الفهرس 
PHYSIOLOGY OF LABOROnly 14 pages are availabe for public view
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Abstract
Cervical ripening is commonly stimulated pharmacologically before induction of labor, to reduce the risk of failed induction and of operative delivery. Vaginal low-dose misoprostol (a prostaglandin E1 analogue), is recommended by WHO for induction of labor, and it is the current method of choice used for cervical ripening.
In comparison with dinoprostone (a prostaglandin E2 analogue), misoprostol has better efficacy for cervical ripening, which leads to a shorter time from initial dose to delivery and also from initial dose to beginning of the active phase of labor and less need for oxytocin use.
However, using prostaglandins is not without adverse maternal and fetal effects, mainly because of their stimulatory effects on uterine contractions, which may result in uterine rupture and fetal. The ideal agent for the induction of cervical ripening should produce adequate cervical change with minimal fetal and maternal side-effects. Many agents have been proposed for inducing labor and cervical ripening such as: oxytocin, corticosteroids, oestrogen and relaxin
Sildenafil has not been used as a drug for induction of labor in previous studies. However, due to its vasodilator activity, like its family member nitrates, it could be effective if it is used alongside Misoprostol according to FIGO guidelines for induction of abortion.
To the best of our knowledge, No data regarding use of vaginal Sildenafil Citrate and misoprostol for cervical ripening. Thus, the present study was conducted to compare between the role of intravaginal administration of Sildenafil Citrate and misoprostol versus Misoprostol alone in induction of labor.
This randomized controlled clinical trial was conducted at tertiary care hospital at Ain Shams University Maternity hospital (labor ward) and was randomly selected from full term patients attending the labor ward and scheduled for induction of labor.
During this study, 137 patients were assessed for eligibility and 70 patients were included in the study (35 in each group). Of all eligible patients, 64 patients were excluded from the study based on the inclusion criteria and 3 patients refused to participate in of the study.
Ultimately, the analysis was based on the data of 70 patients scheduled for induction of labor and divided into two groups.
Our results revealed that failed induction and uterine hyperstimulation were statistically non-significantly less frequent among sildenafil group.
Our results revealed that the need to cesarean section was statistically significantly less frequent among sildenafil group.
Our results revealed that the duration of induction to active phase interval and the duration of active stage of labor were significantly shorter among Sildenafil group than among Control group.
Consequently, rate of successful induction and completed vaginal delivery (induction to end of delivery) were significantly higher among Sildenafil group than among control group.
We concluded that both intravaginal misoprostol and combination of vaginal Sildenafil Citrate and misoprostol are safe and effective modes of labor induction. vaginal Sildenafil Citrate and misoprostol is more effective than misoprostol alone in terms of post induction Bishop Score, shorter induction to active phase interval and induction to delivery interval.
We recommend Combination of Vaginal Sildenafil Citrate with misoprostol for preinduction cervical ripening.
CONCLUSION
As an evident from the current study, both intravaginal misoprostol and combination of vaginal Sildenafil Citrate and misoprostol are safe and effective modes of labor induction. vaginal Sildenafil Citrate and misoprostol is more effective than misoprostol alone in terms of post induction Bishop Score, shorter induction to active phase interval and induction to delivery interval.
Thus, the combined use of Vaginal Sildenafil Citrate with misoprostol for preinduction cervical ripening at term may prove to be a major therapeutic advance.
RECOMMENDATIONS
Combination of Vaginal Sildenafil Citrate with misoprostol for preinduction cervical ripening is recommended.
It should be noted that further studies require increased sample size.
Considering the small samples of our study, more data are still needed to verify our conclusions.