International Journal of Clinical Obstetrics and Gynaecology

Author(s): Dr. Nisiya KS, Dr. Uma Devi and Dr. Farzana M Ahmed

Abstract: Background: Labour induction is one of the most common obstetric procedures worldwide. There are a number of methods to induce labour, prostaglandins being the most effective one. The effects and properties of prostaglandins have been extensively investigated and many studies have compared the efficacy of different formulations available. There is a need to identify an effective method which is safe and cost effective associated with ease of introduction and removal in the event of complications. A method which reduces the number of vaginal examination thereby decreasing patient discomfort and doctor’s workload should be considered. Hence the purpose of this study is to compare the efficacy, safety and acceptability (doctor and patient) of dinoprostone intracervical gel and dinoprostone vaginal insert.Materials and Methods: In this prospective comparative study, 120 pregnant women undergoing procedure of induction of labour in Santosh Hospital from September 2017 to May 2019 were assigned randomly to two groups, dinoprostone intracervical gel and dinoprostone sustained release intravaginal insert. Group A received 500 mcg of dinoprostone gel intracervically at 6th hourly intervals till active labour ensue for a maximum of 3 doses. Group B received ten milligrams of dinoprostone vaginal insert for single application for maximum of 24 hours.Results: Induction delivery interval was significantly lower (p value-<0.001) in dinoprostone vaginal insert group than with intracervical gel group. Need for oxytocin was lesser (p value-<0.001) when dinoprostone vaginal insert was used compared to intracervical gel. No significant difference between two groups was found on caesarean section rate (p value-0.803). Rate of hyperstimulation was high in dinoprostone vaginal insert group, while there was no significant difference noted in meconium stained liquor (p value-0.729) and postpartum hemorrhage (p value-0.648) between 2 groups. The patient acceptability was found to be higher in dinoprostone vaginal insert group as there was less intensity of labour pain (p value-<0.001) in 1st stage of labour and decreased number of pervaginal examinations. Fetal outcome in each case was assessed with APGAR score at 1 and 5 minutes after the delivery of the fetus and no significant difference were found in both the groups.Conclusion: Dinoprostone intracervical gel and dinoprostone vaginal insert are safe and efficacious methods of induction of labour. However intravaginal insert was found to be easy to use and more efficacious method of induction with less pain during the initial hours of active labour. The method of induction should be individualized based on affordability and patient acceptability.

DOI: https://doi.org/10.33545/gynae.2022.v6.i1c.1130

Pages: 152-160 | 3939 Views | 3443 Downloads

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