Can Cervical Ripening at Term Reduce Cesarean Section Rate? A Comparative Study of Cervical Ripening Versus Expectant Management at Term

Shehla  Baqai; Zubaida Shaheen; Shazia  Tufail; Sadia  Ghaffar; Rehana  Kanwal; Humaira Osman  Jaffery

doi:10.51253/pafmj.v75i3.8353

Authors

Shehla Baqai Department of Obstetrics and Gynecology, Combined Military Hospital, Lahore Medical College Lahore/ National University of Medical Sciences (NUMS) Pakistan
Zubaida Shaheen Department of Obstetrics and Gynecology, Combined Military Hospital, Lahore Medical College Lahore/ National University of Medical Sciences (NUMS) Pakistan
Shazia Tufail Department of Obstetrics and Gynecology, Combined Military Hospital, Lahore Medical College Lahore/ National University of Medical Sciences (NUMS) Pakistan
Sadia Ghaffar Department of Obstetrics and Gynecology, Combined Military Hospital, Lahore Medical College Lahore/ National University of Medical Sciences (NUMS) Pakistan
Rehana Kanwal Department of Obstetrics and Gynecology, Combined Military Hospital, Lahore Medical College Lahore/ National University of Medical Sciences (NUMS) Pakistan
Humaira Osman Jaffery Department of Obstetrics and Gynecology, Combined Military Hospital, Lahore Medical College Lahore/ National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i3.8353

Keywords:

Cervix, Cervical Ripening, Cesarean Section, Prostaglandins

Abstract

Objective: To compare the obstetrical outcome in cervical ripening versus expectant management at term and evaluate the efficacy of Dinoprostone as a cervical ripening agent in unfavorable cervix.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital Lahore, Pakistan from Jan 2020 to Jun 2021.

Methodology: Five hundred pregnant women were recruited through nonprobability consecutive sampling; the women were randomly placed into two groups of 250 patients each. Group-1 received Dinoprostone Vaginal pessary while Group-2 was the control group with no intervention and expectant management. All women were followed till delivery. The mode of delivery in the two groups and the time interval from cervical ripening till delivery was analyzed and compared.

Results: Mean age of the patients was 30.43±4.16 years. Comparison of mode of delivery yielded a statistically significant difference with comparatively greater number of vaginal deliveries (86% vs 64%) in the cervical ripening group as compared to the control group. Mean interval from cervical ripening to delivery in Group-1 was 20.75±3.859 hours, minimum interval being 12 hours while the maximum interval was 48 hours. In both the groups, a significantly greater number of primigravidae (96, 33.1%) were found to have undergone LSCS more than the multigravidae (29, 27.6%).

Conclusion: Cervical ripening with Dinoprostone at term is an effective, safe and acceptable method in women with unripe cervix. Dinoprostone application resulted in effective cervical ripening, shortened application delivery interval and decreased cesarean delivery rate.

Downloads

Download data is not yet available.

References

Amjad A, Amjad U, Zakar R, Usman A, Zakar MZ, Fischer F et al. Factors associated with caesarean deliveries among child-bearing women in Pakistan: secondary analysis of data from the demographic and health survey, 2012–13. BMC Pregnancy Childbirth 2018; 18(1): 113.

https://doi.org/10.1186/s12884-018-1743-z

Abbas F, Amir ud Din R, Sadiq M. Prevalence and determinants of Caesarean delivery in Punjab, Pakistan. East Mediterr Health J 2018; 24(11): 1058–1069.

https://doi.org/10.26719/2018.24.11.1058

Niino Y. The increasing caesarean rate globally and what we can do about it. Biosci Trends 2018; 5(4): 139–150.

https://doi.org/10.5582/bst.2011.v5.4.139

WHO, HRP. WHO statement on caesarean section rates 2015. Available from:

https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/. [Accessed on 3rd January, 2022]

Stotland NE, Hopkins LM, Caughey AB. Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas. Obstet Gynecol 2004; 104(4): 671-677.

https://doi.org/10.1097/01.aog.0000139515.97799.f6

Black M, Bhattacharya S, Philip S, Norman JE, McLernon DJ. Planned caesarean delivery at term and adverse outcomes in childhood health. JAMA 2015; 314(21): 2271-2279.

https://doi.org/10.1001/jama.2015.16176

Jakub M, Marta M, Jagoda G, Kamila G, Stanislaw G. Is unfavourable cervix prior to induction of labor risk for adverse obstetrical outcome in time of universal ripening agents usage? Single center retrospective observational study. J Pregnancy 2020 :2020: 4985693. https://doi.org/10.1155/2020/4985693

Yaddehige SS, Kalanso oriya HD, Rameez FMM. Comparison of cervical massage with membrane sweeping for pre-induction cervical ripening at term; a randomized controlled trial. Sri Lanka J Obstet Gynaecol 2019; 41: 66-74.

https://doi.org/10.4038/sljog.v41i3.7883

Chyu JK, Strassner HT. Prostaglandin E2 for cervical ripening: a randomized comparison of Cervidil versus Prepidil. Am J Obstet Gynecol 1997; 177(3): 606-611.

https://doi.org/10.1016/s0002-9378(97)70153-4

Gupta S, Kuntal N, Gupta VK. Maternal and fetal outcomes with the use of prostaglandin E2 as a cervical ripening agent for induction of labor. Int J Reprod Contracept Obstet Gynecol 2020; 9(1): 44-47. http://doi.org/10.18203/2320-1770

Brane E, Olsson A, Andolf E. A randomized controlled trial on early induction compared to expectant management of nulliparous women with prolonged latent phases. Acta Obstet Gynecol Scand 2014; 93(10): 1042-1049.

https://doi.org/10.1111/aogs.12447

Bishop score. Available from:

https://healthjade.net/bishop-score/

Nicholson JM, Kellar LC, Cronholm PF, Macones GA. Active management of risk in pregnancy at term in an urban population: An association between a higher induction of labor rate and a lower cesarean delivery rate. Am J Obstet Gynecol 2004; 191: 1516-1528. https://doi.org/10.1016/j.ajog.2004.07.002

Goonewardene M, Rameez MFM, Kaluarachchi A, Perera H. WHO recommendations for induction of labour: RHL commentary (last revised: 1 November 2011). The WHO Reproductive Health Library; Geneva: World Health Organization. [Accessed 31 December, 2021]

Goetzl L. Methods of cervical ripening and labor induction: pharmacologic. Clin Obstet Gynecol 2014; 57: 377-390.

https://doi.org/10.1097/grf.0000000000000024

Saad AF, Villarreal J, Eid J, Spencer N, Ellis V, Hankins GA,et al. A randomized controlled trial of Dilapan-S vs Foley balloon for preinduction cervical ripening (DILAFOL trial). Am J Obstet Gynecol 2019; 220(3): 275e1-e9.

https://doi.org/10.1016/j.ajog.2019.01.008

Koenigbauer JF, Schalsinki E, Jarchau U, Gauger U, Brandt K, Klaucki S, et al. Cervical ripening after cesarean section: a prospective dual center study comparing a mechanical osmotic dilator vs prostaglandin E2. J Perinat Med 2021; 49(7): 797-805. https://doi.org/10.1515/jpm-2021-0157

Raza F, Majeed S. Intracervical PGE2 gel for cervical ripening and induction of labor. PJMS 2008; 24(2): 241-245.

Modi S, Mahur J, Shashank VS. Intracervical PGE2 gel application for cervical ripening and induction of labor: a clinical study. Int J Reprod Contracept Obstet Gynecol 2019;8(9):3528-3534.

http://doi.org/10.18203/2320-1770

Noah ML, Decoster JM, Fraser W. Preinduction cervical softening with endocervical PGE2 gel. A multicenter trial. Acta Obstet Gynecol Scand 1987; 66: 3-7.

https://doi.org/10.3109/00016348709092944

Nicholson JM, Perry S, Caughey AB, Rosen S, Keen A, Macones GA. The impact of the active management of risk in pregnancy at term on birth outcomes: A randomized clinical trial. Am J Obstet Gynecol 2008; 198(5): e1-511.15.

https://doi.org/10.1016/j.ajog.2008.03.037

Bashutheen NS, Sharon M. A study of intracervical PGE2 gel for cervical ripening and induction of labour. Int J Contemp Med Res 2018; 5(3): C4-C7.

Calder AA, Embrey MP. Prostaglandins and the unfavorable cervix. Lancet 1973; 2: 1322.

https://doi.org/10.1016/s0140-6736(73)92894-8

Jackson GM, Howard TS, Varner MW. Cervical ripening before induction of labor: A randomized trial of prostaglandin E2 versus low dose oxytocin. Am J Obstet Gynecol 1994; 171: 1092-1096. https://doi.org/10.1016/0002-9378(94)90042-6

Sun G, Lin Y, LuH, He W, LI R, Liu X, et al. Trends in cesarean delivery rates in primiparas and the associated factors. BMC Pregnancy Childbirth 2020; 715(20): 1247.

https://doi.org/10.1186/s12884-020-03398-6