COMPARISON OF MISOPROSTOLAND DINOPROSTONE FOR ELECTIVE INDUCTION OF LABOUR IN NULLIPAROUS WOMEN AT FULL TERM: A RANDOMIZED PROSPECTIVE STUDY

2021 ◽  
pp. 65-67
Author(s):  
Swati Swati ◽  
Rakhi Kumari ◽  
Minu Sharan
Keyword(s):  
Prospective Study ◽  
Neonatal Intensive Care ◽  
Admission Rate ◽  
Neonatal Unit ◽  
Secondary Outcome ◽  
Nulliparous Women ◽  
Misoprostol Group ◽  
Elective Induction ◽  
Unfavorable Cervix ◽  
Vaginal Misoprostol

Background: The objective of this randomized prospective study was to compare the efcacy of 50 mcg vaginal misoprostol and 3 mg dinoprostone, administered every nine hours for a maximum of three doses, for elective induction of labor in nulliparous women with an unfavorable cervix and more than 40 weeks of gestation. Material And Methods: One hundred and sixty-three pregnant women with more than 285 days of gestation were recruited and analyzed. The main outcome measures were time from induction to delivery and incidence of vaginal delivery within 12 and 24 hours. Admission rate to the neonatal intensive care unit within 24 hours post delivery was a secondary outcome. Results: The induction-delivery interval was signicantly lower in the misoprostol group than in the dinoprostone group (11.9 h vs. 15.5 h, p < 0.001). With misoprostol, more women delivered within 12 hours (57.5% vs. 32.5%, p < 0.01) and 24 hours (98.7% vs. 91.4%, p < 0.05), spontaneous rupture of the membranes occurred more frequently (38.8% vs. 20.5%, p < 0.05), there was less need for oxytocin augmentation (65.8% vs. 81.5%, p < 0.05) and fewer additional doses were required (7.5% vs. 22%, p < 0.05). Although not statistically signicant, a lower Caesarean section (CS) rate was observed with misoprostol (7.5% vs. 13.3%, p > 0.05) but with the disadvantage of higher abnormal fetal heart rate (FHR) tracings (22.5% vs. 12%, p > 0.05). From the misoprostol group more neonates were admitted to the intensive neonatal unit, than from the dinoprostone group (13.5% vs. 4.8%, p > 0.05). One woman had an unexplained stillbirth following the administration of one dose of dinoprostone. Conclusions: Vaginal misoprostol, compared with dinoprostone in the regimens used, is more effective in elective inductions of labor beyond 40 weeks of gestation. Nevertheless, this is at the expense of more abnormal FHR tracings and more admissions to the neonatal unit, indicating that the faster approach is not necessarily the better approach to childbirth

scholarly journals Oral Versus Vaginal Misoprostol in the Management of Missed Abortion

2018 ◽  
Vol 24 (2) ◽  
pp. 106-110
Author(s):  
Khondokar Seheli Nasrin Lina ◽  
Mst Rokeya Khatun ◽  
Hasina Akhter
Keyword(s):  
Side Effects ◽  
Care Delivery ◽  
Secondary Outcome ◽  
Cervical Canal ◽  
Secondary Outcome Measure ◽  
Missed Abortion ◽  
Expulsion Rate ◽  
Misoprostol Group ◽  
Oral Group ◽  
Vaginal Misoprostol

Missed abortions are common and represent a significant gynaecological emergency workload. The search for a non invasive method with high success rate has led to the use of misoprostol. Most research into the use of misoprostol for the medical evacuation of missed abortion has concentrated on its effect after oral administration. Recent evidence suggested an improved efficacy of uterine evacuation and a reduced incidence of side-effects if misoprostol was administered vaginally. The present study has been designed to compare the safety and efficacy of oral versus vaginal misoprostol for medical management of missed abortion. The present study was experimental and randomized. A total of 100 women with pregnancies of < 12 weeks from last menses (verified by ultrasound) were recruited for the study. Eligible women were allocated randomly to the two treatment groups by means of lottery. The primary outcome was measured by complete expulsion rate. The secondary outcome measure was patient’s side effects and satisfaction. The following variables were compared: complete or incomplete expulsion of the conceptus in 24 hours, induction expulsion interval time, side effects; dilatation of cervical canal in those patients who required surgical intervention, number of doses required, women’s perception and duration of hospital stay.  The present study demonstrated that early expulsion of the product following induction, complete expulsion of the product after 24 hours, were significantly higher in the vaginal misoprostol group than those in the oral misoprostol group. The dose of misoprostol was also much lower in the vaginal group compared to the oral group. The need for surgical evacuation was markedly decreased in the vaginal group than that in the oral group.  So, treatment of missed abortion by misoprostol through vaginal route should be explored for introduction into health care delivery system nation wide.TAJ 2011; 24(2): 106-110

Risk of cesarean in obese nulliparous women with unfavorable cervix: elective induction vs expectant management at term

2014 ◽  
Vol 211 (1) ◽  
pp. 53.e1-53.e5 ◽  
Author(s):  
Heather Wolfe ◽  
Julia Timofeev ◽  
Eshetu Tefera ◽  
Sameer Desale ◽  
Rita W. Driggers
Keyword(s):  
Expectant Management ◽  
Nulliparous Women ◽  
Elective Induction ◽  
Unfavorable Cervix

scholarly journals COMPARISON OF PROSTAGLANDIN E2 WITH MISOPROSTOL FOR INDUCTION OF LABOUR AT TERM

2008 ◽  
Vol 15 (03) ◽  
pp. 344-349
Author(s):  
TAYYIBA WASIM ◽  
SAQIB SIDDIQ
Keyword(s):  
Prostaglandin E2 ◽  
Neonatal Intensive Care ◽  
Perinatal Death ◽  
Statistical Significance ◽  
Fetal Distress ◽  
Labour Induction ◽  
Vaginal Tablet ◽  
Misoprostol Group ◽  
Meconium Staining ◽  
Vaginal Misoprostol

. Objective: To evaluate the use of vaginal misoprostol compared with vaginal prostaglandin E2(PGE2) for labour induction at term. Design: Experimental. Setting: Gynae Unit III, Department of Obstetrics andGynaecology SIMS / Services Hospital Lahore. Methods: Patients were randomized to two groups with 100 patientsin each group. One group received 50:g of misoprostol vaginally every four hours up till 5 doses , second group wasgiven 3mg PGE2 vaginal tablet every 6hrs up till 3doses. The drug was stopped earlier if active labour started.Results: 96% of patients were successfully induced in misoprostol group verses 84%patients in PGE2 group (P=0.01).Mean induction delivery interval was significantly short in misoprostol group 13.3 + 8.7 hours verses 18.5 + 11.3 hoursin PGE2 group (P=0.01). 35% patients in misoprostol group and 40% in PGE2 group (P=0.46) had C/Sections.Increase Meconium staining and fetal heart rate abnormalities was seen in misoprostol group (P=0.03). 20% of babiesin misoprostol group had low APGR Score and needed neonatal intensive care unit admission, as compared to 12%in PGE2 group but failed to show statistical significance (P=0.12). There was no perinatal death in both groups. Hyperstimulation was seen in only one patient of misoprostol group. Conclusion: Misoprostol is more effective than PGE2in successfully inducing the patient but it does not reduce C/Section rate. Moreover it is associated with increasechances of fetal distress. Despite being cheaper than PGE2, it cannot be advocated superior to PGE2 in terms offetomaternal outcome. Further studies with lower doses of misoprostol are recommended.

The value of ultrasound measurement of cervical length and parity in prediction of cesarean section risk in term premature rupture of membranes and unfavorable cervix

2017 ◽  
Vol 45 (1) ◽  
Author(s):  
Nada Aracic ◽  
Ivica Stipic ◽  
Ivana Jakus Alujevic ◽  
Petar Poljak ◽  
Mario Stipic
Keyword(s):  
Cesarean Section ◽  
Neonatal Intensive Care ◽  
Perinatal Death ◽  
Mode Of Delivery ◽  
Cervical Length ◽  
Ultrasound Measurement ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Nulliparous Women ◽  
Unfavorable Cervix

AbstractAim:To evaluate the influence of cervical length (CL) and parity as prediction factors for assessment of cesarean section (CS) risk in women with premature rupture of membranes (PROM) at term and unfavorable cervix, undergoing induction of labor (IOL) with dinoprostone intracervical gel.Methods:A prospective study involved 50 nulliparous and 51 multiparous women admitted for IOL. Pre-induction CL was measured and delivery outcomes were recorded.Results:Nulliparous women were younger than the multiparous (26.6±5.2 vs. 30.5±4.9; P<0.001) and had longer pre-induction CL (35.6±5.5 vs. 31.5±4.8; P<0.001) and induction-delivery interval (582 vs. 420 min; P<0.001). There was no difference in the mode of delivery, CS indications, Apgar score, neonatal weight, the rate of neonatal intensive care unit admission and perinatal death in respect of parity. CL was significantly shorter in vaginal vs. cesarean deliveries regardless of parity (31.4 vs. 38.8 mm, P<0.001, respectively). Cut-off values of CL for predicting CS were 37.5 mm in nulliparae and 34.5 mm in multiparae.Conclusions:CLs of 37.5 mm in nulliparae and 34.5 mm in multiparae were determined as the cut-off values in predicting CS risk in women with PROM at term and unfavorable cervix.

Chorioamnionitis after premature rupture of membranes in nulliparas undergoing labor induction: prostaglandin E2 vs. oxytocin

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Moti Gulersen ◽  
Cristina Zottola ◽  
Xueying Li ◽  
David Krantz ◽  
Mariella DiSturco ◽  
...  
Keyword(s):  
Prostaglandin E2 ◽  
Neonatal Intensive Care ◽  
Labor Induction ◽  
Cervical Ripening ◽  
Time Interval ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Chi Squared ◽  
Unfavorable Cervix ◽  
Cox Proportional Hazard Regression

Abstract Objectives To assess the risk of chorioamnionitis in nulliparous, term, singleton, vertex (NTSV) pregnancies with premature rupture of membranes (PROM) and an unfavorable cervix undergoing labor induction with either prostaglandin E2 (PGE2) or oxytocin only. Methods Retrospective cohort of NTSV pregnancies presenting with PROM who underwent labor induction with either PGE2 (n=94) or oxytocin (n=181) between October 2015 and March 2019. The primary outcome of chorioamnionitis was compared between the two groups. Statistical analysis included Chi-squared and Wilcoxon rank-sum tests, as well as logistic regression. For time to delivery, a Cox proportional hazard regression was used to determine the hazard ratio (HR) and adjusted HR (aHR). Results Baseline characteristics were similar between the two groups. Cervical ripening with PGE2 was associated with an increased rate of chorioamnionitis (18.1 vs. 6.1%; aOR 4.14, p=0.001), increased neonatal intensive care unit admissions (20.2 vs. 9.9%; aOR 2.4, p=0.02), longer time interval from PROM to delivery (24.4 vs. 17.9 h; aHR 0.56, p=<0.0001), and lower incidence of meconium (7.4 vs. 14.4%; aOR 0.26, p=0.01), compared to the oxytocin group. Conclusions Based on our data, the use of oxytocin appears both superior and safer compared to PGE2 in NTSV pregnancies with PROM undergoing labor induction.

scholarly journals Perinatal Outcome of the Second Twin

2015 ◽  
Vol 10 (1) ◽  
pp. 89-93
Author(s):  
R Joshi ◽  
G Baral
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Mode Of Delivery ◽  
Admission Rate ◽  
Second Twin

Aims: The purpose of this study was to determine the perinatal outcome of the second twin compared to the first one. Methods: This is a hospital based comparative study of 60 pregnant women with twin pregnancy at Paropakar Maternity and Women’s Hospital, Kathmandu from 14 January 2013 to13 April 2013. Apgar score and admission to neonatal intensive care unit of the first and the second twins were studied in relation to the gestational age, chorionicity, mode of delivery, inter-delivery interval and birth weight. Mc Nemars test was used with 0.05 as the level of significance. Results: Among 60 sets of twins, Apgar score of the second twin was found to be lower than the first one (p=0.02) in general and in preterm gestation (p=0.049), dichorionic diamniotic chorionicity (p=0.012), vaginal delivery (p<0.001), inter-delivery interval of <30 minutes (p=0.007) and birth weight discordance of <30 % (p=0.014). Admission to neonatal intensive care unit was not significant (p=0.5). Conclusions: Second twin had low Apgar score and the neonatal admission rate was similar for both twins. 

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