Evaluating misoprostol and mechanical methods for induction of labour

Weeks, Andrew; Lightly, Kate; Mol, Ben Willem; Frohlich, Julie; Pontefract, Sarah; Williams, Myfanwy J

doi:10.1111/1471-0528.17136

Cited by 11 publications

(12 citation statements)

References 23 publications

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“…Additionally, the groups of patients with full-term pregnancy (37–41 Group) and post-term pregnancy (+41 Group) were characterized by a high percentage of vaginal deliveries within 24 h. These data show that misoprostol may be a highly effective IOL agent. Despite the fact that these data are not statistically significant, they are consistent with the research conducted so far on this issue [ 2 , 26 , 27 ].…”

Section: Discussionsupporting

confidence: 90%

The Efficacy of Misoprostol Vaginal Inserts for Induction of Labor in Women with Very Unfavorable Cervices

Socha

Flis

Wartęga

et al. 2023

JCM

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Background: The purpose of the present study was to evaluate the effectiveness of a misoprostol vaginal insert as an induction-of-labor (IOL) agent in women with an unfavorable cervix (Bishop score < 2) in achieving vaginal delivery (VD) within 48 h, depending on the gestational week, with particular emphasis on the cesarean section (CS) percentage, intrapartum analgesia application and possible side effects, such as tachysystole ratio. Methods: In this retrospective observational study involving 6000 screened pregnant patients, 190 women (3%) fulfilled the study inclusion criteria and underwent vaginal misoprostol IOL. The pregnant women were collected into three groups: patients who delivered at up to 37 weeks of gestation (<37 Group)—42 patients; patients who delivered between 37 and 41 weeks of gestation (37–41 Group)—76 patients; and patients who delivered after 41 weeks of gestation (41+ Group)—72 patients. The outcomes included time to delivery and mode of delivery, rate of tachysystole, need for intrapartum analgesia, and need for oxytocin augmentation. Results: Most of the patients delivered vaginally (54.8% in <37 Group vs. 57.9% in 37–41 Group vs. 61.1% in 41+ Group). A total of 89.5% (170/190) of patients delivered within 48 h (<37 Group—78.6% vs. 37–41 Group—89.5% vs. 41+ Group—95.8%). Statistical significance was demonstrated for the increased rate of vaginal deliveries and shortened time to delivery in the 41+ weeks group (p = 0.0026 and p = 0.0038). The indications for cesarean section were as follows: abnormal CTG pattern vs. lack of labor progression: 42.1% vs. 57.9% in <37 Group, 59.4% vs. 40.6% in 37–41 Group and 71.4% vs. 28.6% in 41+ Group. Statistical significance was demonstrated for the increased rate of abnormal CTG patterns as cesarean section indications in the 41+ Group (p = 0.0019). The need for oxytocin augmentation in each group was: 35.7% in <37 Group vs. 19.7% in 37–41 Group vs. 11.1% in 41+ Group. Statistical significance was shown for decreased need for oxytocin augmentation in +41 Group (p = 0.0016). The need for intrapartum anesthesia, depending on the group, was: 78.6% in <37 Group vs. 82.9% in 37–41 Group vs. 83.3% in 41+ Group. Statistical significance was demonstrated for increased need for intrapartum anesthesia application during labor in +41 Group (p = 0.0018). The prevalence of hyperstimulation was similar in all three groups (4.8% vs. 7.9% vs. 5.6% p > 0.05). Conclusions: The misoprostol vaginal regimen for IOL used in our study is effective in achieving vaginal delivery within 48 h. In post-term women, the use of this regimen is characterized by an increased rate of vaginal deliveries, a shorter time to delivery and a lower need for oxytocin.

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Section: Discussionsupporting

confidence: 90%

The Efficacy of Misoprostol Vaginal Inserts for Induction of Labor in Women with Very Unfavorable Cervices

Socha

Flis

Wartęga

et al. 2023

JCM

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“…According to a recent Cochrane Review mechanical induction using balloon catheters is as effective as induction of labor using vaginally applied PGE 2 but is associated with a more favorable safety profile 31 , however, there was not enough research on other mechanical methods such as osmotic dilators to reach a robust conclusion 31 32 .…”

Section: Discussionmentioning

confidence: 99%

Synthetic Osmotic Dilators for Pre-Induction Cervical Ripening – an Evidence-Based Review

Rath

Kummer

Königbauer

et al. 2023

Geburtshilfe Frauenheilkd

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Mechanical methods have gained growing interest for pre-induction cervical ripening in women with an unripe cervix, since they have a better safety profile compared to prostaglandins. Balloon catheters have been the gold standard method for decades, while there was a lack of data on synthetic osmotic cervical dilators.Not until 2015, when Dilapan-S was approved by the Food and Drug Administration (FDA) for induction of labor, numerous studies have been published on the use of Dilapan-S in this field. The rate of vaginal deliveries associated with the use of Dilapan-S ranges from 61.6 to 81.7%, and no serious complications needing further interventions have been reported to this date.Dilapan-S was shown to be as effective as the Foley balloon catheter as well as the 10 mg PGE2 vaginal insert and orally applied misoprostol (25 µg every 2 hours) in achieving vaginal delivery, but patient’s satisfaction during the cervical ripening process was significantly higher compared to the other methods and the rate of uterine hyperstimulation was significantly lower compared to prostaglandins (PGs).Minor complications (e.g. vaginal bleeding) associated with the use of Dilapan-S were < 2%, and maternal infectious morbidity was not higher compared to Foley balloon and vaginal PGE2 or misoprostol.Due to these beneficial properties Dilapan-S might be an ideal option for outpatient cervical ripening, as shown in a recent randomized clinical trial comparing inpatient to outpatient cervical ripening.Furthermore, according to the manufacturers’ product information, Dilapan-S is the only cervical ripening method that is not contraindicated for induction of labor in women with a previous cesarean section. Upcoming guidelines should consider synthetic osmotic cervical dilators as an effective and safe method for cervical ripening/induction of labor acknowledging that more evidence-based data are mandatory, particularly in patients with a previous cesarean section.

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“…Einem aktuellen Cochrane-Review zufolge sind Ballonkatheter ebenso wirksam wie die vaginale Anwendung von PGE 2 , weisen aber ein besseres Sicherheitsprofil auf [18], während zu anderen Methoden bisher keine ausreichenden Daten für eine fundierte Schlussfolgerung vorliegen [18,19].…”

Section: Diskussionunclassified

Synthetische osmotische Dilatatoren zur Zervixreifung vor Geburtseinleitung

Rath,

Kummer,

Königbauer

et al. 2024

Hebamme

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In den vergangenen 20 Jahren hat sich der Anteil der eingeleiteten Geburten in Ländern mit hohem Durchschnittseinkommen nahezu verdoppelt. In Deutschland lag er 2020 bei 21,8% 1. Geburtseinleitungen bei unreifer Zervix sind mit längerer Behandlungsdauer, höheren Kosten, schmerzhafteren Wehen und geringerer Akzeptanz der Schwangeren verbunden 2. Aufgrund kontraktionsbedingter uteriner Hypoperfusion ist der Stress für die feto-plazentare Einheit erhöht, was bei verminderter fetaler Reserve zu fetalem Distress führen kann. Damit ist das Interesse an mechanischen Methoden (Ballonkatheter, synthetische osmotische Dilatatoren) zur Zervixreifung vor Einleitung gestiegen 3. Der Artikel zeigt anhand 2015-2022 veröffentlichter Studien über die Anwendung von Dilapan-S zur Zervixreifung bzw. Geburtseinleitung – evidenzbasierte Empfehlungen für die klinische Praxis auf.

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Evaluating misoprostol and mechanical methods for induction of labour

Cited by 11 publications

References 23 publications

The Efficacy of Misoprostol Vaginal Inserts for Induction of Labor in Women with Very Unfavorable Cervices

The Efficacy of Misoprostol Vaginal Inserts for Induction of Labor in Women with Very Unfavorable Cervices

Synthetic Osmotic Dilators for Pre-Induction Cervical Ripening – an Evidence-Based Review

Synthetische osmotische Dilatatoren zur Zervixreifung vor Geburtseinleitung

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