Effect Of COOK Sac And Dinoprostone On Cervical Ripening And Labor Induction In Full-term Primiparas

Objective: Systematically analysis and evaluate the effect of COOK sac and Dinoprostone on cervical ripening and labor induction in term primiparas to find more suitable、efficient and safer approach of induced labor.Methods: 120 full-term primiparas which had induced labor induction and immature cervix delivered in one maternity ward of Dalian Maternity Hospital from January 2009 toJanuary2014.These primiparas were induced by COOK sac or propess.The exclusion criteria:Age≤19 or ≥35;multiparae;dead fetus;Bishop score >6;Premature rupture of membranes.The COOK sac group included 60 cases.Average age was(28.9±2.9)y,ranging from 23y-34 y,average BMI was(27.8±3.7)kg/m2,the average gestational age induced labor was(40.3±0.9)weeks,average cervical Bishop score before induction of labor was(3.03±1.49);The propess group included 60 cases.Average age was(27.9±2.5)y,ranging from 20y-34 y,average BMI was(27.8±2.8)kg/m2,the average gestational age induced labor was(40.4 ± 0.8)weeks,average cervical Bishop score before induction of labor(3.08±1.34).Main outcome measures:Bishop score before and after induced labor;Induced labor time;Induced labor to delivery time;total stage of labor;delivery mode(the rate of cesarean and vaginal births);the complication occurred during induced labor to delivery(intrauterine infection,fetal distress,placental abruption,precipitate labor,assisted vaginal delivery,postpartum bleeding and the rate of newborn into the intensive careunit);puerperal infection;neonatal birth weight;neonatal 5 min after birth Apgar score;Compare the differences between COOK sac group and propess group in cervical ripening,induced labor time,total stage of labor,delivery mode and the complication occurred during induced labor to delivery,they were statistically analyzed by SPSS19.0.We used t test to analysis the measurement data and use the χ2test to analysis the count data,P<0.05 regareded as statistically significant.Results:(1).Before induced labor:The COOK sac group included 60 cases.Average age was(28.9±2.9)y,ranging from 22y-34 y,Average BMI was(27.8±3.7)kg/m2,the average gestational age induced labor was(40.3 ± 0.9)weeks,average cervical Bishop score before induction of labor(3.03 ± 1.49);The propess group included 60 cases.Average age was(27.9 ± 2.5)y,ranging from 20y-34 y,Average BMI was(27.8 ±2.8)kg/m2,the average gestational age induced labor was(40.4±0.8)weeks,average cervical Bishop score before induction of labor was(3.08 ± 1.34).No statistical difference was observed above between two groups(P>0.05).No statistical difference was observed in induced labor indications between two groups(P>0.05).(2).Cervical ripening:The difference of average cervical Bishop score after induction of labor between COOK sac group(5.60 ±1.76)and propess group(6.50 ±1.38)was significant(P=0.002).The average increased extent of Bishop score between COOK sac group(2.96±1.32)and propess group(2.73±1.32)were both significantly elevated(P=0.0001).(3).Result of induced labor:The COOK sac group:Induced labor time was(25.6±14.1)h,induced labor to delivery time was(35.6±15.5)h;The propess group:Induced labor time was(11.7 ± 8.0)h,induced labor to delivery time was(21.2 ± 8.7)h,in which the two groups had significant difference(P=0.0001).On the side of total stage of labor,there was no significant difference between COOK sac group(10.1±3.3)h and propess group(9.7 ± 4.0)h(P > 0.05).The rate of vaginal delievary within 24 h in COOK sac group(11.7%)was lower than that in propess group(43.3%)(P<0.05).(4).Pregnancy outcome and pregnancy complication:The rate of cesarean in the propess group was 33.3%(20 cases),which was significantly higher than 16.7%(10 cases)in the COOK sac group(P<0.05).The rate of fetal distress in propess group(16.7%)was significantly higher than that in COOK sac group(5%)(P<0.05).There was a case of placental abruption,the newborn was in the NICU after cesarean section.The rate of assisted vaginal delivery(6.7%vs0.0%)and intrauterine infection(5.0%vs0.0%)in COOK sac group was higher than propess group,the rate of precipitate labor(8.3%vs0.0%)in propess group was higher than that in COOK sac group,while there was no statistical difference was observed in these complications(P>0.05).neonatal birth weight and The average neonatal 5 min after birth Apgar score in propess group(9.63±1.17)was lower than COOK sac group(9.95±0.22)(P<0.05).The two groups had no significantly difference in neonatal birth weight(P>0.05).Conclusions:Propess can improve the extent cervical maturity better than COOK sac,as well as reduce the induced labor time.Both propess and COOK sac cannot shorten the total labor time.Compare to COOK sac,during the process of induced labor by propess,there was a higher risk of frequent or too strong uterine contraction which lead to higher rate of cesarean,fetal distress and precipitate labor.The COOK sac has higher vaginal delivery rate and better prognosis of the newborn.What needs to be pointed out is that during the process of delivery,the rate of intrauterine infection and assisted vaginal delivery in COOK sac has a tendency to increase.Continuous fetal monitoring when necessary and vaginal examination can reduce complication occurred during induced labor to delivery and win a better pregnancy outcome.