Results of using a combined method of cervical preparation for childbirth
Objective. To optimize approaches to preparing the cervix uteri for childbirth in patients with the maternal passages being unprepared for labor. To comparatively evaluate the efficiency of a combined method for cervical preparation for childbirth with DILAPAN-S in combination with mifepristone, that of mechanical methods for cervical preparation with DILAPAN-S and a Foley catheter, as well as medical preparation of the cervix with prostaglandin E2(PGE2).Brega E.S., Sakharova G.V., Pekarev O.G.
Subjects and methods. The prospective comparative study enrolled 158 pregnant women aged 23 to 38 years (259-284 days of pregnancy). DILAPAN-S 4 was inserted for up to 12 hours in combination with mifepristone 200 mg twice at a 24-hour interval to prepare the cervix uteri for childbirth in 28 women (Group 1); the cervix uteri was prepared for childbirth, by inserting four DILAPAN-S dilators in 30 patients (Group 2); this was carried out, by inserting the balloon of a Foley catheter into the cervix for up to 12 hours in 50 patients (Group 3); the soft maternal passages were prepared for childbirth, by administering PGE2 gel 0.5 mg twice at a 6-hour interval in 50 patients (Group 4).
Results. The DILAPAN-S + mifepristone group displayed a mean Bishop score of 1.5, 2.14, and 1.9 higher than in the DILAPAN-S, Foley catheter, and PGE2 gel groups, respectively. In addition, the proportion of vaginal births was significantly higher in Group 1 than in the Foley catheter and PGE2 gel groups. The duration of labor differed in Groups 1-3, 2-3, and 3-4. Additional labor preinduction and induction were needed only in Groups 2, 3, and 4.
Conclusion. The combined method of cervical preparation for childbirth with DILAPAN-S in combination with mifepristone of 200 mg twice is a more effective method than mechanical techniques, such as DILAPAN-S, a Foley catheter or medical preparation of the cervix with PGE2 gel.
Keywords
preparation of the cervix uteri for childbirth
preinduction
dilapan
mifepristone
Foley catheter
prepidil gel
prostaglandins
dinoprostone
prostaglandin E2
Supplementary Materials
- Table 1. Assessment of the degree of maturity of the cervix by the Bishop scale
- Table 2. Assessment of the fetal state on the Apgar scale
- Table 3. Indications for pre-induction of labor
- Table 4. Assessment of the cervix by the Bishop scale before and after pre-induction
- Table 5. Indications for cesarean delivery in patients after pre-induction
- Fig. 1. Evaluation of the preparation of the cervix in groups
- Fig. 2. Indications for delivery by cesarean section
- Fig. 3. Average duration of delivery (min.)
References
1. Баев О.Р., Румянцева В.П., Кан Н.Е., Тетруашвили Н.К., Тютюнник В.Л., Ходжаева З.С., Адамян Л.В., Сухих Г.Т. Подготовка шейки матки к родам и родовозбуждение. Клинический протокол. М.: Федеральное государственное бюджетное учреждение Научный центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова Минздравсоцразвития России; 2012. [Baev O.R., Rumyantseva V.P., Kan N.E., Tetruashvili N.K., Tyutyunnik V.L., Khodzhaeva Z.S., Adamyan L.V., Sukhikh G.T. Preparation of the cervix for childbirth and induction. Clinical protocol. Moscow: Federal State Budgetary Institution Research Center of Obstetrics, Gynecology and Perinatology named after. academician V.I. Kulakov, Ministry of Health and Social Development of Russia; 2012. (in Russian)]
2. Айламазян Э.К., Кулаков В.И., Радзинский В.Е., Савельева Г.М., ред. Акушерство. Национальное руководство. М.: ГЭОТАР-Медиа; 2014. [Aylamazyan E.K., Kulakov V.I., Radzinsky V.E., Saveleva G.M., ed. Obstetrics. National guideline. Moscow: GEOTAR-Media; 2014. (in Russian)]
3. Sanchez-Ramos L. Induction of labor. Obstet. Gynecol. Clin. North Am. 2005; 32(2): 181-200. doi: 10.1016/j.ogc.2004.12.004.
4. Jozwiak M., Bloemenkamp K.W., Kelly A.J., Mol B.W., Irion O., Boulvain M. Mechanical methods for induction of labour. Cochrane Database Syst. Rev. 2012; (3): CD001233. doi: 10.1002/14651858.CD001233.pub2.
5. Embrey M.P., Mollison B.G. The unfavourable cervix and induction of labour using a cervical balloon. J. Obstet. Gynaecol. Br. Commonw. 1967; 74(1): 44-8.
6. Lim C.E.D., Ng R.W.C., Xu K. Non-hormonal methods for induction of labour. Curr. Opin. Obstet. Gynecol. 2013; 25(6): 441-7.
7. Drunecký T., Reidingerová M., Plisová M., Dudič M., Gdovinová D., Stoy V. Experimental comparison of properties of natural and synthetic osmotic dilators. Arch. Gynecol. Obstet. 2015; 292(2): 349-54. doi: 10.1007/s00404-015-3623-3.
8. Cromi A., Ghezzi F., Uccella S., Agosti M., Serati M., Marchitelli G., Bolis P. A randomized trial of preinduction cervical ripening: Dinoprostone vaginal insert versus double-balloon catheter. Am. J. Obstet. Gynecol. 2012; 207(2): 125. e1-7. doi: 10.1016/j.ajog.2012.05.020.
9. Bruckner T., Cheng Y., Caughey A. Increased neonatal mortality among normal-weight births beyond 41 weeks of gestation in California. Am. J. Obstet. Gynecol. 2008; 199(4):421. e1-7.
10. Hoopmann M., Hirneth J., Pauluschke-Fröhlich J., Yazdi B., Abele H., Wallwiener D., Kagan K.O. Influence of mifepristone in induction time for terminations in the second and third trimester. Geburtshilfe Frauenheilkd. 2014; 74(4): 350-4. doi: 10.1055/s-0033-1360361.
Received 09.06.2017
Accepted 23.06.2017
About the Authors
Brega Yevgeny S., obstetrician-gynecologist, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia.117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: e_brega@oparina4.ru
Sakharova Galina K., Clinical resident, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: g_sakharova@oparina4.ru
Pekarev Oleg Grigorievich, MD, professor, deputy chief physician of the Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: o_pekarev@oparina4.ru
For citations: Brega E.S., Sakharova G.V., Pekarev O.G. Results of using a combined method of cervical preparation for childbirth. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (11): 37-43. (in Russian)
https://dx.doi.org/10.18565/aig.2017.11.37-43
Similar Articles
