A comparative study of single and double dose of intracervical Prostaglandin E2 gel for cervical ripening
Abstract
Introduction: Induction of labour should be safe for both the mother and baby that is a method with short induction delivery interval, absence of side effects and conveniences for both the patients and medical staffs. A lamp of success was lit with the introduction of prostaglandins, one of the factor that influences successful induction of labor.
Material & methods: A case control study was carried out in department of obstetrics and gynecology in tertiary care teaching hospital of North India. A total 100 patients were taken in two groups, 50 patients of study group were induced with two doses of PGE2 gel, 6 hours apart and 50 patients of control group were induced with single dose of PGE2 gel given intracervically.
Results: In this study age group of the patients ranges from 18-35 years and the parity was up to para 4. It was evident that major indication of induction of labor was PIH and post dated pregnancies. All the patients had Bishop score 4 or less indicating an unripe cervix. There was significant increase in mean Bishop score after second dose instillation in study.ie 6.84 as compared to control group where second dose were not instilled. Mean induction delivery interval in study group is 13.14 hrs as compared to controls 16.37 hrs. 25 out of 50 patients in study group delivered within 12 hrs as compared to 6 out of 50 patients in control groups.
Conclusion: The above study concluded that intracervical double dose of PGE2 gel is significantly effective for pre induction cervical ripening and 94% of patients went into labor spontaneously without requiring stimulation by other oxytosis.
Downloads
References
2. K. Dahiya, K. Malik, A. Dahiya and S. Nanda. Comparison of the Efficacy of Foley Catheter Balloon with Dinoprostone Gel for Cervical Ripening at Term. International Journal of Clinical Medicine, Vol. 3 No. 6, 2012, pp. 527-531. doi: 10.4236/ijcm.2012.36095.
3. Osaheni Lucky Lawani,1 Azubuike Kanario Onyebuchi,2 Chukwuemeka Anthony Iyoke Obstetric Outcome and Significance of Labour Induction in a Health Resource Poor Setting. Hindawi Publishing Corporation Obstetrics and Gynecology International Volume 2014, Article ID 419621, 5 pages http://dx.doi.org/10.1155/2014/419621.
4. N. Uldbjerg, G. Ekman and A. Malmstrom. Ripening of the Human Uterine Cervix Related to Changes in Glyco-saminoglycans and Collagenolytic Activity. American Journal of Obstetrics & Gynecology, Vol. 147, No. 6, 1983, pp. 662-666. Available on search.scirp.org
5. K. F. Trofatter, D. Bowers, R. N. Standby, A. Gall and A. P. Killam, “Preinduction Cervical Ripening with Pros-taglandin E2 Gel,” American Journal of Obstetrics & Gynecology, Vol. 153, No. 3, 1985, pp. 268-271. Available onsearch.scirp.org/references/7427369
6. R. P. Prins, R. N. Bolton and C. Mark, “Cervical Ripen-ing with Intravaginal Prostaglandin E2 Gel,” Obstetrics & Gynecology, Vol. 63, 1984, pp. 697-702 available on www.jourlib.org/references/7427370 [PubMed]
7. Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol. 1964 Aug;24:266-8. [PubMed]
8. Mundle WR, Young DC. Vaginal misoprostol for induction of labor: a randomized controlled trial. Obstet Gynecol. 1996 Oct;88(4 Pt 1):521-5. [PubMed]
9. Bartha TL, Comino-Delgado R, Garcia-Benasach F et al. Oral misoprostol and intracervical dinoprostone for cervical ripening and labor induction: a randomized comparison. Obstet Gynecol2000;96:465-9. avilable on medind.nic.in. [PubMed]
10. Wing DA, Jones MM, Rahall A et al. A comparison of misoprostol and prostaglandin E2 gel for preinduction cervical ripening and labor induction. Am J Obstet Gynecol. 1995 Jun;172(6):1804-10. [PubMed]
11. Murthy Bhaskar Krishnamurthy, Arkalgud Mangala Srikantaiah. Misoprostol alone versus a combination of dinoprostone and oxytocin for induction of labor. J Obstet Gynecol India Vol. 56, No. 5 : September/October 2006 Pg 413-416. Available onhttp://medind.nic.in
12. Alfirevic Z, Weeks A. Oral misoprostol for induction of labour. Cochrane Database Syst Rev2006;( 2): CD001338. DOI: 10.1002/14651858. CD001338.pub2.
13. Hofmeyr GJ, Gülmezoglu AM. Vaginal misoprostol for cervical ripening and induction of labour (Cochrane Review). In: The Cochrane Library, Issue 4, 2004. Oxford: Update Software.available onhttps://books.google.co.in
14 Sanchez-Ramos L, Kaunitz AM, Delke I. Labour induction with 25 microg versus 50 microg intravaginal misoprostol: a systematic review. Obstet Gynecol 2002; 99: 145-151.available on archives.who.int
15. Has R, Batukan C, Ermis H, Cevher E, Araman A, Kilic G, Ibrahimoglu L. Comparison of 25 and 50 microg vaginally administered misoprostol for preinduction of cervical ripening and labour induction. Gynecol Obstet Invest 2002; 53:16-21.available on pjmhsonline.com
16. Ozsoy M, Ozsoy D. Induction of labor with 50 and 100 microg of misoprostol: comparison of maternal and fetal outcomes. Eur J Obstet Gynecol Reprod Biol 2004; 113: 41-44.available on europepmc.org [PubMed]
17. Meydanli MM, Çalıkan E, Burak F, Narin MA, Atmaca R. Labor induction post-term with 25 micrograms vs. 50 micrograms of intravaginal misoprostol. Int J Gynaecol Obstet. 2003 Jun;81(3):249-55. [PubMed]
18. Lokugamage AU, Forsyth SF, Sullivan KR, El Refaey H, Rodeck CH. Randomized trial in multiparous patients: investigating a single vs. two-dose regimen of intravaginal misoprostol for induction of labor. Acta Obstet GynecolScand 2003; 82(2):138-142. [PubMed]
19. Diro M1, Adra A, Gilles JM, Nassar A, Rodriguez A, Salamat SM, Beydoun SN, O'Sullivan MJ, Yasin SY, Burkett G. A double-blind randomized trial of two dose regimens of misoprostol for cervical ripening and labor induction. J Matern Fetal Med. 1999 May-Jun;8(3):114-8.
20. B.L. KUDAGI, L. SAILAJA1, R. PRAVIN KUMAR1, C. SURESH BABU. a comparitive study of intravaginal misoprostol with intra cervical dinoprostone gel for induction of labour in pregnancy Asian J Pharm Clin Res, Vol 6, Issue 2, 2013, 174-178.
21. Smiti Nanda, Savita Rani, Singhal, Akta Papneja. Induction of labour with intravaginal Misoprostol and prostaglandin E2 gel: A comparative study. Trop Doct. 2007;37:21-4. [PubMed]
22. Gupta N, Mishra SL, Jain Shradha. A randomized clinical trial comparing misoprostol and dinoprostone for cervical ripening and labour induction. J Obstetrics and Gynaecology 2006;56 Suppl 2:149-51. Available on medind.nic.in [PubMed]
23. Belfrage P, Smedvig E, Gjessing L, Eggebo TM, Okland I. A randomized prospective study of Misoprostol and dinoproston for induction of labour. Acta Obstet Gynecol Scand. 2000 Dec;79(12):1065-8. [PubMed]
24. Neiger R, Greaves PC. Comparison between vaginal misoprostol and cervical dinoprostone for cervical ripening and labour induction. Tenn Med. 2001 Jan;94(1):25-7. [PubMed]
25. Buser D, Mora G, Arias F. A randomized comparison between misoprostol and dinoprostone for cervical ripening and labour induction in patients with unfavorable cervices. Obstet Gynecol. 1997 Apr;89(4):581-5.
26. Danielian P, Porter B, Ferri N, Summers J, Templeton A. Misoprostol for induction of labour at term: a more effective agent than dinoprostone vaginal gel. Br J Obstet Gynaecol. 1999 Aug;106(8):793-7.