Misoprostol Vaginal Insert for Successful Labor Induction

Miller, Hugh; Parker, Lamar; Powers, Barbara; Rayburn, William F.

doi:10.1097/aog.0b013e318209d669

Cited by 36 publications

(36 citation statements)

References 13 publications

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“…The period from the beginning of labor induction to amniotic fluid rupture was shorter in misoprostol group. In previous studies, including large meta-analysis, the results were similar to those shown below [8]. Nevertheless, it should be noted that in the literature comparisons of exact these two types of prostaglandin administration are not available.…”

Section: Discussionsupporting

confidence: 72%

Analysis of intravaginal misoprostol 0.2 mg versus intracervical dinoprostone 0.5 mg doses for labor induction at term pregnancies

et al. 2017

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Objectives: Labor-induction methods are used in about 23% of labors. Most commonly, pharmacological methods are used to pre-induct the labor with dinoprostone -a PGE2 analog, and misoprostol -a PGE1 analog. The aim of this study was to evaluate two pharmacological methods of labor induction with the use of prostaglandins applied via an intravaginal insert containing misoprostol at a dose of 0.2 mg and intracervical gel containing dinoprostone at a dose of 0.5 mg. Material and methods:This retrospective study was conducted on a group of 50 adult patients qualified for the pre-induction of labor. Following data were recorded: the time from the drug administration to the beginning of regular contractile function, the time from administration to amniotic fluid rupture, the time from medicament administration to the vaginal labor or caesarean section, the duration of I, II and III stages of labor, the delivery method and in the event of caesarean section -the indications for surgery. Results:In comparison to dinoprostone, the misoprostol application was found to shorten the time from drug administration to amniotic fluid rupture by 14.1 hours, the time to the beginning of the first stage of labor by 11.7 hours and from the drug administration to the delivery by 17.3 hours (p-value < 0.05). The duration of the first stage of labor in the misoprostol group was shorter by 1.2 hours than in dinoprostone group (p-value < 0.05). Conclusions:Application of intravaginal insert with misoprostol at a dose of 0.2 mg appears to be a more effective method of labor induction in comparison to intracervical gel with dinoprostone at a dose of 0.5mg. Thorough analysis of these methods requires further studies.

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Section: Discussionsupporting

confidence: 72%

Analysis of intravaginal misoprostol 0.2 mg versus intracervical dinoprostone 0.5 mg doses for labor induction at term pregnancies

et al. 2017

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“…Yet, we observed this rate to be relatively higher in the primigravida group (40.58% vs. 16.13%) and in the group with concomitant preeclampsia or diabetes. However, other authors report the caesarean section rate after pre-induction with MVI to be even lower -from 22.9% to 27.1% [19,24]. Similarly to other studies, we report the risk of intrauterine fetal hypoxia to be the most common indication for a caesarean section [3,15,24].…”

Section: %mentioning

confidence: 46%

“…In our study we recorded only 2% of cases with tachysystoly, same for hyperstimulation. This is a very low proportion compared to literature, where such rate was reported to reach 13% to 53% of pregnancies [3,15,16,19]. Abnormalities of cardiotocographic tracing were recorded in 43% of cases but less than half of them required caesarean section.…”

Section: %mentioning

confidence: 50%

“…The literature is rich is articles that compare and assess the effectiveness and safety of pre-induction methods involving prostaglandins such as dinoprostone gel and vaginal insert or misoprostol in form of tablets or inserts [7,[15][16][17][18][19]. Misoprostol tablets are registered in Europe for the prevention and treatment of gastric ulcers only.…”

Section: Discussionmentioning

confidence: 99%

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Obstetric outcomes of pre-induction of labor with a 200 μg misoprostol vaginal insert

et al. 2017

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Objectives: Labor induction is indicated in 20% to 40% of pregnancies. Over half of pregnancies qualified for the induction of labor require stimulation of the cervix to ripen. The drug used increasingly more often in pre-induction is the PGE-1 prostaglandin analog -misoprostol 200 μg. Material and methods:The study includes a total of 100 patients qualified for labor pre-induction with Misodel® (misoprostol 200 μg vaginal insert). The study group comprises two subgroups: primigravidas and multiparas. Assessments included: indications for labor pre-induction, time from Misodel application to delivery, caesarean section rate and indications, duration of first and second stage of labor, rate of vaginal deliveries, need for oxytocin or fenoterol administration side effects and newborn condition. Results:The most common indication for labor induction was gestational diabetes and pregnancy past term. The average time to vaginal delivery was 14 h 45 min, time to the onset of active phase of labor -11 h 45 min, time to membranes' rupture -15 h, time to vaginal delivery -14 h 18 min. The times of multiparas were significantly shorter. The rate of vaginal deliveries within 12 hours amounted to 42.42%, while within 24 hours it reached 83.33%. The overall caesarean section rate was 33%. The most common indication for caesarean section was the risk of intrauterine hypoxia. Tachysystole and hyperstimulation was observed in 4% of cases, while abnormalities in the cardiotocographic tracing in 43%. Conclusions:Misodel is an effective method for labor pre-induction, without affecting the caesarean section rate and has no adverse effect on the newborn condition.

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“…2 In another Cochrane review quoted by Bernardes et al in support of their main finding, Wood et al pointed out that their meta-analysis was heavily influenced by the Canadian Post Dates Trial, where cervical ripening with intracervical prostaglandin E was only planned in the immediate induction group (51% of the women in this group), and was discouraged in the expectantly managed (EM) group (9%). 3,4 In the study conducted by Bernardes et al, 96.3% of women in the induction group benefitted from timely cervical ripening with intracervical or intravaginal prostaglandins or a balloon catheter, versus 'only' 48% of women in the EM group. Of note, the proportion of women who received local prostaglandins or balloon catheter in the EM group of the study by Bernardes et al was similar to the induction group in the Canadian Post Dates Trial, in line with a very active policy of cervical ripening that probably explains the low caesarean rate in the DIGITAT and HYPITAT studies.…”

mentioning

confidence: 99%

Authors' reply re: Caesarean section rates and adverse neonatal outcomes after induction of labour versus expectant management in women with an unripe cervix: a secondary analysis of the HYPITAT and DIGITAT trials

Bernardes¹,

Groen

2017

BJOG

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Misoprostol Vaginal Insert for Successful Labor Induction

Abstract: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00828711.

Cited by 36 publications

References 13 publications

Analysis of intravaginal misoprostol 0.2 mg versus intracervical dinoprostone 0.5 mg doses for labor induction at term pregnancies

Analysis of intravaginal misoprostol 0.2 mg versus intracervical dinoprostone 0.5 mg doses for labor induction at term pregnancies

Obstetric outcomes of pre-induction of labor with a 200 μg misoprostol vaginal insert

Authors' reply re: Caesarean section rates and adverse neonatal outcomes after induction of labour versus expectant management in women with an unripe cervix: a secondary analysis of the HYPITAT and DIGITAT trials

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