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Created on : 10 Feb 2004
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Randomized trial between two active labor management protocols in the presence of an unfavorable cervix. American Journal of Obstetrics and Gynecology 2004;190(1):124-28.

Author(s) :

Bolnick JM, Velazquez MD, Gonzalez JL, Rappaport VJ, McIlwain-Dunivan G, Rayburn WF.

Year of publication :

2004

URL(s) :

http://www.sciencedirect.com/science?_ob=ArticleUR…

Résumé (français)  :

Abstract (English)  :

OBJECTIVE : The purpose of this study was to compare the efficacy of two protocols for active management of labor at term in the presence of an unfavorable cervix.


STUDY DESIGN : Pregnancies that underwent labor induction at 37 weeks of gestation with an unfavorable cervix (Bishop score, 6) were randomly assigned to receive vaginally either a single dose of sustained-release dinoprostone (Cervidil) with concurrent low-dose oxytocin or multidosing of misoprostol (25 g every 4 hours) followed by high-dose oxytocin. The primary outcome was the time interval from induction to vaginal delivery. Other parameters included excess uterine activity and cesarean delivery rates.


RESULTS : A total of 151 patients (dinoprostone, 74 patients; misoprostol, 77 patients) were enrolled. The mean time from the initiation of induction to vaginal delivery was the same in the dinoprostone and misoprostol groups (15.7 hours; 95% CI, 13.7-17.7 hours vs 16.0 hours; 95% CI, 14.1-17.8 hours; P = .34), regardless of parity. The dinoprostone and misoprostol groups did not differ statistically in the percent of patients who were delivered vaginally by 12 hours (36.2% vs 29.7%), 18 hours (63.8% vs 56.3%), and 24 hours (81.0% vs 81.3%). Excess uterine activity was not more common in either group, and hyperstimulation syndrome was absent in all cases. Primary cesarean delivery rates were similar (dinoprostone, 21.6%; misoprostol, 16.9%; relative risk, 1.3; 95% CI, 0.7-2.5), with a failed induction that occurred in one case in each group.


CONCLUSION : Sustained-release dinoprostone with concurrent low-dose oxytocin and intermittent misoprostol with delayed high-dose oxytocin are effective alternatives for active management of labor with an unfavorable cervix.

Sumário (português)  :

Resumen (español)  :

Comments :

Argument (français) :

Essai comparatif randomisé de deux protocoles de gestion active du travail en présence d’un col défavorable

Argument (English):

Argumento (português):

Argumento (español):

Keywords :

➡ c-section/caesarean ; evidence-based medicine/midwifery ; physiology ; induction of labor ; post-term pregnancy ; misoprostol (Cytotec)

Author of this record :

Cécile Loup — 10 Feb 2004
➡ latest update : Bernard Bel — 02 Dec 2007