ABSTRACT
Background: Objective of this study was to study the effect of vaginal misoprostol, dinoprostone gel, foley catheter, extra amniotic saline infusion along with vaginal misoprostol for induction of labor at term on maternal and fetal outcome.Methods: A one-year prospective observational study was conducted in the department of obstetrics and gynecology, SDM College of Medical Science and Hospital, Dharwad. Totally 100 postdated primigravida women with singleton gestation, vertex presentation and intact membrane who were induced with any four methods of induction 1) Tab. misoprostol 25 µg vaginally, 2) Intracervical dinoprostone gel, 3) Foley catheter and 4) Extra amniotic saline infusion along with tab. misoprostol 25 µg vaginally with 25 patients selected in each group, by random allocation technique and included in the study. Outcome measures analysed were the demographic profile, bishop score, induction to delivery interval, mode of delivery, maternal and fetal complications. Statistical analysis was done using SPSS 17 software.Results: Mean induction delivery interval was significant between PGE1 versus foley group (p=0.0034). In this study, 60% patients in dinoprostone group had Vaginal delivery and 72% in the EASI + misoprostol group underwent cesarean section (p=0.0372). NICU admission was maximum with EASI + vaginal misoprostol group and minimum with vaginal misoprostol alone.Conclusions: The groups were comparable with respect to maternal age, bishop score and fetal weight. The vaginal misoprostol group had shortest induction delivery interval. The maximum number of patients in dinoprostone gel group underwent vaginal delivery with a highest cesarean section and NICU admission with the EASI + misoprostol group.
ABSTRACT
Induction of labour is an intervention to artificially stimulate uterine contractions leading to progressive dilation and effacement of cervix. This results in delivery of foetus before the onset of spontaneous labour. Dinoprostone gel and Misoprostol are commonly used drugs for cervical ripening. We wanted to compare the efficacy and safety of Dinoprostone with Misoprostol for cervical ripening and induction of labour in women with unfavourable cervix. METHODSThis is a prospective study conducted among 200 antenatal women who required induction of labour for different indications. 100 patients with an indication for induction were given 25 mcg of intravaginal misoprostol and repeat dose up to a maximum of 3 doses every 4 hours as needed. The other 100 patients were given 0.5 mg of intracervical dinoprostone gel and repeated for a maximum of 3 doses every 6 hours as needed. Progress of labour was monitored. Bishop score was determined. RESULTSPostdatism was the most common cause of induction (45% and 58%) in both the groups. The difference in values of mean induction delivery time in both primipara and multipara was not significant statistically for both the drugs. Study showed that the number of caesarean sections was significantly (p value 0.028) reduced with the use of misoprostol for induction of labour. The most common indication for operative delivery was foetal distress (11% in the misoprostol group and 17% in the dinoprostone group). Maternal and foetal complication rate in both the groups was similar. CONCLUSIONSCaesarean rate was significantly less with intravaginal misoprostol group compared to dinoprostone group. Other factors had no statistical significance. Vaginal misoprostol is thus a better option for induction of labour.
ABSTRACT
Background: The objective of the present study was to compare the two most commonly used agents for induction of labor-vaginal misoprostol and intracervical dinoprostone gel in terms of the incidence of cardiotocography (CTG) abnormalities and its correlation with fetal distress and fetomaternal outcome.Methods: This is prospective case-control study conducted in department of obstetrics and gynecology, RIMS, Ranchi over a period of 15 months. 112 women requiring induction were randomly assigned to two groups of 56 each, Group M received vaginal misoprostol and Group D received intracervical dinoprostone E2 gel. 56 women with spontaneous labor served as control group. Groups were compared in terms of the incidence of suspicious or pathological CTG tracings, fetal distress, induction to vaginal delivery time, vaginal delivery rates, dose requirements, rate of emergency cesarean.Results: Misoprostol was associated with shorter induction to delivery time (9.54 hours) than dinoprostone gel (13.54 hours), higher vaginal delivery rates (80.35% versus 62.5%), higher delivery rates (73.9%) with single dose itself unlike Group D, where 47.22% required more than one dose. Incidence of suspicious CTG was higher in group M (15.68%) versus 10.25% in Group D. Incidence of pathological CTG was also highest in Group M (7.8%) followed by Group D (2.56%) and Group C (7.8%). Dinoprostone gel lead to failed induction in 25% women, and hence higher caesarean rates.Conclusions: While misoprostol is a better agent for induction when compared with dinoprostone E2 gel in terms of induction-delivery time, higher vaginal delivery rates, less dose requirement, it is associated with greater incidence of non-reassuring/pathological CTG. There was justified improvement in perinatal outcome due to preparedness beforehand with use of CTG.
ABSTRACT
Background: The aim of our study was to compare the efficacy, safety and patient’s satisfaction of intracervical Foley catheter with intracervical dinoprostone gel (PGE2 gel) for cervical ripening for successful induction of labor.Methods: Prospective study was conducted in Department of Obstetrics and Gynaecology, M P Shah Medical College, Jamnagar, Gujarat. 317 women with term pregnancy with bishop score of less than 4 with various indications for induction were included. Intracervical foley catheter was kept in 162 women for cervical ripening (group A) while intracervical PGE2 gel was kept in rest 155 women (group B). The change in the bishop score, progress of labor, adverse effects and outcome of labor along with the patient’s satisfaction were assessed.Results: With regard to the obstetrical parameters, the two groups were comparable with respect to maternal age, gestational age, parity, indication for induction and initial bishop score. At 12 hours, both the groups showed significant improvement in bishop score, 5.2±1.81 and 4.8±1.76 in Foley catheter and PGE2 gel respectively. Mean induction to delivery interval was 18.8±5.5 in group A and 17.9±5.3 in group B, which was statistically insignificant. No significant differences in side effects, mode of delivery and APGAR score were noted in both the groups. However, the incidence of hyperstimulation and tachysystole was higher in PGE2 gel group.Conclusions: This study shows that both Foley catheter and dinoprostone gel appear to be equally effective agents for cervical ripening. Infect foley catheter is cheap, causes less fetal distress and is safer than PGE2 gel.