Dinoprostone For Labor Induction Research Articles

The Efficacy and Safety of Dinoprostone Vaginal Insert for Labor Induction Following Optimization of Standard Operating Procedure: A Retrospective Study in China

Background: The study aimed to assess the efficacy and safety of dinoprostone vaginal insert in labor induction following optimization of standard operating procedure (SOP) and to discover independent predictors of vaginal delivery. Methods: This study comprised 551 pregnant women who required cervical ripening with dinoprostone before induction of labor. Using univariate and multivariate analyses, independent predictors of vaginal delivery were identified. Results: 443 of the 551 women (80.4%) gave birth vaginally. Vaginal delivery was predicted by maternal age (24–30 vs. < 24, P < 0.001; 30–35 vs. < 24, P = 0.03), gestational age (P = 0.005), birth weight (P < 0.001), parity (P = 0.001), pre-pregnancy BMI (P < 0.001), premature rupture of membranes (P = 0.001), meconium-stained amniotic fluid (P < 0.001), fundal height (P < 0.001) and the Bishop score (P < 0.001). None of the women exhibited severe postpartum hemorrhage. Conclusions: The maternal age, gestational age, birth weight, parity, body mass index, premature membrane rupture, amniotic fluid contamination, fundal height, and the Bishop score were independent predictors of vaginal delivery. These may guide the clinical use of dinoprostone for induction of labor.

Efficacy and safety of double balloon catheter and dinoprostone for labor induction in multipara at term

PurposeThe aim of this study was to comparatively assess the efficacy and safety of double balloon catheter (DBC) and dinoprostone as labor-inducing agents just for multipara at term.MethodsA retrospective cohort study was conducted among multipara at term with a Bishop score < 6 who needed planned labor induction from January 1, 2020, to December 30, 2020 in Maternal and Child Health Hospital of Hubei province, Tongji Medical College, Huazhong University of Science and Technology. They were divided into DBC group and dinoprostone group, respectively. Baseline maternal data, maternal and neonatal outcomes were recorded for statistical analysis. Total vaginal delivery rate, rate of vaginal delivery within 24 h, rate of uterine hyperstimulation combined with abnormal fetal heart rate(FHR) were regarded as the primary outcome variables. The difference between groups was considered statistically significant when p value < 0.05.ResultsA total of 202 multiparas was included for analysis (95 women in DBC group vs 107 women in dinoprostone group). There were no significant differences in total vaginal delivery rate and rate of vaginal delivery within 24 h between groups. Uterine hyperstimulation combined with abnormal FHR occurred exclusively in dinoprostone group.ConclusionDBC and dinoprostone seem to be equally effective, while, DBC seems to be safer than dinoprostone.

INDUCTION OF LABOR AND ITS FETOMATERNAL OUTCOME

Induction of labor is opted for benefits of expeditious delivery to outweigh the risks of continuing the pregnancy. Aims and Objectives: To study the indications and methods of induction of labor &amp; to correlate Feto-Maternal outcome. Materials &amp; Methods: The present study was conducted on 150 pregnant women. It is a prospective observational study, conducted from April 2021 to September 2021. Patient details with Indication, examination, pre-induction Modified Bishops score, Partogram, were noted of 150 pregnant women and the results were analyzed. Electronic fetal heart rate monitoring was done in all except Intra-uterine Fetal Demise (IUFD) cases. Methods used were Dinoprostone, misoprostol, mechanical dilatation using foleys catheter single or in combination with each other. SPSS version 23.0 was used for statistical analysis, statistical significance was set as p&lt;0.05. Result: Common indications for induction were Past-dated pregnancy, followed by Gestational- Hypertensive disorders, Oligoamnios, Pre-labor rupture of membranes respectively. Among the 150 mothers, 113(75.3%) delivered vaginally and 37(24.6%) underwent LSCS. Dinoprostone gel was the dominant method used. Mechanical dilatation with Dinoprostone for induction of labor had a better outcome and less rate of failed induction. 4 mothers in this study were diagnosed with IUFD and induced with Mechanical Dilatation followed by Dinoprostone, all delivered vaginally. NICU admissions were required in 21.7%, 25%, 22% of the mothers who were induced with Dinoprostone, Misoprostol and Mechanical Dilatation respectively. Conclusion: Most common indication for induction is Past dated pregnancy. Most common method used is Dinoprostone alone. Perinatal Morbidity was more with Misoprostol. No maternal and Perinatal mortality.

Comparison between commercial product of oral misoprostol and vaginal dinoprostone for induction of labor

Comparison between commercial product of oral misoprostol and vaginal dinoprostone for induction of labor

The use of a vaginal therapeutic system with prostaglandin for induction of labor

Introduction. Induction of labor is one of the most frequent procedures in modern obstetrics, which reduces the frequency of cesarean section and improves pregnancy outcomes. However, the effectiveness and safety of labor induction methods vary. Currently, the vaginal therapeutic system (SVT) with dinoprostone is certified for use for childbirth in Russia. Aim. To conduct a review of the literature data and a pilot study of the effectiveness and safety of the vaginal therapeutic system with dinoprostone for induction of labor. Materials and methods. A review of the literature for 2001–2022 devoted to the use of vaginal systems with gradual release of prostaglandin for induction of labor was conducted. Additionally, a prospective observational study of the effectiveness and safety of the dinoprostone system was conducted in 18 pregnant women. The evaluation criteria were: the frequency of labor, the degree of maturation of the cervix on the Bishop scale, as well as the frequency of vaginal delivery. Results. Literature data indicate that SVT with dinoprostone has comparable efficacy with other methods of pre-induction / induction of labor. The system with dinoprostone has a lower frequency of the side effect of “tachysystole” than the system with misoprostol. Compared with mechanical methods, SVT is assotiated with a lower frequency of oxytocin use. The use of SVT with dinoprostone showed an efficiency of 77.8% (in terms of the of labor start or cervical ripening). No side effects requiring termination of labor induction were registered in our study. Conclusions. Thus, vaginal insertion with prostaglandin E2 – dinoprostone is an effective and safe method of pre-induction of labor. Taking into account the small sample size in our work, it is of interest to continue research in order to obtain more complete data and in comparison with other methods.

Announcing the winner of the John J. Sciarra IJGO Prize Paper Award for 2021

The editors of the International Journal of Gynecology & Obstetrics (IJGO) are pleased to announce the winner of the prize paper award for the best clinical research paper from a low- or middle-income country published in IJGO during 2021. The winning paper is: Tang X, Guo C, Liu S, Guo J, Hua K and Qiu J. A novel prognostic nomogram utilizing the 2018 FIGO staging system for cervical cancer: A large multicenter study. Int J Gynecol Obstet 2021;155:86–94. https://doi.org/10.1002/ijgo.13644. It was published in the October 2021 issue of IJGO. This award brings with it a stipend of £800, a certificate of recognition, and complimentary access to IJGO for a period of 1 year from the date the prize is awarded. All clinical research articles submitted to the IJGO from low- and middle-income countries that were published in 2021 were considered for this prize. The paper was chosen from 95 qualifying articles. Selection and review were undertaken by the editors, and the Editorial Board of IJGO endorsed the decision. The winning paper by Tang et al. evaluated the prognostic performance of the revised 2018 FIGO staging system for cervical cancer in a multicentre study across four sites. In 3238 patients with cervical cancer, 1841 (almost 60%) were re-staged. Almost one third of these were re-staged due to tumor size, approximately 30% due to lymph node metastasis, and one third due to the inconsistency between the pre-operative and post-operative assessments. They concluded that the 2018 FIGO staging system was a better reflection of the survival of cervical cancer patients. This very important work also allowed the group to establish a nomogram that allowed them to predict the prognosis of cervical cancer more accurately. Additional papers that are worthy of special recognition are awarded an honorable mention. While the honorable mention recognition does not include a financial award, each author receives a certificate of recognition and a letter of commendation from the editors of IJGO. The IJGO Prize Paper Award was established in 1998 for the purpose of encouraging investigators, especially young scientists, from low- and middle-income countries to submit their best clinical research articles for publication in the journal. IJGO is the official publication of FIGO (International Federation of Gynecology and Obstetrics), the primary international organization for the specialty of obstetrics and gynecology. FIGO is dedicated to enhancing the health care of women worldwide. HONORABLE MENTIONS 2021 The following 11 papers receive an honorable mention: China Li Y, Wang H, Zhang Y, et al. Correlation between multi-type human papillomavirus infections and viral loads and the cervical pathological grade. Int J Gynecol Obstet. 2020;152:96–102. https://doi.org/10.1002/ijgo.13406 Wang X, Zhang C, Li X, Qi H, Liu Q, Lei J. Safety and efficacy of titrated oral misoprostol solution versus vaginal dinoprostone for induction of labor: a single-center randomized control trial. Int J Gynecol Obstet. 2021;154:436–443. https://doi.org/10.1002/ijgo.13546 Brazil Laporte M, Becerra A, Castro L, Veiga N Jr, Espejo-Arce X, Bahamondes L. Evaluation of clinical performance when intrauterine devices are inserted by different categories of healthcare professional. Int J Gynecol Obstet. 2021;152:196–201. https://doi.org/10.1002/ijgo.13396 Barbieri MM, Herculano TB, Dantas Silva A, Bahamondes L, Juliato CRT, Surita FG. Acceptability of ENG-releasing subdermal implants among postpartum Brazilian young women during the COVID-19 pandemic. Int J Gynecol Obstet. 2021;154:106–112. https://doi.org/10.1002/ijgo.13663 Turkey Karakas LA, Atilgan AO, Akilli H, Kuscu UE, Haberal A, Ayhan A. Nulliparity and postmenopausal status are independent factors of malignancy potential of endometrial intraepithelial neoplasia in polyps. Int J Gynecol Obstet. 2021;152:433–438. https://doi.org/10.1002/ijgo.13448 Iran Ghotbizadeh Vhdani F, Nasiri Khormoji N, Eftekhar N, et al. A double-blind randomized trial on subendometrial injection of vasopressin to control bleeding in postpartum hysterectomy due to abnormally invasive placenta. Int J Gynecol Obstet. 2021;153:228–233. https://doi.org/10.1002/ijgo.13440 South Africa Budhram S, Vannevel V, Botha T, et al. Maternal characteristics and pregnancy outcomes of hospitalized pregnant women with SARS-CoV-2 infection in South Africa: An International Network of Obstetric Survey Systems-based cohort study. Int J Gynecol Obstet. 2021;155:455–465. https://doi.org/10.1002/ijgo.13917 Goldman B, Naidoo T. Formal training in cardiotocograph interpretation of healthcare practitioners improves interpretation: a prospective descriptive analytical study in a resource constrained setting. Int J Gynecol Obstet. 2021;153:527–532. https://doi.org/10.1002/ijgo.13513 Kenya Gwako GN, Obimbo MM, Gichangi PB, Kinuthia J, Gachuno OW, Were F. Association between obstetric and medical risk factors and stillbirths in a low-income urban setting. Int J Gynecol Obstet. 2021;154:331–336. https://doi.org/10.1002/ijgo.13528 Egypt Abdallah A, Khairy M, Tawfik M, et al. Role of first-trimester three-dimensional (3D) power Doppler of placental blood flow and 3D placental volume in early prediction of pre-eclampsia. Int J Gynecol Obstet. 2021;154:466–473. https://doi.org/10.1002/ijgo.13572 Malaysia Goh YP, Tan PC, Hong JGS, Sulaiman S, Omar, SZ. Combined massage and warm compress to the perineum during active second stage of labor in nulliparas: a randomized trial. Int J Gynecol Obstet. 2021;155:532–538. https://doi.org/10.1002/ijgo.13613

A literature review on misoprostol versus dinoprostone for induction of labor

In recent decades, the proportion of women undergoing induction of labor has increased accordingly within countries, industrialized areas, and various hospitals. The main aim of the article is to review most of the literature in order to provide safety and efficacy to obstetrical care providers on induction of labor. Systematic reviews/meta-analyses, cohort studies, and case-controlled studies that compared safety and efficacy during labor induction. Searches were updated on a regular basis using modified bishop scores. Some of the literature was retrieved from the websites of health technology-related agencies clinical trial agencies and clinical practice guidelines. This review mainly summarizes the controversies concerning the indications, methods for induction of labor, medical uses, contra-indications. This emphasizes the evidence of the safety and effectiveness of misoprostol when compared to dinoprostone during induction of labor.

Safety and efficacy of titrated oral misoprostol solution versus vaginal dinoprostone for induction of labor: A single-center randomized control trial.

ObjectiveTo compare the efficacy and safety of the hourly administration of titrated oral misoprostol solution (OMS) and vaginal dinoprostone for induction of labor.MethodsTitrated OMS was administrated hourly for induction of labor, starting with a dose of 20 µg and terminating at a dose of 50 µg. The safety and efficacy of OMS were compared with that of vaginal dinoprostone for induction of labor.ResultsFrom June 2016 to October 2019, 2280 (78.3%) and 2115 (72.9%) women who received titrated OMS and vaginal dinoprostone, respectively, had a vaginal delivery (P = 0.005). Cesarean delivery was performed in 632 (21.7%) and 783 (27.0%) women who received titrated OMS and vaginal dinoprostone, respectively (P = 0.008). Tachysystole with changes in fetal heart rate (FHR) was seen in 104 (3.6%) and 249 (8.6%) women in the OMS and dinoprostone groups, respectively (P = 0.007). The frequency of non‐reassuring FHR was lower in the OMS group compared to the dinoprostone group (P = 0.006).ConclusionThe titrated OMS has an efficacy comparable to vaginal dinoprostone. Moreover, it causes a lower incidence of cesarean delivery, lower frequency of tachysystole with changes in FHR, and non‐reassuring FHR.

994 Concurrent use of prostaglandin E2 and acetaminophen is associated with longer duration of labor induction

Acetaminophen (APAP) is widely used for pain management during pregnancy with a mechanism known to selectively suppresses peripheral prostaglandin E2 (PGE2) release. Dinoprostone is a naturally occurring PGE2 used for induction of labor. This study sought to determine if acetaminophen's suppressive activity on peripheral PGE2 effects the efficacy of dinoprostone for induction of labor. We conducted a 5 year retrospective cohort study and reviewed charts on women who received dinoprostone for induction of labor at term. Term pregnancies were defined as pregnancies between 40-42 weeks gestational age without onset of labor and a bishop score of 6 or less. Patients were included in the study if there received dinoprostone vaginally in doses of 10mg every 12 hours as needed for induction for a late term pregnancy and received between 2000-4000mg of APAP per day over the course of their induction. Patients receiving magnesium sulfate in the context of preeclampsia with severe features excluded. The study included 631 patients, with 303 receiving at least 2000mg of acetaminophen and 328 who did not. Baseline characteristics were not significantly different between treatment groups. Patients receiving acetaminophen experienced a longer duration of induction of labor 9.2±0.9 (1.6-13.7) hours as compared with those not receiving acetaminophen 6.3±1.1 (0.8-10.3), p = 0.02. In crude analysis, compared to those not receiving acetaminophen, receiving acetaminophen was associated with a 32% increased risk of requiring a second dose of dinoprostone (RR 1.78, 95% CI 1.42-1.93, p = 0.04.) After adjusting for BMI, initial cervical dilation at presentation, bishop score, diabetes mellitus, gestational blood pressure >140/90, race, advanced maternal age ( >34 y), and parity, this risk remained significant. APAP use ranging between 2000-4000mg over the course of a patient's labor induction with vaginal dinoprostone appears to be associated with a longer duration of induction. In such cases, other methods of cervical ripening may be a more suitable choice.

860: Use of acetaminophen and vaginal prostaglandin E2 is associated with longer duration of labor induction

Acetaminophen is widely used for pain management during pregnancy as an alternative to NSAIDs and selectively suppresses peripheral prostaglandin E2 (PGE2) release. Dinoprostone is a naturally occurring PGE2 used for induction of labor. This study sought to determine if acetaminophen's suppressive activity on peripheral PGE2 effects the efficacy of dinoprostone for induction of labor. We conducted a 4 year retrospective cohort study and reviewed charts on women who received dinoprostone for induction of labor for late term pregnancies. Late term pregnancies were defined as pregnancies between 41-42 weeks gestational age without onset of labor and a bishop score of 6 or less. Patients were included in the study if there received dinoprostone vaginally in doses of 10mg every 12 hours as needed for induction for a late term pregnancy and received between 2000-4000mg of acetaminophen per day over the course of their induction. The study included 478 patients, with 231 receiving at least 2000mg of acetaminophen and 247 who did not. Baseline characteristics were not significantly different between treatment groups. Patients receiving acetaminophen experienced a longer duration of induction of labor 8.2±0.8 (1.6-13.7) hours as compared with those not receiving acetaminophen 5.9±1.2 (0.8-10.3), p = 0.03. In crude analysis, compared to those not receiving acetaminophen, receiving acetaminophen was associated with a 32% increased risk of requiring a second dose of dinoprostone (RR 1.68, 95% CI 1.32-1.64, p = 0.03.) After adjusting for BMI, initial cervical dilation at presentation, bishop score, diabetes mellitus, gestational blood pressure >140/90, group b-Streptococcus status, race, advanced maternal age (>34 y), and parity, this risk remained significant. Acetaminophen use over the course of a patient’s labor induction with vaginal dinoprostone appears to be associated with a longer duration of induction.

A CLINICAL COMPARATIVE STUDY BETWEEN MISOPROSTOL (PGE1) AND DINOPROSTONE (PGE2) FOR INDUCTION OF LABOUR AT TERM - A PROSPECTIVE RANDOMISED CONTROLLED TRIAL

Background: Comparative study beween misoprostol and dinoprostone for induction of labour at term has been done at various centres which showed misoprostol to be more effective. This study was done, 18 years back in 2001, when the most common method of induction was dinoprostone. Since then both the drugs has been used equally for induction of labour at term. But in recent past, PGE1 is not being used widely because of fear of untoward effect. Hence, the importance this article which shows misoprostol to be more effective with less side effects, easy for storage and low cost. This study is to compare the effectiveness between the two molecules of prostaglandins PGE1 and PGE2 for induction of labour in term. The complication can be reduced by proper selection, 1 to 1 and continuous fetal monitoring.&#x0D; Methods: It was a prospective RCT. 200 Women at term in whom induction of labour was indicated with no contraindications for the use of prostaglandin attending labor room in a tertiary care centre (SAT Hospital Government Medical College Trivandrum) for a period of five months, from September 1St 2000 to January 31st 2001 was chosen to compare the effectiveness of Misoprostol and Dinoprostone for induction of labour at term. Both the groups were comparable in age, parity and bishop score.&#x0D; Results: Among 200, 123(61%) were primigravida and 146 (73%) were in the age group of 21 – 30 yrs. Median induction delivery interval was about 9 hrs shorter in PGE1 group. Only14.14% required oxytocin augmentation in PGE1 Group compared to 50.54% in PGE2 group. There was 8 failures in PGE2 and there was one case of hyper stimulation in PGEI group for which LSCS was done. PGE2 costs 10 times more than PGE1.&#x0D; Conclusion: Misoprostol is faster acting with low induction delivery interval and requirement for oxytoccin augmentation. Misoprostol is low cost drug, affordable to most of our patient from low socio economic status.&#x0D; Keywords: Term pregnancy, Tab Misoprostol, PGE1, Dinoprostone gel, PGE2, Induction of labour.

Low Doses of Vaginal Misoprostol versus Dinoprostone for Induction of Labor in Uncomplicated Term Pregnancy

Background: Prospective cohort observational study to compare the efficacy low doses (25 micrograms misoprostol) tablet with dinoprostone gel (1 mg) introduced vaginally in term pregnancy for induction of labor as regard maternal and fetal outcome. Methods: Three hundred pregnant women in full term (40-41 weeks) pregnancy were assigned for induction of labor either intravaginal misoprostol tablet or dinoprostone gel. They were divided into 2 groups (A, B). Group A (150 ladies) obtained tablet misoprostol 25 micrograms vaginally 4 hourly and Group B (150 ladies) received dinoprostone gel 1 mg vaginally every 6 hourly, both medications were not to be repeated more than 3 doses. Outcomes were: expression of time interval of induction of labor, augmentation requirement, operative and instrumental rate, expenditure efficiency and neonatal outcome. Results: The demographic criteria as regard the age, body mass index, gestational age, initial Bishop’s score and final Bishop’s score were analogous in both group (the misoprostol and dinoprostone groups), respectively with no significant differences but about parity there was significant difference between them with p value 0.4. No significant differences between both group as regard occurrence of non-reassuring FHR, uterine hyper stimulation and meconium stained amniotic fluid but there was significant differences in spontaneous rupture of the membranes and uterine tachysystole with p value 0.02 and 0.01, respectively. Time of labor induction was shorter in the misoprostol group with p<0.001. The need of more doses was fewer in G1 than G2 with p value 0.03. Also the need to oxytocin for augmentation was lesser in G1 than G2 with p value 0.02. In misoprostol group more deliveries within 24 hour, p<0.04. The vaginal deliveries were more in misoprostol group with lesser percentage of CS but with no significant difference. The fetal outcome in both group was similar according to birth weight, Apgar score and at 5, the requirement for neonatal resuscitation and neonatal intensive care unit admission. Conclusions: The time interval for induction of labor by misoprostol tablet vaginally was shorter than dinoprostone gel, associated with fewer requirements to augmentation of labor with oxytocin and more deliveries in the first 24 hours of induction.

A comparison of obstetrical outcomes and costs between misoprostol and dinoprostone for induction of labor

Objective: The objective of this study is to compare resource utilization (efficiency) and obstetrical/cost outcomes of single dose misoprostol versus dinoprostone for induction of labor (IOL) at term.Methods: Retrospective cohort of induced deliveries 37–41 weeks gestation presenting with a Bishop score ≤4 using single-dose-50 mcg vaginal misoprostol or 10 mg-dinoprostone vaginal-inserts. Dinoprostone patients were compared (5:1) with misoprostol patients. The primary outcome variable was length of L&D stay (proxy for resource utilization). Baseline characteristics, clinical outcomes, and costs were compared.Results: Three-hundred thirty-one patients were included, 276 received dinoprostone and 55 received misoprostol. The misoprostol group had statistically significant decreased time to active labor [median 8 h (1.6,24) versus 12(0.8,52)], time-to-delivery [median 11 h (4,31) versus 17(2.8,56)] and L&D stay [median 16 h (13,28) versus 24(18,30)]. Differences remained significant after adjustment for race, method of delivery, birth weight, gravidity/parity, gestational age, and BMI (adjusted p values <0.001, <0.01, and < 0.05, respectively). There were no statistical differences in Apgar scores, tachysystole rate, cesarean section rate, and composite maternal/neonatal morbidity. A policy of using misoprostol would result in annual cost savings of approximately $242 500 at our institution as compared with dinoprostone.Conclusion: Single-dose misoprostol is more efficient in IOL at term with respect to L&D utilization and cost and its use is not associated with increased adverse obstetrical outcomes.

Titrated misoprostol versus dinoprostone for labor induction

Background: Misoprostol is as effective as dinoprostone for labor induction with low cost and temperature stability. Aim: This study designed to compare titrated misoprostol regarding its safety and efficacy with dinoprostone for induction of labor. Subjects and Methods: Women with a single pregnancy, above 37 weeks’ gestation, cephalic presentation, modified Bishop’s score <8, and not in labor with reassuring fetal heart rate, admitted for labor induction enrolled in this randomized controlled study. Studied women were randomized into; Group I: received oral misoprostol titrated in sterile water (200 μg tablet was dissolved in 200 ml sterile water [1 μg/ml]), starting dose of 20 μg misoprostol required, given every 2 h, and stopped if adequate contractions obtained and Group II: received vaginal dinoprostone tablet maximum two doses followed by augmentation of labor by oxytocin ± amniotomy if there is no uterine contractions after two doses of dinoprostone. In Group I, if the contractions were inadequate after two doses of oral titrated misoprostol (20 μg [20 ml]), the starting dose increased to 40 μg (40 ml), escalating the dose from 5 to 10 ml (45–50 μg), and 20 ml (60 μg) maximum ± amniotomy. If the uterine contractions were adequate, the next dose of misoprostol or dinoprostone was omitted. Statistical analysis done using Student’s t‑test for quantitative data and Chi‑square test for qualitative data. Results: Induction‑to‑delivery time was significantly longer in misoprostol than dinoprostone group (975 vs. 670 min, respectively), (P = 0.01). About 20.2% (21/104) of women in misoprostol group did not deliver vaginally within 24 h compared to 7.4% (8/108) in dinoprostone group (significant difference, P = 0.01). Augmentation of labor was significantly high in dinoprostone (37.96% [41/108]) compared to misoprostol group (10.6% [11/104]) (P < 0.01). Conclusion: Titrated misoprostol for induction of labor seems to be associated with significantly longer induction‑to‑delivery time, low incidence of vaginal birth within 24 h, and less need for augmentation of labor compared to vaginal dinoprostone.

Is vaginal misoprostol more effective than dinoprostone for labor induction?

Is vaginal misoprostol more effective than dinoprostone for labor induction?

Effect of Oral Propranolol on Labor Induction

Effect of Oral Propranolol on Labor Induction

Labor induction in nulliparous women with an unfavorable cervix: double balloon catheter versus dinoprostone

We sought to compare the efficacy of the double-balloon catheter and dinoprostone for induction of labor among nulliparous women with an unfavorable cervix. Nulliparous women with a Bishop score <6 were randomized to receive a 10-mg intra-vaginal dinoprostone insert or a double-balloon catheter. Primary outcome was time to delivery. Statistical analyses were performed by intention to treat using the chi-square, Fisher's exact, and Student's t-test, as appropriate. The mean induction-to-delivery time was shorter in the double-balloon group as compared to the dinoprostone group (17.9±5.8 vs. 26.3±9.7 h) as was the time from induction to vaginal delivery (19.13±5 vs. 24.45±8.7 h, respectively). More women in the catheter group were delivered within 24 h compared to the dinoprostone group (87.1% vs. 47.4%). Approximately 50% of women in both groups delivered by cesarean section. Induction of labor with the double-balloon catheter in nulliparous women with an unfavorable cervix is associated with a shorter time to delivery compared to dinoprostone.

Randomized clinical trial between hourly titrated oral misoprostol and vaginal dinoprostone for induction of labor

The objective of the study was to compare the efficacy and safety of hourly titrated oral misoprostol with vaginal dinoprostone insert. Subjects were randomized into hourly titrated oral misoprostol or dinoprostone 10 mg vaginal insert. Misoprostol was given as 20 μg hourly for 2 doses. In the absence of regular uterine contractions, the dose was increased to 30 μg hourly for 3 doses and then 40 μg for 1 dose, 50 μg for 1 dose, and 60 μg hourly for 4 doses. Before the 40 and 50 μg doses, 1 more hour of observation was given. The primary outcome variable was vaginal delivery within 24 hours. Safety assessments included the incidence of maternal morbidity and adverse neonatal outcomes. A total of 160 women was enrolled in the study. The groups were similar for demographic and clinical factors. Vaginal delivery was achieved within 24 hours in 100 women (62.5%): 44 in the dinoprostone group (55.0%) and 56 in the misoprostol group (70.0%) (P= .05). The proportion of women who achieved vaginal delivery within 24hours was significantly greater for nulliparous women in the misoprostol group (24 of 51, 58.5%) compared with the dinoprostone group (12 of 36, 33.3%; P= .0270). Significantly more women with baseline Bishop score of 3 or less in the misoprostol group had successful induction (43 of 59, 72.9%) compared with the dinoprostone group (27 of 60, 45.0%; P= .002). Frequencies of maternal adverse events were similar between groups. Hourly titrated oral misoprostol can provide an efficacious and safe substitute for the expensive dinoprostone vaginal insert.

90: Oral misoprostol vs vaginal dinoprostone for labor induction in nulliparous women at term

between 34 0 and 36 6 weeks of gestation Giuliana Simonazzi, Alessandra Curti, Elisa Moro, Andrea Pedrazzi, Tiziana Martina, Antonio Farina, Nicola Rizzo St. Orsola Malpighi Hospital, University of Bologna, Department of Obstetrics & Gynecology, Bologna, Italy OBJECTIVE: To assess the impact of mode of delivery on respiratory morbidity among late-preterm neonates. STUDY DESIGN: Singleton pregnancies complicated by premature rupture of membranes (PROM) between 34 0 and 36 6 weeks were studied retrospectively. Pregnancies with corticosteroid administration after 34 6 weeks were excluded. Patients were divided into cesarean section (CS) and vaginal delivery groups, matched 1:3 for gestational age. The primary outcome was the rate of respiratory distress syndrome (RDS). Logistic regression was performed to assess the risk of RDS within groups. RESULTS: Between 2005 and 2012, 360 patients delivered between 34 and 36 weeks after premature rupture of membranes at St. OrsolaMalpighi Hospital, Bologna (Italy). In 90 cases elective caesarean section was performed for previous CS (n 50), breech presentation (n 31) or maternal medical indications (n 9). No difference was found for antenatal betamethasone within groups. The overall RDS rate was 15%, while it was 30% and 10% in case of CS and vaginal delivery, respectively (p-value 0.0001). CS seems to be a risk factor for RDS (OR 4.2, p-value 0,0001), as does earlier gestational age at delivery (OR 0.9, p-value 0,0001). Table 1 shows the median risks of RDS in the study population according to the logistic regression model. CONCLUSION: After preterm PROM, CS is associated with a higher risk of neonatal RDS. This is more evident with increasing gestational age, when respiratory morbidity is thought to be less frequent.

Comparison of Low-Dose Oxytocin and Dinoprostone for Labor Induction in Postterm Pregnancies: A Randomized Controlled Prospective Study

Aims: The aim of this study was to compare the efficacy of oxytocin and dinoprostone in achieving successful labor induction and vaginal delivery in postterm women with an unfavorable cervix. Methods: Postterm women with an uncomplicated pregnancy and a Bishop score of ≤6 were randomized to receive either dinoprostone vaginal pessary (Propess®) or low-dose oxytocin. The primary outcomes were the length of the induction-to-delivery period and the incidence of vaginal delivery. Results: A total of 144 women were available for the analysis. The overall vaginal delivery rates were 75% (54/72) for the dinoprostone group and 80.6% (58/72; p = 0.35) for the oxytocin group; the mean induction-to-vaginal delivery interval was 13.3 and 10.3 h in the dinoprostone and the oxytocin group, respectively (p = 0.003). Uterine hyperstimulation was 7.4% compared with 6.8% (p = 0.8), and abnormal fetal heart rate was 26.4% compared with 18% (p = 0.2), respectively. Conclusion: Both oxytocin and dinoprostone seem to have similar obstetric outcomes in postterm pregnancies with an unfavorable cervix, except for a significant superiority of oxytocin for delivery in a shorter period.