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

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

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

scholarly journals A 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 Oral and vaginal route of misoprostol for induction of labour: a comparative study

2019 ◽  
Vol 8 (5) ◽  
pp. 1956
Author(s):  
Deepti D. Sharma ◽  
Kavita A. Chandnani
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Induction Of Labour ◽  
Vaginal Route ◽  
Oral Misoprostol ◽  
Group A ◽  
The Mean ◽  
Vaginal Misoprostol ◽  
Group B ◽  
To Receive

Background: Induction of labour can be defined as “Artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods, for purpose of vaginal delivery.” The key factor for a successful induction is the status of cervix, its form, consistency and dilatation which is determined by the Bishop score. In case of unfavourable cervix or in the pregnancies remote from the term; prostaglandins are more effective than any other method of induction. Introduction of misoprostol, PGE1 analogue, for the induction of labour in 1993 and its approval for clinical use by ACOG (American College of Obstetrics and Gynecology) in 1999 has been the most significant advancement. It is the latest drug for induction of labour which is cheap and stable at room temperature and is being used worldwide in different doses and by various routes. We compared the most commonly preferred two routes; vaginal and oral in terms of success of induction and noted the adverse events and side effects in both routes.Methods: This was a prospective comparative study carried out at SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, Vadodara, Gujarat, 200 patients who required induction of labour were recruited after applying inclusion and exclusion criteria and were randomly divided in two groups- Group A meant to receive 50µg oral misoprostol, Group B - meant to receive 25µg vaginal misoprostol repeated 4 hourly up to maximum of five doses. Progress of labour was charted on the partograph. The mean induction delivery interval, mode of delivery, maternal and neonatal outcomes and complications were observed.Results: The mean induction to delivery interval was significantly less in vaginal group than oral (23.3±12.4 hours in oral vs. 17.3±10 hours in vaginal). Vaginal delivery and cesarean section rates were comparable in both groups (76% in Group A vs. 72% in Group B for vaginal delivery, 18% vs. 20% for Cesarean section, respectively). 58% patients in Group A required more than two doses as compared to 39% in group B, though the difference was statistically not significant. Significant number of patients required added oxytocin administration in Group A (72%). No major complications or adverse events were observed. Neonatal hyperbilirubinemia was seen more in Group A.Conclusions: Both Oral misoprostol in a dose of 50μg and vaginal misoprostol 25 μg every four hours, to a maximum of five doses, have the potential to induce labour safely and effectively. The vaginal route however is beneficial in effecting delivery in lesser time with few numbers of doses as compared to oral route.

scholarly journals A comparative study of oral, sublingual and vaginal route of misoprostol as cervical ripening agent before surgical method of termination of first-trimester pregnancy

2017 ◽  
Vol 6 (4) ◽  
pp. 1295 ◽  
Author(s):  
Divya Sinha ◽  
Sourabh Shrivastava ◽  
Swati Shrivastava
Keyword(s):  
Blood Loss ◽  
First Trimester ◽  
Cervical Ripening ◽  
Vaginal Route ◽  
Surgical Method ◽  
First Trimester Pregnancy ◽  
Medical Termination ◽  
First Trimester Of Pregnancy ◽  
The Mean ◽  
Vaginal Misoprostol

Background: Cervical ripening is a critical step for surgical method of termination of first trimester of pregnancy. Misoprostol, PGE1 analogue have promising role as cervical ripening agent. The present study aimed to compare the efficacy and side effects of oral, sublingual and vaginal misoprostol at dosage of 400mcg for cervical priming before surgical method of termination in first-trimester pregnancy.Methods: It was a prospective hospital based randamosied study. Total 150 patients at 6-12 weeks gestation requesting for medical termination of pregnancy were divided equally in to 3 groups. Every group was advised to have single dose of 400 mcg misoprostol either oral, sublingual or vaginal route respectively 4 hour before suction and evacuation.Results: The sublingual group had highly significant cervical dilatation (P<0.001) and the duration of suction and evacuation was less as compared to the vaginal and oral routes (p<0.000). However, the mean intraoperative blood loss was more in sublingual as compared to the vaginal and oral groups. Loose motions and nausea/vomiting were more with oral routes while blood loss was more in the vaginal route.Conclusions: Thus, it can be concluded from present study that sublingual route of misoprostol is more preferable than oral or vaginal route as pro-abortion cervical ripening agent.

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

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

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

scholarly journals A prospective comparative study of oral and vaginal misoprostol after pre-treatment with single dose of mifepristone for second trimester abortion

2017 ◽  
Vol 7 (1) ◽  
pp. 272
Author(s):  
Aastha Bhaskar ◽  
Richa Kaushik ◽  
Ashwani Kumar
Keyword(s):  
Termination Of Pregnancy ◽  
Cervical Ripening ◽  
P Value ◽  
Second Trimester ◽  
Intrauterine Pregnancy ◽  
Trimester Abortion ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Vaginal Misoprostol

Background: Misoprostol is a synthetic PGE1 analogue which induces cervical ripening as well as strong uterine contractions and leads to expulsion of pregnancy. Misoprostol has been shown to have several advantages over other prostaglandins; it is cheap, stable at room temperature and can be given by various routes. Administration of mifepristone 24 to 48 hours before misoprostol decreases mean induction time which varies with route of administration of misoprostol.Methods: 50 women with single intrauterine pregnancy with gestational age 13-20 weeks, admitted in labour room of Obstetrics and Gynaecology, Pt. B.D. Sharma PGIMS, Rohtak for termination of pregnancy (on account of missed abortion, absent liquor or gross congenital malformation)  were given 200 mg of mifepristone orally after taking written informed consent and excluding scarred uterus, placenta praevia, bronchial asthma, any cardiovascular disease, clotting disorder, long term use of glucocorticoids and history of glaucoma. Then they were randomized into two groups of 25 women each. Group I included 25 women who received oral misoprostol and group II included 25 women who received vaginal misoprostol. Complete abortion was defined as successful expulsion of both foetus and placenta without any intervention. Failure was defined as cases with incomplete expulsion or incomplete dilatation or no dilatation.Results: The mean number of doses of misoprostol used in groups I and group II were 2.80±1.19 and 2.20±0.86 respectively and the difference was statistically significant (p value 0.04). Out of 25 patients included in each group, 64% (n=16) in group I and 80% (n=20) in group II patients had complete expulsion with misoprostol and remaining 36% (n=9) in group I and 20% (n=5) in group II either needed syntocinon or post expulsion evacuation for retained product of conceptions and who did not respond to the given doses of misoprostol at all required mechanical dilatation and evacuation. But this difference was not statistically significant. The mean induction abortion interval in cases of complete expulsion observed in group I was 10.74±4.12 hours and 8.67±3.23 hours in group II which was statistically significant (p value 0.05).Conclusions: Vaginal route is better than oral route for second trimester termination of pregnancy as it requires less number of Misoprostol doses and shorter induction abortion interval.

scholarly journals Efficacy and Safety of Sublingual versus Vaginal Misoprostol for Pre-induction Cervical Ripening among Primigravida

2018 ◽  
Vol 17 (1) ◽  
pp. 18-24
Author(s):  
Indira Acharya ◽  
Sumana Thapa ◽  
Pushpa Chaudhary
Keyword(s):  
Cervical Ripening ◽  
Induction Agent ◽  
Cross Sectional ◽  
Uterine Contractions ◽  
Tertiary Center ◽  
Sublingual Misoprostol ◽  
Misoprostol Group ◽  
The Mean ◽  
The Difference ◽  
Vaginal Misoprostol

Introduction: Induction of labor is an intervention intended to artificially initiate uterine contractions resulting in progressive effacement and dilatation of the cervix. This is a common intervention during pregnancy in both industrialized and non-industrialized countries.Misoprostol is the commonly used induction agent. The objective of this study was to compare the efficacy of sublingual route of misoprostol with that of vaginal for pre-induction cervical ripening at term among Primigravida.Methods: This study was a hospital based cross sectional comparative study, conducted at a tertiary center, Kathmandu over a period of 6 months extending from July 2010 to December 2010. Primigravida at 40-42 weeks of gestation who met the inclusion criteria were enrolled in this study and were randomly enrolled for sublingual misoprostol and vaginal misoprostol.Results: More women in the vaginal misoprostol group had Bishop score more than six after 8 hours of insertion of first dose (80%) compared to those who received sublingual misoprostol (48%). The mean induction to   delivery interval was shorter in the vaginal misoprostol group (12.12 hours) compared to (12.96) in sublingual group. Use of oxytocin for augmentation of labour was required more in the sublingual group but the difference was not significant statistically.Conclusion: Both sublingual and vaginal routes of misoprostol administration were equally effective and appeared safe for pre-induction cervical ripening at term. 

scholarly journals The Role of Low Dose Misoprostol in Cervical Ripening and Induction of Labour Beyond the Age of Viability and its Effects on Maternal and Fetal Outcomes

JMS SKIMS ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 18-21
Author(s):  
Humaira Ali ◽  
Cimona Lyn Saldanha ◽  
Tabasum Parveiz ◽  
Rabia Khurshid
Keyword(s):  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
P Value ◽  
Delivery Time ◽  
Fetal Outcomes ◽  
Group I ◽  
Number Of Patients ◽  
Group Ii ◽  
Vaginal Misoprostol

This study was conducted to compare the efficacy and safety of oral (50 μg) and vaginal (25 μg) misoprostol for cervical ripening and induction of labour. Two hundred patients with indications for labour induction randomly received either 50 μg oral misoprostol every 4 h (Group-I) or 25 μg vaginal misoprostol every 4 h (Group-II), for maximum of six doses. Mean induction to delivery time, delivery within 24 hrs, mode of delivery, oxytocin use, number of doses used, failed induction rate and maternal complication and fetal outcomes were compared for the two groups. Mean induction delivery time was significantly longer in Group-I (20.55±5.59 hrs) than in Group-II (16.70±7.12 hrs) (with mean difference of 3.85 and P-value of <0.001). Mean number of doses of misoprostol used for oral and vaginal misoprostol study populations were 2.61±0.94 and2.37±1.20respectively. Oxytocin augmentation was required in significantly more number of patients in oral group (80%) than in vaginal group (68%) with P-value of 0.027. There were 3 failed inductions in the oral and 4 in the vaginal group after a total of six doses of misoprostol. Incidence of maternal and fetal complications was similar between two groups. Our findings indicated that, 25μg vaginal misoprostol has the potential to induce labor as safely as, and more effectively than, 50 μg oral analogue. JMS 2017; 20(1):18-21

scholarly journals Efficacy and Safety of Sublingual versus Vaginal Misoprostol for Pre-induction Cervical Ripening among Primigravida

2018 ◽  
Vol 17 (2) ◽  
pp. 18
Author(s):  
Indira Acharya ◽  
Sumana Thapa ◽  
Pushpa Chaudhary
Keyword(s):  
Cervical Ripening ◽  
Induction Agent ◽  
Cross Sectional ◽  
Uterine Contractions ◽  
Tertiary Center ◽  
Sublingual Misoprostol ◽  
Misoprostol Group ◽  
The Mean ◽  
The Difference ◽  
Vaginal Misoprostol

<p><strong>Introduction: </strong>Induction of labor is an intervention intended to artificially initiate uterine contractions resulting in progressive effacement and dilatation of the cervix. This is a common intervention during pregnancy in both industrialized and non-industrialized countries.Misoprostol is the commonly used induction agent. The objective of this study was to compare the efficacy of sublingual route of misoprostol with that of vaginal for pre-induction cervical ripening at term among Primigravida.</p><p><strong>Methods:</strong> This study was a hospital based cross sectional comparative study, conducted at a tertiary center, Kathmandu over a period of 6 months extending from July 2010 to December 2010. Primigravida at 40-42 weeks of gestation who met the inclusion criteria were enrolled in this study and were randomly enrolled for sublingual misoprostol and vaginal misoprostol.</p><p><strong>Results: </strong>More women in the vaginal misoprostol group had Bishop score more than six after 8 hours of insertion of first dose (80%) compared to those who received sublingual misoprostol (48%). The mean induction to   delivery interval was shorter in the vaginal misoprostol group (12.12 hours) compared to (12.96) in sublingual group. Use of oxytocin for augmentation of labour was required more in the sublingual group but the difference was not significant statistically.</p><p><strong>Conclusion: </strong>Both sublingual and vaginal routes of misoprostol administration were equally effective and appeared safe for pre-induction cervical ripening at term. </p>

scholarly journals Comparison of the safety and efficacy of intracervical Foleys catheter versus PGE2 gel for induction of labour at term

2021 ◽  
Vol 10 (5) ◽  
pp. 1842
Author(s):  
Prakruti P. Patel ◽  
Mittal V. Bhabhor ◽  
Pankti Jayswal ◽  
Saila A. Khatri ◽  
Grishma P. Brahmbhatt ◽  
...  
Keyword(s):  
Fetal Outcome ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
P Value ◽  
Chi Square ◽  
Medical College ◽  
Mechanical Methods ◽  
Significant Difference ◽  
Chi Square Test ◽  
Nicu Admission

Background: Before the induction of labour cervical ripening is needed for the success of induction to reduce the complication and diminish the rate of cesarean section and duration of labour. Various mechanical methods like Foleys catheter are effective but not much popular because of infection and pharmacological preparations which have more side effects, are used for cervical ripening. Therefore study has been conducted to compare the efficacy and safety of intra cervical Foleys catheter versus PGE2 gel for induction of labour at term. The aims and objectives of this study was to success of induction of labour depends on the cervical status at the time of induction.Methods: A prospective comparative study was conducted in the department of obstetrics and gynecology, L.G. hospital (AMCMET Medical college), Ahmedabad, during period of July 2019 to December 2019. 100 patients at term with a Bishop’s score with various indications for induction were randomly allocated to receive (50 patients) intra cervical Foleys catheter or PGE2 gel (50 patients). Post induction Bishop’s score was noted after 6 hours, 12 hours, 24 hours. Statistical methods used were Student t test and Chi square test to statistically compare the two groups. Differences with a p value of <0.005 was considered statistically significant with confidence limit of 95%.Results: The groups were comparable with respect to maternal age, gestational age, parity, indication of induction and initial bishops score. Both groups showed significant change in the Bishops score, 5.10±1.55 and 5.14±1.60 for Foleys catheter and PGE2 gel, respectively, p<0.001. Fetal outcome was noted in NICU admission and fetal death. No significant difference between two groups.Conclusions: This study shows that both Foleys catheter and PGE2 gel were equally effective in pre induction cervical ripening.

scholarly journals A randomized prospective comparative study to evaluate the efficacy of prostaglandin E2 (Dinoprostone) controlled release vaginal insert versus sublingual prostaglandin E1(Misoprostol) in induction of labor in term gestation

2021 ◽  
Vol 8 (4) ◽  
pp. 457-462
Author(s):  
Rakhee Sahu ◽  
Kirti Janjewal
Keyword(s):  
Comparative Study ◽  
Pregnant Women ◽  
Fetal Outcome ◽  
Induction Of Labor ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Significant Difference ◽  
Misoprostol Group ◽  
Prospective Comparative Study ◽  
The Mean

In modern obstetrics, one of the common challenges is induction of labour (IOL). WHO Global Survey reported that IOL accounted for 9.6% of all deliveries. Prostaglandins have evolved and frequently used pharmacologic agents for IOL, owing to their dual action of cervical ripening and uterine contraction inducing effect. : 1. To compare the efficacy and induction to delivery interval (IDI) of PGE2 vaginal insert and Sublingual PGE1 in induction of labor in term pregnant women; 2. To study the maternal and fetal outcome in both groups.: This a randomized, prospective, comparative study of 100 term pregnant women for induction of labour. Group 1-(50 women) PGE2-10mg vaginal insert and group 2-(50 women) PE1 Sublingual tablets – maximum 200 mcg in 24 hrs, at Dr LH Hiranandani Hospital, Mumbai, India.: In my study the mean induction to delivery interval in Dinoprostone group was 17.47 hours and 23.44 hours in Misoprostol group. So the mean IDI was shorter in Dinoprostone insert group than Misoprostol group by about 6 hours. There was no significant difference noted in terms of overall incidence of caesarean deliveries among the groups. Our study concluded that Dinoprostone 10mg vaginal insert was more efficacious than sublingual Misoprostol in reducing induction to delivery interval without maternal and fetal complications.Our study suggests that the Dinoprostone vaginal insert can be used as both inducing as well as augmentating agent in labour. Dinoprostone vaginal insert maybe more effective in reducing the incidence of caesarean sections.

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