Effect of vaginal washing before Misoprostol insertion on cervical ripening before induction of labor: A randomized single‐blind clinical trial

Abstract

Background Vaginal pH is acidic in pregnancy, but there is no information about pH changes in pregnancy, and contradictory results have been reported from the effectiveness of Misoprostol at different vaginal pH. This study aimed to evaluate the effect of vaginal washing before Misoprostol insertion on cervical ripening before induction of labor in comparison with the control group. Methods This randomized single‐blind clinical trial was performed on 148 pregnant women who were candidates for induction of labor. Subjects were randomly divided into two groups of intervention (vaginal washing with 20 cc of normal saline 0.9% before Misoprostol insertion) and the control group (without vaginal washing). Vaginal pH and Bishop scores were measured before and after the intervention. The two groups were compared in demographic‐obstetric variables, the success rate of induction of labor, maternal and neonatal outcomes, and Misoprostol dose. Results After the intervention, there was no statistically significant difference between the pH before and after in the group with vaginal washing. There was no significant difference between the two groups in the type and duration of labor, and maternal and neonatal outcomes (P > .05). The frequency of normal delivery less than 12 hours in the intervention group was higher than in the control group. Although this difference was not statistically significant due to the small number of subjects, it is clinically significant. Conclusion The results of the present study showed that vaginal washing with normal saline before Misoprostol insertion for induction of labor did not affect the success of induction and duration of labor.

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

“…Overall, five RCTs 12 13 19 20 21 met the inclusion criteria, including a total number of 842 patients of which 414 were in the intervention group and 428 were in the control group. The included trials were performed in the following countries: two trials in Turkey, 12 19 one trial in Iran, 13 one trial in Pakistan, 20 and one trial in India. 21 An initial Bishop's score was assigned to all patients through cervical examination in the included trials.…”

“…Although it did not reach a statistically significant difference, it was considered to be clinically significant. 13 Another RCT by Shabir et al 20 demonstrated a significant decline in the labor duration with vaginal washing using normal saline prior to vaginal dinoprostone insertion during labor induction. Moreover, the rate of failure of labor induction and CS incidence were decreased among vaginal washing group in comparison with control group.…”

“…The included studies were heterogeneous (p ¼ 0.06, I 2 ¼ 55%). However, after removal of the reported heterogeneity by excluding one study 13 (p ¼ 0.29, I 2 ¼ 20%), there was a significant decline in the CS rate among the vaginal washing group (OR ¼ 0.64; 95% CI, 0.42-0.97; p ¼ 0.04), as shown in ►Fig. 8.…”

“…However, a recent trial did not find any benefit from vaginal washing with normal saline prior to intravaginal prostaglan-din administration on the duration of labor and induction success. 13 Our systematic review and meta-analysis aimed to evaluate the impact of vaginal washing with normal saline before intravaginal prostaglandin insertion on labor induction.…”

“…However, a recent trial did not find any benefit from vaginal washing with normal saline prior to intravaginal prostaglandin administration on the duration of labor and induction success. 13…”