No abstract available.
Cervical Ripening* ; Female ; Pregnancy

Dinoprostone ; Pregnant Women ; Cervical Ripening

Cervical Ripening ; Female ; Humans ; Integrative Medicine ; Pregnancy

No abstract available.
Cervical Ripening* ; Cervix Uteri* ; Dinoprostone* ; Female ; Misoprostol* ; Pregnancy ; Pregnancy*

OBJECTIVE: To determine whether the presence of fetal fibronectin in the cervicovaginal secretion could be used as a clinical marker to predict the outcome of labor induction. METHODS: The study group comprised 58 term pregnant women with intact amnionic membranes, 44 without labor and 14 with irregular labor. All patients had been admitted for induction of labor during Sept. 1, 1999 to Dec. 31, 1999 at the Department of Obstetrics and Gynecology of Yeungnam University Hospital. Fetal fibronectin was assayed with the cervicovaginal secretion. We analyzed the variables of labor outcome by the presence (positove) or absence (negative) of fetal fibronectin and the modified Bishop score. RESULTS: Cervicovaginal fetal fibronectin was detected in 75.0% (33/44) of the women without labor and 85.7% (12/14) with irregular labor, and 76.3% (29/38) with Bishop score 4 or less and 80.0% (16/20) with score 5 or above. There was no statistical differences in the positive rate of fetal fibronectin between the women without labor and those with irregular labor, and the women with Bishop score 4 or less and those with Bishop score 5 or above, respectively. The mean oral PGE2 tablets used for cervical ripening, the mean time interval from the beginning of labor induction to delivery, and the mean cesarean delivery rate were 1.97+/-2.56 tabs and 3.12+/-2.42, 10.12+/- 6.56 hours and 13.88+/-6.14, and 20.0% and 38.4%, in the women with positive fetal fibronectin and those with negative respectively, and 1.83+/-2.50 and 2.42+/-2.60, 10.11+/-7.17 hours and 11.28+/-6.26 hours, and 10.0% and 31.6% in the women with Bishop score 5 or above and those with Bishop score 4 or less, respectively. There were no statistical differences in the mean values between the women with positive and negative fetal fibronectin, and between Bishop score 5 or above and Bishop score 4 or less, respectively. There were no statistical differences in the mean oral PGE2 tablets used for cervical ripening (2.00+/- 2.65 vs. 4.40+/-1.82) and the mean time interval from the beginning of labor induction to delivery (10.11+/- 7.53 vs. 16.17+/-5.38), between the women with positive fetal fibronectin and Bishop score 5 or above and those with negative fetal fibronectin and Bishop score 4 or less, respectively. However, the cesarean delivery rate was significantly lower in the women with positive fetal fibronectin and Bishop score 5 or above than those with negative fetal fibronectin and Bishop score 4 or less (6.3% vs 44.4%, p=0.040). CONCLUSION: The assesment of cervicovaginal fetal fibronectin and Bishop score could be useful in predicting the success or failure of labor induction. But it was not helpful to predict the easiness of labor induction by the presence or absence of fetal fibronectin in the cervicovaginal secretion and/or modified Bishop score.
Amnion ; Biomarkers ; Cervical Ripening ; Dinoprostone ; Equidae ; Female ; Fibronectins* ; Gynecology ; Humans ; Membranes ; Obstetrics ; Pregnancy ; Pregnant Women ; Tablets

OBJECTIVE: To assess the efficacy and safety of vaginal misoprostol after a pretreatment with vaginal estradiol to facilitate the hysteroscopic surgery in postmenopausal women. METHODS: In this observational comparative study, 35 control women (group A) did not receive any pharmacological treatment,26 women (group B) received 25 µg of vaginal estradiol daily for 14 days and 400 µg of vaginal misoprostol 12 hours before hysteroscopic surgery, 32 women (group C) received 400 µg of vaginal misoprostol 12 hours before surgery. RESULTS: Demographic data were well balanced and all variables were not significantly different among the three groups. The study showed a significant difference in the preoperative cervical dilatation among the group B (7.09±1.87 mm), the group A (5.82±1.85 mm; B vs. A, P=0.040) and the group C (5.46±2.07 mm; B vs. C, P=0.007). The dilatation was very easy in 73% of women in group B. The pain scoring post surgery was lower in the group B (B vs. A, P=0.001; B vs. C, P=0.077). In a small subgroup of women with suspected cervical stenosis, there were no statistically significant differences among the three groups considered. No complications during and post hysteroscopy were observed. CONCLUSION: In postmenopausal women the pretreatment with oestrogen appears to have a crucial role in allowing the effect of misoprostol on cervical ripening. The combination of vaginal estradiol and vaginal misoprostol presents minor side effects and has proved to be effective in obtaining satisfying cervical dilatation thus significantly reducing discomfort for the patient.
Cervical Ripening* ; Constriction, Pathologic ; Dilatation ; Estradiol* ; Female ; Humans ; Hysteroscopy* ; Labor Stage, First ; Misoprostol* ; Postmenopause ; Pregnancy

OBJECTIVE: To compare the efficacy and safety of intravaginal administerd misoprostol and PGE2 (dinoprostone) with oxytocin for inducing labor in women with an unfavorable cervix. METHODS: One hundred thirteen patients with indicated for labor induction and unfavorable cervix were randomly assigned and received either misoprostol 50microgram intravaginal with oxytocin intravenous injection or prostaglandin E2(dinoprostone) 3mg intravaginal with oxytocin intravenous injection. RESULTS: Thirty-nine subjects were assigned to misoprostol with oxytocin group and 74 to the PGE2 with oxytocin group. The median interval from induction to vaginal delivery was significantly shorter in the misoprostol with oxytocin group(1274+/-496 versus 1512+/-501 minutes)(p<0.001). No significant difference between two groups were mode of delivery, neonatal and maternal outcomes. CONCLUSION: Intravaginal misoprostol and PGE2 vaginal insert appear to be safe agents for cervical ripening and labor induction. Misoprostol is more effective than PGE2 vaginal insert with oxytocin injection.
Cervical Ripening* ; Cervix Uteri* ; Dinoprostone* ; Female ; Humans ; Injections, Intravenous ; Misoprostol* ; Oxytocin ; Pregnancy ; Pregnancy*

The last step of a successful pregnancy is the safe delivery of the fetus. An important question is if the delivery should vaginal or operative. In addition to the use of conventional antenatal ultrasound, the use of intrapartum ultrasound to evaluate fetal head station, position, cervical ripening, and placental separation is promising. This review evaluates and summarizes the usefulness of intrapartum ultrasound for the evaluation of labor progress and predicting successful operative vaginal delivery.
Cervical Ripening ; Extraction, Obstetrical ; Female ; Fetus ; Head ; Labor, Obstetric ; Pregnancy ; Ultrasonography*

OBJECTIVE: To compare the safety and efficacy of intravaginal misoprostol versus oral dinoprostone for labor induction at term. METHODS: One hundred of patients at term were randomized to receive either 50microgram of misoprostol vaginally every 4 hours or dinoprostone 0.5mg orally every 1 hour for the maximum of six doses. Intravenous infusion of oxytocin was administered under such circumferences as the patient did not go into active labor after maximum dose, SROM was developed without an adequate contraction pattern, or the patient had arrest of dilatation(no change in cervical dilatation for 2 hours). We compared the frequency of oxytocin augmentation, administration to delivery interval, vaginal delivery rate within 12 hours and 24 hours, intrapartum complications, induction failure, mode of delivery, neonatal outcomes, and maternal complications between two groups. RESULTS: The average interval from administration to delivery was shorter in the misoprostol group(739.4+/-372.4min vs 1087.7+/-765.1min, p<0.05), but the interval from administration to vaginal delivery of each group was similar(724.3+/-375.4min vs 800.3+/-697.0min). Regarding the frequency of vaginal delivery within 24 hours, however, misoprostol group was higher than dinoprostone group(88% vs 56%, p<0.001). And oxytocin augmentation of labor occurred less commonly in misoprostol group than in dinoprostone group(20% vs 76%, p<0.05). Any statistically significant difference in intrapartum complications, mode of delivery, and neonatal or maternal adverse outcome was not appeared between these two group. CONCLUSION: Vaginal misoprostol is as effective and safe as oral dinoprostone for cervical ripening and induction of labor at term. In addition, vaginal misoprostol contributes the curtailment of labor induction expenditure due to its moderate price; misoprostol costs 100 won per 50microgram.
Cervical Ripening ; Dinoprostone* ; Female ; Health Expenditures ; Humans ; Infusions, Intravenous ; Labor Stage, First ; Misoprostol* ; Oxytocin ; Pregnancy

OBJECTIVE: To compare the safety and the efficacy of oral 100 microgram versus vaginal 50 microgram misoprostol for labor induction at term. METHODS: Eighty patients with indicated for labor induction were randomized to receive either oral misoprostol 100 microgram or 50 microgram of vaginal misoprostol. In both groups, the dosage was repeated every 6 hours, if needed, to a maximum of four doses. We compared the Bishop score during labor induction, average interval from induction to delivery, vaginal delivery rate within 12 hours and 24 hours, mode of delivery, neonatal outcomes, and maternal complications between two groups. RESULTS: In two groups, demographic characteristics were similar. Regarding the change of Bishop score checked after 4 hours and 8 hours, it was statistically shown that the score was significantly high in oral misoprostol group compared to vaginal misoprostol group (5.9+/-1.4 vs. 5.1+/-1.1, p<0.05; 8.6+/-2.3 vs. 7.1+/-2.1, p<0.05). In nulliparous women, the average interval from induction to delivery was shorter in oral misoprostol group than in vaginal misoprostol group (927.4+/-344.7 minutes vs. 1130.6+/-297.0 minutes, p<0.01). In multiparous women, the average interval from induction to delivery was shorter in oral misoprostol group than in vaginal misoprostol group (674.2+/-110.4 minutes vs. 831.1+/-181.6 minutes, p<0.01). There was no clinical or statistical difference between two groups in mode of delivery, cesarean section rate, fetal heart rate abnormalities, tachysystole, hyperstimulation syndrome, meconium staining and fetal outcome (Apgar score at 1 and 5 minutes, birth weight). CONCLUSION: These results suggest that oral misoprostol 100 microgram is more effective for cervical ripening and induction of labor than vaginal misoprostol 50 microgram.
Cervical Ripening ; Cesarean Section ; Female ; Heart Rate, Fetal ; Humans ; Meconium ; Misoprostol* ; Parturition ; Pregnancy