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J Obstet Gynaecol Res. 2018 Aug;44(8):1404-1414. doi: 10.1111/jog.13691. Epub 2018 Jun 28.

Premaquick© versus modified Bishop score for preinduction cervical assessment at term: A double-blind randomized trial.

Author information

1
Effective Care Research Unit, Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Nigeria.
2
Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
3
Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.
4
Department of Obstetrics and Gynecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria.
5
Measurement and Evaluation Unit, Department of Educational Foundations, Nnamdi Azikiwe University, Awka, Nigeria.
6
Department of Obstetrics and Gynecology, Federal Medical Center, Umuahia, Nigeria.
7
Department of Obstetrics and Gynecology, ESUT Teaching Hospital, Enugu, Nigeria.
8
Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria.
9
Department of Obstetrics and Gynecology, Federal Medical Center, Owerri, Nigeria.

Abstract

AIM:

To test whether Premaquick biomarkers were superior to modified Bishop score for preinduction cervical assessment at term.

METHODS:

A multicenter, double-blind randomized clinical trial in 151 nulliparous, cephalic presenting and singleton pregnancies was conducted. The cervix was considered 'ripe' when at least two out of three Premaquick biomarkers are positive or a Bishop score of ≥6. Main outcome measures were proportion of women who were administered or had additional prostaglandin E1 analogue (PGE1) as a preinduction agent and incidence of uterine rupture. The trial was registered in PACTR registry with approval number PACTR201604001592143. Analysis was performed by intention-to-treat principle.

RESULTS:

The need for initial PGE1 analogue (77.6% vs 98.7%, risk ratio [RR] =0.47, 95% confidence intervals [95% CI] =0.38-0.59, P < 0.001) and additional PGE1 analogue for cervical ripening after one insertion (44.7% vs 68.0%, RR = 0.63, 95% CI = 0.46-0.86, P = 0.004) was significantly lower in Premaquick group. There was no significant difference in incidence of uterine rupture (0% vs 1.4%, RR = 0.000, P = 0.324); however, the frequency of transition to labor was statistically higher in Premaquick group (44.7% vs 22.7%, RR = 1.59, 95% CI = 1.17-2.15, P = 0.004). Interval from start of induction to any type of delivery, need for oxytocin augmentation, vaginal delivery, number of women with cesarean section for failed induction and number of infants admitted to neonatal intensive care unit were similar between the two groups (P > 0.05).

CONCLUSION:

Preinduction cervical assessment with Premaquick was significantly associated with higher frequency of transition to labor and reduced need for PGE1 analogue when compared to modified Bishop score. Further similar trials in other settings are necessary to strengthen or refute this observation.

KEYWORDS:

Premaquick; cervical assessment; induction; labor; modified Bishop score

PMID:
29956434
DOI:
10.1111/jog.13691
[Indexed for MEDLINE]

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