Comparison of Oral and Vaginal Administration of Low-dose Misoprostol for Labor Induction

ABSTRACT Objective Comparison of oral and vaginal administration of lowdose misoprostol for induction of labor at term. Materials and methods Two hundred pregnant women after 37 weeks of gestation with an indication for induction were given 25 μg of misoprostol orally (study group) or vaginally (control group), every 3 hours to a maximum of 8 doses. The induction to delivery interval, requirement of oxytocin, dose of misoprostol used, maternal and neonatal outcome were analyzed statistically. Results The median induction to delivery interval was significantly shorter in those induced with vaginal misoprostol (p = 0.06). The median induction to delivery interval was 21.35 ± 7.44 hours in study group and 14.64 ± 5.49 hours in control group. Eighty-two percent women in study group and 84% women in control group had vaginal delivery. Cesarean section rate was lower in control group, 16% vs 18% in study group, but the difference was not statistically significant (p = 0.790). Oxytocin augmentation was needed for 80% cases in the study group and 54% cases in control group, which was statistically significant (p = 0.006). The incidence of abnormal FHR was more in control group as compared to study group (30 vs 14%). Hyperstimulation syndrome was observed in 4% cases in control group and 2% cases in study group. Neonatal outcome was found to be similar in both groups. Conclusion Vaginal misoprostol achieved higher success rate within a short induction interval but was associated with increase in abnormal FHR pattern and abnormal uterine activity as compared to the oral route. Oral route had comparable efficacy, was safe and well-tolerated route of misoprostol administration for induction of labor at term. How to cite this article Mahajan M, Gupta KB, Sharma R, Jyoti R. Comparison of Oral and Vaginal Administration of Low-dose Misoprostol for Labor Induction. J South Asian Feder Obst Gynae 2012;4(3):137-140.

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

QJM ◽

10.1093/qjmed/hcab115.021 ◽

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 < 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 < 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.

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Low Dose Ketoconazole Therapy and Thyroid Functions in Rats

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2019.77 ◽

2002 ◽

Vol 45 (4) ◽

pp. 177-179 ◽

Cited By ~ 1

Author(s):

Hüseyin Çaksen ◽

Ahmet Tutuş ◽

Selim Kurtoğlu ◽

Figen Öztürk ◽

Yüksel Okumuş ◽

...

Keyword(s):

Thyroid Gland ◽

Epithelial Cells ◽

Low Dose ◽

Thyroid Stimulating Hormone ◽

Control Group ◽

Histopathological Analysis ◽

Study Group ◽

Thyroid Function Tests ◽

End Of Treatment ◽

Thyroid Glands

To determine whether low dose ketoconazole (KTZ) has antithyroid action, we studied thyroid function tests in the 13 rats treated with KTZ (20 mg/kg twice daily) for thirty days. Serum triiodothyronine and thyroxine levels were decreased (P <0.05) and serum thyroid-stimulating hormone levels were mildly increased (P >0.05) at the end of treatment. Histopathological analysis of the thyroid glands demonstrated an increase in cylindrical cells in study group, but the epithelial cells were mainly cubical in control group. These findings showed that low dose KTZ had antithyroid effect in rats. The responsible mechanisms may be direct effect of the drug on thyroid gland.

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Oral misoprostol, low dose vaginal misoprostol, and vaginal dinoprostone for labor induction: Randomized controlled trial

PLoS ONE ◽

10.1371/journal.pone.0227245 ◽

2020 ◽

Vol 15 (1) ◽

pp. e0227245 ◽

Cited By ~ 2

Author(s):

David C. Young ◽

Tina Delaney ◽

B. Anthony Armson ◽

Cora Fanning

Keyword(s):

Randomized Controlled Trial ◽

Low Dose ◽

Controlled Trial ◽

Labor Induction ◽

Randomized Controlled ◽

Oral Misoprostol ◽

Vaginal Misoprostol

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The role of oral mifepristone in pre-induction cervical ripening at term

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194853 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4337

Author(s):

Uma H. Chourasia ◽

Mudita Kamlesh Jain ◽

Juzar I. Fidvi

Keyword(s):

Placebo Group ◽

Labor Induction ◽

Cervical Ripening ◽

Controlled Study ◽

Control Group ◽

Study Group ◽

Bishop Score ◽

The Difference ◽

Pg E2 ◽

To Receive

Background: Planned induction of labor is an established part of modern obstetrics and is used as a definite form of treatment where continuation of pregnancy would be detrimental to the health of mother or fetus. The objective of this study was to evaluate the effect of mifepristone in pre-induction cervical ripening and labor induction.Methods: A total of 200 pregnant women at term with Bishop Score 4 or less were selected for this prospective randomized placebo-controlled study. The sample was equally divided into study group to receive 200 mg of mifepristone and control group to receive placebo orally for 2 days. Bishop score was assessed at every 24 hours interval till patient entered in spontaneous labor or 72 hours after 1st dose. Women who did not enter labor spontaneously, labor induction was planned with per vaginal insertion of prostaglandin (PG) E2 analogue, Dinoprostone gel 2.5 mg or PGE1 analogue Tab. Misoprostol 25 µg.Results: Ninety-six subjects in the study group and eighty-one in the control achieved successful ripening of cervix and the difference was statistically significant. Sixty-eight of study group and thirty-nine of placebo group entered in spontaneous active labor within 72 hours. Requirement of oxytocin as adjuvant treatment was significantly lower in the study group. Nineteen women of study group and fifteen of control group delivered within 24 hours, and eighty-one of study group and sixty-two of placebo delivered in 48 hours. The mean induction delivery interval was 35.53±13.67 hours in the study group, whereas it was significantly prolonged in the placebo group 50.49±20.92 hours. Eighty-two subjects of study group and seventy-eight of the control group delivered vaginally, the differences were statistically not significant.Conclusions: Mifepristone was found to be an effective agent for cervical priming prior to labor induction in women at term and significantly reduces the induction delivery interval compared with placebo.

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Titrated oral misoprostol solution versus vaginal misoprostol for labor induction in primi gravid ladies

QJM ◽

10.1093/qjmed/hcaa056.010 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

I M Abdalfattah ◽

W E Mohammed ◽

A A El-gaml

Keyword(s):

Safety Profile ◽

Tap Water ◽

Maternity Hospital ◽

Labor Induction ◽

Induction Of Labor ◽

Cervical Ripening ◽

Controlled Clinical Trial ◽

Solution Versus ◽

Oral Misoprostol ◽

Vaginal Misoprostol

Abstract Background It is now generally accepted that the uterine cervix plays an important role during pregnancy and labor and that it depends on an active ripening process within the cervix; which is necessary for successful labor induction. Aim of the Work to test the safety and efficacy of titrated oral misoprostol compared to vaginal misoprostol for labor induction in term gravid ladies. Patients and Methods This prospective, single-blinded randomized controlled clinical trial was conducted at Ain-Shams University Maternity Hospital during the period between August 2017 and August 2018. 120 pregnant women planned for induction of labor were recruited in the study according to the inclusion / exclusion criteria. Subjects included in the study were randomized into two groups: patients who received oral 200 ug misoprostol in 200 ml water titrated over 24 hours and placebo tablets vaginally which resemble vagiprost tablets (25 microgram misoprostol) and the second group contained pients who received vaginal misoprostol 25microg maximum four doses, and placebo solution of 200 ml of tap water. Results titrated oral misoprostol is as effective in promoting cervical ripening and inducing labor as intravaginal misoprostol, oral Misoprostol has a similar maternal and perinatal safety profile to vaginal misoprostol. Conclusion This new approach to oral misoprostol administration was successful in minimizing the risk of uterine hyper-stimulation, which has been a feature of misoprostol use for induction of labor, at the expense of a somewhat slower response. Oral Misoprostol has a similar maternal and perinatal safety profile compared to vaginal misoprostol.

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Maternal and neonatal outcome of births in alongside midwifery units: A cohort study from a tertiary center in Germany

10.21203/rs.2.15294/v1 ◽

2019 ◽

Author(s):

Waltraut Maria Merz ◽

Laura Tascon-Padron ◽

Marie-Therese Puth ◽

Andrea Heep ◽

Sophia L. Tietjen ◽

...

Keyword(s):

Primary Outcome ◽

Neonatal Outcome ◽

Obstetric Care ◽

Models Of Care ◽

Low Risk ◽

Control Group ◽

Study Group ◽

Second Stage Of Labor ◽

Second Stage ◽

Low Risk Women

Abstract Background For healthy women entering birth after uneventful pregnancy, midwife-led models of care have the potential to reduce interventions and increase the vaginal birth rate without compromising the maternal or health of the neonate. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. Alongside midwifery units (AMU) have been established in 2003. We compared the outcome of all births in the AMU at our hospital from 2010 to 2017 with a matched group of low-risk women who gave birth during the same period of time in standard obstetric care. Methods We used a retrospective cohort study design. The study group consists of all women admitted to labor ward who had registered for birth in AMU. For the control group, low-risk women were selected; additionally, matching was performed for parity. Mode of birth, postpartum hemorrhage, and obstetric injury was chosen as primary outcome parameter for the mother. For the neonate, a composite primary outcome (5-minute Apgar <7 or umbilical cord arterial pH < 7.20 or transfer to specialist neonatal care) was defined. Secondary outcomes included epidural analgesia, duration of the second stage of labor, and episiotomy rate. Non-inferiority was assessed, and multiple logistic regression analysis was performed. Results 612 women were admitted for labor in AMU, the control group consisted of 612 women giving birth in standard obstetric care. Women in the study group were on average older and had a higher BMI; birthweight was on average 95 g higher. Except for birth injuries, non-inferiority could be established for the primary outcomes. Secondary outcomes occurred less common in the study group, including a shorter duration of the second stage of labor. Overall, 50.3% of women were transferred to standard obstetric care. Regression analysis revealed effects of parity, age and birthweight on the chance of transfer. Conclusion Our investigation confirms comparable maternal and neonatal outcome with less interventions for women giving birth in AMU at our institution. Currently, obstetric services in Germany are almost exclusively provided by consultant-led units. Our results support the integration of AMU as complementary models of care for low-risk women.

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The Effect of Adding Low-Dose Naloxone to Intrathecal Morphine on Postoperative Pain and Morphine Related Side Effects after Cesarean Section: A Double-Blind, Randomized, Clinical Trial

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.852 ◽

2019 ◽

Vol 7 (23) ◽

pp. 3979-3983 ◽

Cited By ~ 1

Author(s):

Saloumeh Peivandi ◽

Mohammad Reza Habibi ◽

Afshin Gholipour Baradari ◽

Abdolmajid Gholinataj ◽

Ali Habibi ◽

...

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Pain Intensity ◽

Spinal Anaesthesia ◽

Postoperative Nausea ◽

Low Dose ◽

Intrathecal Morphine ◽

Control Group ◽

Study Group ◽

Double Blind

BACKGROUND: Nowadays, spinal anaesthesia is a suitable choice for most elective and emergency cesarean section (C-section) deliveries. AIM: This study aimed to determine the effect of adding low-dose naloxone to intrathecal morphine on postoperative pain and morphine related side effects after C-section. MATERIAL AND METHODS: In the present double-blind, randomised clinical trial, 70 women aged over 18 years, who were candidates for elective medical C-section under spinal anaesthesia were selected and randomly assigned to either the study group or the control group. For spinal anaesthesia, 10 mg of Bupivacaine plus 100 μg of morphine was administered for all patients. However, patients in the study group received 20 µg of naloxone intrathecally; but the patients in the control group only received normal saline as a placebo. After surgery, patient-controlled analgesia (PCA) pump with paracetamol (Apotel®) was connected to each patient. The intensity of postoperative pain in the patients was evaluated and recorded using Visual Acuity Screening (VAS) at 2, 4, 6 and 24 hours after the surgery. The patients were also examined for postoperative nausea and pruritus. RESULTS: Regardless of the groups to which the patients were assigned, a significant difference in pain intensity was observed during the study period (time effect; p < 0.001). Although the intensity of pain was lower in the study group, the difference was not statistically significant (group effect; p = 0.84). Also, there was no group time interaction between pain intensity and the times studied (p = 0.61). The incidence rates of postoperative nausea and pruritus were significantly lower in the study group compared to the control group (p < 0.001). CONCLUSION: According to the results of this study, adding low dose naloxone to intrathecal morphine did not significantly change postoperative pain intensity in the patients undergone elective C-section using spinal anaesthesia; however, significantly decreased the severity of postoperative nausea and pruritus.

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High Dose and Low Dose Oxytocin Regimens as Determinants of Successful Labor Induction: A multicenter comparative study

10.21203/rs.2.17285/v2 ◽

2019 ◽

Author(s):

MELESE GEZAHEGN TESEMMA ◽

Demisew Amenu Sori ◽

Desta Hiko Gemeda

Keyword(s):

Low Dose ◽

Statistical Significance ◽

Labor Induction ◽

Induction Of Labor ◽

P Value ◽

High Dose ◽

Bishop Score ◽

Delivery Time ◽

Number Of Patients ◽

Successful Induction

Abstract Background: Induction of labor by Oxytocin is a routine obstetric procedure. However, little is known regarding the optimal dose of oxytocin so as to bring successful induction. This study was aimed at comparing the effects of high dose versus low dose oxytocin regimens on success of induction. Methods: Hospital-based comparative cross-sectional study was conducted in four selected hospitals in Ethiopia from October 1, 2017 to May 30, 2018. A total of 216 pregnant women who undergo induction of labor at gestational age of 37 weeks and above were included. Data were entered into Epi-data version 3.1 and then exported to SPSS version 20 for cleaning and analysis. Chi-square test and logistic regression were done to look for determinants of successful induction. The result was presented using 95% confidence interval of crude and adjusted odds ratios. P-value < 0.05 was used to declare statistical significance. Result: The mean “Induction to delivery time” was 5.9 hours and 6.3 hours for participants who received high dose Oxytocin and low dose Oxytocin respectively. Higher successful induction (72.2% versus 61.1%) and lower Cesarean Section rate (27.8% vs. 38.9) were observed among participants who received low dose Oxytocin compared to high dose. Favourable bishop score [AOR 4.0 95% CI 1.9, 8.5], elective induction [AOR 0.2 95% CI 0.1, 0.4], performing artificial rupture of membrane [AOR 10.1 95% CI 3.2, 32.2], neonatal birth weight of < 4Kg [AOR 4.3, 95% CI 1.6, 11.6] and being parous [AOR 2.1 95% CI 1.1, 4.0] were significantly associated with success of induction. Conclusions: In this study, Different oxytocin regimens didn’t show significant association with success of induction. But, high dose oxytocin regimen was significantly associated with slightly shorter induction to delivery time. Favourable bishop score, emergency induction, performing artificial rupture of membrane and delivery to non-macrosomic fetuses were positive determinants of successful induction.We recommend researchers to conduct multicenter research on a large number of patients that controls confounders to see the real effects of different oxytocin regimens on success of labor induction.

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Outcomes of induction in trial of labor after cesarean delivery

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190882 ◽

2019 ◽

Vol 8 (3) ◽

pp. 1076

Author(s):

Anubha Varshney ◽

Zehra Mohsin

Keyword(s):

Cesarean Section ◽

Cesarean Delivery ◽

Mode Of Delivery ◽

Neonatal Morbidity ◽

Induction Of Labor ◽

Control Group ◽

Study Group ◽

Previous Cesarean Section ◽

Trial Of Labor ◽

Previous Cesarean

Background: The objective of this study is to evaluate the outcomes of induction of labor in women attempting trial of labor after cesarean delivery and to compare maternal and neonatal morbidity and mortality in women who were induced to those delivering spontaneously.Methods: The prospective study was carried out in the Department of Obstetrics and Gynecology in collaboration with the Neonatal Section, Department of Pediatrics at J.N. Medical College and Hospital, AMU Aligarh. The sample included 280 women with one previous cesarean section, of whom 130 women underwent induction of labor (study group) and 150 were admitted with spontaneous onset of labor. Prostaglandin gel and intracervical Foley’s were used for cervical ripening in the study group. Indication of cesarean section, mode of delivery, maternal and neonatal outcome were studied in between groups.Results: Overall rate of vaginal delivery after cesarean section was 45.3% and 56% in both study and control group respectively. The rate of cesarean section were higher in women who were induced and having unfavorable cervix. Maternal and neonatal morbidity were not significantly higher as compared in both groups, however one case of scar rupture was found in study group.Conclusions: Induction of labor in women with previous cesarean section had higher rates of cesarean section however it does not adversely affect neonatal and maternal morbidity. Overall vaginal birth is safe and effective in women with previous cesarean section by prostaglandin gel or intracervical Foley’s. Authors cautiously suggest, induction of labor should be considered in preselected patient with strict monitoring.

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