MATERNAL AND FETAL OUTCOME BY INDUCING LABOUR USING DILAPAN –S, A CERVICAL OSMOTIC DILATOR

Abstract

Induction of labour is a widely used practice in obstetrics. It is the process of artificially stimulating the uterus to start labour and expulsion of fetus prior. Globally, in healthcare facilities, about 10% of all the deliveries involved induction of labour. The commonly used methods for induction of labour are mechanical methods such as osmotic dilators, balloon catheters, amniotomy and pharmacological methods such as oxytocin infusion and prostaglandins . Among mechanical methods, Dilapan-S is the second generation osmotic hygroscopic dilator .It is a synthetic gel rod acting by absorbing fluid from the cells of the cervical canal, resulting in reversible cell wall dehydration and softening.By its mechanical stretch, it increases the volume of the rod(s) initiating the endogenous prostaglandin release causing collagen degradation and ripening of the cervix . OBJECTIVES OF THE STUDY: 1. To determine the efficacy and safety of Dilapan-S, an osmotic cervical dilator in induction of labour. 2. To assess the maternal and perinatal outcome following induction with Dilapan-S. xiii MATERIALS AND METHODS: It was a clinical prospective study which included 55 term pregnant women(37 weeks to 42 weeks of gestation) with cephalic presentation admitted to labour room at Sri Devaraj Urs Academy of Higher Education and Research, after obtaining written informed consent and performing routine investigations. Serial records of cardiotocography, modified BISHOP score, partograph are recorded along with monitoring contractions and performing vaginal examinations to assess the changes of the cervix. Total dose of induction, induction to delivery interval, mode of delivery, maternal and fetal outcome were recorded. RESULTS-This study was performed on 55 pregnant women fulfilling the above inclusion and exclusion criteria admitted to SDUAHER.There was no statistical significance different in Bishop Score distribution with respect to parity. In primigravida, 12 cases(57.1%) required 2 Dilapan-S rods, 7 cases(33.3%) required 3 Dilapan-S rods. In multigravida, 15 cases(44.1%) required 2 Dilapan-S rods, 15 cases(44.1%) required 3 Dilapan-S rods. Hence there was no significant difference in the number of Dilapan-S rods distribution with respect to parity. 85.7% and 82.4% primigravida and multigravida respectively took more than 12 hours time interval in latent stage of labour. So, there was no significant difference in latent time distribution with respect to parity. 57.1% and 41.2% primigravida and multigravida respectively took more than 12 hours induction delivery time interval. This difference is not statistically significant in induction to delivery time interval distribution with respect to parity.Syntocin augmentation was required in 42(72.4%) total, among which 13(61.9%) were primigravida and 29(85%) were multigravida. There was statistical significant difference in the requirement of xiv syntocin augmentation distribution with respect to parity. Also, in almost all vaginal deliveries and vaccum assisted vaginal delivery there was 100% need of syntocin augmentation showing significant difference in need of syntocin augmentation distribution with respect to mode of delivery. Out of 55 cases who underwent induction,60% had vaginal delivery of which 8 were primigravida and 25 were multigravida, 38.2% had LSCS of 12 primigravida and 9 multigravida and 1.8% (one primigravida) had vaccum assisted vaginal delivery. There was a significant difference in mode of delivery distribution with respect to Parity. APGAR score at 1st minute more than 7 was in all the cases of primigravida and 97.1% in multigravida. APGAR score at 5 minutes was more than 9 in all the cases of primigravida and 97.1% in multigravida. There was no statistical significant difference in APGAR comparison with respect to Parity. 6 neonates among primigravida and 3 neonates among multigravida mothers needed NICU admission.There was no statistical significant difference in NICU Admission comparison with respect to Parity. CONCLUSIONDilapan- S was effective method of induction of labour in terms of improving cervical ripening and vaginal delivery rate(60%) and was safe with no uterine hyperstimulation or maternal infections or mortality associated. There was need of syntocin augmentation for most of the patients(76.4%). Dilapan S was safe with good fetal outcome, reassuring type of CTG and with reduced need of NICU admission.