الفهرس 
Induction of LaborOnly 14 pages are availabe for public view
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Abstract
Labor induction at term is applied in various fetal and maternal indications as required for 15–30% of pregnancies in obstetric practice.This procedure, with low Bishop Scores, may result in an exhausting labor course associated with higher rates of operative deliveries, longer hospitalization, and increased medical costs. Cervical ripeners, namely, laminaria tents, estrogen gels, relaxin, prostaglandin (PG) analogs have been used with varying success. Various PG preparations including misoprostol vaginal tablets, dinoprostone vaginal gel and vaginal insert are commercially available to be used in labor induction.
Misoprostol is a synthetic prostaglandin E1 analog and has been reported to be a considerably safe and efficacious cervical ripener. It is inexpensive, easy to administer, stable at room temperature, does not require refrigeration.In spite of different doses and routes of administration (sublingual, oral, vaginal), ideal dosage and mode of administration still remain to be controversial. Potential complications such as uterine rupture, tachysystole and uterine hyperstimulation should be emphasized with respect to adverse maternal and neonatal outcome. A considerable amount of work has concentrated on optimum dosing regimen that minimizes the risk while maintaining efficacy since both efficacy and side effects are suggested to be dose dependent.
At present, the only agent specifically approved by US Food and Drug Administration (FDA) for labor induction is dinoprostone. Dinoprostone; a PGE2 analog has been shown to be an efficacious agent of cervical ripening and labor induction, available as gel, tablet, pessary or suppository. However, it is expensive, requires refrigeration and mostly needs oxytocin augmentation.
In this study, we aimed to compare safety and efficacy of intravaginal misoprostol with that of intravaginal dinoprostone for labor induction in term pregnancies.
This study was conducted in Elgalaa teaching Hospital where 220 pregnant females were included for induction of labor. They were divided into two groups each of 110 female. One group received 50g misoprostol vaginal and the other group received 3 mg dinoprostone vaginal.
In this study, both groups were demographically similar regarding (maternal age, gestational age, parity and Bishop Score), there was no significant statistical difference.
Delivery route was not significantly different between groups, although the study concluded that there was increase in risk of cesarean section in dinoprostone group but the results was not significantly different between groups.
Regarding the time needed for vaginal delivery between both groups, it was found that there was no significant statistical difference.
The need of oxytocin augmentation was not significantly different in both groups.
As regards uterine hyperstimulation there was no significant difference between groups.
The frequency of suspicious and pathological fetal heart rate patterns did not differ significantly.
Neonatal outcomes (Neonatal weight, 5-min Apgar Score <7, meconium stained amnios, NICU admission) did not differ significantly between groups.
There were no significant differences in maternal outcome with respect to abruptio placenta, postpartum atonia and estimated blood loss between the two groups. No maternal death and uterine rupture were reported.
The results suggested that intravaginal misoprostol is as effective in promoting cervical ripening and inducing labor as intravaginal dinoprostone, misoprostol has a similar maternal and perinatal safety profile to dinoprostone. The cost benefit of misoprostol is apparent.