Intravaginal misoprostol versus uterine curettage for missed abortion: A cost-effectiveness analysis.

PURPOSE: To evaluate the cost-effectiveness of a strategy based on direct-acting uterine curettage (UC) versus a pre-direct-acting misoprostol (1600 mg) in patients with missed abortion (MA), from the perspective of a National Health System. METHODS: An open prospective cohort study was carried out at Reina Sofía University Hospital (Córdoba, Spain) from January 1, 2019 to December 31, 2019 in 180 patients diagnosed with MA. The patients chose medical treatment with intravaginal misoprostol (800 µg/4 h) or UC after receiving complete and detailed information. The effectiveness, clinical characteristics of the patients, costs of treating and managing the disease, and satisfaction with the procedures were recorded. RESULTS: One hundred and forty-five patients (80.6%) chose misoprostol versus 35 patients (19.4%) who chose UC. The effectiveness of misoprostol has been 42% evaluated at 48 h; UC success rate has been 100%. The incidence of side effects is significantly higher in patients treated with misoprostol (p < 0.05); as well as the number of care received by the patient (p < 0.05). Satisfaction is higher in patients treated with UC (p < 0.05). However, the cost is almost 5-folds higher in patients treated with UC (p < 0.05). CONCLUSION: UC has a higher success rate, greater satisfaction, and a lower incidence of side effects, although significantly increases the cost compared to misoprostol in MA.

Efficacy and safety of misoprostol, dinoprostone and Cook's balloon for labour induction in women with foetal growth restriction at term.

BACKGROUND AND OBJECTIVES: To compare effectiveness and safety of dinoprostone, misoprostol and Cook's balloon as labour-inducing agents in women with intrauterine growth restriction (IUGR) at term. METHODS: Retrospective cohort chart review of women diagnosed with foetal growth restriction at term in Reina Sofia Hospital, Cordoba, Spain from January 2014 to December 2015. Registration of baseline characteristics and method of induction was made. The main outcome was time from induction to delivery. Obstetric and perinatal outcomes were also collected. RESULTS: A total of 99 women were diagnosed with IUGR in the mentioned period. Of them, 21 women were induced with dinoprostone [dinoprostone group (DG)], 20 with misoprostol (MG) and in 58 with Cook's balloon (CG). Groups were homogeneous regarding pre-induction Bishop score and parity. The CG required more time (24.36 vs. 19.23 h; p = 0.02) and more oxytocin dose for conduction of labour from induction to delivery (6.75 vs. 1.24 mUI; p < 0.01) than DG. Moreover, the CG also needed more oxytocin than MG, 6.75 vs. 2.37 mUI (p < 0.001). Caesarean rate was 5, 14.9 and 17.3% in MG, DG and CG, respectively. No differences were observed in rates of uterine tachysystole, non-reassuring foetal status and neonatal adverse events. INTERPRETATION AND CONCLUSIONS: Prostaglandins were more effective than Cook's balloon to induce labour and achieve vaginal birth in this sample of women with IUGR at term, with a similar safety profile.

What can we do to reduce the associated costs in induction of labour of intrauterine growth restriction foetuses at term? A cost-analysis study.

OBJECTIVE: To evaluate the costs associated with induction of labour in intrauterine growth restriction fetuses comparing different procedures. STUDY DESIGN: 150 pregnancies at term diagnosed with intrauterine growth restriction and indication for induction of labour were included. 24 were ripened with misoprostol 25 µg tablets, 24 with dinoprostone 10 mg vaginal insert, and 77 with Cook® cervical ripening balloon. To determine the costs of induction of labour, method of induction, intrapartum medication, epidural analgesia, type of delivery, and maternal and neonatal admissions were considered. Statistical analysis was performed using the G-Stat 2.0 free statistical software. ANOVA test was used for comparisons between quantitative parametric variables. Chi-squared test or Fisher test was used for qualitative variables. A value of p < 0.05 was considered statistically significant. RESULTS: Up to 70.83% women in dinoprostone group gave birth within the first 24 h compared to 42.66% in misoprostol group and 36.36% in CG (p < 0.01). Misoprostol tablets were cheaper (9.45 ± 1.52 US dollars) than dinoprostone or Cook® balloon (41.67 ± 0 and 59.85 ± 0 54.45 ± 0 US dollars, respectively) (p < 0.01). Costs related to maternal admissions were higher in CG (475.13 ± 146.95$) than dinoprostone group (475.13 ± 146.95$) or MG (427.97 ± 112.65$) (p = 0.03). Total costs in misoprostol group (2765.18 ± 495.38$) were lower than in the dinoprostone group (3075.774 ± 896.14$) or Cook® balloon group (3228.02 ± 902.06$) groups. CONCLUSIONS: Misoprostol for induction of labour had lower related costs than dinoprostone or Cook® balloon, with similar obstetrical and perinatal outcomes.

Vaginal misoprostol and cervical ripening balloon for induction of labor in late-term pregnancies.

AIM: The aim of this study was to compare vaginal misoprostol with the Cook cervical ripening balloon (CCRB) for induction of labor in late-term nulliparous women. METHODS: This open, quasi-experimental, prospective study included 109 nulliparous women with late-term pregnancies and Bishop scores < 7. Fifty-five women were allocated to receive vaginal misoprostol 25 mcg and 54 received the CCRB to induce labor. The primary outcome was the time until delivery. Secondary outcomes included time to the onset of labor and obstetric and perinatal outcomes. RESULTS: Women in the misoprostol group experienced shorter time until delivery (25.41 h vs 31.26 h; P < 0.01) and in a greater percentage gave birth within the first 24 h. Time to active stage of labor was 19.5 h and 23.8 h (P < 0.01) for misoprostol and the CCRB, respectively. 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 in late-term pregnancies.

Influencia de la obesidad en la evolución del parto / Influence of obesity on mode of delivery

Objetivo: Analizar la influencia de la obesidad mórbida en la vía y comienzo del parto. Hipótesis: La obesidad mórbida aumenta la tasa de cesáreas e inducciones. Sujetos y métodos: Se diseñó un estudio retrospectivo, descriptivo poblacional, con gestantes que dieron a luz durante el año 2012 en el Hospital Universitario Reina Sofía; fueron excluidas las gestaciones gemelares. Se incluyó en el grupo de gestantes con obesidad mórbida a aquellas con un índice de masa corporal en la primera visita de embarazo (en torno a las 8 semanas de gestación) igual o superior a 40. El resto de las gestantes se incluyeron en el grupo de gestantes control. Las variables analizadas fueron: edad, paridad, comienzo del parto y tipo de parto. Resultados: Las gestantes con obesidad mórbida tienen una tasa más elevada de cesáreas que el resto de las gestantes (36,76% vs. 18,49%), p < 0,001, al igual que un mayor porcentaje de inducciones (50,79% vs. 25,81%), p < 0,001. Conclusiones: La obesidad mórbida aumenta el riesgo de cesáreas e inducciones (AU)

Objective: To analyze the influence of morbid obesity on mode of delivery and onset of labor. Hypothesis: Morbid obesity increases the cesarean section and induction rates. Subjects and methods: A population-based, retrospective, descriptive study was designed in women giving birth in 2012 at the Reina Sofía Hospital. Twin pregnancies were excluded. The women were classified according to body mass index (BMI) at the first prenatal visit (at around 8 weeks of gestation) into those who were morbidly obese (BMI greater than or equal to 40 kg/m2) and a control group (BMI less than 40 kg/m2). The variables analyzed were age, parity, onset of labor, and mode of delivery. Results: Morbidly obese pregnant women have a higher rate of cesarean sections than the control group (36.76% vs. 18.49%, P<.001) and a higher rate of inductions (50.79% vs. 25.81%, P<.001). Conclusions: Morbid obesity increases the risk of cesarean sections and inductions (AU)