Induction of Labour in Nulliparas with Poor Cervical Score: Oxytocin or Prostaglandin Vaginal Pessaries?

Abstract

In a previous study nulliparas with poor cervical score (less than 5 out of 10) had a 43.5% Caesarean section (CS) rate of which 55% were for failed induction when labour was induced by artificial rupture of membranes and oxytocin infusion. In this study induction of labour by 2 doses of 3 mg prostaglandin E2 (PGE2) vaginal pessaries, 4 hours apart, and if necessary by artificial rupture of membranes and oxytocin infusion 24 hours later, resulted in a CS rate of 23.7% of which 38.9% were for failed induction. The latter regimen resulted in a significantly lower CS rate compared with labour induced by oxytocin infusion and rupture of membranes without the use of prostaglandins (p less than 0.001). In the prostaglandin group 53.3% were established in labour within 24 hours of inserting the pessary and in these patients the CS rate was 18.5%. In those who did not start labour and needed rupture of membranes and oxytocin infusion 24 hours after the first pessary, 34 (47.9%) had a good cervical score (greater than or equal to 6 out of 10) and 37 (52.1%) had a poor cervical score (less than or equal to 5 out of 10) at the time of amniotomy. The CS rates in these groups were 8.8% and 48.6% respectively (p less than 0.001). In nulliparas with poor cervical score induction is better performed with vaginal prostaglandin pessaries in order to reduce the high CS rate associated with artificial rupture of membranes and oxytocin infusion.

The cost‐effectiveness of outpatient (at home) cervical ripening with isosorbide mononitrate prior to induction of labour

“…The study presented in this paper was based on rigorous methods, which included an extensive sensitivity analysis, methods for handling uncertainty and the latest health economic evaluation methods. Moreover, the induction of labour protocol which was developed by the hospital and followed by the trial 14 was generalisable to other UK settings. There are three possible limitations of this work that should be borne in mind by readers.…”

Cervical Ripening Before Induction of Labour in Patients with an Unfavourable Cervix: A Comparative Randomized Study of the Atad Ripener Device, Prostaglandin E2 Vaginal Pessary, and Prostaglandin E2 Intracervical Gel

“…Various mechanical and pharmacological methods have been used to ripen the cervix before induction of labour. Prostaglandin E, (PGE,) is the commonly used local ripening agent ( 4 3 and results in a lower Caesarean section rate than oxytocin when used for induction of labour in the presence of an unfavourable cervix (6,7). As systemic absorption of the drug is common, side-effects such as maternal nausea, vomiting, and initiation of uterine contractions are often encountered.…”

A study of vaginal misoprostol tablet versus intra cervical dinoprostone gel for the induction of labour

“…3,4 Prostaglandins alter the extracellular ground substance of the cervix, ripen the cervix and also increase the activity of collagenase in the cervix. They also allow for an increase in intracellular calcium levels, causing contraction of myometrial muscle.…”