Women’s experience of induction of labor using PGE2 as an inpatient versus balloon catheter as an outpatient

Beckmann, Michael; Acreman, Melissa; Schmidt, Emily; Merollini, Katharina; Miller, Yvette D.

doi:10.1016/j.ejogrb.2020.03.031

Cited by 16 publications

(23 citation statements)

References 20 publications

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“…[16,17] For pregnant women with placenta previa, Mifepristone + Misoprostol and Mifepristone + Ethacridine Lactate are effective and safe methods for termination of mid-trimester pregnancy. [6] As an acceptable method of labor induction, CDB can be safely applied to pregnant women who undergo vaginal delivery with term pregnancy, [18] or to those with history of cesarean section. [19] CDB is also an alternative method for the application of Misoprostol or Ethacridine Lactate in the mid-trimester.…”

Section: Discussionmentioning

confidence: 99%

The method for termination of mid-trimester pregnancy with placenta previa: A case study

Long

et al. 2022

Medicine

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Background: Prenatal bleeding is very dangerous for pregnant women with placenta previa during termination of pregnancy in the mid-trimester. Traditionally, cesarean section or hysterectomy is used to stop bleeding. This study aims to investigate the method for termination of mid-trimester pregnancy with placenta previa, especially emergency uterine artery embolization (UAE) combined with cervical double balloon (CDB).Methods: A retrospective study was conducted based on 261 cases of mid-pregnancy termination in our hospital, where 34 cases with placenta previa were set as the observation group, and the remaining 227 cases were set as control group. At first, the termination method of Mifepristone combined with Misoprostol/Ethacridine Lactate was adopted. If the volume of prenatal bleeding was up to 400 mL, emergency uterine artery embolization (UAE) was implemented to stop bleeding, then cervical double balloon (CDB) was used to promote cervical ripening. Receiver operating characteristic (ROC) curves analysis was performed to assess the accuracy in predicting the length of placental edge crossed the cervical os for prenatal bleeding.Results: The number of gravidity/parities, the rate of cesarean section, the medical cost, the rate of previous cesarean section were all higher in the observation group than in the control group (P < .05). The volume of prenatal hemorrhage, postpartum hemorrhage, the rate of puerperal morbidity, emergency UAE rate and ICU rate were higher in the observation group than in the control group (P < .05). There were 4 cases showing prenatal hemorrhage up to 400 mL and undergoing emergency UAE + CDB in the observation group, while there were no such cases in the control group (P < .05). An optimal cut-off value of 1.7cm for the length of placental edge crossed the cervical os in diagnosing prenatal hemorrhage demonstrated sensitivity and specificity of 75.0% and 86.7%, respectively (area under the ROC curve, 0.858). Conclusion:The combined therapy of mifepristone and Misoprostol/Ethacridine Lactate was useful for termination of midtrimester pregnancy with placenta previa, and attention needs to be attached to prenatal hemorrhage during labor induction. Emergency UAE + CDB is a good combination method to treat prenatal hemorrhage and promote cervical ripening during the induction.

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Section: Discussionmentioning

confidence: 99%

The method for termination of mid-trimester pregnancy with placenta previa: A case study

Long

et al. 2022

Medicine

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“…For pregnant women with prior cesarean or/and placenta previa but without placenta percreta, both the Mifepristone-Misoprostol and Mifepristone-Rivanol are effective and safe methods for the termination of mid-trimester pregnancy [22] . As an acceptable method of labor induction, CDB can be safely applied to pregnant women who undergo vaginal delivery with term pregnancy [23] , or to those with history of cesarean section [24] . CDB is also a safe and effective method for labor induction with oligohydramnios or hepatorenal function impairment in the mid-trimester [25] .…”

Section: Discussionmentioning

confidence: 99%

Different Methods for Termination of Mid-trimester Pregnancy With Placenta Previa 

Long¹,

Wu²,

Du³

et al. 2021

Preprint

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Objective: Investigate the different methods for termination at mid-trimester in pregnant women with placenta previa. Methods: A retrospective study was conducted on 264 cases for termination at mid-pregnancy in our hospital, and 34 cases with placenta previa were set as the observation group, and 230 cases with normal placenta were set as control group. Among them, the preferred methods of termination at first were Mifepristone combined with Misoprostol/Rivanol in the observation group, and Mifepristone combined with Misoprostol/Rivanol/cervical double balloon (CDB) in the control group. If the volume of prenatal bleeding was up to 100 mL in the observation group, emergency artery embolization (UAE) was implemented to stop bleeding, then CDB plus with curettage were used in order. If it failed to induce in the control group, CDB was used subsequently followed with Misoprostol/Rivanol. Then, all those cases were set as the comprehensive-induce group, and the others were set as the simple-induce group.Results: the average maternal age, the number of gravidity/parities, the rate of cesarean section, the hospitalization days and cost, the induction time, the rate of postpartum hemorrhage, puerperal infection were higher in the observation group than those in the control group(p<0.05). There were 4 cases used UAE+CDB+curettage in the observation group and 6 cases used CDB after Misoprostol/Rivanol in the control group. The duration time of termination, the rate of postpartum hemorrhage and transferring to ICU, hospitalization days and cost in the comprehensive-induce group were significantly higher than those in the simple-induce group (p<0.05). All cases were delivered through vaginal successfully.Conclusion: We should pay more attention to the complications of prenatal bleeding, postpartum hemorrhage, puerperal infection during the induction at mid-trimester in pregnant women with placenta previa. Emergency UAE + CDB +curettage is a good combination method in prenatal hemorrhage of placenta previa during termination, and CDB was a good tool for cervical ripen with immature cervical condition in mid-trimester for induction of labor.

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“…In addition, we used real-life data from a large multi-centre RCT including actual costs and clinical events observed. The results of this trial have been reported in three phases, including clinical outcomes ( 16), women's preferences (15) and now cost-effectiveness outcomes. Our findings from different angles strengthen the confidence in our conclusions with the economic benefit, safety and preference of nulliparous women for outpatient-balloon IOL.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Although IOL is very common, there is no standard approach, and numerous methods and protocols of IOL are utilized. There is some high-quality data about clinical outcomes to inform best-practice (3)(4)(5)(6)(7)(8)(9), but scant data about women's healthcare experiences (10)(11)(12)(13)(14)(15) and even less is known as to the healthcare costs. Given limited information on healthcare costs for IOL and scarce healthcare resources, it is imperative that we identify methods of IOL that are safe, effective, acceptable to women, and cost-effective.…”

Section: Introductionmentioning

confidence: 99%

“…Recently we published the largest randomized controlled trial (RCT) of outpatient IOL and demonstrated that outpatient balloon cervical ripening may be a safer method of IOL for nulliparous women, compared to using prostaglandin E2 (PG) as an inpatient (16). We have also shown that outpatient balloons are an acceptable method and more desirable than inpatient management with PG for many women (15). This paper presents the cost-effectiveness analysis from our recently published trial of outpatient IOL (16).…”

Section: Introductionmentioning

confidence: 99%

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Induction of labour using balloon catheter as an outpatient versus prostaglandin as an inpatient: a cost-effectiveness analysis.

Merollini

Beckmann

2020

Preprint

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Objective: To assess the cost-effectiveness of induction of labour (IOL) with outpatient balloon catheter cervical priming versus inpatient prostaglandin (PG) vaginal gel or tape. Design: Economic evaluation alongside a multi-centre, randomized controlled trial. Setting: Eight Australian maternity hospitals. Population: A total of n=448 women with a live singleton pregnancy, cephalic presentation, at or beyond 37+0 weeks gestation, undergoing IOL for low-risk indications between September 2015 and October 2018. Methods: An economic decision tree model was designed from a health services perspective. Sensitivity and subgroup analyses were performed to test the robustness of model outcomes. Main Outcome Measures: We estimated resource use from time of IOL to discharge of mother and infant, collected data on health outcomes (using EQ-5D-3L questionnaire) and reported cost per quality-adjusted life year (QALY) gained, incremental cost-effect ratio (ICER) and net monetary benefit (NMB). Results: Deterministic analysis showed lower mean costs (AUD $7,294 versus AUD $7,585) in the outpatient-balloon (n=205) compared to the inpatient-PG group (n=243), with better health outcomes (0.75 vs 0.74 QALYs gained) and overall higher NMB ($30,054 vs $29,338). In probabilistic analyses outpatient-balloon IOL was cost-effective in 55.3% of all simulations and 59.1% for women with favourable cervix (modified Bishop score >3) and 64.5% for nulliparous women. Conclusions: Outpatient-balloon IOL might be cost-saving compared to inpatient IOL with PG and is most likely to be cost-effective for nulliparous women. Funding: There was no external funding source for this study.

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Women’s experience of induction of labor using PGE2 as an inpatient versus balloon catheter as an outpatient

Cited by 16 publications

References 20 publications

The method for termination of mid-trimester pregnancy with placenta previa: A case study

The method for termination of mid-trimester pregnancy with placenta previa: A case study

Different Methods for Termination of Mid-trimester Pregnancy With Placenta Previa

Induction of labour using balloon catheter as an outpatient versus prostaglandin as an inpatient: a cost-effectiveness analysis.

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Women’s experience of induction of labor using PGE2 as an inpatient versus balloon catheter as an outpatient

Cited by 16 publications

References 20 publications

The method for termination of mid-trimester pregnancy with placenta previa: A case study

The method for termination of mid-trimester pregnancy with placenta previa: A case study

Different Methods for Termination of Mid-trimester Pregnancy With Placenta Previa&nbsp;

Induction of labour using balloon catheter as an outpatient versus prostaglandin as an inpatient: a cost-effectiveness analysis.

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Different Methods for Termination of Mid-trimester Pregnancy With Placenta Previa