الفهرس 
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Abstract
S
UMMARY
he rising incidence of obesity all over the world represents critical health care challenge being doubled over the past 30 years. Around 17.3% of pregnant women are obese.
Obesity in pregnancy is associated with an increased risk of miscarriage, prematurity, congenital anomalies, still birth, cesarean section, dysfunctioning labour, post-partum hemorrhage, and wound infection. Women with booking BMI >30 should have an informed discussion antenatally about intrapartum complications associated with a high BMI include slow labour progression, shoulder dystochia, emergency cesarean section, and post-partum hemorrhage.
There is a higher risk of cesarean section in obese post date pregnant women undergoing induction of labour (IOL). Therefore, obstetricians should pay more attention to advising pregnant women about optimal weight gain during pregnancy and counseling about the chances of vaginal delivery in cases of IOL.
The most common methods of labour induction when the status of cervix is unfavourable involve intravaginal use of misoprostol, transcervical insertion of Foley’s catheter, and insertion of prostaglandin gel whereas with a ripe cervix oxytocin may be administrated intravenously.
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This study aims to compare the effectiveness of intra uterine extra amniotic Foley’s catheter filled with 30 ml sterile saline solution to 25 microgram vaginal misoprostol every 4 hours regimen for induction of labour in obese primigravidas presenting with post date pregnancy.
The present study was a prospective randomized interventional controlled trial.
This clinical trial was conducted at the labour ward of Ain Shams University Maternity Hospital, in the period from December 2019 to December 2020.
The study included 144 patients who were consenting to be recruited in the study and fulfilling the inclusion criteria. If any of the patients refused to continue in the study or any major complication occurs which made the patient not fit in this study; this patient would be considered as a DROP out which was included in sample size calculation.
The patients were classified into 2 groups as follow:
group (A) 72 patients undergone IOL with Foley‘s catheter with 30 ml ballon capacity, which was inserted for a maximum period of 24 hours, till its spontaneous expulsion or till a ripe cervix was reached (Bishop‘s score≥5).
group (B) 72 patients undergone IOL of labour with vaginal misoprostol (receive 25 ug misoprostol (vagiprost,
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Adwia pharma) every 4 hours maximally 5 doses being deposited in posterior fornix. At 3-4 cm dilatation of cervix; amniotomy was done in both groups and oxytocin infusion was used to augment labour if arrest of cervical dilatation and contractions occurred for more than 1 hour.
All pregnant women who met the inclusion criteria were submitted to full history taking, general, abdominal and vaginal examination to determine the initial Bishop‘s score,. Record of the time of insertion of each treatment modality was taken, and time of subsequent doses or adjustment together with information about women‘s progress or events happened during the labor follow up. Artificial rupture of membrane and Oxytocin infusion used in both groups when indicated. Records were kept of occurrence of any complications, route of delivery and time, and the neonatal outcomes including Apgar scores.
Statistical analysis of the obtained results showed that both groups were comparable as regards mean age, BMI, parity, estimated gestational age and the initial Bishop‘s scores (pre-ripening).
Cesarean section rate was significantly higher in Foley catheter group versus misoprostol group (43.1% versus 23.6%).
Time from induction to active phase and from induction to delivery were significantly higher in Foley catheter group
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versus misoprostol group (15.40±2.61 hrs versus 14.30±2.49 hrs and 26.20±6.66 hrs versus 22.97±6.10 hrs).
Augmentation with oxytocin and combined oxytocin and artificial rupture of membrane was significantly higher with the Foley‘s catheter group versus the misoprostol group (6.9 % versus 0 % and 66.7 % versus 41.7 %).
Fetal distress and hyperstimulation (as a maternal complication) were highly significant with misoprostol group versus Foley‘s catheter group (8.3 % versus 0 % and 18.1 % versus 0 %).
There were no significance between two groups in Apgar score at 1 minute and 5 minute, NICU admission and assisted vaginal delivery.
Based on our observations, it was found that both vaginal misoprostol and Foley‘s catheter were effective in induction of labour but rate of normal vaginal delivery and time from induction to active phase and to delivery were higher with the misoprostol group while uterine hyperstimulation and fetal distress were less with the Foley‘s catheter group.