Preparing for induction of labor (original) (raw)
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American Journal of Obstetrics and Gynecology, 1995
Our purpose was to evaluate the effectiveness of oxytocin, prostaglandin Ea intracervical gel, and estrediol cream for ripening the very unfavorable cervix in patients requiring induction of labor at term. STUDY DESIGN: This prospective, randomized study was conducted in a population of women with a very unfavorable cervix (Bishop score < 4) requiring induction of labor. The patients received prostaglandin Ea gel (0.5 mg) intracervically (three doses 6 hours apart), 4 mg estradiol cream in the anterior fornix of the vagina (three doses 6 hours apart), or oxytocin at induction per protocol with an infusion pump. RESULTS: Ninety-nine women were recruited into this trial and evenly distributed among the three groups. The demographics of maternal age, race, parity, gestational age, initial Bishop score, and indication for induction were similar among the groups. The incidence of cesarean deliveries was similar in the three groups with approximately 59% of pregnancies delivered abdominally. For patients undergoing abdominal delivery the maximum cervical dilatation among the oxytocin, estradiol, and prostaglandin E a groups was similar (3.90 -3.02 cm, 3.63 +-2.79 cm, and 4.65 _+ 2.78 cm, respectively; p > 0.05). For all patients birth weight and Apgar scores at 1 and 5 mintues were comparable across all regimens (p > 0.05). In the subset of patients delivered vaginally patients receiving oxytocin for cervical ripening had the greatest improvement in Bishop score over baseline (p = 0.023) with an improvement of 7.08 ---2.42. CONCLUSION: No differences were detected among prostaglandin E a gel, estrogen, and oxytocin in relation to cervical ripening in patients with an unfavorable cervix at term who require an induction of labor. Patients with a very unfavorable cervix at term who require delivery may benefit from serial ripening and inductions. (AM J OBSTET GYNECOL 1995;172:1702-8.)
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. #
Cervical ripening by prostaglandin E2 in patients with a previous cesarean section
Journal of Gynecology Obstetrics and Human Reproduction, 2020
To assess the efficacy and safety of prostaglandin in inducing labor in pregnant women with one previous cesarean section. Secondly, to evaluate predictors of successful vaginal delivery in cervical ripening by prostaglandin in these women. Study design: This was an observational, retrospective, single-center study conducted in a type 3 maternity unit at Bicêtre University Hospital between January 1, 2013 and December 31, 2016. Patients with one previous cesarean section, a singleton pregnancy, a fetus in the cephalic presentation with a medical indication for induction of labor and an unfavorable cervix (Bishop score less than 6) were included in the study. Cervical ripening was performed using a dinoprostone intravaginal device for a duration of 24 h. Results: A total of 153 patients were included in the study. The rate of vaginal delivery was 55.6 % (85/153) overall and 78.3 % (36/46) in the subgroup of 46 women with a previous vaginal delivery before or after the cesarean section. There was no difference in neonatal and maternal morbidity (defined by intraoperative wounds or postpartum hemorrhage or uterine rupture) and mortality between women who delivered vaginally and women who had a cesarean section. The two cases of complete uterine rupture have been reported for patients whose labor was induced by intravaginal prostaglandin followed by intravenous oxytocin. The total maternal morbidity rate was 11.8 % (n = 8/68) in the case of emergency cesarean section. Predictors of vaginal delivery were a history of vaginal delivery, the onset of labor following cervical ripening, and a higher Bishop score before and after the 24 h following the cervical ripening. Conclusion: Cervical ripening by prostaglandin after previous cesarean delivery has a 56 % success rate, with a 1.3 % risk of uterine rupture, especially when prostaglandin is combined with oxytocin. Low-risk patients should be identified to propose cervical ripening by prostaglandin.
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...
Cervical Ripening and Labor Induction: A Current Review
Journal of the Islamic Medical Association of North America, 2007
Labor induction Is often necessary because of maternal ar fetallndlcatlons. When performed with an unripe cervix, it results in prolonged labor, potential medical compliad:ions, and an increased rate of cesarean seclio:o. The purpose of cervk:aI ripening and induction of Iabar Is to achieve vaginal delivery and avoid operative delivery by cesarean section. In this revlew, we present cellular and biochemical events in cervk:aI ripeJling and discuss the indications and contralndlcatlons of labor l!IductIolI, and then describe various pharmacologic and mechanical methods for ripening the cerv:Ix and inducing labor.
American Journal of Obstetrics and Gynecology, 1992
OBJECTIVE: The purpose of this study was to determine if prostaglandin E2 in a controlled-release vaginal pessary can produce cervical ripening at term. STUDY DESIGN: This was a double-blind, randomized, placebo-controlled study conducted at a university center and involving 81 patients with 42 receiving active agent. Categoric data were analyzed by Pearson's x 2 or logistic regression. Continuous variables were analyzed by analysis of variance and the F test.
A Comparison of Oestradiol and Prostaglandin E2 for Ripening the Cervix
BJOG: An International Journal of Obstetrics and Gynaecology, 1981
A study was conducted to compare the cervical ripening effect of extra-amniotic prostaglandin E, with that of extra-amniotic oestradiol valerate in preparation for induction of labour. Sixty primigravidae with an unripe cervix received one or other agent suspended in a viscous gel. The degree of cervical ripening was similar in both groups but more patients treated with prostaglandins became established in labour before planned amniotomy, and poor progress in labour was less common in this group.
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