Comparative study of induction of labour with dinoprostone gel versus mechanical dilatation in unfavorable cervix (low Bishops Score) (original) (raw)
Related papers
INDIAN JOURNAL OF APPLIED RESEARCH, 2021
BACKGROUND: The uterus remains quiescent throughout 9 months and begins to act on its own when full term is approached. Almost 50% women deliver in the duration of one week before and after the calculated EDD; and induction of labour is needed in about 20% of women: to increase the success of labour induction, to reduce the duration and complications of labour and to diminish the rate of caesarean sections. Cervical ripening is needed before induction of labour. There are many methods for induction of labour; however till date, none of them can claimed to be the best. To compare the AIM OF PRESENT STUDY: safety and efcacy of Dinoprostone gel versus intracervical foley's catheter for ripening of cervix and induction of labour. Compara MATERIAL AND METHODS: tive prospective study was conducted on 400 full term uncomplicated primigravida women needing induction of labour between January 2019 to June 2020 in department of obstetrics & gynecology at GMC Kota in Rajasthan.Group A: 20...
International Journal of Advanced Research (IJAR), 2019
Introduction:Induction of labour is an intervention after 28 weeks of gestation, intended to artificially initiate uterine contractions resulting in the progressive effacement and dilatation of the cervix and ending in vaginal delivery. Sometimes because of medical or obstetric complications of pregnancy, cervical ripening and induction of labour is often required. Induction of labour is indicated when the benefits to either the mother or fetus outweigh those of continuing the pregnancy [1]. Aim Of The Study:To compare efficacy and safety of intracervical Foley?s balloon catheter with intracervical prostaglandin E2 gel (dinoprostone) for induction of labour. Objectives:To compare cervical ripening, induction-delivery interval, mode of delivery, maternal complications and fetal outcome by two methods. Materials And Methods:Prospective randomized controlled study. SAMPLE SIZE- Each group 50, determined by statistical analysis. Successful induction considered if the patient entered the active phase of labour/ bishop score 6. Result:In present study, both groups were comparable in age distribution. In both the groups, most of the study subjects were between the age group of 18-25 years (76% in pgE2 v/s 70% in Foley?s catheter group). Mean age in PGE2 gel group was 23.20?3.03 years while Mean age in Intra-Cervical Foley?s Catheter group was 23.92?3.11 years. Mean gestational age in PGE2 gel group was 39.12?1.33 weeks compared to 39.06?1.18 weeks in Intra-Cervical Foley?s Catheter group. At start of induction mean Bishop score was 1.62?1.10 in PGE2 gel group while it was 1.58?1.01 in Intra-Cervical Foley?s Catheter group. Deshmukh V et al also reported similar pre-induction mean Bishop score (1.48?0.67 in Foley?s Catheter group v/s 1.59?0.59 in pgE2 gel group). In our study, post-induction mean Bishop score at 6 hours was 6.56?2.13 in PGE2 gel group while it was 4.70?2.21 in Intra-Cervical Foley?s Catheter group. Mean change in Bishop score between 0 to 6 hours was significantly higher in pgE2 gel group (4.94?1.78) compare to Foley?s catheter group (3.12?1.78). The rate of LSCS in pgE2 gel group was 10% and 32% in Foley?s catheter group respectively. The induction delivery interval showed significantly higher time in intracervical Foley?s catheter groups. The mean induction delivery internal was 13.80?3.83 hrs in Foley?s group and 9.65?2.13 hrs in PGE2 group. In our study, common maternal complication observed were Intrapartum pyrexia (1 case in pgE2 gel group and 8 cases in Foley?s catheter group) and puerperal pyrexia (1 case in pgE2 gel group and 4 cases in Foley?s catheter group). 1 case of hyperstimulation was also seen in pgE2 gel group. Apart from that we have not seen any other complication in mothers. The present study shows that the fetal outcome results were also comparable in both the groups. Conclusion:The results of this trial tended to favor the prostaglandins use over Foley catheter use. The main advantage of the PGE2 gel is that early ripening of cervix, lesser caesarean rate and infection rate as compared to the Foley?s catheter while disadvantage is higher chances of uterine hypertonicity or tachysystole. but Foley?s catheter mimicked the physiology of the labour onset more closely, resulting in a less likelihood of hyperstimulation, fetal heart rate abnormalities and postpartum hemorrhage. Now, there is recent trend of reintroducing the mechanical methods like the Foley catheter, as there is an availability of sterile devices, controlling one of the principal contraindications- infection. Such mechanical methods are advantageous in terms of their reversibility and the reduced expenditure. But Foley?s catheter has been linked with a possibility of infections in some larger studies. Thus, tremendous attention should be drawn towards carrying out aseptic measures while it is being inserted, to avoid maternal and probable neonatal infections.
Indonesian Journal of Obstetrics and Gynecology
Background One of the common practices in modern obstetrical care is labour induction when foetal and maternal complications arise. We endeavoured to compare the efficacy and safety of the inexpensive mechanical method of induction Foley’s catheter to the more established pharmacological agent Intracervical Prostaglandin E2 gel Method The present prospective randomised control study was carried out on 200 women with a term singleton pregnancy in cephalic presentation, with an unfavourable cervix and a valid indication for induction of labour. The patients were randomly allocated using the chit method to either Foley’s catheter [group A, n=100] or PGE2 gel [group B, n=100] . Augmentation with oxytocin was done if required and labor was closely monitored till delivery and the perinatal outcome and maternal side effects was recorded Quantitative variables were compared using unpaired t-test/Mann-Whitney Test and qualitative variables were compared using Chi-Square test /Fisher’s exac...
International Journal of Medical and Biomedical Studies, 2021
Background: This study compared the efficacy and safety of the intracervical Foley catheter and dinoprostone insert for cervical ripening to achieve successful labor induction. Methods: This was a randomized controlled study conducted. Group A received Dinoprostone cervical gel 0.5mg instilled in the cervical canal. Maximum of three doses (1.5mg dinoprostone) could be administered 6 hours apart. Patients randomized to group B were subjected to Foleys catheter insertion. Primary efficacy parameter was change in Bishops score as compared to baseline. Conclusion: Our study showed that for pre induction cervical ripening there was no difference in efficacy between intracervical Foleys catheter and PGE2 gel. Keywords: Foleys catheter, Induction of labour, Prostaglandins
Obstetrical & Gynecological Survey, 2010
Purpose To compare maternal and neonatal outcomes of two methods of labor induction in nulliparous women with unfavorable cervix. Methods A case-control study was performed on nulliparous women with a cervical Bishop score \ 6, who underwent induction of labor with either extra-amniotic Foley catheter (Foley catheter study group) or vaginal tablets of prostaglandin E 2 (PGE 2 control group). The control group was matched for gestational age and for the indication to induce labor. Results A total of 346 nulliparous women were included. Similar rates of cesarean delivery were found in the Foley catheter and the PGE 2 groups (25.4 vs. 24.2 %, respectively, p = 0.8), without differences in maternal or neonatal adverse outcomes. In the Foley catheter group, induction to delivery interval was shorter compared with the PGE 2 group (25.1 vs. 36.6 h, respectively, p \ 0.001), and more women delivered within 24 h (55.0 vs. 40.4 %, respectively, p = 0.01). Conclusion Induction of labor with Foley catheter in nulliparous women with unfavorable cervix is associated with shorter induction to delivery interval, but with similar rates of cesarean deliveries and adverse pregnancy outcomes, as compared with vaginal tablets of PGE 2 .
International Journal of Clinical Obstetrics and Gynaecology, 2022
Background: Labour induction is one of the most common obstetric procedures worldwide. There are a number of methods to induce labour, prostaglandins being the most effective one. The effects and properties of prostaglandins have been extensively investigated and many studies have compared the efficacy of different formulations available. There is a need to identify an effective method which is safe and cost effective associated with ease of introduction and removal in the event of complications. A method which reduces the number of vaginal examination thereby decreasing patient discomfort and doctor's workload should be considered. Hence the purpose of this study is to compare the efficacy, safety and acceptability (doctor and patient) of dinoprostone intracervical gel and dinoprostone vaginal insert. Materials and Methods: In this prospective comparative study, 120 pregnant women undergoing procedure of induction of labour in Santosh Hospital from September 2017 to May 2019 were assigned randomly to two groups, dinoprostone intracervical gel and dinoprostone sustained release intravaginal insert. Group A received 500 mcg of dinoprostone gel intracervically at 6th hourly intervals till active labour ensue for a maximum of 3 doses. Group B received ten milligrams of dinoprostone vaginal insert for single application for maximum of 24 hours. Results: Induction delivery interval was significantly lower (p value-<0.001) in dinoprostone vaginal insert group than with intracervical gel group. Need for oxytocin was lesser (p value-<0.001) when dinoprostone vaginal insert was used compared to intracervical gel. No significant difference between two groups was found on caesarean section rate (p value-0.803). Rate of hyperstimulation was high in dinoprostone vaginal insert group, while there was no significant difference noted in meconium stained liquor (p value-0.729) and postpartum hemorrhage (p value-0.648) between 2 groups. The patient acceptability was found to be higher in dinoprostone vaginal insert group as there was less intensity of labour pain (p value-<0.001) in 1 st stage of labour and decreased number of pervaginal examinations. Fetal outcome in each case was assessed with APGAR score at 1 and 5 minutes after the delivery of the fetus and no significant difference were found in both the groups. Conclusion: Dinoprostone intracervical gel and dinoprostone vaginal insert are safe and efficacious methods of induction of labour. However intravaginal insert was found to be easy to use and more efficacious method of induction with less pain during the initial hours of active labour. The method of induction should be individualized based on affordability and patient acceptability.
Effectiveness of dinoprostone vaginal pessary in induction of labour at term
International journal of reproduction, contraception, obstetrics and gynecology, 2017
Background: Induction of labour is a very common obstetric procedure worldwide. The ultimate goal of induction of labour is to achieve a successful vaginal delivery. Dinoprostone is a Prostaglandin (PGE2) which acts on the collagen structural network of the cervix and makes it favourable, thus increasing the chances of a successful of a vaginal delivery. This study emphasizes on the importance of having a proper induction protocol in place and at the same time judicious use of the agents for induction of labour. This will help to reduce the maternal anxiety and stress associated with the induction of labour. The present study was undertaken to assess the effectiveness of dinoprostone vaginal pessary in induction of labour at term. Methods: Twenty patients with unfavorable cervix at term were studied for the effectiveness of Dinoprostone vaginal pessary in induction of labor. Results: Among the twenty patients 17 (85%) delivered vaginally within 18 hrs and 3 (15%) were in the active ...
Role of dinoprostone gel in induction of labour
International journal of reproduction, contraception, obstetrics and gynecology, 2021
Labor is a process through which the fetus moves from the intrauterine to the extrauterine environment. It is a clinical diagnosis defined as the initiation and perpetuation of uterine contractions with the goal of producing progressive cervical effacement and dilatation. Induction of labor is common in obstetric practice. It means deliberate termination of pregnancy beyond 28 weeks by any method which aims at the initiation of labor and vaginal delivery. 1-3 The goal of modern obstetrics is to improve the safety of the mother and the fetus during the antenatal period as well as parturition. 4,5 The lowest incidence of perinatal morbidity and mortality occurs around 39-40 weeks of gestation. Therefore, some have advocated induction of uncomplicated singleton gestations once they reach full-term. METHODS This retrospective clinical trial was carried out in the department of obstetrics and gynecology at V. S. General hospital and Sardar Vallabhbhai Patel institute of medical science and research, Ahmedabad from May 2019 to May 2020. The purpose of this study was to evaluate the safety and efficacy of intracervical PGE2 as an inducing agent in women with an unfavorable cervix, at term (Bishop score ≤6). This study comprised of 110 women who required labor induction. Inclusion criteria: Singleton pregnancy between 36-40 weeks live ABSTRACT Background: Labour induction is one of the most common intervention in obstetric practice. A simple application of PGE2 intracervical gel can ripen the cervix effectively and improve Bishop's score there by helping in successful vaginal delivery. Considering its good performance, the dinoprostone slow-release vaginal insert is the first choice for elective induction of labour in postdate pregnancy and in patients with term pregnancy of premature rupture of membranes. Methods: This was a single year retrospective study conducted in a tertiary care center of western India from May 2019 to May 2020. Results: In group I women who delivered within 24 hours were included, in group II women who required reinstillation were included. The most common indication for induction in both the groups was past dates (accounting for 36.1% in group I and 47.3% in group II). The success rate in group I was 68.1% while in group II was 36.8%. The rate of cesarean delivery in group I was 25.9%, while in Group II, it was 60.1%. Negligible maternal and neonatal complications were seen in both the groups. Conclusions: The study showed that intracervical application of prostaglandin E2 is an effective, safe and acceptable method for induction of labor in women with unfavorable cervix and indications for induction. All these effects were achieved without increasing maternal and neonatal morbidity
PLOS Medicine, 2021
Background Prolonged pregnancies are a frequent indication for induction of labour. When the cervix is unfavourable, cervical ripening before oxytocin administration is recommended to increase the likelihood of vaginal delivery, but no particular method is currently recommended for cervical ripening of prolonged pregnancies. This trial evaluates whether the use of mechanical cervical ripening with a silicone double balloon catheter for induction of labour in prolonged pregnancies reduces the cesarean section rate for nonreassuring fetal status compared with pharmacological cervical ripening by a vaginal pessary for the slow release of dinoprostone (prostaglandin E2). Methods and findings This is a multicentre, superiority, open-label, parallel-group, randomised controlled trial conducted in 15 French maternity units. Women with singleton pregnancies, a vertex presentation, ≥41+0 and ≤42+0 weeks’ gestation, a Bishop score <6, intact membranes, and no history of cesarean delivery f...