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Am J Perinatol 2024; 41(08): 988-997
DOI: 10.1055/s-0043-1763502
Review Article

Effect of Vaginal Washing before Intravaginal Prostaglandin Insertion on Induction of Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Saeed Baradwan
1   Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
,
Abdulrahman Al-Matary
2   Department of Neonatology, King Fahad Medical City, Riyadh, Saudi Arabia
,
Majed Saeed Alshahrani
3   Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
,
Khalid Khadawardi
4   Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
,
Abdullah Latifah
5   College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
,
Mohamed E. ElHodiby
6   Department of Obstetrics and Gynecology, Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt
,
Mohammed Samy
7   Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Sarah Safwat
7   Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Ahmed Zaki
8   Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
,
Mohamed Hussein
8   Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
,
Mahmoud A. Hegazy
9   Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, New Damietta, Egypt
,
Suzan Elsharkawy
10   Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
,
Ahmed Mohamed Abdelhakim 
11   Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt
,
Rania Mahfouz Abdelwahed
12   Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
,
Maii Nawara
7   Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
,
Mohamed A. Elsenity
7   Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
› Author Affiliations Funding None.
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Abstract

Objective Saline vaginal douching prior to intravaginal prostaglandin application might increase the vaginal pH, leading to improvement of prostaglandin bioavailability, by which the outcomes of labor induction can be greatly improved. Thus, we aimed to evaluate the effect of vaginal washing with normal saline before insertion of vaginal prostaglandin for labor induction.

Study Design A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI Web of Science from inception to March 2022. We selected randomized controlled trials (RCTs) that compared vaginal washing using normal saline versus no vaginal washing in the control group before intravaginal prostaglandin insertion during labor induction. We used RevMan software for our meta-analysis. Our main outcomes were the duration of intravaginal prostaglandin application, duration from intravaginal prostaglandin insertion to active phase of labor, duration from intravaginal prostaglandin insertion till total cervical dilatation, labor induction failure rate, incidence of cesarean section (CS), and rates of neonatal intensive care unit (NICU) admission and fetal infection postdelivery.

Results Five RCTs were retrieved with a total number of 842 patients. Duration of prostaglandin application, duration from prostaglandin insertion to active phase of labor, and time interval from prostaglandin insertion to total cervical dilatation were significantly shorter among vaginal washing group (p < 0.05). Vaginal douching prior to prostaglandin insertion significantly decreased the incidence of failed labor induction (p < 0.001). After the removal of reported heterogeneity, vaginal washing was linked to a significant decline in CS incidence (p = 0.04). In addition, the rates of NICU admission and fetal infection were significantly lower in the vaginal washing group (p < 0.001).

Conclusion Vaginal washing with normal saline before intravaginal prostaglandin insertion is a useful and easily applicable method for labor induction with good outcomes.

Key Points

  • Induction of labor is frequently used in the obstetrics field.

  • We assessed vaginal washing impact before prostaglandin insertion for labor induction.

  • Vaginal washing is an easily applicable method for labor induction with good outcomes.

Keywords

vaginal washing - vaginal douching - labor induction - prostaglandin - cervical ripening


Publication History

Received: 22 April 2022

Accepted: 16 December 2022

Article published online:
21 February 2023

© 2023. Thieme. All rights reserved.

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