The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

The effect of misoprostol with and without evening primrose oil on labor progress and neonatal Apgar score in post-term pregnancies: a clinical trial study

Document Type : Original Article

Authors
Soma Bahmani 1
Roonak Shahoei 2
1 Lecturer, Department of Midwifery, School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran.
2 Associate Professor, Department of Midwifery, Clinical Care Research Center, Health Development Research Institute, Kurdistan University of Medical Sciences, Sanandaj, Iran.
10.22038/ijogi.2023.22598
Abstract
Introduction: One of the possible causes of post-term pregnancies is the unripe cervix. The present study was performed with aim to compare the effect of misoprostol and evening primrose oil on labor progress and neonatal Apgar score in post-term pregnancies.
Methods: This double-blind randomized clinical trial study was conducted in 2018 on 130 pregnant women with post-term pregnancy. The samples were selected by convenience sampling method and randomly assigned to two groups: (evening primrose and misoprostol) and (placebo and misoprostol). To collect the data, a checklist of demographic and clinical information was used along with questions related to bishop score, duration of labor and neonatal Apgar score. Data analysis was done using SPSS statistical software (version 21) and chi-square test, Fisher exact test and independent t-test. P< 0.05 was considered statistically significant.
Results: The mean bishop score in the evening primrose and misoprostol group significantly increased compared to the placebo and misoprostol group (p=0.0001). Also, the length of the latent phase of labor was shorter in the evening primrose and misoprostol group compared to the placebo and misoprostol group. However, based on the results of the chi-square test, there was no significant difference between the two groups in terms of first and fifth minutes Apgar scores (p>0.05).
Conclusion: The use of evening primrose oil vaginal capsule along with misoprostol, compared to misoprostol alone, while helping to prepare the cervix, will be effective in reducing the duration of the latent phase of labor and has no adverse effect on the neonatal Apgar score.
Keywords
Apgar score
Cervical Ripening
Evening primrose oil
Labor
Post-term pregnancy
  1. Mirteimori M, Akhlaghi F, Pourhoseini SA. Cervical ripening and induction of labor in postdate pregnancy by Foley catheter insertion into the cervix as outpatient and inpatient. Iran J Obstet Gynecol Infertil 2021; 24(5):1-7.
  2. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse D, Spong CY, et al. Williams Obstetrics. 24nd New York: McGraw-Hill Education; 2014.
  3. Ministry of health and medical education. National guide to midwifery and childbirth services. Tehran, 2017. Retreived from https://behdasht.gov.ir.
  4. Rezaie M, Seyedoshohadaei F, Nayebi M. Comparison of oral and vaginal prescription of misoprostol in labor induction of post-term pregnancies. The Horizon of Medical Sciences 2016; 22(2):103-9.
  5. Eslamian LA, Shahsavari H. Management and outcome of prolonged pregnancies in Shariati university hospital. Tehran University of Medical Sciences Journal 2008; 65(12):48-54.
  6. Shahali S, Khatami F, Abbaspoor Z, Gheraghian B. The effect of vaginal evening primrose capsule on cervical ripening in nulliparous women with post-term pregnancy: A clinical trial. Iran J Obstet Gynecol Infertil 2018; 21(8):30-8.
  7. Middleton P, Shepherd E, Crowther CA. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews 2018(5).
  8. Bernardes TP, Broekhuijsen K, Koopmans CM, Boers KE, Van Wyk L, Tajik P, et al. Caesarean section rates and adverse neonatal outcomes after induction of labour versus expectant management in women with an unripe cervix: a secondary analysis of the HYPITAT and DIGITAT trials. BJOG: An International Journal of Obstetrics & Gynaecology 2016; 123(9):1501-8.
  9. PonMalar J, Benjamin SJ, Abraham A, Rathore S, Jeyaseelan V, Mathews JE. Randomized double-blind placebo controlled study of preinduction cervical priming with 25 µg of misoprostol in the outpatient setting to prevent formal induction of labour. Archives of gynecology and obstetrics 2017; 295(1):33-8.
  10. Grobman WA, Simon C. Factors associated with the length of the latent phase during labor induction. European Journal of Obstetrics & Gynecology and Reproductive Biology 2007; 132(2):163-6.
  11. Crane JM. Factors predicting labor induction success: a critical analysis. Clinical obstetrics and gynecology 2006; 49(3):573-84.
  12. Di Tommaso M, Seravalli V, Vellucci F, Cozzolino M, Spitaleri M, Susini T. Relationship between cervical dilation and time to delivery in women with preterm labor. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences 2015; 20(10):925-9.
  13. Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database of Systematic Reviews 2010(10).
  14. González CA, Salas Guerra A, Arroyo Llano R. Conducta del cuello uterino durante el embarazo, parto y puerperio [Behavior of cervix during pregnancy, labor and puerperium]. Ginecol Obstet Mex 2010; 78(2):132-7.
  15. Teimouri B, Ghasemi M, Sakhavar N, Khajeh Noori S. Comparison of vaginal trinitroglycerin (TNG) and vaginal misoprostol in cervical ripening at term pregnancy. Iran J Obstet Gynecol Infertil 2018;20(11):8-14.
  16. Inal HA, Inal ZH, Tonguc E, Var T. Comparison of vaginal misoprostol and dinoprostone for cervical ripening before diagnostic hysteroscopy in nulliparous women. Fertility and Sterility 2015; 103(5):1326-31.
  17. Aalami-Harandi R, Karamali M, Moeini A. Safety and effectiveness of oral misoprostol versus oxytocin for labor induction in term pregnancy. J North Khorasan Univ Med Sci 2012; 4(3):303-9.
  18. Mallah F. Comparing the Efficacy and Side Effects of Trans-Cervical Catheter and Vaginal Misoprostol on Cervical Ripening. Alborz University Medical Journal 2016; 5(3):149-56.
  19. Jahdi F, Kalati M, Kashanian M, Naseri M, Haghani H. Effect of oral evening primrose capsules on ripening of the cervix in nulliparous iranian pregnant women (a randomized trial). Acta Medica Mediterranea 2016; 32(Specia):1273-9.
  20. Vahdat M, Tahermanesh K, Kashi AM, Ashouri M, Dodaran MS, Kashanian M, et al. Evening primrose oil effect on the ease of cervical ripening and dilatation before operative hysteroscopy. Thrita 2015; 4(3).
  21. Fallah LT, Najafi A, Fathizadeh N, Khaledian Z. The effect of evening primrose oil on premenstrual syn. Avicenna Journal of Nursing and Midwifery Care 2008; 16(1):35-45.
  22. Eskin NM. Borage and evening primrose oil. European Journal of Lipid Science and Technology 2008; 110(7):651-4.
  23. Beigi A, Kazemipour SM, Tabarestani H. Induction of labor in term pregnancy: Sublingual versus vaginal misoprostol. Tehran University Medical Journal 2010; 68(3):175-81.
  24. Mirzadeh N, Sheikhan Z, Simbar M, Mehrolhasani Y, Saffar A, Yeganeh Z. Comparison Effects of Vaginal Misoprostol with Vaginal Evening Primrose on Ripening Cervix in Nulliparous Women. Advances in Nursing and Midwifery 2020; 29(3):33-40.
  25. Dove D, Johnson P. Oral evening primrose oil:: Its effect on length of pregnancy and selected intrapartum outcomes in low-risk nulliparous women. Journal of Nurse-Midwifery 1999; 44(3):320-4.
  26. Kalati M, Kashanian M, Jahdi F, Naseri M, Haghani H, Sheikhansari N. Evening primrose oil and labour, is it effective? A randomised clinical trial. Journal of Obstetrics and Gynaecology 2018; 38(4):488-92.
  27. Girlie VB. The efficacy of evening primrose oil as a cervical ripening agent for gynecologic procedures: A single-blinded, randomized controlled trial. Philippine Journal of Obstetrics and Gynecology 2015: 25-8.
  28. Hoseinipour MS, Saghafi Z, Loripour M, Rezaeian M. The effect of evening primrose and castor oil capsule on Bishop Score and some delivery outcomes (triple-blind clinical trial). Iran J Obstet Gynecol Infertil 2022; 25(1):56-66.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 26, Issue 3
May 2023
Pages 43-52