Search

1 Trial of labour after cesarean (TOLAC) is a safe alternative to repeat cesarean delivery [1] Pregnant people who have had a previous cesarean delivery can have a TOLAC or [...]

Low-dose oral misoprostol is as effective as vaginal dinoprostone for inducing labor, according to a study of 200 women. Both of these drugs are prostaglandins, which make the uterus contract. Low-dose oral misoprostol has fewer side effects than high-dose oral misoprostol.

An extra-amniotic saline solution infusion combined with oxytocin may be more effective and safer for inducing labor than a vaginal suppository containing misoprostol, according to a study of 200 pregnant women. Women who received the oxytocin and saline infusion gave birth more quickly and had fewer side effects from the treatment.

The drug misoprostol appears to be evenly distributed in the pill, so doctors can be sure their patients are getting the correct dose if they cut the pill into four pieces. This is done because the pill contains 100 micrograms of misoprostol, but doctors recommend using 25 micrograms to induce labor. However, doctors should weigh the pieces and only use pieces that weigh 26.5 milligrams or less.

Vaginal suppositories containing misoprostol are as effective as intravenous oxytocin for inducing labor, according to a study of 104 pregnant women. However, women whose fetus may not tolerate labor should be given oxytocin rather than misoprostol or they will need a cesarean delivery.

An oral dose of misoprostol can cause cervical ripening in pregnant women in labor, according to a study of 339 women who received either oral misoprostol or intravaginal dinoprostone. Cervical ripening means the uterine cervix becomes soft and begins to relax in preparation for childbirth. Women whose labor must be induced are often given treatments to ripen the cervix.

A lozenge containing misoprostol that can be held in the mouth is as effective in inducing labor as a vaginal suppository, according to a study of 157 pregnant women. An oral form of the drug may be more acceptable to women than a vaginal form.

Sublingual misoprostol appears to be more effective in inducing labor than oral misoprostol, according to a study of 100 women. Sublingual medication is placed under the tongue. Seventy-four percent of the women who took sublingual misoprostol delivered within 24 hours compared to 46% of those who took oral misoprostol.

A vaginal suppository containing dinoprostone appears to be effective in inducing labor when used in combination with oxytocin. Dinoprostone is a synthetic version of prostaglandin E(sub 2), which is a natural hormone. It is sold under the trade names Cervidil and Prepidil.

Laminaria japonicum appears to be more effective than extra-amniotic saline solution infusion for softening the cervix in pregnant women who must be delivered before term. The cervix must be softened so it can expand and allow the baby to pass through.

Vaginal suppositories containing misoprostol and abdominal sodium chloride infusions appear to be equally effective in inducing labor. This was the conclusion of a study of 123 pregnant women who were randomly assigned to receive one or the other treatment.

Oral misoprostol appears to be as effective as a Foley catheter and intravenous oxytocin for inducing labor in pregnant women, unless the pregnancy is the woman's first. This was the conclusion of a study of 200 pregnant women who needed induced labor.

A Foley catheter may be more effective than intracervical prostaglandin E(sub)2 for ripening the cervix during induced labor. Ripening the cervix means enlarging and softening the cervix so the baby can pass through. Researchers randomly assigned 77 pregnant women to have a Foley catheter placed into the cervix and 72 pregnant women to have a prostaglandin E(sub)2 gel suppository place in the cervix. Women who had the Foley catheter had shorter labor and lower health care costs than women who received prostaglandin E(sub)2 suppositories.

Prostaglandin E2 intracervical gel, followed immediately by intravenous oxytocin, appears to be more effective than a prostaglandin vaginal insert in inducing obstetrical labor in women with preeclampsia. Preeclampsia is a hypertensive complication of pregnancy that can cause fetal injury, so labor may be medically stimulateds. Researchers compared Prepidil, a prostaglandin gel, and Cervidil, a vaginal insert, in the treatment of 70 preeclamptic patients. Prepidil treatment induced vaginal delivery in an average of 11.5 hours, while Cervidil induced delivery in an average of 25.8 hours.

Prostaglandin E2 as an intracervical gel, when used with oxytocin, may more rapidly and less expensively induce labor, compared to a prostaglandin vaginal insert. Researchers compared Prepidil gel and the Cervidil insert for inducing labor in pregnant women with resistant cervices. The gel induced labor leading to delivery in an average of 11 hours, compared to 25 hours in patients given the vaginal insert. Treatment with the gel form of the drug was $458 less expensive than the insert.

A vaginal pessary that slowly releases prostaglandin E2 appears to be more effective in softening the cervix in preparation for childbirth. The cervix must soften and dilate so the baby can pass through it, and prostaglandins are often used for this purpose. Researchers compared a slow-release vaginal pessary called Cervidil with a prostaglandin E2 cervical gel call Prepidil in 90 women who were randomly assigned to one or the other. The Cervidil pessary softened the cervix faster and shortened the time to delivery.

A vaginal gel containing prostaglandin E2 may be effective in ripening the cervix in some women with prolonged pregnancies. Cervical ripening is the term used for the softening of the cervix, which must occur if it is to open wide enough to allow the baby to pass through the birth canal. Researchers randomly assigned 90 women past their due date to receive a vaginal gel containing prostaglandin E2 or a placebo at the time they came for fetal heart rate monitoring. Women with a Bishop score between 3 and 6 who received prostaglandin E2 required fewer labor inductions compared to the other groups.

Vaginal misoprostol appears to be as effective as intravenous oxytocin in inducing labor in pregnant women with premature rupture of membranes. Researchers randomly assigned 197 pregnant women to receive intravenous oxytocin or vaginally administered misoprostol. Those in the misoprostol group took an average of an hour longer to deliver, but 86% of the women in both groups ultimately had a vaginal delivery. Fetal and maternal outcomes were similar in both groups.

A balloon catheter combined with the prostaglandin E2 gel dinoprostone appears to be more effective than misoprostol in ripening the cervix to induce labor. Misoprostol is a synthetic version of prostaglandin E1. Researchers compared intravaginal misoprostol with intravaginal dinoprostone combined with a balloon catheter to stretch the cervix. Cervical ripening was faster in the catheter/dinoprostone group and their labor was shorter compared to the misoprostol group.

Prostaglandin gel and cervix manipulation appear to be effective in promoting labor in women beyond the 41st week of pregnancy. These techniques are used to ripen the cervix, allowing delivery of the infant. Researchers evaluated the two techniques along with daily cervical examinations (the control group) in 105 women with a pregnancy beyond the 41st week. Twenty percent or fewer patients in the groups receiving these techniques required labor induction compared to 69% of the control group.

Injection of dexamethasone through the cervix may shorten the time from induction of labor to delivery. Ninety-eight women requiring cervical ripening, softening and thinning of the cervix, and induction of labor had Foley balloon catheters inserted through the cervix and either saline or dexamethasone was injected. Intravenous oxytocin was administered to induce labor. The 50 women treated with dexamethasone experienced shorter intervals between induction and active labor and shorter times between induction and delivery than the 48 women in the group receiving saline only.

A single dose of misoprostol may be more efficient in inducing and shortening the length of labor than a dose of prostaglandin E2 (PGE2) gel. Seventy-five women requiring softening and thinning of the cervix before labor inducement were treated with either misoprostol or PGE2. Average labor time in misoprostol-treated women was 14.7 hours compared with 20.4 hours in the group treated with PGE2. Only 58% of the women using misoprostol required further labor inducement with oxytocin, contrasted with 81% using PGE2. Misoprostol, a synthetic prostaglandin, costs far less than PGE2.

A synthetic hormone, misoprostol, may be more effective in inducing labor than the commonly used prostaglandin E2 (PGE2). One-hundred women were given either misoprostol or PGE2 intravaginally to induce labor. The dose was repeated as needed at 6, 24, and 30 hours. The group receiving misoprostol delivered within 24 hours more often than the other group, and fewer of the misoprostol group required more than two doses. No significant increase in adverse effects were seen with misoprostol compared with PGE2, and misoprostol costs less and stores more easily.

A time-released, medicated, cervical suppository called Cervidil appears to be more effective in reducing time to cervical ripening and time in labor than a medicated gel called Prepidil. Both preparations, however, ultimately achieve their desired purpose. Thirty-seven women were given Cervidil and 36 matched women were given Prepidil to induce labor. Women delivered an average of 20.6 hours after Cervidil insertion and 26.4 hours after Prepidil application. Twenty-four percent of those given Cervidil did not require oxytocin to induce labor. All but 3% given Prepidil later required oxytocin.

A medicated tablet called Cytotec that contains misoprostol and is placed on the cervix appears to be equally effective in reducing a woman's time in labor as a medicated, time-released vaginal suppository called Cervidil that contains dinoprostone. Ninety-nine women were treated with Cytotec and 101 women were treated with Cervidil to induce labor. Women given Cytotec delivered an average of one hour earlier and were less likely to experience rapid contractions but were slightly more likely to need oxytocin than those given Cervidil. An equal number of women in each group ultimately delivered by cesarean.

A lower dose of a labor-inducing medication called misoprostol may be safer for the infant even though the higher dose may speed up the delivery process. Labor and delivery statistics were analyzed among 399 women given either 25 micrograms or 50 micrograms of misoprostol to induce labor. Infants born to mothers given the higher dose had more rapid heart beats and a more acidic cord pH than those given the lower dose. Women given the higher dose delivered in 826 minutes compared to 970 minutes in those given the lower dose. More women given one dose of 50 micrograms of misoprostol delivered vaginally than those given one 25 microgram dose.

Vaginally administered prostaglandin E2 gel may be as safe and effective as insertion into the cervix. Prostaglandin E2 gel is used to soften the cervix in women undergoing induction of labor. Researchers randomly assigned 83 women undergoing induction of labor to either vaginal or cervical insertion of prostaglandin E2 gel. No differences were seen in any parameters relating to the effectiveness of the gel or the effectiveness of labor induction or of complications or problems relating to the gel.

Injecting saline into the amniotic fluid sac in pregnancies with low amniotic fluid levels appears to be a safe and effective way to prevent complications at birth. Researchers randomly assigned 39 at-term women with low amniotic fluid levels to receive a saline injection (study group) and 40 at-term women with similarly low amniotic fluid levels to have their labor induced (control group). The control group had five times more cesarean deliveries and was 12.9 times more likely to have a newborn with an abnormal heart rate. There were no complications associated with the saline injections.

A hygroscopic cervical dilator appears to help ripen the cervix but may not improve labor outcomes with induction of labor. Softening and thinning an unready cervix is thought to increase the chances of successful induction of labor. A group of 240 women who required induction of labor but had unripe cervixes were randomly assigned to preinduction insertion of a synthetic hygroscopic dilator or not. The dilator improved cervical readiness for labor but did not reduce the length of labor or the cesarean rate, which approached 4 in 10 women in both groups.

More frequent vaginal doses of misoprostol to ripen the cervix before induction of labor may offer advantages over spacing doses wider apart. Researchers randomly assigned 522 women requiring labor induction to a maximum of 8 doses given every 3 hours or 6 doses given every 4 hours. Average time to vaginal birth was shorter in the 3-hour regimen, and 42% of women required oxytocin stimulation of labor versus 51%. However, the cesarean rate was 21% overall and did not differ between groups, and more than one-third of fetuses in both groups experienced abnormal fetal heart rate patterns.

A prostaglandin gel applied to the vagina may be more effective than intravenous oxytocin in ripening the cervix before labor induction. Researchers compared the effectiveness of two doses of intravaginal prostaglandin E2 gel applied four hours apart to 10 hours of oxytocin infusion in 200 women with unripe cervices before labor induction. Use of the prostaglandin E2 gel was linked to more successful labor inductions and less time to active labor than with oxytocin. Cesarean delivery rates were similar for both treatments. The gel and oxytocin were found to be safe for mothers and infants.

The use of high-dose oxytocin might reduce the rate of cesarean sections without increasing the incidence of birth complications. Oxytocin is used to induce labor when the cervix fails to dilate at term. Of 310 women at 37 weeks gestation or greater who were eligible for induced labor, 156 were given low-dose oxytocin and 154 were given high-dose oxytocin. Low-dose oxytocin consisted of an infusion of 1 milliunits per minute (mU/min) and increasing up to 4 mU/min. High-dose oxytocin consisted of 4 mU/min and higher doses until the uterus began to contract. High-dose oxytocin reduced the cesarean rate substantially with no increase in complications of labor or fetal distress. High-dose oxytocin also reduced the time it took for the cervix to dilate.

There appears to be little difference in delivery outcomes when using prostaglandin E2 to induce labor when the chemical is given vaginally or inside the cervix. Researchers randomized 288 women who were more than 37 weeks pregnant to receive prostaglandin E2 gel administered vaginally (140 women) or inside the cervix (142 women). If the women had not gone into labor after 6 hours, another dose was given. The only statistically significant difference between the groups was that the Bishop score was more likely to increase following the treatment in women who received prostaglandin E2 inside the cervix. Women who had had previous pregnancies were more likely to have a higher Bishop score after prostaglandin E2 administration regardless of how they received it. Almost half of the women receiving intracervical prostaglandin E2 went into labor after one dose, compared to 34% of those receiving the chemical vaginally.

Inducing labor by using a vaginal prostaglandin suppository may reduce the risk of complications and allow this procedure to be done on an outpatient basis. Researchers treated 100 women attending an outpatient clinic who were between 38 and 40 weeks pregnant with a vaginal suppository once a day for five days. Fifty women received 2 milligram prostaglandin E2 (PGE2) suppositories and 50 received a placebo. The women were placed on a fetal monitor 10 minutes before they received the suppository and at least 30 minutes after. The median time to delivery in the women receiving PGE2 was 4 days compared to 10 days in the women receiving a placebo. Twenty-six percent of the women receiving PGE2 were admitted for labor after the first dose, compared to 8% of those receiving a placebo. By the end of 5 days, 54% of the women receiving PGE2 were admitted for labor, compared to 20% in the placebo group.

Doctors who rupture the amniotic membranes of pregnant women undergoing labor induction may need to consider the timing of rupture and the dose of the inducing drug to prevent infection and compression of the umbilical cord. Researchers compared the outcomes of women undergoing labor induction, 106 of whom had their membranes ruptured early in labor and 103 of whom did not have their membranes ruptured until their cervices were dilated halfway. Women whose membranes were ruptured early had shorter labors but a higher incidence of infection and serious umbilical cord compression. The risk of infection was reduced if they received oxytocin every 30 minutes rather than every 60 minutes. Labor induction may need to be tailored according to the risks and reasons for induction.

A prostaglandin E1 gel applied to the inside of the vagina may be more effective in inducing labor and less expensive than a prostaglandin E2 gel applied to the cervix. Researchers gave intravaginal prostaglandin E1 (misoprostol) gel to 49 pregnant women who needed to have labor induced and intracervical prostaglandin E2 (dinoprostone Prepidil) gel to 50 other patients. All women were at least 35 weeks' pregnant. Intravaginal prostaglandin E1 gel induced labor more quickly and provided shorter labors than did the intracervical prostaglandin E2 gel. Fewer doses were required among women receiving prostaglandin E1 gel. The cesarean delivery rate was 20% in both groups. Misoprostol overstimulated the uterus in 2% of the women but did not lead to undesirable outcomes.

The commercially available cervical ripening gel, dinoprostone, may be more effective than gels prepared by hospital pharmacists. Hospital-compounded prostaglandin E2 gel preparations are much less expensive than dinoprostone. Researchers compared the effectiveness of dinoprostone applied to the cervices of 70 women undergoing labor induction to that of a hospital-prepared gel on 64 women. Both gels had the same concentration, 0.5 milligrams, of prostaglandin E2. Women receiving dinoprostone had a lower cesarean section rate (12.9%) than did the women receiving the hospital-compounded gel (28.1%). More fetal heart rate abnormalities, resulting in cesarean sections, occurred in the hospital-compounded gel group. The differences in how the two gels worked could not be detected, but the low cost of the hospital-prepared gel was offset by the increase in cost associated with higher rates of cesarean section amongst women using it.

Some pregnant women with an unfavorable cervix during induction of labor with a full-term infant may be helped by cervical ripening agents. Researchers divided 99 women into three treatment groups: oxytocin infusion, estradiol cream administered vaginally, and prostaglandin E2 gel applied to the cervix. A total of 59% of the women had to be delivered by cesarean section. Of these women, none of the treatments produced significant differences in cervical ripening. Of the women who were delivered vaginally of infants, those who received oxytocin experienced the most dramatic cervical change. Oxytocin is the least expensive option, so may be the best candidate for reducing the cesarean delivery rate.

Cervical insertion of prostaglandin E2 (PGE2) gel and insertion of a balloon catheter proved equally effective in ripening the cervix prior to labor induction. Women anticipating labor induction with a Bishop score (a 10-point scale measuring cervical readiness for labor) less than or equal to 4 were randomly assigned to have PGE2 gel cervically instilled or a balloon cather instilled and inflated the night before induction. Thirty-four women received the catheter and 28 the gel. The PGE2 group averaged an increase in Bishop score of 4.1 and the catheter group averaged 4.8. The cesarean rate was 18% in the catheter group versus 25% in the PGE2 group. In the catheter group, half of labors were free of complications versus 36% of the PGE2 group. This was primarily due to a fetal distress rate of 24% in the catheter group versus 39% in the PGE2 group. These differences were not statistically significant.

Low-dose oxytocin therapy and prostaglandin E2 (PGE2) gel may produce equally good results among women undergoing cervical ripening prior to induction of labor. A group of 158 women beyond 28 weeks gestation undergoing induction with an unfavorable cervix (Bishop score at or below 5) were randomly assigned to PGE2 therapy or low-dose I.V. oxytocin. All women received both therapies, but in one group, the gel contained no PGE2, and in the other, the I.V. contained saline. Two doses of gel were given six hours apart and the I.V. was run for 12 hours. Women with PGE2 ripening were equally likely to have a Bishop score greater than or equal to 6 at time of induction (64% vs. 52%) and to have a vaginal birth (76% vs. 75%). Women were more likely to give birth within 24 hours with PGE2 ripening (64% vs. 47%), but the few hours' difference was not clinically important. Hyperstimulation during cervical ripening occurred only during PGE2 ripening.

When vaginal instillation of a higher dose of prostaglandin E2 (PGE2) was compared with intracervical administration of a lower dose, both appeared to be equally safe, but intravaginal instillation was easier and had a higher likelihood of cervical change. PGE2 is used to ripen the cervix prior to induction of labor. One hundred women at or beyond 35 weeks gestation who were scheduled for induction and had an unfavorable cervix (Bishop score at or below 4) participated in the study. They all received up to three doses of both intravaginal and intracervical gel at six hour intervals, except that one of the syringes contained a placebo and the other PGE2. Oxytocin induction was carried out either when the Bishop score increased by 3 points or more or after 12 hours. Intravaginal application was more likely to change the Bishop score (60% vs 40%) and to stimulate regular contractions (73% vs. 48%). One woman in each group had uterine hyperstimulation. Similar numbers required oxytocin induction (54% vs 60%) or augmentation (23% vs. 27%), had cesareans (23% vs 27%), or had infants with 5-minute Apgar score less than 7 (4% vs 2%).

Vaginally applied misoprostol (RU 486) may be an effective and safe drug for inducing labor in women whose fetuses have died. Misoprostol is a prostaglandin E2 analog used orally for abortion. Seventy-two women delivered at a Mozambique hospital had misoprostol labor induction for fetal death at gestational ages 18 to 40 weeks. No woman had a uterine scar. The mean length of time from induction to birth was 12.6 hours. Ninety-two percent delivered by 24 hours and all women delivered by 48 hours. No adverse effects were noted and no surgical procedures were required. Moreover, misoprostol costs much less than other alternatives and unlike an oxytocin drip, it does not require continuous supervision.

Oxytocin delivered in pulses by a computer-controlled pump appears to be an effective means of inducing labor and results in pregnant women receiving lower average doses of the drug. Oxytocin stimulates uterine contractions. Women who required labor induction were randomly assigned to either computer-controlled pulsatile delivery of oxytocin (114 women), aggressively managed continuous delivery of the drug (87 women) or conservatively managed delivery of the drug (109 women). Those using the computer-controlled pump received doses of oxytocin from 1 to 20 milliunits (mU) no closer than five minutes apart and no sooner than 30 seconds after a contraction. Women in the other two groups received an initial dose of 0.67 mU of oxytocin. The aggressively managed group received more oxytocin more often than the conservatively managed group. No ill effects on the fetus were noted with any of the protocols. Those using the computer-controlled pulsed doses received 20% less of the drug than those on the continuous infusion protocols. Those in the computer-controlled protocol had the shortest infusion times except for women who had delivered previously and had high scores on a measure of labor progression.

Evidence-based answer Yes, some do. Breast stimulation and electroacupuncture help, while other common remedies that have been studied are ineffective, possibly unsafe, or both. Unilateral breast stimulation shortens the time [...]

Oxytocin, the pituitary hormone which causes uterine contraction, is often given as a continuous intravenous treatment to induce or augment labor. Complications associated with this treatment have included uterine hyperstimulation, fetal distress, and increased neonatal bilirubin levels, and these apparently are related to dosage. Oxytocin is secreted by the pituitary in pulses, and administering the substance in this way may provide for a better response and outcome. The effectiveness and safety of pulsatile intravenous oxytocin therapy in 50 women was compared with continuous intravenous administration in 56 women, all of whom needed induction of labor. The induction-to-delivery time was similar in both groups, with no difference noted in uterine hyperstimulation, use of pain medication, or epidural anesthesia. Six percent of the infants in the pulsed group and 12.5 percent of those in the continuous group were delivered by cesarean section. There were no differences among newborns in birth weight, Apgar score (an index of fetal well-being), or blood acidity. Among infants with hyperbilirubinemia, those in the continuous group were an average of two weeks older in terms of gestational age and tended to have a significantly higher birth weight and level of bilirubin. The pulsed group received less oxytocin, independent of the induction-to-delivery time. The study suggests that pulsed oxytocin is as safe and effective as continuously administered oxytocin and may provide a better margin of safety in high-risk conditions, since lower doses were needed. In addition, pulsed oxytocin may be less likely to result in hyperbilirubinemia among term infants, but more research on these effects are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)