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: 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
[Show abstract] [Hide abstract]
ABSTRACT: Labor is induced in approximately 20% of pregnancies in Europe and North America. Labor induction in patients with an unfavorable cervix is associated with a higher incidence of prolonged labor and higher rates of operative and cesarean delivery. Prostaglandins used for cervical ripening lead to shorter labor, less use of oxytocin and a greater likelihood of vaginal delivery within 24 h. Dinoprostone (prostaglandin E2) has been used since the 1970’s and is recognized as an agent that not only results in cervical ripening but also activates myometrial contractility. A proprietary sustained- and controlled-release dinoprostone vaginal insert releases a continuous dose of dinoprostone for 12 h and has been shown to decrease the time to vaginal delivery compared with placebo. This controlled-release insert has been compared with various prostaglandin agents and provides safe and efficacious cervical ripening in women with an unfavorable cervix.Expert Review of Obstetrics & Gynecology 01/2014; 3(1). DOI:10.1586/1747418.104.22.168
[Show abstract] [Hide abstract]
ABSTRACT: To compare the efficacy and safety of misoprostol alone with dinoprostone followed by misoprostol, all inserted intravaginally in induction of labor at term and the obstetrical outcome. A pilot study comprising 111 primigravidae, >37 gestational weeks with singleton pregnancy in cephalic presentation having an unfavorable Bishop score admitted for labor induction, were considered and randomly allocated into two groups. In group I (n=55) with intravaginal 25mcg misoprostol 4 hourly (six doses at the most) and and group II (n=56), with dinoprostone 0.5mg followed eight hours later by 25mcg misoprostol induction to vaginal delivery time was found to be significantly different, being 14.8 h in group-I and shorter in group-II with a mean of 11.6 h. Vaginal delivery rates within 12 h (groups-I and -II: 47.2%, as compared to 60.7%, respectively) were found to be higher with dinoprostone-misoprostol induction, as well as vaginal delivery rates in 24 h, 80.0% and 91.1%. The need for oxytocin augmentation was more frequent in the misoprostol than in the dinoprostone-misoprostol group, (61.8%, and 39.3%), and all these observations were statistically significant. Abnormal foetal heart rate pattern occurred more frequently (18.2%) in group-I in contrast to 5.3% in group-II, as was the incidence rate of (18.2%) who had passage of meconium in group-I, this rate being significantly different from group-II having meconium passage in 3 cases, a rate of 5.3%. Using dinoprostone followed by vaginal misoprostol is safe and effective for induction of labor with less need for oxytocin augmentation and shorter induction delivery interval.06/2011; 12(2):80-5. DOI:10.5152/jtgga.2011.20