Presentan : Riza Sufriadi

PEMBIMBING : Dr.dr. Hasanuddin,SpOG(K)

ABSTRACK
Aim: to compare vaginal misoprostol with the Cook cervical ripening balloon (CCRB)
Methods: This open, quasi-experimental, prospective study included 109 nulliparous
women with late-term pregnancies and Bishop scores < 7.
The primary outcome was the time until delivery. Secondary outcome included time to
the onset of labor and obstetric and perinatal outcomes.
Results: Women in the misoprostol group experienced shorter time until delivery and in
a greater percentage gave birth within the first 24 h. Time to active stage of labor.
There were no differences in the rates of cesarean section or post-partum anemia.
Additionally, there were no differences in rates of tachysystolia, intrapartum fever, or
meconium. Perinatal outcomes, post-partum pH, Apgar scores, and neonatal admissions
were similar in the two groups.
Conclusion: Misoprostol 25 mcg reduces labor induction time compared with the CCRB
with similar safety
INTRODUCTON
Post-term pregnancy is defined as a pregnancy that extends to ≥42+0 weeks of
gestation or 294 days from the first day of the last menstrual period.

Post-term pregnancies are associated with increased fetal and neonatal morbidity
and mortality.

For these reasons, induction of labor is recommended in late-term pregnancies,

defined as one that has reached 41+0 –41+6 weeks of gestation, in order to reduce
post-term pregnancies and to avoid related adverse outcomes
For pregnant women with unfavorable Bishop scores, defined as <7, cervical
ripening is necessary before inducing labor. Prostaglandin E1 (PGE1) or E2
(PGE2), misoprostol and dinoprostone, as well as mechanical methods, such as
the Cook cervical ripening balloon (CCRB), are the most common options for
cervical ripening.

The present study was designed to compare the effectiveness and safety of
vaginally administered misoprostol with the CCRB for onset of labor in a
homogeneous group of nulliparous women with late-term pregnancies.
METHODS
This survey was conducted as an open prospective cohort study, Data were analyzed
using the G-Stat 2.0 free statistical software
Place: Reina Sofia Hospital, Córdoba, Spain
Period : from July 2015 to January 2016, 109 women were recruited to compare
vaginally administered misoprostol 25 mcg (55 womens) and the CCRB (54 womens)
as methods of induction of labor
Inclusion Criteria: Nulliparous pregnant women between 41+0 and 42+0 WGA, with
singleton Live Head Presentation, Bishop score < 7
Exclusion criteria: premature rupture of membranes, multiple gestation, history of
previous SC, major uterine surgery, absence of fetal well-being, previous childbirths,
chorioamnionitis or an active infection in the birth canal, metrorrhagia, and non-
cephalic presentation.
Misoprostol 25 mcg tablets were administered vaginally every 4 h up to a maximum
of four tablets.
The CCRB was inserted bimanually into the cervical canal; both the intrauterine and
intravaginal balloons were filled with 50 mL glucosaline solution and left in place for
up to 24 h.
The following variables were recorded: maternal age, gestational age, previous
childbirths, body mass index, Bishop score, misoprostol doses, type of anesthesia,
hours until the onset of active stage of labor and delivery, presence of uterine
tachysystolia, intrapartum fever (>38°C), maternal hemoglobin, meconium, type of
delivery and reasons for operative delivery, oxytocin use, birthweight, and Apgar
score. Maternal and newborn complications, including neonatal intensive care unit
admissions
RESULT
 DISCUSSION
One of the most frequent indications for labor induction is late-term pregnancy. There
are two types of labor-inducing agents: (i) pharmacological, such as prostaglandins
(PGE1 and PGE2); and (ii) mechanical, such as Foley’s catheter and the CCRB.
Results from study suggest that misoprostol is very effective and in our observed it
was not associated with an increased rate of uterine hyperstimulation, cesarean
section, or neonatal admissions.
However, some reports suggest that the main adverse effect of prostaglandins is an
increased prevalence of uterine tachysystolia, which may originate from abnormal
fetal heart rate, resulting in nonreassuring fetal status and increased rate of cesarean
sections and instrumental deliveries.
In accordance with a recent study by Mackeen et al., the present series did not
observe a higher incidence of chorioamnionitis or intrapartum fever associated with
the use of mechanical methods; however, in a systematic review by Mozurkewich et
al., an increased rate of infection with mechanical methods was suggested.

In our study, misoprostol was associated with a shorter time until delivery with an
increased likelihood of giving birth within the first 24 h compared with the CCRB and
shorter elapsed time from administration until the onset of the active stage of labor.
In other reports, misoprostol has also been related to a shorter induction time and a
higher frequency of vaginal deliveries within the first 12 h compared with
dinoprostone and mechanical methods.
In conclusion, although further studies solving the present limitations are needed, it
appears that 25-mcg misoprostol tablets vagina are safe, effective, and reduce
labor induction time in lateterm nulliparous pregnant women when compared with the
CCRB.
TELAAH KRITIS
KOMPONEN YA/TIDAK KETERANGAN

Ruang Lingkup dan Tujuan

1. Apakah dijabarkan isu yang jelas
2. Apakah sasaran panduan tersebut
jelas
Metode
1. Apakah dilakukan secara legal dan
komperhensiv
2. Apakah ada Kriteria Inklusi/Ekslusi
3. Apakah Metode pengumpulan sampel
dan pengolahan data dijelaskan
4. Apakah Kelebihan, Resiko dan efek
samping dijelaskan
Ya
Induksi Pematangan Serviks
Ya
Ya open prospective cohort study and was
approved by the institutional review board of
the Reina Sofia Hospital, Córdoba, Spain
(Reference 243–23/07/2015).
Ya Dijelaskan dalam metode
ya Dijelaskan dalam metode
Ya Termasuk dalam item Survey
TELAAH KRITIS
KOMPONEN YA/TIDAK KETERANGAN

APLIKABILITAS
1. Apakah Dijelaskan Metode lain Tidak
untuk tatalaksana/diagnosis
2. Apakah rekomendasi kunci dapat
diidentifikasi Ya
Conflic Of Ineterest
1. Apakah survey tersebut independent Ya Dijelaskan dalam disclosure
dari sumber pendanaan
2. Conflict of interest dijelaskan Ya Dijelaskan dalam disclosure
3. Seberapa Up todate panduan tersebut ya Diterbitkan tahun 2017
TERIMA KASIH