open access

Vol 88, No 11 (2017)
Research paper
Published online: 2017-11-30
Get Citation

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

Iwona Jagielska1, Anita Kazdepka-Ziemińska1, Małgorzata Tyloch1, Paulina Sopońska-Brzoszczyk1, Karina Nowak1, Dawid Dziedzic1, Ewa Dzikowska1, Marek Grabiec1
DOI: 10.5603/GP.a2017.0109
·
Pubmed: 29303214
·
Ginekol Pol 2017;88(11):606-612.
Affiliations
  1. Department of Obstetrics and Gynecology, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland, Poland

open access

Vol 88, No 11 (2017)
ORIGINAL PAPERS Obstetrics
Published online: 2017-11-30

Abstract

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® (miso-prostol 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.

Abstract

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® (miso-prostol 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.

Get Citation

Keywords

labor, induction, preinduction, pregnancy, prostaglandins, misoprostol

About this article
Title

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

Journal

Ginekologia Polska

Issue

Vol 88, No 11 (2017)

Article type

Research paper

Pages

606-612

Published online

2017-11-30

DOI

10.5603/GP.a2017.0109

Pubmed

29303214

Bibliographic record

Ginekol Pol 2017;88(11):606-612.

Keywords

labor
induction
preinduction
pregnancy
prostaglandins
misoprostol

Authors

Iwona Jagielska
Anita Kazdepka-Ziemińska
Małgorzata Tyloch
Paulina Sopońska-Brzoszczyk
Karina Nowak
Dawid Dziedzic
Ewa Dzikowska
Marek Grabiec

References (30)
  1. Bomba-Opoń D, Drews K, Huras H, et al. Polish Gynecological Society Recommendations for Labor Induction. Ginekol Pol. 2017; 88(4): 224–234.
  2. Kosinska-Kaczynska K, Ciechanowicz P, Saletra A, et al. Two methods of cervix ripening: intracervical Foley catether and dinoprostone - which one is actually more efficient? Neuro Endocrinol Lett. 2015; 36(3): 257–261.
  3. Wing DA, Brown R, Plante LA, et al. Misoprostol vaginal insert and time to vaginal delivery: a randomized controlled trial. Obstet Gynecol. 2013; 122(2 Pt 1): 201–209.
  4. Stephenson ML, Hawkins JS, Powers BL, et al. Misoprostol vaginal insert for induction of labor: a delivery system with accurate dosing and rapid discontinuation. Womens Health (Lond). 2014; 10(1): 29–36.
  5. Czajkowski K, Bręborowicz G, Kotarski J, et al. Rekomendacje zespołu ekspertów Polskiego Towarzystwa Ginekologicznego dotyczące opieki okołoporodowej i prowadzenia porodu. Ginekol Pol. 2009; 80: 548–557.
  6. Induction of Labour at Term in Older Mothers. Scientific Impact Paper No. 34 February 2013 https://www. rcog org uk/globalassets/documents/guidelines/scientific-impact-papers/sip. ; 34: pdf.
  7. Górnisiewicz T, Jaworowski A, Zembala-Szczerba M, et al. Analysis of intravaginal misoprostol 0.2 mg versus intracervical dinoprostone 0.5 mg doses for labor induction at term pregnancies. Ginekol Pol. 2017; 88(6): 320–324.
  8. Kostrzewa M, Kalinka J. Indukcja porodu. Część 2. Przegląd najczęściej stosowanych metod indukcji porodu. Perinatologia, Neonatologia i Ginekologia. 2013; 6(1): 19–23.
  9. Huras H. Indukcja porodu – algorytm postępowania. Algorytmy postępowania w ginekologii i położnictwie, Sep 16-17 2016, Warsaw, Poland, Medical Tribune Polska.
  10. Leduc D, Biringer A, Lee L, et al. Induction of Labour. Journal of Obstetrics and Gynaecology Canada. 2013; 35(9): 840–857.
  11. ACOG Committee on Practice Bulletins -- Obstetrics. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol. 2009; 114(2 Pt 1): 386–397.
  12. Stephenson ML, Wing DA. A novel misoprostol delivery system for induction of labor: clinical utility and patient considerations. Drug Des Devel Ther. 2015; 9: 2321–2327.
  13. Ulan A, Ulan J, Wagner E, et al. Indukcja porodu. European Journal of Medical Technologies. 2015; 2(7): 16–19.
  14. Stephenson ML, Wing DA. Misoprostol for induction of labor. Semin Perinatol. 2015; 39(6): 459–462.
  15. Rugarn O, Tipping D, Powers B, et al. Induction of labour with retrievable prostaglandin vaginal inserts: outcomes following retrieval due to an intrapartum adverse event. BJOG. 2017; 124(5): 796–803.
  16. Mayer RB, Oppelt P, Shebl O, et al. Initial clinical experience with a misoprostol vaginal insert in comparison with a dinoprostone insert for inducing labor. Eur J Obstet Gynecol Reprod Biol. 2016; 200: 89–93.
  17. Madaan M, Agrawal S, Puri M, et al. Is low dose vaginal misoprostol better than dinoprostone gel for induction of labor: a randomized controlled trial. J Clin Diagn Res. 2014; 8(9): OC31–OC34.
  18. Draycott T, van der Nelson H, Montouchet C, et al. Reduction in resource use with the misoprostol vaginal insert vs the dinoprostone vaginal insert for labour induction: a model-based analysis from a United Kingdom healthcare perspective. BMC Health Serv Res. 2016; 16: 49.
  19. Wing DA, Miller H, Parker L, et al. Misoprostol Vaginal Insert Miso-Obs-204 Investigators. Misoprostol vaginal insert for successful labor induction: a randomized controlled trial. Obstet Gynecol. 2011; 117(3): 533–541.
  20. Duro Gómez J, Garrido Oyarzún MF, Rodríguez Marín AB, et al. Vaginal misoprostol and cervical ripening balloon for induction of labor in late-term pregnancies. J Obstet Gynaecol Res. 2017; 43(1): 87–91.
  21. Miller H, Goetzl L, Wing DA, et al. Optimising daytime deliveries when inducing labour using prostaglandin vaginal inserts. J Matern Fetal Neonatal Med. 2016; 29(4): 517–522.
  22. Gupta S, Hak J, Kumar D. Comparative Study of Efficacy of Misoprostol Vs Dinoprostone Gel For Induction of Labour. JK Science. 2016 Jul. ; 18(3): 166–171.
  23. Tsikouras P, Koukouli Z, Manav B, et al. Induction of Labor in Post-Term Nulliparous and Parous Women - Potential Advantages of Misoprostol over Dinoprostone. Geburtshilfe Frauenheilkd. 2016; 76(7): 785–792.
  24. Aduloju OP, Akintayo AA, Adanikin AI, et al. Combined Foley's catheter with vaginal misoprostol for pre-induction cervical ripening: A randomised controlled trial. Aust N Z J Obstet Gynaecol. 2016; 56(6): 578–584.
  25. Frohn WE, Simmons S, Carlan SJ. Prostaglandin E2 gel versus misoprostol for cervical ripening in patients with premature rupture of membranes after 34 weeks. Obstet Gynecol. 2002; 99(2): 206–210.
  26. Jagielska I, Kazdepka-Ziemińska A, Janicki R, et al. Ocena skuteczności i bezpieczeństwa preindukcji porodu cewnikiem Foley’a. Ginekol Pol. 2013 Mar. ; 84(3): 180–5.
  27. Burke N, Burke G, Breathnach F, et al. 645: Effect of induction of labor on cesarean delivery rates in nulliparous patients: results from the prospective multi-center Genesis Study. American Journal of Obstetrics and Gynecology. 2016; 214(1): S343–S344.
  28. Wood S, Cooper S, Ross S. Does induction of labour increase the risk of caesarean section? A systematic review and meta-analysis of trials in women with intact membranes. BJOG. 2014; 121(6): 674–85; discussion 685.
  29. Kostrzewa M, Kalinka J. Indukcja porodu. Część 1. Kontrowersje i korzyści wynikające ze wskazań do indukcji porodu, Perinatologia Neonatologia i Ginekologia. 2012; 5(4): 185–189.
  30. Shetty A, Burt R, Rice P, et al. Women's perceptions, expectations and satisfaction with induced labour--a questionnaire-based study. Eur J Obstet Gynecol Reprod Biol. 2005; 123(1): 56–61.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl