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Inleiding van de baring Refereeravond 17-02-2011.

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1 Inleiding van de baring Refereeravond 17-02-2011

2 Huidige protocol Bishop < 6 (mult) of < 7 (primi) = PG / mechanisch Bishop 0 1 2 3 ontsluiting01-23-4≥5 verstrijking0-3040-5060-70≥80 consistentiestugmedweek positieSacrmedcentr indalingH1H2H3

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 prostaglandines NVOG 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: amniotomie NVOG 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:IUVD NVOG 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 StudyDinoprostoneMisoprostolRR95% CI Harms et al12/60 (20.0%)18/61 (29.5%)0.680.36–1.28 Bolnick et al27/74 (36.5%)23/77 (29.9%)1.220.77–1.93 Wing et al19/98 (19.4%)20/99 (20.2%)0.960.55–1.68 Sanchez22/115 (19.1%)44/108 (0.41%)0.470.30–0.73 Garry et al11/89 (12.4%)43/97 (44.3%)0.280.15–0.51 Ozkan et al25/56 (44.6%)37/56 (66.1%)0.680.48–0.96 Pooled RR 116/492 (23.6%)185/498 (37.1%)0.650.44–0.96

12 Literatuur TABLE 3. Vaginal delivery within 24 hours of induction with dinoprostone vs misoprostol StudyDinoprostoneaMisoprostolaRR95% CI Harms et al36/60 (60.0%)44/61 (72.1%)0.830.64–1.08 Bolnick et al60/74 (81.1%)63/77 (81.8%)0.990.85–1.15 Ramsey et al18/38 (47.4%)23/38 (60.5%)0.780.51–1.19 Wing et al45/98 (45.9%)51/99 (51.5%)0.890.67–1.19 Sanchez70/115 (60.8%)77/108 (71.3%)0.850.71–1.03 Khoury et al17/39 (43.6%)19/40 (47.5%)0.920.57–1.49 Garry et al34/89 (38.2%)66/97 (68.0%)0.560.41–0.76 Rozenberg et al32/70 (45.7%)51/70 (72.9%)0.630.47–0.84 Ozkan et al36/56 (64.3%)41/56 (73.2%)0.880.68–1.12 Tanir et al27/44 (61.4%)25/43 (58.1%)1.050.74–1.49 Pooled RR 375/683 (54.9%)460/689 (66.8%)0.830.74–0.94

13 Literatuur TABLE 4. Oxytocin augmentation for induction with dinoprostone vs misoprostol StudyDinoprostoneaMisoprostolaRR95% CI Bebbington 76/102 (74.5%)47/98 (48.0%)1.551.23–1.97 Ramsey et al 32/38 (84.2%)22/38 (57.9%)1.451.07–1.97 Wing et al 43/98 (43.9%)50/99 (50.5%)0.870.65–1.17 Sanchez79/115 (68.7%)43/108 (39.8%)1.731.33–2.24 Khoury et al 36/39 (92.3%)32/40 (80.0%)1.150.96–1.38 Garry et al 60/89 (67.4%)43/97 (44.3%)1.521.17–1.98 Rozenberg 47/70 (67.1%)22/70 (31.4%)2.131.46–3.13 Ozkan 35/56 (62.5%)20/56 (35.7%)1.751.17–2.63 Pooled RR408/607 (67.2%)279/606 (46.0%)1.451.20–1.74

14 Literatuur TABLE 5. Cesarean rates for induction with dinoprostone vs misoprostol StudyDinoprostoneaMisoprostolaRR95% CI Harms et al 13/60 (21.7%)11/61 (18.0%)1.200.59–2.47 Bebbington et al 31/102 (30.4%)19/98 (19.4%)1.570.95–2.58 Bolnick et al 16/74 (21.6%)13/77 (16.9%)1.280.66–2.47 Ramsey et al 4/38 (10.5%)5/38 (13.2%)0.800.23–2.75 Wing et al 20/98 (20.4%)18/99 (18.2%)1.120.63–1.99 Sanchez 15/115 (13.0%)24/108 (22.2%)0.590.33–1.06 Khoury et al 11/39 (28.2%)11/40 (27.5%)1.030.50–2.09 Garry et al 35/89 (39.3%)28/97 (28.9%)1.360.91–2.04 Rozenberg et al 16/70 (22.9%)13/70 (18.6%)1.230.64–2.36 Ozkan et al 18/56 (32.1%)14/56 (25.0%)1.290.71–2.32 Tanir et al 17/44 (38.6%)40/43 (93.0%)0.420.28–0.61 pooled RR196/785 (25.0%)196/787 (24.9%)1.010.85–1.19

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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