Clinical and elastographic evaluation of methods for ripening an unripe cervix


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Abstract

Aim. To investigate the effectiveness of a combined use of DILAPAN-S expanders and oral mifepristone for cervical ripen ing and induction of labor. Material and methods. This prospective study comprised 200 pregnant women aged 23 to 38, who had an unfavorable cervix and indications for labor pre-induction. Fifty women (group 1) received four DILAPAN-S dilators for up to 12 hours co-administered with two 200 mg doses of oral mifepristone taken 24 hours apart. DILAPAN-S dilators were inserted simultaneously with the second mifepristone dose. DILAPAN-S dilators alone were used in 50 women (group 2). In group 3 (n=50), patients underwent cervical ripening with a Foley balloon catheter inserted into the cervix for up to 12 hours. Patients in group 4 (n=50) received cervical ripening with two doses of prostaglandin E2 gel 0.5 mg intracervically. Cervical ripening was assessed using the Bishop score and sonoelastography. Results. DILAPAN-S in combination with mifepristone was more effective than other cervical ripening modalities when cervical maturation was assessed both by Bishop score and sonoelastography. Conclusion The combined use of four DILAPAN-S expanders and two 200 mg doses of oral mifepristone (2 tablets) is effective in inducing cervical ripening for labor induction. The effectiveness of this method is conf irmed by both a subjective assessment (Bishop score) and by a more objective sonoelastography with determining the color elastotype and calculating the strain ratio.

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About the authors

E. S Brega

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia

Email: e_brega@oparina4.ru
obstetrician-gynecologist 117997, Russia, Moscow, Ac. Oparina str. 4

O. G Pekarev

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia

Email: o_pekarev@oparina4.ru
MD, professor, deputy director of institution of obstetrics 117997, Russia, Moscow, Ac. Oparina str. 4

A. I Gus

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia

Email: a_gus@oparina4.ru
MD, professor, the leader of the department of functional diagnostics department of diagnostic imaging 117997, Russia, Moscow, Ac. Oparina str. 4

S. S Lun’kov

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia

Email: s_lunkov@oparina4.ru
doctor of the department of functional diagnostics department of diagnostic imaging 117997, Russia, Moscow, Ac. Oparina str. 4

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