Oral Misoprostol vs Intravaginal Dinoprostone for Pre-Induction Cervical Ripening in Post-Term, Uncomplicated Pregnancies: A Randomized Controlled Trial  

作　　者：Yasiru Nuwanjith Godakandage Rameez Furukan Yasiru Nuwanjith Godakandage;Rameez Furukan(Teaching Hospital Mahamodara and Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka)

机构地区：[1]Teaching Hospital Mahamodara and Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka

出　　处：《Open Journal of Obstetrics and Gynecology》2024年第12期1807-1820,共14页妇产科期刊(英文)

摘　　要：Objectives To compare the effectiveness and safety of oral misoprostol 50 µg three doses, 4 hours apart vs. intravaginal PGE2 (Dinoprostone) 3 mg two doses 8 hours apart for pre-induction cervical ripening in women with uncomplicated, singleton, postdated pregnancies. Methodology This randomized controlled trial was conducted on women with uncomplicated, post- dated, singleton pregnancies with cephalic presentation, intact membranes and a modified bishops score (MBS) of ≤5 without any contraindications for vaginal delivery. Maternal and fetal outcomes and progression of labour were monitored as the outcome variables. Ethical clearance was obtained. Results The number of patients participated in the study was 208, 1:1 allocation is used. Of the mothers, 40.4% of those who took misoprostol (MP) and 51.9% of those who received Dinoprostone (PGE2) went into spontaneous labour (SOL, p = 0.09). The mean intervention to delivery time in SOL was longer for the group that got MP (p = 0.022). Around 30% of each group were not favourable for IOL after 24 hours of intervention, with favourable cervix (MBS ≥ 7) reported in 68.4% of mothers taking MP and in 70.74% of mothers taking PGE2. The group using MP had the lowest percentage of mothers who underwent emergency LSCS (6.7%) and the lowest percentage of mothers who underwent LSCS due to an abnormal CTG (1.9%) compared to the group using PGE2, both of which were statistically significant (p = 0.047, p = 0.002 respectively). The MP group had the fewest hyperstimulation among the maternal morbidities (n = 5 (4.8%), p = 0.049), however neither serious PPH nor uterine ruptures nor a significant difference in newborn morbidities was noted between the two groups. Multivariate analysis demonstrates that MP administration considerably increases SOL and has a risk of having an abnormal CTG. Conclusion Administration of oral MP has a higher chance of SOL, with a longer delivery time and lower likelihood of emergency LSCS, but with a risk of having a suspicious or pathological CTGObjectives To compare the effectiveness and safety of oral misoprostol 50 µg three doses, 4 hours apart vs. intravaginal PGE2 (Dinoprostone) 3 mg two doses 8 hours apart for pre-induction cervical ripening in women with uncomplicated, singleton, postdated pregnancies. Methodology This randomized controlled trial was conducted on women with uncomplicated, post- dated, singleton pregnancies with cephalic presentation, intact membranes and a modified bishops score (MBS) of ≤5 without any contraindications for vaginal delivery. Maternal and fetal outcomes and progression of labour were monitored as the outcome variables. Ethical clearance was obtained. Results The number of patients participated in the study was 208, 1:1 allocation is used. Of the mothers, 40.4% of those who took misoprostol (MP) and 51.9% of those who received Dinoprostone (PGE2) went into spontaneous labour (SOL, p = 0.09). The mean intervention to delivery time in SOL was longer for the group that got MP (p = 0.022). Around 30% of each group were not favourable for IOL after 24 hours of intervention, with favourable cervix (MBS ≥ 7) reported in 68.4% of mothers taking MP and in 70.74% of mothers taking PGE2. The group using MP had the lowest percentage of mothers who underwent emergency LSCS (6.7%) and the lowest percentage of mothers who underwent LSCS due to an abnormal CTG (1.9%) compared to the group using PGE2, both of which were statistically significant (p = 0.047, p = 0.002 respectively). The MP group had the fewest hyperstimulation among the maternal morbidities (n = 5 (4.8%), p = 0.049), however neither serious PPH nor uterine ruptures nor a significant difference in newborn morbidities was noted between the two groups. Multivariate analysis demonstrates that MP administration considerably increases SOL and has a risk of having an abnormal CTG. Conclusion Administration of oral MP has a higher chance of SOL, with a longer delivery time and lower likelihood of emergency LSCS, but with a risk of having a suspicious or pathological CTG

关 键 词：PROSTAGLANDIN DINOPROSTONE MISOPROSTOL SOL IOL Emergency LSCS 

分 类 号：R16[医药卫生—公共卫生与预防医学]