WHAT IS THE POSITION OF THE MECHANICAL PRE-INDUCTION CERVICAL RIPENING IN MODERN OBSTETRICS?
|Fakulta / Pracoviště MU|
|Popis||Objective: To evaluate the effectiveness and safety of mechanical pre-induction cervical ripening before labor induction using osmotic cervical dilators Dilapan-S. Material and Methods: A retrospective study of 68 patients who gave birth at the Gynaecology and Obstetrics University Hospital Brno in 2010-2011 and osmotic cervical dilators Dilapan-S for pre-induction cervical ripening before labor induction were used. Only patients which completed the 36th week of gestation, singleton pregnancy and foetus in head longitudinal position have been included. Efficacy of pre-induction and the mode of delivery was assessed. The incidence of contraction activity during pre-induction, uterine hypertonus, signs of intrauterine foetal distress and infectious complications in the mother and newborn were evaluated. Results: The most common indications for pre-induction cervical ripening was post-term pregnancy (38.2 %), diabetes mellitus (19,1 %) and maternal hypertensive disorders (10.3 %). Previous Caesarean section was present in medical history of 16 patients (23,5%). The mean cervix score before pre-induction was 2.9 (min. 2 - max. 4) and 6,1 after pre-induction. . The final cervix score 5 or more were achieved by 54 patients (79%). In 3 cases were applied 3 pieces of Dilapan-S and all achieved cervix score >5. In all other cases, were applied 2 pieces of Dilapan-S. The mean duration of pre-induction was 14 hours 35 min. Contraction activity during pre-induction was observed in 18 patients (26.5 %), as mild were rated by 16 patients. Cardiotocography (CTG) during pre-induction was performed in 67 patients (98.5 %). Uterine hyperactivity was not recorded. 37 patients (54.4 %) delivered vaglnally, 31 patients (45.6 %) delivered by Caesarean section. When comparing the subgroup of patients with a Caesarean section in medical history (n = 16) and the subgroup of patients without previous CS (n = 72), there was no significant difference in the ratio of completed vaginal birth (50.0 % versus 53.8 %). The pH value of 7.10 and less was found in five patients (7.3 %). In the subgroup of patients with a history of Caesarean section, the value of pH < 7.10 and less does not occurred. Apgar score at 5th minute less than 5 in our group was not observed. 2 patients underwent the postpartum period febrile illness with antibiotics therapy, which in one case was evaluated as pyelonephritis and in the second case as in open abdominal wound infection after Caesarean section. 4 infants (5.8 %) were treated for acute conjunctivitis which corresponds to an average incidence in the population. Other complications in the mother or infant were not recorded. Conclusion: Osmotic cervical dilators Dilapan-S are highly effective and safe in pre-induction cervical ripening before labor induction in the group of patients with an unfavourable cervix score. The advantage is the low incidence of adverse contractile activity during pre-induction. It can be effectively used even in patients with a history of previous Caesarean section. Infectious complications in mothers and newborns in our sample were not recorded.|