DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175291

A prospective randomized trial of trans cervical Foley’s with extra amniotic saline infusion versus intra cervical prostaglandin E2 gel for induction of labour setting

Sunil Kumar, Rita D., R. M. Desai, Mohan Kumar K. R., Dhanalaxmi .

Abstract


Background: This study evaluated the effectiveness of Extra-amniotic saline infusion (EASI) in comparison with that of intracervical Prostaglandin E2 (PGE2) gel for cervical ripening and induction of labour.

Methods: The study conducted in SDM College of Medical College Dharwad, Department of OBG, from December 2012 to November 2013. Consecutive patients with unfavorable cervices requiring pre-induction cervical ripening and induction of labour for various indications were asked to participate in this study. 50 patients (Group A) underwent extra amniotic saline infusion and 50 patients (Group B) underwent PGE2 gel application. Post induction augmentation if required was administered. Labour profile outcomes were compared between the groups.

Results: Results were comparable in terms of maternal age, indication for induction in majority of cases, pre-induction Bishop Score, mode of delivery, complications and side effects, neonatal complications, and Apgar Score. The mean post induction Bishop Score was higher in EASI group by an average of 9. The mean duration of augmentation was more in PGE2 group by an average of 2 hrs. The induction delivery interval (IDI) was prolonged by an average of 3.5 hours in PGE2 group.

Conclusions: For pre-induction cervical ripening the extra amniotic saline infusion is valid alternative for the PGE2 gel. Both the modes of induction were equally safe and effective in terms of mode of delivery and Apgar Score. EASI, however, had rapid cervical ripening and shorter induction delivery interval.


Keywords


Bishop score, Cervical ripening, Extra amniotic saline infusion, PGE2 gel, Induction of labour

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References


Cunnigham FG, Levano KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Labor and delivery. Willams Obstetrics, 23rd ed. New York: McGraw Hill; 2010: 136, 146, 374, 378, 500, 630.

Mishra R, Management of labour. Renumishra. Ian Donald’s, Practical obstetric problems. 7th ed. BI publications: New Delhi;2014:496.

Fuents A, Williams M. Cervical assessment. Clinical Obstet Gynecol. 1995;38(2)224-31.

Calder AA, Greer LA. Cervical Physiology and induction of labour. Bonnar J Rec Adv Obstet Gynecol. 2002;17:98-100.

Gransstrom L, Ekman G, Malmsrom A. Insufficient remodelling of uterine connective tissue in women with protracted labour. Br J Obstet Gynecol 1999;98(12):1212-16.

Liggins GC. Ripening of the cervix. Semin Perinatol. 1978;2:261.

Humera B, Edwin C. Physiopharmacology of labour. Sabartanam A, Gita A, Leone KP eds. The Management of labour. 3rd ed. Chennai;Universities press;2011:2.

Huszar G, Walsh MP. Biochemistry of the myometrium and the cervix. In Biology uterus, Wynn R, Jolliee W. 2nd ed; New York; Plenum Medical. 1989:355-402.

Roy AC, Arulkumaran S. Pharmacology of Parturition. Ann Acad Med Singapore. 1991;20:71-7.

Arulkumaran S, Rao B, Ratnam R. Text Book of Obstetrics and Gynecology for PG. 1999;2:101-78.

Weiss G, Teichman S, Stewart D, Nader D, Wood S, Unemori E. A Randomized, Double‐Blind, Placebo‐Controlled Trial of Relaxin for Cervical Ripening in Post‐Delivery Date Pregnancies. Annals New York Acad Sci. 2009 Apr 1;1160(1):385-6.

Osman I, Young A, Ledingham MA, Thomson AJ, Jordan F, Greer IA et al. Leukocyte density and pro-inflammatory cytokine expression in human fetal membranes, decidua, cervix and myometrium before and during labour at term. Mol Hum Reprod. 2003;9:41-45.

Fisk NM, Ronderos-Dumit D, Tanninrandorn Y, et al. Normal amniotic pressure throughout gestation. Br J Obstet Gynecol. 1986;155(1):108-12.

Lyall F, Lye S, Teoh T, Cousins F, Milligan G, Robson SC. Expression of Gsalpha, connexin-43, connexin-26, and EPI, 3 and 4 receptors in myometrium of prelabour singleton versus multiple gestations and the effect of mechanical stretch and steroids on Gsalpha. J Soc Gynecol Invest. 2002;9:299.

Gardner MO, Goldenberg RL, Cliver SP, Tucker JM, Nelson KG, Copper RL. The origin and outcome of preterm twin pregnancies. Obstet Gynecol. 1995;85:553.

Many A, Lazebhink N, Hill LM. The underlying cause of polyhydramnios determines prematurity. Prenatal Diag. 1996;16:55.

Guinn DA, Goepfert AR, Christine M, Owen J, Hauth JC. Extra-amniotic saline, laminaria, or prostaglandin E 2 gel for labor induction with unfavorable cervix: a randomized controlled trial. Obstet Gynecol. 2000 Jul 31;96(1):106-12.

Goldman JB, Wigton TR. A randomized comparison of extra amniotic saline infusion and intra cervical dinoprostone gel for cervical ripening. Obstet Gynecol. 1999;93:271-4.

Rouben D, Arias F. A randomized trial of extra-amniotic saline infusion plus intracervical Foley catheter balloon versus prostaglandin E2 vaginal gel for ripening the cervix and inducing labor in patient with unfavorable cervixes. Obstet Gynecol. 1993;82:290-4.

Sherman DJ, Frenkel E, Pansky M, Caspi E, Bukovsky I, Langer R. Balloon cervical ripening with extra-amniotic infusion of saline or prostaglandin E 2: a double-blind, randomized controlled study. Obstet Gynecol. 2001 Mar 31;97(3):375-80.

Schreyer P, Sherman DJ, Ariely S, Herman A, Caspi E. Ripening the highly unfavorable cervix with extra-amniotic saline instillation or vaginal prostaglandin E2 application. Obstet Gynecol. 1989 Jun 1;73(6):938-42.