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Inleiding van de baring

Inleiding van de baring. Refereeravond 17-02-2011. Bishop < 6 (mult) of < 7 (primi) = PG / mechanisch. Huidige protocol. Inleiding prostaglandines. Misoprostol 25 mcg misoprostol in fornix posterior Gift a 4 uur, max 3x/dag Gedurende 2 dagen, daarna rustdag.

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Inleiding van de baring

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  1. Inleiding van de baring Refereeravond 17-02-2011

  2. Bishop < 6 (mult) of < 7 (primi) = PG / mechanisch Huidige protocol

  3. Inleiding prostaglandines • Misoprostol • 25 mcg misoprostol in fornix posterior • Gift a 4 uur, max 3x/dag • Gedurende 2 dagen, daarna rustdag. • Absolute contra-indicatie: litteken uterus

  4. Inleiding prostaglandines • Prostin-gel • Gift a 4 uur • 1mg-2mg-1mg • Max 4 mg/dag • 2e dag: 2mg-1mg-1mg.

  5. Inleiding mechanisch • Dilapan • Niet meer toegepast --> vervangen door balloncatheter

  6. Inleiding prostaglandinesNVOG richtlijn • Geen informed consent nodig voor misoprostol • Ernstige leverfunctiestoornissen = relatieve contra-indicatie voor miso

  7. Inleiding: amniotomie • Amniotomie • Indien na 1 uur niet contractiel: start Synto • 3 IE Synto (=1 ampul) opgelost in 0,9% NaCl --> pomp stand 1ml/uur = 60 mIE/uur • Ophogen tot 3 weeen/10 min

  8. Inleiding: amniotomieNVOG • Conform protocol MCH • Evidence voor snellere partus & minder kunstverlossingen bij snel starten Synto na arom Howarth GR, Botha DJ. Amniotomy plus intravenous oxytocin for induction of labour. Cochrane Syst Rev 2001, issue 3.

  9. Inleiding:IUVD • Misoprostol • 100-400mcg afh termijn. (max 1600mcg/24 uur). • Nalador • Start 30 mcg/uur, na 1 uur 60 mcg/uur • Synto

  10. Inleiding:IUVDNVOG • Conform protocol MCH • Mifepristone 200mg oraal 36-48 uur voor inductie = verkorting tijdsduur • Effektiviteit mifepristone bij IUVD?

  11. Literatuur • Labor induction with intravaginal misoprostol compared with the dinoprostone vaginal insert: a systematic review and metaanalysis. • Austin SC, Sanchez-Ramos L, Adair CD. • Am J Obstet Gynecol. 2010 Jun;202(6):624.e1-9. Epub 2010 Apr 28 • TABLE 2. Vaginal delivery within 12 hours of induction with dinoprostone vs misoprostol • Study Dinoprostone Misoprostol RR 95% CI • Harms et al 12/60 (20.0%) 18/61 (29.5%) 0.68 0.36–1.28 • Bolnick et al 27/74 (36.5%) 23/77 (29.9%) 1.22 0.77–1.93 • Wing et al 19/98 (19.4%) 20/99 (20.2%) 0.96 0.55–1.68 • Sanchez 22/115 (19.1%) 44/108 (0.41%) 0.47 0.30–0.73 • Garry et al 11/89 (12.4%) 43/97 (44.3%) 0.28 0.15–0.51 • Ozkan et al 25/56 (44.6%) 37/56 (66.1%) 0.68 0.48–0.96 • Pooled RR 116/492 (23.6%) 185/498 (37.1%) 0.65 0.44–0.96

  12. Literatuur • TABLE 3. Vaginal delivery within 24 hours of induction with dinoprostone vs misoprostol • Study Dinoprostonea Misoprostola RR 95% CI • Harms et al 36/60 (60.0%) 44/61 (72.1%) 0.83 0.64–1.08 • Bolnick et al 60/74 (81.1%) 63/77 (81.8%) 0.99 0.85–1.15 • Ramsey et al 18/38 (47.4%) 23/38 (60.5%) 0.78 0.51–1.19 • Wing et al 45/98 (45.9%) 51/99 (51.5%) 0.89 0.67–1.19 • Sanchez 70/115 (60.8%) 77/108 (71.3%) 0.85 0.71–1.03 • Khoury et al 17/39 (43.6%) 19/40 (47.5%) 0.92 0.57–1.49 • Garry et al 34/89 (38.2%) 66/97 (68.0%) 0.56 0.41–0.76 • Rozenberg et al 32/70 (45.7%) 51/70 (72.9%) 0.63 0.47–0.84 • Ozkan et al 36/56 (64.3%) 41/56 (73.2%) 0.88 0.68–1.12 • Tanir et al 27/44 (61.4%) 25/43 (58.1%) 1.05 0.74–1.49 • Pooled RR 375/683 (54.9%) 460/689 (66.8%) 0.83 0.74–0.94

  13. Literatuur • TABLE 4. Oxytocin augmentation for induction with dinoprostone vs misoprostol • Study Dinoprostonea Misoprostola RR 95% CI • Bebbington 76/102 (74.5%) 47/98 (48.0%) 1.55 1.23–1.97 • Ramsey et al 32/38 (84.2%) 22/38 (57.9%) 1.45 1.07–1.97 • Wing et al 43/98 (43.9%) 50/99 (50.5%) 0.87 0.65–1.17 • Sanchez 79/115 (68.7%) 43/108 (39.8%) 1.73 1.33–2.24 • Khoury et al 36/39 (92.3%) 32/40 (80.0%) 1.15 0.96–1.38 • Garry et al 60/89 (67.4%) 43/97 (44.3%) 1.52 1.17–1.98 • Rozenberg 47/70 (67.1%) 22/70 (31.4%) 2.13 1.46–3.13 • Ozkan 35/56 (62.5%) 20/56 (35.7%) 1.75 1.17–2.63 • Pooled RR 408/607 (67.2%) 279/606 (46.0%) 1.45 1.20–1.74

  14. Literatuur • TABLE 5. Cesarean rates for induction with dinoprostone vs misoprostol • Study Dinoprostonea Misoprostola RR 95% CI • Harms et al 13/60 (21.7%) 11/61 (18.0%) 1.20 0.59–2.47 • Bebbington et al 31/102 (30.4%) 19/98 (19.4%) 1.57 0.95–2.58 • Bolnick et al 16/74 (21.6%) 13/77 (16.9%) 1.28 0.66–2.47 • Ramsey et al 4/38 (10.5%) 5/38 (13.2%) 0.80 0.23–2.75 • Wing et al 20/98 (20.4%) 18/99 (18.2%) 1.12 0.63–1.99 • Sanchez 15/115 (13.0%) 24/108 (22.2%) 0.59 0.33–1.06 • Khoury et al 11/39 (28.2%) 11/40 (27.5%) 1.03 0.50–2.09 • Garry et al 35/89 (39.3%) 28/97 (28.9%) 1.36 0.91–2.04 • Rozenberg et al 16/70 (22.9%) 13/70 (18.6%) 1.23 0.64–2.36 • Ozkan et al 18/56 (32.1%) 14/56 (25.0%) 1.29 0.71–2.32 • Tanir et al 17/44 (38.6%) 40/43 (93.0%) 0.42 0.28–0.61 • pooled RR 196/785 (25.0%) 196/787 (24.9%) 1.01 0.85–1.19

  15. Literatuur • Ballon vs prostaglandines • Foley catheter balloon vs locally applied prostaglandins for cervical ripening and labor induction: a systematic review and metaanalysis. • Vaknin Z, Kurzweil Y, Sherman D. • Am J Obstet Gynecol. 2010 Nov;203(5):418-29.

  16. Literatuur sectio

  17. Literatuur Overstimulatie

  18. Literatuur • Conclusie: • Miso effectiever dan Prostin • Ballon gelijkwaardig aan PG mbt sectio • PG meer hyperstimulatie.

  19. Literatuur • PROBAAT studie: • ballon even effectief, minder maternale & neonatale morbiditeit • Maternale infectie, fluxus, opname neonaat, hyperstimulatie

  20. Aanbevelingen lokaal protocol • Toevoegen type/urgentie inleidingen • Verwijderen Dilapan methode • Protocol voor Foley ballon • Geen informed consent nodig bij Miso • Na AROM vroeger starten met Synto = ½ uur + infuus meteen prikken. • Dosering Synto aanpassen • CAVE leverfunctiestoornissen bij misoprostol --> ballon bij HELLP? • Mifepriston bij IUVD?

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