The Experts below are selected from a list of 7209 Experts worldwide ranked by ideXlab platform
Karen E. George - One of the best experts on this subject based on the ideXlab platform.
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Mifepristone versus laminaria: a randomized controlled trial of Cervical Ripening in midtrimester termination.
Contraception, 2007Co-Authors: Beth A. Prairie, Michele R. Lauria, Nathalie Kapp, Todd A. Mackenzie, Emily R. Baker, Karen E. GeorgeAbstract:Abstract Background Mifepristone was compared with laminaria for Cervical Ripening in second-trimester induction of labor (IOL). Study Design We performed a randomized, controlled, open-label study of women undergoing second-trimester IOL for fetal demise, aneuploidy or anomalies at a single tertiary care center from January 2004 to May 2006. Main outcome measures were induction-to-delivery time and pain with Cervical Ripening. Results Of 50 eligible women, 37 were enrolled in the study, of whom 33 completed the study: 16 were randomized to laminaria and 17 to mifepristone. Induction-to-delivery time was significantly shorter in the mifepristone arm (mean=10 h vs. 16 h, p=.01; median=7.5 h vs. 13.4 h, p=.01). Pain with Cervical Ripening was also significantly less in the mifepristone group than in the laminaria group (median=1 vs. 6 on an 11-point visual analogue scale, p Conclusion Mifepristone shortens the induction-to-delivery time and decreases pain with Cervical Ripening when compared with laminaria for second-trimester induction.
Phillip M Zegelbone - One of the best experts on this subject based on the ideXlab platform.
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Other mechanical methods for pre-induction Cervical Ripening
Seminars in perinatology, 2015Co-Authors: Danielle E Durie, Aminatu Lawal, Phillip M ZegelboneAbstract:Pre-induction Cervical Ripening is an important part of the labor induction process in women with an unfavorable cervix. This can be achieved either by pharmacologic or mechanical methods of Cervical Ripening. While the Foley catheter is the most commonly used mechanical method for labor induction, other mechanical methods are also available. This article reviews the safety profiles of osmotic dilators, extra-amniotic saline infusion, double-balloon catheters, and also compares their efficacy to that of other mechanical and pharmacologic Cervical Ripening methods. While mechanical methods have been shown to be safe and effective for Cervical Ripening, none of these alternatives has been shown to be superior to the Foley catheter.
Chukwuemeka E Nwachukwu - One of the best experts on this subject based on the ideXlab platform.
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methods for assessing pre induction Cervical Ripening
Cochrane Database of Systematic Reviews, 2015Co-Authors: Ifeanyichukwu U Ezebialu, Ahizechukwu C Eke, George Uchenna Eleje, Chukwuemeka E NwachukwuAbstract:Background Induction of labour is the artificial initiation of labour in a pregnant woman after the age of fetal viability but without any objective evidence of active phase labour and with intact fetal membranes. The need for induction of labour may arise due to a problem in the mother, her fetus or both, and the procedure may be carried out at or before term. Obstetricians have long known that for this to be successful, it is important that the uterine cervix (the neck of the womb) has favourable characteristics in terms of readiness to go into the labour state. Objectives To compare Bishop score with any other method for assessing pre-induction Cervical Ripening in women admitted for induction of labour. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies to identify randomised controlled trials (RCTs). Selection criteria All RCTs comparing Bishop score with any other methods of pre-induction Cervical assessment in women admitted for induction of labour. Cluster-RCTs were eligible for inclusion but none were identified. Quasi-RCTs and studies using a cross-over design were not eligible for inclusion. Studies published in abstract form were eligible for inclusion if they provided sufficient information. Comparisons could include the following. 1. Bishop score versus transvaginal ultrasound (TVUS). 2. Bishop score versus Insulin-like growth factor binding protein-1 (IGFBP-1). 3. Bishop score versus vaginal fetal fibronectin (fFN). However, we only identified data for a comparison of Bishop score versus TVUS. Data collection and analysis Two review authors independently assessed the trials for inclusion, extracted the data and assessed trial quality. Data were checked for accuracy. Main results We included two trials that recruited a total of 234 women. The overall risk of bias was low for the two studies. Both studies compared Bishop score withTVUS. The two included studies did not show any clear difference between the Bishop score and TVUS groups for the following main outcomes: vaginal birth (RR 1.07, 95% CI 0.92 to 1.25, moderate quality evidence), caesarean delivery (RR 0.81, 95% CI 0.49 to 1.34, moderate quality evidence), neonatal admission into neonatal intensive care unit (RR 1.67, 95% CI 0.41 to 6.71, moderate quality evidence). Both studies only provided median data in relation to induction-delivery interval and reported no clear difference between the Bishop and TVUS groups. Perinatal mortality was not reported in the included studies. For the review's secondary outcomes, the need for misoprostol for Cervical Ripening was more frequent in the TVUS group compared to the Bishop score group (RR 0.52, 95% CI 0.41 to 0.66, two studies, 234 women, moderate quality evidence). In contrast, there were no clear differences between the Bishop scope and TVUS groups in terms of meconium staining of the amniotic fluid, fetal heart rate abnormality in labour, and Apgar score less than seven. Only one trial reported median data on the induction-delivery interval and induction to active phase interval, the trialist reported no difference between the Bishop group and the TVUS group for this outcome. Neither of the included studies reported on uterine rupture. Authors' conclusions Moderate quality evidence from two small RCTs involving 234 women that compared two different methods for assessing pre-induction Cervical Ripening (Bishop score and TVUS) did not demonstrate superiority of one method over the other in terms of the main outcomes assessed in this review. We did not identify any data relating to perinatal mortality. Whilst use of TVUS was associated with an increased need for misoprostol for Cervical Ripening, both methods could be complementary. The choice of a particular method of assessing pre-induction Cervical Ripening may differ depending on the environment and need where one is practicing since some methods (i.e. TVUS) may not be readily available and affordable in resource-poor settings where the sequelae of labour and its management is prevalent. The evidence in this review is based on two studies that enrolled a small number of women and there is insufficient evidence to support the use of TVUS over the standard digital vaginal assessment in pre-induction Cervical Ripening. Further adequately powered RCTs involving TVUS and the Bishop score and including other methods of pre-induction Cervical Ripening assessment are warranted. Such studies need to address uterine rupture, perinatal mortality, optimal cut-off value of the Cervical length and Bishop score to classify women as having favourable or unfavourable cervices and cost should be included as an outcome.
Andrew M Kaunitz - One of the best experts on this subject based on the ideXlab platform.
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Do mechanical methods of Cervical Ripening increase infectious morbidity? A systematic review.
American journal of obstetrics and gynecology, 2008Co-Authors: Jennifer Heinemann, Geoff Gillen, Luis Sanchez-ramos, Andrew M KaunitzAbstract:The purpose of this study was to review systematically randomized controlled trials that were associated with Cervical Ripening. We identified randomized controlled trials that compared the use of Foley catheter, with or without extraamniotic saline solution infusion, Laminaria, or hygroscopic dilators for Cervical Ripening or induction with pharmacologic agents or placebo. Randomized controlled trials that evaluated maternal or neonatal infection were selected. The outcomes that were assessed were maternal and neonatal infection, chorioamnionitis, and endomyometritis. Thirty studies met inclusion criteria. Compared with the use of pharmacologic methods alone, patients who underwent Cervical Ripening with mechanical agents had a significantly higher rate of maternal infection rates. Similar results were noted for patients who underwent Ripening with Foley catheter alone in comparison with pharmacologic agents. No difference was noted in maternal infection rates for patients who underwent Ripening with extraamniotic saline solution infusion, Laminaria, or hygroscopic dilators. Compared with the use of pharmacologic agents alone, maternal and neonatal infectious morbidity appears to be increased when mechanical agents are used for Cervical Ripening.
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misoprostol for Cervical Ripening and labor induction a meta analysis
Obstetrics & Gynecology, 1997Co-Authors: Luis Sanchezramos, Isaac Delke, Andrew M Kaunitz, Robert L Wears, Francisco L. GaudierAbstract:Objective To analyze published randomized trials assessing the safety and efficacy of misoprostol for Cervical Ripening and labor induction. Data Sources We supplemented a search of entries in electronic data bases with references cited in original studies and review articles to identify randomized trials of misoprostol for Cervical Ripening and labor induction. Methods of Study Selection Two blinded investigators performed independent trial quality evaluation and data abstraction of randomized clinical trials assessing the efficacy of misoprostol as a Cervical Ripening and labor-inducing agent. Tabulation, Integration, and Results We calculated an estimate of the odds ratio (OR) and risk difference for dichotomous outcomes, using both a random- and fixed-effects model. Continuous outcomes were pooled using a variance-weighted average of the within-study difference in means. Of 16 studies identified, eight met our criteria for meta-analysis. These eight trials included 966 patients (488 received misoprostol and 478 were controls). Women who received misoprostol for Cervical Ripening and labor induction had a significantly lower overall cesarean rate (OR 0.67, 95% confidence interval [CI] 0.48, 0.93) and a higher incidence of vaginal delivery within 24 hours of misoprostol application (OR 2.64, 95% CI 1.87, 3.71). Use of misoprostol was associated with a higher incidence of tachysystole (OR 2.70, 95% CI 1.80, 4.04) but not hyperstimulation (OR 1.91, 95% CI 0.98, 3.73). The incidences of abnormal 5-minute Apgar scores and admissions to the neonatal intensive care unit were similar in the misoprostol and control groups. The pooled estimate of the mean interval from start of induction to delivery was 4.6 hours fewer (95% CI −3.5, −5.7) in the misoprostol group. Conclusion Published data confirm the safety and efficacy of intravaginal misoprostol as an agent for Cervical Ripening and labor induction.
Edward R Yeomans - One of the best experts on this subject based on the ideXlab platform.
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randomized trial of preinduction Cervical Ripening misoprostol vs oxytocin
American Journal of Obstetrics and Gynecology, 2008Co-Authors: Linda Fonseca, Hilaire Wood, Michael J Lucas, Susan M Ramin, Deepali G Phatak, Larry C Gilstrap, Edward R YeomansAbstract:Objective The purpose of this study was to compare the vaginal delivery rate in women who undergo labor induction with preinduction misoprostol or oxytocin alone. Study Design Women with singleton pregnancies and Bishop scores Results One hundred sixty-three women received oxytocin, and 164 women received misoprostol. Maternal demographics, pretreatment Bishop scores, and labor analgesia were similar between groups. Vaginal delivery rates were also similar: 87% (n = 141) for oxytocin and 81% (n = 133) for misoprostol. Mean time from treatment to delivery was shorter for the oxytocin group, compared with the misoprostol group (13.1 vs 16.3 hours; P = .005). There was no difference in maternal complications or neonatal outcomes between groups. Conclusion Preinduction Cervical Ripening with misoprostol did not improve the vaginal delivery rate and resulted in longer intervals to active labor and delivery. Preinduction Cervical Ripening with misoprostol may not be necessary.