Effect of Vaginal Washing before Intravaginal Prostaglandin Insertion on Induction of Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Saeed Baradwan; Abdulrahman Al-Matary; Majed Saeed Alshahrani; Khalid Khadawardi; Abdullah Latifah; Mohamed E. ElHodiby; Mohammed Samy; Sarah Safwat; Ahmed Zaki; Mohamed Hussein; Mahmoud A. Hegazy; Suzan Elsharkawy; Ahmed Mohamed Abdelhakim; Rania Mahfouz Abdelwahed; Maii Nawara; Mohamed A. Elsenity

doi:10.1055/s-0043-1763502

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(08): 988-997
DOI: 10.1055/s-0043-1763502

Review Article

Effect of Vaginal Washing before Intravaginal Prostaglandin Insertion on Induction of Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Saeed Baradwan

¹Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia

,

Abdulrahman Al-Matary

²Department of Neonatology, King Fahad Medical City, Riyadh, Saudi Arabia

,

Majed Saeed Alshahrani

³Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia

,

Khalid Khadawardi

⁴Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia

,

Abdullah Latifah

⁵College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

,

Mohamed E. ElHodiby

⁶Department of Obstetrics and Gynecology, Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt

,

Mohammed Samy

⁷Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

,

Sarah Safwat

⁷Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

,

Ahmed Zaki

⁸Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

,

Mohamed Hussein

⁸Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

,

Mahmoud A. Hegazy

⁹Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, New Damietta, Egypt

,

Suzan Elsharkawy

¹⁰Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Alexandria, Egypt

,

Ahmed Mohamed Abdelhakim

¹¹Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt

,

Rania Mahfouz Abdelwahed

¹²Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt

,

Maii Nawara

⁷Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

,

Mohamed A. Elsenity

⁷Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

› Author Affiliations

Abstract

Objective Saline vaginal douching prior to intravaginal prostaglandin application might increase the vaginal pH, leading to improvement of prostaglandin bioavailability, by which the outcomes of labor induction can be greatly improved. Thus, we aimed to evaluate the effect of vaginal washing with normal saline before insertion of vaginal prostaglandin for labor induction.

Study Design A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI Web of Science from inception to March 2022. We selected randomized controlled trials (RCTs) that compared vaginal washing using normal saline versus no vaginal washing in the control group before intravaginal prostaglandin insertion during labor induction. We used RevMan software for our meta-analysis. Our main outcomes were the duration of intravaginal prostaglandin application, duration from intravaginal prostaglandin insertion to active phase of labor, duration from intravaginal prostaglandin insertion till total cervical dilatation, labor induction failure rate, incidence of cesarean section (CS), and rates of neonatal intensive care unit (NICU) admission and fetal infection postdelivery.

Results Five RCTs were retrieved with a total number of 842 patients. Duration of prostaglandin application, duration from prostaglandin insertion to active phase of labor, and time interval from prostaglandin insertion to total cervical dilatation were significantly shorter among vaginal washing group (p < 0.05). Vaginal douching prior to prostaglandin insertion significantly decreased the incidence of failed labor induction (p < 0.001). After the removal of reported heterogeneity, vaginal washing was linked to a significant decline in CS incidence (p = 0.04). In addition, the rates of NICU admission and fetal infection were significantly lower in the vaginal washing group (p < 0.001).

Conclusion Vaginal washing with normal saline before intravaginal prostaglandin insertion is a useful and easily applicable method for labor induction with good outcomes.

Key Points

Induction of labor is frequently used in the obstetrics field.
We assessed vaginal washing impact before prostaglandin insertion for labor induction.
Vaginal washing is an easily applicable method for labor induction with good outcomes.

Keywords

vaginal washing - vaginal douching - labor induction - prostaglandin - cervical ripening

Full Text

References

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