Effect of Intravenous Dexamethasone on Preparing the Cervix and Labor Induction
The use of corticosteroids is one of the methods put forward for the strengthening and speeding up the process of labor. After identification of glucocorticoid receptors in human amnion, the role of corticosteroids in starting the process of labor has been studied in numerous studies.The purpose of this study was to determine the effect of intravenous Dexamethasone on preparing the cervix and on labor induction. A randomized, clinical, and double – blind trial was conducted on 172 women divided into a control and an experimental group. The inclusion criteria were that they had to be primparous, in or before the 40 the week of pregnancy, and with Bishop scores (B.S.s) of 4 or lower. The exclusion criteria were diabetes, preeclampsia, macrosomia, twin pregnancy, rupture of the membrane (ROM), breech, and women suffering from background diseases. The B.S.s of the women was measured in charge of the study, and each woman was intravenously injected with eight milligrams of Dexamethasone or eight milligrams of distilled water. Four hours after the injections, the B.S.s of the participants was measured, and they were put under the conditions of labor induction using oxytocin. Information was collected in checklists A and B. The patients were compared with respect to B.S., the time the induction started, the average interval between the start of induction and the beginning of the active phase of childbirth, and the average length of time between the start of the active phase and the second stage of childbirth.The first and five minutes Apgar scores of the two groups of women were compared. The frequencies, the means, and the standard deviations were calculated using the SPSS – 16 software, and analysis of the results was performed with the Student’s t- test and the chi-square test with P<0.05. There were no statistically significant differences between the two groups in terms of their age, period of pregnancy, and B.S. at the start of the study. The average B.S. of women four hours after the injections with Dexamethasone was 5.9 ± 1.57, and the corresponding figure for women in the control group was 4.6 ± 1.72. These figures were significantly different at P<0.001. The average interval between labor induction and the start of the active phase in the, group injected with Dexamethasone was significantly less than that of the control group (2.87±0.93 versus 3.80± 0.93 at P<0.001). The average duration of the active phase of the second stage of childbirth was 3.47±1.10 hours in the experimental group and 3.6 ± 0.99 hours in the control group at P<0.49. These two figures were not significantly different. The Apgar scores of the first and fifth minutes after the birth of the children of the two groups of women were not significantly different. It was found that intravenous Dexamethasone improves the Bishop score of the cervix and thus causes softening of the cervix and reduces the length of time between labor induction and the start of the active phase of childbirth.
Hoffman B, Schorge J, Schaffer J, et al, editors. Williams obstetrics. 23rd ed. New York: MacGrawhill books; 2012: p. 96-122.
Kavanagh J, Kelly AJ, Thomas J. Corticosteroids for cervical ripening and induction of labor. Cochrane Database Syst Rev 2006;(2):CD003100.
Kavanagh J, Kelly AJ, Thomas J. Corticosteroids for induction of labor. Cochrane Database Syst Rev 2001;(2):CD003100.
Goolsby L, Schlecht K, Racowsky C, et al. Maternal serum dehydroepiandrosterone sulfate levels and the efficiency of labor in young nulliparas. Obstet Gynecol 1996;88(1):56-9.
Doganay M, Erdemoglu E, Avsar AF, et al. Maternal serum levels of dehydro-epiandrosterone sulfate and labor induction in postterm pregnancies. Int J Gynaecol Obstet 2004;85(3):245-9.
Mears K, McAuliffe F, Grimes H, et al. Fetal cortisol in relation to labor, intrapartum events and mode of delivery. J Obstet Gynaecol 2004;24(2):129-32.
Wood CE, Keller WM. Induction of parturition by cortisole: effects on negative feedback sensitivity and plasma CRH. J Dev Physiol 1991;16(5):287-92.
Berkowitz GS, Lapinski RH, Lockwood CJ, et al. Corticotrophin releasing factor and its binding protein: aternal serum levels in term and preterm deliveries. Am J Obstet Gynecol 1996;174(5):1477-83.
Campbell EA, Linton EA, Wolfe CDA, et al. Plasma corticotrophin releasing hormone concentrations during pregnancy and parturition. J Clin Endocrinol and Metabol 1999;64(5):1054-59.
Kalantaridou S, Makrigiannakis A, Zoumakis E, et al. Peripheral corticotrophin-releasing hormone is produced in the immune and reproductive systems: actions, potential roles and clinical implications. Front Biosci 2007;12:572-80.
O’Sullivan J, Iyer S, Taylor N, et al. Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is associated with a prolonged gestational age. Arch Dis Child 2007;92(8):690-2.
Barkai G, Cohen SB, Kees S, et al. Induction of labor with use of a foley catheter and extra-amniotic corticosteroids.m Am J Obstet Gynecol 1997;177(5):1145-8.
Ziaei S, Rosebehani N, Kazeminejad. The effects of intramuscular dministration of corticosteroids on the induction of parturition. J Perinat Med 2003;31(2):134-9.
Lindsay JR, Nieman LK. The Hypothalamic Pituitary- Adrenal Axis in Pregnancy: Challenges in Disease Detection and Treatment. Endocr Rev 2005;26(6):775-99.
Levy R, Ferber A, Ben-Arie A, et al. A randomized comparison of early versus late amniotomy following cervical ripening with a foley catheter. BJOG 2002;109(2):168-72.
Ruiz R, Fullerton J, Brown CE, et al. Predicting Risk of Preterm Birth: The Roles of Stress,Clinical Risk Factors, and Corticotropin-Releasing Hormone. Biol Res Nurs 2002;4(1):54-64.
Gitau R, Fisk NM, Glover V. Human fetal and maternal corticotrophin releasing hormone responses to acute stress. Arch Dis Child Fetal Neonatal Ed 2004;89(1):F29-32.
Kashanian M, Mokhtari F, Karimi MA. Evaluation of the Effects of Intramuscular Dexamethasone on the Induction and Duration of Labor and its Complications RJMS 2009;15(60 and 61):159-65.
Batista M, Reyes R, Santana M, et al. Induction of parturition with aglepristone in the Majorera goat. Reprod Domest Anim 2011;46(5):882-8.
Xu Z, Zhao J, Zhang H, et al. Spontaneous Miscarriages Are Explained by the Stress/Glucocorticoid/Lipoxin A4 Axis. J Immunol 2013;190(12):6051-8.