Induction of labour using prostaglandin E2 pessaries.

Shepherd, John H.; Pearce, J. M.; Sims, C. D.

doi:10.1136/bmj.2.6182.108

Cited by 67 publications

(7 citation statements)

References 10 publications

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“…The condition of the cervix before induction has long been recognized as the single most important prognostic feature determining the outcome of induced labour (Turnbull & Anderson 1968). Although failed induction of labour is seen less frequently since the introduction of prostaglandins to ripen the cervix, the need for caesarean delivery remains increased for women with a low Bishop score (Shepherd et al 1979). Our observations indicate that sonographic estimates of fetal size may provide useful prognostic information about the prospects of vaginal delivery irrespective of the Bishop score: the majority of forceps or caesarean births for failure to progress were carried out for babies with an abdominal circumference >340 mm.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of fetal ultrasonography before induction of labour

Saunders

Amis

Marsh

1992

BJOG

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Objective To investigate whether ultrasound examination of the fetus and amniotic fluid before induction of labour can provide useful prognostic information about the course of labour and mode of delivery. Design A prospective observational study. Setting The delivery suite of St Mary's Hospital, London. Subjects 101 women undergoing induction of labour. Measured variables Biparietal diameter, head circumference, abdominal circumference, occipital position, amniotic fluid volume and umbilical artery Doppler velocimetry waveforms. Main outcome measures The outcome of labour was assessed in terms of the induction delivery interval, the mode of delivery and the incidence of abnormal cardiotocograms in labour. Results Seven women were delivered by emergency caesarean section early in the first stage of labour because of a significant abnormality of the fetal heart trace and these pregnancies were characterized by small fetal abdominal circumference measurements. Marked oligohydramnios was also noted in five of these seven subjects. Small or average size babies who were surrounded by an adequate volume of amniotic fluid tended to be born spontaneously, whereas the majority of operative deliveries for failure to progress in labour were associated with fetal abdominal circumference measurements ≥340 mm. The mean Bishop score of women before labour who delivered spontaneously was not significantly different from the scores of women who had a forceps delivery or caesarean section. Abnormal cord Doppler waveforms were observed in only one instance. Conclusions In women undergoing induction of labour, the measurement by ultrasonography of two variables (fetal abdominal circumference and amniotic fluid volume) may allow the prospective identification of pregnancies at increased risk of fetal distress or dystocia. If these findings can be replicated in early spontaneous labour than more rational utilization of resources may be possible in hospital based obstetric practice.

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Section: Discussionmentioning

confidence: 99%

The prognostic value of fetal ultrasonography before induction of labour

Saunders

Amis

Marsh

1992

BJOG

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“…A considerable proportion of cases could have been managed by antenatal monitoring until spontaneous labour occurred or the cervix became more favourable for induction. If the indication warrants early induction, the cervix could be ripened prior to induction by intravaginal prostaglandin Ez gel (9) or induction of labour undertaken with vaginal prostaglandin Ez pessaries which has been reported to have reduced the Caesarean section rate for failed induction of labour (10). However adverse outcome has been reported (11).…”

Section: Discussionmentioning

confidence: 99%

Failed Induction of Labour

Arulkumaran

Gibb

TambyRaja

et al. 1985

Aust NZ J Obst Gynaeco

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Over a 15-month period 1,057 consecutive inductions of labour were performed representing a 10% induction rate; 174 (16.5%) of these patients were delivered by Caesarean section of which 74 (7.0%) were for failed induction of labour, 58 (5.5%) for fetal distress, 19 (1.8%) for cephalopelvic disproportion, 6 for malposition and 17 for other reasons. The mean cervical score at induction of labour was 5.7 and 5.5 for cephalopelvic disproportion (CPD) and malposition respectively but was 4.0 for failed induction. The mean cervical dilatation at the time of Caesarean section was 5.7 cm and 6.6 cm for CPD and malposition respectively whereas it was 3.5 cm for failed induction. Mean maximum dose of oxytocin was 19.2 milliunits per minute (mu/min) and 22.5 mu/min for CPD and malposition respectively whereas it was 24.7 mu/min for cases of failed induction. Nulliparas with a cervical score of 3 or less had a 65.4% Caesarean section rate of which more than two-thirds were for failed induction of labour. Analysis of indications for induction of labour revealed that a fair number of inductions had debatable obstetric indications. Tailoring induction of labour to the cervical score and indication might reduce the Caesarean section rate for failed induction of labour. Rational management to ensure an adequate dose of oxytocin and sufficient time in the first stage of labour is important. Failed induction of labour may be differentiated from failure of labour progress due to CPD or malposition.

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“…During the 24 h after starting treatment, another 7 nulliparous and 1 multiparous women gave birth. Furthermore, another 5 nulliparous had a favorable cervix and were delivered within 12 h after the start of intravenous infusion of (2)(3)(4)(5)(6)(7)(8)(9) Undelivered 36 h after start of treatment (failures) 0 2 oxytocin. The remaining 5 nulliparae and 10 multiparae all had a n unfavorable cervix and were given another PGE, suppository and all but 2 multiparous women were delivered within 12 h. These 2 latter patients wereconsidered as failures and delivered by cesarean section.…”

Section: Resultsmentioning

confidence: 99%

Cervical priming and labor induction with vaginal application of 3 mg Pge₂ in suppositories in term pregnant women with premature rupture of amniotic membranes and unfavorable cervix

Granström

Ekman

Ulmsten

1987

Acta Obstet Gynecol Scand

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Sixty-one term pregnant women, 29 nulliparous (Group A) and 32 multiparous (Group B) with unfavorable cervix and premature rupture of the membranes (PROM) were given 3 mg PGE2 in suppository form for cervical ripening and labor induction. Five hours after starting the treatment, 12 women of the 29 in Group A and 21 of the 31 in Group B had a favorable cervix and established labor. The remaining 17 nulliparae and 11 multiparae still had an unfavorable cervix and were then given another PGE2 suppository. Until the next morning, i.e. within 24 h, 19 nulliparous and 22 multiparous women gave birth whereas a further 5 nulliparous women who now had favorable cervix but no uterine contractions were delivered after stimulation with intravenous oxytocin. The remaining undelivered women were given another PGE2 suppository. With or without additional oxytocin stimulation, all but 2 multiparous women could be delivered within a further 12 hours. The total number of instrumental deliveries in Group A was 2 caesarean sections due to disproportion (7%) and 5 ventouses. In Group B, 3 caesarean sections (9%) had to be carried out, one due to fetal distress and 2 due to failed induction. From the results of this study we conclude that vaginal application of 3 mg PGE2 in suppository form can be used to induce labor in patients with PROM and unripe cervix. However, when the results are compared with those obtained in previous studies after application of PGE2 in gel, the latter technique seems preferable.

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Induction of labour using prostaglandin E2 pessaries.

Cited by 67 publications

References 10 publications

The prognostic value of fetal ultrasonography before induction of labour

The prognostic value of fetal ultrasonography before induction of labour

Failed Induction of Labour

Cervical priming and labor induction with vaginal application of 3 mg Pge₂ in suppositories in term pregnant women with premature rupture of amniotic membranes and unfavorable cervix

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Induction of labour using prostaglandin E2 pessaries.

Cited by 67 publications

References 10 publications

The prognostic value of fetal ultrasonography before induction of labour

The prognostic value of fetal ultrasonography before induction of labour

Failed Induction of Labour

Cervical priming and labor induction with vaginal application of 3 mg Pge2 in suppositories in term pregnant women with premature rupture of amniotic membranes and unfavorable cervix

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Cervical priming and labor induction with vaginal application of 3 mg Pge₂ in suppositories in term pregnant women with premature rupture of amniotic membranes and unfavorable cervix