Khaled İbrahim Abu El AİSH, Haly Suliman ZOUROB

Oral misoprostol versus dinoprostone vaginal tablets for labor induction

Amaç: Doğum indüksiyonu yaygın bir obstetrik uygulamasıdır. Bu çalışma, doğum indüksiyonu için uygun ve güvenli ilacı bulmak ve doğum indüksiyonunda oral misoprostol ve vajinal dinoprostonun güvenlik ve etkinliği bakımından karşılaştırılması için yapılmıştır. Materyal ve Metod: Provizyonel, prospektif ve kesitsel olan bu çalışmada, doğum indüksiyonu için tıbbi veya obstetrik endikasyonlu baş prezentasyonu ile karaktrize 155 tekil gebe iki gruba ayrılmıştır. İlk grupa nullipar ve düşük doğum sayısı (1-4) olanlar için oral olarak 50 mikrogram, grand multiparite (≥5) için 25 mikrogram misoprostol günde en fazla 4 doz olacak şekilde her 6 saatte bir oral olarak verilmiştir. İkinci grupta dinoproston 3mg vajinal tabletleri nulliparlara 1,5mg, düşük doğum sayısı olanlara ve Grand multipariteye sahip olanlara 1,5 mg olarak her 8 saatte bir posterior fornikse yerleştirilmiştir. Birincil sonlanım ölçütleri: indüksiyon başarısı, indüksiyon-verilme sıklığı ve kullanılan dozun sayısı. İkincil sonlanım ölçütleri: maternal yan etkiler, sezeryan oranı, ilacın verilme biçimi ve neonatal sonlanım. Bilgiler hasta vaka notlarından toplanmıştır ve SPSS (version13.0) yazılımı kullanılarak analiz edilmiştir. Farklılıkların istatistiksel anlamı için p

Anahtar Kelimeler:

Misprostol, dinoproston, doğum indüksiyonu, indüksiyon verilme aralığı, servikal olgunlaşma

Oral misoprostol versus dinoprostone vaginal tablets for labor induction

Purpose: Induction of labour is common in obstetric practice. We conducted this study to find the appropriate and safe drug for labour induction and to compare the safety and efficacy of oral misoprostol and vaginal dinoprostone for labour induction. Material and Methods: In a provisional, prospective and cross-sectional study, one hundred and fifty five singleton cephalic presentation full term pregnancies with medical or obstetric indication for labour induction were allocated in two groups. First group received oral 50 micrograms for nulliparas and low parity group (1-4), and 25micrograms for grand multiparas (≥ 5) misoprostol orally every 6 hours to a maximum of four doses daily. In the second group vaginal tablets of dinoprostone 3mg then 1.5mg for nulliparas and 1.5mg for low parity and grand multiparas groups were inserted in the posterior fornix, every 8 hours. Primary outcome measures were: induction success, induction-delivery interval and number of used doses. Secondary outcome measures included: maternal side effects, caesarean section rate, mode of delivery and neonatal outcome. Data was collected from patient case notes and analyzed using software SPSS (version 13.0) and p-value < 0.05 was used as statistical significance of differences. Results: In our study there were no significant differences in baseline parameters in the two groups nor in the indications for labor induction except misoprostol was used in premature rupture of membrane. Induction of labor succeeded in 123 (79.35%) women without other interventions from other methods (80.26% misoprostol group versus 78.5% dinoprostone p=0.492). It was observed that there were no significant differences between the two groups in final outcomes nor in obstetrical complications. There was no significance in differences between misoprostol and dinoprostone groups in induction-delivery interval (15.2 ± 14.5 hours versus 16.4 ± 11.3 hours p=0.6 resp.). Conclusion: This study demonstrated that oral misoprostol is as effective as vaginal dinoprostone tablets for induction of labor and can be a good alternative for this purpose.

Keywords:

Misoprostol, dinoprostone, ınduction of labour, ınduction delivery interval, cervical ripening,

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Riskin-Mashiah S, Wilkins I. Cervical ripening. Obstet Gynecol Clin NorthAm. 1999; 26: 243
Tenore JL. Methods for cervical ripening and induction of labor. Am Fam Physician. 2003; 67: 2123-8.
Guerra GV, Cecatti JG, Souza JP, Faündes A, Morais SS, Gülmezoglu AM, Passini R Jr, Parpinelli MA, Carroli G; for the WHO Global Survey on Maternal; Perinatal Health in Latin America Study Group. Elective induction versus spontaneous labour in Latin America. Bull World Health Organ. 2011; 89: 657-665.
Caughey AB, Sundaram V, Kaimal AJ, Cheng YW, Gienger A, Little SE, Lee JF, Wong L, Shaffer BL, Tran SH, Padula A, McDonald KM, Long EF, Owens DK, Bravata DM. Maternal and neonatal outcomes of elective induction of labor. Evid Rep Technol Assess (Full Rep). 2009; 176: 1-257.
Crane JM, Butler B, Young DC, Hannah ME. Misoprostol compared with prostaglandin E2 for labour induction in women at term with intact membranes and unfavourable cervix: a systematic review. BJOG 2006; 113(12): 1366
Nassar N, Sullivan EA, Lancaster P, Day P. Australia's mothers and babies 1998. Sydney: AIHW National Perinatal Statistics Unit, 2000.
Boulvain M, Kelly A, Irion O. Intracervical prostaglandins for induction of labour Cochrane Database Syst Rev 2008; 1: CD006971
Fekih M, Ben Zina N, Jnifen A, Nouri S, Ben Regaya L, Memmi A, Bouguizene S, Chaieb A, Bibi M, Sboui H, Khairi H. Comparing two Prepidil gel regimens for cervical ripening before induction of labor at term: a randomized trial. J Gynecol Obstet Biol Reprod (Paris). 2009; 38: 335-40.
Goffinet F, Humbert R, Clerson P, Philippe HJ, Breart G, Cabrol D. [National survey on the use of induced labor by obstetricians. Study Group on Induced Labor]. J Gynecol Obstet Bio Reprod (Paris). 1999; 28: 319-29.
Getahun D, Dublin S, Fassett M. .Recent Trends in Induction of Labor. Clin Med Res 2011; 9:178.
Garry D, Figueroa R, Kalish RB, Catalano CJ , Maulik D. Randomized controlled trial of vaginal misoprostol versus dinoprostone vaginal insert for labor induction. J. Matern.Fetal Neonatal Med. 2003: 13: 254–9.
Wing D.A, Ham D, Paul R.H. A comparison of orally administered misoprostol with vaginally administered misoprostol for cervical ripening and labor induction. Am. J. Obstet. Gynecol. 1999; 280: 1155–60.
Kwon JS, Davies G, Mackenzie VP. A comparison of oral and vaginal misoprostol for induction of labour at term: a randomized trial. Br. J. Obstet. Gynaecol. 2001; 108: 23–6.
Williams MC, Tsibris CM, Davis G, Baiano J, Brien WFO. Dose variation that is associated with approximated one-quarter tablet doses of misoprostol. Am. J. Obstet. Gynecol. 2002; 187: 615–9.
Windrim R, Bennet K, Mundle W, Young D. Oral administration of misoprostol for labourinduction: a randomised controlled trial. Obstet. Gynecol. 1997; 89: 392–7.
Dällenbach P, Boulvain M, Viardot C, Irion O. Oral misoprostol or vaginal dinoprostone for labour induction: a randomized controlled trial. Obstet. Gynecol. 2003; 188: 162–167.
Barrilleaux PS, Bofill JA, Terrone DA, Magann EF, May WL, Morrison JC. Cervical ripening and induction of labour with misoprostol, dinoprostone gel, and a Foley catheter: a randomized trial of 3 techniques. Am. J. Obstet. Gynecol. 2002; 186: 1124–9.
Langenegger EJ, Odendaal HJ, Grové D. Oral misoprostol versus intracervical dinoprostone for induction of labor. International Journal of Gynecology & Obstetrics. 2005; 88: 242-8
Weeks A, Alfirevic Z, Faşndes A, Hofmeyr GJ, Safar P, Wing D. Misoprostol for induction of labor with a live fetus. International Journal of Gynecology & Obstetrics. 2007; 99: 194-7.
Chung JH, Huang WH, Rumney PJ, Garite TJ, Nageotte MP. A prospective randomized controlled trial that compared misoprostol, Foley catheter and combination misoprostol– Foley catheter for labor induction. Am J obstet Gynecol. 2003; 189: 1031–5.
Kashanian M, Akbarian A.R, Fekrat M. Cervical ripening and induction of labor with intravaginal misoprostol and Foley catheter cervical traction. International Journal of Gynecology & Obstetrics. 2006; 92: 79-80.
Jozwiak M et al. Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): An open-label, randomised controlled trial. Lancet. 2011; 378: 2095 - 2103
Crane JMG, Delaney T, Hutchens D. Oral misoprostol for premature rupture of membranes at term. American Journal of Obstetrics and Gynecology. 2003; 189: 720-4.
Yazışma Adresi / Address for Correspondence: Dr. Khaled Ibrahim Abu El aish Al Helal Emirati Hospital GAZA STRIP e-mail: khaledaish@yahoo.com geliş tarihi/received :24.10.2012 kabul tarihi/accepted:17.12.2012