Efficacy of vaginal douching before the application of Dinoprostone pessary in labour induction, a randomized controlled study

Öz

Aim: To investigate the effects on delivery and neonatal outcomes of vaginal douching, which can be performed before the application of dinoprostone pessary in the vagina for labour induction. Materials and method: In this prospective study 240 women with singleton, term pregnancy who underwent labour induction, were randomized into two groups. Application of dinoprostone pessary intra-vaginally with vaginal douching group (n=103) and it without vaginal douching group (n=116) were compared firstly for duration of dinoprostone application intra-vaginally secondly for duration from the beginning of dinoprostone application intra-vaginally to the active phase of labor, duration from the beginning of dinoprostone application intra-vaginally to total cervical dilatation, induction need, route of delivery (vaginal/cesarean), and uterine hyperstimulation. The birth weight, 1 and 5-minute Apgar scores, intubation need, NICU admission, presence of meconium, and fetal infection were compared between the newborns of the two groups. Data were statistically compared using the Student’s-t test, Mann-Whitney U test and Pearson Chi-square test. Results: Intra-vaginal dinoprostone pessary application with vaginal douching compared it without douching had shorter duration of dinoprostone application (p=0.001), duration from the beginning of dinoprostone application to the active phase of labor (p=0.001) and duration from the beginning of dinoprostone application to total cervical dilatation (p=0.001). Route of delivery was not statistically different between the groups (p=0.414). Uterine hyperstimulation was more frequent in the vaginal douche group however it did not reach the statistical significance (p=0.058). Neonatal mean birth weight and 5-minute Apgar scores were higher in the vaginal douching group (p=0.660, 0.091) while intubation need, presence of meconium, and fetal infection rates were lower with statistical significance (p=0.007, 0.018, 0.011, respectively). Conclusion: As a safe, easy to perform and cheap procedure, vaginal douching prior to dinoprostone pessary application intra-vaginally can augment the induction of labour in women without increasing maternal or fetal adverse outcomes.

Anahtar Kelimeler

• delivery,delivery,dinoprostone,dinoprostone,labour induction,labour induction

Doğum indüksiyonunda Dinoproston peser yerleştirilmesi öncesi vajinal duşun etkinliği, bir randomize kontrollü çalişma

Öz

Amaç: Doğum indüksiyonu için vajene dinoproston peser yerleştirilmesi öncesi uygulanabilen vajinal duşun doğum ve yenidoğan sonuçlarına etkisini incelemek. Materyal ve metod: Bu prospektif çalışmada doğum indüksiyonu yapılan 240 tekil, term gebe iki gruba randomize edildi. Vajinal duş ile dinoproston peser yerleştirilen grup (n=103) ile vajinal duş olmaksızın dinoproston peser yerleştirilen grup (n=116) birincil olarak vajen içi dinoproston yerleştirme süresi ikincil olarak vajen içine dinoproston yerleştirme başlangıcından aktif faza kadar olan süre, vajen içine dinoproston yerleştirme başlangıcından serviksin tamamen açılmasına kadar geçen süre, indüksiyon ihtiyacı, doğum şekli (vajinal/sezeryan), ve uterus hiper-stimülasyonu yönünden karşılaştırıldı. Doğum ağırlığı, 5. Dakika Apgar skoru, entübasyon ihtiyacı, mekonyum varlığı, ve fetal enfeksiyon her iki grubun yenidoğanları arasında karşılaştırıldı. Veriler Student’s-t test, Mann-Whitney U test and Pearson Chi-square test kullanılarak istatistiksel olarak karşılaştırıldı. Bulgular: Vajinal duş ile vajen içine dinoproston peser yerleştirilen grubun dinoproston aplikasyon süresi (p=0.001), dinoproston peser aplikasyonu başlangıcından aktif faza kadar olan süre (p=0.001) ve dinoproston peser aplikasyonu başlangıcından serviksin tamamen açılmasına kadar geçen süre (p=0.001) vajinal duş yapılmayan gruba göre daha kısaydı. Doğum şekli gruplar arasında istatistiksel farklılık göstermiyordu (p=0.414). Uterus hiper-stimülasyonu vajinal duş yapılan grupta daha fazla olsa da istatistiksel anlama ulaşmamaktaydı (p=0.058). Yenidoğan ortalama ağırlığı ve 5. Dakika Apgar skoru vajinal duş yapılan grupta daha fazlaydı (p=0.660, 0.091), fakat entübasyon ihtiyacı, mekonyum varlığı, ve fetal enfeksiyon oranı istatistiksel anlamda daha düşüktü (sırasıyla p=0.007, 0.018, 0.011). Sonuç: Uygulaması güvenli, kolay ve ucuz bir prosedür olan vajen içi dinoproston peser aplikasyonu öncesi vajinal duş, anne ve fetal olumsuz sonuçlara yol açmaksızın kadınlarda doğum indüksiyonunu hızlandırabilir.

Anahtar Kelimeler

• Dinoproston,doğum indüksiyonu,vajinal duş

Kaynakça

1. References 1. Chowdhary A, Bagga R, Jasvinder Kalra, Jain V, Saha SC, Kumar P. Comparison of intracervical Foley catheter used alone or combined with a single dose of dinoprostone gel for cervical ripening: a randomised study. Journal of Obstetrics and Gynaecology 2019; 39(4): 461–467.
2. References 2. Yount SM, Lassiter N. The Pharmacology of Prostaglandins for Induction of Labor. Vol. 58, Journal of Midwifery and Women’s Health 2013. p. 133–144.
3. References 3. Bakker R, Pierce S, Myers D. The role of prostaglandins E1 and E2, dinoprostone, and misoprostol in cervical ripening and the induction of labor: a mechanistic approach. Archives of Gynecology and Obstetrics 2017; 296(2): 167–179.
4. References 4. Lyrenäs S, Clason I, Ulmsten U. In vivo controlled release of PGE2 from a vaginal insert (0.8 mm, 10 mg) during induction of labour. British Journal of Obstetrics and Gynaecology 2001; 108(2): 169–178.
5. References 5. Basirat Z, Barat SH, Ghanbarpour A, Golsorkhtabar-Amiri M. Does vaginal pH affect the efficacy of dinoprostone in cervical ripening/labor duration? Clinical and Experimental Obstetrics and Gynecology 2012; 39(4): 522–525.
6. References 6. Johnson TA, Greer IA, Kelly RW, Calder AA. The effect of pH on release of PGE2 from vaginal and endocervical preparations for induction of labour: an in‐vitro study. BJOG: An International Journal of Obstetrics & Gynaecology 1992; 99(11): 877–880.
7. References 7. Godha K, Tucker KM, Biehl C, Archer DF, Mirkin S. Human vaginal pH and microbiota: an update. Vol. 34, Gynecological Endocrinology 2018. p. 451–455.
8. References 8. Johnson TA, Greer IA, Kelly RW, Calder AA. The effect of pH on release of PGE2 from vaginal and endocervical preparations for induction of labour: an in‐vitro study. BJOG: An International Journal of Obstetrics & Gynaecology 1992; 99(11): 877–880.

9. References 9. Martino JL, Vermund SH. Vaginal douching: Evidence for risks or benefits to women’s health. Vol. 24, Epidemiologic Reviews 2002. p. 109–124.
10. References 10. Ramsey PS, Ogburn PL, Harris DY, Heise RH, DiMarco CS, Ramin KD. Effect of vaginal pH on efficacy of the controlled-release dinoprostone vaginal insert for cervical ripening/labor induction. Journal of Maternal-Fetal and Neonatal Medicine 2003; 13(4): 250–253.
11. References 11. Yayla AÇ, Kurek EM, Ozkaya E, Yenidede I, Bostanci EE, Kilicci C, et al. Effect of vaginal washing before intravaginal dinoprostone insertion for labor induction: A randomized clinical trial. Journal of Obstetrics and Gynaecology Research 2018; 44(12): 2149–2155.
12. References 12. Zhang J, Troendle J, Mikolajczyk R, Sundaram R, Beaver J, Fraser W. The natural history of the normal first stage of labor. Obstetrics and Gynecology 2010; 115(4): 705–710.
13. References 13. Shetty A, Mackie L, Danielian P, Rice P, Templeton A. Sublingual compared with oral misoprostol in term labour induction: A randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology 2002; 109(6): 645–650.
14. References 14. Willhite LA, O’Connell MB. Urogenital atrophy: Prevention and treatment. Vol. 21, Pharmacotherapy 2001. p. 464–480.
15. References 15. Önen Ş, Özakşit G, Yilmaz B, Güngör T, Bilge Ü, Süt N, et al. The role of vaginal pH on efficacy of controlled-release dinoprostone vaginal insert for cervical ripening/labor induction: A prospective double-blind study. Journal of the Turkish German Gynecology Association 2008; 9(4): 206–211.
16. References 16. Ramsey PS, Ogburn PL Jr, Harris DY, Heise RH, Ramin KD. Effect of vaginal pH on efficacy of the dinoprostone gel for cervical ripening/labor induction. American Journal of Obstetrics and Gynecology 2002; 187(4): 843–846.
17. References 17. Singh U, Mehrotra S, Gupta HP, Dhakad A, Jain V. A prospective double blind trial investigating impact of vaginal pH on efficacy of prostaglandin gel for cervical ripening and course of labour. Journal of Obstetrics and Gynaecology 2011; 31(3): 217–219.
18. References 18. Yanikkerem E, Yasayan A. Vaginal douching practice: Frequency, associated factors and relationship with vulvovaginal symptoms. Journal of the Pakistan Medical Association 2016; 66(4): 387–392.
19. References 19. Ahmed AI, Zhu L, Aldhaheri S, Sakr S, Minkoff H, Haberman S. Uterine tachysystole in spontaneous labor at term. Journal of Maternal-Fetal and Neonatal Medicine 2016; 29(20): 3335–3339.
20. References 20. Cheng YW, Shaffer BL, Bryant AS, Caughey AB. Length of the first stage of labor and associated perinatal outcomes in nulliparous women. Obstetrics and Gynecology 2010; 116(5): 1127–1135.