Comparison of the Effect of Misoprostol and Evening Primrose oil Capsules with Misoprostol on Delivery Method in Post-Term Pregnancy: Clinical Trial

Abstract

Introduction: Post-term pregnancies are pregnancies that last more than 42 full weeks (294 days) from the first day of the last menstrual period. With increasing gestational age, the rate of maternal and fetal morbidity and mortality significantly increases. Among medical methods, misoprostol is widely used to prepare the cervix in post-term pregnancies. But today, due to the high side effects of misoprostol, especially the increasing need for cesarean section, some complementary medicine methods are used to prepare the cervix. The aim of this study was to compare the effect of Misoprostol and Evening primrose oil capsule with Misoprostol on delivery method in post-term pregnancies.Methods: This study was performed as a single-blind randomized clinical trial on 130 pregnant women with post-term pregnancy referring to the delivery ward of Besat Hospital in Sanandaj, Iran. The samples were selected by available sampling method and assigned to the intervention and control groups by random sampling method. In the intervention group, a 500 mg capsule of evening primrose oil was given vaginally and 25 micrograms of misoprostol were given sublingually, and in the control group, an ineffective capsule was given vaginally with 25 micrograms of misoprostol sublingually. Demographic data, clinical characteristics and delivery method were used for data collection. Data were analyzed by SPSS software version 21 and statistical tests such as Chi-square, t-test and ANOVA. P-value less than 0.05 was considered significant.Results: Findings showed that there was no significant difference between the two groups in terms of demographic and midwifery characteristics and the two groups were homogeneous in this respect (P value>0.05). But in the evening primrose oil and misoprostol group, the mean bishop score was significantly increased compared to the misoprostol group (P value<0.05). Also, in the evening primrose oil and misoprostol group (12.3%), the need for cesarean section was lower than placebo and misoprostol group (41.5%) (P value<0.0001). Conclusion:The results of the study showed that the use of vaginal capsules of evening primrose oil with misoprostol compared to misoprostol alone while helping to ripening the cervix is associated with a lower rate of cesarean section.

Comparison of Misoprostol and Evening Primrose Oil on Cervical Preparation Before Gynecological Surgery

“…The findings of the present study on the better efficacy of EPO compared to misoprostol are important because misoprostol is currently widely used for cervical dilation in gynecological procedures. However, as mentioned earlier, misoprostol has unpleasant adverse effects 2,9,20–22 . Consequently, EPO, which is a vegetable oil, has fewer side effects, lower price, and easier availability 11,15–18,23,24 …”

“…However, as mentioned earlier, misoprostol has unpleasant adverse effects. 2,9,[20][21][22] Consequently, EPO, which is a vegetable oil, has fewer side effects, lower price, and easier availability. 11,[15][16][17][18]23,24 Carreon and Gladys 24 compared the effect of oral EPO with vaginal dinoprostone in cervical preparation in hysteroscopic candidates.…”

Comparison of the effect of vaginal misoprostol and evening primrose oil capsule with misoprostol alone on the consequences of abortion in women with intrauterine fetal death: a randomized clinical trial

“…However, the duration of the latent phase in the intervention group decreased, and the Bishop score increased [ 12 ]. In this regard, Bahmani et al’s study also showed that vaginal EPO capsule plus misoprostol is more effective than sublingual misoprostol in cervical preparation [ 18 ]. Another study compared the vaginal administration of EPO capsules with misoprostol to dilate the cervix before gynecological procedures; it reported that cervical dilatation in the EPO group reached an appropriate level in a shorter time than in the misoprostol group [ 8 ].…”

“…In this regard, Najafi et al showed that vaginal administration of EPO capsules reduced the need for labor induction in the intervention group compared to the control group [ 30 ]. Also, the findings of another study showed that the use of vaginal EPO capsules plus misoprostol for cervical ripening in women with prolonged pregnancies is much more effective than misoprostol alone [ 18 ]. Nouri et al reported that EPO capsules were superior to misoprostol for cervical preparation before gynecological procedures [ 8 ].…”

“…Another systematic review and meta-analysis reported that oral administration of EPO is not effective in preparing the cervix [ 15 ]. Meanwhile, other studies have shown that vaginal administration of EPO capsules in post-term pregnancies [ 10 , 16 – 18 ] and in women who underwent gynecological surgery [ 8 , 9 ] improves Bishop score and reduces the duration of cervical ripening. Despite an extensive database search, the authors did not find a study that investigated the effect of EPO on abortion induction.…”