Oral versus vaginal prostaglandin for labor induction (original) (raw)
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Primary Care Update for OB/GYNS, 1998
This outpatient study was a randomized, multicenter investigation involving pregnant women at term with one previous low transverse cesarean section. Each had an unfavorable cervix (Bishop score Յ4) and was a candidate for vaginal delivery. Those randomly assigned to receive the gel, rather than expectant management, were given a 0.5 mg dose of PGE 2 (Prepidil) intracervically at 39 weeks gestation. This cervical ripening treatment was repeated at weekly office visits for up to 3 doses. Results: Of the 294 cases, 143 received the gel while 151 underwent expectant management. No differences between the two groups were found for maternal demographics, race, parity, or predose Bishop score. The rates of repeat cesarean section did not differ (P ϭ .68) with use of the gel (61, 42%) or with expectant therapy (48, 45%). The onset of active labor, the duration of labor among those delivering vaginally, and the 1-minute and 5-minute Apgar scores were not different between the two groups. No uterine rupture was apparent, and adverse effects during labor were as likely to occur in the two groups.
IP innovative publication pvt. ltd, 2019
Introduction: The aim of induction is to achieve successful vaginal delivery where continuation of pregnancy is not desirable. Unfavourable cervix is one of the main causes of failed induction. Introduction of prostaglandins has revolutionised the scenario of cervical ripening. More than one dose of Prosta glandin E2 (PGE2) gel may be necessary to facilitate cervical ripening and increase the chances of vaginal delivery. Materials and Methods: This retrospective study was done to find the efficacy of multiple instillations of intravaginal Prostaglandin E2 gel and to compare the maternal and fetal outcome between the single instillation group and multiple instillation group. The women who went into labour or achieved cervical ripening with a single instillation of Prostaglandin E2 gel forms Group A. Those who required more than one instillation of prostaglandin E2 gel forms Group B. Both groups were compared for specific parameters. Results: Primigravidas required multiple instillations. Postdated pregnancy was the most common indication for Induction of Labour. 45.2% of primis had only single dose and 54.8% required multiple doses. About two third (77.8%) of multipara required only one dose and a third of multipara needed multiple doses. In Group A 90.7% had vaginal delivery, 9.3% had Caesarean section. Group B 95.7% had vaginal delivery and 4.3% had Caesarean section. Conclusion: Though PGE2 0.5mg gel is recommended to be used intracervically, it is equally effective intravaginally. Three doses of intravaginal PGE2 can be safely used without the risk of uterine hyperstimulation. There is no increased fetal risk with multiple instillations of intravaginal PGE2 gel.
Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term.
Cochrane database of …, 2003
Prostaglandins have been used for induction of labour since the 1960s. This is one of a series of reviews evaluating methods of induction of labour. This review focuses on prostaglandins given per vaginam, evaluating these in comparison with placebo (or expectant management) and with each other; prostaglandins (PGE2 and PGF2a); different formulations (gels, tablets, pessaries) and doses.
IP Innovative Publication Pvt. Ltd, 2017
Induction of labour is an intervention designed to artificially initiate uterine contractions leading to progressive dilatation and effacement of the cervix and birth of the baby. There are various methods of induction of labour. Locally applied PGs have been thought to be most physiological in initiating the process of labour by promoting both cervical ripening and myometrial contraction the present study was carried out to compare the efficacy, safety and tolerance of intravaginal misoprostol (PGE1) tablets with intravaginal dinoprostone (PGE2) gel for cervical ripening and labour induction at term. A randomized control study was carried out. Two hundred women with unfavorable cervix were randomly allocated in two groups of 100 women each for misoprostol group and dinoprostone group respectively. Success of induction, mean induction to delivery interval, mode of delivery, maternal complications and Apgar score were analyzed. Statistical analysis was done by unpaired one tailed test and chi square test. The mean induction to active phase of labour was 11.61 hrs in misoprostol group and 14:29 hrs in dinoprostone group, mean induction to delivery interval was 15:07 hrs in misoprostol group and 18.11hrs in dinoprostone group. 86% of women in misoprostol group delivered vaginally as compared to 75% in dinoprostone group. No significant difference in the maternal and fetal outcome w was noted. Intravaginal tablet misoprostol 25 mcg every 6hrs for maximum of 100 mcg is an effective, safe, tolerable, low cost and simple method of cervical ripening and induction of labour at term.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Induction of labour is significant when continuing pregnancy possess adverse effect on health of mother and her unborn baby. Different methods have been used for induction of labour. At present there is very less literature regarding simultaneous use of Foleys catheter and PGs. The present study was done to compare the efficacy of using intracervical Foleys catheter and PGE2 gel simultaneously versus PGE2 gel alone for induction of labour.Methods: Prospective study, conducted in department of obstetrics and gynaecology for duration of 6 months. 100 women requiring induction of labour were included in the study and were randomly divided into two groups. 50 women were included in group A (simultaneous use of intracervical Foley catheter with PGE2 gel) and 50 women were included in Group B (intravaginal insertion of PGE2 gel only).Results: Maternal age, gestation age, parity, indication of induction and primary Bishops score were comparable in both the groups. Mean inducti...
Scholars International Journal of Obstetrics and Gynecology
Background: The aim of induction of labor is to initiate labor when maternal and fetal conditions necessitate delivery before the onset of spontaneous contractions. The success of this obstetric practice is highly dependent upon the condition of the cervix. Cervical ripening is a complex process that results in physical softening and distensibility of the cervix, ultimately leading to partial cervical effacement and dilatation. Objective: The purpose of the current study was to compare the effectiveness and safety of the pessary to intravaginal dinoprostone gel for induction of labor. Results: A total of 200 women were included in the study, of whom100 received dinoprostone pessary and 100 dinoprostone intravaginal gel. Tachysystole was diagnosed by the research team in 33 women, (4.5%) of those received the pessary and (2.4%) of those received gel (Table 4). In Caesarean section for suspected fetal compromise associated with uterine Tachysystole was performed in seven women in the pessary group and one in the gel group. There was no correlation between the initial Bishop score and the occurrence of uterine Tachysystole. (4.1%) women in the pessary group had a postpartum haemorrhage with estimated volume of ≥ 1000 mL compared to (2.2%) women in the gel group (P = 0.08). Conclusion: In this retrospective study, use of dinoprostone vaginal pessaries for induction of labour resulted in no advantage compared with dinoprostone intravaginal gel and clinically significant tachysystole appeared more common.
Outcome of induction of labor with prostaglandin E1 25 mg vaginal tablet – A retrospective study
Tropical Journal of Obstetrics and Gynaecology, 2019
Context: Labor induction with prostaglandin E1 (PGE1) vaginal tablet results in shorter induction delivery interval and decreased rate of failed induction of labor and reduced caesarean section rate. However, higher doses may be associated with uterine hyper stimulation. It is therefore necessary to determine the safe dose of PGE1 for labor induction. Aims: To assess the maternal and neonatal outcome with use of 25 mg vaginal misoprostol for induction of labor. Settings and Design: A retrospective analysis conducted in an obstetric department of a tertiary care teaching institute. Materials and Methods: The sample consists of women with singleton term pregnancy, with Bishop's score <6 compared with women with spontaneous onset of labor. Statistical Analysis Used: Statistical significance was assessed at 5% level of significance. Chi-square test, with correction for continuity where applicable, was carried out to compare proportions across subgroups or between induction and spontaneous onset groups. Results: The rate of vaginal delivery was higher among spontaneous onset group compared with induction group ( 2 (1) = 30.3, P < 0.001). The induction delivery interval of vaginal delivery was less than 24 h in 91.85% of women. Neonatal intensive care unit admission frequency was similar among both groups ( 2 (1) = 0.14, P = 0.704). The induction group was with less frequency of meconium staining than the control group ( 2 (1) = 8.05, P = 0.0046). Conclusion: Our study showed a higher rate of vaginal delivery with induction delivery interval less than 24 h in a majority of women with better neonatal and maternal outcomes.
Obstetrics & Gynecology, 1999
Objective: To compare the clinical effectiveness and safety of outpatient administration of intracervical prostaglandin (PG) E 2 gel with expectant treatment for women desiring vaginal births after cesareans. Methods: This was a randomized, multicenter investigation involving term pregnant women who each had one previous low-transverse cesarean and an unfavorable cervix (Bishop score no more than 6), and who was a candidate for vaginal delivery. They were assigned to receive 0.5 mg of PGE 2 , (Prepidil; Pharmacia-Upjohn, Kalamazoo, MI) intracervically at 39 weeks' gestation, repeated at weekly office visits for up to three doses, or expectant treatment. The main outcome variable was vaginal birth. Results: Of 294 cases, 143 received gel and 151 were treated expectantly. No differences between groups were found for maternal age, race, or Bishop score. Compared with the expectant treatment group, the PGE 2 gel group was not more likely to deliver sooner or vaginally (57% versus 55%, P ؍ ؍ ؍ .68). The onset of labor, duration of labor among those delivering vaginally, and 1-and 5-minute Apgar scores were not different between groups. No uterine ruptures occurred, and adverse effects were equally likely in both groups. Conclusion: Although its safety was confirmed for outpatient use, weekly doses of intracervical PGE 2 did not improve the likelihood of vaginal births after cesareans.