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

Author:

Baradwan Saeed1,Al-Matary Abdulrahman2,Alshahrani Majed Saeed3,Khadawardi Khalid4,Latifah Abdullah5,ElHodiby Mohamed E.6,Samy Mohammed7,Safwat Sarah7,Zaki Ahmed8,Hussein Mohamed8,Hegazy Mahmoud A.9,Elsharkawy Suzan10,Abdelhakim Ahmed Mohamed11ORCID,Abdelwahed Rania Mahfouz12,Nawara Maii7,Elsenity Mohamed A.7

Affiliation:

1. Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia

2. Department of Neonatology, King Fahad Medical City, Riyadh, Saudi Arabia

3. Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia

4. Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia

5. College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

6. Department of Obstetrics and Gynecology, Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt

7. Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

8. Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

9. Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, New Damietta, Egypt

10. Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Alexandria, Egypt

11. Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo, Egypt

12. Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt

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

Publisher

Georg Thieme Verlag KG

Subject

Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health

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