scholarly journals Preinduction cervical ripening with vaginal misoprostol in second and third trimester intrauterine fetal demise

2019 ◽  
Vol 14 (2) ◽  
pp. 57-61
Author(s):  
Rakshya Parajuli ◽  
Madhu Shrestha ◽  
Gehanath Baral
Keyword(s):  
Side Effects ◽  
Vaginal Delivery ◽  
International Federation ◽  
Cervical Ripening ◽  
Bishop Score ◽  
Third Trimester ◽  
Fetal Demise ◽  
Trimester Pregnancy ◽  
Intrauterine Fetal Demise ◽  
Vaginal Misoprostol

Aim: To study the effectiveness of vaginal misoprostol according to the FIGO 2017 guideline for preinduction cervical ripening in second and third trimester pregnancy with intrauterine fetal demise. Methods: During six months period from October 2017 to April 2018 at Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, Nepal, cases admitted for second and third trimester termination of pregnancy for fetal demise were studied using the International Federation of Gynaecology and Obstetrics (FIGO) recommended doses of vaginal misoprostol. For gestational age of 13-26 weeks 200µg, for 27-28 weeks dose of 100µg and for >28 weeks dose of 25µg, every 6 hours was used. Main outcome measured included change in modified Bishop Score, insertion of first dose of vaginal misoprostol to delivery interval and maternal side effects. Results: In this study including 54 cases, mean preinduction Bishop score was 2.12. Bishop score remained unchanged in 2 cases, 28 had score between 4 to 6, 10 cases had score between 7 to 8 and 14 cases had Bishop score more than 8. The change in Bishop Score is statistically significant (p=0.007). 50 cases had vaginal delivery and it occurred within 19.83±13.1 hours. It took minimum 3 hours to maximum 52 hours from the first dose of misoprostol to delivery of the fetus. No side effects were noted within 24 hours of the last dose of vaginal misoprostol. Conclusions: Vaginal misoprostol according to FIGO guideline 2017 is safe and effective for preinduction cervical ripening in second and third trimester intrauterine fetal demise leading to successful vaginal delivery.

scholarly journals Misoprostol for Termination of Second Trimester Pregnancy

2015 ◽  
Vol 1 (1) ◽  
pp. 16-19
Author(s):  
Sarada Duwal Shrestha ◽  
Alka Singh ◽  
Laxmi RC ◽  
Benita Pradhan ◽  
Wufei Shah ◽  
...  
Keyword(s):  
Side Effects ◽  
Success Rate ◽  
Congenital Anomalies ◽  
Second Trimester ◽  
Plain Language ◽  
Fetal Demise ◽  
Trimester Pregnancy ◽  
Second Trimester Pregnancy ◽  
Vaginal Misoprostol ◽  
Maternal Side

Introductions: The termination of second trimester pregnancy is challenging due unfavorable cervix. This study evaluate the efficacy and maternal side effects of intravaginal misoprostol for termination of second trimester pregnancy. Methods: During one year period from 15th June 2011 to 14th June 2012, Department of Obstetrics and Gynaecology of Patan Hospital, women admitted for second trimester termination of pregnancy for fetal congenital anomalies and intrauterine fetal demise were studied using the International Federation of Gynaecology and Obstetrics recommended doses of vaginal misoprostol. For congenital anomalies, 400 mcg 3 hourly to a maximum of 5 doses were used. For fetal demise, gestational age of 13-17 weeks received 200 mcg every 6 hourly to a maximum of 4 doses, and 18-26 weeks dose was adjusted to 100 mcg. Main outcome measures included success rate of abortion within 48 hours, induction to delivery interval and maternal side effects. Results: There were 40 patients during study period. Success rate for termination of 2nd trimester pregnancy within 48 hours was 88.8% for congenital anomalies. For fetal demise, success of termination was 90.9% at 13-17 weeks and 100% at 18-26 weeks. Median time from induction to delivery was 26.8 hours for congenital anomalies. For fetal demise, it was 18 hours for 13-17 weeks was and 24 hours at 18 to 26 weeks respectively. Abdominal pain was seen in all doses of misoprostol. Conclusions: Vaginal misoprostol is an effective method for termination of second trimester pregnancy. Plain Language Summary: The study was conducted to see the effectiveness of vaginal misoprostol for termination of second trimester pregnancy. The success rate of termination for congenital abnormality and fetal demise was high. Vaginal misoprostol was an effective method for termination of second trimester pregnancy. DOI: http://dx.doi.org/10.3126/jpahs.v1i1.13010 Journal of Patan Academy of Health Sciences. 2014 Jun;1(1):16-19

scholarly journals Low Dose Vaginal Misoprostol in the Management of Women with Intrauterine Fetal Death

2010 ◽  
Vol 3 ◽  
pp. CMWH.S5797
Author(s):  
M.N. El-Gharib ◽  
M.T. El-Ebyary ◽  
T.S. Alhawary ◽  
S.H. Elshourbagy
Keyword(s):  
Fetal Death ◽  
Mean Value ◽  
University Hospital ◽  
Intrauterine Fetal Death ◽  
Third Trimester ◽  
Trimester Pregnancy ◽  
Observational Cohort ◽  
The Mean ◽  
Vaginal Misoprostol ◽  
Duration Of Gestation

Objectives The study was conducted to assess the effectiveness and side effects of vaginal misoprostol (Vagiprost® tablet) in termination of second and third trimester pregnancy complicated with intrauterine fetal death. Design A prospective observational cohort study. Setting Tanta University Hospital. Patients The study was carried out on 324 women with fetal demise in the second and third trimesters. Cases were collected during the period from January 2008 to December 2009. Intervention All patients were subjected to history taking, physical examination, Bishop Scoring. Application of 25 μg misoprostol in the posterior fornix of the vagina, this will be repeated every 4 hours over 24 hours. The adverse effects, progress, and outcomes were assessed. Results the success rate was 90% and 45% in women with third and second trimesters respectively. The mean induction-termination interval was 8.95 ± 2.63 and 15.3 ± 5.37 hours for women with third and second trimesters respectively. The induction termination interval correlated negatively with the duration of gestation. Approximately, 90% of second trimester and 55% of third trimester women required oxytocin augmentation. The mean value of total required dose of misoprostol was 166.3 ± 7.5 and 120 ± 28.79 μg for women with second and third trimesters respectively. Conclusion Vagiprost appears to be a safe, effective, practical, and inexpensive method for termination of third trimester pregnancy complicated with of intrauterine fetal death (IUFD), its effects increase with parity and duration of gestation.

scholarly journals INDUCTION OF LABOR;

2017 ◽  
Vol 24 (02) ◽  
pp. 288-292
Author(s):  
Raheela Baloch ◽  
Nigar Jabeen ◽  
Sana Zahiruddin ◽  
Ms. Kiran Mawani
Keyword(s):  
Side Effects ◽  
Prostaglandin E2 ◽  
Apgar Score ◽  
Mode Of Delivery ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Bishop Score ◽  
Efficacy And Safety ◽  
Vaginal Deliveries ◽  
Number Of Patients

Efficacy and safety of intra-vaginal prostaglandin E2 pessary for induction ofLabor. Objectives: To evaluate the efficacy and safety of intra-vaginal prostaglandin E2 pessaryfor induction of Labor. Study Design: Case control study. Setting: Gynecological and obstetricward of Liaquat University of Medical and Health Sciences Hospital, Hyderabad. Period: 14 Feb2012 to 13 Feb 2013. Study Population: All the Pregnant women at term or post term admittedin gynae ward from 14th February 2012 to 13th February 2013. Results: 100 women recruitedin the study, study carried out at Gynecological ward of Liaquat University of Medical and HealthSciences Hospital Hyderabad. Analysis of booking status listed in Table-I revealed that 68% (n= 68) were un-booked having no antenatal care and 32.0% (n = 32) were booked. There wereno protocol violation, relation to the parity listed in Table-II showed maximum number of patients(n = 62) 62.0% Primigravida and (n = 38) 38.0% multigravidas were include. Age distributionis listed in Table-III maximum patients (n = 49) 49.0% at age between 26 - 35 years, 35 (35.0%)were between 20 - 25 years, 10 (10.0%) were >35 years and 06 (6.0%) patients were belong toless than 20 years. Regarding the gestational age 57 (57.0%) patients in our study presentedbetween 37 - 39 weeks of gestation. However, 47 (47.0%) patients were at 40 - >40 weeksof gestation showed in the (Table-IV). Indication for cervical ripening and induction of laboris listed on Table-V commonest indication was pregnancy induced hypertension followed byprolonged pregnancy, and IUGR etc. Table-VI shows the Bishop score 30 (30.0%) had BishopScore 2 – 3, while 70(70.00%) had a bishop score 4-5. Table-VII shows induction-deliveryinterval, Greater number of women (66/100) delivered within 24 hours of start of induction.Table-VIII showed mode of delivery, majority of the women had normal vaginal deliveries 64.00while 16 deliveries by assisted vaginal deliveries while in remaining 20 cases caesarean sectiondone. Table-IX shows four babies had an Apgar score 4/10 at end of 1 min and 7/10 at end of5 min, whereas 96 babies had an Apgar score of 9/10 in 1 min. The indications for caesareansection are shown in Table-X. There were 09(9%) cases of failed induction, 11 cases of a fetaldistress (Meconium stained liquor). There was no increased incidence of neonatal sepsis orChorioamniotis or puerperal sepsis in any of our patients. No perinatal morbidity or mortalityor any severe maternal complications were noted while mild side effects were noted which ismentioned in (Table-XI). Conclusion: In developed countries prostaglandin E2 are widely usedfor ripening of unfavorable cervix in induction of labor but patient response vomiting, diarrhea,tachycardia, and fever are commonly observed minor side effects. Induction with Prostaglandinreduced the rate of pregnancies progressing beyond 41 weeks and related feto-maternalmorbidity and mortality. After excluding contra indication all women should be offered inductionat 41 completed weeks. Induction with prostaglandin with medical disorder like preeclampsia issafe and better feto maternal outcome.

scholarly journals Remdesivir Treatment for Severe COVID-19 in Third-Trimester Pregnancy: Case Report and Management Discussion

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Grace A Maldarelli ◽  
Megan Savage ◽  
Shawn Mazur ◽  
Corrina Oxford-Horrey ◽  
Mirella Salvatore ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
Vaginal Delivery ◽  
Third Trimester ◽  
Trimester Pregnancy ◽  
In Pregnancy

Abstract We report a case of COVID-19 in third-trimester pregnancy, who required support in an intensive care unit and received remdesivir. After discharge, she had an uncomplicated vaginal delivery at term. COVID-19 in pregnancy may be managed without emergent delivery; a multispecialty team is critical in caring for these patients.

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

Induction of Labour Using Oral Prostaglandin E2 Tablets

1975 ◽  
Vol 3 (5) ◽  
pp. 300-303 ◽  
Author(s):  
M G Elder ◽  
M Stone
Keyword(s):  
Side Effects ◽  
Prostaglandin E2 ◽  
Vaginal Delivery ◽  
Maximum Dose ◽  
Induction Of Labour ◽  
Prostaglandin E ◽  
Bishop Score ◽  
Gastrointestinal Side Effects ◽  
Hourly Dose

Labour was induced in 91 patients by means of low amniotomy and an escalating dose of oral prostaglandin E2 tablets* up to a maximum dose of 1.5 mg hourly. This regime led to vaginal delivery in 91.2% of patients. The induction delivery interval was 11.2 ± 4.9 and 7.5 ± 4.5 hours for primiparous and multiparous patients respectively. The incidence of gastrointestinal side-effects was 15.4%, with 6 patients being unable to tolerate the regime. It is suggested that a higher hourly dose is necessary for primiparous patients with a low Bishop score.

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