Comparative study of the outcome of induction of labor using 25 µg and 50 µg of vaginal misoprostol

Transvaginal sonographic measurement of cervical length versus Bishop score in labor induction at term for prediction of caesarean delivery

OBJECTIVE

The current study aims to compare between a transvaginal sonographic measurement of cervical length and Bishop score in the induction of labor (IOL) at term for prediction of cesarean delivery (CD).

MATERIALS AND METHODS

A prospective cohort study included 320 full-term pregnant women attending Ain Shams Maternity Hospital in the period from August 2017 to February 2018 were enrolled. Seventy-three women were delivered by CD (positive group), and 247 women were delivered vaginally (negative group). All patients had a vaginal examination for assessing the Bishop Score before IOL then a transvaginal ultrasound for assessment of cervical length. IOL was initiated by using PGE1 analog. The primary outcome measure was the accuracy of the cervical length or the bishop score for prediction of the CD.

RESULTS

In our current study, CD was achieved in 22.8% of all participants while vaginal delivery was achieved in 77.8% after IOL by misoprostol 25 micrograms within 24 h from the beginning of induction. Both the cervical length and Bishop Score had poor predictive value for CD (AUC = 0.694 and 0.623, respectively).

CONCLUSIONS

Both transvaginal sonography for cervical length and Bishop score are useful predictors of the need for CD following labor induction.

A comparison of induction of labor success rates over three time periods in 20 years at a single academic tertiary care center: are we improving vaginal delivery rates?

OBJECTIVE

To compare the rates of successful induction of labor during three one-year periods over 20 years at a single institution.

METHODS

All women at 37 weeks or beyond with a living, singleton, cephalic fetus admitted for induction of labor in 1992, 2002, and 2012 were included. The use of induction agents and rates of successful vaginal delivery were compared.

RESULTS

A total of 627 women were evaluated, 219 in 1992, 220 in 2002, and 188 in 2012. Various induction agents were employed over the 20 year period. However, the rates of successful vaginal deliveries did not significantly vary over the three time periods, 79.5% in 1992, 72.3% in 2002, 76.1% in 2012, p = .21. In subgroup analysis, no significant differences were found among women with one or more prior vaginal delivery, no prior vaginal delivery, or after excluding those with a prior cesarean section. In multiple variable logistic regression analysis, no induction agent besides amniotomy improved successful vaginal delivery rates.

CONCLUSIONS

Despite the multiple induction agents available at our tertiary care institution over the past 20 years, we were unable to demonstrate any significant improvement in successful vaginal delivery rates after induction of labor.

Induction of Labor in Post-Term Nulliparous and Parous Women - Potential Advantages of Misoprostol over Dinoprostone

INTRODUCTION

We undertook a prospective cohort study to compare the effectiveness and safety of 50 µg misoprostol versus 3 mg dinoprostone in two vaginal doses 6 hours apart, followed if necessary by oxytocin for labor induction in low-risk post-term (> 40 weeks) pregnancies with unfavorable cervix (Bishop score ≤ 6).

METHODS

Labor induction and subsequent management were conducted using a standardized protocol. The primary outcome of the study was labor induction rate. Secondary outcomes included mode of delivery, time interval from induction to delivery, maternal complications and neonatal outcome.

RESULTS

107 patients received misoprostol (Group A) and 99 patients received dinoprostone (Group B). Compared with group A, more women in Group B needed a second vaginal dose of prostaglandin or oxytocin infusion in order to proceed to labor (21.5 vs. 43.4 %; p = 0.01). Misoprostol alone as a single or double vaginal dose was more effective than dinoprostone alone in inducing labor without oxytocin administration (85.0 vs. 50.4 %; p = 0.04). Overall, the rate of successful induction of labor did not differ between groups (91.6 vs. 85.8 %; p = 0.75). Vaginal delivery, operative vaginal delivery and Caesarean section rates were not significantly different. Time interval from induction to delivery however, was shorter for Group A (median 11 hours vs. 14.1 hours; p < 0.001). Though emergency Caesarean section due to fetal distress was more frequent in Group A (16.8 vs. 4.0 %; p = 0.007), low Apgar scores < 7 and NICU admissions did not differ significantly. Maternal complications, mostly not serious, were higher in Group A (31.8 vs. 2.0, p < 0.001).

CONCLUSION

Misoprostol is a more effective agent than dinoprost in post-term pregnancy for labor induction with few maternal adverse effects.

Induction of labor in twin pregnancies with oral misoprostol versus vaginal dinoprostone--is it effective and safe?

OBJECTIVE

To compare the effectiveness and safety of oral misoprostol versus vaginal dinoprostone for the induction of labor in twin pregnancies.

METHODS

All twin pregnancies ≥ 34 weeks 0 days that were induced with either misoprostol or dinoprostone in St. Hedwig Hospital between 2002 and 2013 were included in this retrospective study. Length of induction, mode of delivery, maternal and neonatal outcomes were compared between the two groups.

RESULTS

After identifying 186 twin mothers matching the inclusion criteria, 154 women were induced with misoprostol (group A) and 32 with dinoprostone (group B). There were no differences in demographic data between the groups. Rates of successful vaginal delivery (53.9% versus 56.3%) and length of induction to delivery (30.2 h versus 26.9 h) were also similar. There were slightly higher rates of postpartum hemorrhage in group B (16.6% versus 10.8%), but without reaching statistical significance. Neonatal outcomes regarding umbilical artery pH <7.20 and one minute Apgar also were without significant differences.

CONCLUSIONS

Study data indicate that oral misoprostol and vaginal dinoprostone are similarly effective and safe for the induction of labor in twin gestations. Further trials with larger series are needed to confirm these results.