articles on slidemethods of priming.pptx

review of articles on methods of priming

1. Topic discussion on options of priming: ( vaginal misoprostol vs trans cervical Foley catheter ) Presenter: Dr Mekonnen G(R-III ) Moderator: Dr F ikrte (R-IV) 1 1/15/2024 by Dr. Mekonnen G.

2. O bjective To review the evidences on options of priming (vaginal misoprostol vs trans cervical Foley catheter). To recommend safer , more cost effective , and more efficient means of preinduction ripening method in our setup taking evidences as baseline. 1/15/2024 by Dr. Mekonnen G. 2

3. Introduction As many as 15 – 30% of pregnant women undergo induction of labor for various reasons P ost-term pregnancy IUGR Preeclampsia, diabetes mellitus O ligohydramnios A bnormal results of antepartum surveillance 1/15/2024 by Dr. Mekonnen G. 3

4. Cont … The success of induction depends on whether the cervix is favorable for induction or not at the time of labor induction . Patients with unfavorable cervices undergoing induction of labor are at high risk of F ebrile morbidity P rolonged labor I ncreased rate of caesarean delivery F etal asphyxia at birth 1/15/2024 by Dr. Mekonnen G. 4

5. Cont … Cervical ripening usually begins before the onset of labor contractions and is necessary for cervical dilatation. It is the result of a series of complex biochemical processes V arious enzymes stimulate chemical reactions R esults in rearrangement and realignment of the collagen fibers C ervix thins, softens, relaxes, and opens in response to uterine contractions 1/15/2024 by Dr. Mekonnen G. 5

6. Cont … In the preparation of the cervix for labor and delivery, a variety of mechanical or pharmacological methods have been developed to induce cervical ripening. Hygroscopic dilators Trans cervical Balloon catheters Antiprogesterone Relaxin gel Prostaglandin preparations 1/15/2024 by Dr. Mekonnen G. 6

7. The purpose of this study was to compare the safety and efficacy of intravaginal misoprostol and an intracervical Foley’s balloon catheter for preinduction cervical ripening and labor induction. A total of 120 patients requiring indicated induction of labor with an unfavourable cervix ( Bishop’s score <=4) were randomised prospectively to receive either 50 mg intravaginal misoprostol every 6 h for a maximum of two doses , or an intracervical Foley balloon catheter for 12 h followed by an intravenous oxytocin infusion. The two arms of the study were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop’s scores . 1/15/2024 by Dr. Mekonnen G. 7

8. Result There were significant change in the Bishop’s score in the two groups (5.9 + 0.2 and 4.0 + 0.2, respectively, p 5 0.001) but no inter group differences. Oxytocin induction or augmentation of labor occurred more in the catheter group (95%) than in the misoprostol group (43.3%) (p 50.0001). Induction to delivery interval was significantly shorter in the misoprostol group than in the catheter group (8.7 + 2.4 vs 11.9 + 2.7 h p 50.0001 ). There was no significant difference noted in the caesarean or other operative delivery rates among patients in the two treatment groups. There was a higher incidence of tachysystole and hyperstimulation in the misoprostol group than in the catheter group (p 50.03). No differences were observed between groups for meconium passage, 1- or 5-min Apgar scores <7 and admission into the neonatal intensive care unit. 1/15/2024 by Dr. Mekonnen G. 8

9. conclusion T he maternal and perinatal outcomes in this study have shown no difference confirming the efficacy and safety of both methods we observe a decrease in the induction-to-delivery interval when misoprostol is used for this purpose. 1/15/2024 by Dr. Mekonnen G. 9

10. CONT… Objective T o compare the effectiveness of the intravaginal Misoprostol and transcervical Foley catheters as pre-induction cervical ripening agents T o estimate the proportion of patients achieving vaginal delivery T o compare the complications of labor and fetal outcome between the two groups 1/15/2024 by Dr. Mekonnen G. 10

11. Cont … 1/15/2024 by Dr. Mekonnen G. 11

12. Cont … Conclusion This study further demonstrated additional advantages of a shorter duration of cervical ripening and reduced oxytocin requirement for induction of labor with intravaginal Misoprostol . A similar proportion of patients achieved vaginal delivery in both groups. The route of delivery, labor complications and fetal outcome were similar with both methods. 1/15/2024 by Dr. Mekonnen G. 12

13. Background: The efficacy and safety of low dose misoprostol as a ripening agent compared to the widely used balloon catheter in developing countries is undetermined . Objective : To compare the safety and efficacy of a low dose intravaginal misoprostol and intracervical Foley’s catheter for cervical ripening. Results : Failure to achieve cervical ripening within two hours was reduced with misoprostol (Relative Risk [RR] 0.63, 95% [ CI] 0.43 - 0.92). Need for oxytocin augmentation was less in the misoprostol group (RR 0.76, 95% CI 0.64 to 0.91). No significant differences existed in rates for uterine hyperstimulation , Caesarean section, maternal and neonatal morbidity. 1/15/2024 by Dr. Mekonnen G. 13

14. Result cont … 1/15/2024 by Dr. Mekonnen G. 14

15. Cont … C onclusion L ow dose of misoprostol used was more effective than intracervical ballon catheter for cervical ripening It is promising as a drug to use in developing countries 1/15/2024 by Dr. Mekonnen G. 15

16. A Randomized Comparison of Transcervical Foley Catheter to Intravaginal Misoprostol for Preinduction Cervical Ripening Objective : To compare the efficacy of intravaginal misoprostol tablets with transcervical Foley catheter for preinduction cervical ripening. 1/15/2024 by Dr. Mekonnen G. 16

17. Cont … Results :- Among 111 women, 53 were allocated to misoprostol and 58 to Foley bulb. Contractile abnormalities were more frequent in the misoprostol (20.4%) than the Foley group (0%)( P < .001). No statistically significant differences were noted between groups in change in Bishop score, pre-induction cervical ripening times, and total induction times. There were no statistically significant differences in mode of delivery or adverse neonatal outcomes. 1/15/2024 by Dr. Mekonnen G. 17

18. Cont … Conclusion : Intravaginal misoprostol and transcervical Foley catheter are equivalent for cervical ripening . Uterine contractile abnormalities and meconium passage are more common with misoprostol. ( Obstet Gynecol 2001;97:603–7.© 2001 by The American College of Obstetricians and Gynecologists.) 1/15/2024 by Dr. Mekonnen G. 18

19. 1/15/2024 by Dr. Mekonnen G. 19

20. 1/15/2024 by Dr. Mekonnen G. 20

21. Results: Mean duration of onset of labour was 13.60±5.0 and 15.26±3.58 hours, induction-full dilatation was 18.83±2.94 and 20.03±2.46 hours and induction-delivery interval was 20.04±2.82 and 21.18±2.32 hours in the misoprostol and Foley’s catheter groups respectively. The differences were not significant. Mode of delivery and fetal outcome were also same in both group Conclusion: prostaglandins are currently most commonly accepted and widely used agents for the ripening of unfavourable cervix and for induction of labour in the developed countries Foley’s catheter for cervical ripening has been found as an alternative method to prostaglandins 1/15/2024 by Dr. Mekonnen G. 21

22. Result Vaginal delivery was significantly higher in misoprostol group (89.9 vs. 62.7, p < 0.01 ). The mean of delivery time was significantly shorter in misoprostol group (11.08 ± 5.6 vs. 13.6 ± 16.0 h, p < 0.05). Conclusion: The results of the present study indicate that vaginal misoprostol improves the process of delivery and increases the rate of vaginal delivery in the cases of unripe cervix. However, more studies with higher volume samples can be led to justify these result 1/15/2024 by Dr. Mekonnen G. 22

23. 1/15/2024 by Dr. Mekonnen G. 23

24. summary Misoprostol acts as a ripening agent and an induction agent, with close to 40% of women entering labor without added oxytocin. Misoprostol is safer , more cost effective, and more efficient means of preinduction ripening method in our setup. 1/15/2024 by Dr. Mekonnen G. 24

25. Recommendation Misoprostol can be used as priming method in our setup because of its; Safety cost effectiveness efficient 1/15/2024 by Dr. Mekonnen G. 25

26. References Abdi , N., Alavi , A., Pakbaz , F.  et al.  Vaginal misoprostol versus intracervical Foley catheter for cervical ripening in postdate primigravid women: a randomized clinical trial.  BMC Pregnancy Childbirth   21 , 533 (2021). https://doi.org/10.1186/s12884-021-04011-0 OA Adeniji , A Oladokun , O Olayemi , OI Adeniji , AA Odukogbe , O Ogunbode , CO Aimakhu , AO Omigbodun & AO Ilesanmi (2005) Pre-induction cervical ripening: Transcervical foley catheter versus intravaginal misoprostol, Journal of Obstetrics and Gynaecology , 25:2, 134-139 T.O. Tabowei , MBBS, FMCOG, FWACS and V.O. Oboro , MBChB , FMCOG, FWACS, Department of Obstetrics and Gynaecology , Zonal General Hospital, Kwale , Delta State, Nigeria : LOW DOSE INTRAVAGINAL MISOPROSTOL VERSUS INTRACERVICAL BALOON CATHETER FOR PRE-INDUCTION CERVICAL RIPENING, East African Medical Journal Vol. 80 No 2 February 2003 J FERDOUSa , NN KHANAMb , MR BEGUMc , S AKHTER: Cervical Ripening: Comparative Study between Intracervical Balooning by Foley’s Catheter and Intravaginal Misoprostol Tablet Journal of Bangladesh College of Physicians and Surgeons Vol. 27, No. 1, January 2009 Fatemeh Vahid Roudsari a , Sedigheh Ayati a *, Marzieh Ghasemi a , Maliheh Hasanzadeh Mofrad a , Mohamad Taghi Shakeri b , Farnoush Farshidi a and Masoud Shahabian c : Comparison of Vaginal Misoprostol with Foley Catheter for Cervical Ripening and Induction of Labor, Iranian Journal of Pharmaceutical Research (2011), 10 (1): 149-154 Tajossadat Allameh , Zahra Sadat Seyed-Hoseini , Zahra Allameh , Maryam Dehghan : Cervical ripening: Intravaginal Misoprostol in Compare to Intracervical Foley Single Balloon Catheter, A Randomized Clinical Trial, JOGCR. 2023; 8(2): 113-119 Alfred Osoti , Davies Kiprop Kibii , Tito Mario Kual Tong* and Innocent Maranga : Effect of extra-amniotic Foley’s catheter and vaginal misoprostol versus vaginal misoprostol alone on cervical ripening and induction of labor in Kenya, a randomized controlled trial, Osoti et al. BMC Pregnancy and Childbirth (2018) 18:300 A. T. OWOLABI, O. KUTI, & I. O. OGUNLOLA : Randomised trial of intravaginal misoprostol and intracervical Foley catheter for cervical ripening and induction of labour , Journal of Obstetrics and Gynaecology , August 2005; 25(6): 565 – 568 Nazanin Abdi1*, Azin Alavi1, Forough Pakbaz1 and Hossein Darabi : Vaginal misoprostol versus intracervical Foley catheter for cervical ripening in postdate primigravid women: a randomized clinical trial, https://doi.org/10.1186/s12884-021-04011-0 1/15/2024 by Dr. Mekonnen G. 26