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.
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ABSTRACT: A better understanding of the mechanisms underlying parturition would provide an important step toward improving therapies for the prevention of preterm labor. Aldo-keto reductases (AKR) from the 1D, 1C, and 1B subfamilies likely contribute to determining the timing of parturition through metabolism of progesterone and prostaglandins. Placental AKR1D1 (human 5β reductase) likely contributes to the maintenance of pregnancy through the formation of 5β-dihydroprogesterone (DHP). AKR1C1, AKR1C2, and AKR1C3 catalyze the 20-ketosteroid and 3-ketosteroid reduction of progestins. They could therefore eliminate tocolytic progestins at term. Activation of the F prostanoid receptor by its ligands also plays a critical role in initiation of labor. AKR1C3 and AKR1B1 have prostaglandin (PG) F synthase activities that likely contribute to the initiation of labor. AKR1C3 converts PGH(2) to PGF(2α) and PGD(2) to 9α,11β-PGF(2). AKR1B1 also reduces PGH(2) to PGF(2α), but does not form 9α,11β-PGF(2). Consistent with the potential role for AKR1C3 in the initiation of parturition, indomethacin, which is a potent and isoform selective inhibitor of AKR1C3, has long been used for tocolysis.Frontiers in Pharmacology 01/2011; 2:92. DOI:10.3389/fphar.2011.00092
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ABSTRACT: Induction of labor is common in clinical practice. Many different medical and mechanical methods have been used, but the current gold standard is vaginal dinoprostone. Misoprostol has been used for the induction of labor since 1987. In early studies with large misoprostol doses (e.g. 200 microg) there were high rates of uterine hyperstimulation. Cochrane meta-analysis, however, shows that when used in low doses it is as effective as vaginal dinoprostone and with no excess of hyperstimulation. 25 microg vaginal misoprostol 4-hourly, 50 microg oral misoprostol 4-hourly or 20 microg oral misoprostol solution 2-hourly are all safe and effective regimens. Reports of uterine rupture in women with previous cesarean sections mean that it remains contraindicated in this group.International Journal of Gynecology & Obstetrics 01/2008; 99 Suppl 2:S194-7. DOI:10.1016/j.ijgo.2007.09.011 · 1.56 Impact Factor
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ABSTRACT: The use of prostaglandin preparations with or without oxytocin infusion, is widely recognized and accepted as a standard method of induction of labour. It has been shown to reduce induction time and the risk of failed induction. The objective of this quasi-experimental observational study was to determine the effectiveness and safety of Misoprostol administered vaginally for induction of labour to achieve vaginal delivery. This study was conducted from October 2004 to October 2007. The study was conducted at Shaheena Jamil Teaching Hospital, Frontier Medical College, Abbottabad and Women and Children Hospital Abbottabad. A total of 6299 obstetric patients were received for delivery and 946 patients had to undergo induction of labour. Primary outcome measures were to address clinical effectiveness (delivery within 24-hours) and safety (uterine hyper-stimulation, Caesarean Section and serious Maternal Morbidity). Secondary outcome measures included neonatal outcome. Out of 946 cases, successful vaginal deliveries were achieved in 843 (89.1%) cases. Time interval between induction and delivery was 4-24 hours. Oxytocin was required in 107 (12%) patients. Caesarean Section had to be done in 103 (10.8%) cases. The indications for Caesarean Section were foetal distress in 42 (40%), occipito-posterior position in 8 (7.7%), abruptioplacentae 2 (1.9%), cord around the neck 9 (7%), uterine hyperstimulation 6 (5.8%) and failure to progress in 20 (19%) cases. Admission to NICU was 28 (3.3%) and Neonatal deaths were 5 (0.5%). Postpartum Haemorrhage (PPH) was observed in 22 (2.3%) patients. There was no case of rupture uterus. Vaginal Misoprostol appears to be safe and effective for cervical ripening in 3rd Trimester. It helps vaginal delivery within 24 hours, does not increase incidence of Caesarean Section and has no adverse effect on foetal outcome. It could also be used in circumstances where extensive monitoring techniques are not available though close observation and vigilance is mandatory.Journal of Ayub Medical College, Abbottabad: JAMC 20(3):33-5.