The Efficacy and Safety of Dinoprostone Vaginal Insert for Labor Induction Following Optimization of Standard Operating Procedure: A Retrospective Study in China

Background:The study aimed to assess the efficacy and safety of dinoprostone vaginal insert in labor induction following optimization of standard operating procedure(SOP)and to discover independent predictors of vaginal delivery.Methods:This study comprised 551 pregnant women who required cervical ripening with dinoprostone before induction of labor.Using univariate and multivariate analyses,independent predictors of vaginal delivery were identified.Results:443 of the 551 women(80.4%)gave birth vaginally.Vaginal delivery was predicted by maternal age(24-30 vs.<24,P<0.001;30-35 vs.<24,P=0.03),gestational age(P=0.005),birth weight(P<0.001),parity(P=0.001),pre-pregnancy BMI(P<0.001),premature rupture of membranes(P=0.001),meconium-stained amniotic fluid(P<0.001),fundal height(P<0.001)and the Bishop score(P<0.001).None of the women exhibited severe postpartum hemorrhage.Conclusions:The maternal age,gestational age,birth weight,parity,body mass index,premature membrane rupture,amniotic fluid contamination,fundal height,and the Bishop score were independent predictors of vaginal delivery.These may guide the clinical use of dinoprostone for induction of labor.

Effectiveness of Dinoprostone and Cook's Balloon for Labor Induction in Primipara Women at Term

Labor induction is commonly used for achieving successful vaginal delivery.This study aimed to compare the effectiveness of dinoprostone and Cook's balloon as labor-inducing agents in primipara women at term.A retrospective cohort study among primipara women was conducted in Hubei Maternity and Child Health Hospital.Basic clinical characteristics were collected.The main outcomes were vaginal delivery rate,cesarean section rate and forceps delivery rate.Obstetric and perinatal outcomes were also compared.Univariate and multivariate analyses were further performed to evaluate the predictors for vaginal delivery within 24 h.A total of 845 eligible primipara women undergoing labor induction were recruited.Of them,141 women were induced with dinoprostone(dinoprostone group,DG),and 704 with Cook's balloon(Cook's balloon group,CG).Groups were homogeneous except more women with premature rupture of membranes in DG,with gestational hypertension in CG(P<0.05).The vaginal delivery rate within 12 h was 1.98%and 16.52%in CG and DG respectively(P=0.0001).Besides,the vaginal delivery rate within 24 h was 37.62%and 52.26%in CG and DG respectively(P=0.0079).DG showed the lower rate of oxytocin augmentation,artificial rupture of membrane and postpartum hemorrhage and the shorter interval from insertion to active labor than CG(P<0.05).Multivariate regression analysis revealed that abortion history,oxytocin augmentation,artificial rupture of membrane,and obstric analgesia were independent predictors for vaginal delivery within 24 h.In conclusion,dinoprostone was more effective than Cook's balloon to induce labor and achieve vaginal birth in the sample of primipara women at term.

Comparison of the Efficacy of Foley Catheter Balloon with Dinoprostone Gel for Cervical Ripening at Term

Objective: The purpose of this study was to compare the efficacy of extra-amniotic Foley catheter with intra cervical Dinoprostone gel for preinduction cervical ripening. Study Design: A randomized, prospective study was conducted in the Department of Obstetrics and Gynecology, PGIMS Rohtak on 100 pregnant women admitted for induction of labor. Fifty patients were randomized to receive Dinoprostone gel and 50 patients to receive intracervical, extra-amniotic Foley catheter. Results: The two groups were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop scores. Both groups had a significant change in Bishop score (4.18 ± 1.81 and 4.6 ± 1.48 respectively, p < 0.001);however, there was no significant difference between the groups. Mean duration of induction to delivery was 18.51 ± 8.52 in Foley catheter group and 18.21 ± 11.13 in prostaglandin group, the difference being statistically insignificant. Among 50 cases of prostaglandin only single dose was sufficient for 23 (46%) cases to induce labor. But in 27 (54%) cases 2nd dose of prostaglandin were required. The expenditure of intervention showed that Rs. 325 were required for induction by prostaglandin as compared to Rs. 60/- for Induction by Foley’s catheter and the difference was highly significant statistically There was no difference between the groups in mode of delivery, infant weight, apgar score and intrapartum complications. Conclusion: In conclusion, although both Foley catheter and dinoprostone gel appear to be effective agents for cervical ripening. Foley catheter causes less fetal distress, cheap and safety profile of Foley catheter is such that it can be used on an out patient basis, but not dinoprostone gel. These results make Foley catheter comparable or even superior to dinoprostone gel for cervical ripening specially in developing countries.

Low-Dose Misoprostol versus Vaginal-Insert Dinoprostone for At-Term Labor Induction: A Prospective Cohort Study

Introduction: Given the pharmacological change taking place in Spanish delivery rooms, we designed this study to compare the effectiveness and safety of misoprostol (25 mcg/4h) to 10 mg dinoprostone in its slow-releasing vaginalinsert form to induce at-term labor. Methods: In a prospective cohort study (2013-2015), 401 at-term pregnant women referred for induction (Bishop score ≤ 6), who gave birth at the Rey Juan Carlos Hospital in Móstoles (Madrid, Spain), of whom 241 participants were induced with misoprostol and 160 with dinoprostone. Patients were recruited by non-probabilistic sampling of consecutive cases as the inductions in the Obstetrics Block during the study period were indicated. Results: The cesarean section rate was 14% for the misoprostol group and 19% for the dinoprostone group [RR = 1.38 (95%CI: 0.89 - 2.13), p = 0.145]. No differences were found in the vaginal birth rate in <24 h from starting induction [44% vs. 53%, RR = 1.08 (0.90 - 1.29), p = 0.401], nor in the vaginal birth rate in <12 h, requiring oxytocin or meconium fluid, or for maternal-neonatal complications deriving from the method employed. The percentage of cesarean sections due to failed induction was lower in the misoprostol group (15% vs. 39%, p = 0.028). The time between induction and giving birth was shorter for the dinoprostone group (20 h vs. 23.4 h, p = 0.018). Conclusion: Inducing delivery by low-dose misoprostol offers similar effectiveness and safety to induction by dinoprostone in its slow-releasing vaginal-insert form. However, our sample is limited, and few studies are available on the subject. Further analyses to draw solid conclusions are required.

Comparison of the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter in term nulliparous women with borderline oligohydramnios

Backgrounds:At present,there is no consensus on the induction methods in term pregnancy with borderline oligohydramnios.This study aimed to compare the effectiveness and pregnancy outcomes of labor induction with dinoprostone or single-balloon catheter(SBC)in term nulliparous women with borderline oligohydramnios.Methods:We conducted a retrospective cohort study from January 2016 to November 2018.During the study period,a total of 244 cases were enrolled.Of these,103 cases were selected for induction using dinoprostone and 141 cases were selected for induction with SBC.The pregnancy outcomes between the two groups were compared.Primary outcomes were successful vaginal delivery rates.Secondary outcomes were maternal and neonatal adverse events.Multivariate logistic regression was used to assess the risk factors for vaginal delivery failure in the two groups.Results:The successful vaginal delivery rates were similar between the dinoprostone group and the SBC group(64.1%[66/103]vs.59.6%,[84/141]P=0.475),even after adjustment for potential confounding factors(adjusted odds ratio[aOR]:1.07,95%confidence interval[CI]:0.57-2.00,P=0.835).The incidence of intra-amniotic infection was lower in the dinoprostone group than in the SBC group(1.9%[2/103]vs.7.8%[11/141],P<0.001),but the presence of non-reassuring fetal heart rate was higher in the dinoprostone group than in the SBC group(12.6%[13/103]vs.0.7%,[1/141]P<0.001).Multivariate logistic regression showed that nuchal cord was a risk factor for vaginal delivery failure after induction with dinoprostone(aOR:6.71,95%CI:1.96-22.95).There were three factors related to vaginal delivery failure after induction with SBC,namely gestational age(aOR:1.51,95%CI:1.07-2.14),body mass index(BMI)>30 kg/m^(2)(aOR:2.98,95%CI:1.10-8.02),and fetal weight>3500 g(aOR:2.49,95%CI:1.12-5.50).Conclusions:Term nulliparous women with borderline oligohydramnios have similar successful vaginal delivery rates after induction with dinoprostone or SBC,with their advantages and disadvantages.In women with nuchal cord,the risk of vaginal delivery failure is increased if dinoprostone is used in the induction of labor.BMI>30 kg/m^(2),large gestational age,and estimated fetal weight>3500 g are risk factors for vaginal delivery failure after induction with SBC.

Comparative study for success rate of vaginal birth after cesarean section following labor induction by two forms of vaginal dinosprostone: A pilot study

Background: Cesarean delivery has become the most common major surgical procedure in many parts of the world. Induction of labor in women with prior cesarean delivery is an alternative to mitigate the rising cesarean rates. Objectives: To compare the VBAC success rate between two vaginal forms of dinoprostone for labor induction in women with prior cesarean section. Material and Methods: A pilot study was conducted at a large Governmental Hospital, Dhahran, Saudi Arabia, including 200 women with prior cesarean section and planned for labor induction. Participants were randomly allocated into two groups. Group A (n = 100) received dinoprostone 1.5 mg vaginal tablet. Group B (n = 100) received 10 mg dinoprostone sustained release vaginal pessary. Primary outcome was vaginal delivery rate. Secondary outcomes included maternal and neonatal outcomes. Results: The dinoprostone vaginal tablet and dinoprostone vaginal pessary had a comparable vaginal delivery rate (67% and 64%, respectively;p = 0.78). The median patient satisfaction with the birth process was superior in the dinoprostone vaginal pessary group (p = 0.04). Maternal and neonatal outcomes were similar in both groups. Conclusion: Both forms of dinoprostone were effective methods for labor induction in women with prior cesarean section. However, the patient satisfaction with the birth process was in favor of the dinoprostone sustained release vaginal pessary.

Efficacy and safety of oral solution dosed misoprostol versus misoprostol vaginally in labour induction

Background: Labour induction is one of the most common medical procedures in obstetrics. The aim is to end the pregnancy when continuity is a risk to mother or fetus. Its main side effect is the increase in the cesarean rate, compared to spontaneous onset deliveries. On the other hand, mortality and morbidity in cesareans are higher. The most common pharmacological drugs used for induction are prostaglandins: dinoprostone and misoprostol. The “gold standard” for labour induction is vaginal misoprostol. The oral route is also effective and also has several benefits like faster onset and easear administration. In recent years several publications state that the administration of misoprostol oral solution, given in doses gradually, is associated with a lower cesarean and hyperstimulation rate than the cases where vaginal misoprostol has been used in pregnant women with unripe cervix. Furthermore, being its half life shorter, it may be very useful in case of uterine hyperstimulation and, probably, a high percentage of women prefer this oral administration to the vaginal one. The objective of this study is to compare the efficacy, safety and side effects on mother and fetus on use of oral versus vaginal administration for induction of labour for prolonged gestation (41 weeks) and premature rupture of membranes, both with live fetus. Methods/Design: Design: double blind controlled trial. Study population: Pregnant women whose labour will be induced due to premature rupture of membranes or prolonged gestation. Inclusion Criteria: 1) Bishop Test equal to or less than 7;2) Single pregnancy;3) Pregnancy at term (37 - 42 weeks);4) No history of uterine surgery;5) Cephalic presentation;6) Live fetus;7) No prostaglandins contraindications. Discussion: Nowadays induction rates are very high, ranging from 25% to 30% approximately. In these cases caesarean rates are higher than when the delivery starts spontaneously. That is one of the main reasons why caesareans have increased, mainly in the cases of nuliparous women with immature cervix. If we can prove the hypothetical good results obtained through the use of dosed oral misoprotol, we will be able to reduce the number of induced deliveries by cesarean, and so improve the levels of security for the mother and the foetus, and, as a consequence, provide a higher quality of medical attention to the newborn and the mother.

Efficacy of horse oil on lipopolysaccharide-induced inflammation in human keratinocytes

OBJECTIVE: To investigate the efficacy of horse oil on lipopolysaccharide(LPS)-induced inflammation in human keratinocytes.METHODS: Western blot analysis was performed to measure the expression of cyclooxygenase-2(COX-2) and IκBα. ELISA was used to analyze prostaglandin E2(PGE2) levels.RESULTS: Horse oil decreased LPS-induced COX-2 and PGE2 levels in a dose-dependent manner. Nuclear factor-kappa B(NF-κB) plays a key role in the expression of inflammatory cytokines and mediators. Therefore, we investigated the influence of horse oil on the NF-κB signaling pathways. Horse oil inhibited translocation of NF-κB from the cytosol to the nucleus. Furthermore, LPS-induced degradation of IκBα was recovered by horse oil. The activation of p38 mitogen-activated protein kinase(MAPK) reportedly induces degradation of IκBα In agreement with this, LPS activated p38 MAPK and caused IκBα degradation. Conversely, horse oil inhibited LPS-induced p38 MAPK activation and IκBαdegradation. In addition, a specific p38 MAPK inhibitor, SB203580, blocked IκBα degradation.CONCLUSION: Horse oil decreased COX-2 and PGE2 by inhibiting p38 MAPK activation, IκBα degradation, and the translocation of NF-κB.

Mechanism of action of prostaglandin E_2 in the dog skeletal muscle circulation

Objective To determine whether prostaglandin E2 (PGE2) influences the dog skeletal muscle circulation by a direct action on the vascular smooth muscle or via pre- or post-synaptic modulation of sympathetic neurotransmission.Methods In 18 anaesthetised dogs, a gracilis muscle was vascularly isolated and perfused at constant flow. Sympathetic vasoconstrictor tone on the muscles was reflexly controlled by alterations to the pressure at which the isolated carotid sinuses were perfused. The effects of PGE2 injection into the muscle were compared at low carotid sinus pressure, high carotid sinus pressure, and following denervation of the muscle, with or without noradrenaline infusion.Results At all levels of sympathetic tone, PGE2 produced significantly more vasodilation than the saline vehicle. However, at a carotid sinus pressure of 46.0±2.3 mmHg (1 mmHg=0.133 kPa), PGE2 caused a decrease in femoral arterial perfusion pressure of 52.6±7.1 mmHg, which was significantly greater than the response at a carotid sinus pressure of 208.5±3.7 (33.6±4.2 mmHg decrease) or following denervation (25.6±3.7 mmHg decrease). In a separate group of denervated muscles, PGE2 caused a similar decrease in perfusion pressure in the presence or absence of a noradrenaline infusion.Conclusions PGE2 appears to cause vasodilation through two separate mechanisms: one mechanism involves presynaptic inhibition of sympathetic vasoconstrictor tone, whilst the other is independent of the sympathetic nervous system, and is therefore presumably a direct action on the vascular smooth muscle or endothelium. Under our experimental conditions, both mechanisms contributed equally to the vasodilation.