To compare safety and efficacy of oral misoprostol (25 microgram) with intracervical dinoprostone gel (0.5 mg) for cervical ripening and induction of labour

Meenakshi Priya, - (2014) To compare safety and efficacy of oral misoprostol (25 microgram) with intracervical dinoprostone gel (0.5 mg) for cervical ripening and induction of labour. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.


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INTRODUCTION: Labour induction is an obstetrical intervention designed to artificially initiate the process of cervical effacement, dilatation, uterine contractions and eventually delivery of the baby. The indications are postdated pregnancy, gestational diabetes, hypertensive disorders, fetal growth restriction and pre labour rupture of membranes. Sometimes it is essential to induce labour when the risk to the mother and / or fetus with pregnancy continuation outweighs the risk that are involved with intervention. Prolong labour, increased instrumental delivery and increased cesarean section are more associated with Induction of labour with an unfavorable cervix compared to spontaneous onset of labour or induction of labour with a favorable cervix. The success of labour is decided by the improvement in the bishop score. Therefore, it is necessary to use optimal techniques for cervical ripening and safe confinement. There are many methods for labour induction which includes, prostaglandins, mechanical methods, membrane sweeping, oxytocin, antiprogesterone etc. AIM OF THE STUDY: A comparative study of safety and efficacy of oral misoprostol (25 microgram) with dinoprostone gel (0.5mg) for cervical ripening and induction of labour. OBJECTIVES: PRIMARY OBJECTIVE: To compare safety and efficacy of oral misoprostol (25 microgram) with intracervical dinoprostone gel (0.5 mg) for cervical ripening and induction of labour. SECONDARY OBJECTIVE: 1. To compare change in bishop score. 2. To compare mode of delivery. 3. To compare the need for augmentation of labour in active phase. 4. To compare patient satisfaction. 5. To compare side effects and neonatal outcome. MATERIALS AND METHODS: The study was conducted in the department of obstetrics and gynecology, PSG Hospitals, Coimbatore from August 2012 to August 2013. STUDY DESIGN: Prospective study. STUDY POPULATION: Study group consisted of two groups. These groups constituted of pregnant women at term admitted to PSG hospitals for induction of labour for either medical or obstetrics reasons. SELECTION CRITERIA: 1. singleton pregnancy. 2. vertex presentation. 3. bishop score <5. 4. completed 37 weeks. 5. need for induction. EXCLUSION CRITERIA: 1. multiple gestation. 2. non vertex presentation. 3. preterm. 4. previous LSCS. 5. multiparity. 6. cephalopelvic disproportion. Patients who needed induction were identified and selected for induction by random allocation table. After obtaining informed consent they were induced with PGE2 gel and oral misoprostol by whichever method they were selected. CONCLUSION: In our study, 217 singleton primigravida who consented for the study and in whom cervical ripening and labour induction was indicated were studied. 104 women received misoprostol 25microgm oral and 107 women received dinoprostone gel 0.5mg intracervically. • The overall improvement in bishop score was better with oral misoprostol. • There was a significant change in bishop score in both groups but in oral misoprostol, the cervix once it became favourable it progressed very smoothly. • The need for augmentation with vaginal misoprostol is less with oral misoprostol (27.9%) when compared to PGE2 gel (51.4%). • 35.6% of oral misoprostol did not need acceleration when compared to PGE2 gel 6.5%. • In those who needed acceleration with both oxytocin and ARM was less with oral misoprostol 35.6% when compared to PGE2 gel 56.1%. • The incidence of LSCS in oral misoprostol 31.7% when compared to PGE2 gel 34.6%. • 20.2% had induction delivery interval less than 12 hrs when compared to PGE2 gel 14.0%. • Incidence of complication is less in oral misoprostol (26.9%). 25% had fetal distress and none had hyperstimulation in oral misoprostol where as PGE2 gel 43% had fetal distress and 4% had hyperstimulation. • There were no NICU admission and neonatal asphyxia in both the groups. • The incidence of complication was not statistically significant between the two groups, but the incidence of hyperstimulation was present only with PGE2 gel. • Both group ‘s satisfaction were assessed and they expressed a preference to oral misoprostol because of its ease of administration and cost effectiveness. • Post induction bishop score of 0-3 is more in oral misoprostol (13.4%) post induction score of 0-3 in PGE2 is less when compared. (4.8%) • This shows that with very unfavourable cervix PGE2 gel is a better method of induction when compared to oral misoprostol. • The induction delivery interval was > 48 hours in .8.7% in oral misoprostol and 1.9% in PGE2 gel delivered by cesaerean section. In case of prolonged labor with failed induction, other modes of induction also failed to improve the bishop score. • The number of doses needed for augmentation is more with oral misoprostol because of difference in the route of administration and bio availability of the drugs. Hereby we conclude saying oral misoprostol is as efficacious as PGE2 gel in induction of labor.

Item Type: Thesis (Masters)
Uncontrolled Keywords: compare ; safety ; efficacy ; oral misoprostol ; 25 microgram ; intracervical dinoprostone gel ; cervical ripening ; induction of labour.
Subjects: MEDICAL > Obstetrics and Gynaecology
Depositing User: Subramani R
Date Deposited: 25 Nov 2017 02:07
Last Modified: 24 Jun 2018 12:20

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