Vaginal Misoprostol for Cervical Ripening at Term: Comparison of Outpatient vs. Inpatient Administration

Chang, Daniel W.; Velazquez, Maria; Colyer, Martha; Klaus, Patty; Mallipeddi, Sai K.; Rayburn, William F.

doi:10.1097/01.ogx.0000201917.38046.8e

Cited by 10 publications

(29 citation statements)

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“…Chang et al 34 performed an outpatient vs. inpatient concurrent cohort study of 276 patients receiving 50 mcg vaginal misoprostol. Performed in a community hospital, the outpatient group was given 1 dose of misoprostol and instructed to return the next morning for labor induction.…”

Section: Outpatient Datamentioning

confidence: 99%

“…None of the studies showed any difference in adverse maternal or fetal outcomes between the inpatient and outpatient groups; however, the studies were all small and not powered to detect rare adverse events. [32][33][34][35] An additional issue that must be considered is the use of misoprostol for cervical induction in low-resource settings. 35 In cases of late-term and post-term pregnancies in countries where antenatal testing is not an option and resources for emergency cesarean deliveries are scarce, currently small risks that are associated with misoprostol may be favorable compared to the risks associated with prolonged pregnancies.…”

Section: Safetymentioning

confidence: 99%

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Outpatient cervical ripening

Amorosa

Stone

2015

Seminars in Perinatology

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Section: Outpatient Datamentioning

confidence: 99%

Section: Safetymentioning

confidence: 99%

Outpatient cervical ripening

Amorosa

Stone

2015

Seminars in Perinatology

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“…Participants' weighted mean age was 28.8 years and weighted body mass index (BMI) was 26.7. BMI was reported in only 18% of studies (6 RCTs 26,34,40,48,52,53 and 1 cohort study) 61 , and the timing of measurement was not reported. Race was reported in 33% of studies.…”

Section: Description Of Included Evidencementioning

confidence: 99%

“…Funding was government in one, 66 and multiple sources in the other. 27 Six cohort studies compared prostaglandin use for cervical ripening in the outpatient versus inpatient setting; five 25,30,32,55,61 assessed dinoprostone (N=3,690, with two studies having an overlap of 793 women in their study populations, out of 1,343 in one and 1,179 in the other 30,55 ), and one (N=273) assessed misoprostol. 29 For meta-analyses and SOE assessments, only the larger of the two studies with overlapping data were considered.…”

Section: Summary Of Findingsmentioning

confidence: 99%

Cervical Ripening in the Outpatient Setting

McDonagh¹,

Skelly²,

Hermesch³

et al. 2021

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Objectives. To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient setting (vs. inpatient, vs. other outpatient intervention) and of fetal surveillance when a prostaglandin is used for cervical ripening. Data sources. Electronic databases (Ovid® MEDLINE®, Embase®, CINAHL®, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews) to July 2020; reference lists; and a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) and cohort studies of cervical ripening comparing prostaglandins and mechanical methods in outpatient versus inpatient settings; one outpatient method versus another (including placebo or expectant management); and different methods/protocols for fetal surveillance in cervical ripening using prostaglandins. When data from similar study designs, populations, and outcomes were available, random effects using profile likelihood meta-analyses were conducted. Inconsistency (using I2) and small sample size bias (publication bias, if ≥10 studies) were assessed. Strength of evidence (SOE) was assessed. All review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center methods guidance. Results. We included 30 RCTs and 10 cohort studies (73% fair quality) involving 9,618 women. The evidence is most applicable to women aged 25 to 30 years with singleton, vertex presentation and low-risk pregnancies. No studies on fetal surveillance were found. The frequency of cesarean delivery (2 RCTs, 4 cohort studies) or suspected neonatal sepsis (2 RCTs) was not significantly different using outpatient versus inpatient dinoprostone for cervical ripening (SOE: low). In comparisons of outpatient versus inpatient single-balloon catheters (3 RCTs, 2 cohort studies), differences between groups on cesarean delivery, birth trauma (e.g., cephalohematoma), and uterine infection were small and not statistically significant (SOE: low), and while shoulder dystocia occurred less frequently in the outpatient group (1 RCT; 3% vs. 11%), the difference was not statistically significant (SOE: low). In comparing outpatient catheters and inpatient dinoprostone (1 double-balloon and 1 single-balloon RCT), the difference between groups for both cesarean delivery and postpartum hemorrhage was small and not statistically significant (SOE: low). Evidence on other outcomes in these comparisons and for misoprostol, double-balloon catheters, and hygroscopic dilators was insufficient to draw conclusions. In head to head comparisons in the outpatient setting, the frequency of cesarean delivery was not significantly different between 2.5 mg and 5 mg dinoprostone gel, or latex and silicone single-balloon catheters (1 RCT each, SOE: low). Differences between prostaglandins and placebo for cervical ripening were small and not significantly different for cesarean delivery (12 RCTs), shoulder dystocia (3 RCTs), or uterine infection (7 RCTs) (SOE: low). These findings did not change according to the specific prostaglandin, route of administration, study quality, or gestational age. Small, nonsignificant differences in the frequency of cesarean delivery (6 RCTs) and uterine infection (3 RCTs) were also found between dinoprostone and either membrane sweeping or expectant management (SOE: low). These findings did not change according to the specific prostaglandin or study quality. Evidence on other comparisons (e.g., single-balloon catheter vs. dinoprostone) or other outcomes was insufficient. For all comparisons, there was insufficient evidence on other important outcomes such as perinatal mortality and time from admission to vaginal birth. Limitations of the evidence include the quantity, quality, and sample sizes of trials for specific interventions, particularly rare harm outcomes. Conclusions. In women with low-risk pregnancies, the risk of cesarean delivery and fetal, neonatal, or maternal harms using either dinoprostone or single-balloon catheters was not significantly different for cervical ripening in the outpatient versus inpatient setting, and similar when compared with placebo, expectant management, or membrane sweeping in the outpatient setting. This evidence is low strength, and future studies are needed to confirm these findings.

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“…Biaya lebih hanya akan dibebankan jika sampel mendapat terapi khusus sehubungan dengan proses/komplikasi persalinan. 10 Incerpi pada penelitiannya pada tahun 2001 juga menyimpulkan bahwa misoprostol 25µgr pervaginam selang 3 hari yang diberikan perambulatoir ternyata ditolerir dengan baik oleh janin.…”

Section: Hasil Dan Pembahasanunclassified

Pengaruh Pemberian Misoprostol 25 µg Peroral Ambulatoir pada Tenggat Waktu Persalinan Wanita Hamil > 40 Minggu Resiko Rendah

Trihastuti

Purwaka

2015

MOG

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Tujuan: Mengukur pengaruh misoprostol 25 µg per oral ambulatoir terhadap interval persalinan wanita hamil risiko rendah. Bahan dan Metode: Penelitian acak, tersamar ganda, menggunakan plasebo yang membandingkan 25 µg rawat jalan secara lisan misoprostol dengan plasebo pada wanita hamil risiko rendah yang tidak melahirkan selama > 40 minggu. Setiap subjek menerima 25-mg misoprostol per oral3x/hari dan diulang setiap 36 jam jika masih belum persalinan, dengan dosis maksimum 9 dosis. Setelah pemberian obat, pasien diperbolehkan menjalani persalinan spontan kecuali terdapat indikasi untuk induksi. Hasil: Dua puluh satu wanita hamil dimasukkan secara acak dalam setiap kelompok untuk mendapatkan misoprostol dan placebo. Indikator utama hasil: interval persalinan, skor Apgar dan insidens operasi caesar. Analisis statistik dilakukan dengan uji Student t, 2, dan MannWhitney U, dengan P <0,05 dianggap signifikan secara statistik. Interval rata-rata dari dosis awal hingga persalinan secara signifikan lebih rendah pada kelompok misoprostol, 74,23 ± 54,42 dibandingkan dengan 200,97 ± 118,05 jam (P = 0,000). Tidak ada perbedaan dalam skor Apgar menit pertama (P = 0.713) dan menit kelima (P = 0.655). Tiga subjek dari kelompok misoprostol menjalani operasi caesar karena alasan obstetri, tapi tidak ada pasien mengalami hiperstimulasi atau memerlukan persalinan sesar untuk penilaian janin yang meragukan selama induksi. Namun, karena ukuran sampel yang kecil, efek samping seringkali terlewatkan. Simpulan: misoprostol 25-g per oral ambulatoir efektif dan aman dalam menurunkan tenggat waktu persalinan wanita usia kehamilan > 40 minggu.Kata kunci: misoprostol per oral ambulatoir, induksi persalinan, kehamilan lewat waktu Objectives: To estimate the effect of 25 µg outpatient orally misoprostol on the interval to delivery in low risk pregnant women. Materials and Methods: Randomized, double blind, placebo-controlled trial comparing 25-µg outpatient orally misoprostol to placebo in low risk pregnant women who were not in labor at > 40 weeks. Every subject received 25-µg orally misoprostol 3x/days and repeated every 36 hours if still not in labor, with maximum doses of 9 doses. After administration of medication, they permitted to go into spontaneous labor unless an indication for induction developed. Results: Twenty-one women were randomly assigned for each group to received misoprostol and placebo. Main outcome measures: interval to delivery, Apgar score and incidence of caesarean section. Statistical analysis was performed with the Student t, 2, and Mann-Whitney U tests, with P <.05 considered statistically significant. The mean interval from initial dose to delivery was significantly less in the misoprostol group, 74,23±54,42 compared with 200,97±118,05 hours (P = 0,000). There was no difference in Apgar score first minute (P = 0,713) and fifth minute (P = 0,655). Three subjects from misoprostol grup had caesarean section due to obstetrical reason, but no patient had hyperstimulation or required cesarean delivery for nonreas...

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Vaginal Misoprostol for Cervical Ripening at Term: Comparison of Outpatient vs. Inpatient Administration

Cited by 10 publications

References 0 publications

Outpatient cervical ripening

Outpatient cervical ripening

Cervical Ripening in the Outpatient Setting

Pengaruh Pemberian Misoprostol 25 µg Peroral Ambulatoir pada Tenggat Waktu Persalinan Wanita Hamil > 40 Minggu Resiko Rendah

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