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 Oral misoprostol solution in comparison to vaginal misoprostol for induction of labour in a randomized controlled trial

2020 ◽  
Vol 9 (9) ◽  
pp. 3530
Author(s):  
Ahmed M. Abbas ◽  
Peter R. Thabet ◽  
Amgad E. Abour Gamrah ◽  
Osama S. El-Kady
Keyword(s):  
Controlled Trial ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Controlled Clinical Trial ◽  
P Value ◽  
Randomized Controlled ◽  
Group I ◽  
Oral Misoprostol ◽  
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: This randomized controlled clinical trial was conducted on a total of 100 patients randomly selected among primigravida at term women undergoing induction of labour for obstetric or medical indication for labour induction in Ain Shams University Maternity Hospital. They were divided into two Groups: Group I: patients undergoing induction of labour using misoprostol oral solution and Group II: patients undergoing induction of labour using vaginal misoprostol.Results: Oral misoprostol solution has less induction delivery duration and less side effects than vaginal misoprostol. The induction-delivery time with the oral route compared to the vaginal one (15.2 versus 20.3 hours respectively) with significant p-value (<0.001).Conclusions: Titrated oral misoprostol is safe and effective for labour induction in primigravida patients with unfavorable cervix.

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 A Comparison of Orally Administered Misoprostol With Vaginally Administered Misoprostol For Cervical Ripening And Labour Induction

KYAMC Journal ◽  
2017 ◽  
Vol 7 (1) ◽  
pp. 668-672 ◽  
Author(s):  
Sohana Siddique ◽  
Muhammad Jahangir Howlader ◽  
Joysree Saha ◽  
Kazi Shahnaz Begum
Keyword(s):  
Mode Of Delivery ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Efficacy And Safety ◽  
Cross Sectional ◽  
Oral Misoprostol ◽  
Number Of Patients ◽  
Oral Group ◽  
Vaginal Misoprostol ◽  
Duration Of Pregnancy

Objective: To compare efficacy and safety of oral misoprostol over vaginal misoprostol for labour induction.Materials and Methods: This is a cross sectional interventional hospital based comparative study which was carried in the department of Obstetrics and Gynecology in DMCH from 01.07.2008 to 31.12.2008.Results: Almost equal number of patients delivered vaginally spontaneously in both group, there is no association between route of administration and mode of delivery. Nausea,vomiting occurred more in oral group and uterine hypertonicity more in vaginal group.Conclusion: In this study, 50 patients were randomly selected for oral group and 50 patients for vaginal group. There were no significant differences regarding age, duration of pregnancy, Bishop's score and indication of induction of labour.KYAMC Journal Vol. 7, No.-1, Jul 2016, Page 668-672

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 Evaluation of Intubating Conditions during Direct Laryngoscopy using Sniffing Position and Simple Head Extension- A Randomised Clinical Trial

2021 ◽  
Author(s):  
Amanjot Singh ◽  
Rupinder Kaur ◽  
Gurpreet Singh ◽  
Kewal Krishan Gupta
Keyword(s):  
Clinical Trial ◽  
Tracheal Intubation ◽  
Direct Laryngoscopy ◽  
Randomised Clinical Trial ◽  
P Value ◽  
Group I ◽  
Head Extension ◽  
Number Of Patients ◽  
Lehane Grade ◽  
Group Ii

Introduction: Optimal laryngeal visualisation during direct laryngoscopy requires adequate positioning of the head and neck. Traditionally, Sniffing Position (SP) is the recommended position to provide superior glottic visualisation. However various studies in recent past have challenged the superiority of SP. Aim: To evaluate whether SP provides better glottic visualisation and ease of intubation {as assessed by total Intubation Difficulty Score (IDS) score as well as its individual components} compared to Simple Head Extension (SHE) during direct laryngoscopy and endotracheal intubation. Materials and Methods: The randomised clinical trial was conducted at GGS Medical College and Hospital, Faridkot, Punjab, India, from May 2019 to October 2020, on 220 patients. Patients undergoing elective surgeries under general anaesthesia were randomly divided into two groups. Laryngoscopy and tracheal intubation in Group I was done in SP, which was obtained by placing a non compressible pillow of height 8 cm under the patient’s head. Patients in Group II underwent laryngoscopy and tracheal intubation in SHE position. Glottic visualisation using modified Cormack and Lehane (CL) grades, IDS and sympathetic responses between the two groups were studied. The data was compared using student’s t-test and Chi-square test. Results: Cormack and Lehane Grade I was seen in 69 (62.7%) of patients in Group I as against 51(46.4%) of patients in Group II (p-value=0.015). Easy intubation (total IDS score=0) was seen in a greater number of patients in Group I (60.9%) as compared to Group II (40.95%) (p-value=0.003). Slight difficulty in intubation (total IDS score=1-5) was encountered in 50.0% of patients in group II (n=55) and 35.5% of patients in group I (n=39) (p-value=0.029). Conclusion: The present study concluded that use of SP resulted in better glottic visualisation and was associated with favourable intubation conditions as compared to SHE position.

scholarly journals Mifepristone versus oxytocin for cervical ripening prior to induction of labour

2018 ◽  
Vol 6 (3) ◽  
pp. 90-95
Author(s):  
Rosina Manandhar ◽  
Rachana Saha ◽  
Junu Bajracharya ◽  
Rumina Malla
Keyword(s):  
Controlled Trial ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Good Alternative ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
P Value ◽  
Delivery Mode ◽  
Vaginal Deliveries ◽  
Number Of Patients

Background: Induction of labour is one of the most important interventions done in modern obstetric practice and the success of induction techniques depends upon its role in cervical ripening and improvement in the Bishop’s score.Objectives: This study was done to compare the improvement in Bishop’s score among the women receiving oral mifepristone and oxytocin infusion to ripen the cervix prior to induction of labour at term.Methods: This was a hospital based, prospective randomized controlled trial conducted from August 2015 to February 2016. A total 68 patients were randomized into two groups: Mifepristone group and Oxytocin group. The improvement in Bishop’s score prior to and after 48 hours of cervical ripening, induction to delivery interval in vaginal delivery, mode of delivery, any adverse maternal and foetal outcome were recorded in both the groups.Results: The study demonstrated an overall significant improvement in Bishop’s score in mifepristone group compared to oxytocin group (p-value=0.003). A significant number of patients in mifepristone group had improved mean Bishop’s score (p-value=0.001) after 48 hours of cervical ripening. There were more vaginal deliveries in the mifepristone group, with shorter mean induction to delivery interval as compared to the oxytocin group. There were no maternal side effects and adverse perinatal outcomes in both the groups.Conclusions: Mifepristone is a good alternative to oxytocin for cervical ripening for induction of labour.

scholarly journals Role of dinoprostone gel in induction of labour

2021 ◽  
Vol 10 (3) ◽  
pp. 1017
Author(s):  
Meet S. Patel ◽  
Shashwat K. Jani ◽  
Babulal S. Patel ◽  
Akshay C. Shah
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Induction Of Labour ◽  
Labour Induction ◽  
Western India ◽  
Group I ◽  
First Choice ◽  
Acceptable Method ◽  
Group Ii

Background: Labour induction is one of the most common intervention in obstetric practice. A simple application of PGE2 intracervical gel can ripen the cervix effectively and improve Bishop’s score there by helping in successful vaginal delivery. Considering its good performance, the dinoprostone slow-release vaginal insert is the first choice for elective induction of labour in postdate pregnancy and in patients with term pregnancy of premature rupture of membranes.Methods: This was a single year retrospective study conducted in a tertiary care center of western India from May 2019 to May 2020.Results: In group I women who delivered within 24 hours were included, in group II women who required re-instillation were included. The most common indication for induction in both the groups was past dates (accounting for 36.1% in group I and 47.3% in group II). The success rate in group I was 68.1% while in group II was 36.8%.  The rate of cesarean delivery in group I was 25.9%, while in Group II, it was 60.1%. Negligible maternal and neonatal complications were seen in both the groups.  Conclusions: The study showed that intracervical application of prostaglandin E2 is an effective, safe and acceptable method for induction of labor in women with unfavorable cervix and indications for induction. All these effects were achieved without increasing maternal and neonatal morbidity 

scholarly journals Efficacy of Dinoprostone Vaginal Pessary for Cervical Ripening and Induction of Labour

2021 ◽  
Vol 10 (12) ◽  
pp. 873-877
Author(s):  
Mamatha C ◽  
Sarmishta M ◽  
Dhanalakshmi M.G
Keyword(s):  
Pregnant Women ◽  
Vaginal Delivery ◽  
Active Phase ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Time Interval ◽  
Delivery Time ◽  
Phase Time ◽  
Vaginal Pessary

BACKGROUND To evaluate the efficacy of dinoprostone vaginal pessary for cervical ripening and labour induction in term pregnant women. METHODS This was a prospective observational study conducted at Sri Ramachandra Institute of Higher Education and Research from September 2016 to September 2018. The study included pregnant women with singleton pregnancy and gestational age (GA) between 37 weeks and 41 weeks of gestation. The estimated sample size was 100. All 100 women were induced with dinoprostone vaginal pessary. RESULTS The average induction to active phase interval was 10 hours 58 minutes. About 60.3 % of primigravida had an active phase time interval of 12 hours 03 minutes; and 95.2 % of primigravida delivered < 24 hours with a mean induction to delivery time interval of 17 hours 36 minutes. 4 % of primigravida had failed induction. About 84.8 % of multigravida delivered with mean induction to active phase time interval of 08 hours 57 minutes and 100 % of multigravida delivered < 24 hours with a mean induction to delivery time interval of 12 hours 19 minutes. Out of 100 patients, 80 % of patients delivered by spontaneous vaginal delivery with episiotomy, 5 % of patients delivered by assisted vaginal delivery with episiotomy and 15 % of patients delivered by Caesarean section. Almost 97 % of multiparous women delivered vaginally. No adverse maternal and neonatal outcome was noted in the present study. CONCLUSIONS Dinoprostone vaginal pessary is highly effective in the induction of labour at term in properly selected cases. In terms of success and failure, dinoprostone vaginal pessary does not differ much from dinoprostone gel. KEY WORDS Labour Induction, Propess, Dinoprostone

scholarly journals Comparative study of efficacy and safety of vaginal misoprostol versus oral misoprostol in induction of labour when used in equal doses

2017 ◽  
Vol 6 (9) ◽  
pp. 3828
Author(s):  
Ambika H. E. ◽  
Swathi Bhat ◽  
Lepakshi B. G. ◽  
Savitha C. S.
Keyword(s):  
Induction Of Labour ◽  
Labour Induction ◽  
Successful Outcome ◽  
P Value ◽  
Oral Misoprostol ◽  
Significant Difference ◽  
Successful Induction ◽  
Oral Group ◽  
Vaginal Misoprostol ◽  
Group B

Background: It was a randomized controlled prospective study. A large number of women in their advanced pregnancies often need labour induction for various reasons. This study aims to evaluate a safe, effective and inexpensive mode of medical induction. The purpose of the study is to evaluate the safety and efficacy of vaginal misoprostol versus oral misoprostol in induction of labour when used in equal doses.Methods: Two hundred patients were included in the study. They were divided into two groups of 100 patients each. One group i.e. Group A received vaginal misoprostol while the other group i.e. Group B received oral misoprostol. The dosage was 50μg every 6th hourly maximum of four doses. The progress of labour in both groups was charted on a partogram. The outcome of pregnancy, maternal and foetal outcomes were statistically analysed.Results: When compared with respect to age, height, gestational age, indication for induction, there was no difference in either of the groups. The numbers of doses of misoprostol for successful outcome of labour in the vaginal group i.e. 2.25±0.53 was lesser than the dosage needed in the oral group i.e. 2.71±0.60 (P value M 0.0001). which is highly significant. The induction-delivery interval was also less in the vaginal group compared to the oral group. (12.90±2.40 hours versus 15±75 hours). Only 13 women in the vaginal group needed acceleration with oxytocin in contrast to 17 women in the oral group. The need for caesarean section in women induced with vaginal misoprostol was 12 women in comparison to oral group which was 32 women. No statistically significant difference was seen in neonatal outcome in either of the groups.Conclusions: When given in equal doses the vaginal administration of misoprostol is more effective in successful induction of labour when compared to oral misoprostol.

scholarly journals TO COMPARE THE EFFICACY OF PGE2 GEL AND 25ΜG OF INTRAVAGINAL MISOPROSTOL FOR INDUCTION OF LABOR IN TERM PROM

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Sunita Maheshwari ◽  
Shweta Jinger
Keyword(s):  
Low Dose ◽  
Induction Of Labour ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Term Pregnancy ◽  
Vaginal Tablet ◽  
Misoprostol Group ◽  
Group A ◽  
Vaginal Misoprostol ◽  
Group B

Background: Induction of labour is one of the most common obstetric interventions worldwide. The study was conducted to compare the efficacy and safety of 25µg (low dose) vaginal Misoprostol with intracervical Dinoprostone for cervical ripening and induction of labour in term pregnancy. Methods: For the purpose of this study, 100 term pregnancy patients (only primigravidae and second gravidae) were included who had spontaneous rupture of membrane before onset of labor. Data was collected from cases admitted in labor room at Pannadhay Mahila Chikitsalaya associated with RNT Medical College,Udaipur between July 2014 to July 2015. Results: Requirement of Oxytocin for augmentation of labor between group A and group B. It is evident from the table that oxytocin was required in only 16% of patients in group A, while 46% in group B. This indicates that requirement of oxytocin was significantly less in misoprostol group (P<0.001). Conclusion: This study was designed to assess efficacy of a 25 μg misoprostol vaginal tablet, Finding confirms that vaginal misoprostol tablet is as effective as dinoprostone in cervical ripening and labour induction with dinoprostone. Keywords: Cervical ripening, Dinoprostone, Labour induction, Low- dose misoprostol.

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