scholarly journals Vaginal administration of isosorbide mononitrate for cervical ripening prior to induction of labor for postdated pregnancy: a randomized controlled trial

2018 ◽  
Vol 1 (1) ◽  
pp. 51-58
Author(s):  
Rubina Rai ◽  
P Basnet ◽  
A Thakur ◽  
T Pradhan
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Controlled Trial ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Isosorbide Mononitrate ◽  
Oral Misoprostol ◽  
Significant Difference ◽  
Unfavorable Cervix

 Introduction: Induction of labor is commonly practiced intervention in modern Obstetrics. The aim of induction of labor is to initiate labor when maternal and fetal conditions necessitate delivery before the onset of spontaneous contraction with purpose to achieve safe vaginal delivery. Induction of labor is one of the most commonly practiced interventions in the Department of Obstetrics and Gynecology every day. The success of this obstetric practice is highly dependent upon the condition of the cervix which is assessed with Bishop‟s Score and it is well known that unfavorable cervix is associated with failure of induction and cesarean section. In the recent years, there has been a considerable interest in the use of nitrous oxide donors for cervical ripening and labor induction.Objective: To evaluate whether isosorbide mononitrate administered vaginally prior to induction in postdated pregnancy is effective for pre-induction cervical ripening and thus, improves the process of induction of labor.Methods: One hundred and twenty women scheduled for labor induction were recruited and assigned randomly to isosorbide mononitrate or placebo followed by misoprostol 25μg. The efficacy of the medication was evaluated by predetermined outcome variables for cervical ripening and induction of labor and delivery.Results: The groups were comparable with respect to age, gestational age and Bishop‟s score. Women receiving isosorbide with misoprostol didn‟t show any improvement in the Bishop‟s score compared to misoprostol and placebo. There was no significant difference between the two groups regarding time of delivery and onset of active stage of labor from induction. Cesarean delivery rates were similar between the two groups; however, the indications of the cesarean section were different between the two groups which were significant statistically. Neonatal outcome were similar between the two groups.Conclusion: The addition of vaginal isosorbide mononitrate to oral misoprostol for cervical ripening and labor induction did not reduce time to vaginal delivery and didn‟t help in improving pre-induction cervical score.Journal of BP Koirala Institute of Health Sciences, Vol. 1, No. 1, 2018, page: 51-58

Effectiveness of Sequential Low Dose Oral Misoprostol Solution for Induction of Labor: An Experience in a Thai Quaternary Hospital

2021 ◽  
Vol 104 (4) ◽  
pp. 645-653
Keyword(s):  
Birth Weight ◽  
Cesarean Section ◽  
Vaginal Delivery ◽  
Pregnancy Outcomes ◽  
Associated Factors ◽  
Low Dose ◽  
Labor Induction ◽  
Cervical Ripening ◽  
Bishop Score ◽  
Oral Misoprostol

Background: Siriraj Hospital has seen remarkably high cesarean section rates during the last decade. A labor induction protocol has been established to reduce cesarean section rate from “failed induction”. Objective: To determine effectiveness of a sequential low dose misoprostol solution protocol for labor induction. Cervical ripening and vaginal delivery rates, pregnancy outcomes, and associated factors of successful vaginal delivery were determined. Materials and Methods: The present study was a retrospective observational study. Medical records of women with a term singleton pregnancy and with Bishop score of 6 or less who underwent labor induction were reviewed. The induction protocol started with series 1 which was 25 mL oral misoprostol solution (1 mcg/mL) every two hours for a maximum of 24 hours. If Bishop score was 6 or less by the end of series 1, then series 2 would follow, comprising 50 mL oral misoprostol solution (1 mcg/mL) every four hours for a maximum of 24 hours. Data of Bishop scores, delivery route by the end of each series, pregnancy outcomes, and possible associated factors were collected. Results: One hundred twenty-eight women were analyzed. The overall rate of cervical ripening, with a Bishop score of more than 6, was 92.2%, and at 88.3% with series 1 only. Successful vaginal delivery was achieved in 70 cases (54.7%), 53 of whom were delivered within 24 hours. Significantly associated factors with successful vaginal delivery were multiparity, and birth weight of 3,200 grams or less; adjusted OR 4.0 (95% CI 1.31 to 12.16, p=0.015) and 3.4 (95% CI 1.48 to 7.63, p=0.004), respectively. No serious adverse pregnancy outcomes were observed. Conclusion: With Siriraj induction protocol, success rates of cervical ripening and vaginal delivery were 92.2% and 54.7%, respectively, without serious adverse outcomes. Significant associated factors of successful vaginal delivery were multiparity and birth weight of 3,200 grams or less. Keywords: Oral misoprostol, Misoprostol solution, Low dose, Labor induction, Cervical ripenting, Vaginal delivery

A comparison of the efficacy and safety of repetitive hourly dose of oral misoprostol and two hourly dose oral regimens for cervical ripening and labor induction: A R.C.T

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sabry S Mohamed ◽  
Hayam F Mohammed ◽  
Ahmed M Essam El Din Mansour ◽  
Essam S Hagag
Keyword(s):  
Risk Group ◽  
Controlled Trial ◽  
Mode Of Delivery ◽  
Labor Induction ◽  
University Hospital ◽  
Cervical Ripening ◽  
Group I ◽  
Oral Misoprostol ◽  
Significant Difference ◽  
Hourly Dose

Abstract Background Labor induction most frequently conducted through interventional procedures, and their use has been increasing in the past several decades. In a survey by the National Center for Health Statistics the rate of labor induction was noted to have increased from 9.5% in 1991 to 22.5% in 2006. This randomized controlled trial was conducted at Ain Shams University Maternity Hospital (pre-labour ward) in the period between January 2019 and January 2020. Patients and Methods This study was conducted on 150 pregnant women attending Ain Shams University Hospital outpatient clinic, they were classified according to the indication for labor induction into 2 groups, high risk group and low risk group. Results that there was no statistically significant difference between groups according to baseline characteristics, indication of induction and need for oxytocin. Regarding medications side effect and maternal outcomes, our results showed that there was statistically significant difference between groups according to pyrexia. Regarding mode of delivery, our results showed that there was no statistically significant difference between groups. Regarding no. of req. doses and duration of delivery, our results showed that there was statistically significant difference between groups according to no. of req. doses and duration of delivery (hrs) and total dose of misoprostol (µg), more in group I (hourly dose) than II (2 hours dose). Regarding fetal outcomes (Apgar score at 1 and 5 min, birth weight (kg), meconium staining, NICU admission), our results showed that there was no statistically significant difference between 2 groups. Conclusion The repetitive hourly dose of misoprostol solution (10 μg -10 mL- oral misoprostol administered hourly up to12 doses) has similar efficacy as oral misoprostol solution every 2 hours (20 μg -20 mL- administered every 2 hours up to 6 doses) but with more side effects.

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 Autophagy and Human Parturition: Evaluation of LC3 Expression in Placenta from Spontaneous or Medically Induced Onset of Labor

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Laura Avagliano ◽  
Eleonora Virgili ◽  
Chiara Garò ◽  
Federica Quadrelli ◽  
Patrizia Doi ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Uterine Contractions ◽  
Prepregnancy Body Mass Index ◽  
Significant Difference ◽  
The Impact ◽  
Labor Onset ◽  
Human Parturition ◽  
Stimulation Of

Induction of labor is one of the most used procedures in obstetrics, performed to achieve vaginal delivery through cervical ripening and stimulation of uterine contractions. We investigated the impact of induction of labor upon placental autophagy, a catabolic pathway activated in response to alteration of the physiological intracellular conditions. We collected 28 singleton placentas at the time of uncomplicated term vaginal delivery (7 spontaneous onset of labor, 21 induced labor). Autophagy was evaluated by immunohistochemistry, immunofluorescence, and immunoblotting. No significant difference in the autophagy expression was found between spontaneous or induced onset of labor. We found an inverse relationship between autophagy expression and the maternal prepregnancy body mass index, irrespective of the mode of labor onset. This result could be related to the nutritional maternal habits before and throughout pregnancy rather than rapid metabolic changes during labor.

scholarly journals Misoprostol versus oxytocin for labor induction in term and post-term pregnancy: randomized controlled trial

2003 ◽  
Vol 121 (3) ◽  
pp. 102-106 ◽  
Author(s):  
Márcia Maria Auxiliadora de Aquino ◽  
José Guilherme Cecatti
Keyword(s):  
Randomized Controlled Trial ◽  
Pregnant Women ◽  
Latent Period ◽  
Vaginal Delivery ◽  
Controlled Trial ◽  
Neonatal Morbidity ◽  
Labor Induction ◽  
Cervical Ripening ◽  
Randomized Controlled ◽  
Misoprostol Group

CONTEXT: Misoprostol, a synthetic E1 methyl analog prostaglandin, is at present receiving attention as a cervical modifier and labor induction agent. However, there is still a need for better determination of its safety and effectiveness. OBJECTIVE: To compare intravaginal misoprostol versus intravenous oxytocin for cervical ripening and labor induction in pregnant women with unripe cervices. DESIGN: Randomized controlled trial. SETTING: The study was performed at the Leonor Mendes de Barros Maternity Hospital between November 1998 and December 2000. PARTICIPANTS: 210 pregnant women with intact membranes and indication for labor induction were selected. PROCEDURES: The women randomly received 25 µg of vaginal misoprostol every 4 hours, not exceeding 8 doses (105 women), or oxytocin in a continuous infusion (105 women). MAIN MEASUREMENTS: The main parameters measured were: latent period, time from induction to vaginal delivery, delivery route, occurrence of vaginal delivery with time, occurrence of uterine tonus alterations, hypoxia and neonatal morbidity. To verify the statistical significance of the differences between the groups, the chi-squared, Student t and log-rank tests were used. RESULTS: There were no significant differences between the groups concerning conditions for labor induction, age, parity, race, marital status, family income, initial Bishop Index and number of prenatal visits. The cesarean section rate, latent period and period from induction to vaginal delivery were significantly lower for the misoprostol group. With regard to uterine tonus alterations, tachysystole was significantly more common in the misoprostol group. However, there was no difference in hypoxia and neonatal morbidity between the groups. CONCLUSION: 25 µg of misoprostol used vaginally every 4 hours is safer and more efficient for cervical ripening and labor induction than oxytocin.

scholarly journals Sublingual Misoprostol versus Foley catheter for cervical ripening in women with preeclampsia or gestational hypertension: A randomized control trial

2019 ◽  
Author(s):  
Sedigheh Ayati ◽  
Elahe Hasanzadeh ◽  
Leila Pourali ◽  
Mohammadtaghi Shakeri ◽  
Atiye Vatanchi
Keyword(s):  
Vaginal Delivery ◽  
Randomized Control Trial ◽  
Gestational Hypertension ◽  
Pregnancy Termination ◽  
Foley Catheter ◽  
Labor Induction ◽  
Cervical Ripening ◽  
Significant Difference ◽  
Sublingual Misoprostol ◽  
Randomized Control

Background: Delivery is the only definite cure for hypertensive disorders. Therefore, cervical ripening and labor induction are important to achieve favorable outcomes. Objective: This Randomized Control Trial (RCT) is aimed to compare the effects of sublingual misoprostol and Foley catheter in cervical ripening and labor induction among patients with preeclampsia or gestational hypertension. Materials and Methods: A total number of 144 women with preeclampsia or gestational hypertention with indication of pregnancy termination, who were referred to academic hospitals of the University of Medical Sciences in Mashhad, Iran, between March 2015 and December 2016, were randomly divided into two groups. In group one (n = 72), 25 μg of misoprostol tablet was administrated sublingually every 4 hr up to six doses. In group two (n = 72), a 16F Foley catheter was placed through the internal cervical os, inflated with 60 cc of sterile saline. Results: There were no significant differences between groups regarding the demographic characteristics, primary bishop score, and pregnancy termination indication. The cervical ripening time (primary outcome) (8.2 vs 14.2 hr, p < 0.00), induction to delivery interval (15.5 vs 19.9 hr, p < 0.00), and vaginal delivery before 24 hr (63.9% vs 40%, p = 0.03) were significantly different between the two groups. There was no significant difference between groups in view of oxytocin requirement (p = 0.12), neonatal Apgar score (p = 0.84), or neonatal intensive care unit admission (p = 78). Conclusion: This trial showed that the application of sublingual misoprostol, compared to the Foley catheter, can reduce cervical ripening period and other parameters related to the duration of vaginal delivery. This misoprostol regimen showed inconsiderable maternal complications.

scholarly journals Comparison of titrated oral misoprostol solution versus vaginal misoprostol for induction of labour in term obstetric patients for obstetric and neonatal outcomes: a randomized controlled trial

2018 ◽  
Vol 7 (6) ◽  
pp. 2339
Author(s):  
Puneeta Mahajan ◽  
Rajendra Popatrao Shitole
Keyword(s):  
Vaginal Delivery ◽  
Controlled Trial ◽  
Oral Solution ◽  
Cervical Ripening ◽  
Labour Induction ◽  
P Value ◽  
Oral Misoprostol ◽  
Unfavourable Cervix ◽  
Oral Group ◽  
Vaginal Misoprostol

Background: With more than 15% of all gravid women requiring prostaglandins in cervical ripening and labour induction. However, evidence is not clear about the preferred route or dose of the drug. So this study was designed with objectives to compare the induction delivery interval and safety of titrated oral misoprostol solution with vaginal misoprostol for labour induction in term primigravida women.Methods: In this randomised controlled trial out of 576 eligible women, 220 women as per inclusion criteria between 37 and 42 weeks of gestation with an unfavourable cervix (Bishop score <6) with indication for labour induction were randomly assigned (110each) to receive titrated oral solution of 20 mL misoprostol solution (1 mcg/mL) every 1 hour for four doses and then were titrated against individual uterine response or vaginal misoprostol 25 mcg every 4 hours. Vaginal delivery within 12 hours was the primary outcome. The data were analyzed by intention-to-treat.Results: Vaginal delivery occurred within 12 hours in 56 (50.9%) women in the titrated oral group and 24 (21.8%) women in the vaginal group with significant p-value (<0.001). The incidence of caesarean, hyper stimulation, low apgar score was less in the titrated oral group. More women experienced nausea in the titrated oral group.Conclusions:Titrated oral misoprostol is safe and effective for labour induction in primigravida patients with unfavourable cervix. 

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