الفهرس | Only 14 pages are availabe for public view |
Abstract Cervical status is one of the most important factors for predicting successful induction of labor. Women who require labor induction often present with unfavorable cervix, the induction rate is around 10-20%. Pre induction cervical ripening is often done to increase the likelihood of successful labor induction. Cervical ripening or preparedness for induction should be assessed before a regimen is selected. Assessment is accomplished by calculation of Bishop’s score. The common clinical practice nowadays in pregnant women undergoing pre-induction cervical ripening by the use of prostaglandins E2 or by mechanical methods such as an interacervical balloon catheter like the Foley’s catheter 30ml or 60ml). The aim of this study was to compare the efficacy of transcervical Foley’s catheter balloon versus prostaglandins E2 tablet(s) as pre-induction cervical ripening agent. The present study was a prospective randomized clinical trial. Ninety pregnant women admitted for labor induction, which was conducted at the labor ward of Ain Shams Maternity Hospital, during the period from June 2013 to August 2014 after obtained an informed consent. The women in this study subdivided into groups (prostaglandin E2 group) which used of 3 mg dinoprostone inserted vaginally every six hours, for a maximum dose of (2 doses), (Foley’s catheter 30ml group) assigned for the use of the transcervical Foley’s catheter with 30 ml balloon capacity, which was inserted for a maximum period of 12 hours, till its spontaneous expulsion, or till a ripe cervix was reached (Bishop’s score≥5) and (Foley’s catheter 60ml group) as Foley’s catheter 30ml but 60 ml balloon capacity. All pregnant women who met the inclusion criteria were submitted to full history taking, general, abdominal and vaginal examination to determine the initial Bishop’s score,. Record of the time of insertion of each treatment modality was taken, and time of subsequent doses or adjustment together with information about women’s progress or events happened during the labor follow up. Oxytocin was used (and recorded in the special forms) in three groups when indicated, with respect that it was not started until 6 hours after the last dose in those pregnant women who received intravaginal dinoprostone. Records were kept of occurrence of any complications, route of delivery and time, and the neonatal outcomes including Apgar scores. Statistical analysis of the obtained results showed the three groups as regard mean age, parity, estimated gestational age and the initial Bishop’s scores (preripening). The indications for labor induction varied between past data, hypertensive disorders, oligohydramnios and gestational diabetes were no statistically significantly. Preinduction Bishop’s scores were no statistically significantly between women of (Foley’s catheter 60ml group or Foley’s catheter 30ml group compared to dinoprostone (prostaglandin E2 group). On the other hand three treatment modalities (each separately) showed statistical significant improvement in the pre induction Bishop’s scores compared to the initial ones. Foley’s catheter 60ml had significantly reduced the time of cervical ripening and the total time from start ripening till delivery when compared to prostaglandin E2 group or Foley’s catheter 30ml group. Three treatment modalities (prostaglandin E2 group, Foley’s catheter 30ml Foley’s catheter 60ml) were no statistically significantly on the route of delivery of the women ,neonatal outcomes, Apgar scores and the need for oxygen supplementation during post delivery neonatal resuscitation. Three treatment modalities (prostaglandin E2 group, Foley’s catheter 30ml or Foley’s catheter 60ml) were effective in achieving pre-induction cervical ripening, but the latter had achieved shorter time of achieving the desired effects. |