The Effect of Vaginal pH on the Efficacy of Vaginal Misoprostol for the Induction of Midtrimester Pregnancy Termination

Zanjani, Mansooreh; Kohpayeh, Jalil; Karimi, Zhila

doi:10.17795/ogcr-8953

Cited by 3 publications

(8 citation statements)

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“…Some studies have reported higher efficacy of Misoprostol in an acidic environment and some in an alkaline environment 10‐13,18 . Other studies suggest that when the acidic environment in the vagina is created with acetic acid, the success rate of Misoprostol increases 12,13 and some studies have considered the effectiveness of vaginal Misoprostol in moderate acidity 5 and refused the effect of acidic environment 14 . Other studies have found that high vaginal pH is effective in improving the function and bioactivity of prostaglandins, reducing the active phase of labor 15,16 .…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, conflicting results have been obtained in studies that the researcher's hypothesis was prostaglandins are effective in acidic media. Some studies have reported that acidic vaginal pH in the first and second trimesters has no effect on the induction of labor with Misoprostol, 14,19 while Rashwan et al reported positive and effective results 12 . According to the results of indirect studies, it is not yet possible to make an accurate conclusion about the effect of pH on the induction of the labor process.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, 95% of pregnancies were successful in the acetic acid group compared to 85% in the control group, but this difference was not statistically significant. Success rates between 24 and 48 hours, adverse effects and mean termination time, total Misoprostol consumption, and the number of curettages was comparable between groups, but it was observed that increased vaginal acidity did not improve the effectiveness of vaginal Misoprostol for termination of second‐trimester pregnancy 14 . Another study was conducted by Najafian to evaluate the effectiveness of vaginal Misoprostol and vaginal washing with 3% acetic acid for termination of pregnancy in the first trimester.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13]18 Other studies suggest that when the acidic environment in the vagina is created with acetic acid, the success rate of Misoprostol increases 12,13 and some studies have considered the effectiveness of vaginal Misoprostol in moderate acidity 5 and refused the effect of acidic environment. 14 of prostaglandins, reducing the active phase of labor. 15,16 Finally, Chandra et al have reported no efficacy and the optimal pH for achieving maximal Misoprostol efficacy has not yet been identified.…”

Section: Discussionmentioning

confidence: 99%

“…When the acidic environment in the vagina is created with acetic acid, the success rate of induction with Misoprostol increases 12,13 . Other studies have found more efficacy for vaginal Misoprostol in moderate acidity and refused the effect of an acidic environment 14 …”

Section: Introductionmentioning

confidence: 99%

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

Kabodmehri

Sharami

Milani

et al. 2022

Health Science Reports

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Kabodmehri

Sharami

Milani

et al. 2022

Health Science Reports

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

et al. 2023

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Objective Saline vaginal douching prior to intravaginal prostaglandin application might increase the vaginal pH, leading to improvement of prostaglandin bioavailability, by which the outcomes of labor induction can be greatly improved. Thus, we aimed to evaluate the effect of vaginal washing with normal saline before insertion of vaginal prostaglandin for labor induction. Study Design A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI Web of Science from inception to March 2022. We selected randomized controlled trials (RCTs) that compared vaginal washing using normal saline versus no vaginal washing in the control group before intravaginal prostaglandin insertion during labor induction. We used RevMan software for our meta-analysis. Our main outcomes were the duration of intravaginal prostaglandin application, duration from intravaginal prostaglandin insertion to active phase of labor, duration from intravaginal prostaglandin insertion till total cervical dilatation, labor induction failure rate, incidence of cesarean section (CS), and rates of neonatal intensive care unit (NICU) admission and fetal infection postdelivery. Results Five RCTs were retrieved with a total number of 842 patients. Duration of prostaglandin application, duration from prostaglandin insertion to active phase of labor, and time interval from prostaglandin insertion to total cervical dilatation were significantly shorter among vaginal washing group (p < 0.05). Vaginal douching prior to prostaglandin insertion significantly decreased the incidence of failed labor induction (p < 0.001). After the removal of reported heterogeneity, vaginal washing was linked to a significant decline in CS incidence (p = 0.04). In addition, the rates of NICU admission and fetal infection were significantly lower in the vaginal washing group (p < 0.001). Conclusion Vaginal washing with normal saline before intravaginal prostaglandin insertion is a useful and easily applicable method for labor induction with good outcomes. Key Points

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Comparative study regarding effect of pH on Misoprostol in induction of labor in full term primigravida pregnant women, a double blind randomized controlled trial

Rashwan

Alalfy

El-Sharkawy

et al. 2020

Journal of Perinatal Medicine

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ObjectivesTo evaluate the effect of altering vaginal pH on induction of labor in full-term pregnancies using Misoprostol.MethodsThis randomized controlled trial was conducted at Kasralainy Hospital, Cairo University, Egypt and Algezeera Hospital, Egypt. A total of 218 healthy term primigravida pregnant women who were scheduled for pregnancy termination were recruited in the study. The included patients were divided into three groups; Group A: Those who received normal saline vaginal wash (0.9% NaCl), Group B: those who received alkaline vaginal wash (5% sodium bicarbonate) and Group C: those who received acidic vaginal wash (5% acetic acid). Patients received 25 μg of Misoprostol E1 (Vagiprost® Adwia Pharmaceuticals, Egypt) every 6 h for a maximum of 24 h (total of four potential doses).ResultsThe ‘acid’ group participants took a mean time of 20.46 h to reach active stage of labor, followed by the ‘normal saline’ group with 21.45 h and the ‘alkaline’ group with 22.59 h. The difference between the groups was statistically significant, with a p-value of 0.013.ConclusionsDouching the vagina with acidic solution seems to supplement the effect of Misoprostol on inducing labor in full-term pregnancies, as evidenced by having the shortest mean time needed to reach active stage of labor.

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The Effect of Vaginal pH on the Efficacy of Vaginal Misoprostol for the Induction of Midtrimester Pregnancy Termination

Abstract: Background: Vaginal misoprostol is said to dissolve better in an acidic environment, thus, in this study we aimed to evaluate the influence of increasing vaginal acidity on the effectiveness of vaginal misoprostol for the induction of midtrimester pregnancy using acidic environment.

Cited by 3 publications

References 10 publications

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

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

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

Comparative study regarding effect of pH on Misoprostol in induction of labor in full term primigravida pregnant women, a double blind randomized controlled trial

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