Effect of vaginal pH on efficacy of misoprostol for cervical ripening and labor induction

Ramsey, Patrick S.; Ogburn, Paul L.; Harris, Denise Y.; Heise, Robert H.; Ramin, Kirk D.

doi:10.1067/mob.2000.107441

Cited by 27 publications

(19 citation statements)

References 13 publications

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“…Contradictory results relating vaginal pH to induction to delivery interval have been reported [6,7]. Our study did not demonstrate any significant difference in time interval from induction to vaginal delivery in the lower versus higher vaginal pH group.…”

Section: Discussioncontrasting

confidence: 56%

“…Our study administered 25 mg of misoprostol per vaginuum, the currently recommended dose for labor induction (ACOG) as opposed to the 50 mg dose evaluated in previous studies [6,7]. Although an interim assessment of pH group allocation suggested equal distribution of lower and higher groups, final recruitment did not meet the sample size estimated by power calculations as two thirds of the patients had a vaginal pH 4 5.…”

Section: Discussionmentioning

confidence: 83%

“…The interval from induction to vaginal delivery was 2 h and 40 min longer in the lower pH group, a clinically relevant difference. Ramsey et al [6] examined the effect of vaginal pH in 37 women undergoing labor induction using 50 mg of vaginal misoprostol and also found no difference in outcomes such as time to vaginal delivery or time to full dilatation, between the high and low pH groups, but the study may have lacked sufficient power to detect a difference. In Ramsey's study, the interval from induction to vaginal delivery was 40 min longer in the lower pH.…”

Section: Discussionmentioning

confidence: 96%

“…Earlier studies that examined the influence of vaginal pH on misoprostol efficacy have used higher doses than the currently recommended regimen and report contradictory results [6][7][8]. We designed this prospective observational study to evaluate the influence of vaginal pH on labour induction with lower dose vaginal misoprostol.…”

Section: Introductionmentioning

confidence: 99%

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The effect of vaginal pH on labor induction with vaginal misoprostol

Chandra

Allen

Lee

et al. 2005

The Journal of Maternal-Fetal & Neonatal Medicine

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The effect of vaginal pH on labor induction with vaginal misoprostol

Chandra

Allen

Lee

et al. 2005

The Journal of Maternal-Fetal & Neonatal Medicine

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“…Oxytocin was not administered earlier than 4 h after the last misoprostol dose recommended by the American College of Obstetricians and Gynecologists (ACOG) guidelines [12] . After transfer to the labor unit, patients in active phase of labor (at least 4 cm dilatation with regular uterine contractions), who subsequently had arrest of dilatation (no change in cervical dilatation 1 2 h) received oxytocin augmentation [13] . Oxytocin was started at 1 mU/min and increased by 1 mU/min every 15 min until adequate contractions persisted.…”

Section: Methodsmentioning

confidence: 99%

Misoprostol 50 μg Sublingually versus Vaginally for Labor Induction at Term: A Randomized Study

Çalışkan

Bodur

Özeren

et al. 2005

Gynecol Obstet Invest

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Objective: To compare the efficacy of misoprostol 50 µg vaginally and 50 µg sublingually for labor induction at term. Materials and Methods: One hundred and sixty women were randomized to receive misoprostol 50 µg vaginally (n = 80) or 50 µg sublingually misoprostol (n = 80). The doses were given every 4 h (maximum 6 doses). Primary outcome measure was number of cesarean deliveries. Induction to delivery time, delivery within 24 h, the number of misoprostol doses given; the need for oxytocin augmentation, tachysystole and uterine hyperstimulation rates and neonatal outcomes were secondary outcome measures. Results: The mean induction to delivery time was 748 ± 379 min in the vaginal group and 711 ± 425 in the sublingual group (p = 0.56). The number of women delivering within 24 h was 73 (91.3%) in the vaginal group and 74 (92.5%) in the sublingual group (p = 0.78). The mean number of misoprostol doses required was significantly higher in the sublingual group (1.9 ± 1.2) compared with the vaginal group (1.1 ± 0.4; p < 0.001). More women in the sublingual group experienced tachysystole (n = 14, 17.5%) compared with the vaginal group (n = 3, 3.8%; p = 0.005). Seven cases (8.8%) in the vaginal group and 12 cases in the sublingual group (15%) required emergent cesarean delivery for fetal heart rate abnormalities (p = 0.22). Other neonatal outcomes including umbilical artery pH, Apgar scores and intensive care unit admission were similar in the two groups. Conclusion: Sublingual misoprostol is as efficacious as vaginal misoprostol for induction of labor. More frequent tachysystole is observed with misoprostol 50 µg sublingually, but neonatal outcomes are similar.

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