Labor induction at advanced maternal age


Górnisiewicz, Teresa


labor induction ; dinoprostone ; misoprostol


The age of the woman giving birth has recently become a new indication for induction of labor, due to the increasing number of matema! and fetal complications, including the intrauterine foetal death, of which the risk increases with the age of the pregnant woman and the duration of pregnancy. The reasons for the observed dependencies are still unknown. Some researchers believe that in the group of 40-year-old women, the 39th week of pregnancy can be considered as a biologically mature pregnancy and labor induction should be considered in order to end the pregnancy4. Developing the safest and most beneficial method of labor induction in patients of advanced age defined as 35 years of age and more is an extremely important and still open task. Too little research has been done on induction of labor in this age group of patients, which is associated with many unknowns regarding both the choice of the best procedure and the timing of its implementation. Objectives The goal of the presented dissertation is determining whether one of the two prostaglandins, dinoprostone or misoprostol, outweighs the other in terms of efficacy and safety, used as a method of induction of labor in women of advanced age defined as 35 years of age and older. Detailed objectives: - evaluation of the effects and comparison of two methods of pharmacological pre-induction of labor ( dinoprostone ; and misoprostol) and development of the optimal method of combining these methods - assessment of whether the presence of the disease during pregnancy affects the efficacy and safety of pre-induction with dinoprostone or misoprostol - determination of risk factors for caesarean section using the above­mentioned prostaglandins Efficacy was measured as a time from the initiation of treatment to the onset of labor and delivery, while safety was measured by the frequency of emergency cesarean sections, the presence of complications in delivery, and a few health indicators in newboms. Conclusions Main conclusion: After taking into account the efficacy and safety of two prostaglandins used for pharmacological pre-induction of labor - dinoprostone and misoprostol, the research shows a greater benefit of using dinoprostone in the gro up of women at an advanced age defined above 35 years of age. Detailed conclusions: 1) the use of misoprostol rises more than twice not only the chance but also shortens the time to start labor and delivery itself, regardless of the method of delivery - via vaginal delivery or cesarean section, regardless of the pregnant age, number of deliveries or the condition of the cervix, 2) in the group of women over 35, there were no differences in the time necessary to start labor or the delivery itself, regardless of the method of delivery, comp ; aring both prostaglandins, 3) comorbidities seem to increase the risk of caesarean section in misoprostol-induced women over 35 years old, 4) comorbidities seem to lengthen the time needed to induce labor and delivery, regardless of the type of delivery route in the dinoprostone­induced group, 5) induction with misoprostol in the group of women with comorbidities resulted in lower Apgar scores in newboms of women over 35 years ald, 6) in the misoprostol-induced group, the age of the woman over 35 and the gestational age be low 3 8 weeks of pregnancy are risk factors for cesarean section, 7) nulliparity and arterial hypertension are the risk factors for the need to end the pregnancy by cesarean section, regardless the method of pre-induction with misoprostol or dinoprostone.

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Level of degree:

2 - studia doktoranckie

Degree grantor:

Wydział Lekarski


Huras, Hubert

Date issued:



Praca doktorska

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pol; eng

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