E2 Vaginal Tablets Research Articles

Induced labour with prostaglandin E2 in different parity groups after premature rupture of membranes

The study compared the outcome of induction of labour with prostaglandin E2 vaginal tablets in patients with premature rupture of membranes (PROM) at term in different parity groups. A retrospective review was made of the hospital records of 169 women attending the maternity unit of King Faisal Military Hospital, Saudi Arabia. There were no statistically significant differences between the 3 groups (parity 0, parity 1-4 and parity 5+) in rates of labour augmentation, caesarean sections, neonatal intensive care admissions or low Apgar scores. There were no serious complications of induction of labour such as infection or uterine hyperstimulation or rupture. Prostaglandin E2 may be used with care for labour induction in women with PROM at term, even grand multiparas, unless there is history of previous caesarean delivery.

Foley catheter for cervical priming in induction of labour at University Obstetrics Unit, Colombo, Sri Lanka: a clinical audit with a patient satisfaction survey

BackgroundIntracervical insertion of a Foley catheter (FC) has shown to be a safe, effective and relatively feasible mechanical method of cervical priming in induction of labour (IOL). We evaluated indications, effectiveness, patient acceptability and outcomes of FC use in IOL adhering to the ward protocol in our unit.MethodsA clinical audit with a patient satisfaction survey conducted between July and September 2013 in University Obstetric Unit, Colombo, Sri Lanka. Patients selected for IOL for obstetric reasons were primed with Foley as per ward protocol. All had singleton pregnancies with cephalic presentation, intact membranes and period of gestation of 37 weeks or above. Women with a history of more than one caesarean section or uterine surgery, low-lying placenta and fetal growth restriction were excluded. Subjects who had a Modified Bishop Score (MBS) of less than 3, a 16Fr FC was inserted into cervical canal. Catheter was left undisturbed until spontaneous expulsion or no longer than 48 h. In women with MBS of less than 6 at 48 h after FC insertion, 3 mg prostaglandin E2 vaginal tablet was used subsequently. Artificial membrane rupture with or without oxytocin was used if MBS of 6 or more and in women not in labour 24 h after prostaglandins. Patient satisfaction for Foley insertion was assessed with regards to the degree of comfort using a validated visual analogue scale (0–10).ResultsThere were a total of 910 deliveries during the study period. Fifty-six women were primed with FC. Thirty-two (57%) were nulliparous. During induction of labour, 53(95%) reported mild or no discomfort. MBS of 6 or more was achieved in 36/56 (64%) Foley insertions. Twenty needed further intervention with prostaglandins. FC only group had 5 caesarean sections and 31 vaginal deliveries and Foley/prostaglandin group had 7 caesarean sections and 13 vaginal deliveries. Of the 24 women who were induced due to completion of 41 weeks of gestation with otherwise uncomplicated pregnancies, 17 had MBS >6 post priming with Foley and 20 (83%) delivered vaginally. Subjects who had Foley only had a lesser chance of having a caesarean delivery compared to subjects who had Foley followed by prostaglandin (relative risk = 0.40, 95% CI = 0.15–1.09, P = 0.09).DiscussionFC is a good choice for pre-induction cervical priming with high patient comfort. FC becomes more important in IOL cost reduction in our setting. FC alone seems to be an effective for IOL in women who have completed 41 weeks of gestation with otherwise uncomplicated pregnancies.

Induction of labor single vaginal PGE 2 vs early Amniotomy and I/V oxytocin

Objective: To compare two methods of induction of labour. Amniotomy with intravenous oxytocin infusion versus single use of prostaglandin E2 vaginal tablet. Design Perspective randomized clinical trial . Setting: The department of Gynae & Obs Nishtar Hospital Multan & Ganga Ram hospital lahore 100 patients were recruited .50 were randomized for amniotomy followed by oxytocin infusion. Second group underwent labour induction with PGE2 which was repeated after 6 hours, if n o change in bishop score is observed. Period: 17 .2 .2004 to 17 .2.2005 Results: In the study the results regarding mean Bishop score change, duration of labour and apgar score at 5 minutes were comparable in both groups. In the group 2 mean induction to delivery time was 9 hours.(6-12 hrs).The mean cervical change score was 8.5 Duration of labour in group 2 was in the mean of 7hrs. In group 1 mean cervical change was 7.5 (range5-7), induction to delivery time was 10.5 hrs. The duration of labour was 7.5 hrs. Analgesic requirements varied in both groups. No patient with PGE2 required pain relief before membrane rupture. In the oxytocin group narcotic analgesia was given from the start of uterine contractions. Conclusion: PGE2 vaginal tablet for induction of labour in case of unfavourable cervix is superior to use of amniotomy and oxytocin. It was found to be safe and effective with minimum of patient interference.

Prostaglandin E2 vaginal gel or tablets for the induction of labour at term: a randomised controlled trial

BJOG: An International Journal of Obstetrics & GynaecologyVolume 118, Issue 13 p. 1679-1680 Correspondence Prostaglandin E2 vaginal gel or tablets for the induction of labour at term: a randomised controlled trial Z Khan, Z Khan Singleton Hospital, Swansea, UKSearch for more papers by this authorF Majoko, F Majoko Singleton Hospital, Swansea, UKSearch for more papers by this author Z Khan, Z Khan Singleton Hospital, Swansea, UKSearch for more papers by this authorF Majoko, F Majoko Singleton Hospital, Swansea, UKSearch for more papers by this author First published: 11 November 2011 https://doi.org/10.1111/j.1471-0528.2011.03160.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume118, Issue13December 2011Pages 1679-1680 RelatedInformation

Prostaglandin E2 vaginal gel or tablets for the induction of labour at term: a randomised controlled trial

Prostaglandin E2 vaginal gel or tablets for the induction of labour at term: a randomised controlled trial

Prostaglandin E2 vaginal gel or tablets for the induction of labour at term: a randomised controlled trial

Prostaglandin E2 vaginal gel or tablets for the induction of labour at term: a randomised controlled trial

Prostaglandin E2 vaginal gel or tablets for the induction of labour at term: a randomised controlled trial

To compare the effectiveness of prostaglandin E2 (dinopristone) vaginal gel versus vaginal tablets for the induction of labour at term.Randomised controlled clinical trial. University maternity hospital in London.Pregnant women with cephalic presentation undergoing induction of labour after 37 weeks of gestation.Prostaglandin E2 vaginal tablets (3 mg) or vaginal gel (1 mg/ 2 mg) was administered at 6-hourly intervals until the cervix was suitable for amniotomy.Induction to delivery interval, in minutes; rate of failed induction of labour requiring caesarean delivery.Eighty-two women received prostaglandin gel; 83 women received vaginal tablets. There were significant differences between the two treatment groups in the primary outcomes. The mean induction to delivery interval was significantly shorter in women who received the gel (1400 minutes, 690-2280 minutes, versus 1780 minutes, 960-2640 minutes; P = 0.03). The rate of failed induction of labour was significantly higher in women who received tablets (10.84 versus 1.22%; P = 0.01). Subanalysis showed that these differences were only representative of differences in the groups of primigravid women. There were no significant differences in any of the secondary outcomes, including the number of women who required syntocinon augmentation, the rate of uterine hyperstimulation, the need for epidural analgesia, meconium staining of liquor, the need for fetal blood sampling, or delivery by caesarean section. There were no differences in adverse maternal and neonatal outcomes.Prostaglandin E2 vaginal gel is superior to vaginal tablets for the induction of labour.

Cost-effectiveness analysis of prostaglandin E2 gel for the induction of labour at term

To estimate the cost-effectiveness of prostaglandin E2 (dinoprostone) vaginal gel for the induction of labour at term from the perspective of the UK's National Health Service. Economic evaluation conducted as part of a randomised controlled trial. Maternity department at a major teaching hospital in London, UK. A cohort of 165 pregnant women presenting as cephalic between 36(+⁶) and 41(+⁶) weeks of gestation, for whom induction of labour was deemed necessary. Either 3-mg Prostin E2 vaginal tablets or 1- or 2-mg Prostin E2 vaginal gel were administered at 6-hourly intervals. Incremental cost per hour prevented between induction and delivery. The nonparametric bootstrap method was used to construct cost-effectiveness acceptability curves and estimate net benefits at alternative cost-effectiveness thresholds. Women receiving the gel accrued nonsignificantly higher costs (incremental cost £630; bootstrap 95% CI -£353, £2320; P = 0.43), and experienced a significantly reduced interval between induction and delivery (median of 1400 versus 1780 minutes; mean of 1711 versus 2765 minutes; P = 0.03). The incremental cost per hour prevented from induction of labour to delivery was estimated at £36. At a cost-effectiveness threshold of £100 per hour of care prevented, the probability that the gel is cost-effective was estimated at 0.83, and the mean net benefit to the health services was estimated at £1121 (bootstrap 95% CI -£1133, £3379). The results were sensitive to the inclusion of neonatal costs in the analysis and the value of the cost-effectiveness threshold. Notably, excluding neonatal costs increased the probability that the gel is cost-effective at a cost-effectiveness threshold of £100 per hour of care prevented to 0.99. This study suggests that prostaglandin E2 gel is probably more cost-effective than prostaglandin E2 tablets for the induction of labour at term. Given that the results are applicable to the general obstetric population requiring induction of labour at term, decision-makers should consider the likely economic impacts of their implementation.

Intravenous dexmedetomidine infusion for labour analgesia in patient with preeclampsia

Intravenous dexmedetomidine infusion for labour analgesia in patient with preeclampsia

Effective Treatment of Vaginal Atrophy With an Ultra–Low-Dose Estradiol Vaginal Tablet

To evaluate the efficacy of ultra-low-dose 10-microgram 17beta-estradiol (E2) vaginal tablets for treatment of vaginal atrophy. Postmenopausal women (N=309) were randomly assigned to 10-microgram E2 or placebo vaginal tablets for 52 weeks in a multicenter, double-blind study. Primary efficacy endpoints included change from baseline to week 12 in vaginal cytology, vaginal pH, and most bothersome urogenital symptoms score. Grading of vaginal health was a secondary efficacy assessment. Safety assessments included endometrial biopsy, physical and gynecologic examinations, and recording adverse events. At week 12, the change from baseline for 10 micrograms E2 compared with placebo demonstrated significant improvement in vaginal Maturation Index (proportion of parabasal cells: -37% compared with -9%; superficial cells: 13% compared with 4%; intermediate cells: 24% compared with 5%; P<.001 for each), Maturation Value (25.0 compared with 6.5, P<.001), grading of vaginal health (-0.91 compared with -0.51, P<.001), vaginal pH grade (-1.3 compared with -0.4, P<.001), and most bothersome symptoms score (-1.23 compared with -0.87, P=.003). For each component of vaginal Maturation Index, vaginal Maturation Value, grading of vaginal health, and vaginal pH, treatment effects were statistically different from placebo after 2 weeks of treatment. For most bothersome symptoms, treatment effect became apparent after 4 weeks and reached statistical significance at week 8 of therapy. All treatment effects were statistically significant at week 52. There were no major safety findings regarding physical, gynecologic, or laboratory assessments. After 12 weeks of treatment, an ultra-low-dose 10-microgram E2 vaginal tablet, compared with placebo, demonstrated significant improvement for the primary endpoints: vaginal cytology and pH and most bothersome urogenital symptoms score. ClinicalTrials.gov, http://clinicaltrials.gov, NCT00108849 I.

Induction of labor with prostaglandin E2 vaginal tablets in parous and grandmultiparous patients with previous cesarean section

Objectives: To compare the outcome of induction of labor with prostaglandin E2 vaginal tablets between lower parity (parity 1–5) and grandmultiparous (parity >5) patients with a history of one previous lower segment cesarean section. Methods: A prospective study of 113 patients conducted at King Faisal Military Hospital, Khamis Mushayt, Saudi Arabia during a 5-year period spanning January1995 to December 1999. Results: There were no statistically significant differences in the two groups regarding mean maternal age, dose of prostaglandin used, gestation at delivery, mean birth weight, P>0.05. Syntocinon augmentation was used in 16 (21.9%) of the lower parity patients compared with 8 (20.0%) in the grandmultiparas but this was not statistically significant, ( P=0.677). However, there was a statistically significant difference in the cesarean section rate between the two groups, P=0.019. Although no cases of uterine hyperstimulation were recorded, there was one rupture of the uterus in each of the two groups of patients; 1.36% and 2.5%, respectively, but this was not statistically significant, P=1.000. Conclusions: The complications of induction of labor with prostaglandin E2 vaginal tablets in grandmultiparous patients with previous cesarean section were similar to those with lower parity but the cesarean section rate was significantly higher. However, larger studies are needed for validation.

Randomized Comparison of Glyceryl Trinitrate and Prostaglandin E2 for Cervical Ripening at Term

In Brief Objective To estimate the adverse effects of glyceryl trinitrate compared with prostaglandin (PG) E2 vaginal tablet for cervical ripening in term pregnancy. Methods One hundred ten women with term pregnancies referred for induction of labor with Bishop scores of 6 or less were randomly assigned to receive a 500-μg glyceryl trinitrate tablet vaginally (n = 54) or a 3-mg PGE2 tablet vaginally (n = 56), every 6 hours for maximum of two doses. Subjects were sent to the labor ward for amniotomy or oxytocin if their Bishop scores were more than 6 or their cervices were not ripe 24 hours after treatment. Adverse effects, changes in the Bishop scores, progress, and outcomes of labor were assessed. Results Glyceryl trinitrate was associated with fewer episodes of uterine tachysystole (0% versus 9%; P = .02). The median Bishop score after 12 hours was lower in women given glyceryl trinitrate compared with those given PGE2. Adverse effects, including headache and palpitations, were more frequent with glyceryl trinitrate than with PGE2. The cesarean rate was not significantly different between groups. Conclusion Cervical ripening with glyceryl trinitrate resulted in fewer episodes of tachysystole, but there were significantly more minor side effects. It can be used for cervical ripening at term, but it was not as effective as PGE2. Glyceryl trinitrate for cervical ripening caused fewer tachysystoles but was less effective than prostaglandin E2.

Randomized comparison of glyceryl trinitrate and prostaglandin E2 for cervical ripening at term

Objective: To estimate the adverse effects of glyceryl trinitrate compared with prostaglandin (PG) E2 vaginal tablet for cervical ripening in term pregnancy. Methods: One hundred ten women with term pregnancies referred for induction of labor with Bishop scores of 6 or less were randomly assigned to receive a 500-μg glyceryl trinitrate tablet vaginally ( n = 54) or a 3-mg PGE2 tablet vaginally ( n = 56), every 6 hours for maximum of two doses. Subjects were sent to the labor ward for amniotomy or oxytocin if their Bishop scores were more than 6 or their cervices were not ripe 24 hours after treatment. Adverse effects, changes in the Bishop scores, progress, and outcomes of labor were assessed. Results: Glyceryl trinitrate was associated with fewer episodes of uterine tachysystole (0% versus 9%; P = .02). The median Bishop score after 12 hours was lower in women given glyceryl trinitrate compared with those given PGE2. Adverse effects, including headache and palpitations, were more frequent with glyceryl trinitrate than with PGE2. The cesarean rate was not significantly different between groups. Conclusion: Cervical ripening with glyceryl trinitrate resulted in fewer episodes of tachysystole, but there were significantly more minor side effects. It can be used for cervical ripening at term, but it was not as effective as PGE2.

The experience with prostaglandin E2 vaginal tablets for induction of labour in grand and great grand multiparae. A two year review in Saudi Arabia

In an attempt to review our experience with prostaglandin E2 vaginal tablets in induction of labour in grandmultiparae (parity 5-9) and great grandmultiparae (parity > 9) a retrospective study was carried out at King Faisal Military Hospital in Saudi Arabia over a 2-year period. An evaluation of our protocol for induction of labour using prostaglandin in these groups of patients was also made. The patients included 271 grandmultiparae and 63 great grandmultiparae. There were no serious side effects in our series referable to the prostaglandin induction. There were no significant differences in the two groups regarding the mean total dose of prostaglandin used, mean length of second stage of labour, mean birth weight and admission to the neonatal intensive care unit (P > 0.05). However, the need for syntocinon augmentation was more in the great grandmultiparae (29% vs. 19%) but this was not significant statistically (P = 0.64). The caesarean section rate was higher in the great grandmultiparae (14% vs.10%) but not statistically significant (P = 0.19). None of the babies in the study group had an Apgar score less than 7 at 5 minutes. This study has shown that it may be safe to use prostaglandin E2 vaginal tablets for induction of labour in grandmultiparae and great grandmultiparae in our environment although the sample size may not be large enough to draw definite conclusions. Our protocol of stepwise increase in prostaglandin dose did not increase maternal or fetal morbidity but might actually have reduced the number of caesarean sections performed and therefore maternal mortality associated with caesarean section in the grandmultiparae. A multicentre prospective trial is eagerly awaited.

A comparison of an intravaginal controlled release prostaglandin E2 (10 mg) for cervical ripening and initiation of labour versus prostaglandin E2 vaginal tablet (3 mg)

(1998). A comparison of an intravaginal controlled release prostaglandin E2 (10 mg) for cervical ripening and initiation of labour versus prostaglandin E2 vaginal tablet (3 mg) Journal of Obstetrics and Gynaecology: Vol. 18, No. 5, pp. 460-461.

Pdate on prostaglandin E2 vaginal tablet for induction of labor

pdate on prostaglandin E2 vaginal tablet for induction of labor

Routine revision of uterine scar after prior cesarean section.

Up until the early seventies fear of uterine rupture led to the widespread practice of 'once a section, always a section'. Nowadays, there is a consistent trend toward vaginal birth after a prior cesarean delivery, making early detection of uterine scar dehiscence at delivery important. However, the need for routine transcervical revision of the uterine scar following vaginal delivery is controversial in the medical literature. The present study reviewed 467 women who underwent vaginal delivery following a previous cesarean section. In 414 patients the scar was examined transcervically, and not one case of dehiscence of the scar was detected. The patients included four with twin pregnancies, and four with breech presentations (two underwent external cephalic version). Intrauterine pressure was monitored in 17 cases; Prostaglandin E2 vaginal tablets were used in 46 patients, and in 14 cases labor was augmented by Pitocin. Our results suggest that routine revision of a uterine scar at the time of a subsequent vaginal delivery is usually unnecessary.

Uterine rupture with the use of a low‐dose vaginal PGE2 tablet

Prostaglandin E2 (PGE2) vaginal tablets, suppositories and gel are increasingly being used for the induction of labor. Ease of administration and supervision are their greatest advantage, while hyperstimulation and rupture of the uterus are the main risks. A 26-year-old woman, gravida 5, para 2, with no history of cesarean section, was induced at 40 weeks' normal gestation, because of mild pregnancy-induced hypertension. Half a tablet (1.5 mg) of PGE2 was inserted into the cervix. Three hours later, tetanic uterine contractions started. In a precipitated labor she delivered a female weighing 3,250 gr, about 20 minutes after the appearance of uterine contractions. Severe post partum hemorrhage occurred, and examination disclosed an isthmical uterine rupture. Subtotal hysterectomy was performed at laparotomy. The postoperative course was uneventful. The use of PGE2 should be of concern in multiparous patients, or those with scarred uteri. This case highlights the risk of even a small dose of PGE2 administered into the cervix.

Induction of labour in primigravid women with an unfavourable cervix: A prospective comparative study of prostaglandin E2 vaginal tablets and gel

(1993). Induction of labour in primigravid women with an unfavourable cervix: A prospective comparative study of prostaglandin E2 vaginal tablets and gel. Journal of Obstetrics and Gynaecology: Vol. 13, No. 2, pp. 112-113.

A comparison of prostaglandin E2vaginal tablets with vaginal gel for ripening the unfavourable cervix and induction of labour

SummaryA prospective controlled trial was conducted at Coventry Maternity Hospital to compare the efficacy of prostaglandin E2 vaginal tablets (3 mg initially, 6 mg maximum) and prostaglandin E2 vaginal gel (1 mg initially, 3 mg maximum) for ripening the unfavourable cervix and induction of labour.Two hundred patients were studied; 104 were given tablets and 96 gel. All the pregnancies were singleton and were at least 36 weeks. All patients completed a standard questionnaire using a 100 mm linear analogue scale to assess the acceptability of the two methods of induction. Scores for discomfort and pain were low and did not differ between the two groups, but patients who had previously had labour induced found the gel more acceptable than the tablets.Twenty per cent of all patients did not need amnio-tomy. Forty per cent of the table and 50 per cent of the gel patients did not need augmentation of labour with oxytocin. There was no difference in cervical ripening or induction to delivery intervals between t...