Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term.
ABSTRACT Prostaglandins have been used for induction of labour since the 1960s. Initial work focused on prostaglandin F2a as prostaglandin E2 was considered unsuitable for a number of reasons. With the development of alternative routes of administration, comparisons were made between various formulations of vaginal prostaglandins. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology.
To determine the effects of vaginal prostaglandins E2 and F2a for third trimester cervical ripening or induction of labour in comparison with placebo/no treatment or other vaginal prostaglandins (except misoprostol).
The Cochrane Pregnancy and Childbirth Group trials register (May 2003) and bibliographies of relevant papers.
Clinical trials comparing vaginal prostaglandins used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods.
A strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction.
In total, 101 studies were considered: 43 excluded and 57 (10,039 women) included. One study is awaiting assessment. Vaginal prostaglandin E2 compared with placebo or no treatment reduced the likelihood of vaginal delivery not being achieved within 24 hours (18% versus 99%, relative risk (RR) 0.19, 95% confidence interval (CI) 0.14 to 0.25, 2 trials, 384 women), there was no evidence of a difference between caesarean section rates although the risk of uterine hyperstimulation with fetal heart rate changes was increased (4.6% versus 0.51%, RR 4.14, 95% CI 1.93 to 8.90, 13 trials, 1203 women). Comparison of vaginal prostaglandin F2a with placebo showed similar caesarean section rates but the cervical score was more likely to be improved (15% versus 60%, RR 0.25, 95% CI 0.13 to 0.49, 5 trials, 467 women), and the risk of oxytocin augmentation reduced (53.9% versus 89.1%, RR 0.60, 95% CI 0.43 to 0.84, 11 trials, 1265 women) with the use of vaginal PGF2a. There were insufficient data to make meaningful conclusions for the comparison of vaginal PGE2 and PGF2a.PGE2 tablet, gel and pessary appear to be as efficacious as each other. Lower dose regimens, as defined in the review, appear as efficacious as higher dose regimens.
The primary aim of this review was to examine the efficacy of vaginal prostaglandin E2 and F2a. This is reflected by an increase in successful vaginal delivery rates in 24 hours, no increase in operative delivery rates and significant improvements in cervical favourability within 24 to 48 hours. Further research is needed to quantify the cost-analysis of induction of labour with vaginal prostaglandins, with special attention to different methods of administration.
[Show abstract] [Hide abstract]
ABSTRACT: To assess whether outpatient cervical ripening at 41 0/7 weeks of gestation with the nitric oxide donor isosorbide mononitrate reduces cesarean delivery rates in nulliparous women with an unfavorable cervix. We recruited nulliparous pregnant women with a Bishop score less than 6 in a randomized, multicenter, double-blind, placebo-controlled trial. Women received 40 mg vaginal isosorbide mononitrate or a placebo at 41 0/7, 41 2/7, and 41 4/7 weeks of gestation. They returned home between visits. At 41 5/7 weeks of gestation, for women who had not yet given birth, labor was induced with oxytocin or prostaglandins, depending on cervical status. We needed 685 women per group to detect a 25% reduction in the cesarean delivery rate, the primary outcome measure, from 25% in the placebo group to 18.75% in the isosorbide mononitrate group (1-β=0.8, α=0.05, two-sided). The NOCETER (NO donors for reduction of CEsareans at TERm) trial was a negative study. The cesarean delivery rate was 27.3% (185/678) in the isosorbide mononitrate group and 27.2% (186/684) in the placebo group (relative risk 1.00, 95% confidence interval [CI] 0.84-1.19). None of the maternal secondary efficacy outcomes differed between groups. Side effects were more common among women receiving isosorbide mononitrate than in the placebo group (78.8% [534/678] compared with 27.9% [191/684], relative risk 2.82, 95% CI 2.49-3.20). Composite perinatal morbidity did not differ between groups. Outpatient cervical ripening with vaginal isosorbide mononitrate for prolonged pregnancy in nulliparous women does not reduce cesarean delivery rate. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00930618. : I.
[Show abstract] [Hide abstract]
ABSTRACT: Abstract Objective: To compare the efficacy and safety of the use of transcervical Foley's catheter versus Cook cervical ripening balloon in pregnant women with stillbirth, unfavorable cervix and scarred uterus. Design: Randomized controlled study. Setting: El Minia University Hospital, El Minia, Egypt. Patients and Methods: Two hundred pregnant women with stillbirth, unfavorable cervix and scarred uterus were recruited into this study. They were randomized into two groups. In group I (n=100), cervical ripening was done using Foley's catheter. In group II (n=100), cervical ripening was done using Cook cervical ripening balloon. Main outcome measures: Balloon insertion to delivery interval, successful ripening rate, Cesarean delivery rate, maternal adverse events and maternal satisfaction Results: Time from balloon insertion to expulsion and from balloon insertion to delivery was significantly shorter in Foley's catheter group. However, the difference between the two groups regarding time from balloon insertion to active labor, time from balloon expulsion to delivery, cervical ripening, CS, instrumental delivery, pain score, need for analgesia, hospital stay and maternal satisfaction was not statistically significant. Conclusions: Foley's catheter and Cook cervical ripening balloon are comparable regarding efficacy and safety profile when used to ripen the cervix in pregnant women with stillbirth; unfavorable cervix and scarred uterus. However, Foley's catheter has a shorter induction to delivery interval and is relatively cheaper device.Journal of Maternal-Fetal and Neonatal Medicine 07/2014; DOI:10.3109/14767058.2014.947576 · 1.21 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Background: Prematurity is the second-leading cause of death in children under the age of 5 worldwide. It is predicted that the future climate will have more intense, longer lasting and frequent extreme heat episodes, and so the temperature effect on the risk of preterm birth is generating considerable interest in the public health field. Our aim was to explore the potential short-term effects of elevated temperatures on the risk of preterm birth in Valencia (Spain). Methods: All singleton natural births born in the metropolitan area of Valencia during the warm season (May-September, 2006-2010) were included (N=20,148). We applied time-series quasi-Poisson generalized additive models to evaluate the risk of preterm birth at different maximum apparent and minimum temperature values (50th, 90th and 99th percentiles of the warm season) up to 3 weeks before delivery (reference: overall annual median value). In addition, three temperature-interval-specific estimates were obtained for changes between each of these temperature values. We took into account the pregnancies at risk adjusted by the gestational age distribution of the set in each day. We used distributed-lag nonlinear models with a flexible function in the shape of the relationship and lag structure. Results: Risk of preterm birth increased up to 20% when maximum apparent temperature exceeded the 90th percentile two days before delivery and 5% when minimum temperature rose to the 90th percentile in the last week. Differences between interval-specific risk estimates across lags were observed. Conclusion: Exposure to elevated temperatures was associated with an increased risk of preterm birth in the following three weeks.Environmental Research 08/2014; 134C:210-217. DOI:10.1016/j.envres.2014.07.021 · 3.95 Impact Factor