جستجوی مقالات مرتبط با کلیدواژه « آماده سازی سرویکس » در نشریات گروه « پزشکی »

Cervical ripening is essential for vaginal delivery, therefore, a safe and appropriate method should be considered for cervical ripening. Today, various medical methods are used for cervical ripening, such as estrogen gels, prostaglandins, and nitroglycerine. However, the preference of one to the other is unknown. This study was performed aimed to compare the effects of vaginal misoprostol and vaginal nitroglycerine gelatin capsule on cervical ripening in term and post-term pregnancy.

This trial study was performed in 2019 on 90 pregnant women with term and post-term pregnancies who were candidates for vaginal delivery induced by an unfavorable cervix (bishop score equal or <4) and referred to Fatemieh Hospital in Hamadan. Patients were divided into two groups of vaginal nitroglycerine and vaginal misoprostol. The data of the two groups related to demographics, dilatation, labor progress, newborn Apgar and postpartum bleeding were recorded in the forms through observation. Data were analyzed by SPSS software (version 20) and T-test, Chi-square, and Fisher tests. P<0.05 was considered statistically significant.

The rate of cervical ripening in the nitroglycerine group was significantly higher than the misoprostol group (P<0.05). The incidence of side effects such as headache, hypotension, and postpartum bleeding before and after delivery was 6 cases (13%) in the nitroglycerin group and 12 cases (33.3%) in the misoprostol group, which was statistically significant (p<0.05). Moreover, the active phase of labor was significantly shorter in the misoprostol group than the nitroglycerin group (p<0.05).

vaginal nitroglycerine gelatin capsule with a suitable dose can cause rapid and transient softening of the cervix and can help to vaginal delivery. The side effects of vaginal nitroglycerine gelatin capsule are more limited and controllable than the side effects of vaginal misoprostol.

One of the most common methods of pregnancy termination in postdate pregnancies is cervical ripening by insertion of a Foley catheter in the hospital. Recently, some studies have been performed on cervical ripening as outpatient to reduce the length of hospital stay. This study was performed with aim to compare the results of outpatient and inpatient cervical ripening.

This case-control study was performed on 231 women with prolonged pregnancies in 2019. First, Foley catheter was inserted through the cervix. Outpatient group was sent to the home and the other group was hospitalized. After spontaneous excretion of the catheter, induction was performed in both groups using misoprostol and oxytocin. Duration of catheter insertion until its excretion and until delivery, dose of misoprostol and oxytocin, length of hospital stay, incidence of postpartum fever and rate of cesarean section were determined in both groups. Data were analyzed by SPSS software version 16) and Chi-square, independent T-test and or non-parametric equivalent tests. p < 0.05 was considered statistically significant.

The time interval between Foley catheter incretion and excretion (P=0.000) and the time interval between insertion of the Foley catheter and delivery (p=0.046) was significant between the two groups and was less in the hospitalized group. The need for misoprostol (p=0.001) and oxytocin (p=0.02) was different between the two groups and was less in the outpatient group. Mode of delivery (p= 0.892) and postpartum fever (p=0.202) was not significantly different between the two groups; the duration of hospitalization was shorter in outpatient group (p=0.051).

Outpatient cervical ripening in postdate pregnancy has no complication and shortens the duration of hospitalization.

The use of misoprostol and transcervical Foley catheter is an effective method in cervical ripening. According to the literature, there is a controversy surrounding the results of the comparison of these two methods and the combined method. This study was conducted to compare the individual and combined administration of misoprostol and transcervical Foley catheter in Ayatollah Mousavi Hospital, Zanjan, Iran, during 2013-14.
This randomized clinical trial was carried out among 85 nulliparous women with the gestational age of 40 weeks or more and the Bishop score of equal to or less than 4 with less than two contractions every 10 min. The subjects were randomly assigned into three groups of misoprostol (n=30), transcervical catheter (n=30), and combined (n=25). The misoprostol group received the maximum dose of 100 µg of misoprostol in equally divided doses every 4 h. A transcervical Foley catheter 18 F, inflated with 50 cc of normal saline was inserted into the cervices of the participants in the transcervical catheter group. Additionally, the combined group were simultaneously treated with both methods. The time interval between the intervention and the onset of labor, duration of the latent and active phases, and method of delivery (cesarean section or natural vaginal delivery), and the rates of neonatal and maternal complications were compared in these three groups. Data analysis was performed using the Chi-squared test and one-way analysis of variance in the SPSS software, version 22. The P-value less than 0.05 was considered statistically significant.
No significant difference was observed between the groups in terms of the method of delivery, duration of the active phase, meconium, fetal distress, chorioamnionitis, and uterine tachysystole (P>0.05). However, the duration of latent phase was significantly shorter in the combined group compared to the misoprostol group (P=0.002, P=0.001). The duration of the first phase of labor was significantly shorter in the combined group in comparison to the transcervical Foley catheter group (P=0.009).
Given the results, both methods were effective in cervical ripening; nevertheless, the combined method was more effective than using transcervical Foley catheter in shortening the duration of the first phase of labor.

Cervical ripening is essential in vaginal delivery; so, a safe and suitable method should be considered for cervical ripening. Nowadays, different methods are used for cervical ripening, including estrogen gels, prostaglandins and TNGs that their preference is unclear. This study was performed with aim to compare vaginal misoprostol and trinitroglycerin (TNG) on cervical ripening at term pregnancy.
This randomized clinical trial was performed in 2011 on 148 primigravida patients with term pregnancy and unfavorable cervix (Bishop score ≤ 4) who were candidate for induced vaginal delivery and referred to Zahedan Ali Ebne Abi Talib hospital. The patients were divided into two groups: group A (400 µg vaginal TNG) and group B (25 µg vaginal misoprostol). The outcomes in two groups were recorded in the forms by observation. Data was analyzed by SPSS software (version 11.5) and Chi-square and T-test. P After administration of the drugs, cervical ripening (P Misoprostol compared to TNG causes more effective and rapid cervical ripening and also has less side-effect.

Cervical ripening plays a pivotal role in successful induction of labor. Considering the importance of vaginal delivery, numerous methods have been proposed to ripen the cervix before proceeding with labor induction. This study aimed to compare the effects of transcervical catheter, Laminaria, and Isosorbide mononitrate on cervical ripening.
This clinical study was conducted at Kosar Teaching Hospital of Qazvin, Iran on 75 singleton nulliparous women with gestational age of ≥39 weeks and Bishop score of less than four. Participants were randomly divided into three groups of transcervical catheter, Laminaria, and isosorbide mononitrate. In the first group, oxytocin was administered after the spontaneous discharge of catheter, and immediately after obtaining the Bishop score of >4 in the other groups. The following parameters were recorded and compared between the study groups: interval between the time of labor induction and cervical ripening, Bishop score at the time of induction, interval between oxytocin administration and full cervical dilation, duration of the second and third labor phases, mode of delivery, and maternal and neonatal complications (IRCT: 2014012616368N1).
FINDINGS: In this study, mean duration of cervical ripening was 150±42.42 minutes in the catheter group, 337.77±99.38 minutes in the Laminaria group, and 732.63±105.03 minutes in the isosorbide mononitrate group (p=0.001). Bishop scores at the time of labor induction and during the interval between induction and full cervical dilation were significantly lower in the transcervical catheter group (p=0.001). Moreover, no significant differences were observed between the study groups in terms of the duration of the second and third labor phases, mode of delivery, and maternal and neonatal complications.
According to results of this study, use of transcervical catheter led to the improvement of the Bishop score and reduced length of labor phases.

Induction of labor with an unfavorable cervix is one of the common reasons of pharmacologic and non pharmacologic agents available for cervical ripening and labor induction. The aim of this study was the assessment of cervical ripening with misoprostol in third trimester termination of pregnancy.

This clinical trial study was conducted on 100 candidates for termination of pregnancy in Kosar hospital with gestational age ≤ 28 weeks. The including criteria were nuliparity and primiparity intact membrane single fetus bishop score ≤5 reassuring FHR and cephalic presentation. The excluding criteria were unexplained vaginal bleeding placental previa estimated fetal weight over 4kg any C.P.D previous uterine scar and medical contraindication of misoprostol. The patients were divided into two groups with random allocation. In case group one dose of vaginal misoprostol inserted posterior cul-de-sac. In control group induction of labor with low dose of oxytocin was done.

T he gestational age of mother's parity initial bishop score mode of delivery staining of meconium first and fifth Apgar score was similar in both groups. Interval induction until delivery in misoprostol group was less than other group 442.7 ± 345 min Vs 635.9 ±371 min. About 22 women in misoprostol group did not need oxytocin for induction and alone with single dose of misoprostol were delivered (16womans 72/7%) NVD and (6womans 27/3%) C/S.

Further studies are recommended on the use of misoprostol on labor induction before the end of term pregnancies with unfavorable cervix.

Sometimes despite an unripe cervix, induction of labor may be needed. In these cases, safe and suitable method should be considered for cervical ripening and pregnancy termination. The aim of this study was to assess the comparison of vaginal misoprostol with foley catheter for cervical ripening and induction of labor. This randomized clinical trial was performed on 110 pregnant women referred to the teaching hospit-als of Mashhad University of Medical Sciences during a time period of September 2007 to March 2008. The women were randomly divided into two groups: misoprostol (49 cases) and foley catheter (59 cases). For first group, 25 microgram vaginal misoprostol every 4 hour up to maximum 6 doses was administered. For second group, foley catheter 18F inflated with 50 cc of sterile water was placed through the internal os of the cervix. Data was analyzed by SPSS software. P < 0.05 was considered statistically significant. Two groups were similar in the view of demographic characteristics, cesarean indications, maternal-fetal outcomes and neonatal outcomes. Vaginal delivery was significantly higher in misoprostol group (89.9 vs. 62.7, P = 0.001). The mean of delivery time was significantly shorter in misoprostol group (11.08 ± 5.6 vs. 13.6 ± 16.0 h, P < 0.05). In the case of need to pregnancy termination and unripe cervix, two methods of misoprostol and foley catheter are suitable, but it seems that misoprostol decreases time of delivery and need to cesarean more than the other.

It is necessary to terminate pregnancy for fetal or maternal indications in some second trimester pregnancies. The cervix is usually unripe in 2nd trimester, so pre-induction ripening is mandatory. The aim of this study is to compare the efficacy of extra-amniotic saline infusion with prostaglandin E2 suppository in pre-induction cervical ripening in 2nd trimester pregnancies. In this study, women (n= 80) with indications of termination of pregnancy (range 14-28 weeks) and bishop scores of 3 and lower were assigned randomly to receive extra-amniotic saline infusion (2ML/ min) or prostaglandin suppository (6mg).We induced uterine contractions using intravenous oxytocin only when contractions had not commenced by 6 hours after extra-amniotic saline infusion and 4 hours after prostaglandin. We assessed ripening efficacy, success and failure of therapy, mean time of induction, and complications of two methods. Statistical analysis was done based on the data. The mean pre-ripening bishop score was l.2±0.53 in group 1 (extra-amniotic saline infusion) and 1.68±0.66 in group 2 (prostaglandin). The mean post- ripening BSC was 4.5±2.14 in group I and 3 ± 1.6 in group 2, which was significant. There were 20 (%50) fetus expulsion in group 1 and 8 (20%) in group 2. The mean time for induction was 17.27 ± 8.38 hours in group 1 and 20.9 ±6.17 hours in group 2, which was statistically significant. One patient in group 1 had vaginal bleeding because of warfarin use. Three patients had nausea in group 2. There were no other complications in both methods. Cervical ripening by extra-amniotic saline infusion is faster and more effective than 6 mg prostaglandin E2 suppository, resulting in a higher rate of fetus expulsion in 2nd trimester.

Finding the most suitable method for cervical ripening in patients with all the indications for terminating their pregnancy, is a considerable problem in obstetrics. The objective of this study was to compare intravaginal misoprostol, traction on the cervix with a Foley catheter and a combination of the two methods for the induction of labor. This randomized clinical trial was performed at Shahid Akbar-Abadi teaching Hospital from March 2004 to February 2005, on 300 pregnant women with a gestational age of 28 weeks, who had the indications for terminating their pregnancy. All of the cases had a Bishop score of 5 and were singletons. In 100 patients (Group 1), misoprostol (25g every 3 hours up to a maximum dose of 6) was used intravaginally. In the next 100 patients (Group 2), a No. 16 Foley’s catheter was introduced into the intracervical canal, its bulb being filled with 30 ml of distilled water, to exert traction on the cervix. In the last 100 patients (Group 3), a combination of the two methods was used. The time interval between the start of the methods to delivery, duration of the active phase of labor, the interval between the beginning of the methods to beginning of the active phase, cesarean section rates and neonatal Apgar scores were compared in the three groups. The obtained data were statistically analyzed by SPSS software employing χ2, one-way ANOVA and Kruskal Wallis tests. There were no statistically significant differences between the three groups according to age, gestational age, parity and Bishop scores. The interval between the beginning of the methods and delivery was shorter in the misoprostol group (p0.001)_10.53 hours in misoprostol group, 12.32.4 hours in the Foley catheter group and 11.72.5 hours in the combination group. The duration of active phase in the misoprostol group was less than the Foley catheter group (p0.001)_ 5.51.9 hours in the misoprostol group, 6.61.6 hours in the Foley catheter group and 6.11.5 hours in the combination group. There was no statistically significant difference between the three groups regarding the interval between the beginning of the methods and the beginning of the active phase, neonatal Apgar score or cesarean section rates. Misoprostol and Foley catheters are good methods for cervical ripening and the induction of labor, but the combination of the two methods does not increase their effectiveness and there seems to be no synergistic effects.