Comparison between extra amniotic saline infusion vs PGE2 for cervical ripening – a randomised trial (original) (raw)
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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.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Background: Induction of labor is a common procedure in obstetrics. It is usually performed when risk of continuing a pregnancy is more than benefit of delivery. Cervical ripening has got a close relationship with the success rate of delivery. Although there are many methods for cervical ripening, in this study Foley’s catheter and intra-cervical PGE2 gel are compared for labor induction and cervical ripening.Methods: This is a prospective randomized comparative study, undertaken in the department of obstetrics and gynecology, Tata Main Hospital, Jamshedpur. 70 cases in which labor was induced with Foley’s catheter were compared to other 70 cases who were induced with PGE2 gel.Results: The commonest indication for induction in Foley’s and PGE2 gel group was pregnancy induced hypertension. There was significant increase in the post induction Bishop’s score in both the groups. The induction to delivery interval was significantly lower in Foley’s group as compared to PGE2 group (p<0...
International Journal of Gynecology & Obstetrics, 1999
Objecti¨e: To compare the effectiveness of extra-amniotic saline infusion versus extra-amniotic prostaglandin F ␣ 2 for cervical ripening, induction of labor and achievement of vaginal delivery in patients with unfavorable cervices. Method: A randomized trial of extra-amniotic saline infusion versus extra-amniotic prostaglandin F ␣ performed at 2 2 2 of first choice in resource-poor settings. ᮊ 1999 International Federation of Gynecology and Obstetrics
Pre-term cervical ripening and labor induction
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2002
Objective: To evaluate retrospectively pre-term induction; with Prostaglandin (PG) E 2 -gel and i.v. oxtytocin, respectively. Methods: Fifty pre-term women with a gestational age between 28 þ 0 and 36 þ 6 and medical indications for labor induction were compared with the two next induced at term and post-term. The obstetric end points were numbers of PGE 2 -gel applications, failed inductions, instrumental delivery and heavy bleeding after partus (>1000 ml). The neonatal outcome was registered as operative delivery for fetal distress (ODFD) or Apgar score <7 at 5 0 . Results: The number of PGE 2 -gel applications did not differ. The duration of labor was shorter in the pre-term group (P ¼ 0:043). A five-fold higher risk of heavy postpartum bleeding (>1000 ml) was noticed in the post-term group compared to the pre-term. The incidence of low Apgar scores were similar in the three groups. Conclusions: Safe vaginal labor induction and delivery can be anticipated pre-term with PGE 2 -gel. #
Journal of Medical Science And clinical Research, 2017
Aim: To evaluate the efficacy of transcervical Foley catheter with extra amniotic saline infusion in cervical ripening before induction of labour with intravaginal prostaglandin E1. Methodology: 106 patients with cephalic presentation, singleton pregnancy with intact membranes having modified Bishop's score < /= 2 were selected. They were randomly divided in to two groups of 53 each. In group A Foley catheter with extra amniotic saline infusion was given for cervical ripening before the induction of labour with intravaginal PG E1 and in group B , PG E1 was given intravaginally without using Foley and extra amniotic saline infusion. Induction to delivery interval was calculated from the time when the intravaginal PG E1 is kept. Results: There was significant improvement in modified Bishop score after Foley catheter expulsion in group A. The mean induction to delivery interval was significantly shorter and rate of vaginal delivery within 24 hours was significantly higher when compared to group B. There was no significant difference in mode of delivery, intra partum complications, rate of ARM, oxytocin use or neonatal outcomes. Conclusion: Intra cervical Foley catheter with extra amniotic saline infusion is an effective method for cervical ripening in women with very unfavourable cervices.
Journal of obstetrics and gynaecology of India, 2011
The success of induction of labor depends on the cervical status at the time of induction. For effective cervical ripening both Foley's catheter and PGE(2) gel are used. The aim of this study was to compare the efficacy of intra cervical Foley's catheter and intra cervical PGE(2) gel in cervical ripening for the successful induction of labor. A randomized, prospective study was conducted in the Dept of OBGY, GMCH, Aurangabad from July 2005-January 2008. 400 patients at term with a Bishop's score ≤3 with various indications for induction were randomly allocated to receive (200 pts) intra-cervical Foley's catheter or PGE(2) gel (200 pts). After 6 h post induction, Bishop's score was noted labor was augmented if required. Statistical analysis was done using Chi square test and t test. The groups were comparable with respect to maternal age, gestation age, indication of induction and initial Bishop's score. Both the groups showed significant change in the Bishop&...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2021
Background: Labour is clinically defined as the initiation and perpetuation of uterine contraction with goal of producing progressive cervical effacement and dilatation. The Foley’s catheter is an effective alternative to prostaglandins for cervical ripening/labour induction. Study was done to compare the efficacy of intracervical Foley’s catheter and PGE2 gel as a cervical ripening agent and to study maternal and fetal outcome in terms of mode of delivery and Apgar score.Methods: This randomized controlled study was conducted in Obstetrics and Gynaecology department, Government Medical College, Patiala. 200 women with indication for induction of labour were enrolled in the study to investigate the efficacy and fetomaternal outcome of induction of labour with intracervical Foley’s catheter comparing with PGE2 gel.Results: The mean age in group A was 24.41±3.37 and in group B was 24.24±3.17 years. The 95% women were induced successfully in group A and 97% were successfully induced in...
2017
Materials and Methods: A two year study was conducted at Yenepoya medical College Hospital Derelakatte Mangalore. Study evaluated fifty women presenting for induction of labour with Bishops score less than five. All were 18 years of age or older with singleton pregnancy at or beyond 37 completed weeks of gestation. All women had a 16F Foleys catheter inserted through the cervix into the lower uterine segment. The bulb was inflated with a 60ml of normal saline, the Foleys was left in place for 10-12 hours unless membranes ruptured or it fell off spontaneously. 25 out of the 50 women had 200ml normal saline infused through catheter through the distal port. Results: All 50 showed Bishops score above 6 after a minimum of 10 hours. The average time for induction to vaginal delivery was similar in both groups (17.2 hours in Foleys and 16.8 hours in EASI), (p value <0.5). There was no statistically significant difference between two the two groups in change of BISHOP score, however each...
European Journal of Obstetrics & Gynecology and Reproductive Biology, 1994
with prostaglandin E, (PGE,) in vaginal pessaries. Study group: One-hundred and nine pregnant women with unfavourable cervices. Major outcome measures: The effkiency of inducing vaginal delivery and the level of 'disadvantages following induction of labour' (DisFIL scorings). Results: Overall, BCEAS was less efficient inducing vaginal delivery than vaginal PGEz (P < 0.01) because of a significant difference among parous women (P < 0.01). In the (larger) primiparous women group, and particularly in the subgroup of these having very low pelvic scores (Lange score, I 3), the efficiencies of the two methods were equal (P = 0.06) and P = 0.55, respectively). The levels of DisFIL scorings were not significantly different. However, higher rates of caesarean section followed BCEAS than PGE, (29% and 100/o, respectively; P < 0.05). Serious infectious complications were not recorded following BCEAS. No difference was apparent in the status of the neonates (judging from Apgar scores and umbilical artery pH and SBE). The women, delivering vaginally, commented the two methods equally favourably. Conclusion: BCEAS was less efficacious than vaginal PGE, pcssaries, though among primiparous women, especially those with very unfavourable cervices, the difference was not significant. Further refinements of the method are suggested.
Paediatric and Perinatal Epidemiology, 2019
Background: There is no consensus about the ideal cervical ripening method to use for induction of labour. Objective: To compare in current practice the effectiveness and safety of four cervical ripening methods. Methods: We performed a matched comparative study using data from the MEDIP prospective population-based cohort conducted during one month in 2015 in all maternity units of seven French perinatal networks (3042 consecutive women with a live fetus and induction of labour). We analysed 1671 women with singleton cephalic fetus, unscarred uterus, and bishop score <7. Dinoprostone vaginal pessary (reference) was compared to dinoprostone vaginal gel, misoprostol vaginal tablet, and balloon catheter. Effectiveness outcomes were the need for more than one induction agent, oxytocin use, failure to achieve vaginal delivery within 24 hours (VD < 24 hours), and caesarean delivery. Safety outcomes were meconium-stained amniotic fluid, uterine hyperstimulation, NICU admission, and post-partum haemorrhage. Coarsened exact matching was used to balance confounders among the groups. Outcomes were compared using multivariable logistic regression models. Results: Compared to the dinoprostone pessary (N = 1142, 68.3%), dinoprostone gel (N = 335, 20.1%) was associated with less failure to achieve VD < 24 hours (adjusted OR 0.66, 95% CI 0.47, 0.91). Misoprostol (N = 103, 6.2%) was associated with less need of more than one induction agent (aOR 0.56, 95% CI 0.34, 0.92) and less oxytocin use (aOR 0.60, 95% CI 0.37, 0.99). The balloon catheter (N = 91, 5.4%) was associated with more failure to achieve VD < 24 hours (aOR 2.62, 95% CI 1.37, 5.01), more caesarean delivery (aOR 1.84, 95% CI 1.09, 3.08), and less meconium-stained amniotic fluid (aOR 0.12, 95% CI 0.02, 0.70). Uterine hyperstimulation rates seemed lower with the balloon catheter (1.2% vs 4.2% for the pessary). Conclusions: In current practice, no cervical ripening method appears clearly superior to the others considering all effectiveness and safety outcomes.