare nasal and upper airway dimensions in patients with cleft lip and palate (CLP) who underwent nasoalveolar molding (NAM) with those without NAM during infancy using acoustic pharyngometry and rhinometry. Materials and Methods: Eccovision acoustic pharyngometry and rhinometry (Sleep Group Solutions) was used for assessment of mean area and volume of nasal and upper airway in patients with complete unilateral CLP (age range 16-21 years) treated with NAM (group 1, n = 19) versus without NAM (group 2, n = 22). Results: The mean nasal cross-sectional areas and volume were higher in group 1 compared to group 2 on both cleft ( P value <.001) and noncleft side ( P value >.05). The mean area and volume of upper airway were also significantly higher in group 1 compared to group 2 ( P value <.05). Conclusions: Nasoalveolar molding being one of the first interventions in chronology of treatment of patients with CLP, its long-term outcome on nasal and upper airway patency needs to be ascertained. The results of the present study show that the patients with CLP who have undergone NAM during infancy have better improvement in nasal and upper airway patency compared with those who had not undergone NAM procedure. The basic advantages of being noninvasive, nonionizing and providing dynamic assessment of nasal and upper airway patency make acoustic pharyngometry and rhinometry a diagnostic tool of choice to be used in patients with CLP.

P–391 Role of subcutaneous granulocyte colony-stimulating factor infusion in thin endometrium

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
K Banerjee ◽  
B Singla
Keyword(s):  
Pregnancy Rate ◽  
Clinical Pregnancy ◽  
P Value ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Thin Endometrium ◽  
Group 2 ◽  
Stimulating Factor ◽  
Group 1

Abstract Study question To assess the role of subcutaneous granulocyte colony-stimulating factor (G-CSF) in thin endometrium cases. Summary answer G CSF has beneficial role to improve the endometrium thickness in thin endometrium. What is known already Endometrium is very important for embryo implantation and the endometrial thickness is the marker of receptivity of the endometrium. Study design, size, duration Study design - Retrospective analysis Size - 88 infertile females with thin endometrium (&lt; 7 mm) in the age group of 23 to 40 years Duration - one year. Participants/materials, setting, methods In the group 1 of 44 females, subcutaneous infusion of G CSF (300 mcg/ml) was added along with other supplements and if lining was not more than 7 mm in 72 hours, then second infusion was given. In the group 2 of 44 females, only estradiol valerate and sildenafil were given.The efficacy of G CSF was evaluated by assessing the endometrium thickness before embryo transfer, pregnancy rates and clinical pregnancy rates. Main results and the role of chance There was no difference between the two groups regarding demographic variables, egg reserve, sperm parameters, number of embryos transferred and embryo quality. . The pregnancy rate was 60% (24 out of 40 cases) in the group 1 that was significantly higher than in-group 2 that was 31% (9 out of 29 cases) with p value &lt; 0.0001. The clinical pregnancy rate was also significantly higher in-group 1 (55%) as compared to group 2 (24%) with p value &lt; 0.0001. Limitations, reasons for caution Further larger cohort studies are required to explore the subcutaneous role of G CSF in thin endometrium. Wider implications of the findings: Granulocyte colony-stimulating factor has beneficial role to improve the endometrium thickness in thin endometrium. In most of previous studies, the intrauterine infusion of G CSF was given to improve the uterine lining. This is one of the few studies done that showed subcutaneous role of G CSF in thin endometrium. Trial registration number Not applicable

A Comparative Study Between Preoperative Subconjunctival Bevacizumab Injection And Postoperative Topical Application In Prevention Of Recurrence After Excision Of Primary Pterygium In Egyptian Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Basma Helal Mohamed ◽  
Othman Ali Othman Ziko ◽  
Hisham M Khairy Abd El Dayem ◽  
Nancy Ezzelregal Khamis Ahmed
Keyword(s):  
Corneal Thickness ◽  
Anterior Segment ◽  
P Value ◽  
Eye Drops ◽  
Subconjunctival Injection ◽  
Fibrovascular Tissue ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1 ◽  
Primary Pterygium

Abstract Purpose to compare between recurrence incidence after primary pterygium excision when using preoperative subconjunctival injection of Bevacizumab (Avastin) and using it as a postoperative eye drops. Methods thirty two eyes of thirty patients (two patients had bilateral pterygium) with primary pterygia were clinically examined, classified into 3 groups and operated by simple excision with bare sclera technique. Group 1 included 10 patients received Bevacizumab (Avastin) in the form of eye drops (10 mg/ml) 3 times daily for 6 days postoperative. Group 2 included 10 patients received preoperative Bevacizumab in the form of subconjunctival injection (1.25 mg/0.05ml) single dose 1 week preoperative. Group 3 included 10 patients (12 eyes) 2 patients with bilateral Pterygium didn’t receive any form of Bevacizumab. Postoperative follow up was done clinically and by serial photography at 1 week, 1 month, 3 months and 6 months searching for signs of recurrence and/or complications. Results The results showed different grades of recurrence in 18 eyes of 32.True recurrence was seen in 7 patients of 18 (1 patient in group 1, 2 in group 2 and 4 in group3).Recurrence grades in group 1and 2 who used the Bevacizumab (20%grade II, 50% grade III, and 30% grade IV). Recurrence could be predicted by 100% depending on fibrovascular tissue appearing in the surgical bed at 3 months postoperative (P value 0.038).Preoperative fleshy pterygium has high statistical significance in realation to recurrence(P value = 0.006).Patient’s sex, residence and occupation had no statistically significant value in the process of recurrence (P value &gt; 0.05). Patients with recurrent Pterygia (in group 1&2) had statistically significant changes in the corneal K- readings at 3 months and 6 months.No significant difference in the limbal or central corneal thickness in the operated eye and the other eye (Pvalue &gt; 0.05). Conclusion Bevacizumab (Avastin) is a well tolerated drug with multiple drug delivery methods.The eye drops give better results than the subconjunctival injection.Appearance of fibrovascular tissue in the surgical bed at 3 months predict the recurrence by 100%. Preoperative fleshy pterygia will mostly recur again whatever Bevacizumab form was used .The corneal thickness by anterior segment OCT has no role in prediction or detection of early pterygium recurrence.

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