Department of Obstetrics & Gynecology, Akbarabadi Teaching Hospital, Iran University of Medical Sciences, Tehran, Iran.
Faculty of Medicine, University of Exeter, Exeter, UK.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5616-5620. doi: 10.1080/14767058.2021.1888912. Epub 2021 Feb 23.
Labor induction is an important issue in modern obstetrics. One of the important factors for the success of induction of labor is the Bishop score of cervix.
The purpose of the present study was to evaluate and compare the efficacy of dilapan with extra-amniotic saline infusion and oral misoprostol for cervical ripening in term pregnancies.
This clinical trial study was performed on 120 nulliparous pregnant women with the Bishop score of less than 5. Group one, group two and group three received dilapan, extra amniotic saline infusion (EASI) and misoprostol respectively. All three groups were compared for duration from beginning of the intervention up to cervical ripening and Bishop Score of ≥7, duration of active phase and the second stage of labor, number of deliveries in the first 24 h, duration from beginning of the intervention up to delivery, rout of delivery as well as neonatal weight, neonatal Apgar score; hyper- stimulation, and need for oxytocin and oxytocin doses administered after 12 h of intervention.
The number of deliveries in the first 24 h after intervention were not significantly different between the three groups. There was no significant difference between the three groups according to duration from beginning of the intervention up to cervical ripening and Bishop Score of ≥7, duration of active phase and the second stage of labor, duration from beginning of the intervention up to delivery, rout of delivery as well as neonatal weight, neonatal Apgar score; and hyperstimulation. The Bishop Score was higher in the misoprostol group 6 h after intervention [dilapan: 4.32 ± 1.38, EASI: 5.47 ± 1.28, and misoprostol: 6.72 ± 1.61 ( = .000)], Oxytocin requirement [dilapan: 38 (95%) women, EASI: 37 (92.50%) and misoprostol: 30 (75%) women, = .013], and required dose [dilapan: 7543 ± 2465 miu/ml, EASI: 5758 ± 1615miu/ml and misoprostol: 4930 ± 2589miu/ml, = .000] were lower in misoprostol group.
Dilapan is an effective and safe method for cervical ripening in full term gestations. In cases where misoprostol and EASI cannot be used or are not desirable, dilapan can be used as an alternative.Trial registration number and registry website: IRCT20091023002624N25.
分娩诱导是现代产科的一个重要问题。诱导分娩成功的一个重要因素是宫颈的 Bishop 评分。
本研究旨在评估和比较宫颈扩张器、羊膜外盐水输注和口服米索前列醇在足月妊娠中的促宫颈成熟效果。
本临床试验研究纳入了 120 名 Bishop 评分小于 5 的初产妇。一组、二组和三组分别接受宫颈扩张器、羊膜外盐水输注（EASI）和米索前列醇。比较三组从干预开始到宫颈成熟和 Bishop 评分≥7 的时间、活跃期和第二产程的时间、24 小时内分娩的人数、从干预开始到分娩的时间、分娩方式以及新生儿体重、新生儿 Apgar 评分；过度刺激，以及 12 小时后干预所需的催产素和催产素剂量。
三组 24 小时内分娩人数无显著差异。三组从干预开始到宫颈成熟和 Bishop 评分≥7、活跃期和第二产程、从干预开始到分娩、分娩方式以及新生儿体重、新生儿 Apgar 评分和过度刺激的时间均无显著差异。米索前列醇组干预后 6 小时 Bishop 评分较高[宫颈扩张器：4.32±1.38，EASI：5.47±1.28，米索前列醇：6.72±1.61（ = .000)]，催产素需求[宫颈扩张器：38（95%）例，EASI：37（92.50%）例，米索前列醇：30（75%）例， = .013]和所需剂量[宫颈扩张器：7543±2465miu/ml，EASI：5758±1615miu/ml，米索前列醇：4930±2589miu/ml， = .000]均较低。
宫颈扩张器是足月妊娠促宫颈成熟的有效、安全方法。在不能使用米索前列醇或 EASI 或不希望使用的情况下，可以使用宫颈扩张器作为替代方法。
IRCT20091023002624N25。
