Nonpharmaceutical ripening of the unfavorable cervix and induction of labor by a novel double balloon device

Article Abstract:

A successful vaginal delivery depends on the ''ripening'' of the cervix, or dilation of the neck of the uterus to allow passage of the infant. The artificial ripening of the cervix and induction of labor have always been considered as challenges of childbirth. The pituitary hormone oxytocin, which stimulates the uterus to contract, is usually given intravenously, but is associated with prolonged induction periods, a large rate of failure, and patient discomfort. Another commonly used ripening agent is prostaglandin (PG), which was initially given directly into the circulation. PG is now applied vaginally or outside of the amniotic membrane, which surrounds the fetus. The absorption of PG into the circulation commonly occurs and is associated with increased muscle tone of the uterus, nausea, and vomiting. A stable PGE2 gel was developed to be inserted into the cervix. However, the gel may spill over into the vagina, thereby reducing its effectiveness, or may cause excess activity of the uterus. The PGE2 gel should be inserted directly into the cervix and maintained in place using a catheter with two small inflatable balloons. A device called the Atad Ripener Device was developed to allow the gel to be applied in the endocervical canal between the two balloons, and thereby prevent gel spillage. The effectiveness of intracervical PGE2 gel and Atad Ripener device in artificial ripening of the cervix was assessed. The PGE2 gel was applied into the cervix by a cannula in 48 women, and by the Atad Ripener Device in 70 women. The duration between artificial ripening of the cervix and delivery was 34.2 hours for PGE2 gel applied by a cannula; and 20.8 hours for the Atad Ripener Device with either a PGE2 gel or placebo gel, a gel with no therapeutic effect. The Atad Ripener Device used alone was shown to be effective in inducing labor and was also well tolerated by patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Obstetrics

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Randomized trial of Dilapan and Laminaria as cervical ripening agents before induction of labor

Article Abstract:

The onset of labor is signaled by uterine contractions accompanied by dilation and thinning of the cervix. The success of labor induction depends on the ability of the cervix to ripen (soften) prior to induction procedures. The effectiveness of two types of cervical ripening devices, Dilapan and Laminaria japonicum, used prior to the induction of labor, was compared. The two devices were inserted into the cervical canal one day before the induction of labor. The cervix was assessed before and after insertion, using the Bishop scoring system. Ripening was considered successful if the Bishop score was greater than four. The effectiveness was judged by the number of devices required, the time it took from induction to delivery, and the time from induction to complete cervical dilation. For the 23 patients dilated with Dilapan, an average of 4.3 devices were needed, compared with an average 9.7 laminaria devices used on the other 18 patients. It took an average of 10.8 hours to achieve complete dilation after Dilapan, compared with 14.7 hours in the Laminaria-treated group. Dilapan cervical ripening agents required fewer devices to achieve complete cervical dilatation. No complications were experienced during cervical ripening with either device. The induction-to-delivery time was faster after Dilapan than Laminaria. Dilapan is an effective cervical ripening agent which can be used prior to the induction of labor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Product/Service Evaluation, Kelps, Laminaria, Dilapan (Medical instrument)

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