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DOI: 10.1055/s-2007-989479
© Georg Thieme Verlag KG Stuttgart · New York
Selection of Appropriate Prostaglandin for the Induction of Labor at Term is More Predictive for the Achievement of Delivery within 24 Hours than Pre-assessed Cervical Parameters - A Prospective, Randomized Trial
Die Auswahl eines geeigneten Prostaglandins hat einen höheren prädiktiven Wert für eine Geburt innerhalb 24 h als Bishop-Score und Zervixlänge - Eine prospektive, randomisierte StudiePublication History
received 4.7.2007
accepted 10.12.2007
Publication Date:
26 February 2008 (online)
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Abstract
Objective: To compare the efficacy of vaginal misoprostol and dinoprostone gel for induction of labor at term and to evaluate the predictive value of pre-assessed Bishop score and sonographic estimated cervical length. Methods: One hundred and seven patients were prospectively randomized to receive either 50 µg misoprostol vaginally every 12 hours, or 2 mg of dinoprostone gel for nulliparae with an unfavorable cervix. 1 mg was given in case of multiparity or nulliparity with a Bishop score of > 5, according to the RCOG guidelines. Primary outcome was the achievement of vaginal delivery within 24 hours. Secondary outcome parameters included the induction to delivery interval, mode of delivery, drug related side effects, and the predictive value of the Bishop score and sonographic estimated cervical length. Results: The probability of delivering within 24 hours was more than threefold higher with misoprostol than with dinoprostone: odds ratio [OR]: 3.23; 95 percent confidence interval [CI]: 1.14 - 9.16, p: 0.03. In contrast, predictive values of both cervical parameters for delivery within 24 hours were not significant (Bishop score: [OR]: 1.28; [CI: 0.92 - 1.77], p: 0.14, cervical length: [OR]: 0.98; [CI: 0.92 - 1.03], p: 0.40). No difference was observed in the induction to delivery interval between both groups, and no correlation between cervical parameters and induction to delivery interval. Conclusion: Vaginal misoprostol is an effective, safe and cost-effective alternative to dinoprostone for cervical ripening and labor induction. The preinduced assessed cervical parameters showed poor predictive values for estimation of delivery within 24 hours and no correlation with the induction to delivery interval.
Zusammenfassung
Fragestellung: Vergleich der Effektivität von vaginal appliziertem Misoprostol versus Dinoproston zur Geburtseinleitung am Termin und Evaluierung des prädiktiven Wertes der zervikalen Parameter (Bishop-Score und sonografisch gemessene Zervixlänge). Material und Methodik: Prospektive Randomisierung von 107 Patientinnen, welche entweder 50 µg Misoprostol alle 12 Stunden oder 2 mg Dinoproston bei Nulliparität und unreifer Zervix beziehungsweise 1 mg bei Multiparität oder bei Nulliparität mit reifer Zervix (Bishop-Score > 5) nach den Richtlinien des RCOG erhielten. Primärer Outcome-Parameter war eine vaginale Geburt innerhalb von 24 Stunden. Sekundäre Outcome-Parameter beinhalteten den Intervall bis zur Geburt, die Geburtsart, medikamentöse Nebenwirkungen sowie die prädiktiven Werte des Bishop-Scores und der sonografisch gemessenen Zervixlänge. Resultate: Die Wahrscheinlichkeit einer Geburt innerhalb von 24 Stunden war in der Misoprostol-Gruppe mehr als 3-fach höher, in der Dinoproston-Gruppe: Odds Ratio [OR]: 3,23; 95 %-Konfidenzintervall [CI]: 1,14 - 9,16, p: 0,03. Die beiden zervikalen Parameter zeigten keine signifikanten prädiktiven Werte in Bezug auf eine Geburt innerhalb von 24 Stunden (Bishop-Score: [OR]: 1,28; [CI: 0,92 - 1,77], p: 0,14, Zervixlänge: [OR]: 0,98; [CI: 0,92 - 1,03], p: 0,40). Es zeigte sich kein Unterschied im Zeitrahmen der Geburtseinleitung zwischen beiden Medikamenten. Ebenso fand sich keine Korrelation zwischen dem Zeitabstand der Einleitung bis Geburt und den zervikalen Parametern. Schlussfolgerung: Vaginal appliziertes Misoprostol ist eine wirkungsvolle, sichere und kostengünstige Alternative zu Dinoproston in der Geburtseinleitung. Die vorgängig erhobenen zervikalen Parameter zeigen niedrige prädiktive Werte im Hinblick auf das Eintreten einer Geburt innerhalb von 24 Stunden und keine Korrelation mit der Zeitdauer der Einleitung bis Geburt.
Key words
pregnancy - labor - induced - misoprostol - dinoprostone - cervical length
Schlüsselwörter
Schwangerschaft - Geburt - Geburtseinleitung - Misoprostol - Dinoprostone - Zervixlänge
References
- 1 Mercer B M. Induction of labor in the nulliparous gravida with an unfavorable cervix. Obstet Gynecol. 2005; 105 688-689
- 2 Yeast J D, Jones A, Poskin M. Induction of labor and the relationship to cesarean delivery: a review of 7001 consecutive inductions. Am J Obstet Gynecol. 1999; 180 628-633
- 3 Maslow A S, Sweeny A L. Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term. Obstet Gynecol. 2000; 95 917-922
- 4 ACOG Committee Opinion Number 283, May 2003. New U.S. Food and Drug Administration labelling on Cytotec (misoprostol) use and pregnancy. Obstet Gynecol. 2003; 101 1049-1050
- 5 ACOC committee . ACOC committee opinion. New U.S. Food and Drug Administration labeling on Cytotec (misoprostol) use and pregnancy. Number 283. May 2003. Int J Gynaecol Obstet. 2003; 82 137-138
- 6 Bishop E. Pelvic scoring for elective induction. Obstet Gynecol. 1964; 24 266-268
- 7 Pandis G K, Papageorghiou A T, Ramanathan V G, Thompson M O, Nicolaides K H. Preinduction sonographic measurement of cervical length in the prediction of successful induction of labour. Ultrasound Obstet Gynecol. 2001; 18 623-628
- 8 Ware V, Raynor B D. Transvaginal ultrasonographic cervical measurement as a predictor of successful labor induction. Am J Obstet Gynecol. 2000; 182 1030-1032
- 9 Watson W J, Stevens D, Welter S, Day D. Factors predicting successful labor induction. Obstet Gynecol. 1996; 88 990-992
- 10 Gonen R, Degani S, Ron A. Prediction of successful induction of labor: comparison of transvaginal ultrasonography and the Bishop score. Eur J Ultrasound. 1998; 7 183-187
- 11 Royal College of Obstetricians and Gynaecologists .Induction of labor. Evidence-based clinical guideline number 9. London; RCOG Press 2001
- 12 Royal College of Obstetricians and Gynaecologists; Clinical Effectiveness Support Unit .The use of electronic fetal monitoring. The use of cardiotocography in intrapartum fetal surveillance. Evidence-based clinical guideline number 8. London; RCOG Press 2001
- 13 Gregson S, Waterstone M, Norman I, Murrells T. A randomised controlled trial comparing low dose vaginal misoprostol and dinoprostone vaginal gel for inducing labor at term. BJOG. 2005; 112 438-444
- 14 Surbek, Boesiger H, Hoesli I, Pavic N, Holzgreve W. A double-blind comparison of the safety and efficacy of intravaginal misoprostol and prostaglandin E2 to induce labor. Am J Obstet Gynecol. 1997; 177 1018-1023
- 15 Drack G, Hohlfeld P, Schneider H, Primaresi P, Vogel E. Task-force of the Swiss Society of Obstetrics and Gynecology . Guideline: Surveillance and management of post-term deliveries. Schweiz. Ärztezeitung. 2002; 83 717-722
- 16 Hofmeyr G J, Gulmezoglu A M, Alfirevic Z. Misoprostol for induction of labor: a systematic review. Br J Obstet Gynaecol. 1999; 106 798-803
- 17 Danelian P, Poter B, Ferri N, Summers J, Templeton A. Misoprostol for induction of labour at term: a more effective agent than dinoprostone gel. Br J Obstet Gynaecol. 1999; 106 793-797
- 18 Sanchez-Ramos L, Kaunitz A, Wears R, Delke I, Gaudier L. Misoprostol for cervical ripening and labour induction: a meta-analysis. Obstet Gynaecol. 1997; 89 633-642
- 19 Wing D A, Rahall A, Goodwin T M, Paul R H. A comparison of misoprostol and prostaglandin E2 gel for preinduction cervical ripening and labour induction. Am J Obstet Gynecol. 1995; 172 1804-1810
- 20 Wing D A. Labor induction with misoprostol. Am J Obstet Gynecol. 1999; 181 339-345
- 21 Sanchez-Ramos L, Kaunitz A M. Misoprostol for cervical ripening and labor induction: a systematic review of the literature. Clin Obstet Gynecol. 2000; 43 475-488
- 22 Ramsey P S, Meyer L, Walkes B A, Harris D, Ogburn Jr P L, Heise R H, Ramin K D. Cardiotocographic abnormalities associated with dinoprostone and misoprostol cervical ripening. Obstet Gynecol. 2005; 105 85-90
- 23 Williams M C, Krammer J, O'Brien W F. The value of the cervical score in predicting successful outcome of labor induction. Obstet Gynecol. 1997; 90 784-789
- 24 Hendrix N W, Chauhan S P, Morrison J C, Magann E F, Martin J N, Devoe L D. Bishop score: a poor diagnostic test to predict failed induction versus vaginal delivery. South Med J. 1998; 91 248-252
- 25 Reis F M, Gervasi M T, Florio P, Bracalente G, Fadalti M, Severi F M, Petraglia F. Prediction of successful induction of labor at term: role of clinical history, digital examination, ultrasound assessment of the cervix, and fetal fibronectin assay. Am J Obstet Gynecol. 2003; 189 1361-1367
- 26 Rozenberg P, Chevret S, Chastang C, Ville Y. Comparison of digital and ultrasonographic examination of the cervix in predicting time interval from induction to delievery in women with low Bishop score. BJOG. 2005; 112 192-196
- 27 Chandra S, Crane J M, Hutchens D, Young D C. Transvaginal ultrasound and digital examination in predicting successful labor induction. Obstet Gynecol. 2001; 98 2-6
- 28 Ramanathan G, Yu C, Osei E, Nicolaides K H. Ultrasound examination at 37 weeks' gestation in the prediction of pregnancy outcome: the value of cervical assessment. Ultrasound Obstet Gynecol. 2003; 22 598-603
- 29 Lyons C, Beharry K, Akmal Y, Attenello F, Nageotte M P. In vitro response of prostaglandin E2 receptor (EP3) in the term pregnant rat uterus and cervix to misoprostol. Prostaglandins Other Lipid Mediat. 2003; 70 317-329
PD Dr. I. Hösli
Universitäts-Frauenklinik Basel
Spitalstrasse 21
4031 Basel
Switzerland
Email: ihoesli@uhbs.ch