Ripening Agents Research Articles

Use of Nitric Oxide Donor Isosorbide Mononitrate for Cervical Ripening at 41 Weeks’ Gestation

Background: The ideal agent for cervical ripening would induce adequate cervical ripening with minimal adverse effects to the mother and the fetus; the most favorable method for cervical ripening is not fully agreed till now; however, vaginal administration of isosorbide mononitrate (IMN) is considered a low-risk method of labor induction for post term. Our study was designed to assess the effect of IMN on cervical ripening and labor induction among 41 weeks pregnant women. Objectives: To assess the efficacy of the nitric oxide donor isosorbide mononitrate on cervical ripening at 41 weeks gestation. Materials and Methods: This study was conducted on 100 pregnant women recruited from the outpatient clinic fulfilling the inclusion criteria. Cases were divided into 2 groups. In first group 40 mg isosorbide mononitrate (IMN) tablet was applied vaginally in posterior fornix, and in second group placebo was applied vaginally in posterior fornix. Following up the cervical status after 24 hours of administration, the patient were asked about new symptoms especially headache, palpitation, dizziness or abdominal pain and the mode of delivery was assessed. Results: There was a significant improvement in the bishop score in the first group rather than the placebo group. No significant difference between the two groups was as regards the mode of delivery. Conclusion: IMN may be used for cervical preparation only before induction of labor in post term cases.

Cervical ripening before first trimester surgical evacuation for non-viable pregnancy

Cervical ripening before first trimester surgical evacuation for non-viable pregnancy

Preoperative ripening of the cervix before operative hysteroscopy.

Preoperative ripening of the cervix before operative hysteroscopy.

Misoprostol: An Effective Agent for Cervical Ripening and Labor Induction: A 2-Year Review in a Tertiary Center

Background: Misoprostol a PGE1 analogue has increasingly been used for cervical ripening in preparation for induction of labour with variable outcome for both mother and baby. Objectives: To determine the effectiveness of Misoprostol in cervical ripening and labour outcome in Aminu Kano Teaching Hospital Kano. Study Design: A study of all patients who had cervical ripening for induction of labour using Misoprostol at AKTH Kano, Nigeria, between 1st Jan 2012-31st Dec 2013. Socio-demographic data of these patients including number of doses inserted before ripening is achieved, duration, course and outcome of labour were documented. Result: Four hundred and two women were admitted for cervical ripening. 365 women met the inclusion criteria out of the 358 folders retrieved, giving a retrieval rate of 98%. Despite this six folders did not contain enough information for the study and were excluded leaving us with a sample size of 352. They had a successful cervical ripening with an average of 2 insertions. Spontaneous onset of labour without further intervention was observed in 266 women (75.5%). However, 86 women (24.5%) were induced with oxytocin following cervical ripening. The mean duration of labour among those that had spontaneous onset of labour following Misoprostol insertion was 9.8 hours. 96% of the patients had vaginal delivery while 4% had Caesarean section. Conclusion: Misoprostol was associated with favorable outcome following cervical ripening with a low caesarean section rate.

Effect of Biological and Chemical Ripening Agents on the Nutritional and Metal Composition of Banana (<i>Musa spp</i>)

The use of potentially toxic ripening agents is common in developing countries. Four ripening agents namely calcium carbide, potash, African mango and jathropha curcas leaf were used and compared with a control with no ripening agent. Result showed that RB1 and RB2 were the first to ripen at 3days with RB5 at 6th day. Protein content reduced in the ripened samples in the order of 4.12>3.68>3.04>2.52>1.99>1.77%. Protein value was lowest when calcium carbide was used. Fat ash and fiber contents range between 0.28-1.72, 0.75-2.75and 0.50-1.75% respectively. The moisture content increased from 65.50 to 74.0%, while carbohydrate content range is 17.49-29.29%. Pb, Cu, Zn and Mn values of 0.22, 0.87, 1.96 and 0.67ppm was highest in calcium carbide ripened banana and lowest in the control 0.09, 0.26, 0.37 and 0.19 ppm.Keywords: Banana; ripening; ripening agents; postharvest losses; metal contamination

Isosorbide Mononitrate a Nitric Oxide Donor: A Study of Its Efficacy and Safety as an Agent for Cervical Ripening.

To study the efficacy and safety profile of isosorbide mononitrate (IMN) as an agent for cervical ripening. This study was conducted in the Department of Obstetrics and Gynecology, M Y Hospital & M G M Medical College Indore from September 2011 to February 2013. Pregnant women attending the antenatal clinics were screened for possible participation in the study after explaining the nature of the study. This study was conducted on 150 patients. An initial dose of 40mg IMN was applied in the posterior vaginal fornix, and the same dose was repeated after 6h. Cervical ripening was assessed by the change in Bishop Score 12h after the initial application. In a study of 150 cases, mean maternal age was 22.2±2.6years (range 19-35years) and mean gestational age was 40.5±1.07 (range 40-42weeks). 52 women were primigravidas, while 98 were multigravidas. The mean Bishop Score-before drug administration was 1.94±1.3 (range 0-5), and mean fetal heart rate was 137±6.2bpm. The mean of Bishop scores before IMN administration was 1.94±1.3, while mean of Bishop score after drug administration was 6.7±2.2; mean difference was equal to 4.76. P value was equal to 0.0001. By conventional criteria, this difference is considered to be statistically significant. The mode of delivery 96 (64%) delivered vaginally, while 54 (36%) were delivered by Cesarean section. Mean Apgar score at 1min was 8.2±0.9SD (range 7-10), while mean Apgar score at 5min was 9.4±0.6 (range 8-10). The only side effect noted was headache, and 30 cases (20%) complained of headache. IMN seems to be effective, safe, inexpensive, and well-tolerated agent for cervical ripening. It is cost effective and safe with minimal side effects.

PL.74 Induction of Labour with Propess®

IntroductionPropess® is a vaginal delivery system that consists of a non-biodegradable polymeric drug delivery device containing 10 mg dinoprostone (Prostaglandin E2) dispersed throughout its matrix. Introduction in most units as...

Comparative Study of Oral and Vaginal Misoprostol for Induction of Labour, Maternal and Foetal Outcome

Misoprostol is a new promising agent for cervical ripening and induction of labour .The ideal dose, route and frequency of administration of misoprostol are still under investigation. Although, vaginal application of misoprostol has been validated as a reasonable mean of induction, there is a patient resistance to digital examination and there is a risk of ascending infection. For this reason, oral administration of misoprostol for cervical ripening and labour induction has been tried. To compare 50μg of oral misoprostol versus 25μg of intravaginal misoprostol for induction of labour at term and maternal, foetal outcomes. Two hundred women who were at term, with indication for induction of labour and Bishop scores of ≤5 were randomly assigned to receive misoprostol 50μg or 25μg intravaginal, every 4-6 hours, for a maximum of 5 doses. In either group, pregnant females with inadequate uterine contractions despite being given maximum 5 doses of misoprostol, were augmented using oxytocin. The primary outcome measure was time-interval from induction to vaginal delivery and vaginal delivery rate within 24 hours. The median induction to vaginal delivery time in oral group (12.92h) and vaginal group (14.04 h) was not significant. Oral misoprostol resulted in more number of vaginal deliveries as compared to vaginal misoprostol (94% as compared to 86%), which was not significant. There was a significantly higher incidence of uterine tachysystole in the vaginal group, as compared to oral group. There were no significant differences between the groups with respect to oxytocin augmentation, caesarean section rate, analgesic requirement and neonatal outcome. Oral misoprostol is as efficacious as vaginal misoprostol because of shorter induction delivery interval, lower caesarean section rates, and lower incidence of failed induction rates. Lower incidence of foetal distress and easy intake are observed if the drug is administered orally.

Physico-chemical properties and toxic effect of fruit-ripening agent calcium carbide

Ripening is the final stage of the maturation process, when the fruit changes color, softens and develops the flavor, texture and aroma that constitute optimum eating quality. This study was conducted to discuss the use of unsatisfactory calcium carbide to ripen fruits for domestic markets as well as their toxic effects on human health. The commonly used ripening agents are calcium carbide, acetylene, ethylene, propylene, ethrel (2-chloroethyl phosphonic acid), glycol, ethanol and some other agents. The calcium carbide is one of the most commonly used ripening agent for fruits, while other calcium salts like calcium ammonium nitrate, calcium chloride and calcium sulfate are used to delay fruit ripening agents for local fruit industries. The use of calcium carbide is being discouraged worldwide, due to associated health hazards. Calcium carbide treatment of food is extremely hazardous because it contains traces of arsenic and phosphorous, and once dissolved in water, it produces acetylene gas. Arsenic, phosphorous and acetylene gas may affect the different body organs and causes various health problems like headache, dizziness, mood disturbances, sleepiness, mental confusion, memory loss, cerebral edema, seizures and prolonged hypoxia.

Effect of bacterial vaginosis on the pharmacokinetics of misoprostol in early pregnancy

Misoprostol has been shown to be an effective agent for cervical ripening and termination of early pregnancy especially when administered vaginally. Our objective was to evaluate whether bacterial vaginosis (BV) affected the pharmacokinetics of vaginally administered misoprostol during early pregnancy. Ten women with BV and 10 healthy women requesting medical abortion up to 9 weeks of pregnancy were administered 200 mg mifepristone followed 24-48 h later by a single dose of 800 µg misoprostol vaginally. Blood samples were taken before (0 h) and 0.5, 1, 2, 3 and 4 h after misoprostol administration. Misoprostol acid was determined in serum samples using liquid chromatography/tandem mass spectrometry. All women with BV had a vaginal pH > 4.7. The mean bioavailability measured as the area under the curve (AUC) and maximum concentration (C(max)) appeared higher in the control than in the BV group (1458.7 versus 878.1 pg h/ml) and (630.7 versus 342.5 pg/ml), respectively, but did not achieve statistical significance and there was no other significant difference in the pharmacokinetics between the two groups. However, if two women with vaginal pH > 4.7 were excluded from the control group the difference in AUC₂₄₀ (1359 versus 878.1 pgh/ml) reached statistical significance (P = 0.048). BV had an effect on pharmacokinetics of vaginally administered misoprostol in early pregnancy. However, the results should be interpreted with caution due to the small sample size and marked individual variations.

Clinical interventions that increase the uptake and success of vaginal birth after caesarean section: a systematic review

The aim of this study was to review clinical interventions that increase the uptake and/or the success rates of vaginal birth after caesarean section. Repeat caesarean section is the main reason for the increase in surgical births. The risk of uterine rupture in women who have prior caesarean sections prevents many clinicians from recommending vaginal birth after caesarean. Despite this, support for vaginal birth after caesarean continues. A search of five databases and a number of relevant professional websites was undertaken up to December 2008. A systematic review of quantitative studies that involved a comparison group and examined a clinical intervention for increasing the uptake and/or the success of vaginal birth after caesarean section was undertaken. An assessment of quality was made using the Critical Skills Appraisal Programme. Induction of labour using artificial rupture of membranes, prostaglandins, oxytocin infusion or a combination, was associated with lower vaginal birth rates. Cervical ripening agents such as prostaglandins and transcervical catheters may result in lower vaginal birth rates compared with spontaneous labour. The impact of epidural anaesthesia in labour on vaginal birth after caesarean success is inconclusive. X-ray pelvimetry is associated with reduced uptake of vaginal birth after caesarean and higher caesarean section rates. Scoring systems to predict likelihood of vaginal birth are largely unhelpful. There is insufficient data in relation to vaginal birth after caesarean section between different closure methods for the primary caesarean section. Clinical factors can affect vaginal birth after caesarean uptake and success.

Randomized Clinical Trial of Pre-Induction Cervical Ripening by Isosorbide Mononitrate at Term Prgnancy

Background and objective: Induction of labor is deemed successful when it initiates uterine contractions, progressively dilates and effaces the cervix, and leading to the normal vaginal birth of the baby with no maternal or fetal complications . Because the success of induction is related to cervical ripening, artificial cervical ripening before labor induction is used when the cervix is unfavorable to reduce the associated risk of cesarean delivery. The objective is to test the efficacy and safety of Isosorbide mononitrate for cervical ripening before the induction of labor at term, from. Methods: A randomized clinical trial was conducted in maternity hospital in Sulaimani, from the 1st of January 2008 to the 1st of July 2008. Forty six pregnant women with gestational age of (37- 42) weeks, singleton, viable, low risk pregnancy and cephalic presentation with Bishop score of less than 6 were selected for induction of labor for various causes. Forty eight hours before induction, 40 mg IMN (2 tablets of 20 mg) were inserted vaginally up to 3 doses 16 hours apart. Results: It was found that the mean ± SD Bishop score before IMN administration was (1.95 ± 1.5), while after IMN was (6.65± 3.06) P-value = 0.0001. Sixteen cases (35.6%) went to active labor. The mean ± SD time of admission in labor room was (5.06 ± 3.8) hours.43 cases (93.5%) needed oxytocin for their inductions & eighteen cases (39.1%) were delivered by C/S. There was no significant change in FHR before and after IMN and all women delivered active babies with normal Apgar score. The main side effect was headache which was experienced by 31cases (63.4%). Conclusion: IMN is an effective and safe agent for cervical ripening which can be used as an outpatient basis.

Safety and Efficacy of Misoprostol and Dinoprostone as Cervical Ripening Agents

The study compares safety and efficacy of misoprostol and dinoprostone as cervical ripening agents. Patients with term, vertex, singleton pregnancy and Bishop score of 4 or less were randomly assigned to receive misoprostol pessary (n=35, 50 microg intravaginally) or dinoprostone gel (n=31, 0.5 mg intracervically) at 6 hourly intervals. If there were no progress in cervical dilatation or effective uterine contraction even after maximum dose, patients were taken for cesarean section. Patients who achieved Bishop's score more than 7 but the delivery was not progressing, were augmented with oxytocin drip. No uterine hyperstimulation was observed in both groups. However, abnormal fetal heart rate was observed in 3(8.6%) cases in misoprostol group and 2 (6.5%) in dinoprostone group. There was no statistically significant difference in meconium passage in two groups. Apgar score less than 7 at 1 minute was seen in 6 (19.4%) and 11 (31.4%) neonates in dinoprostone and misoprostol group respectively. However Apgar score less than 7 at 5 minutes was found in only one neonate of dinoprostone treated patient. Both drugs were found to be equally effective in improving Bishops score with no significant difference in mean induction to delivery time. Cesarean section was done among 32.3% and 28.6% respectively in dinoprostone and misoprostol groups. There was significant reduction in the need for oxytocin augmentation in misoprostol (37.1%) group than in dinoprostone (67.7%) group. Vaginal misoprostol is an effective, safer and cheaper alternative to dinoprostone as a cervical ripening agent in underdeveloped countries.

321: Cervical ripening with hyaluronidase: effect on myometrial contractility in vivo and in vitro

We have shown that intracervical injection of hyaluronidase can induce cervical ripening and accelerate parturition after induction of labor in rats. Hyaluronidase also affects the biophysical properties of the rat cervix consistent with augmented ripening. A common issue using cervical ripening agents is their concomitant effect on uterine activity. The objective of this study was to determine whether hyaluronidase causes an increase in uterine contractility. Timed pregnant Sprague-Dawley rats were injected intracervically with 100 I.U. of hyaluronidase or saline on day 18 of pregnancy (n=7 or 8 per group). All rats were euthanized at term. Uterine rings were isolated for isometric tension experiments. Cumulative dose response curves to oxytocin and hyaluronidase, as well as the maximum contractile response to KCl (60 mM) were obtained and compared between the two groups. There was no difference in the contractile response of rat myometrium to oxytocin between hyaluronidase treated animals and controls (figure). Similarly, exposure of the myometrium to increasing doses of hyaluronidase did not cause uterine contractions in either of the study groups (figure). There was no signifiacnt variation in the maximal myometrial response to KCl between groups. Despite its effect on cervical maturation, the use of hyaluronidase is not associated with an increase in uterine contractions or myometrial sensitivity to oxytocin. This makes hyaluronidase a potentially superior agent for pre-induction cervical ripening as compared to currently available agents. It may be a safer alternative in women with a history of a previous cesarean delivery, or a candidate for use in outpatient settings.

"PROM"

Objective: To assess and compare the number of subjects in both groups (Study and comparison), who went into active labourwithin 24 hours and to compare the various complications (maternal & fetal) in both groups. Study Design: Quasi experimental. Sampling Technique: Convenience sampling. Sample Size & Setting: A total of 100 pregnant women presenting with history of leaking amniotic fluid at term (>37 wks) to labour ward of obstetrics and Gynaecology unit, Bahawal Victoria Hospital, Bahawalpur were included in the study. Material & Method: The pregnant women fulfilling the inclusion criteria were enrolled as our study subjects. Rupture of membranes was confirmed by nitrazine test.Thepatients were randomized into two groups (50 women in study and 50 in comparison group). In study group, 50 (Ligm of misoprostol was givenorally after initial assessment of mother and fetus. The dose was repeated 4 hourly, if there was no uterine activity. The number of patients going into active labour and delivering within 24 hours were noted. Different complications (maternal & fetal) faced during all procedure were also recorded and managed. In comparison group, patients were managed were also recorded and managed. In comparison group, patients were managed conservatively for 24 hours. Like in study group, number of patients gong into active labour and delivering with in 24 hours were noted. Different maternal & fetal complications occurring in this group were also recorded and managed. Results: A total of 100 Pregnant women were included in the study. The sample size (100 patients with PROM at term) was completed in 5 months. During that period over all 1105 deliveries were conducted, so the incidence of PROM at term in the study was 9.4%. It was observed in the study group, that all the patients (100%) went into active labour and 96% were delivered within 24 hours of PROM. While in comparison group 72% patients went into active labour and only 62% were delivered within 24 hours of PROM. The results showed that in study group 36 patients went into active labour with only one dose of oral misoprostol, 9 patients required 2 doses and 5 patients required 3 doses of oral misoprostol for going into active labour. When maternal complications were compared in both groups, 92% patients in study group had no complication while only 8% patients had to face different complications. In comparison group 86% had no complication and in 14% patients different complications occurred. Regarding fetal complications 4% fetus/neonates had to face different complications in each group. In current study there was no significant difference in the mode of delivery between the two groups. Conclusion: It was concluded that active management of pre labour rupture of membrances at term with oral misoprostol is a better option than the expectant management. Oral misoprostol in dose of 50 jugm is an effective agent for cervical ripening and induction of labour in PROM at term as significantly high percentage of patients delivered within 24 hours with no increase in maternal and fetal complications.

Complications of labor induction among multiparous women in a community-based hospital system

The purpose of this study was to examine complications of labor induction compared to spontaneous labor in multiparas. This was a retrospective cohort study of multiparous women with live, singleton pregnancies at term, who had no contraindications to labor or labor induction. Cesarean delivery was the primary outcome. Of the study subjects, 7208 experienced spontaneous labor, 2190 underwent labor induction with oxytocin, and 239 underwent labor induction requiring cervical ripening agents. Oxytocin-induced multiparas were 37% more likely to require cesarean compared to those with spontaneous labor (OR, 1.37; 95% CI, 1.10-1.71) and nearly 3 times more likely to undergo cesarean when cervical ripening agents were used (OR, 2.82; 95% CI, 1.84-4.53). Women requiring cervical ripening were also 10 times more likely to spend more than 12 hours in labor than those with spontaneous labor. Multiparas undergoing labor induction are at increased risk for obstetric complications compared to spontaneous labor.

Vaginal Misoprostol Administration for Cervical Ripening and Labor Induction

Intravaginal misoprostol has been shown to be an effective agent for cervical ripening and induction of labor. Vaginal application of misoprostol has been reported in over 9000 women worldwide and seems to have safety profile similar to that of endocervically and intravaginally administered dinoprostone. Concern arises with the use of higher doses of intravaginal misoprostol (50 mcg or more) and the association with uterine contractile abnormalities and for this reason, use of low-dose misoprostol regimen has been recommended by the American College of Obstetricians and Gynecologists. The recommendation is use of a 25-mcg dose of misoprostol inserted into the posterior vaginal fornix and repeated every 3 to 6 hours as needed. Misoprostol administration to women with prior cesarean births seems to increase the likelihood of uterine scar disruption and should not be used in these women. There are reports of uterine rupture in women with unscarred uteri treated with vaginally applied misoprostol. Therefore, all patients need to be monitored adequately after misoprostol administration. Although there is a growing body of data regarding the ambulatory use of intravaginal misoprostol for cervical ripening, its use for this purpose cannot be recommended outside of investigational protocols at this time because of concerns for maternal and neonatal safety.

Therapeutic termination of second trimester pregnancies with low dose misoprostol.

To determine the effectiveness of 50 microg misoprostol for midtrimester termination of pregnancies. Experimental, cross-sectional study. Department of Gynaecology and Obstetrics, Unit II, Jinnah Postgraduate Medical Centre, Karachi, a tertiary care centre, from 1st Jan 2003 to 30th June 2005. The study subjects were 54 pregnant women admitted during the 2nd trimester (14-26 weeks) of gestation, willing or requiring termination of pregnancy. Those patients were included in the study who were admitted with closed cervical os, either had intrauterine death, fetal anomaly, medical disorder (hypertension or diabetes) or history of previous ceasrean section. Cases of placenta previa, acute asthma, glaucoma, cardiac diseases and allergy to prostaglandins were excluded. Each patient received 50 microg misoprostol intravaginally. Maximum 4 doses were given at 4 hours interval and state of cervical os was assessed by vaginal examination before insertion of next dose or at the onset of uterine contractions. After 4 doses of misoprostol, patients were kept under observation and watched for uterine contractions to start or for expulsion of products. Syntocinon infusion was started to augment labour where products of conception failed to expel out inspite of open os. Outcome measures include success rate of termination within 12, 24, 36 and 48 hours, mean induction - abortion time interval and maternal side effects. The success rate of termination within 12, 24, 36 and 48 hours were 27.7%, 83.3%, 94.4% and 96.3% respectively. Mean induction to abortion time interval, in case of abortion within 48 hours, was found to be 18.9 +/- 11.58 (range 4 - 48 hours). Dead fetuses were aborted earlier than alive fetuses. The mean induction abortion time interval was 17.01 +/- 8.7 hours in dead and 23.4+/-15.9 hours in alive fetuses (t -value:1.9, p: 0.05). Two patients failed to deliver within 48 hours of induction. Two patients suffered from febrile illness. Vaginal administration of 50 microg misoprostol every 4 hourly is an effective and safe agent for ripening of cervix and convenient way of inducing abortion during 2nd trimester of pregnancy in a women either with alive or dead fetus. It is associated with a low frequency of side effect.

Cervico-vaginal foetal fibronectin: A predictor of cervical response at pre-induction cervical ripening

Not all pregnant women with an "unripe" cervix can be successfully ripened by the cervical ripening agents; therefore tests with predictive information are justified. To examine the effect of the presence of foetal fibronectin (FFN) in the cervico-vaginal secretions on pre-induction cervical ripening with either intravaginal Misoprostol or transcervical Foley catheter. Twenty (20) patients managed at a tertiary health institution in South-western Nigeria between March and May 2003 were randomised for cervical ripening by either intravaginal Misoprostol or Transcervical Foley catheters. Cervico-vaginal secretions were assessed for presence of FFN with Foetal Fibronectin Enzyme Immunoassay Kit (Adeza Corp.) prior to commencement of cervical ripening. FFN status, Pre-ripening and Pre-induction modified Bishop scores and duration of cervical ripening. Ten of the fifteen patients with positive membrane immunoassay for FFN achieved ripened cervix (modified Bishop score > or = 6) within 6 - 12 hours of exposure to the agents of cervical ripening. In the FFN negative group, only 2 of the five patients achieved ripe cervix within the >12 - 18 hours period, the rest being in the >18 - 24 hours period. Foetal fibronectin test may offer useful predictive information prior to institution of processes of cervical ripening in patients with unfavourable cervices.

Misoprostol for Cervical Ripening and Labor Induction in Pregnancies with Oligohydramnios

The efficacy and safety of misoprostol for cervical ripening and labor induction in patients with oligohydramnios was investigated. 57 pregnancies with oligohydramnios and 58 cases with a normal amniotic fluid volume (controls) were enrolled in this prospective trial. All patients received 50 µg of intravaginal misoprostol every 5 h. Primary outcomes were: cesarean section rate; induction to delivery time; oxytocin augmentation; uterine hyperstimulation; meconium passage; fetal heart rate (FHR) changes; fetal distress requiring delivery, and Apgar scores. There were no differences in the mean time to delivery, cesarean section rate, oxytocin augmentation or Apgar scores. The mean induction to delivery time in oligohydramnios and control groups were, 11 h 43 min and 11 h 18 min, respectively (p > 0.05). FHR changes were observed in 26.3% of oligohydramnios group and 32.7% of control group (p > 0.05). There was no statistically significant difference in the cesarean section rate and the uterine hyperstimulation between the 2 groups. These data suggest that misoprostol can be used as an effective agent for cervical ripening and labor induction in pregnancies with oligohydramnios without increasing the risk for perinatal outcome, compared to those with normal amniotic fluid volumes.