scholarly journals Use of Misoprostol in Pregnancy- A Review Article

2012 ◽  
Vol 22 (2) ◽  
pp. 94-98
Author(s):  
Syeda Ummay Kulsum ◽  
Sabera Khatun ◽  
SM Shahnawaz Bin Tabib
Keyword(s):  
Prostaglandin E2 ◽  
Review Article ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Pharmacological Agents ◽  
Tablet Form ◽  
Cytoprotective Agent ◽  
Medicine Today

Prostaglandins are the pharmacological agents used for induction of labour and augmentation of labour. Prostaglandin E2 gel is used for cervical ripening and induction of labour. These are however, costly and need to be stored in a refrigerator at a temperature of 2 - 8°C, half life 18 months. The Tablet form of prostaglandin E2 is not available in Bangladesh. Misoprostol, a synthetic prostaglandin (PG) E1 analogue is used orally for the treatment of gastric and duodenal ulcer and used as a cytoprotective agent. It was first used for labour induction in 1987. Prostaglandin can be used in several gynaecological and obstetric conditions. It can be given through several routes. This article will elaborately delinate the role of misoprostol, a prostaglandin in obstetrics and gynaecological conditions. Medicine Today 2010 Volume 22 Number 02 Page 94-98 DOI: http://dx.doi.org/10.3329/medtoday.v22i2.12443

scholarly journals A comparative study of intra-cervical foley’s catheter and PGE2 gel for induction of labour at term

2019 ◽  
Vol 8 (9) ◽  
pp. 3689
Author(s):  
Anjali R. Kanada ◽  
Mahima Jain
Keyword(s):  
Side Effects ◽  
Caesarean Section ◽  
Comparative Study ◽  
Foley Catheter ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Mechanical Methods ◽  
Significant Difference ◽  
Foley’S Catheter

Background: In cervical ripening, before induction of labour, is needed to increase the success of labour induction, to reduce complications and to diminish the rate of caesarean section and duration of labour. Pharmacological preparations are in widespread use for cervical ripening but are not free from side-effects and complications. Mechanical methods, i.e. the use of Foley’s catheter balloon, though effective have not gained much popularity because of the fear of infection. Therefore, the study has been conducted to prove the efficacy and safety of extra amniotic Foley catheter balloon and to compare it with intra-cervical prostaglandin E2 (PGE2) gel. The objective of the study was to the success of induction of labor depends on the cervical status at the time of induction. For effective cervical ripening both Foley's catheter and PGE2 gel are used. The aim of this study was to compare the efficacy of intra cervical Foley's catheter and intra cervical PGE2 gel in cervical ripening for the successful induction of labor.Methods: A randomized, comparative study was conducted in the department of obstetrics and gynaecology, Civil hospital, B.J. Medical College Ahmedabad, during a period of 8 month from September 2018 to April 2019. 100 patients at term with a Bishop's score ≤5 with various indications for induction were randomly allocated to group F (intra-cervical Foley’s catheter) and group P (PGE2 gel) with 50 women included in each group.Results: The groups were comparable with respect to maternal age, gestation age, indication of induction and initial Bishop's score. Both the groups showed significant change in the Bishop's score, 5.10±1.55 and 5.14±1.60 for Foley's catheter and PGE2 gel, respectively, p <0.001. However there was no significant difference between the two groups. There was no significant difference in the side effects and caesarean section rate in both groups. The induction to delivery interval was 16.01±5.50 hours in group F and 16.85 ± 3.81 hours in group P (p=0.073). Apgar scores, birth weights and NICU admissions showed no significant difference between the two groups.Conclusions: The study shows that both Foley's catheter and PGE2 gel are equally effective in pre induction cervical ripening.

scholarly journals Comparative study on cervical ripening and labour induction with dinoprostone versus foley’s catheter with extra amniotic saline infusion

2020 ◽  
Vol 9 (10) ◽  
pp. 4080
Author(s):  
Rachel Alexander A. ◽  
Gigi A.
Keyword(s):  
Gestational Age ◽  
Mode Of Delivery ◽  
Cost Effective ◽  
Similar Efficacy ◽  
Saline Infusion ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Maternal Complications ◽  
Significant Difference

Background: Induction of labour is defined as initiation of uterine contractions before spontaneous onset of labour. This observational study compares the effect of prostaglandin E2 (PGE2) and extra amniotic saline infusion (EASI) for pre-labour ripening of unfavourable uterine cervix.Methods: This was a prospective study conducted on 100 pregnant women with gestational age ≥37 weeks during a year period in the department of obstetrics and gynaecology of government TD medical college, Alappuzha, Kerala. The period of study was for one year from June 2002 to July 2003. All patients were divided into two groups. Group-1 contains 47 patients who received intracervical PGE2, (Dinoprostone gel, 0.5 mg). Group-2 contains 53 patients who were induced with EASI. The main outcome variables were the number of subjects with favourable Bishop's score, mode of delivery, maternal complications and neonatal outcomes.Results: Majority of the patients in both the groups were in the age of 21-30 years. There was significant difference in age, parity and gestational age of both groups. In this study it was found significant difference in the occurrence of hyper stimulation among PGE2 and EASI; whereas, there was no significant difference in the occurrence of maternal pyrexia among two groups. High incidence of caesarean section was found in EASI. APGAR score of new born babies was high in labour induced with PGE2.Conclusions: PGE2 and EASI have similar efficacy in induction of labour, but EASI is associated with more side effects. Cost wise EASI is more cost effective than PGE2.

scholarly journals Mifepristone as pre-induction cervical ripening agent: a review article

2019 ◽  
Vol 8 (11) ◽  
pp. 4636
Author(s):  
Nikita . ◽  
Seetesh Ghose ◽  
Setu Rathod
Keyword(s):  
Adverse Effects ◽  
Vaginal Delivery ◽  
Perinatal Outcome ◽  
Neonatal Outcome ◽  
Mode Of Delivery ◽  
Review Article ◽  
Induction Of Labour ◽  
Present Review ◽  
Cervical Ripening ◽  
Successful Induction

Induction of labour after the period of viability by any methods medical, surgical or combined, for the purpose of vaginal delivery. The success of induction, to a great extent, depend upon pre-induction cervical status i.e. cervical ripening. So, ripening of cervix prior to induction i.e. pre-induction cervical ripening is one of the important steps for successful induction of labour. There are different methods for cervical ripening like prostaglandins (PGE). However, use of prostaglandins (PGE) and oxytocin as labour inducing agent has its own adverse effects on maternal and perinatal outcome. So, constant efforts are made for the less use of uterotonins. The present review aims to study the efficacy of oral Mifepristone for improvement in Bishop’s score, requirement of additional uterotonics, induction delivery interval, mode of delivery and neonatal outcome. Electronic databases were searched by using keywords ‘Mifepristone, RU486, PGE2 gel, Cervical ripening, Bishop’s score and Induction of labour’ and eleven articles were found from 2009 to 2018 which fulfils our study criteria and thus they were taken for review. Based on all the studies, Mifepristone appears to be effective cervical ripening in comparison to other agents with significant improvement in Bishop’s score, higher vaginal delivery rate, shorter induction delivery interval and good neonatal outcome.

scholarly journals Role of mifepristone in pre-induction cervical ripening: a double blind placebo-controlled study

2021 ◽  
Vol 11 (1) ◽  
pp. 110
Author(s):  
Sandeep Sood ◽  
Bhupesh Kumar Goyal ◽  
Navpreet Kaur
Keyword(s):  
Primary Outcome Measure ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Controlled Study ◽  
Double Blind Study ◽  
Bishop Score ◽  
Double Blind ◽  
Spontaneous Labour ◽  
Meconium Staining

Background: Mifepristone has been used for cervical priming and labour induction for long with modest success. This double-blind study compares mifepristone with placebo in causing cervical ripening and inducing spontaneous labour in women past their expected date of delivery.Methods: 200 women at 40 weeks gestation received mifepristone or placebo after Bishop score was assessed. 48 hours later, cervical score was rechecked. Improvement in Bishop score was noted as primary outcome measure. Incidence of spontaneous labour, cesarean delivery and meconium staining of liquor during labour was also monitored.Results: 16 women went into labour before 48 hours and 184 were evaluable. Improvement in Bishop score was noted in significantly more women in mifepristone group (82/94 versus 42/90, p<0.0001). Mean change in Bishop score was 3.22 in mifepristone group and 1.61 in placebo group. This advantage in cervical ripening with mifepristone did not translate into better obstetric outcome. The incidence of spontaneous labour (64/94 mifepristone versus 60/90 placebo), cesarean section (4/94 versus 12/90) and MSL (8/94 versus 10/90) was comparable in the two groups and did not reach statistical significance.Conclusions: Mifepristone has a beneficial effect on cervical ripening in term pregnancies but does not offer obstetric advantage in terms of higher rates of spontaneous labour or vaginal delivery. 

scholarly journals Prostaglandin insert Dinoprostone versus trans-cervical balloon catheter for out-patient labour induction: A randomised controlled trial of feasibility (PROBIT-F)

2020 ◽  
Author(s):  
Amarnath Bhide ◽  
Christine McCourt ◽  
Barbara Barrett ◽  
Georgina Cupples ◽  
Rose Coates ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Health Economics ◽  
Controlled Trial ◽  
Good Condition ◽  
Balloon Catheter ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Patient Questionnaire ◽  
Randomised Controlled

Abstract BackgroundThe aim was to assess the feasibility of conducting a randomised controlled trial (RCT) of induction of labour comparing use of two methods in the out-patient setting.MethodsAn open-label feasibility RCT was conducted in two UK maternity units from October 2017 to March 2019. Women aged ≥16 years, undergoing Induction of labour (IoL) at term, with intact membranes and deemed suitable for out-patient IoL according to local guidelines were considered eligible. They were randomised to cervical ripening balloon catheter (CRB) or vaginal Dinoprostone (Propess). The participants completed a questionnaire and a sub-group underwent detailed interview. Health economics data were collected. Women who declined to participate were also requested to complete a decliners’ questionnaire.ResultsDuring the study period 274 eligible women were identified. 230 (83.9%) were approached for participation of whom 84 (36.5%) agreed. Of these, 38 were randomised to Propess (n=20) and CRB (n=18). The intended sample size of 120 was not reached due to restrictive criteria for suitability for out-patient IoL. The intervention as randomised was received by 29/38 (76%) women. Five of the 29 participants could not go home after intervention. Spontaneous vaginal delivery was observed in 9/20 (45%) women in the Dinoprostone group, and 11/18 (61%) women in the CRB group. Severe maternal adverse events were recorded in one woman in each group. All babies were born with good condition (5-minute Apgar score >7) and all except one (37/38, 97.4%) remained with the mother after delivery. No deaths were recorded.Full health economics data were available for 36 out of the 38 participants. 21% of women in the Dinoprostone group were re-admitted prior to diagnosis of active labour compared to 12% in the CRB group. The patient questionnaire was complete and available for analysis for 37/38 (97.4%) women. Interviews were undertaken for 21/38 women.ConclusionsA third of the approached eligible women agreed for randomisation. An RCT is not feasible using existing criteria and further modifications to the eligibility criteria for out-patient IoL would be needed to reach sufficient numbers in the current service context.

scholarly journals Labour Induction Methods: An Overview

2021 ◽  
pp. 119-127
Author(s):  
Sanjivani Wanjari ◽  
Anil Wanjari
Keyword(s):  
Cervical Ripening ◽  
Labour Induction ◽  
Pharmacological Agents ◽  
Mechanical Methods ◽  
Surgical Methods ◽  
The Status ◽  
Oxytocin Infusion ◽  
Posterior Fornix ◽  
Foley’S Catheter ◽  
Pharmacological Method

Overall the rate of induced labours has increased and almost 25% of women undergo labour induction worldwide. Cervical ripening and cervical preparedness is necessary before labour can be induced. The status of the cervix is traditionally assessed with help of Bishop’s score. Labour induction becomes necessary when the cervix is not favourable as noted on the cervical scoring system. Mechanical or surgical methods or a combination of both can be sued for labour induction. These include Foley’s catheter induction, sweeping of membranes, amniotomy etc. Pharmacological agents like oxytocin, prostaglandins PGE1 & PGE2 and newer agents like mifepristone can be used.  Mechanical methods like Foley’s catheter induction are associated with lesser FHR variability and decreased rates of caesarean section as compared with oxytocin infusion or prostaglandins used locally. Oxytocin is the most widely used pharmacological method used for induction of labour. Proper titration of oxytocin can result in contractions that mimic normal labour. Oxytocin is often combined with amniotomy.  Prostaglandins PGE1 & PGE2 are safe and effective options for labour induction. Prostaglandin PGE1 or misoprostol is used in the dose of 25 microgram mcg given orally or vaginally or via the sub-lingual route. Prostaglandin PGE2 or dinoprostone is used intra-cervically or vaginally in the posterior fornix. The newer drug mifepristone is being studied as cervical ripening agents because of its anti-progesterone effect.

scholarly journals Vaginal Prostaglandin E2 pessary versus gel in induction of labor at term

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
Humaira Akram ◽  
Zohra Khan ◽  
Tabinad Rana
Keyword(s):  
Cost Effectiveness ◽  
Side Effects ◽  
Prostaglandin E2 ◽  
Neonatal Outcome ◽  
Mode Of Delivery ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Bishop Score ◽  
Vaginal Pessary ◽  
Number Of Patients

Objective: To compare the prostaglandin E2 Vaginal pessary and gel with respect to cervical ripening, labour out come, side effects and cost effectiveness in induction of labour at term. Design: Experimental study. Place and duration of study: Lady Willingdon Hospital, Lahore February to July, 2005. Subjects and Methods: The trial was conducted on two group of patient for labour induction such that one group (n=30) received PGE2 vaginal pessary 6 hourly to maximum of 3 doses. Other group (n=30) received PGE2 gel at 6 hourly interval upto 2 doses. Labour induction, number of doses applied, need of augmentation, side effects, induction to delivery interval, mode of delivery, neonatal outcome and cost effectiveness were the main outcome measures. Results: Our results depicted that PGE2 gel produced favourable bishop score more rapidly and initiating uterine contraction simultaneously than PGE2 pessary. Few patients required oxytocin augmentation in gel group (P<0.05). There was no statistically significant d ifference in number of patients delivering vaginally with in 24 hours, the neonatal outcome and cost effectiveness in two groups (P>0.05). However, more side effects such as uterine contractions, abnormalities, and fetal distress observed in gel group (P<0.05). Conclusion: The PGE2 pessary was safe and easily applied, but PGE2 intracervical gel was more effective as it achieved greater changes in mean bishop score. However, more side effects encountered with gel category.

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