Prostaglandin vaginal gel induction of labor comparing amniotomy with repeat prostaglandin gel

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• 作者：Michael Beckmann ; MBBS ; FRANZCOG^a ; ^b ; ^{Michael.Beckmann@mater.org.au" class="auth_mail" title="E-mail the corresponding author} ; Sailesh Kumar ; MBBS ; FRANZCOG ; CMFM ; FRCOG ; FRCS ; PhD^a ; ^b ; Vicki Flenady ; RN ; RM ; MMedSci ; PhD^a ; Ellen Harker ; MBBS^a
• 关键词：cervical ripening ; induced labor
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：213
• 期：6
• 页码：859.e1-859.e9
• 全文大小：639 K

文摘

The purpose of this study was to compare 2 inductions of labor protocols.

Study Design

Women with live singleton pregnancies at ≥37 + 0 weeks gestation who were booked for prostaglandins 2 (PGE₂) vaginal gel induction with a modified Bishop’s score of <7 were eligible for inclusion. After an evening dose of PGE₂ vaginal gel, women were assigned randomly the next morning into the amniotomy or repeat-PGE₂ group. The amniotomy group underwent artificial rupture of membranes (ARM), regardless of modified Bishop’s score, and received further PGE₂ doses only if ARM was not technically possible. The repeat-PGE₂ group received further PGE₂ (to a maximum of 3 doses) until a modified Bishop’s score ≥7 occurred, when an ARM was performed. In both groups, Syntocinon was commenced once membranes were ruptured. The primary outcome measure was time from commencement of induction until birth.

Results

Two hundred forty-five women were assigned randomly into either the amniotomy (n = 121) or repeat-PGE₂ group (n = 124). The time for induction of labor–to-birth was >5 hours shorter in the amniotomy group (24.8 vs 30.0 hours; mean difference, 5.2 h; 95% confidence interval, –2.5 to –7.8). Fewer women in the amniotomy group remained undelivered after 24 hours (47.1% vs 67.7%; P < .01). However, the likelihood of an in-hours birth and the length of hospital stay were no different between the groups. There was no difference in the mode of birth or any of the secondary outcomes.

Conclusion

After an initial dose of PGE₂ vaginal gel, an amniotomy (once technically possible) is associated with a shorter induction of labor–to-birth time compared with the use of repeat doses of PGE₂. Administering more PGE₂ with the aim of starting contractions or making the cervix “more favorable,” appears to have no clinical advantage.