ABSTRACT
Background: PGE2 gel (cerviprime) not only helps in cervical ripening but also sensitizes the uterine musculature to physiological PGE2 for generation and maintenance of uterine contractions. In the present study the efficacy of PGE2 intracerival gel for ripening and induction of labour has been reported.Methods: This is a randomized prospective study of 80 cases admitted to the labour room during period of 2 years i.e. March 2017 to March 2019 in Department of Obstetrics and Gynecology, KBNIMS, Gulbarga, Karnataka. All patients had clear indications for termination of pregnancy. The initial bishop score determined prior to induction by pelvic examination. Under aseptic precautions PGE2 endocervical gel was instilled. The results analyzed for successful ripening, induction delivery interval, results in primigravida and multigravida with single instillation or reinstallation if required, mode of delivery and maternal and perinatal complications.Results: The present study of 80 cases showed that a single application of intracervical PGE2 gel caused favorable changes in cervix by increasing Bishop score and shortened induction delivery interval with minimal side effects. Successful ripening with single application was achieved in 92.5% of cases (primi 42.5% and multi 50%). Only 6.25% of primi's and 1.25% of multi’s required reinstallation of PGE2 gel. Successful induction was achieved in 47.5% primi's and 50% multi’s i.e. 97.5% cases.Conclusions: The study concludes that single low dose intracervical PGE2 (cerviprime) gel proved to a safe, reliable and effective method for cervical ripening and induction of labour.
ABSTRACT
Background: Mifepristone and Dinoprostone are used in inducing labour in pregnancy by acting as cervical ripening drugs. A randomized case control study to evaluate the efficacy, safety and fetomaternal outcome of induction of labour with oral Mifepristone and intracervical Dinoprostone gel was done.Methods: About 300 patients were included after taking informed consent. 150 patients were placed in each group A and B. In group A patients received 200 mg oral Mifepristone tablet and in group B 0.5 mg Dinoprostone gel was given intracervically and 2nd dose was repeated after 6 hours later if adequate uterine contractions were not achieved. A detailed analysis was carried out in both groups regarding efficacy and safety of drugs in terms of necessity of augmentation of labour with oxytocin, induction to delivery interval, fetal outcome in terms of NICU admission.Results: 59.33% cases in Mifepristone group and 72% case in Dinoprostone group required augmentation with oxytocin. Mean induction delivery interval in Mifepristone group in primigravida was 17.998±1.128 hrs and mean induction delievery interval in multigravida was 11.648±1.112 hours. 88% cases in mifipristone group and 80% cases in Dinoprostone group delivered vaginally. NICU admission was 1.33% in Mifepristone group and 2.66% in PGE2 gel group.Conclusions: Mifepristone when compared with intracervical Dinoprostone gel, acts as a better cervical ripening agent and requires lesser need for Oxytocin augmentation. Though, mean induction delivery interval was more with Mifepistone, the incidence of successful vaginal delivery was higher as compared to Dinoprostone.