Effect of vaginal pH on efficacy of dinoprostone gel for labour induction

Kurian, Maria Joseph; Rao, Bharathi; Rao, Arun A; Shameem, V P A

doi:10.18203/2320-1770.ijrcog20160884

Cited by 7 publications

(6 citation statements)

References 14 publications

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“…No significant difference was found in our study with respect to time taken to enter the active phase of labour in the two groups. Similar findings had been reported by U. Singh et al ,[ 9 ] Kurian et al ,[ 10 ] Ramsey et al ,[ 5 ] and Onen et al . [ 11 ] However, in studies conducted by Goswami et al ,[ 8 ] Aruna et al ,[ 7 ] and Yayla Abide et al ,[ 12 ] a significant difference was reported between the two groups; that is, this duration was significantly shorter in the high-pH group than the low-pH group.…”

Section: Discussionsupporting

confidence: 91%

Effect of vaginal douching with normal saline before insertion of dinoprostone vaginal insert for labor induction

Verma,

Pandey,

Singh

et al. 2024

Journal of Family Medicine and Primary Care

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Objective: Vaginal pH has been suggested to be one of the causative factors, responsible for variation in prostaglandin efficacy for induction of labour. The purpose of this study was to analyse the effect of vaginal douching with normal saline before insertion of dinoprostone vaginal insert for induction of labour. Methods: This randomised controlled study was done in the Department of Obstetrics and Gynaecology for a period of 1 year. Using a computer-generated random number table, subjects were allocated in two groups. In group A (study group), vaginal douching was done with 20 cc of sterile 0.9% NaCl and vaginal pH was again measured with pH paper strips just before inserting dinoprostone pessary. Dinoprostone pessary was inserted without douching in group B (control group). Results: There was a significant increase in the vaginal pH after douching with normal saline (4.91 vs 5.52, P < 0.001). Mean intrinsic vaginal pH (pH before inserting dinoprostone insert) in women who delivered vaginally was significantly higher than that of the women who had a caesarean section (5.10 vs 4.63, P < 0.001). Time interval between dinoprostone insertion to active phase of labour, duration of active phase of labour, time interval between dinoprostone insertion, and complete cervical dilatation and mode of delivery were not significantly different between the two groups. Conclusion: Although douching with normal saline increases vaginal pH, douching does not help in increasing the chances of vaginal delivery because it gives a transient effect. Rather, it is intrinsic vaginal pH, which is a better decisive factor for successful vaginal delivery.

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Section: Discussionsupporting

confidence: 91%

Effect of vaginal douching with normal saline before insertion of dinoprostone vaginal insert for labor induction

Verma,

Pandey,

Singh

et al. 2024

Journal of Family Medicine and Primary Care

View full text Add to dashboard Cite

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“…Concerning this, a few researches have explored the effect of pH on drug performance. For instance, the effect of the vaginal pH over the induction of labor with misoprostol and dinoprostone was studied by Chandra et al [81] and by Kurian et al [82], respectively. No effect was observed when misoprostol was employed (pKa = 14.68), while the pH was a positive factor for the effectiveness of dinoprostone (pKa = 4.9).…”

Section: Possible Effects Of Changes In Vaginal Microbiota On Drugmentioning

confidence: 99%

Modifications in Vaginal Microbiota and Their Influence on Drug Release: Challenges and Opportunities

et al. 2019

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Vaginal drug delivery represents an attractive alternative to achieve local and systemic effects due to the high contact surface exposed, the mucoadhesion of the epithelium, and the high innervation that facilitates the absorption of drugs into the bloodstream. However, despite the confinement of the vaginal cavity, it is an organ with a highly variable microenvironment. Mechanical alterations such as coitus, or chemical changes such as pH and viscosity, modify the release of drugs. In addition, changes in vaginal microbiota can influence the entire vaginal microenvironment, thus determining the disposition of drugs in the vaginal cavity and decreasing their therapeutic efficacy. Therefore, the influence of microorganisms on vaginal homeostasis can change the pre-established scenario for the application of drugs. This review aims to provide an explanation of normal vaginal microbiota, the factors that modify it, its involvement in the administration of drugs, and new proposals for the design of novel pharmaceutical dosage forms. Finally, challenges and opportunities directed toward the conception of new effective formulations are discussed.

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“…30 Other studies reported the benefits of high vaginal pH in improving prostaglandin effectiveness in reducing the duration of the active phase of labor. 10 31 Moreover, Kurian et al 32 stated women with multiple parities were more likely to have a higher vaginal pH, leading to an increase in dinoprostone gel efficacy causing higher Bishop's scores and more normal vaginal deliveries compared with those with lower vaginal pH. On the contrary, Chandra et al 33 demonstrated that vaginal pH has no effect in reducing labor duration among women undergoing labor induction with vaginal prostaglandin as well as the optimal pH in the vagina for reaching the maximal prostaglandin efficacy has not yet been detected.…”

Section: Discussionmentioning

confidence: 99%

Effect of Vaginal Washing before Intravaginal Prostaglandin Insertion on Induction of Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials

et al. 2023

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Objective Saline vaginal douching prior to intravaginal prostaglandin application might increase the vaginal pH, leading to improvement of prostaglandin bioavailability, by which the outcomes of labor induction can be greatly improved. Thus, we aimed to evaluate the effect of vaginal washing with normal saline before insertion of vaginal prostaglandin for labor induction. Study Design A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI Web of Science from inception to March 2022. We selected randomized controlled trials (RCTs) that compared vaginal washing using normal saline versus no vaginal washing in the control group before intravaginal prostaglandin insertion during labor induction. We used RevMan software for our meta-analysis. Our main outcomes were the duration of intravaginal prostaglandin application, duration from intravaginal prostaglandin insertion to active phase of labor, duration from intravaginal prostaglandin insertion till total cervical dilatation, labor induction failure rate, incidence of cesarean section (CS), and rates of neonatal intensive care unit (NICU) admission and fetal infection postdelivery. Results Five RCTs were retrieved with a total number of 842 patients. Duration of prostaglandin application, duration from prostaglandin insertion to active phase of labor, and time interval from prostaglandin insertion to total cervical dilatation were significantly shorter among vaginal washing group (p < 0.05). Vaginal douching prior to prostaglandin insertion significantly decreased the incidence of failed labor induction (p < 0.001). After the removal of reported heterogeneity, vaginal washing was linked to a significant decline in CS incidence (p = 0.04). In addition, the rates of NICU admission and fetal infection were significantly lower in the vaginal washing group (p < 0.001). Conclusion Vaginal washing with normal saline before intravaginal prostaglandin insertion is a useful and easily applicable method for labor induction with good outcomes. Key Points

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Effect of vaginal pH on efficacy of dinoprostone gel for labour induction

Cited by 7 publications

References 14 publications

Effect of vaginal douching with normal saline before insertion of dinoprostone vaginal insert for labor induction

Effect of vaginal douching with normal saline before insertion of dinoprostone vaginal insert for labor induction

Modifications in Vaginal Microbiota and Their Influence on Drug Release: Challenges and Opportunities

Effect of Vaginal Washing before Intravaginal Prostaglandin Insertion on Induction of Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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