Intravenous Dexamethasone Versus Vaginal Misoprostol in Enhancing Cervical Ripening and Labor Induction; Randomized Controlled Clinical Trial

Abstract

Induction of labor refers to iatrogenic stimulation of uterine contractions prior to the onset of spontaneous labor. Different techniques, tools and methods are being in test. Scientists throughout decades have been studying how to shorten the process of labor induction when termination of pregnancy is indicated. Prostaglandins have been involved for a long time in the spontaneous onset of labor. The normal process of labor appears to result in inflammation which increases prostaglandins release. Prostaglandins produced in the myometrial tissue, contribute to the effectiveness of the uterine contractions during the process of labor and also may soften the cervix independent of uterine activity. Interestingly, concentration of CRH levels has been shown recently to increase within the developing fetus during the last 12 weeks of gestation. Consequently these hormonal events and changes cause modified uterine contractility, trigger the membranes to produce more prostaglandins (PGE2 and PGF2α) and increase the estrogen content. Alteration of estrogen to progesterone ratio will eventually lead to increased contractile proteins expression. As a matter of fact, raised CRH near the end of gestation, confirms the existence of a placental-fetal clock.