MISOPROSTOL VERSUS LAMINARIA FOR CERVICAL RIPENING IN PREGNANCIES WITH FETAL
Keywords:
misoprostol, laminaria, cervical ripening, fetal death, randomized controlled trialsAbstract
introduction
Among the severa! agents for cervical ripening studied worlclwiele, prostaglanclins and laminaria tents have been shown to be safe anel effective. Prostaglandins are
more routinely used in the majority of the countries. However, in Brazil only PgE1 methyl-analog (misoprostol) is commercially available, and its use in obstetrics has
increased significantly because of its low cost compareci to other prostaglanelins, showing no loss in efficacy.
Methods
To evaluate the degree of cervical ripening using two different methoels, a ranelomizeel anel blind controllecl clinicai triai was carrieel out on 60 women who hael fetal eleath, gestational age over 15 weeks anel Bishop Jnclex uneler 6, anel were not in labor. They were allocated into two groups: one using a 200ug misoprostol tablet anel the other a laminaria tent, which were inserteel through the externa! cervical os, 24 hours before starting labor ineluction with oxytocin.
Results
There were no significant differences in control variables nor in maternal side effects, but there were different effects on the cervix between the two groups. ln the misoprostol group 78.9% of women delivered vaginally within the first24 hours reserved for cervical ripening. Furthermore, the total amount of oxytocin used, time of hospitalization and total hospital costs were significantly lower in this group.
Conclusion
Both methods were effective and safe for cervical ripening. However misoprostol, in the amount and route used, showed efficacy not only as a method for cervical ripening, but also as an effective agent for labor induction in pregnancies with fetal death.
Downloads
References
American College ofübstetrician anel Gynecologists. ACOG comrnittee opinion. lnduction of labor with misoprostol (Number 228). lnt J Gynecol Obstet 2000; 69:77-8.
Bique C, Bugalho A, Bergstrom S. Labor induction by vaginal misoprostol in grand multiparous women. Acta Obstet Gynecol Scand 1999; 181 (2):339-45.
Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol 1964; 24:266-8.
Blanchard K, Clark S, WinikoffB, Gaines G,Kabani G, Shannon C. Misoprostol for Women's Health: a review. Obstet Gynecol 2002; 99:316-32.
Boulvain M, Kelly A, Lohse C, Stan C, lrion O. Mechanical methods for induction of labour (Cochrane Review). Cochrane Database Syst Rev 2001;4 CD001233.
Bugalho A, Bique C, Machungo F, Faaundes A. lnduction of labor with intra vaginal misoprostol in intrauterine fetal death. Am J Obstet Gynecol 1994; 171 :538-41.
Cullen BM, Harkness RD. The effect ofhormones on the physical properties and collagen content of the rat's uterine cervix. J Physiol 1960; 152 :419-36.
Cunninghan FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap III LC, Hankins GDY, et ai. armai labor and delivery. Parturition. ln: Willians Obstetrics. 21 th ecl. New York: Prentice-Hal l lnternational; 2001.
Ellwood DA, Mitchell MD, Anderson ABM, Turnbull AC. The in vitro production of prostanoids by the human cervix during pregnancy: preliminary observations. Br J Obstet Gynaecol 1980; 83:244-7.
FletcherH, Mitchel S, Simeon D, Frederick J, Brown D. lntravaginal misoprostol as a cervical ripening agent. Br JObstet Gynecol 1993; 100:641-4.
HarknessMLR, HarknessRD. Changes in thephysical properties ofthe cervix ofthe rat during pregnancy. J Physiol 1959; 148:524-47.
Hem WM. Laminaria, induced fetal demise anel misoprostol in late abortion. lnt J Gynecol and Obst 2001; 75:279-86.
Hofmeyr GJ, Gulmezoglu AM, Alfirevic Z. Misoprostol for induction of labour: a systematic review. Br J Obstet Gynaecol 1999; 106(8):798-803.
Kazzi GM, Bottoms SF, Rosen MG. Efficacy anel safety of laminaria digita ta for preinduction ripening of cervix. Obstet Gynecol 1982; 60:440-3.
Mariani Neto C, Leão EJ, Barreto EMCP, Kenj G, Aquino MMA, Tuffi YHB. Uso do misoprostol para indução do parto com feto morto. [Use ofmisoprostol for labor induction in fetal death]. Rev Paul Med 1987; 105:325-8.
Morris ND, McCallum GI, Hammond L. Preoperative cervical dilatation: a triai of laminaria tents and prostaglandin F 2., gel. Aust N Z J Obstet Gynaecol 1986; 26:36-9.
Parpinelli MA, Cecatti JG, Ribeiro ST, Besteti Pires HM, Faúndes A. Uso da laminaria no preparo do colo uterino para indução de parto em gestações com óbito fetal [Laminaria tent for cervical ripening in fetal death]. Rev Bras Ginecol Obstet 1996; 18 (9): 697-702.
Poma PA. Cervical ripening: a review anel recommendations for clinicai practice. J Reprod Med 1999; 44(8):657-68.
Royal Society of Medicine Services. The role of prostaglandins in labour. ln: International Congress and Symposium Series, Number 92. London; 1985.
Tang OS, Schweer H, Seyberth HW, Lee SWH, Ho PC. Pharmacokinetics of different routes of adrninistration ofmisoprostol. Humarn Reprod 2002; 17:332-6.
Wing DA, Ham D, Paul RH. A comparison of orally administered with vaginally administered rnisoprostol for cervical ripening and labor induction. Am J Obstet Gynecol 1999; 180(5): 1155-60.
Wing DA. Labor induction with misoprostol. Am J Obstet Gynecol 1999; 181 (2):339-45.
Wing DA, Rahall A, fones MM, Goodwin TM, Paul RH. Misoprostol: an effective agent for cervical ripening and labor induction. Am J Obstet Gynecol 1995; 172:1811-6.
Zieman M, F ong SK, BenowitzNL, Banskter D, Damey PD. Absorption kinetics ofmisoprostol with oral or vaginal administration. Obstet Gynecol 1997; 90(1 ):88-92.
