misoprostol and Pregnancy--Prolonged

Being one of the most common indications of labor induction, postdate pregnancy can lead to serious maternal and fetal complications. In this study we aimed to compare vaginal misoprostol with intracervical Foley catheter (FC) for cervical ripening in postdate primigravid women.. This randomized clinical trial included 120 primigravid women aged 18-35 years with singleton,  postdate pregnancies, and Bishop score ≤ 4. Participants were randomized into two equal groups. The first group received 25 µg vaginal misoprostol and the second group had an 18 Fr FC inserted into their cervical canal. Labor induction was performed using oxytocin in both groups if progression of labor or true contractions did not occur within 6 h of the interventions. In case of nonreassuring fetal heart rate, fetal distress, placental abruption, or prolonged labor, C-section was performed.. The frequency of normal vaginal delivery, Cesarean section, meconium-stained amniotic fluid, and neonatal intensive care unit admission did not differ significantly between groups. Placental abruption and uterine tachysystole occurred more frequently in the misoprostol group (15.0 vs. 1.7%, P = 0.008 and 21.7 vs. 0.0%, P < 0.001, respectively). A significantly higher number of women in the FC group required oxytocin (73.3 vs. 41.7%, P < 0.001). Duration of labor was significantly higher in the FC group (P = 0.001).. Due to the lower rate of placental abruption and uterine tachysystole observed with FC, it appears to be superior to vaginal misoprostol for cervical ripening in postdate primigravid women; however, its longer labor duration and higher oxytocin requirement should be taken into consideration.. Iranian Registry of Clinical Trials, IRCT20181218042033N4 . Registered 19/04/2020. Retrospectively registered, https://www.irct.ir/trial/47037.

Topics: Administration, Intravaginal; Adolescent; Adult; Cervical Ripening; Cervix Uteri; Female; Gravidity; Humans; Iran; Misoprostol; Oxytocics; Pregnancy; Pregnancy, Prolonged; Urinary Catheterization; Young Adult

Prolonged pregnancies are associated with foetal and neonatal complications. This study was performed to evaluate the efficacy of intravaginal isosorbide mononitrate (IMN) for cervical ripening in prolonged pregnancies. 122 pregnant women were recruited. Women were assigned to 25 µg sublingual misoprostol plus 40 mg isosorbide mononitrate or placebo. Statistical analysis was done using SPSS software (version 23) and

Topics: Administration, Intravaginal; Adult; Cervical Ripening; Drug Therapy, Combination; Female; Humans; Isosorbide Dinitrate; Labor, Induced; Misoprostol; Nitric Oxide Donors; Oxytocics; Pregnancy; Pregnancy, Prolonged; Treatment Outcome

The aim of this study was to compare the efficacy and safety of a low-dose protocol of vaginal misoprostol and vaginal dinoprostone insert for induction of labor in women with post-term pregnancies.. We designed a prospective, randomized, open-labeled trial with evaluators blinded to the end-point, including women of at least 41 weeks of gestational age with uncomplicated singleton pregnancies and a Bishop score <6. They were randomized into dinoprostone or misoprostol groups in a 1:1 ratio. Baseline maternal data and perinatal outcomes were recorded for statistical analysis. Successful vaginal delivery within 24 hours was the primary outcome variable. A P value <0.05 was considered statistically significant. This study was registered in ClinicalTrials.gov (number NTC03744364).. We included 198 women for analysis (99 women in each group). Vaginal birth rate within 24 hours did not differ between groups (49.5% vs 42.4%; P = 0.412). When the Bishop score was <4, dinoprostone insert showed a higher probability of vaginal delivery within 12 hours (17.8% vs 4%; P = 0.012). In the dinoprostone group, removal of the insert was more likely to be due to an adverse event (5.1% vs 14.1%; P = 0.051) and an abnormal fetal heart rate pattern during active labor (44.4% vs 58.6%; P = 0.047). Both groups were similar in neonatal outcomes including Apgar score, umbilical cord pH and neonatal intensive care unit admission.. Low-dose vaginal misoprostol and vaginal dinoprostone insert seem to be equally effective and safe for induction of labor in pregnant women with a gestational age beyond 41 weeks.

Topics: Administration, Intravaginal; Adult; Dinoprostone; Female; Humans; Labor, Induced; Misoprostol; Oxytocics; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Prospective Studies

We evaluated the effectiveness of oral misoprostol for outpatient cervical ripening and labor induction in prolonged pregnancies. We performed a randomized, double-blind, placebo-controlled study of women at 40 to 42 weeks' gestation with well-dated pregnancies, singleton gestations, Bishop scores less than 6, vertex presentations, and intact membranes. Subjects received either oral misoprostol 100 microg or placebo daily for 3 days unless the subject developed significant cervical change or began labor spontaneously. Study drug was repeated every 24 hours for a maximum of three doses if subjects did not develop significant cervical change or enter labor. Induction of labor was not allowed while the subject was enrolled in the study. Forty-three subjects were randomized to receive misoprostol and 44 randomized to receive placebo. A significant difference was noted in reduction of time from study entry to both active phase (p < 0.001) and delivery (p < 0.001) in the misoprostol group. Fewer women remained undelivered after the 72-hour study period in the misoprostol group. There were no differences in route of delivery or neonatal outcomes between groups.. Daily administration of oral misoprostol over 3 days to women with prolonged pregnancies shortened time intervals from dosing to entry into active labor and delivery compared with placebo.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Ambulatory Care; Cervical Ripening; Chi-Square Distribution; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fetal Monitoring; Follow-Up Studies; Humans; Labor, Induced; Misoprostol; Pilot Projects; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Probability; Reference Values; Risk Assessment; Treatment Outcome

To evaluate the effect and risk of misoprostol for stimulating cervical maturity in women with post-term pregnancy negative for insulin-like growth factor binding protein-1 (IGFBP-1) in cervical secretion with modified Bishop score less than 3.. Seventy-one women with post-term pregnancy randomized into misoprostol group (n=37) and control group (n=34) received misoprostol placement at the posterior vaginal fornix and routine intravenous oxytocin infusion, respectively, to stimulate cervical maturity. Failure to respond to the treatment within the initial 24 h necessitated a repeated administration for no more than 3 times in all. Modified Bishop score was recorded and fetal heart monitored once every 24 h, and IGFBP-1 in the cervical secretion was detected at 24 and 48 h after drug administration.. The misoprostol group showed better effect of cervical maturity stimulation than the control group (P<0.001), and the positivity rates of IGFBP-1 24 and 48 h after drug administration were significantly higher than that of the control group (P<0.01 and 0.001). The number of cases with indication for cesarean section was significant higher in the control group (P<0.001). There were no significant differences in postpartum hemorrhage, excessive uterine contraction, incidence of fecal contamination of the amniotic fluid or Apgar score of the newborn between the two groups (P>0.05).. Misoprostol is safe and effective for stimulating cervical maturity in women with post-term pregnancy who have modified Bishop score lower than 3 and are negative for IGPBF-1 in cervical secretion. Oxytocin is not advised for use in such gravida for stimulating cervical maturity. IGFBP-1 in cervical secretion may serve as an important index for evaluating the cervical maturity.

Topics: Abortifacient Agents, Nonsteroidal; Administration, Intravaginal; Adult; Cervical Ripening; Cervix Uteri; Female; Heart Rate, Fetal; Humans; Insulin-Like Growth Factor Binding Protein 1; Misoprostol; Pregnancy; Pregnancy, Prolonged; Treatment Outcome

Within the obstetric community, several studies suggest that cervical ripening and labor induction after 40 weeks' gestation leads to improved maternal and neonatal outcomes. The most effective drug regimen to safely promote labor has not been determined.. Forty-nine subjects followed in an outpatient obstetrical clinic with pregnancies of at least 40 weeks' gestation, and an unfavorable Bishop score were assigned randomly to receive oral misoprostol 50 or 25 microg every 3 days for a maximum of three doses.. Twenty-three subjects received misoprostol 25 microg and 26 received 50 microg. The mean interval (+/-standard deviation) from start of cervical ripening to delivery was 2.4 days +/-0.3 vs. 3.9 days +/-0.7 for the 50 and 25 microg groups (P<0.05). No adverse events were noted. However, due to small sample size, less frequent adverse events may be missed. Type II errors cannot be excluded.. In the prevention of postdate pregnancy, outpatients use of oral misoprostol 50 microg appears to result in earlier delivery, as compared to 25 microg.

Topics: Adult; Ambulatory Care; Cervical Ripening; Dose-Response Relationship, Drug; Female; Humans; Misoprostol; Oxytocics; Pregnancy; Pregnancy, Prolonged

To compare the efficacy of low dose vaginal misoprostol and dinoprostone vaginal gel for induction of labour at term.. A single-blind randomised controlled trial.. Antenatal and labour ward of a UK district general hospital.. Two hundred and sixty-eight women requiring induction of labour at term (>37 weeks of gestation) with no significant fetal or medical condition, no previous uterine surgery and no contraindication to prostaglandin.. Misoprostol 25 microg (one-quarter of a 100 microg tablet) was inserted into the posterior vaginal fornix every 4 hours (to a maximum of six doses) or dinoprostone vaginal gel 1-2 mg 6 hourly (maximum of 3 mg in 24 hours).. Induction-to-vaginal delivery interval.. Requirements for oxytocin, mode of delivery, number of women delivering < 24 hours, incidence of uterine contraction abnormalities, incidence of abnormal cardiotocograph (CTG) recordings, 5-minute Apgar scores, umbilical cord pH recordings, analgesia requirements, admission to NICU and blood loss at delivery.. There were no significant differences between the two groups in induction-to-vaginal delivery interval, mode of delivery, number of women delivering within 24 hours and neonatal outcomes. The incidence of uterine contraction abnormalities (tachysystole and hyperstimulation) and the incidence of abnormal CTG recordings were also similar for both groups.. Low dose vaginal misoprostol is as effective as dinoprostone gel for inducing labour at term. There would be substantial cost savings, estimated at around 3.9 million UK pounds per annum, for maternity services if low dose misoprostol became the agent of choice for inducing labour in the UK.

Topics: Administration, Intravaginal; Delivery, Obstetric; Dinoprostone; Female; Humans; Labor, Induced; Misoprostol; Oxytocics; Pregnancy; Pregnancy, Prolonged; Single-Blind Method; Vaginal Creams, Foams, and Jellies

Interventions that may help shorten the duration of pregnancy in an African setting where facilities for fetal monitoring in post-term pregnancy are limited, and induction is not without its hazards, are needed.. To determine whether outpatient administration of intravaginal misoprostol safely decreases the interval to delivery in postdate pregnancies.. Open randomized controlled trial.. Zonal district hospitals, Kwale, Southern Nigeria (August 2000 to October 2001).. Seventy-seven women were randomized at 40 weeks gestation to receive either 25 microg misoprostol intravaginally (38) or gentle cervical assessment only (39) on an outpatient basis. Subjects were then allowed to go into spontaneous labor unless an indication for induction developed.. Interval to delivery, duration of labor, and incidence of side-effects.. Misoprostol was associated with significant decrease in mean time to delivery (4.5 +/- 4.1 versus 7.4 +/- 5.2 days; P = 0.008), earlier gestational age at delivery (40.6 +/- 0.6 versus 41.4 +/- 0.05 weeks; P < 0.001) and shorter duration of active labor (6.1 +/- 4.0 versus 8.2 +/- 5.3 h; P = 0.028), without any significant increase in fetal distress, low Apgar score at delivery or other side-effects.. Outpatient administration of low-dose misoprostol can safely shorten the length of gestation in postdate pregnancies.

Topics: Administration, Intravaginal; Adult; Ambulatory Care; Cervical Ripening; Chi-Square Distribution; Female; Gestational Age; Humans; Misoprostol; Oxytocics; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Statistics, Nonparametric

The purpose of this study was to compare the safety and efficacy of misoprostol and dinoprostone in pregnancies at high risk of fetal distress.. Medical indications for the induction of labor with postdate pregnancy or intrauterine growth restriction were randomized. A sequential design that was based on the triangular test was used.. At the fourth interim analysis, which included 140 patients, the trial was stopped because no significant difference was found in neonatal safety between misoprostol and dinoprostone, which was assessed on arterial cord pH <7.20 (14.3% vs 10.0%, respectively; P=.60). Neonatal tolerance was similar in the 2 groups, with no difference in the cesarean delivery rate for fetal distress or in the incidence of meconium-stained amniotic fluid. Time to vaginal delivery was shortened by misoprostol (P=.03).. Misoprostol and dinoprostone are equally safe for the induction of labor in pregnancies that are at high risk of fetal distress; however, misoprostol allowed the earlier induction of labor than did dinoprostone.

Topics: Administration, Intravaginal; Adult; Cesarean Section; Dinoprostone; Female; Fetal Distress; Fetal Growth Retardation; Humans; Labor, Induced; Misoprostol; Oxytocics; Pregnancy; Pregnancy, High-Risk; Pregnancy, Prolonged

To compare the effect of misoprostol (PGE(1)) versus dinoprostone (PGE(2)) on blood flow in uteroplacental circulation during labor induction.. Eighty-four women with indications for induction of labor were assigned to receive either misoprostol 50 microg per vagina every 4 h as needed or 0.5 mg doses of dinoprostone given intra-cervically every 6 h by means of a randomization table generated by computer. Doppler velocimetry of umbilical, uterine and arcuate arteries was performed immediately before and 2-3 h after the administration of misoprostol or dinoprostone. The SAS system was used to perform statistical analysis.. There were no significant changes of pulsatility index (PI), resistance index (RI) and systolic/diastolic (S/D) ratio in umbilical arteries after both prostaglandin compounds. Vaginal application of misoprostol significantly increased all ratios in arcuate artery and S/D ratio in uterine artery. Intra-cervically dinoprostone significantly increased PI, RI and S/D ratio in arcuate and uterine arteries.. Our results indicate that vaginal misoprostol and cervical dinoprostone administration increases uteroplacental resistance but does not affect umbilical blood flow. Misoprostol would be as safe and effective agent as dinoprostone for cervical ripening and labor induction.

Topics: Blood Flow Velocity; Dinoprostone; Female; Fetus; Hemodynamics; Humans; Labor, Induced; Misoprostol; Oxytocics; Placental Circulation; Pregnancy; Pregnancy, Prolonged; Pulsatile Flow; Regional Blood Flow; Ultrasonography; Uterus; Vascular Resistance

To compare the safety and efficacy of misoprostol with that of dinoprostone for the induction of labour at term, or near term.. Three hundred and ninety-six women with term pregnancies were randomised to receive either oral or vaginal misoprostol, or dinoprostone. Women who had had a previous caesarean section (CS) or those with a malpresentation or who were parity > or = 5, were excluded. The control group received dinoprostone 1 mg inserted in the posterior fornix and repeated 6-hourly to a maximum of three doses. The study group received either oral misoprostol 20 micrograms 2-hourly to a maximum of four doses (80 micrograms), or vaginal misoprostol 25 micrograms in the posterior fornix with a switch to the oral misoprostol regimen if there was no change in the Bishop's score or no palpable uterine contractions.. There was no significant difference in vaginal delivery rate within 24 hours between the groups (58.1% v. 58%, p = 0.633). There were no significant differences in CS rates between the groups; however, more CSs were performed for fetal distress in the misoprostol group than in the dinoprostone group (28% v. 25%). There was a significantly higher incidence of hyperstimulation in the vaginal misoprostol group (21.4%) than in the other two groups (oral misoprostol 16.5%, dinoprostone 8.9%) (p = 0.004). The incidence of meconium staining of liquor was comparable between the groups.. In selected women, the efficacy of misoprostol for the induction of labour at term is similar to that of dinoprostone but misoprostol is associated with a higher incidence of hyperstimulation.

Topics: Adult; Cervical Ripening; Delivery, Obstetric; Dinoprostone; Female; Humans; Infant, Newborn; Misoprostol; Obstetric Labor Complications; Oxytocics; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Prospective Studies; Treatment Outcome

Misoprostol, a synthetic E1 methyl analog prostaglandin, is at present receiving attention as a cervical modifier and labor induction agent. However, there is still a need for better determination of its safety and effectiveness.. To compare intravaginal misoprostol versus intravenous oxytocin for cervical ripening and labor induction in pregnant women with unripe cervices.. Randomized controlled trial.. The study was performed at the Leonor Mendes de Barros Maternity Hospital between November 1998 and December 2000.. 210 pregnant women with intact membranes and indication for labor induction were selected.. The women randomly received 25 g of vaginal misoprostol every 4 hours, not exceeding 8 doses (105 women), or oxytocin in a continuous infusion (105 women).. The main parameters measured were: latent period, time from induction to vaginal delivery, delivery route, occurrence of vaginal delivery with time, occurrence of uterine tonus alterations, hypoxia and neonatal morbidity. To verify the statistical significance of the differences between the groups, the chi-squared, Student t and log-rank tests were used.. There were no significant differences between the groups concerning conditions for labor induction, age, parity, race, marital status, family income, initial Bishop Index and number of prenatal visits. The cesarean section rate, latent period and period from induction to vaginal delivery were significantly lower for the misoprostol group. With regard to uterine tonus alterations, tachysystole was significantly more common in the misoprostol group. However, there was no difference in hypoxia and neonatal morbidity between the groups.. 25 g of misoprostol used vaginally every 4 hours is safer and more efficient for cervical ripening and labor induction than oxytocin.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Cervical Ripening; Female; Humans; Labor, Induced; Misoprostol; Oxytocin; Pregnancy; Pregnancy, Prolonged; Reaction Time; Treatment Outcome

To compare the effect of mifepristone with placebo on cervical ripening before labor induction in prolonged pregnancies.. One hundred eighty women with pregnancies beyond 41 weeks and undilated, uneffaced cervices were assigned randomly to receive mifepristone 200 mg or placebo and observed for 24 hours. We then gave intravaginal misoprostol 25 microg every 4 hours or intravenous oxytocin. We expected 60% of placebo-treated and 80% of mifepristone-treated women to deliver vaginally within 48 hours.. Among 180 subjects, 97 received mifepristone and 83 received placebo. The mean interval (+/- standard deviation [SD]) from start of induction to delivery was 2209 +/- 698 minutes for mifepristone-treated subjects and 2671 +/- 884 minutes for placebo-treated subjects (P <.001, log-transformed data). Twelve (13. 6%) mifepristone-treated women and seven (10.8%) placebo-treated women delivered vaginally on day 1 (P =.60). After 24 hours, the median Bishop score for both groups was 3 (0-11) (P =.51). One hundred thirty-one subjects required misoprostol, 65 (67.0%) were mifepristone-treated women, and 66 (79.5%) placebo-treated women (P =.06). The median (range) oxytocin dose was 871.5 (0-22,174) mU for mifepristone-treated women and 2021.0 (0-24,750) mU for placebo-treated women (P =.02). Seventy-seven (87.5%) mifepristone-treated women and 46 (70.8%) placebo-treated women delivered vaginally 48 hours after the start of treatment (P =.01). There were nine cesareans in the mifepristone group and 18 in the placebo group (P =.02). More nonreassuring fetal heart rate patterns and uterine contractile abnormalities occurred in mifepristone-treated subjects. There were no statistically significant differences in neonatal outcomes between groups.. Mifepristone had a modest effect on cervical ripening when given 24 hours before labor induction, appearing to reduce the need for misoprostol and oxytocin compared with placebo.

Topics: Adult; Cervical Ripening; Cesarean Section; Double-Blind Method; Female; Humans; Labor, Induced; Mifepristone; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy, Prolonged

To compare the effect of misoprostol vs. oxytocin on blood flow in uteroplacental circulation during labor induction.. Ninety-one women with indications for induction of labor were assigned to receive either misoprostol 50 microg per vagina every 4 h as needed or intravenous oxytocin by means of a randomization table generated by computer. Doppler velocimetry of umbilical, uterine and arcuate arteries was performed immediately before and 2-3 h after administration of misoprostol or oxytocin. Pulsatility index (PI), resistance index (RI) and systolic/diastolic (S/D) ratios were measured for these arteries. The SAS system was used to perform statistical analysis.. There were no significant changes of PI, RI and S/D ratios in umbilical arteries during misoprostol and oxytocin inductions. Vaginal application of misoprostol significantly increased PI, RI and S/D ratios in arcuate arteries and S/D ratio in uterine arteries.. Our results indicate that intravaginal misoprostol administration increases uteroplacental resistance but probably does not substantially affect placental perfusion.

Topics: Administration, Intravaginal; Female; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Placental Circulation; Pregnancy; Pregnancy, Prolonged; Pulsatile Flow; Regional Blood Flow; Vascular Resistance

Dinoprostone, is presently used in our standard protocol for cervical ripening and labour induction. In search for a cheaper alternative, misoprostol has been found to be a good substitute. In view of the potential saving it might offer, we set out to test its efficacy against the standard dinoprostone.. A randomised double-blind study involving 50 pregnant women with prolonged pregnancy, treated at a government hospital in Malaysia, was carried out. Two hundred micrograms of intravaginal misoprostol were compared with 3 mg of dinoprostone in each treatment arm.. In the misoprostol group, labour was successfully established in 92% of cases compared to 64% in the dinoprostone group (p = 0.04). The induction-delivery interval was shorter with more women delivering within 12 hours (72% vs 28%, p = 0.047). Maternal and neonatal complications, mode of delivery, the need for oxytocin and pethidine were quite similar statistically. Polysystole was more frequent (28% vs 12%, p = 0.28) in the misoprostol group but it was not associated with fetal distress.. The study showed that misoprostol was a more effective drug in labour induction.

Topics: Administration, Topical; Adult; Cervix Uteri; Dinoprostone; Double-Blind Method; Female; Humans; Labor, Induced; Misoprostol; Oxytocics; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Treatment Outcome; Vagina

The efficacy of oxytocin for induction of labor at 41 to 42 weeks of gestational age, was compared with misoprostol (a PGE1 analog) in 100 pregnant women. Half a tablet containing 100 mcg of misoprostol was placed intravaginally in 50 women and the remaining 50 received iv oxytocin (2-32 mU/min). The obstetric features were similar in both groups. Delivery within 24 hours was achieved in 88% of the patients induced with misoprostol and in 72% with oxytocin (p < 0.05). The mean time from induction to delivery was similar, 10.3-10.9 hrs (p NS) and no differences in obstetric and perinatal outcomes were found. Polisystoly with misoprostol, was the only side effect observed in the study (11.4%), and was without neonatal consequences.. intravaginal misoprostol (100 mcg), is more effective, cheaper and less stressful than IVI oxytocin in post term inductions. The safety profiles of both were similar.

Topics: Abortifacient Agents, Nonsteroidal; Administration, Intravaginal; Adult; Female; Humans; Infusions, Intravenous; Labor, Induced; Misoprostol; Oxytocin; Pregnancy; Pregnancy, Prolonged; Uterine Contraction

The aim of our study was to evaluate the efficacy and safety of oral mifepristone use for cervical ripening and the initiation of labor in women with normal pregnancies at or beyond term.. We conducted a monocentric, prospective, comparative study on the induction of labor in women with an unfavorable cervix after 37 or more weeks of gestation in the Franck Joly Hospital, French Guiana. The immediate induction of labor by mifepristone was compared to expectant management and the induction of labor with routine cervical ripening agents during two consecutive periods. During the first period, patients received mifepristone (600 mg orally at the moment of enrollment) and were evaluated after 48 h. In the second period, patients did not receive any drugs and were evaluated after 48 h of expectant management.. Spontaneous labor or a Bishop Score ≥6 within 48 h of mifepristone administration.. enrollment-induction to delivery interval, rate of failed induction, doses of prostaglandin used, mode of delivery, requirement of oxytocin augmentation, and neonatal outcomes.. This study enrolled 231 women, 108 in the first and 123 in the second period undergoing induced labor at term caused by various obstetric conditions. There were no significant differences between groups for age, body mass index, gravida, parity, the initial Bishop Score, scarred uterus, or post-term pregnancy. There were statistically significant differences between the two groups concerning spontaneous labor and/ or a Bishop Score ≥6 within 48 h (p < 10-3) and received doses of misoprostol (p = 0.01). Patients receiving mifepristone were 10 times more likely to be in labor after 48 h of inclusion (RR = 9.98, CI 95 % = [4.47-22.29]). The enrollment-induction to delivery interval was significantly shorter for the mifepristone group (p < 0.001). There were no other differences in mode of delivery, placenta abnormalities or neonatal outcomes.. Mifepristone efficiently induced cervical ripening and labor initiation in women with normal pregnancies at or beyond term. It may offer an alternative method to the classic induction especially for patients seeking spontaneous labor.

Topics: Administration, Oral; Adult; Case-Control Studies; Cervical Ripening; Female; Humans; Labor, Induced; Misoprostol; Oxytocics; Pregnancy; Pregnancy, Prolonged; Prospective Studies

To test the hypothesis that there is a higher rate of unsuccessful induction of labor (IOL) in post-term obese pregnant women compared to non-obese ones.. In this prospective cohort study, 144 obese (BMI > 30) and 144 non-obese (BMI < 29.9) post-term (> 41 weeks) pregnant women were recruited. IOL was done by misoprostol or amniotomy and oxytocin infusion according to the Bishop score. Comparison of percentage of failed IOL in both groups (primary outcome) was performed by the Chi-test. Logistic regression and multivariable regression were performed to assess the odds ratio (OR) of cesarean section (CS) and coefficient of delay in labor till vaginal delivery (VD) in obese versus (vs) non-obese groups. Adjustment for gestational age, parity, Bishop Score, membrane rupture and amniotic fluid index was done in both regression analyses.. CS rate was significantly higher in obese group [26.4 vs 15.9%; difference in proportion (95% CI) 0.1 (0.01, 0.19); P value 0.02]. 106 (73.6%) obese women and 121 (84.1%) non-obese women delivered vaginally. In addition, the duration till VD was significantly higher in obese group (22 vs 19 h, P value 0.01). After adjustment for possible confounding factors, the CS was still higher in the obese group in comparison to non-obese group (OR 2.02; 95% CI 1.1, 3.7; P value 0.02). This finding suggested that obesity was an independent factor for failure of IOL. In addition, after adjustment for these confounders, obesity had the risk of increasing labor duration by 2.3 h (95% CI 0.1, 4.5) in cases that ended in VD.. Based on our results, we conclude that there is a higher risk of CS in obese postdate pregnant women undergoing IOL in comparison to non-obese counterparts. Therefore, obstetricians should pay more attention to advising pregnant women about optimal weight gain during pregnancy and counseling about the chances of VD in cases of IOL. CLINCALTRIAL.. NCT02788305.

Topics: Adult; Amnion; Cesarean Section; Female; Gestational Age; Humans; Labor, Induced; Misoprostol; Obesity; Oxytocin; Parity; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Prospective Studies; Young Adult

To evaluate the effectiveness and safety of 25 mcg sublingual misoprostol for induction of Labor at term according to parity and membrane integrity.. We conducted a prospective observational study on singleton pregnancies undergoing induction of Labor at term. Twenty-five mcg of misoprostol were administered sublingually every 4 h. Main outcomes were vaginal deliveries within 24 h, time-to-vaginal-delivery, hyper-stimulation syndrome, cesarean section rate, arterial pH< 7.0 and NICU admission rate.. We studied 508 patients, 375 nulliparous and 133 multiparous women. Sixty-five percent and 78%, respectively, delivered vaginally within 24 h from first administration. Median time-to-vaginal-delivery was significantly shorter in PROM than in women with intact membranes (p < 0.001). Epidural analgesia prolonged time-to-vaginal-delivery among nulliparous women (p < 0.0005). A positive correlation between BMI and time to delivery was observed in both nulliparous and multiparous women (p < 0.05). Cesarean section rate was 22% in nulliparous and 6% in multiparous group. Induction failure was 1.4% and uterine hyper-stimulation 1%. No pH≤ 7.00 was recorded; overall 7 (1.4%) newborns were admitted to NICU.. Sublingually administered misoprostol is an effective and safe method for induction of Labor at term. Parity, status of membranes and BMI significantly affect time to delivery.

Topics: Administration, Sublingual; Adult; Amnion; Body Mass Index; Cesarean Section; Female; Humans; Labor, Induced; Labor, Obstetric; Misoprostol; Oxytocics; Parity; Pregnancy; Pregnancy, Prolonged; Prospective Studies; Term Birth; Time Factors

Topics: Anaphylaxis; Cervical Ripening; Cesarean Section; Female; Humans; Isosorbide Dinitrate; Labor, Induced; Misoprostol; Nitric Oxide Donors; Oxytocics; Pregnancy; Pregnancy, Prolonged

Topics: Anaphylaxis; Cervical Ripening; Cesarean Section; Female; Humans; Isosorbide Dinitrate; Labor, Induced; Misoprostol; Nitric Oxide Donors; Oxytocics; Pregnancy; Pregnancy, Prolonged

A 32-year-old woman had labour induced (25 + 25 microgram misoprostol vaginally) at 291 days gestation for post-term pregnancy. A cardiotocography (CTG) showed normal conditions. The woman went home to await regular contractions in line with hospital policy. She awoke at 3.15 a.m. with abdominal pain and came to the labour ward at 3.45 a.m. with less pain but a desire to push. The cervix was dilated but the foetal head sat high in the pelvis. Internal CTG showed a pre-terminal pattern. A girl was born at 4.27 a.m. She had hypoxic-ischaemic encephalopathy (APGAR at 1, 5 and 10 min.: 1, 3, 3; umbilical cord arterial blood pH 6.71, base excess -19.9 mmol/l). At the age of three years she had severe cerebral palsy.

Topics: Adult; Cerebral Palsy; Female; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Labor, Induced; Misoprostol; Obstetric Labor Complications; Oxytocics; Pregnancy; Pregnancy, Prolonged

To compare the outcome of induced labor at term using sequential intracervical Foley catheter with intravaginal misoprostol versus intravaginal misoprostol alone.. A prospective matched case control study among parturient with prolonged pregnancy and unfavorable cervix at a tertiary hospital in Nigeria.. The study population was 100 with a mean age of 29.46 ± 3.88 years. Parturient with prior cervical priming using intracervical Foley catheter had significantly lower oxytocin augmentation of uterine contractions in labor (44 vs. 64%, P = 0.045), shorter mean insertion to active phase labor duration (233 ± 98 vs. 354 ± 154 min, P = 0.0001), shorter insertion to delivery interval (514 ± 175 vs. 627 ± 268, P = 0.014), more vaginal delivery <12 h (92.5 vs. 60%, P = 0.001) and less delivery by caesarean section (20 vs. 40%, P = 0.029).. The sequential combination of intracervical Foley catheter and intravaginal misoprostol for cervical ripening and induction of labor appears to be a safe and more effective method compared to intravaginal misoprostol in parturient at term with unfavorable cervices.

Topics: Administration, Intravaginal; Adult; Case-Control Studies; Catheterization; Cervical Ripening; Cervix Uteri; Female; Humans; Labor, Induced; Misoprostol; Oxytocics; Pregnancy; Pregnancy, Prolonged; Prospective Studies; Term Birth

To differentiate the effect of gestation on the mode of delivery by analysing the difference in the mode of induction, length of labour and the difference in parity or Bishop score and their effect on the mode of delivery of postdates women.. A cross-sectional observational study.. PAEC General Hospital, Islamabad, from July 2006 to July 2008.. Patients were induced at 41 weeks (Group B) and > 40 weeks (Group A) of gestation. Tab misoprostol and PGE2 tablets were administered according to amniotic fluid index (AFI) and parity. Study variables included duration of gestation, mode of induction, length of labour, difference in parity and Bishop score assessed before induction in each group. The outcome was assessed by applying Chi-square test by comparing mode of delivery with the study variables in both groups.. A total of 78 patients were inducted in the study. They were divided in group B (n = 39) induced 41 weeks and group A (n = 39) induced at 40 weeks. Eighty four percent (n = 35) patients in group B delivered vaginally as compared to 71% (n = 28) in the 40 weeks group (p < 0.0001). The higher number of vaginal deliveries in 41 weeks group was independent of association between the induction agent, parity and mode of delivery.. The mean length of gestation was the single most important factor among the studied variables in predicting a vaginal delivery.

Topics: Administration, Oral; Adult; Amniotic Fluid; Cervical Ripening; Cross-Sectional Studies; Delivery, Obstetric; Dinoprostone; Female; Gestational Age; Humans; Labor, Induced; Misoprostol; Oxytocics; Parity; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy, Prolonged; Young Adult

Topics: Ambulatory Care; Cervical Ripening; Contraindications; Female; Humans; Misoprostol; Oxytocics; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged

It is generally believed that postpartum blood loss is less in patients whose labour is induced with prostaglandins than in patients delivered without induction. However, postpartum blood loss is known to be greater with precipitate labour and labours induced with oxytocin and prostaglandins, unless an oxytocic agent is continued after delivery. A retrospective study was undertaken at the University Hospital of the West Indies to look at the outcome of induced labour during 3 months, October-December 1998. Misoprostol induction was compared to the outcome after oxytocin induction, misoprostol induction plus oxytocin augmentation and those patients who delivered without oxytocics during this same time period. During that period, 524 patients were delivered and 51 (9.7%) were induced with misoprostol, 174 (33.2%) with oxytocin, 21 (4%) misoprostol plus oxytocin and 271 (51.7%) without oxytocic. Seven patients were eliminated from further analysis, as we were unsure of their induction status. Results showed no significant differences between the groups for variables such as maternal age, parity and fetal birth weight. There was a significantly greater mean blood loss at delivery with all induced labour compared with those not induced. For misoprostol 162.5(SD 190) ml, oxytocin (150 (SD 100) ml and for oxytocin plus misoprostol 150 (SD 150) ml, while controls had the lowest mean blood loss 100 (SD 130) ml occurring where no predelivery oxytocic was needed (P<0.03). Postpartum haemorrhage was highest with misoprostol 5.8% versus 4.4% for no oxytocic, 1.1% for oxytocin and 0% for misoprostol plus oxytocin. However, none of these values reached statistical significance. The misoprostol group also had the shortest first stage, 333 minutes versus 557 minutes for oxytocin, 576 minutes when both misoprostol and oxytocin was used and 344 minutes with no oxytocic. Blood loss was also independently directly associated with placental weight (P=0.01) and fetal birth weight (P=0.03), as well as the length of the third stage of labour (P=0.01), but not the length of the first stage of labour. Induction of labour with oxytocic agents is associated with greater blood loss. However, increased blood loss is not due to precipitate labour alone.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Age Distribution; Case-Control Studies; Female; Follow-Up Studies; Gestational Age; Humans; Incidence; Labor Stage, Third; Labor, Induced; Misoprostol; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy, Prolonged; Probability; Reference Values; Retrospective Studies; Risk Assessment; Severity of Illness Index

To compare labour induction intervals between vaginal misoprostol and intravenous oxytocin as well as side effects of induction in post term pregnancies with intact membranes.. One hundred women were retrospectively selected to two groups treated with vaginal misoprostol 50 micrograms every 12 hours as needed to maximum 150 micrograms and treated with intravenous oxytocin. The primary outcome measure was time from induction to vaginal delivery. Statistical analysis was performed by t-Student test.. Maternal age, parity, gestation were similar. There was a statistically important difference in labour induction intervals between the two groups. The mean time +/- SD to vaginal delivery in misoprostol group was 20.6 +/- 15.2 hours compared with 11.23 +/- 7.4 hours with oxytocin (p = 0.0396). Induction of labour failed in 12% and 32% in misoprostol and oxytocin treated group. Pethidine consumption in oxytocin treated group was higher (41 mg vs 89 mg, p = 0.04). Episodes of vomiting were more frequent in misoprostol treated group (22% vs 6%). There were no episodes of uterine hyperstimulation in both groups.. Oxytocin stimulation resulted in a shorter induction to delivery interval. In misoprostol group induction failed in only 12% whereas in oxytocin group in 32%. There were no serious side effects in both groups. In misoprostol treated group patients required less analgetics then in oxytocin treated group.

Topics: Adult; Female; Humans; Infant, Newborn; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Retrospective Studies; Time Factors

16 women with prolonged pregnancy and indications to induction of labour were involved into prospective analysis. Sixty of them were given 50 micrograms of Mizoprostol straight into posterior vaginal fornix (only once). In 56 women the labour was induced by intravenous administration of 5 IU Oxytocin. Effectiveness and safety of both preparations used in labour induction were compared. Non-significant higher effectiveness and significant faster induction of uterine contractions by Oxytocin was found. Mizoprostol administration significantly shortens duration of the first labour period. Eventually, time from the medicine administration until the labour in both groups was comparative.

Topics: Administration, Intravaginal; Adult; Female; Humans; Infusions, Intravenous; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Prospective Studies; Uterine Contraction

Safety and effectiveness testing of Misoprostol use at prolonged pregnancies.. Prospective, clinical study.. 50 pregnant women with prolonged pregnancy, monocyesis, cephalic longitudinal foetus lie, existing foetal membranes and lack of spontaneous delivery action. Women were given 50 micrograms Misoprostol (Cytotec) to posterior vaginal fornix in case to provoke delivery. Effectiveness of inducing, delivery lasting, way of its finishing and infant condition at birth were controlled. Results were matched with control group of 35 patients with physiological pregnancy, who delivered in spontaneous partus.. Effective provocation was observed at 38 pregnant. Natural way delivery was observed at 40 patients. In 10 cases caesarean section was done. Lasting time of birth, way of finishing, infant condition at birth and number of complication do not differ statistically between examined and control group.. Misoprostol can be effective and save of delivery induction in prolonged pregnancy.

Topics: Adult; Female; Humans; Labor, Induced; Misoprostol; Oxytocics; Pregnancy; Pregnancy, Prolonged

Topics: Female; Humans; Labor, Induced; Misoprostol; Oxytocics; Pregnancy; Pregnancy, Prolonged