Misoprostol Vaginal Insert and Time to Vaginal Delivery

Wing, Deborah A.; Brown, Raymond; Plante, Lauren A.; Miller, Hugh; Rugarn, Olof; Powers, Barbara

doi:10.1097/aog.0b013e31829a2dd6

Cited by 96 publications

(182 citation statements)

References 7 publications

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“…The results of this study concerning average age, parity and duration of pregnancy are comparable to the results reported in literature [4,6,21,22]. Yet, similarly to studies of Wing et al, Tsicouras et al or that of Kosińska-Kaczyńska et al, in our study the primigravidas prevail (65-82%), which is associated with the cervix being more immature in that subgroup, hence more often selected for pre-induction [2,3,7,23]. To support this, we show that the Bishop score in our study was significantly higher compared to the multiparas subgroup.…”

Section: Discussionsupporting

confidence: 89%

“…Induction of labor is an obstetric procedure that is used increasingly more often (20-40% of pregnancies) [1][2][3][4][5][6][7]. The reason for that may be the increased proportion of pregnant patients with a chronic condition (for instance obesity, hypertension, diabetes mellitus) and the advancements in diagnostic methods during prenatal care that allow early detection of threats to fetal well-being [1,4].…”

Section: Introductionmentioning

confidence: 99%

“…Most studies confirm high efficacy of prostaglandins in inducing labor within 24 hours with no related increase in caesarean section rate and with lower oxytocin use. Factors to be taken into account are the risk of overstimulation and uterine tachysystole as well as the contraindications for prostaglandin use such as previous caesarean section or other surgical intervention on the uterus [1][2][3]. The misoprostol vaginal insert (MVI) containing 200 [μg] of misoprostol is a novel product that releases the PGE1 synthetic analog at the rate of 7 μg per hour for 24 hours [12].…”

Section: Introductionmentioning

confidence: 99%

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Obstetric outcomes of pre-induction of labor with a 200 μg misoprostol vaginal insert

et al. 2017

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Objectives: Labor induction is indicated in 20% to 40% of pregnancies. Over half of pregnancies qualified for the induction of labor require stimulation of the cervix to ripen. The drug used increasingly more often in pre-induction is the PGE-1 prostaglandin analog -misoprostol 200 μg. Material and methods:The study includes a total of 100 patients qualified for labor pre-induction with Misodel® (misoprostol 200 μg vaginal insert). The study group comprises two subgroups: primigravidas and multiparas. Assessments included: indications for labor pre-induction, time from Misodel application to delivery, caesarean section rate and indications, duration of first and second stage of labor, rate of vaginal deliveries, need for oxytocin or fenoterol administration side effects and newborn condition. Results:The most common indication for labor induction was gestational diabetes and pregnancy past term. The average time to vaginal delivery was 14 h 45 min, time to the onset of active phase of labor -11 h 45 min, time to membranes' rupture -15 h, time to vaginal delivery -14 h 18 min. The times of multiparas were significantly shorter. The rate of vaginal deliveries within 12 hours amounted to 42.42%, while within 24 hours it reached 83.33%. The overall caesarean section rate was 33%. The most common indication for caesarean section was the risk of intrauterine hypoxia. Tachysystole and hyperstimulation was observed in 4% of cases, while abnormalities in the cardiotocographic tracing in 43%. Conclusions:Misodel is an effective method for labor pre-induction, without affecting the caesarean section rate and has no adverse effect on the newborn condition.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Obstetric outcomes of pre-induction of labor with a 200 μg misoprostol vaginal insert

et al. 2017

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“…The primary publication contains a detailed description of the study protocol and eligible study population 5. For a list of other investigators involved in the trial, see Appendix S1.…”

Section: Methodsmentioning

confidence: 99%

Induction of labour with retrievable prostaglandin vaginal inserts: outcomes following retrieval due to an intrapartum adverse event

Rugarn

Tipping²,

Powers

et al. 2016

BJOG

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ObjectiveTo assess adverse event (AE) resolution, delivery mode and neonatal outcomes after misoprostol or dinoprostone vaginal insert (MVI or DVI) retrieval due to AE during induction of labour (IOL).DesignRandomised, double‐blind trial, EXPEDITE.SettingThirty five obstetric departments, USA.PopulationConsisted of 1358 pregnant women with modified Bishop score ≤4 eligible for pharmacological IOL.Methods Post hoc analysis.Main outcome measures AEs prompting insert retrieval, times to AE resolution, delivery, delivery mode and neonatal intensive care unit (NICU) admissions.Results77/678 (11.4%) and 27/680 (4.0%) women had MVI and DVI retrieved due to AE, respectively (P < 0.001). The most common AEs prompting retrieval were uterine tachysystole with fetal heart rate (FHR) involvement and category II/III FHR pattern. Time to AE resolution varied for both treatments depending on the type of AE. For uterine tachysystole with FHR involvement, median resolution times were 1 hour 34.5 minutes (n = 36) and 8.5 minutes (n = 8) for MVI and DVI, respectively. Caesarean delivery occurred in a high proportion of women with insert retrieved due to AE (MVI: 44/77 (57.1%); DVI: 19/27 (70.4%)); the majority of caesareans were performed at least several hours after insert retrieval. Median times from retrieval to any delivery were not increased for women with insert retrieved due to AE. NICU admissions were 8/77 (10.4%) and 1/27 (3.7%) for MVI and DVI, respectively (P = 0.440).Conclusions AEs leading to insert retrieval were primarily uterine tachysystole with FHR involvement and category II/III FHR patterns. Insert retrieval due to an AE did not prolong time to delivery for either prostaglandin insert.Tweetable abstractInduction with prostaglandin vaginal inserts: outcomes following retrieval due to intrapartum adverse event.

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“…Median time to delivery depends on the medical agent used and ranges in the literature from 21-32 hours (e.g. 200 µg Misoprostol vaginally, 10 mg dinoproston vaginally) [13] . In our study the median time to delivery was 36 hours.…”

Section: Time Interval To Deliverymentioning

confidence: 99%

Cervical ripening with an osmotic dilator (Dilapan-S) in term pregnancies – An observational study

Maier¹

2015

JGNB

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Objective: The procedure of labor induction becomes increasingly important as the number of pregnancies requiring induction rises in the Western countries due to multiple reasons. In addition, a growing number of patients is aiming to achieve vaginal birth after cesarean section (VBAC). No pharmacological agent is licensed in this group of patients. A newly developed hydrophilic agent (Dilapan-S) is now available for cervical ripening, and is indicated also for patients with a previous cesarean section. Methods: Observational, non-interventional study in a tertiary perinatal center in Berlin, Germany in 2014. Eighty-three women at term with a singleton pregnancy and cephalic presentation were included. Results: In total, 60.2% of patients delivered vaginally, 4.8% by ventouse/forceps and 34.9% by secondary cesarean section. Parous women were found to have a significantly higher chance of vaginal birth (82.6% vs. 60.2% in total, p = 0.019). Patient's ≥ 35 years showed a tendency towards increased rates of ventouse and cesarean section (11.1% vs. 4.8% and 38.9% vs. 34.9% respectively). There was a tendency towards a higher rate of vaginal birth in patients with previous cesarean section (66.7% vs. 59.2%). No adverse fetal or maternal outcomes were noted. Conclusions:The application of Dilapan-S is cost-effective as patients can be seen in outpatient care. The device is efficient and safe. It is an attractive option for physicians and patients to lower the cesarean section rate by facilitating VBAC.

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Misoprostol Vaginal Insert and Time to Vaginal Delivery

Abstract: I.

Cited by 96 publications

References 7 publications

Obstetric outcomes of pre-induction of labor with a 200 μg misoprostol vaginal insert

Obstetric outcomes of pre-induction of labor with a 200 μg misoprostol vaginal insert

Induction of labour with retrievable prostaglandin vaginal inserts: outcomes following retrieval due to an intrapartum adverse event

Cervical ripening with an osmotic dilator (Dilapan-S) in term pregnancies – An observational study

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