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Title: | A RANDOMISED CONTROLLED TRIAL COMPARING INTRAVAGINAL MISOPROSTOL ALONE VERSUS COMBINATION OF CERVICAL FOLEYS CATHETER AND INTRAVAGINAL MISOPROSTOL FOR INDUCTION OF LABOUR |
Authors: | TEJASHREE N.R |
Issue Date: | Apr-2021 |
Publisher: | SDUAHER |
Abstract: | Induction of labour is commonly performed in the obstetric department. now a days which indicates the need of effective methods for the induction of labour. Around 20% of deliveries are initiated using induction methods.When the risk of continuing the pregnancy is more than benefits of delivery an induction for labour is preferred. Common indication for induction of labour include maternal medical conditions like hypertension or diabetes mellitus, premature rupture of membranes, chorioamnionitis, placental abruption or foetal conditions like foetal growth restriction or oligohydramnios and post term pregnancy. Cervical ripening has a major in successful induction of labour and vaginal delivery. It is the first component of induction of labour where in cervix is softened in preparation of labour. Mechanical methods like Foley’s catheter or pharmacologic methods are used for the cervical ripening. Cervical ripening takes place with a series of biochemical processes which cause many changes in cervix like collagen fibril rearrangement and realignment, glycosaminoglycan composition changes, increased production of cytokine and infiltration of white blood cells. Balloon catheters and hygroscopic dilators are mechanical methods of cervical ripening. Balloon catheters like Foley’s catheter cause cervical ripening by stimulating endogenous release of prostaglandins through physical and mechanical stretching of cervix. Foley’s catheter induces changes in biochemical mediators resulting in cervical ripening. OBJECTIVES OF THE STUDY 1. To determine the safety and efficacy of 25 microgram intravaginal misoprostol for induction of labor in primigravida with term pregnancy. 2. To determine the safety and efficacy of combined intracervical foleys- intravaginal misoprostol for induction of labor in primigravida with term pregnancy. 3. To compare the maternal and fetal outcomes between the groups. STUDY DESIGN: It is a randomised controlled trail conducted on Primigravida at term gestation who are admitted in labour ward for induction of labour at RL Jalappa Hospital, Kolar during the study period. MATERIALS AND METHODS:200 pregnant women included in the study. They were alternatively divided into 2 groups(combined group and misoprostol group).In combined group , 16F foleys catheter inserted aseptically into cervix with concurrent intravaginal administration of 25 microgram misoprostol 6th hourly for a maximum of 4 doses. In misoprostol group 25 micrograms misoprostol inserted into the posterior fornix of vagina every 6 hours until the cervix was favourable(Bishop score >/- 6). Progress of labour is monitored by a partogram and in all cases fetal heart was monitored by continuos CTG.Outcome measures such as rate of vaginal delivery , induction to active stage interval , induction to delivery interval, NICU admissions , maternal complications were recorded. RESULTS: Two hundred women were included in the final analysis. The combined group and misoprostol group showed a mean age of 24.85 ± 4.93 and 24.55 ± 4.35 years. Preinduction modified bishop score 2, 3, 4 and 5 were identified in the combined group with 34%, 31%, 29% and 6% whereas, in misoprostol group with 33%, 46%, 12% and 9% respectively. In the combined group, APGAR at 1 minutes were >=7 and <7 in 83% and 17% of participants whereas, in misoprostol group identified with 71% and 29%. Similarly, APGAR at 5 minutes in combined group were >=9 in in 84% and <9 in 16% of participants whereas, in misoprostol group identified with 72% and 28%. CONCLUSION: The combined use of foleys catheter plus misoprostol is associated with shorter duration of cervical ripening , shorter induction to delivery interval . The combined use of foleys catheter and misoprostol also appears to cause less hyperstimulation and tachysystole compared with misoprostol alone. Perinatal outcome was similar between between the two groups. |
URI: | http://172.16.4.202:8080/xmlui/handle/123456789/8078 |
Appears in Collections: | Obstetrics & Gynaecology |
Files in This Item:
File | Description | Size | Format | |
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Dr. TEJASHREE N.R final ed.pdf | 1.49 MB | Adobe PDF | View/Open |
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