Trial of extra amniotic saline infusion with oxytocin versus prostaglandin E2 pessary for induction of labor

ABSTRACT

To determine the effectiveness and safety of cost-effective extra-amniotic saline infusion [EASI] and simultaneous intravenous oxytocin infusion versus prostaglandin E2 vaginal pessary [PGE2] for induction of labor. Design: Prospective randomized comparative study. Place and Duration of Study Labor room at the Mother and Child Health Centre, PIMS, Islamabad from September 2000 to December 2001. Subjects and Women with singleton alive pregnancies and Bishop score < 6, requiring induction of labor at >37 weeks gestation were randomly assigned to induction either with PGE2 3 mg vaginal pessary in two doses 6 hourly or EASI for 12 hours with simultaneous intravenous oxytocin infusion. Artificial rupture of membranes was done12 hours post-induction and oxytocin infusion started in PGE2. Main outcome measures were induction delivery interval and the mode of delivery. Secondary outcome measures were the change in modified Bishop score 6 hours postinduction and neonatal outcome in the two induction modes. After 4 exclusions, 100 women were recruited in each arm. Mean induction delivery interval was 11.1 and 14.3 hours [p=.00] in PGE2 and EASI respectively. The cesarean rate was 11% and 15%[p=0.4] in PGE2 and EASI respectively. Mean Bishop score at induction was 3.2 in PGE2 and 3.1 in EASI, while after 6 hours it was 4.8 and 6.8 [p=0.00] respectively. Mean APGAR scores at 1 and 10 minutes were identical that is 6.2 and 8.6 respectively. Both the modes of induction were equally safe and effective in terms of the mode of delivery and APGAR score. EASI, however, had more rapid cervical ripening and shorter induction delivery interval