Humaira Safrin, H (2018) Effect of vaginal PH on efficacy of dinoprostone gel for labour induction. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Induction of labour can be defined as an intervention intended to artificially initiate uterine contractions resulting in progressive effacement and dilation of cervix. This should ideally result in the birth of the baby through vaginal route. The more common indications include post term pregnancy, membrane rupture without labour, gestational hypertension, oligohydramnios, non reassuring fetal status and various maternal medical conditions such as chronic hypertension and diabetes (American College of Obstetricians and Gynaecologists, 2013b). Before induction one must ensure that the gestational age and fetal lung maturity is confirmed. Induction of labour is one of the most common interventions practiced in modern world. Overall throughout the world, up to 20 per cent of women have labour induced by one method or the other. Induction rates vary with practices and cultural backgrounds. The availability of newer oxytocics and induction techniques which are safer, more effective and predictable than the older techniques has made the process of induction more easier. AIM OF THE STUDY: 1. To evaluate the influence of vaginal pH on the efficacy of PGE2 gel for cervical ripening/labour induction. 2. To improve patient selection for PGE2 induction and reduce the incidence of failed induction with PGE2 gel. 3. To asses the labour outcome in induction with PGE2 by knowing the vaginal pH prior induction. 4. To asses whether vaginal pH itself has a significant effect on the Bishop score prior induction or not. MATERIALS AND METHODS: The Prospective study was conducted in Govt. RSRM Lying In Hospital, Chennai during the period of December 2016 to September 2017 after getting approval from the Institutional Ethical Committee. 100 patients who underwent induction of labour for various reasons were selected for the study and examined. Before other examinations were performed, each participant underwent a speculum examination and vaginal pH value was assessed by using pH indicator paper (both broad & narrow spectrum). The indicator paper was placed on the lateral vaginal wall between the two valves of Cusco’s speculum until it became wet. Colour change of the strip was immediately compared with the manufacturer’s colorimetric scale and the finding was recorded. A vaginal examination was then performed to determine the Bishop’s score. Bishop score was assessed. Inclusion criteria: 1. An unfavourable cervical Bishop score of ≤ 5, 2. Singleton pregnancy with vertex presentation and no contraindication to vaginal delivery. 3. Assuring fetal heart rate. Exclusion criteria: 1. Known hypersensitivity to prostaglandins, 2. Placenta previa, 3. Suspected chorioamnionitis, 4. Parity of > 3, 5. A previous caesarean delivery or a history of uterine surgery, 6. Previous attempted induction of labour for this pregnancy, 7. Cephalopelvic disproportion. CONCLUSION: Induction of labour is one of the most common obstetric practices carried out in the world. Compared to spontaneous onset of labour, induction of labour is complicated by a higher rate of Caesareansection. This difference is greater for nulliparous women with unfavourable cervix. The pH is important in terms of the design and the efficacy of vaginal drug delivery systems. To assess the pre induction favorability of the cervix vaginal pH appears to be better tool. Vaginal pH measurement is easy to do. So this study was conducted with 100 patients who underwent induction of labour at 37 to 40weeks 6 days in our hospital. The most common indication for induction was postdated pregnancy. PGE2 gel induction was done and the results were tabulated and analysed. Vaginal pH in the range of 5 to 6 was found to be a better predictor of normal vaginal delivery than Modified Bishop’s Score. This is a objective, more reproducible and quantitative method which can be performed easily anywhere. Therefore more liberal use of vaginal pH for pre induction cervical assessment in term pregnancy would enable obstetricians to predict the outcome of labour induction and to select a safe and more efficient policy of induction. Hence, findings of the present study suggest that parity influences vaginal pH and vaginal pH itself has a significant effect on cervical ripening and the Bishop Score prior induction. Higher vaginal pH more often responds to a single induction and is more often associated with vaginal deliveries than LSCS. Hence knowing the vaginal pH prior induction could prove to be a useful tool in assessing the labour outcome of a patient undergoing labour induction with PGE2 gel. Further research is required to find various agents that would increase the vaginal pH thereby creating a favorable environment for PGE2 gel induction.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | vaginal PH ; dinoprostone gel ; labour induction. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Jul 2018 02:57 |
| Last Modified: | 16 Jul 2018 02:57 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8849 |
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