Induction Of Labor In Patients Research Articles

Comparative cost analysis of prostaglandin analogues dinoprostone and misoprostol as labor preinduction agents

Objective: To compare the relative cost efficacy of three commercially available prostaglandin analogues, misoprostol (Cytotec®, PGE 1), dinoprostone gel (Prepidil®, PGE 2), and dinoprostone pessary (Cervidil®, PGE 2), as labor preinduction agents. Methods: The investigation was conducted as a prospective randomized, blinded phase III clinical trial. One hundred twelve gravid females undergoing induction of labor with an unfavorable cervix (Bishop score ≤5) were enrolled and randomized to receive either Cytotec® 50 μg q6 hours × 2 doses, Prepidil® 0.5 mg q6 hours × 2 doses, or Cervidil® 10 mg × 1 intravaginally. Twelve hours after initial treatment, cervical Bishop score was reassigned by the same blinded initial examiner and oxytocin induction initiated per standardized protocol. Therapeutic efficacy and cost of the labor preinduction/induction with the study treatments were compared. Statistical comparisons between groups were made using ANOVA with Bonferroni post test, Wilcoxon rank sum test, and χ 2 test. Results: The three study groups did not differ significantly with respect to parity, gestational age, indication for induction, or initial cervical Bishop score. A significantly greater proportion of patients had a favorable cervix (Bishop score ≥6) after the initial preinduction interval in the Cytotec® (79.0%) and Cervidil® groups (60.5%) as compared to Prepidil® (40.0%) ( P < .05). The average relative cost per patient for prostaglandin preinduction was significantly less with Cytotec® ($0.42) as compared to both Cervidil® ($168.00) and Prepidil® ($184.17) ( P < .0001). A greater percentage of patients treated with Cytotec® (42.1%) achieved active labor and delivered without the use of oxytocin when compared to Cervidil® (15.8%) or Prepidil® treatment groups (2.9%) ( P < .05). Additionally, time to delivery (±SD) was significantly shorter in the Cytotec® group (24.0 ± 10.8 h) as compared to the Cervidil® (32.2 ± 14.7 h) or Prepidil® groups (33.9 ± 16.2 h) ( P < .05). This reduction in time resulted in a significantly lower overall mean cost per patient incurred by labor induction in the Cytotec® group ($723.66) as compared to the Cervidil® ($1058.90) or Prepidil® treatment ($1124.84) ( P < .01). No significant differences were noted with respect to rate of cesarean delivery. Conclusion: Misoprostol is more cost-effective than the comparable commercial dinoprostone prostaglandin preparations as an adjuvant to labor induction in patients with an unfavorable cervix.

Randomized trial of two doses of the prostaglandin E 1 analog misoprostol for labor induction

OBJECTIVE: Our purpose was to compare the safety and effectiveness of intravaginally administered misoprostol at doses of 25 μg and 50 μg for indicated labor induction in patients with an unfavorable cervix. STUDY DESIGN: Three hundred ninety-nine patients received either 25 μg or 50 μg of misoprostol, placed intravaginally in the posterior fornix, in this randomized double-blind trial. The dose was repeated every 3 hours until adequate labor was achieved (at least three contractions in 10 minutes). RESULTS: Among 399 patients evaluated, 192 patients were allocated to the 25 μg group and 207 patients to the 50 μg group. The start-to-delivery interval was shorter in the 50 μg group (826 minutes vs 970 minutes, p = 0.02). The incidence of vaginal delivery after one dose was higher in the 50 μg group (38.2% vs 25.0%, p = 0.007). Patients receiving 25 μg required oxytocin augmentation more frequently than did those receiving 50 μg (27.1% vs 16.9%, p = 0.02). No differences were noted in the cesarean or other operative delivery rates among patients in the two treatment groups. The incidence of newborns with a cord pH <7.16 was greater in the 50 μg group (13.0% vs 6.8%, p = 0.04). Although the incidence of hyperstimulation was similar between the groups, the incidence of tachysystole was higher in the 50 μg group (32.8% vs 15.6%, p = 0.0001). CONCLUSIONS: Although a dose of 50 μg is associated with a shorter start-to-delivery interval and a higher incidence of vaginal delivery after one dose, 25 μg of intravaginal misoprostol is effective and associated with a lower incidence of tachysystole and cord pH values <7.16. (Am J Obstet Gynecol 1997;177:364-71.)

A randomized comparison between misoprostol and dinoprostone for cervical ripening and labor induction in patients with unfavorable cervices

To compare the efficacy and safety of two prostaglandin derivatives, misoprostol and dinoprostone, for ripening the cervix and inducing labor in women with an unfavorable cervix. One hundred fifty-five women admitted for induction of labor to St. John's Mercy Medical Center, a teaching community hospital, were randomized to one of two methods: intravaginal misoprostol, 50 microg every 4 hours up to three doses (n = 76); and intracervical dinoprostone gel, 0.5 mg every 6 hours up to three doses (n = 79). Misoprostol was more effective than dinoprostone in causing cervical ripening (P = .01), inducing labor (P < .001), shortening the duration of labor (P < .001), and decreasing the need for oxytocin augmentation (P < .001). Nonreassuring fetal heart monitoring patterns associated with hyperstimulation were significantly more frequent (P < .001), and the incidence of cesarean deliveries because of this indication was significantly higher (P = .002) in patients receiving misoprostol. Misoprostol is an effective agent for cervical ripening and labor induction, but it causes an increase in cesarean deliveries associated with uterine hyperstimulation.

Cervical priming with oral misoprostol in pre-labor rupture of membranes at term

To investigate the effectiveness of oral misoprostol as a cervical priming agent for patients presenting with pre-labor rupture of membranes at term. Eighty patients presenting with pre-labor rupture of membranes at term were randomized to receive either 200 micrograms of misoprostol or 50 mg of vitamin B6 orally 1 hour after admission. Labor was induced with intravenous oxytocin infusion 12 hours after oral medication if the patient did not go into labor. We compared the induction rate, duration of labor, mode of delivery, and leaking-to-delivery interval in the two groups. The cervical score was significantly improved and the induction rate was also reduced in the misoprostol group when compared with the control group. The interval from recruitment to onset of labor, duration of labor, and the interval from recruitment to delivery were significantly shorter in the misoprostol group. The mode of delivery and the perinatal outcome were similar for the two groups. Oral misoprostol is an effective agent for cervical priming and labor induction in patients with pre-labor rupture of membranes at term.

A randomized comparison of prostaglandin E 2 oxytocin, and the double-balloon device in inducing labor

To compare the efficacy of three methods for ripening and dilating the unfavorable cervix for induction of labor. Pregnant women having an indication for induction of labor with a singleton vertex fetus, intact membranes, and Bishop score of no more than 4 were randomized to one of three induction methods: intravaginal prostaglandin (PG) E2 tablets (3 mg) followed by a second dose if labor did not start; continuous intravenous oxytocin drip; or the Atad Ripener Device, with inflation of both balloons and removal after 12 hours. For all patients, the cervix was assessed by the same investigator before induction and 12 hours later. Thirty subjects were included in the PGE2 group, 30 in the oxytocin group, and 35 in the Atad Ripener Device group. The postpartum course was comparable in all. The change in Bishop score in the PGE2 and Atad Ripener Device groups was significantly better than in the oxytocin group (median and range of 5[0-9] and 5[0-7], respectively, versus 2.5 [0-9]; P < .01). Cervical dilation more than 3 cm was more frequent in the Atad Ripener Device group compared with both the PGE2 and oxytocin groups (85.7 versus 50 and 23.3%, respectively; P < .01). The trial of induction failed in only two patients (5.7%) in the Atad Ripener Device group, compared with six (20%) in the PGE2 and 16 (53.3%) in the oxytocin groups (P < .001). Mean (+/- standard deviation) induction-to-delivery interval was 21.3 +/- 7.0 hours in the Atad Ripener Device group, 23.2 +/- 12.5 hours in the PGE2 group, and 28.2 +/- 14.7 hours in the oxytocin group. The success rate for vaginal delivery was significantly better in the Atad Ripener Device and PGE2 groups compared with the oxytocin group (77.1 and 70%, respectively, versus 26.7%; P < .01). The Atad Ripener Device had a significantly better success rate for cervical dilation and a lower failure rate than those for PGE2 and oxytocin. The PGE2 and Atad Ripener Device groups had better results than the oxytocin group in regard to Bishop score change and induction-to-delivery interval. The Atad Ripener Device may be a superior method for cervical ripening and labor induction in patients with unfavorable cervices.

Labor induction in patients with previous cesarean section.

To determine the efficacy and safety of labor induction in patients previously delivered by at least one low transverse cesarean section, a retrospective review was done at a single tertiary perinatal center, the University of Florida Health Science Center, Jacksonville. All patients with a previous cesarean section who required labor induction from 1988 until the end of 1992 were identified. Duration and outcome of labor induction, including mode of delivery, maternal and perinatal morbidity, and birth trauma, were evaluated. Of 160 patients with a previous cesarean, 50 (31.3%) had a repeat operation compared to 18 (11.2%) in the no previous cesarean group (p = 0.001, odds ratio = 3.59; 95% confidence interval, 1.98, 6.49). Women in the cesarean group had a higher incidence of operative vaginal deliveries, prolonged duration of the first and second stages of labor, rate and maximum dose of oxytocin infusion. One patient in the previous cesarean group experienced uterine rupture. There was no difference in the rate of infants with low 5-minute Apgar scores or with cord pH values less than 7.20. Labor induction in women with previous low transverse cesarean sections results in an acceptable rate of vaginal delivery and appears safe for both mother and fetus.

Intracervical Prostaglandin E sub 2 for Induction of Labor in Patients With Premature Rupture of Membranes and an Unripe Cervix

Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel. Am J Perinatol 1994;11:436-438

230 Intracervical Prostaglandin E2 for Induction of Labor in Patients with Premature Rupture of Membranes and An Unfavourable Cervix

230 Intracervical Prostaglandin E2 for Induction of Labor in Patients with Premature Rupture of Membranes and An Unfavourable Cervix

Prostaglandin E 2 for induction of labor in patients with premature rupture of membranes at term

International Journal of Gynecology & ObstetricsVolume 39, Issue 3 p. 257-257 Citations from the literature pregnancy and delivery Prostaglandin E2 for induction of labor in patients with premature rupture of membranes at term DA Ray, DA RaySearch for more papers by this authorTJ Garite, TJ GariteSearch for more papers by this author DA Ray, DA RaySearch for more papers by this authorTJ Garite, TJ GariteSearch for more papers by this author First published: November 1992 https://doi.org/10.1016/0020-7292(92)90706-OAboutPDF 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. Volume39, Issue3November 1992Pages 257-257 RelatedInformation

Prostaglandin E2 for induction of labor in patients with premature rupture of membranes at term

A prospective study comparing three management schemes for patients at term with premature rupture of membranes was performed. One hundred forty patients were randomized to one of three study groups: prostaglandin E2, placebo, or oxytocin. Patients randomized to prostaglandin E2 and placebo received vaginal suppositories containing 3 mg prostaglandin E2 or glycerin only, respectively; suppositories were administered in a double-blind fashion, on one or two occasions, 6 hours apart. Oxytocin was given only if labor was not established after 12 hours or to augment inadequate labor. In patients randomized to oxytocin labor was induced with intravenous oxytocin. The time interval to delivery, delivery outcome, and complications were analyzed. Patients receiving prostaglandin E2 were more likely to be in labor after one suppository and to be delivered without the addition of oxytocin when compared with placebo. The time interval to delivery was shorter with prostaglandin E2 and oxytocin induction versus placebo ("expectant management"). The incidence of maternal infection was lowest in patients with labor induced by prostaglandin E2. Although the overall cesarean section rate was low, there was a trend toward a lower rate with prostaglandin E2 induction. No adverse effects were observed with prostaglandin E2. Prostaglandin E2 can be used successfully to induce labor after premature rupture of membranes at term with greater ease of administration when compared with oxytocin.

A prospective study of two dosing regimens of oxytocin for the induction of labor in patients with unfavorable cervices

The ideal regimen for induction of labor with oxytocin with respect to the magnitude and frequency of dosage changes has not been defined. In spite of few data regarding labor induction with an unfavorable cervix, the initial dose recommended by the American College of Obstetricians and Gynecologists is lower than that of other commonly used protocols. Eighty patients with unfavorable cervices and unruptured membranes, without evidence of labor, were randomized to one of two protocols and met criteria for data analysis. Patients in both protocols were given an initial dose of oxytocin of 2 mU/min. Patients in protocol A (n = 32) then received incremental increases of oxytocin of 1 mU/min at 30-minute intervals, while those in protocol B (n = 48) received incremental increases of 2 mU/min at 15-minute intervals. Induction failures were higher among patients on protocol A (31% vs 8%, p \\lt 0.05). Patients on protocol B had shorter times to delivery (mean = 10 hours 57 minutes vs 8 hours 3 minutes; p \\lt 0.05). The number of operative deliveries were similar regardless of protocol. There were no significant differences (p = NS) among groups and protocols in maternal and fetal complications, cesarean section rate, and uterine hyperstimulation. In this population a more aggressive protocol may lead to fewer induction failures and shorter induction-to-delivery intervals.

A comparative randomized study of oral prostaglandin E 2 (PGE 2) tablets and intravenous oxytocin in induction of labor in patients with premature rupture of membranes before 37 weeks of pregnancy

In a randomized prospective study, we compared the use of intravenous oxytocin with oral PGE 2 tablets for stimulation of labor in cases of premature rupture of membranes (PROM) before term, where the onset of spontaneous labor did not occur within the first 3 h. This study represents the first of its kind in which oral PGE 2 and oxytocin have been directly compared as oxytocic agents for PROM before 37 weeks. Labor induction was successful in 96% of patients in the PGE 2 group compared with 84% in the oxytocin group. The incidence of cesarean section (CS) was 5% and 16% in the PGE 2 and the oxytocin groups, respectively. While 10% of the CS were performed due to fetal bradycardia in the oxytocin group, none was performed in the PGE 2 group despite the fact that the latter group had relatively lower Bishop scores. The data presented indicate that oral PGE 2 is safe and effective in initiating active labor in healthy women at pre-term with PROM. Thus we recommend its use to induce labor 3 h after rupture of membranes before 37 weeks gestation.

Management of severe pre-eclampsia with prostaglandin A, a useful therapeutic approach

SummarySummaryThe vasodepressor prostaglandin A, (PGA1) was administered by i.v. infusion till delivery or to a maximum of 24 hours to 27 women (34-40 weeks pregnant) with severe pregnancy induced hypertension. Intracervical prostaglandin E, gel was applied as a supplement to PGA1 infusion to ripen the unfavourable cervix in selected cases. The patients were assigned at random to one of three equal groups according to the time of gel instillation relative to the onset of PGA1 infusion; 6 hours before the onset of infusion (group I), simultaneous with the infusion (group II) or 3 hours after starting the infusion (group III). The PGA1 infusion reduced blood pressure to normal in most cases and successfully induced labour in 8 out of 9 cases in each group. Group II had the best clinical results, having the shortest mean induction-delivery time. There were no serious fetal or maternal side effects. The proposed therapeutic regimen has the advantage of a successful induction of normotensive labour in patients...

The efficiency of prostaglandin E 2 vaginal suppositories versus intracervical prostaglandin gel for induction of labor in patients with unfavorable inducibility prospects

Two different applications of prostaglandin E 2 for induction of labor were randomly used in 113 women with an unripe cervix; 57 women were given prostaglandin suppositories each containing 2.5 mg PGE 2 in a basis of Witepsol S55 (Dynamit Nobel), another 56 women were treated with intracervical gel containing 1 mg PGE 2 in 5 g hydroxypropylmethyl cellulose. The treatment was repeated after 4 h if the cervix was still unripe, and the procedure was repeated the following day if the cervix was still unfavorable. Cesarean sections was performed within 48 h after the start of induction and before the second stage of labor in 8 women in the suppository group and 7 women in the intracervical gel group. Of the remaining 98 women, 73% ( 34 48 women) in the suppository group and 36% ( 18 50 women) in the cervical gel group had delivered within 24 h (p < 0.01). After 48 h, 88% ( 42 48 women) in the suppository group and 74% of the women ( 37 50 women) in the cervical gel group had delivered (p > 0.05). The induction-delivery interval in the suppository group was half that found in the cervical gel group. There was no significant difference between the two groups in the use of instrumental vaginal deliveries and cesarean sections nor was there any difference with regard to fetal distress. The post-delivery condition of the newborn was similar in the two groups. No side-effects were reported in either of the two groups.

Induction of cervical compliance by balloon catheter in late pregnancy

Balloon catheter was used for pre-induction cervical priming and in order to enhance induction of labor in 51 patients. This procedure was found to be a safe and effective adjunct to induction of labor in patients with unripe cervices (mean Bishop score 3.4) with induction of labor to delivery time of 6.5 h.

Prolonged pregnancy: is induction of labour indicated? A prospective study.

A prospective controlled study of 2000 patients to determine the incidence of postmaturity and the effect of a policy of non-induction of labour in prolonged pregnancy is reported. 'Certain postmaturity' was identified in 4% of the patients and was associated with an increased incidence of babies with Apgar scores of less than 5 at 1 min; induction of labour at 42 weeks gestation did not affect the neonatal outcome compared with that in patients allowed to go into spontaneous labour. Induction of labour in patients designated as 'certain postmature' and 'uncertain postmature' reduced the number of vaginal deliveries and increased the caesarean section rate from 9.6 to 26.7 and from 2.2 to 31.2% respectively. The failure to improve the perinatal outcome does not support or justify induction of labour for uncomplicated postmaturity.

Intramuscular administration of 15(s)-15-methyl prostaglandin F2 alpha for induction of labour in patients with fetal death.

Labour was induced with repeated intramuscular injections of 125 or 250 micrograms of a 15-methyl analogue of prostaglandin F2 alpha (15-me-PGF2 alpha) in 97 women harbouring a dead fetus for 1 to 42 days in the second or third trimester of pregnancy. The 24-hour cumulative expulsion rate was 93 per cent in 35 nulliparae and 95 per cent in 61 multiparae in whom labour was successfully induced. There was one failure in a parous patient. The median time interval between the first injection and delivery was significantly longer in nulliparae (10.4 hours) than in parous women (7.3 hours). There were no important differences in efficacy or side effects between the 125 and the 250 micrograms dosage scheme. No serious complications occurred, but gastrointestinal side effects were prominent. It is concluded that these side effects are compensated for by the simplicity, efficacy and safety of the procedure.

The stretch modulus of human cervical tissue in spontaneous, oxytocin-induced, and prostaglandin E2-induced labor

A total of 62 strips of cervical tissue from 28 patients at term were tested for stiffness (stretch modulus) by elongation and measuring the tension produced by a given stretch. The stretch modulus was taken as the slope of the linear regression curve derived from the linear portion of the stress-strain relationship. The data were obtained from three patient categories: (1) 17 strips from seven patients undergoing spontaneous labor, (2) 18 strips from 10 patients with labor induced by PGE2, and (3) 27 strips from 11 patients with labor induced by oxytocin. The stretch moduli of cervical tissue obtained from spontaneous and oxytocin-induced labor patients were similar. The stretch moduli of cervical tissue obtained from PGE2-induced labor patients were significantly lower than those from either the spontaneous or the oxytocin-induced labor groups. These results show that PGE2, when used for induction of labor at term, has the ability to lower the stiffness of cervical tissue. This property of prostaglandin may be useful therapeutically for the indicated induction of labor in patients with an unfavorable cervix.

RIPENING OF THE CERVIX AND INDUCTION OF LABOR IN PATIENTS AT TERM BY SINGLE INTRACERVICAL APPLICATION OF PROSTAGLANDIN E2 IN VISCOUS GEL

Prostaglandin E2 (PGE2) suspended in a viscous gel was deposited intracervically to 115 patients at term with an unripe cervix. 45 of these patients were given a single dose of 1.0 mg PGE2, whereas the remaining 70 received only half that dose, i.e. 0.5 mg. Irrespective of dose greater than 60 per cent of the patients were induced into labor and delivered without further stimulation within less than 24 hours. The mean induction delivery time was 10 hours. In the remaining patients a considerable ripening of the cervix was registered. Hypercontractility did occur in one patient given 1.0 mg PGE2, otherwise no maternal side effects were observed. There were no adverse effects on the fetuses. The number of instrumental deliveries was 19 per cent including 9 per cent cesarean sections. It is concluded that locally applied PGE2-gel can be used to produce ripening of the cervix and/or induce labor in patients at term with an unripe cervix. Since there was practically no difference in efficiency between the two doses but one case of hyperstimulation in patients given 1.0 mg PGE2, the smaller dose, i.e. 0.5 mg is recommended.

Induction of labor in patients with missed abortion and fetal death in utero with prostaglandin E2 suppositories

Labor was successfully induced in 20 patients with a diagnosis of missed abortion or intrauterine fetal death (IUFD) by intravaginal administration of prostaglandin E2 suppositories. Fifteen patients delivered with the prostaglandin alone while a concomitant oxytocin infusion was employed to augment contractions in the other five patients. The mean induction-delivery time was 9.80 hours; nulliparous patients delivered in a mean time of 7.78 hours, parous patients in a mean time of 12.29 hours. The uterus appeared to be sensitive to the PGE2 stimulation in all patients and all were delivered completely without the need for surgical intervention. Fifty per cent of patients were delivered within 8 hours and 80 per cent by 12 hours. The side effects associated with prostaglandin administration—vomiting, diarrhea, and temperature elevation—were well tolerated and therapy did not have to be terminated in any patient. The administration of PGE2 vaginal suppositories offers an effective and safe technique for the induction of labor in patients with IUFD. Labor can be induced with PGE2 suppositories as soon as the diagnosis of IUFD is confirmed, which climinates the need for waiting until spontaneous labor occurs.