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. 2011 Jun 1;12(2):80-5.
doi: 10.5152/jtgga.2011.20. eCollection 2011.

Shortening the induction delivery interval with prostaglandins: a randomized controlled trial of solo or in combination

Rajiv Mahendru  1 , Shweta Yadav  1
Affiliations

Shortening the induction delivery interval with prostaglandins: a randomized controlled trial of solo or in combination

Rajiv Mahendru et al. J Turk Ger Gynecol Assoc. .

Abstract
in English, Turkish

Objective: To compare the efficacy and safety of misoprostol alone with dinoprostone followed by misoprostol, all inserted intravaginally in induction of labor at term and the obstetrical outcome.

Material and methods: A pilot study comprising 111 primigravidae, >37 gestational weeks with singleton pregnancy in cephalic presentation having an unfavorable Bishop score admitted for labor induction, were considered and randomly allocated into two groups. In group I (n=55) with intravaginal 25mcg misoprostol 4 hourly (six doses at the most) and and group II (n=56), with dinoprostone 0.5mg followed eight hours later by 25mcg misoprostol induction to vaginal delivery time was found to be significantly different, being 14.8 h in group-I and shorter in group-II with a mean of 11.6 h. Vaginal delivery rates within 12 h (groups-I and -II: 47.2%, as compared to 60.7%, respectively) were found to be higher with dinoprostone-misoprostol induction, as well as vaginal delivery rates in 24 h, 80.0% and 91.1%. The need for oxytocin augmentation was more frequent in the misoprostol than in the dinoprostone-misoprostol group, (61.8%, and 39.3%), and all these observations were statistically significant. Abnormal foetal heart rate pattern occurred more frequently (18.2%) in group-I in contrast to 5.3% in group-II, as was the incidence rate of (18.2%) who had passage of meconium in group-I, this rate being significantly different from group-II having meconium passage in 3 cases, a rate of 5.3%.

Conclusion: Using dinoprostone followed by vaginal misoprostol is safe and effective for induction of labor with less need for oxytocin augmentation and shorter induction delivery interval.

Amaç: Termde doğumun indüklenmesinde intravajinal olarak kullanılan tek baş ına misoprostol ile misoprostolün izlediği dinoprostonun etkililik ve güvenliliklerini ve obstetrik sonucu kıyaslamak.

Gereç ve yöntemler: >37 gebelik haftasında, sefalik prezentasyonda tekli gebeliği olan ve uygun olmayan Bishop skoru olup doğum indüksiyonu için başvuran 111 ilk gebeliği içeren bir pilot çalışma düşünüldü ve randomize olarak iki gruba ayrıldı. İntravajinal 4 saatte bir (en fazla altı doz) 25 mcg misoprostol alan grup I (n=55) ve 0.5 mg dinoproston ve takiben sekiz saat sonra 25 mcg mizoprostol alan grup II (n=56)’de vajinal doğum indüksiyon süresi anlamlı olarak farklı bulundu; grup I’de 14.8 saat, grup II’de ortalama 11.6 saat ile daha kısa olarak. 12 saat içinde vajinal doğum oranları (grup I ve II’de sırasıyla %47.2’ye kıyasla %60.7) dinoproston-misoprostol indüksiyonu ile daha yüksek bulundu; 24 saatteki vajinal doğum oranları da sırasıyla %80.0 ve %91.1 idi. Oksitosin ilavesi gereksinimi misoprostolde dinoproston-misoprostol grubundan daha sıktı (%61.8 ve %39.3) ve bütün bu gözlemler istatistiksel olarak anlamlıydı. Anormal fötal kalp hızı paterni grup-I’de grup II’ye kıyasla daha sıklıkla görüldü (sırasıyla %18.2 ve %5.3); benzer şekilde grup I’de mekonyum pasajı olanların insindans hızı (%18.2), 3 vakada mekonyum pasajı olan grup II’den (%5.3) anlamlı olarak farklı idi.

Sonuç: Vajinal misoprostol uygulamasının takip ettiği dinoproston kullanımı; oksitosin ilavesine daha az gerek duyulması ve daha kısa indüksiyon-doğum aralığ ı ile doğumun indüksiyonu için güvenilir ve etkilidir.

Keywords: Labor induction; intravaginal; prostaglandin.

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Figures

Figure 1
Figure 1
The CONSORT Flow Diagram showing the progress of participants at each stage of the study *(non-cephalic presentation n=9, favorable Bishop score n=8, non-compliance to written informed consent n=7, severe intra-uterine growth restriction n=3, major degree placenta praevia n=2, signs of fetal compromise n=2)
See this image and copyright information in PMC

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