Prostaglandin E2 Gel For Induction Research Articles

The Comparative Study of Intravaginal Misoprostol and Intracervical Prostaglandin E2 Gel for Induction of Labour

The Comparative Study of Intravaginal Misoprostol and Intracervical Prostaglandin E2 Gel for Induction of Labour

Efficacy of Prostaglandin E2 Gel in Induction of Labor

The main purpose of induction of labour is to perform safe vaginal delivery before and after completion of term. If such conditions not identified and managed properly it is fatal to mothers as well as fetal life.

Foley Catheter Versus Vaginal Prostaglandin E2 Gel for Induction of Labor at Term (PROBAAT Trial)

Foley Catheter Versus Vaginal Prostaglandin E2 Gel for Induction of Labor at Term (PROBAAT Trial)

Foley Catheter Versus Vaginal Prostaglandin E2 Gel for Induction of Labor at Term (PROBAAT Trial)

Pharmacological methods (e.g., prostaglandins) are the primary means for induction of labor in women with an unfavorable cervix. However, mechanical methods are also used, most commonly a Foley catheter balloon. When used for induction, it has been demonstrated that the Foley catheter and prostaglandins have similar cesarean rates. However, it is unclear whether the rates of fetal distress, postpartum hemorrhage, or other complications differ between the 2 methods. Moreover, there are concerns that the use of the Foley catheter for induction may increase the risk of maternal and neonatal infection. This open-label randomized controlled trial compared the effectiveness and safety of a Foley catheter and vaginal prostaglandin E2 gel for induction of labor in women with an unfavorable cervix in a term pregnancy. The study was conducted in 12 hospitals in the Netherlands between 2009 and 2010. The participants were women with a term pregnancy, singleton gestation, cephalic presentation, intact membranes, an indication for induction, and no previous cesarean delivery. All were randomly assigned to either induction of labor with a Foley catheter (n = 412) or vaginal prostaglandin E2 gel (n = 412). The primary study outcome measure was the cesarean rate. Secondary outcomes included time from intervention to birth and maternal and neonatal morbidity. There was no significant difference in cesarean rates between the 2 groups (23% vs. 20%); the risk ratio was 1.13, with a 95% confidence interval of 0 · 87–1 · 47 (P = 0.38). Findings from a meta-analysis, including the results of this trial, confirmed that use of the Foley catheter for induction does not reduce the cesarean section rate compared with use of prostaglandin E2 gel. Use of the Foley catheter was associated with a lower rate of operative delivery for suspected fetal distress and fewer admissions of newborns to neonatal intensive care units. The only serious maternal adverse events—1 uterine perforation and 1 uterine rupture—occurred in the prostaglandin group. These findings indicate that induction of labor with the Foley catheter in term women with an unfavorable cervix has similar cesarean rates compared with vaginal prostaglandin E2 gel, with fewer side effects.

Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): an open-label, randomised controlled trial

Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): an open-label, randomised controlled trial

Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): an open-label, randomised controlled trial

Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): an open-label, randomised controlled trial

288: Consecutive intra-umbilical vein injection of misoprostol and intravenous sulprostone in the management of retained placenta: a retrospective cohort study

and intravenous sulprostone in the management of retained placenta: a retrospective cohort study Frouke Notten, Liesbeth Scheepers Maastricht University Medical Center, GROWSchool for Oncology and Developmental Biology,Department of Obstetrics and Gynaecology, Maastricht, Netherlands, Maastricht University Medical Centre, GROWSchool for Oncology and Developmental Biology,Department of Obstetrics and Gynaecology, Maastricht, Netherlands OBJECTIVE: The treatment of retained placenta (RP) is manual removal of the placenta (MRP). A randomized controlled trial concluded that intravenous administration of sulprostone reduces the need for MRP. Intra umbilical vein injection of uterotonics is also used, but oxytocin seems ineffective. We compare the use of intraumbilical misoprostol followed if necessary by intravenous sulprostone, with expectative management followed by MRP after 60 minutes. In both groups blood loss 500 cc or hemodynamic instability was reason for immediate MRP. Our primary outcomes are the need for MRP and the amount of blood loss. STUDY DESIGN: We compared cohort A (1-1-2007 to 31-09-2008) managed by an expectant protocol, with cohort B (1-4-2009 to 31-122010) managed by a medical intervention protocol. We collected data from women with a vaginal delivery after 24 weeks of gestation. Women who didnt expell the placenta after 20 minutes were included. Baselinecharacteristics were not different. The chi square ( 2) and sample T test were used to analyse data. Results were considered significant if p 0,05. RESULTS: In cohort A 1936 women gave birth, of 275 women the placenta was not expelled after 20 minutes and 57 (20.7%) women needed MRP. In cohort B 2149 women gave birth, of 219 women the placenta was not expelled after 20 minutes and 35 (16.1%) women needed MRP. There was no significant difference in the number of MRPs or blood loss. Per protocol analyses did not show differences in results. Subgroupanalysis showed a trend (p 0.099) towards less MRPs after 34 weeks in the medical intervention cohort. CONCLUSION: We conclude that the use of intra-umbilical misoprostol and intravenous sulprostone consecutively, did not reduce the number of MRPs as well as the total amount of blood loss. The trend towards less MRPs in the medical intervention group is probably caused by more active management towards the expulsion of the placenta in the second time period. Considering the risks and side effects of the use of these drugs, we reject routine use in the management of RP. 289 Cost-effectiveness of induction of labor at term with a Foley catheter compared to prostaglandin E2 gel (based on the PROBAAT trial; registration NTR 1646) Gert-Jan van Baaren, Marta Jozwiak, Katrien Oude Rengerink, Marjan Benthem, Marja G.K. Dijksterhuis, Marloes E. van Huizen, Paulien C.M. van der Salm, Nico W.E. Schuitemaker, Dimitri N.M. Papatsonis, Denise A.M. Perquin, Martina Porath, Joris A.M. van der Post, Robert J.P. Rijnders, Hubertina C.J. Scheepers, Marc Spaanderman, Marielle G. van Pampus, Jan Willem de Leeuw, Ben W.J. Mol, Kitty W.M. Bloemenkamp Academic Medical Center, Department of Obstetrics and Gynecology, Amsterdam, Netherlands, Groene Hart Hospital, Department of Obstetrics and Gynecology, Gouda, Netherlands, Academic Medical Center, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, Netherlands, Ikazia Hospital, Department of Obstetrics and Gynecology, Rotterdam, Netherlands, Haga Hospital, Department of Obstetrics and Gynecology, The Hague, Netherlands, Meander Medical Center, Department of Obstetrics and Gynecology, Amersfoort, Netherlands, Diakonessen Hospital, Department of Obstetrics and Gynecology, Utrecht, Netherland Antilles, Amphia Hospital, Department of Obstetrics and Gynecology, Breda, Netherlands, Medical Centre Leeuwarden, Department of Obstetrics and Gynecology, Leeuwarden, Netherlands, Maxima Medical Center, Department of Obstetrics and Gynecology, Veldhoven, Netherlands, Jeroen Bosch Hospital, Department of Obstetrics and Gynecology, Den Bosch, Netherlands, Maastricht University Medical Centre, Department of Obstetrics and Gynecology, Maastricht, Netherlands, UMC St. Radboud, Department of Obstetrics and Gynecology, Nijmegen, Netherlands, University Medical Centre Groningen, Department of Obstetrics and Gynecology, Groningen, Netherlands, Ikazia Hospital, Department of Obstetrics and Gynecology, Rotterdam, Netherlands, Leiden University Medical Centre, Department of Obstetrics and Gynecology, Leiden, Netherlands OBJECTIVE: To assess the economic consequences of term induction of labor using a Foley catheter compared to prostaglandin E2 gel. STUDY DESIGN: We performed a cost-effectiveness analysis alongside a multicenter randomized clinical trial comparing Foley catheters and vaginal prostaglandin E2 gel for induction of labor at term. Pregnant women at term with a singleton in cephalic presentation, intact membranes, an unfavorable cervix with an indication for induction of labor and without a prior caesarean section were enrolled. The analysis was performed from a hospital perspective and all direct medical costs from randomization to 6 weeks post-randomization were included. Health outcomes were expressed as adverse outcomes (e.g. asphyxia and hemorrhage) and neonatal admissions. Sensitivity analysis was performed for multiple parameters. www.AJOG.org Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging Poster Session II

Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): an open-label, randomised controlled trial

Induction of labour is a common obstetric procedure. Both mechanical (eg, Foley catheters) and pharmacological methods (eg, prostaglandins) are used for induction of labour in women with an unfavourable cervix. We aimed to compare the effectiveness and safety of induction of labour with a Foley catheter with induction with vaginal prostaglandin E2 gel. We did an open-label, randomised controlled trial in 12 hospitals in the Netherlands between Feb 10, 2009, and May 17, 2010. We enrolled women with a term singleton pregnancy in cephalic presentation, intact membranes, an unfavourable cervix, an indication for induction of labour, and no prior caesarean section. Participants were randomly allocated by an online randomisation system to induction of labour with a 30 mL Foley catheter or vaginal prostaglandin E2 gel (1:1 ratio). Because of the nature of the intervention this study was not blinded. The primary outcome was caesarean section rate. Secondary outcomes were maternal and neonatal morbidity and time from intervention to birth. All analyses were done on an intention-to-treat basis. We also did a meta-analysis that included our trial. The trial was registered with the Dutch trial registry, number NTR 1646. 824 women were allocated to induction of labour with a Foley catheter (n=412) or vaginal prostaglandin E2 gel (n=412). Caesarean section rates were much the same between the two groups (23%vs 20%, risk ratio [RR] 1·13, 95% CI 0·87-1·47). A meta-analysis including our trial data confirmed that a Foley catheter did not reduce caesarean section rates. We recorded two serious maternal adverse events, both in the prostaglandin group: one uterine perforation and one uterine rupture. In women with an unfavourable cervix at term, induction of labour with a Foley catheter is similar to induction of labour with prostaglandin E2 gel, with fewer maternal and neonatal side-effects. None.

Role of Prostaglandin E2 Gel for Induction of Labour in Preeclamptic Patients

Key words: prostaglandin E2 gel; induction of labour; pre-eclampsia DOI: 10.3329/jcmcta.v20i1.4928 Journal of Chittagong Medical College Teachers' Association 2009: 20(1):12-15