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Clinical Use of Eicosanoids for Cervical Ripening before Induction of Labor
Published in Murray D. Mitchell, Eicosanoids in Reproduction, 2020
There are, however, only seven published English language reports on controlled comparisons between various routes of prostaglandin administration for cervical ripening.34,43,90–94 They have involved comparisons between oral and vaginal administration,90,91 between oral and extraamniotic administration,90 between vaginal and endocervical administration,34,43 between vaginal and extra-amniotic administration,90,92,93 and between endocervical and extra-amniotic administration.94 Only two of these comparisons, both of them comparing the endocervical and vaginal routes of administration have been conducted in a double-blind manner.34,43 The other investigators all used either alternate allocation or did not describe their method of random or quasi-random allocation. There is thus potential for bias in all except two of these trials.34,43 Moreover, the total numbers of women included in these comparisons are small. In addition, they have occasionally been divided over several groups. For example, Davey and McNab reported controlled comparisons in which a total of 33 women were “randomized” to five different dose regimens of PGE2, three of which were administered vaginally and two orally.91
Effect of dexamethasone on labour induction and cervical ripening in term pregnancies: a systematic review and meta-analysis
Published in Journal of Obstetrics and Gynaecology, 2022
Shahla Hemmatzadeh, Parivash Ahmadpoor, Sevda Kamrani, Mojgan Mirghafourvand
In this study, dexamethasone did not significantly affect the caesarean section rate. In the study conducted by Barkai et al. (1997), there was no significant difference between the dexamethasone and control groups in this regard. However, the indication for caesarean section in the control group was the lack of progression of labour, that is, although the rate of the caesarean section did not decrease in the intervention group, the labour and delivery process was not disrupted as in the control group. This indicated the effect of dexamethasone on cervical effacement. They hence concluded that dexamethasone probably reduced the risk of induction failure by improving the Bishop score (Barkai et al. 1997). Several studies have shown that the intramuscular or extra- amniotic administration of corticosteroids increases the rate of normal delivery in sheep and humans. As glucocorticoid receptors have been found in amniotic membranes, it is hypothesised that corticosteroids are possibly involved in labour, especially in the paracrine or autocrine modes. To increase the success rate of vaginal delivery and prevent unnecessary caesarean sections, it is necessary to evaluate the pre-induction cervical conditions based on the Bishop score.