ABSTRACT
Background@#A prolonged interval from prelabor rupture of membranes to delivery is associated with an increase in the incidence of maternal and neonatal morbidities and mortality. Various agents have been tested to improve the cervical Bishop score to expedite the delivery of the fetus and lessen the maternal and neonatal complications.@*Objective@#To compare two protocols for labor induction in pregnant women with prelabor rupture of membranes (PROM).@*Population@#Subjects were recruited from the University of Santo Tomas Hospital (Private Division and Clinical Division). Pregnant women with a live, term, singleton fetus, cephalic presentation, a reactive Non stress test, who presented with PROM and a Bishop score of ?5, with no previous Cesarean section, or other uterine surgery.@*Methodology@#This is a two-arm superiority, open label, randomized controlled trial. Pregnant women with a live, term, singleton fetus, cephalic presentation, a reactive Non stress test, who presented with PROM and a Bishop score of ?5, and with no previous Cesarean section or other uterine surgery were randomly assigned to receive either intravenous (IV) oxytocin infusion or intracervical dinoprostone 0.5 mg gel followed 6 hours later by IV oxytocin infusion.@*Results@#Vaginal delivery within 24 hours of labor induction increased significantly with intracervical dinoprostone gel followed by IV oxytocin infusion (87% versus 61%; RR: 1.43; 95% CI: 0.99 – 2.06; P<0.044). Comparable result was observed for nulliparous women included in the study population. The time interval from labor induction to active phase was significantly shorter in the dinoprostone-oxytocin group than in the oxytocin alone group (2.4 ± 2.1 versus 6.3 ± 1.4 hours; p<0.001). The time interval from labor induction to delivery was also significantly shorter in the dinoprostoneoxytocin group (6.3 ± 1.5 versus 10.4 ± 1.4 hours; p<0.000). Cesarean delivery rates were statistically similar in the dinoprostone-oxytocin and oxytocin alone groups (17% versus 40%; p=0.102). The neonatal outcomes were comparable in both groups, except for birth weight.@*Conclusion@#Intracervical dinoprostone 0.5 mg gel followed 6 hours later by an oxytocin infusion in term women presenting with PROM and an unfavorable cervix (Bishop Score of 5 or less) was associated with a higher rate of vaginal delivery within 24 hours, shorter time interval from labor induction to active phase of labor, and shorter time interval from labor induction to delivery, and no difference in maternal and neonatal complications was observed compared with oxytocin infusion alone.
Subject(s)
Dinoprostone , Oxytocin , Labor, ObstetricABSTRACT
To compare efficacy, safety and tolerance of intravaginal misoprostol with intracervical dinoprostone for cervical ripening and labour induction in women with unfavorable cervices.Two hundred women requiring induction of labour at or beyond term were randomized to receive one of the two methods: intravaginal misoprostol 25 ug every 4 hours up to a maximum of eight doses and intracervical diniprostone gel 0.5 mg every 6 hours up to a maximum of three doses. Induction delivery interval was significantly shorter (p< 0.01) in the study group 10.86 hours (651.470 minutes) versus 13.31 hours (798.625 minutes). The proportion of women delivering vaginally within 24 hours was 84% in misoprostol group and 69% in dinoprostone group. The rates of women who needed oxytocin (28% versus 48%) were higher in dinoprostone group. Cesarean section rate in the study group was lower than in control group but not significantly so (15% versus 24%; p=0.09). Foetal distress was more common in the study group than in the control group but not significantly so (23% versus 18%; p=0.38). Neonatal outcome was comparable in the two groups. There were no significant maternal complications in both the groups. Intravaginal misoprostol 25 ug every four hours was more effective for cervical ripening and labour induction than intracervical dinoprostone 0.5 mg every six hours.