This study compared the efficacy and safety of intravaginal misoprostol versus transcervical Foley catheter for cervical ripening prior to labor induction. 104 women with unfavorable cervices (Bishop score ≤4) were randomly assigned to receive either 25 μg misoprostol vaginally every 6 hours or a Foley catheter inserted transcervically. The misoprostol group had a shorter mean induction to delivery interval (14.03 hours) compared to the Foley catheter group (18.40 hours). The rate of vaginal delivery was also higher in the misoprostol group (76.7%) than the Foley catheter group (56.8%). However, both methods were found to be equally
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Intrauterine insemination versus fallopian tube sperm perfusion in non tubal ...Internet Medical Journal
Background: Controlled ovarian hyper stimulation (COH) combined with intrauterine insemination (IUI), using a volume of 0.5 mail of inseminate is commonly offered to couples with non tubal infertility. Another method is Fallopian tube sperm perfusion (FSP) which is based on a pressure injection of 4 ml of sperm suspension while attempting to seal the cervix to prevent semen reflux. This technique ensures the presence of higher sperm density in the fallopian tubes at the time of ovulation than standard IUI. The aim of this study was to compare the efficiency of IUI and FSP in the treatment of infertility.
Methods: 200 consecutive patients with infertility in 404 stimulated cycles were included in the study. Those randomized to standard IUI included 100 patients in 184 cycles [158 Clomiphene citrate/human menopausal gonadotrophin cycles and 26 Letrozole/FSH cycles exclusively for polycystic ovarian disease patients] (group A). Patients subjected to FSP included 100 patients in 220 cycles (193 Clomiphene citrate/human menopausal gonadotrophin cycles and 27 Letrozole/FSH cycles exclusively for polycystic ovarian disease patients] (group B). Swim up semen preparation technique was used in all cases. Insemination was performed in both groups 34-37 hours after hCG administration. Standard IUI was performed using 0.5 ml of inseminate. In FSP 4ml inseminate was used.
Results: In group A (184 IUI cycles in 100 patients), 22 clinical pregnancies (presence of gestational sac with fetal cardiac activity) occurred (11.95% per cycle over four cycles). In group B, (220 cycles of FSP in 100 patients), 48 clinical pregnancies occurred (21.81%per cycle over four cycles) and this difference was statistically significant (p<0.05).
Conclusions: For non-tubal sub fertility, the results indicate clear benefit for FSP (Fallopian tube sperm perfusion) over IUI (Intrauterine insemination).
Key Words: Intrauterine insemination, Fallopian tube sperm perfusion, Non-tubal infertility.
Authors: Dr. Col (Retd) G S Shekhawat, MD(Obst & Gyn) * (Corresponding. Author), Dr Priyanka S, MBBS+
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Intrauterine insemination versus fallopian tube sperm perfusion in non tubal ...Internet Medical Journal
Background: Controlled ovarian hyper stimulation (COH) combined with intrauterine insemination (IUI), using a volume of 0.5 mail of inseminate is commonly offered to couples with non tubal infertility. Another method is Fallopian tube sperm perfusion (FSP) which is based on a pressure injection of 4 ml of sperm suspension while attempting to seal the cervix to prevent semen reflux. This technique ensures the presence of higher sperm density in the fallopian tubes at the time of ovulation than standard IUI. The aim of this study was to compare the efficiency of IUI and FSP in the treatment of infertility.
Methods: 200 consecutive patients with infertility in 404 stimulated cycles were included in the study. Those randomized to standard IUI included 100 patients in 184 cycles [158 Clomiphene citrate/human menopausal gonadotrophin cycles and 26 Letrozole/FSH cycles exclusively for polycystic ovarian disease patients] (group A). Patients subjected to FSP included 100 patients in 220 cycles (193 Clomiphene citrate/human menopausal gonadotrophin cycles and 27 Letrozole/FSH cycles exclusively for polycystic ovarian disease patients] (group B). Swim up semen preparation technique was used in all cases. Insemination was performed in both groups 34-37 hours after hCG administration. Standard IUI was performed using 0.5 ml of inseminate. In FSP 4ml inseminate was used.
Results: In group A (184 IUI cycles in 100 patients), 22 clinical pregnancies (presence of gestational sac with fetal cardiac activity) occurred (11.95% per cycle over four cycles). In group B, (220 cycles of FSP in 100 patients), 48 clinical pregnancies occurred (21.81%per cycle over four cycles) and this difference was statistically significant (p<0.05).
Conclusions: For non-tubal sub fertility, the results indicate clear benefit for FSP (Fallopian tube sperm perfusion) over IUI (Intrauterine insemination).
Key Words: Intrauterine insemination, Fallopian tube sperm perfusion, Non-tubal infertility.
Authors: Dr. Col (Retd) G S Shekhawat, MD(Obst & Gyn) * (Corresponding. Author), Dr Priyanka S, MBBS+
GnRH Agonist in Endometriosis- An Old Good FriendSujoy Dasgupta
Invited Lecture delivered by Dr Sujoy Dasgupta in the "Dream City Meet"- the East Zone Conference of Endometriosis Society of India, held on 24 December 2019 at Durgapur
Dr Sujoy Dasgupta was invited to deliver a lecture at the Conference of IMA (Indian Medical Association), held at July 2019 in Kolkata. This session was sponsored by Meyer Organic.
Dr Sujoy Dasgupta was invited to deliver a lecture at BOGSCON (The Annual Conference of Bengal Obstetric and Gynaecological Society) held at Kolkata in December 2019
It describes the Progesterone physiology. It describes the latest evidence as regards progesterone formulations, use of progesterone as Luteal phase support. It scrutinizes the value of serum progesterone in monitoring luteal phase
Evolution and current practices in emergency contraceptives BY DR ALKA MUKHER...alka mukherjee
ey facts
Emergency contraception (EC) can prevent up to over 95% of pregnancies when taken within 5 days after intercourse.
EC can be used in the following situations: unprotected intercourse, concerns about possible contraceptive failure, incorrect use of contraceptives, and sexual assault if without contraception coverage.
Methods of emergency contraception are the copper-bearing intrauterine devices (IUDs) and the emergency contraceptive pills (ECPs).
A copper-bearing IUD is the most effective form of emergency contraception available.
The emergency contraceptive pill regimens recommended by WHO are ulipristal acetate, levonorgestrel, or combined oral contraceptives (COCs) consisting of ethinyl estradiol plus levonorgestrel.
Progesterone for luteal phase support in IVF cyclesHesham Al-Inany
Luteal phase support is essential for IVF cycles. Progesterone has many forms and modalities: which to use? this talk is an attempt to answer this question
GnRH Agonist in Endometriosis- An Old Good FriendSujoy Dasgupta
Invited Lecture delivered by Dr Sujoy Dasgupta in the "Dream City Meet"- the East Zone Conference of Endometriosis Society of India, held on 24 December 2019 at Durgapur
Dr Sujoy Dasgupta was invited to deliver a lecture at the Conference of IMA (Indian Medical Association), held at July 2019 in Kolkata. This session was sponsored by Meyer Organic.
Dr Sujoy Dasgupta was invited to deliver a lecture at BOGSCON (The Annual Conference of Bengal Obstetric and Gynaecological Society) held at Kolkata in December 2019
It describes the Progesterone physiology. It describes the latest evidence as regards progesterone formulations, use of progesterone as Luteal phase support. It scrutinizes the value of serum progesterone in monitoring luteal phase
Evolution and current practices in emergency contraceptives BY DR ALKA MUKHER...alka mukherjee
ey facts
Emergency contraception (EC) can prevent up to over 95% of pregnancies when taken within 5 days after intercourse.
EC can be used in the following situations: unprotected intercourse, concerns about possible contraceptive failure, incorrect use of contraceptives, and sexual assault if without contraception coverage.
Methods of emergency contraception are the copper-bearing intrauterine devices (IUDs) and the emergency contraceptive pills (ECPs).
A copper-bearing IUD is the most effective form of emergency contraception available.
The emergency contraceptive pill regimens recommended by WHO are ulipristal acetate, levonorgestrel, or combined oral contraceptives (COCs) consisting of ethinyl estradiol plus levonorgestrel.
Progesterone for luteal phase support in IVF cyclesHesham Al-Inany
Luteal phase support is essential for IVF cycles. Progesterone has many forms and modalities: which to use? this talk is an attempt to answer this question
The study focused at examining the extent of environmental awareness in Motor Vehicles Garages in Mbeya City. The study used structured questionnaires, interviews and observation to collect data. A total of 41 Garages and 12 Car wash sites were surveyed. Study revealed that a total of 51,300 litres of water were used for cleaning 1026 cars per week; with high risk of health problems, due to contamination. The study also revealed that efforts by government has been at place, these effort includes training the garage owners, sales of some waste products to some companies for recycling purposes. The study identified challenges facing the garages this included many garage sites were built in residential areas, poor record keeping of waste products etc and this was partly contributed by their poor academic backgrounds, which did not cover environmental issues in detail. As a result many garages had poor management of waste generated in their working places. This study recommended that more efforts should done by Mbeya City authorities to provide environmental awareness to Garages employees and communities around.
Lingual thyroid gland is a rare clinical entity and occurs due to the failure of the thyroid gland to descend to its normal cervical location during embryogenesis. This ectopic thyroid gland located at the base of the tongue may present with symptoms like dysphagia, dysphonia, upper airway obstruction or haemorrhage and maybe associated with thyroid dysfunction. We are presenting here the case of a 16 year-old girl who reported to our hospital with complaints of foreign body sensation in the throat & dysphagia. The CT scan reported an SOL base of tongue. An emergency surgery was conducted due to sudden appearance of dyspnoea & increase in dysphagia. A post operative Thyroid scan & Biopsy confirmed the diagnosis of Lingual thyroid. Thyroid functions showed Hypothyroidism. The TSH level was 98.1 µIU/ml and T3 & T4 levels were 0.1 ng/ml & 2.3 µg/dl respectively.
CONCLUSION: Ectopic Thyroid is a rare anomaly with Lingual thyroid accounting for majority of cases. Dysphagia and dysphonia are common presenting symptoms and majority of cases with thyroid dysfunction have hypothyroidism. Pathogenesis of this ectopic is unknown. Genetic factors have been associated with thyroid gland morphogenesis & differentiation but so far no mutation in known genes has been associated with human thyroid ectopy.
Diesel Injectors are one of the changing parameters in engine design. Piezoelectric Diesel Injectors are one of the changing designs adopted in engine systems especially CRDi engines. It enables better fuel economy and emission control. This paper provides with an overview, design and constructional features, working and applications of piezoelectric diesel Injectors.
The purpose of this study was to investigate any
influence of maternal and/or paternal age, three sperm
parameters (sperm count/ml, motility and morphology) on
pregnancy outcomes in intracytoplasmic sperm injection (ICSI)
cycles. In all, 785 ICSI cases were analyzed retrospectively.
Pregnancy outcome were influenced by the age of the maternal,
paternal partners and sperm count x10⁶. The clinical pregnancy
rate with respect to the age of female partner and male partner
was revealed a significant inverse correlation between them with
(P = <0.001) for each partner. The relationship between clinical
pregnancy rate and sperm count x10⁶/ml was revealed a
significant difference between the groups (P= 0.046). On the other
hand no basic semen parameters (motility and normal
morphology) influence on ICSI pregnancy outcome was found in
the subgroup of patients. We conclude that the influence on
pregnancy outcome after ICSI is related mostly to maternal and
paternal age.
Characterization and the Kinetics of drying at the drying oven and with micro...Open Access Research Paper
The objective of this work is to contribute to valorization de Nephelium lappaceum by the characterization of kinetics of drying of seeds of Nephelium lappaceum. The seeds were dehydrated until a constant mass respectively in a drying oven and a microwawe oven. The temperatures and the powers of drying are respectively: 50, 60 and 70°C and 140, 280 and 420 W. The results show that the curves of drying of seeds of Nephelium lappaceum do not present a phase of constant kinetics. The coefficients of diffusion vary between 2.09.10-8 to 2.98. 10-8m-2/s in the interval of 50°C at 70°C and between 4.83×10-07 at 9.04×10-07 m-8/s for the powers going of 140 W with 420 W the relation between Arrhenius and a value of energy of activation of 16.49 kJ. mol-1 expressed the effect of the temperature on effective diffusivity.
Accuracy of cervico vaginal fetal fibronectin test in predicting risk of spon...Open Access Research Paper
Preterm delivery is the leading cause of neonatal mortality. One of the best predictors to assess the risk of preterm labour (PTB) is by measuring fetal fibronectin (fFN) in cervico vaginal secretion after 26 weeks of pregnancy. The aim is to evaluate the diagnostic accuracy of qualitative cervico vaginal fFN in symptomatic women and asymptomatic high risk women during antenatal care. Prospective study which was conducted in Basrah Maternity and Child Hospital. It included 106 pregnant women at gestational age more than 26 weeks who had uterine contraction with or without pervious risk factors for PTB. Cervico vaginal fluid sampling was undertaken from all women included in the study after the age of 26 weeks of gestation and qualitative fFN assessment was done with 50ng/ml is the cut off point for positivity. As regard qualitative fFN assessment for predicting of PTB sensitivity, specificity, PPV, NPV, were 71%, 87%, 40.50%, 94% respectively in symptomatic women. While in asymptomatic women with previous high risk had 26% sensitivity, 84% specificity, 32% PPV, and 87% NPV. Qualitative assessment of fFN in cervico vaginal fluid is good predictive marker in detecting of PTB.
— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.
Optimal Timing of Oocyte Preincubation for Intra Cytoplasmic Sperm Injection ...theijes
IN Vitro Fertilization (IVF) i.e. fertilizing an oocyte with the sperm under in vitro condition is the most convincing option for treating infertility in the couples in which conception is not possible with conventional treatments. It is achieved either by co-culturing oocyte with sperms (conventional IVF) or by injecting single sperm in the cytoplasm of oocyte (Intra Cytoplasmic Sperm Injection - ICSI). The cultured embryos are then transferred from day2 to 4 (cleavage stage) or day 5 (blastocyst stage) in the uterus of the woman under treatment for implantation. The benefit of in vitro oocyte culture prior to insemination during conventional IVF has been demonstrated; however there are discrepancies about its advantage during ICSI procedure. We undertook this work to examine the effect of duration of pre-incubation on the rate of fertilization after ICSI. This work was carried out by making the retrospective analysis of data regarding oocyte pre incubation accumulated at Niramaya IVF Center during June 2010 to December 2015.ICSI cycles were categorized in to 5 different groups according to the duration of oocyte incubation period prior to ICSI as : Group I - oocytes not incubated, Group II - oocytes incubated between 1-3 hours, Group III- oocytes incubated between 3-5 hours, Group IV - oocytes incubated between 5-7 hours and Group V - oocytes incubated formore than 7 hours. It was observed that rate of fertilization varies with the duration of pre-incubation of oocyte prior to ICSI. We concluded that in vitro culture of oocyte for short duration prior to ICSI has beneficial impact on fertilization.
Live birth by fallopian tube sperm perfusion in hyperprolactinemic woman afte...lukeman Joseph Ade shittu
The case presented describes a live birth following treatment of a 35-year-old woman with fallopian tube sperm perfusion (FTSP) using donor sperm after three-repeated unsuccessful courses of In-vitro fertilization (IVF) with Percutaneous Epididymal Sperm Aspiration (PESA), Testicular Sperm Extraction (TESE), and donor sperm. The indication of FTSP is hereby explored and discussed.
The Detection of a Salivary Ferning Pattern Using the Knowhen Ovulation Monit...KNOWHEN
The ability to detect the period of potential monthly fertility is of great importance to a large segment of the female population in their reproductive years, both in terms of contraception as well as conception. In the current study, the KNOWHEN® ovulation monitoring system was used by a group of women who tested their saliva on a daily
basis for the presence of a ferning pattern, a known biologic marker of impending ovulation. Transvaginal ultrasound examination, which is the “gold standard” for the detection of ovulation, was employed to visually determine if the cycle was ovulatory, either by demonstrating the presence of a dominant ovarian follicle or a corpus luteum found at the site of follicular rupture. If neither were observed, the cycle was determined to be anovulatory. The presence or absence of a ferning pattern in saliva was correlated with the actual documentation of ovulation with transvaginal ultrasound examination. Twenty two (22) women were studied for a total of 41 menstrual cycles. Salivary ferning was observed in 29 of 30 ovulatory cycles. False positive results in which ferning was present in an anovulatory cycle, occurred twice in 10 anovulatory menstrual cycles. Our findings indicate a strong correlation between the presence of salivary ferning and ovulation, as detected by the Knowhen ovulation microscope (Log Odds ratio 7.64, P<0.01, CI 4.26 to 11.02), thus validating its use. Age and weight did not appear to affect ferning, alone or together (P: NS).
http://knowhen.com/
Effect of Nesting on Posture Discomfort and Physiological Parameters of Low B...iosrjce
A study was conducted to determine the effectiveness of “nesting” among low birth weight infants in
NICU of selected government hospital of Delhi. An experimental study was conducted in which low birth weight
infants (birth weight 1.00-2.5kg) were stratified into three groups based on their birth weight (1.0-1.5kg, 1.5-
2.0kg, 2.0-2.5kg). The samples consisted of 60 low birth weight infants; 30 in experimental group and 30 in
control group. Pre-test Post-test control group design was used in which nesting was provided in experimental
group 9 hours per day for 5 days. Posture, comfort and physiological parameters were assessed before and
during administration of nesting. A significant improvement in posture (t=12.64) was observed in experimental
group during application of nesting. A significant reduction in the discomfort was observed in experimental
group as compared to control group (t=10.65).Low birth weight infants exhibit comparatively stable
physiological parameters during the period of nesting.
Intrauterine insemination (IUI) is procedure which involves placing sperm inside a woman's uterus to facilitate fertilization. The ovaries are stimulated with tablets and injections and then monitored for the probable time of ovulation. For more info visit :-//www.newhopeivf.com/intrauterine-insemination-iui.html
Annals of Nutritional Disorders & Therapy is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of nutritional disorders resulting from either excessive or inadequate intake of food and nutrients leading to various Nutritional diseases including obesity, eating disorders, malnutrition, developmental abnormalities that could be prevented by diet, hereditary metabolic disorders that retort to dietary treatment, food allergies and intolerances, and potential hazards in the food supply. It also focuses upon the chronic diseases caused due to improper nutrition such as cardiovascular disease, hypertension, cancer, and diabetes mellitus.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and technology with intent to bridge the gap between academia and research access.
Annals of Nutritional Disorders & Therapy journal accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of nutritional disorders resulting from either excessive or inadequate intake of food and nutrients.
"Heart failure is a typical clinical accompanied by symptoms syndrome (e.g. shortness of breath, ankle swelling and fatigue) that lead to structural or functional abnormalities of the heart (e.g. high venous pressure, pulmonary edema and peripheral edema).
In recent years, the significant role of B-type natriuretic peptide has been revealed in the pathogenesis of heart disease and the use of the drug sacubitril/valsartan has started. It has a positive effect on the regulation of the level of B-type natriuretic peptide in the body. It is obviously seen from the the world literature that natriuretic peptides play an important role in the pathophysiology of heart failure. For this reason, many studies suggest that the importance of natriuretic peptides in the diagnosis and treatment of heart failure is recommended.
Due to this, we tried to investigate the effects of a comprehensive medication therapy with a combination of sacubitril/valsartan in the patients with chronic heart failure."
Parallel generators of pseudo random numbers with control of calculation errors
Sub1594
1. International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438
Volume 4 Issue 1, January 2015
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
Comparison of Vaginal Misoprostol and Foley
Catheter for Cervical Ripening
Nasreen Noor1
, Mehkat Ansari S. Manazir Ali2
Abstract: Objectives: To compare the efficacy and safety of intravaginal misoprostol with transcervical foley catheter for cervical
ripening. Material And Methods: The present study was a prospective study and was conducted in the Department of Obstetrics and
Gynaecology in collaboration with the Department of Paediatrics, J.N.M.C.H., A.M.U., Aligarh during 2013-2014 after getting approval
from Institutional Ethics Committee. One hundred and four women with term gestation, with Bishop score < 4 with various indications
for labour induction were randomly divided into two groups. In Group I, 25 µg of misoprostol tablet was placed intravaginally, 4 hourly
up to maximum 6 doses. In Group II , Foley catheter 16F, inflated with 50 cc of sterile saline , was placed through the internal os of the
cervix. Statistical analysis was done using SPSS software. Results: Two groups were similar in view of their demographic
characteristics. The induction to delivery interval (mean ± SD) in women induced with intravaginal misoprostol was 14.03 ± 7.61 hours
of transcervical Foley catheter was 18.40 ± 8.02 hours. Misoprostol is associated with a shorter induction to delivery interval. The rate of
vaginal delivery was 76.7% Vs 56.8% in misoprostol and Foley catheter group respectively which was significantly higher in misoprostol
group (p<0.001). Neonatal outcome was similar in both the groups. Conclusion: The use of Foley catheter is as effective as misoprostol
for cervical ripening, but less effective in triggering spontaneous labour. Misoprostol is associated with a shorter induction to delivery
interval and it increases the rate of vaginal delivery in cases of unripe cervix at term.
Keywords: Cervical Ripening, Labour Induction, Foley Catheter
1. Introduction
In the recent decade, acknowledgement of the cervix as a
functional organ is one of the major advances in
reproductive physiology. The cervix must remain closed
during pregnancy to maintain pregnancy, yet open during
parturition. Its activity must be performed at the right time,
in right sequence and within reasonable period of time. The
process that co-ordinates these activities in labour is an
equal mixture of uterine contractions, cervical effacement
and dilatation.
In1964,Bishop introduced numeric scoring system to
quantify physical examination of cervix. Bishop score
consists of summation of five observations dealing with
conditions of dilatation, effacement, consistency, position of
the cervix as well as station of presenting part. Of all the
parameters dilatation weighs the most in importance and
position of cervix weighs the least in determining
predictability of score(1). When a high score is present, it is
assumed that those changes that constitute cervical ripening
have occurred and no further attempts to ripen the cervix are
needed. Cervical ripening would be especially beneficial in
patients with cervical score less than 4. The physical and
biochemical changes in the uterine cervix which normally
precede the onset of parturition, are referred to as ripening
and seem to be essential for normal labour and delivery.
When cervix is unfavourable, cervical ripening is
recommended to increase the likelihood of successful
induction(2). A potential effect of induction of labour with
an unripe cervix lead to high rate of induction failure and
caesarean delivery(3).
Ripening of the cervix may be achieved by both
pharmacological and non-pharmacological (mechanical)
methods. The pharmacological preparation includes the
prostaglandins. Two different preparations of prostaglandins
are available, one is prostaglandin E2 (PGE2) or
dinoprostone which is unstable at room temperature and
requires refrigeration. The other is prostaglandin E1 ( PGE1)
analogue misoprostol, which has also been evaluated for
possible use in cervical ripening and induction of labour.
Vaginal misoprostol is currently widely used for ripening of
cervix and induction of labour, however, there are ongoing
trials regarding optimal dose, dosing regimen and route of
administration. Non-pharmacological method includes the
transcervical use of foley catheter for cervical ripening and
induction of labour. Embrey and Mollison first described
using a transcervical Foley catheter for cervical
ripening(4).Foley catheter appears to induce labour not only
through direct mechanical dilatation of cervix but also by
stimulating endogenous release of prostaglandin. Thus,
ripening of the cervix is merely the first step that is
sometimes necessary in induction of labour. However,
currently available studies are underpowered to estimate the
advantages and disadvantages of Foley catheter and
misoprostol. In view of the scarce evidence on the subject
we conducted this study comparing the effectiveness and
safety of intravaginal misoprostol with transcervical Foley
catheter for cervical ripening.
2. Material and Methods:
The present study was a prospective study and was
conducted in the Department of Obstetrics and Gynaecology
in collaboration with the Department of Paediatrics,
J.N.M.C.H., A.M.U., Aligarh during 2013-2014 after getting
approval from Institutional Ethical Committee. A total of
one hundred and four (104) women requiring indicated
induction of labour with an unfavourable cervix (Bishop
score ≤ 4) were included in the study after informed consent.
Women were randomly divided into two groups. 60 women
induced with intravaginal misoprostol as group I and 44
women induced with transcervical Foley catheter as group
II. They were selected from the patients attending antenatal
clinic (ANC), outpatient department (OPD) and patients
admitted in the hospital. The two groups were comparable
with respect to maternal age, parity, gestational and
preinduction Bishop score. Demographic and clinical data
were collected at routine antenatal visits . Inclusion criteria
Paper ID: SUB1594 475
2. International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438
Volume 4 Issue 1, January 2015
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
was singleton gestation, more than or equal to 37 weeks of
gestation with intact membranes and Bishop score ≤ 4. We
excluded the cases with rupture of membranes,
chorioamnionitis, antepartum haemorrhage, cervical dilation
> 2.5 cm, contracted pelvis polyhydramnios, indication for
immediate delivery and previous uterine surgery (for Group
I)In Group I, 25 mcg of misoprostol tablet was placed
intravaginally, 6 hourly for maximum 6 doses. In the
presence of spontaneous and frequent contractions (>40-45
seconds every 3minutes), the next dose was not
administered. If there was no effective uterine contractions
after the sixth dose, then it was considered as failure of
induction by the concerned method. In Group II, 18 F Foley
catheter was inserted into the endocervical canal under direct
vision by doing a perspeculum examination. The catheter
was advanced into the endocervical canal. Once past the
internal os, the balloon was filled with 50 ml of sterile saline
solution and the catheter was taped to the inner-thigh to
maintain traction.The catheter was checked for extrusion of
the balloon from the cervix every 6 hours by cervical
examination and the catheter was remain in place until the
balloon was expelled spontaneously and labour
augmentation was done by artificial membrane rupture or
oxytocin drip, whichever is indicated. The primary outcome
measures were postinduction Bishop score and induction to
delivery interval . Secondary outcome measures includes
uterine contractile abnormalities , meconium stained liquor,
mode of delivery , maternal and neonatal outcome, neonatal
birth weight and Apgar score. Any maternal or fetal
complication was also recorded. The data was tabulated and
analysed. All the results were expressed as mean±standard
deviation. Students ‘t’ test and chi–square test were used to
determine the significance of differences between them.
3. Results
A total of one hundred and four (104) women were included
in the study. They were randomly divided into two groups.
60 women induced with intravaginal misoprostol as group I
and 44 women induced with transcervical Foley catheter as
group II. Maternal baseline characterstics were similar
between the two groups in terms of age, parity, gestational
age and preinduction Bishop score. Table- I The two groups
were comparable with respect to indications for induction of
labour as shown in Table-II
As shown in Table III, the preinduction and postinduction
Bishop score (mean ± SD) in women induced with
intravaginal misoprostol was 2.52 ± 0.77 and 7.43 ± 1.90
while that in women induced with transcervical Foley
catheter was 2.34 ± 0.67 and 7.45 ± 1.26 respectively. Both
the groups were comparable with respect to cervical ripening
(p > 0.05). The induction to delivery interval (mean ± SD) in
women induced with intravaginal misoprostol was 14.03 ±
7.61 hours while that of women induced with transcervical
Foley catheter was 18.40 ± 8.02 hours. The induction to
delivery interval in misoprostol group was significantly
shorter than that in Foley catheter group (p < 0.01).
As depicted in Table-IV, the rate of vaginal delivery was
46 women (76.7%) and 25 women (56.8%) while 14 women
(23.3%) and 19 women (43.2%) delivered through caesarean
section in misoprostol and Foley catheter group respectively.
The rate of vaginal delivery was significantly more in
misoprostol group as compared to Foley catheter group (p <
0.05). The caesarean section rate was more in Foley catheter
group as compared to misoprostol group and the results were
statistically significant (p < 0.05).
The birth weight (Mean±SD) was 2.79 ± 0.43 kg and 2.91 ±
0.53 kg in misoprostol and Foley catheter group. The
difference in the birth weight between the two study groups
was statistically not significant (p > 0.05). The Apgar score
at 1minute and 5 minute (Mean±SD) was 7.80 ± 0.77 Vs
7.91 ± 0.33 and 8.92 ± 0.38 Vs 8.98 ± 0.15 in misoprostol
and Foley catheter group respectively. Statistically there was
no significant difference in the Apgar score between the two
groups at 1 and 5 minute (p > 0.05).
4. Discussion
The use of cervical ripening agents prior to conventional
methods of induction is now a standard practice. Until now
different methods for labour induction are used. In literature,
contradictory results are reported regarding efficacy and
safety of the induction methods. Therefore in this study, we
compared the efficacy and safety of 25 µg vaginal
misoprostol with transcervical Foley catheter for
preinduction cervical ripening. The results of present study
show that the rate of cervical ripening was same with both
the agents. Our study is in accordance to the studies of
Sciscione et al.5
and Chung et al.6
, who also reported no
differences between Foley catheter and intravaginal
misoprostol for cervical ripening. Fekrat et al.7
evaluated
three methods of cervical ripening with vaginal misoprostol
and Foley catheter and the combination of these two
methods and they reported that vaginal misoprostol was
more effective than other two methods. Hofmeyr et al.8
evaluated intravaginal misoprostol and other conventional
intravaginal prostaglandins and showed that the misoprostol
is more effective for cervical ripening . Our findings are
against the results of these studies, the most important cause
for this may be lower dose of misoprostol (25 µg) used in
our study compared with their studies. The study of Adeniji
et al.9
recommends a maximum dose of 50 µg every 6 hours
for cervical ripening.
The results of present study show that induction to delivery
interval was significantly shorter in misoprostol group as
compared to Foley catheter group. Sheikher et al.10
also
found shorter induction delivery interval in vaginal
misoprostol group compared to Foley catheter group. The
shorter induction delivery interval in misoprostol group
could be explained on the basis of greater oxytocic effect on
uterus via vaginal route due to direct access to myometrium
by cervical canal. Our study is not in accordance with Prager
et al.11
, who found that induction to delivery interval was
significantly shorter in Foley catheter group as compared to
misoprostol and PGE2.
In our study, women undergoing vaginal delivery were
significantly more in misoprostol group as compared to
Foley catheter group and women undergoing caesarean
section were .Our study is in harmony with Moraes Filho et
al.12
who also noticed significantly more vaginal delivery in
misoprostol group. Roudsari et al.13
found that the rate of
Paper ID: SUB1594 476
3. International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438
Volume 4 Issue 1, January 2015
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
vaginal delivery was significantly more in Foley catheter
group as compared to misoprostol group . Our results were
not in harmony with the findings of Adeniji et al.9
who did
not found any significant difference in the mode of delivery
between the two groups.
In this study, there was a tendency towards more frequent
caesarean section in response to foetal distress among
women administered misoprostol. This finding is in
agreement with most of the studies that have demonstrated a
higher incidence of hyperstimulation associated with foetal
distress in women induced with misoprostol. Both the
groups were comparable in terms of meconium amniotic
fluid as an indication of caesarean section. Statistically there
was no significant difference in the Apgar score between the
two groups at1 and 5 minute .Similar results were obtained
by Moraes Filho et al.12
and Roudsari et al.13
and our present
study support these results . Like most of the studies, the two
groups in our study were comparable in terms of NICU
admission.
5. Conclusion
The results of the present study suggest that both the modes
of induction are safe and effective. Misoprostol is associated
with a shorter induction to delivery interval and it increases
the rate of vaginal delivery in cases of unripe cervix at term.
The potential advantages of transcervical Foley catheter over
misoprostol are reversibility, easy availability and lack of
local and systemic serious side effects. However, further
studies with larger sample size would be of sufficient power
to assess significant adverse maternal and neonatal
complications.
References
[1] Bishop EH. Pelvis scoring for elective induction. Obstet
Gynecol 1964; 24:266-8.
[2] Wing D.Induction of labour, indications, techniques and
complications (www.Up To Date.com) 31st
July 2006
[3] Hofmeyr GJ.Induction of labourwith an unfavourable
cervix. Best Prac Res Clin Obstet Gynaecol 2003: 17:
777-794
[4] Embrey MP, Mollison BG. The unfavourable cervix
and induction of labour using a cervical balloon. J
Obstet Gynaecol Br Commonw 1967;74:44-48
[5] Sciscione AC,Nguyen L,Manley J, Pollock M, Maas B
and Colmorgen G. A randomizedcomparison of
transcervical Foley catheter to intravaginal misoprostol
for preinduction cervical ripening. Obstet.
Gynecol.2001; 97: 603-7.
[6] Chung JH, Huang WH, Rumney PJ, Garite TJ,
Nageotte MP. A prospective randomized controlled trial
that compared misoprostol, Foley catheter, and
combination misoprostol-Foley catheter for labor
induction. Am J Obstet Gynecol 2003;189:1031-5.
[7] Fekrat M, Kashanian M, Alavi SMH and Ali Nejad S.
Comparison of 3 techniques for cervical ripening and
induction of labor with vaginal misoprostol and foley
catheter and combination of these two methods. J.
Fertility Infertility (2007) 8: 149-54.
[8] Hofmeyr GJ and Gulmezoglu AM. Vaginal misoprostol
for cervical ripening and induction of labour. Cochrane
Database Syst. Rev. (2003) 1:CD 000941
[9] Adeniji AO, Olayemi O and Odukogbe AA. Intra-
vaginal misoprostol versus transcervical Foley catheter
in pre-induction cervical ripening. Int. J. Gynaecol.
Obstet. (2006) 92: 130-2.
[10]Sheikher C, Suri N, Kholi U. Comparative Evaluation
of Oral misoprostol, Vaginal misoprostol and
Intracervical Folley’s Catheter for Induction of Labour
at Term.JK Science (2009); 11(2): 75
[11]Prager M, Eneroth GE, Edlund M, Marions L. A
randomised controlled trial of intravaginal
dinoprostone, intravaginal misoprostol and transcervical
balloon catheter for labour induction. BJOG : an
international journal of obstetrics and gynaecology
2008;115:1443-1450
[12]Moraes Filho OB, Albuquerque RM, Cecatti JG. A
randomized controlled trial comparing vaginal
misoprostol versus Foley catheter plus oxytocin for
labour induction. Acta Obstet Gynecol Scand 2010;89:
1045-52.
[13] Roudsari FV, Ayati S, Ghasemi M, Mofrad MH,
Shakerib MT, Farshidi F, Shahabian M. Comparison of
Vaginal Misoprostol with Foley Catheter for Cervical
Ripening and Induction of Labor. Iranian Journal of
Pharmaceutical Research (2011), 10 (1): 149-154
Table I: Demographic Profile
Parameters
Group I(n=
60)
(Misoprostol)
Group
II(n=44)
(Foley
Catheter)
‘p’
value
Age (years)
(Mean ±SD)
25.1 ± 2.8 25.6 ± 4.1 >0.05
Gravidity Primi 41.7% 31.8% >0.05
Multi 58.3% 68.2% >0.05
Gestational
age(weeks)
(Mean ±SD)
39.1 ± 1.4 39.4 ± 1.2 >0.05
Table II: Indication for Induction Of Labour
Indication for
induction
Group I
(Misoprostol)
Group II
(Foley Catheter) ‘p’ value
n % n %
≥ 40 weeks 29 48.3 27 61.3 >0.05
Oligohydramnios 11 18.3 08 18.2 >0.05
Preeclampsia 11 18.3 04 09.1 >0.05
IUGR 07 11.7 04 09.1 >0.05
Table III: Bishop Score in Group I and Group II
Parameters Group I(n=60)
(Misoprostol)
GroupII(n=44)
(Foley Catheter)
‘p’ value
Preinduction Bishop score 2.52 ± 0.77 2.34 ± 0.67 >0.05
Postinduction Bishop
score
7.43 ± 1.90 7.45 ± 1.26 >0.05
Induction to active phase
interval (hrs) (Mean ± SD)
11.6 ± 5.21 11.8 ± 5.82 >0.05
Induction to delivery
interval(hrs)(Mean ± SD)
14.03 ± 7.61 18.40 ± 8.02 < 0.01
Paper ID: SUB1594 477
4. International Journal of Science and Research (IJSR)
ISSN (Online): 2319-7064
Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438
Volume 4 Issue 1, January 2015
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
Table IV: Comparison of Mode of Delivery
Mode of delivery
Group I
(Misoprostol)
Group II
(Foley Catheter)
Total ‘ p’
value
n % n % n %
Vaginal delivery
46 76.7 25 56.8 71 68.3 <0.05
Caesarean
delivery
14 23.3 19 43.2 33 31.7 <0.05
Total
60 100.0 44 100.0 104 100.0
Table V: Neonatal Outcome in Group I and Group II
Parameters Group I(n=60)
(Misoprostol)
GroupII(n=44)
(Foley Catheter)
‘p’
value
Birth weight (kg) (Mean
± SD)
2.79 ± 0.43 2.91 ± 0.53 >0.05
Apgar score (at 1 min)
Mean ± SD
7.80 ± 0.77 7.91 ± 0.33 >0.05
Apgar score (at 5 min)
Mean ± SD
8.92 ± 0.38 8.98 ± 0.15 >0.05
NICU admission 13.3% 13.6% >0.05
Meconium aspiration
syndrome
8.3% 9.1% >0.05
Paper ID: SUB1594 478