A randomized trial of vaginal prostaglandin E2 gel and dinoprostone vaginal insert for induction of labor at term (original) (raw)
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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.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: In modern medicine induction of labour is required in patients for a good feto-maternal outcome. PGE2 is a prostaglandin analogue which has been used as a cervical ripening agent to improve bishops score. Objective of this study was to evaluate the efficacy of intravaginal PGE2 gel as a cervical ripening agent in unfavourable cervix for induction of labor and any complications associated with its use.Methods: This study comprised of 90 women who required labor induction. Singleton pregnancy above 37 weeks, live intrauterine fetus, Cephalic presentation, Bishop score of 1-6, reactive FHR pattern were included. Women who required only single induction were categorized as Group 1. Those requiring more than one dose after reassessment of bishops scoring at 6, 12 and 18 hours belonged to Group 2.Results: Group1 had more of younger population below 30 years consisting more primigravidas with > 80% women having gestational age of > 39 weeks. Most common indication for ind...
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.
2015
Our purpose was to compare the efficacy of two different dinoprostone delivery methods for induction of labour. In a prospective randomized study, 128 patients were randomly assigned to receive either one dose of intracervical prostaglandin E2 (PGE2) Gel 0.5 mg or 3 doses of vaginal administration of oral PGE2 Tablet (Primiprost) 0.5 mg for induction of labour during the period from April 2010 to March 2013. Outcomes were studied as changes in Bisop’s score, induction to delivery interval, augmentation with oxytocin use or artificial rupture of membrane and vaginal delivery. Mean change in Bisop’s score at 6 hours and 12 hours were 7.725 and 8.945 in cerviprime group versus 4.015 and 5.863 in primiprost group (p=0.0001). Induction delivery interval was shorter in the gel group with a mean of 12.66 hours where as 20.732 h in tablets group (p=0.0001). Out of total 128 patients 93 delivered vaginally of which 57 % belongs to gel group and 43% to tablet group ( p=0.017). During course o...
2015
Our purpose was to compare the efficacy of two different dinoprostone delivery methods for induction of labour. In a prospective randomized study, 128 patients were randomly assigned to receive either one dose of intracervical prostaglandin E2 (PGE2) Gel 0.5 mg or 3 doses of vaginal administration of oral PGE2 Tablet (Primiprost) 0.5 mg for induction of labour during the period from April 2010 to March 2013. Outcomes were studied as changes in Bisop’s score, induction to delivery interval, augmentation with oxytocin use or artificial rupture of membrane and vaginal delivery. Mean change in Bisop’s score at 6 hours and 12 hours were 7.725 and 8.945 in cerviprime group versus 4.015 and 5.863 in primiprost group (p=0.0001). Induction delivery interval was shorter in the gel group with a mean of 12.66 hours where as 20.732 h in tablets group (p=0.0001). Out of total 128 patients 93 delivered vaginally of which 57 % belongs to gel group and 43% to tablet group ( p=0.017). During course o...
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.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Background: To compare the efficacy, efficiency and safety of extra amniotic Foley catheter with intracervical PGE2 gel and intravaginal misoprostol tablet for pre induction cervical ripening. Design of the study was to prospective randomized comparative study. Settings includes, this study was conducted in Mahatma Gandhi Medical College and Research Institute, Puducherry during November 2009 to May 2011. Methods: Participants for pre induction cervical ripening were randomized to receive either extra amniotic Foley catheter, intravaginal misoprostol tablet 25µg every four hours or intracervical PGE2 gel 0.5mg every six hours. The post ripening Bishop Score at 12 hours and 24 hours were assessed. The outcome measured was the time taken by the participants to achieve Bishop Score >5. The other outcomes included induction ripening interval, induction delivery interval, mode of delivery, requirement of additional agents, maternal and fetal complications. Results: The post ripening Bishop Score was significantly higher in PGE2 gel group with statistical significance. The induction ripening and the induction delivery interval was significantly shorter in misoprostol tablet group with a 'p' value <0.001. The incidence of NICU admission and other complications like meconium stained liquor, respiratory distress and maternal fever were more associated with misoprostol tablet group. Conclusions: PGE2 gel is an efficient agent for pre induction cervical ripening when compared to Foley catheter and misoprostol tablet though it is expensive, unstable and requires refrigeration. Tablet misoprostol significantly reduces the ripening duration, ripening delivery interval and the total duration to delivery. Misoprostol tablet is inexpensive, stable at room temperature and easy to administer. It also reduces the need for oxytocin augmentation. However the safety of misoprostol is still a concern due to increased maternal and neonatal complications. Foley catheter alone is not a good cervical ripening agent.