Comparison of the efficacy, safety, acceptability and fetomaternal outcomes of combination of mifepristone and foley’s catheter with foley’s catheter alone in induction of labour in term pregnancies with previous lower segment caesarean section

Background: Objective of the study was to compare the efficacy, safety, acceptability, fetomaternal outcomes of combination of mifepristone and Foley’s catheter with Foley’s catheter alone in induction of labor in term pregnancies with previous Lower segment caesarean section (LSCS).Methods: This was a prospective study of 36 women induced with mifepristone and foley’s catheter and 36 women induced with foley’s catheter alone at 37 weeks to 41+6 weeks with previous LSCS.Results: Mean bishop score on admission in combined group (2.44) was comparable with that of foley’s alone group (2.91, p=0.888). Mean Bishop score (BS) after foley’s expulsion in group A and group B was 7.46 and 6.33 respectively, which was statistically significant (p<0.001). In group A 69.5% of women delivered vaginally compared to 52.2% in group B which was comparable (p=0.230). Mean induction to delivery interval was significantly short in combination group (15.5±1.3 hours versus 20.8±1.07 hours, p=0.003). 50% women in group A required oxytocin for induction/ augmentation of labour as compared to 77.8% in group B (p=0.02). Failed induction was statistically higher in group B (p<0.05). No difference was found with regards scar dehiscence, scar rupture, Postpartum hemorrhage (PPH), wound infection, puerperal pyrexia, Meconium stained liquor (MSL), fetal distress, mean birth weight, 1 and 5 minutes Appearance, pulse, grimace, activity, and respiration (APGAR) score, neonatal outcome, hospital stay.Conclusions: Priming with mifepristone before insertion of foley’s catheter results in significant change in BS signifying that combination promotes early cervical ripening as compared to foley’s catheter alone. Mifepristone plays significant role in cervical ripening, reduces induction to delivery interval, oxytocin requirement and failed induction.

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A comparative study of induction of preterm vaginal delivery at 20 to 28 weeks gestation in previous one lower segment caesarean section by foley catheter and prostaglandin E2 gel

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20173488 ◽

2017 ◽

Vol 6 (8) ◽

pp. 3581

Author(s):

Shruti Agarwal ◽

Neelam Bharadwaj ◽

Lata Rajoria ◽

Indira Lamba

Keyword(s):

Caesarean Section ◽

Prostaglandin E2 ◽

Foley Catheter ◽

Induction Of Labour ◽

P Value ◽

Lower Segment ◽

Lower Segment Caesarean Section ◽

Catheter Group ◽

Group A ◽

Group B

Background: The aim of the study to assess the maternal outcome and safety of induced preterm vaginal birth after a previous one lower segment caesarean delivery.Methods: In this study, 100 women who had singleton pregnancies with a previous one term lower segment caesarean section, in whom induction of labour was required in between 20 to 28 wks of gestation, were included. Group A (n= 50) were induced by transcervical foley catheter and group B (n= 50) were induced by prostaglandin E2 gel and then progression of labour was monitored. Both groups were compared in terms of induction delivery interval, efficacy and safety.Results: In our study, all women were delivered vaginally and hysterotomy was not required. The mean induction delivery interval in Foley catheter group (20.180±3.3499 hrs) was significantly shorter (p-value <0.001) than PGE2 gel group B (24.050±3.6537 hrs). There was no case of uterine rupture, puerperal pyrexia, postpartum haemorrhage and uterine hyperstimulation.Conclusions: Women with previous lower segment caesarean section in whom premature induction of labour is required for any reason can be done easily, safely and effectively without maternal morbidity. Induction can be done more effectively by using transcervical foley catheter than intracervical prostaglandin E2 gel. It has shorter induction delivery interval and low complication. Hence, I suggest that every woman with previous one lower segment caesarean section who requires premature induction should go for trial of labour before repeating caesarean section.

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Is Unfavourable Cervix prior to Labor Induction Risk for Adverse Obstetrical Outcome in Time of Universal Ripening Agents Usage? Single Center Retrospective Observational Study

Journal of Pregnancy ◽

10.1155/2020/4985693 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Mlodawski Jakub ◽

Mlodawska Marta ◽

Galuszewska Jagoda ◽

Glijer Kamila ◽

Gluszek Stanislaw

Keyword(s):

Caesarean Section ◽

Apgar Score ◽

Foley Catheter ◽

Vacuum Extraction ◽

Bishop Score ◽

Dose Infusion ◽

Unfavourable Cervix ◽

Group A ◽

Failed Induction ◽

Group B

Cervical assessment on the Bishop scale prior to induction of labor (IOL) is one of the strongest prognostic criteria in relation to the success of the procedure. The commonly used preinduction methods are mainly aimed at reducing the percentage of cesarean sections. Our study has analyzed obstetric results of patients who had unripe cervix (Bishop score <7) before IOL and used preinduction (Foley catheter or misoprostol vaginal insert releasing 7 mcg of misoprostol per hour for 24 hours) with obstetric results of patients in whom, due to favourable cervix, only a low-dose infusion of oxytocin was used. We reviewed the medical records of 1010 single pregnancies in whom IOL was performed. We divided the patients into two groups: group A (where preinduction was used) and group B (Bishop score ≥7 points) where preinduction was not used. Patients in group A were more likely to complete the delivery by caesarean section (OR=4.58, 95% CI 3.22-6.51), and more likely to have events that were indications for operative delivery: unreassuring fetal heart rate trace (OR=3.29, 95% CI 2.07-5.23) and arrested labor or failed induction (OR=3.4, 95% CI 2.06-5.62). The groups did not differ in the percentage of vacuum extraction, postpartum haemorrhage, and meconium stained amniotic fluid. In group B, more infants were born with umbilical cord blood pH <7.1 (1.38% vs. 0%), both groups included no deliveries of newborns with Apgar score ≤3 points, the groups did not differ in terms of the percentage of newborns with Apgar score between 4 and 7 at birth (OR=0.66, 95% CI 0.29-1.49). The immature cervix and the need to use labor preinduction is a risk factor for caesarean section. The necessity of preinduction does not impair neonatological results.

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Comparative study between transcervical extra-amniotic Foley’s bulb and prostaglandin E2 gel for pre-induction cervical ripening

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205461 ◽

2020 ◽

Vol 10 (1) ◽

pp. 119

Author(s):

Prajakta Goswami ◽

Kapil Annaldewar ◽

Deepali Giri ◽

Sachin Giri

Keyword(s):

Prostaglandin E2 ◽

Vaginal Delivery ◽

Foley Catheter ◽

Induction Of Labor ◽

Cervical Ripening ◽

Normal Vaginal Delivery ◽

Bishop Score ◽

Group A ◽

Foley’S Catheter ◽

Group B

Background: Induction of labor is an artificial initiation of uterine activity before the spontaneous onset of labor with the aim of achieving vaginal delivery. Various pharmacological and non-pharmacological methods have been studied for the purpose.Methods: This randomized prospective study conducted in the Department of Obstetrics and Gynaecology at the Seth V. C. Gandhi & M. A. Vora Municipal General Hospital (Rajawadi Hospital), Mumbai from June 2019 to April 2020. It included pregnant patients admitted to the labor ward for induction of labor. A total 200 women were recruited and randomly allocated to the two study groups fulfilling the following selection criteria. Of these, 100 women were included in Foley's catheter group (group A) and 100 in (group B) prostaglandin E2 (PGE2) group. Results: The subjects included mainly were of 24-28 years age group. The period of gestation was 37-42 weeks in majority of the women in both the groups. Maximum numbers of women in both groups were primigravidae, being 66% in group A and 70% in group B. Foley catheter proved to be a highly effective pre-induction ripening agent for unfavorable cervix, compared to PGE2 gel, as evident by the mean Bishop score at 12 hours (p<0.05) and by the difference in change of Bishop score over 12 hours (p<0.05) in both groups A and B. Women in both the groups had a high rate of normal vaginal delivery, rate being significantly more in Foley’s group.Conclusions: This study concludes that extra-amniotic Foley’s catheter balloon is an effective, safe, simple, low cost, reversible, non-pharmacological mechanical method of pre-induction cervical ripening.

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A comparative study of transcervical foley’s catheter with intracervical PGE2 gel for pre-induction cervical ripening

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202351 ◽

2020 ◽

Vol 9 (6) ◽

pp. 2581

Author(s):

Anupma . ◽

U. Karya ◽

Harsha S. Gaikwad ◽

Anamika . ◽

Shalini .

Keyword(s):

Induction Of Labour ◽

Cervical Ripening ◽

Rank Test ◽

Bishop Score ◽

Medical College ◽

Signed Rank ◽

Signed Rank Test ◽

Group A ◽

Foley’S Catheter ◽

Group B

Background: To compare the efficacy of transcervical foley’s catheter with intracervical PGE2 gel for pre -induction cervical ripening.Methods: It was a prospective interventional study conducted between April 2012 to April 2013 in the department of obstetrics and gynecology at L. L. R. M. medical college and S. V. B. P. hospital Meerut. A total of 80 pregnant women of ≥28 weeks of gestation with bishop score less than or equal to 4 and with various indications for induction of labour were randomly allocated to receive intracervical PGE2 gel (Group A) or transcervical foley’s catheter (Group B). Bishop score was repeated after 6 hours by the same person and the results were compared.Results: The groups were comparable with respect to maternal age, gestational age, indications of induction of labour and initial bishop’s score. The intragroup results were calculated by Wilcoxon signed rank test and intergroup results were calculated by Mann Whitney U-test. The change in bishop score in PGE2 group was 3 and in foley’s group was 3.25 after 6 hours of induction (interquartile range of median) which is significant. The mean change in bishops score was 2.65 in PGE2 group and 3.1 in foley’s group after 6 hours of induction and was significant, however the bishop’s score was comparable in both the groups and statistically insignificant.Conclusions: Both foley’s catheter and PGE2 gel are equally effective in pre-induction cervical ripening of cervix.

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Comparative study of intrathecal preservative-free midazolam versus nalbuphine as an adjuvant to intrathecal bupivacaine (0.5%) in patients undergoing elective lower-segment caesarean section

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00151-9 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Manisha Kapdi ◽

Shruti Desai

Keyword(s):

Caesarean Section ◽

Adverse Effects ◽

Postoperative Analgesia ◽

Lower Segment ◽

Hemodynamic Stability ◽

Lower Segment Caesarean Section ◽

Institutional Review ◽

Group A ◽

Group B ◽

Preservative Free

Abstract Background Intrathecal anesthesia is common for parturients undergoing lower-segment caesarean section. Various adjuvants are added to intrathecal bupivacaine for potentiating pharmacological effects, improving quality of sensorimotor block and postoperative analgesia, and preventing adverse effects. The study period was from November 2017 to September 2018, and it was a randomized double-blinded observational study. The sample size calculation was done according to results of our pilot study (done with 5 patients in each group) and discussion with the institutional review board. Also, in this study, we aim to assess nalbuphine/midazolam as adjuvant to intrathecal bupivacaine for LSCS in terms of quality of sensorimotor block, postoperative analgesia, adverse effects, hemodynamic stability, and Apgar scores of baby at 1 and 5 min. One hundred full-term parturients between 20 and 35 years of ASA grade I/II scheduled for elective lower-segment caesarean section after approval from the institutional review board, and written informed consent were allocated into 2 groups. Randomization was done at the time of giving intrathecal anesthesia by odd and even numbers in an opaque sealed envelope. Group A (n = 50): Bupivacaine heavy (0.5%) 2.0 ml (10 mg) + 0.2 ml Preservative-free inj. midazolam 1 mg Group B (n = 50): Bupivacaine heavy (0.5 %) 2.0 ml (10 mg) + 0.2 ml (0.75 mg) Preservative-free inj. nalbuphine The primary outcome was to assess the perioperative hemodynamic stability, Apgar score, and postoperative analgesia, and the secondary outcome was to assess the complications and adverse effects during the study period. Results The onset of sensory and motor block was earlier in group A than in group B. Total duration of effective postoperative analgesia was more in the midazolam group as compared with the nalbuphine group. The incidence of complications (nausea, vomiting, and pruritus) were more in group B as compared with group A. Conclusion Nalbuphine and midazolam both are good adjuvants to hyperbaric bupivacaine for LSCS in terms of hemodynamic stability and good Apgar scores at 1 and 5 min. Intrathecal midazolam provides better postoperative analgesia and less adverse effects.

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TO DETERMINE EFFICACY OF GRANISETRON VERSUS PLACEBO FOR REDUCING SHIVERING IN PATIENTS UNDERGOING LOWER SEGMENT CAESAREAN SECTION UNDER SPINAL ANAESTHESIA

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i2.3577 ◽

2021 ◽

Vol 71 (2) ◽

pp. 530-34

Author(s):

Sana Abbas ◽

Bilal Yasin ◽

Basit Mehmood Khan ◽

Umer Hayat ◽

Beenish Abbas ◽

...

Keyword(s):

Caesarean Section ◽

Spinal Anaesthesia ◽

Elective Caesarean Section ◽

Patient Comfort ◽

Military Hospital ◽

P Value ◽

Intravenous Bolus ◽

Lower Segment ◽

Group A ◽

Group B

Objective: To determine the efficacy of granisetron versus placebo (saline) for reducing shivering in patients undergoing lower segment caeserian section under spinal anaesthesia. Study Design: Comparative cross - sectional study. Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital Rawalpindi, from Apr to Sep 2019. Methodology: Total 178 patients undergoing lower segment ceaserian section under spinal anaesthesia with age ranges from 18-40 years of American Society of Anaesthesiologists status I & II with full term pregnancy scheduled for elective caesarean section under spinal anaesthesia. Group A (n=92) received an intravenous bolus of 1 mg granisetron in a 10ml syringe and Group B (n=86) received intravenous bolus of normal saline in a 10ml syringe, drugs were administered immediately before spinal anaesthesia by anaesthetist as coded syringes. Heart rate, blood pressure, core body temperature and shivering scores were measured at 0 minutes, 30 minutes and 60 minutes, average surgery time recorded to be 60 minutes. Results: None of the patients in group A (drug group) exhibited appreciable post spinal shivering whereas 25 (29%) in group B (placebo) had clinically significant shivering necessitated administration of other established pharmacological agents to abort shivering in order to ensure patient comfort and satisfaction with statistically significant p-value of <0.05. Conclusion: Prophylactic injection granisetron was efficacious against post spinal shivering, moreover provides worth while relief of nausea and vomiting which is dilemma with most of the drugs employed for control of post spinal shivering.

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A comparative study of intracervical foley’s catheter with oxytocin and vaginal misoprostol for induction of labour

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203836 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3660

Author(s):

Priyanka . ◽

Shashi Bala Arya ◽

Mirdu Sinha ◽

J. K. Goel

Keyword(s):

Pregnant Women ◽

Induction Of Labour ◽

Labour Induction ◽

Bishop Score ◽

Misoprostol Group ◽

Successful Induction ◽

Group A ◽

Vaginal Misoprostol ◽

Foley’S Catheter ◽

Group B

Background: Induction of labour implies stimulation of uterine contraction before spontaneous onset of labour with or without ruptured membranes. Aim of this study was to compare the efficacy and safety of intracervical Foley’s catheter with oxytocin and vaginal misoprostol for labour induction at term.Methods: A total 100 term pregnant women were chosen with bishop score <6 and divided into two groups: Foley’s catheter with oxytocin (Group A) and vaginal misoprostol (Group B). In Group A, a 16 F Foley’s catheter introduced beyond internal os and traction applied every 4 hourly to check for expulsion with simultaneous oxytocin infusion (2 mU/min up to 32 mU/min). In Group B, 25 mcg misoprostol administered every 4 hourly (maximum 6 doses or 150 mcg). Data analysed using SPSS software 20.0. A p value <0.05 was considered statistically significant.Results: No statistical difference found between demographic variables between two groups. Both primigravida and multigravida had poor pre-induction bishop score in both groups. Foley’s catheter (80%) and misoprostol group (96%) had successful induction and was statistically significant (p<0.05). Foley’s catheter took more time from induction-delivery both in primigravida and post-dated pregnant women. The rate of cesarean in Foley’s catheter group was high (62.5%) including 33% cases with failed induction. Foley’s catheter had less maternal and neonatal complications, less NICU admission as compared to misoprostol (p>0.05).Conclusions: Misoprostol was found better for successful induction, decreases induction-to-delivery interval and increases vaginal delivery as compared to Foley’s catheter but it needs constant supervision in view of hyperstimulation and tachysystole.

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EFFICACY OF PHENYLEPHRINE OVER EPHEDRINE IN CONTROLLING FALL OF BLOOD PRESSURE: A CROSS SECTIONAL STUDY IN PATIENTS UNDERGOING LOWER SEGMENT CAESAREAN SECTION

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i7.1417 ◽

2020 ◽

Vol 4 (7) ◽

Author(s):

Keshav Saran Agrawal ◽

Aruna Mahanta

Keyword(s):

Blood Pressure ◽

Spinal Anesthesia ◽

Cross Sectional Study ◽

Age Group ◽

Lower Segment ◽

Cross Sectional ◽

Lower Segment Caesarean Section ◽

Block Level ◽

Group A ◽

Group B

Background: most of the lower segment caesarean sections are done under spinal anesthesia and in more that 80% of the cases, maternal fall in blood pressure can be observed intraoperatively. Throughout history many vasopressor drugs have been evaluated for the treatment. Aim: our research was conducted to compare the effect of phenylephrine with ephedrine given for the prophylaxis of prevention of intraoperative fall in blood pressure in females who are undergoing LSCS. Materials and Methods: a total of 100 cases were considered for our study and were randomly distributed in two groups. Group A cases were administered Phenylephrine while ephedrine was given to group B cases just after spinal anesthesia. Results: most of our study subjects were in the age group of 21-25 years who were in the range of 51-55 kgs. Spinal anesthesia was given by using bupivacaine & block level was checked at 2 & 5 mins. Phenylephrine was found to be superior in control of fall in blood pressure as more than 90% of the cases were brought back to their preoperative levels in less than 4 mins after spinal anesthesia. Whereas in group B, ephedrine took much more time of around 10 mins for control of BP. Conclusion: with proper monitoring of heart rate, phenylephrine is superior to ephedrine in controlling the fall in blood pressure. Keywords: Ephedrine, Phenylephrine, Hypotension, Bradycardia.

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Incidence of post-operative (caesarean section) infectious morbidities in cleansing and non-cleansing group after povidone iodine vaginal cleaning

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213457 ◽

2021 ◽

Vol 10 (9) ◽

pp. 3393

Author(s):

Pragya Verma ◽

Dolly Chawla ◽

Rashmi Khatri ◽

Preeti Verma

Keyword(s):

Caesarean Section ◽

Povidone Iodine ◽

Medical College ◽

Lower Segment Caesarean Section ◽

Significant Difference ◽

Maternal Morbidity And Mortality ◽

Group A ◽

Randomized Control ◽

Group B ◽

Control Study

Background: Despite of wide spread use of prophylactic antibiotics and various antiseptic measures, post-operative infection remains one of the significant and serious complication of caesarean delivery contributing to high maternal morbidity and mortality. Objective was to study the incidence of post-operative infectious morbidities in patients with/without povidone iodine vaginal cleansing done prior to caesarean section.Methods: A prospective randomized control study was done in the department of obstetrics and gynecology of Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi.Results: Mean age of participants in group A is 26.22±2.47 years and in group B is 26.48±2.3 years. Majority women (84.0%) underwent emergency lower segment caesarean section (LSCS). (6.4%) women developed post-operative endometritis, out of which maximum (4.6%) belong to no vaginal cleansing group (B) compared to 1.8% in povidone iodine vaginal cleansing group(A), which is statistically significant (p=0.01). Over all (13%) women had post-operative fever, with significant difference among the two groups i.e. (8.6%) were in group B versus (4.4%) in group A (p=0.005).Conclusions: Povidone iodine vaginal cleansing prior to caesarean section is significantly effective in reducing post-operative infectious morbidities.

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Oxytocin Versus Dinoprostone For Labor Induction in Multiparous Women with Unfavorable Cervix

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2020.1039 ◽

2020 ◽

pp. 1

Author(s):

Gul Nihal Buyuk ◽

Umit Yasemin Sert ◽

Zeynep Asli Oskovi kaplan ◽

Serkan Kahyaoglu

Keyword(s):

Cesarean Section ◽

Neonatal Intensive Care ◽

Daily Practice ◽

Induction Of Labor ◽

Cervical Ripening ◽

Delivery Mode ◽

Bishop Score ◽

Multiparous Women ◽

Group A ◽

Group B

OBJECTIVE: Dinoprostone is a drug of choice in our daily practice for the induction of labor. The aim of our study; to compare the use of oxytocin with dinoprostone (PGE2- Propess©) used in term multiparous pregnant women to ripen the cervix.STUDY DESIGN: A total of 507 patients were included in the study. Group A, consisted of 262 women with term multiparous pregnancy Bishop score ≤6 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (Propess© -prostaglandin E2). Group B, consisted of 245 cases of pregnancy with Bishop score ≤6 underwent induction of labor with iv oxytocin and was matched for the patient's age and parity. The following data were recorded: age, gestational age, body mass index, the time from the drug administration to the vaginal labor, delivery mode, indications of induction, cesarean indication, birth weight, Apgar score, and need of neonatal intensive care unit. RESULTS: The primary outcome of the in group B interval from induction to vaginal delivery was similar between the two groups. In group A, 41 patients and in group B, 23 patients had a cesarean section. Cesarean section rate was lower in the oxytocin group (cesarean rate 15.6% versus 9.3%, p<0.05). CONCLUSION: It appears; Dinoprostone ovule increases the cesarean rate in terms, multiparous cases with inappropriate cervical score and does not shorten the duration of delivery. Therefore, the use of oxytocin for cervical ripening in multiparous women may be a more appropriate option.

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