Oxytocin alone versus oxytocin plus papaverine for labor induction in primiparous women after catheter ripening: a randomized controlled trial.

Objective Among deliveries <34 weeks, there is inconclusive evidence regarding the preferred route of delivery when there is a need to expedite delivery during the second stage of labor. As it is unreasonable that future randomized controlled trials will be conducted to settle this query, every clinical data concerning this topic, may be helpful. We aim to compare neonatal outcomes among women undergoing emergent cesarean delivery (ECD) versus vacuum-assisted delivery (VAD) during the second stage of labor among singleton gestations <34 weeks. Methods A retrospective cohort study including all women who underwent either ECD or VAD at the second stage of labor between 30°/7 and 336/7 weeks, during 2011–2019. The primary outcome was the rate of adverse neonatal outcomes, defined as intrapartum death, mechanical ventilation, asphyxia, respiratory distress syndrome, subgaleal hemorrhage, intraventricular hemorrhage, necrotizing enterocolitis, and phototherapy. Results Of the 153,672 live singleton deliveries during the study period, 2871 (1.9%) delivered before 34°/7. Of those 1674 (58.3%) delivered vaginally unassisted and 1137 (39.6%) delivered by a CD during the first stage of labor. A total of 60 deliveries were analyzed, with a median gestational age of 32 weeks, interquartile range (IQR) 31–33. Median birth weight at delivery was 1845 g, IQR 1574–2095. Overall 25 (42%) of women were delivered by VAD and 35 by CD (58%). Indications for expeditious delivery did not differ between the study groups. Neonates delivered by VAD had a higher median birth weight (1940 vs. 1620 g, p = .02). Second stage of labor was longer in the ECD group as compared to the VAD group (median 200 vs. 52 min, p = .01). The rate of Apgar score at 1 min <7 was higher among the CD group (10 (40%) vs. 5 (14%), OR [95% CI]: 4.0 (1.1–13.8), p = .03). Longer length of stay was evident in the CD group as compared to the VAD group (median 30 vs. 21 days, p = .001). The rate of composite neonatal adverse outcome was comparable between the study groups. Adverse outcomes were associated with lower body mass index (median 27.7 vs. 34.9, p = .04), higher rate of premature preterm rupture of membranes (40 (91%) vs. 5 (31%), OR [95% CI]: 22.0 (5.0–91.1), p < .001) and labor dystocia as the indication for expedited delivery (38 (86%) vs. 7 (44%), OR [95% CI]: 8.1 (2.1–30.1), p = .001). Conclusions Cesarean delivery during the second stage of labor of gestations <34 weeks was associated with a higher rate of lower Apgar scores and longer length of stay. Synopsis Delivery by second stage CD of premature neonates <34 weeks is associated with a higher rate of lower Apgar score.

Objective: We aimed to evaluate perinatal outcomes of advanced maternal age (AMA) primiparous women seeking scheduled cesarean delivery (CD) versus a trial of labor (TOL).Materials and methods: This was a retrospective cohort study of primiparous women ≥40 years of age carrying a single fetus, who delivered at a tertiary, university-affiliated medical center (2007–2014). We compared perinatal outcomes of women who chose a scheduled CD with those who chose TOL. Subsequently, we compared women who had successful TOL (sTOL) with those who had a failed TOL (fTOL).Results: Out of 62 102 deliveries during the study period, inclusion criteria were met by 374 women. Of them, 83 (22.2%) women had a scheduled CD, and 291 (77.8%) had TOL. Of the TOL group, 118 women (40.5%) had fTOL and 173 (59.5%) had sTOL. Women in the fTOL had higher rates of 1-min Apgar score <7, neonatal asphyxia and adverse neonatal composite outcome compared with women in the sTOL group (p < .05). After adjusting for potential confounders, compared with sTOL, fTOL was not associated with adverse neonatal composite outcome. Compared with scheduled CD, fTOL was associated with an increased risk for adverse neonatal composite outcome (aOR 2.65, 95% CI 1.13–6.19, p = .03).Conclusion: AMA primiparous women attempting TOL have comparable outcome to those seeking scheduled CD, however, women with fTOL have higher rates of adverse neonatal outcome.

Objective: to evaluate the effects of labor stimulation with oxytocin on maternal and neonatal outcomes. Method: descriptive and analytical study with 338 women who gave birth at a tertiary hospital. Obstetric and neonatal variables were measured and compared in women submitted and non-submitted to stimulation with oxytocin. Statistics were performed using Chi-square test, Fisher exact test, Student t-test; and crude Odds Ratio with 95% confidence interval were calculated. A p < 0.05 was considered statistically significant. Results: stimulation with oxytocin increases the rates of cesarean sections, epidural anesthesia and intrapartum maternal fever in primiparous and multiparous women. It has also been associated with low pH values of umbilical cord blood and with a shorter duration of the first stage of labor in primiparous women. However, it did not affect the rates of 3rd and 4th degree perineal lacerations, episiotomies, advanced neonatal resuscitation, 5-minute Apgar scores and meconium. Conclusion: stimulation with oxytocin should not be used systematically, but only in specific cases. These findings provide further evidence to health professionals and midwives on the use of oxytocin during labor. Under normal conditions, women should be informed of the possible effects of labor stimulation with oxytocin.

Background and Objective: Cervical ripening plays a crucial role in the success of labor induction. When the Bishop score is less than 4, the use of cervical ripening methods becomes necessary. Various mechanical and pharmacological methods exist for this purpose, but the comparison of their effectiveness and safety remains a subject of debate. The present study aimed to compare the effects of traction catheters and extra-amniotic saline infusion (EASI) on cervical readiness in primiparous mothers with a Bishop score of less than 4 who were candidates for pregnancy termination. Materials and Methods: This single-blind randomized clinical trial was conducted on nulliparous women aged 18-35 years, with the gestational age of 37-42 weeks and Bishop scores less than 4, who were referred to the gynecology clinic of Ayatollah Mousavi Hospital in Zanjan City, Iran, in 2022. Women with a history of uterine surgery, active vaginal bleeding, rupture of membranes, and fetal anomalies were excluded from the study. The patients were randomly assigned to either the EASI or transcervical balloon catheter group. The time from oxytocin administration to complete dilation, duration of the second stage of labor, mode of delivery, patient satisfaction, maternal complications, and neonatal outcomes—including birth weight, Apgar scores at 1 and 5 minutes, and need for NICU admission—were recorded. Results: The average age of participants was approximately 27.4. Neonatal outcomes, including Apgar scores and birth weight, indicated no significant differences (P&gt;0.05). However, post-intervention Bishop scores were significantly higher in the traction group compared to the EASI group (P=0.03). A significant difference was observed in the Bishop score before and after intervention in the EASI and traction group (P&lt;0.05). Moreover, satisfaction levels were significantly lower in the EASI group compared to the traction group (P=0.002). Conclusion: The study concluded that maternal and neonatal complications were similar between the EASI and traction groups. Due to the better clinical outcomes and higher satisfaction levels associated with the traction method, it is recommended as the preferred approach for primiparous women.

BackgroundThe rate of cesarean delivery (CD) in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS).MethodsThis study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns. The rate of CD in primiparous women was estimated. Univariate and multivariable logistic regression was performed to analyze factors associated with CD during labor in primiparous women with a single cephalic pregnancy, including estimation of crude and adjusted odds ratios and their respective 95 % confidence intervals.ResultsThe analyzed data are related to the 2814 eligible primiparous women who had vaginal birth or CD during labor in SUS hospitals. In adjusted analyses, residing in the Southeast region was associated with lower CD during labor. Occurrence of clinical and obstetric conditions potentially related to obstetric emergencies before delivery, early admission with < 4 cm of dilatation, a decision late in pregnancy for CD, and the use of analgesia were associated with a greater risk for CD. Favorable advice for vaginal birth during antenatal care, induction of labor, and the use of any good practices during labor were protective factors for CD. The type of professional who attended birth was not significant in the final analyses, but bivariate analysis showed a higher use of good practices and a smaller proportion of epidural analgesia in women cared for by at least one nurse midwife.ConclusionsThe CD rate in primiparous women in SUS in Brazil is extremely high and can compromise the health of these women and their newborns. Information and support for vaginal birth during antenatal care, avoiding early admission, and promoting the use of good practices during labor assistance can reduce unnecessary CD. Considering the experience of other countries, incorporation of nurse midwives in childbirth care may increase the use of good practices during labor.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0231-z) contains supplementary material, which is available to authorized users.

465 Histologic chorioamnionitis in pregnancies complicated by preeclampsia and the effect on neonatal outcomes

The use of Kjelland's forceps is now uncommon, and published maternal and neonatal outcome data are from deliveries conducted more than a decade ago. The role of Kjelland's rotational delivery in the 'modern era' of high caesarean section rates is unclear. To compare the results of attempted Kjelland's forceps rotational delivery with other methods of instrumental delivery in a tertiary hospital. Retrospective review of all instrumental deliveries for singleton pregnancies 34 or more weeks gestation in a four-year birth cohort, with reference to adverse maternal and neonatal outcomes. The outcomes of 1067 attempted instrumental deliveries were analysed. Kjelland's forceps were successful in 95% of attempts. Kjelland's forceps deliveries had a rate of adverse maternal outcomes indistinguishable from non-rotational ventouse, and lower than all other forms of instrumental delivery. Kjelland's forceps also had a lower rate of adverse neonatal outcomes than all other forms of instrumental delivery. Prudent use of Kjelland's forceps by experienced operators is associated with a very low rate of adverse maternal and neonatal outcomes. Training in this important obstetric skill should be reconsidered urgently, before it is lost forever.

Cervical balloon catheter vs Dilapan-S for outpatient cervical ripening: a randomized controlled trial.

To compare the efficacy of transcervical Foley catheter alone (Foley) to transcervical Foley catheter with extraamniotic saline infusion for labor induction and cervical ripening in women with an unfavorable cervix. This was a multicenter, randomized, controlled trial of women presenting for labor induction with a singleton, cephalic fetus, intact membranes, and unfavorable cervix (Bishop score 6 or less). Eligible women were randomly assigned to receive either Foley catheter alone or Foley catheter with extraamniotic saline infusion. All women received concurrent oxytocin administration. The primary study outcome was the induction-to-delivery interval. Secondary outcomes included cesarean delivery, maternal infectious outcomes, and immediate neonatal outcomes. Analysis was by intent to treat. One hundred eighty-eight women met eligibility criteria and were randomly assigned (Foley plus extraamniotic saline infusion, n=97; Foley, n=91). Baseline demographic characteristics, including parity, gestational age, and Bishop score were similar between the study groups. The median induction-to-delivery interval in the extraamniotic saline infusion arm (12.6 hours, interquartile range 9.3-18.8 hours) was similar to that in the Foley arm (13.4 hours, interquartile range 9.6-17.5 hours) (P=. 70). The proportion of women delivered by 24 hours was comparable between groups (delivery 24 hours, extraamniotic saline infusion 89.7%, Foley 87.9%, P=.70), as was the rate of cesarean delivery (Foley 18.7%, extraamniotic saline infusion 27.8%, P=.14). No significant differences were noted between the study groups with respect to rate of chorioamnionitis, endometritis, or immediate birth outcomes. In women with an unfavorable cervix, the addition of extraamniotic saline infusion to a transcervical Foley catheter does not improve efficacy for labor induction. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00442663 I.

To compare the maternal and neonatal outcomes following induction of labor (IOL) using oral misoprostol vs mechanical cervical ripening using a cervical ripening balloon (CRB) in singleton pregnancies complicated by small-for-gestational age (SGA), including those with late-onset fetal growth restriction (FGR). This was a retrospective multicenter cohort study of women with a singleton pregnancy with estimated fetal weight < 10th percentile and a Bishop score of < 7, who underwent IOL ≥ 37 weeks' gestation for suspected SGA or late-onset FGR in one of three European tertiary centers. Participants were assigned to one of two groups depending on whether they underwent cervical ripening using a CRB without pharmacologic agents (CRB-only group) or received oral misoprostol with or without a CRB (misoprostol group). Women who had had a prior Cesarean delivery (CD), those who received vaginal misoprostol and those with early-onset FGR, fetal structural anomalies or contraindications to vaginal delivery were excluded. The primary outcome was CD. Secondary outcomes included spontaneous vaginal delivery (SVD) within 24 h after starting IOL, operative vaginal delivery (OVD), oxytocin augmentation, uterine tachysystole and neonatal outcomes. Inverse probability of treatment weighting was used to account for baseline differences and doubly robust estimation was used to adjust for confounders. A total of 848 women was included in the analysis, of whom 431 (50.8%) received a CRB only and 417 (49.2%) received oral misoprostol with or without a CRB. Baseline characteristics differed between the two groups, with women in the misoprostol group being older, more often nulliparous and undergoing IOL later in gestation. After adjustment, there was no significant difference in the rate of CD between the two groups (adjusted odds ratio (aOR), 1.29 (95% CI, 0.82-2.04)). Women receiving misoprostol were significantly less likely to undergo OVD (aOR, 0.33 (95% CI, 0.18-0.64)) or require oxytocin augmentation (aOR, 0.04 (95% CI, 0.03-0.07)) compared with the CRB-only group. SVD within 24 h after starting IOL was also less likely in the misoprostol group (aOR, 0.49 (95% CI, 0.33-0.74)). Uterine tachysystole occurred more frequently in the misoprostol ± CRB group, but this was not associated with higher rates of CD for fetal distress or adverse neonatal outcomes. The rate of admission to the neonatal intensive care unit was similar between the two groups. Subgroup analysis in pregnancies with confirmed late-onset FGR yielded comparable findings. In pregnancies complicated by late-onset FGR or SGA, oral misoprostol did not increase the risk of CD compared with mechanical cervical ripening only, and was associated with a reduced need for operative interventions and labor augmentation. These findings support the use of oral misoprostol as a safe and effective option for IOL in this high-risk population. Randomized controlled trials are needed to confirm these results. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

The objective of this study is to compare pregnancy outcomes in deliveries complicated by primary meconium-stained amniotic fluid (MSAF, present at membrane rupture) and secondary MSAF (transitioned from clear to MSAF during labor). The medical records and neonatal charts of all deliveries ≥ 370/7 weeks between October 2008 and July 2018 were reviewed. The primary outcome was composite adverse neonatal outcome that included early neonatal complications. Of 30,215 deliveries during the study period, 4302 (14.2 %) were included: 3845 (89.4%) in the primary MSAF group and 457 (10.6%) in the secondary MSAF group. The rate of the primary outcome was higher in the secondary MSAF group (p = 0.006). This association remained significant after controlling for background confounders. The secondary MSAF group had higher rate of cesarean deliveries (CDs) and assisted vaginal deliveries. There was a higher rate of composite adverse neonatal outcome when secondary MSAF was diagnosed < 3 vs. >3 h before delivery (p = 0.004). Secondary MSAF was associated with higher rates of adverse neonatal outcome, CDs, and assisted vaginal deliveries, compared with primary MSAF.

Early vs expectant artificial rupture of membranes following Foley catheter ripening: a randomized controlled trial

ABSTRACTAimThis study aims to examine the effects of lateral positions during the second stage of labour on maternal and neonatal outcomes.DesignA prospective observational study was conducted in three Chinese hospitals from June to November 2020.MethodsEligible women were divided into groups based on their use of lithotomy or lateral positions during the second stage of labour. Propensity score matching (PSM) was employed to assess the effects of lateral positions on maternal outcomes (perineal tears, episiotomy use, postpartum blood loss, duration of the second stage of labour, and mode of birth) and neonatal outcomes (Apgar scores at one and 5 min postpartum).ResultsAfter PSM matching, lateral positions were associated with a 21% reduced risk of episiotomy use among primiparous women. Primiparous women adopting lateral positions also had significantly reduced risks of moderate perineal tears. There were no significant differences in the duration of the second stage of labour, mode of birth or rates of blood loss over 500 mL at 2 h postpartum. However, lateral positions increased the duration of the second stage of labour by 10 min among primiparous women who adopted lateral positions in this study, and both primiparous and parous women using lateral positions had greater postpartum blood loss. Cases of Apgar scores less than seven and severe perineal tears were rare.ConclusionThis prospective observational study indicates that lateral positions during the second stage of labour may offer protective benefits for the perineum among primiparous women. However, their use requires careful clinical judgement, as they may not be suitable for primiparous women experiencing slower labour progress, and additional attention should be given for monitoring postpartum blood loss, regardless of parity.

The relation between low-grade fever during prolonged rupture of membranes (>12 hours) at term and infectious outcomes: a retrospective cohort study

Background Success of induction depends largely on cervical ripening and increases the likelihood of vaginal delivery. This study compared the outcomes for induction of labor using extra-amniotic saline infusion (EASI) vs intracervical dinoprostone gel. Objective: Primary: To compare improvement between pre- and post-induction Bishop’s scores in both the groups. Secondary: To compare induction to delivery interval, mode of delivery, and neonatal outcome in both the groups. Materials and methods A randomized controlled trial of 1 year was conducted in the Department of Obstetrics and Gynaecology, Karnataka Lingayat Education University Dr Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India, on 82 pregnant women from January 2014 to December 2014. The selected women were divided into two groups of 41 each as group I (induced with dinoprostone) and group II (induced with EASI using Foley’s catheter). Results Significantly higher number of women had postinduction Bishop’s scores between 9 and 12 in the dinoprostone group (70.73%; p &lt; 0.001). The mean Bishop’s scores were significantly high in the dinoprostone gel (9.27 ± 3.07) vs EASI (8.22 ± 2.34; p = 0.086). Cervical ripening based on cut-off score of ≥6 was noted in a significantly higher number of women (92.68%) in EASI (p = 0.241). The mean time for cervical ripening was significantly high in dinoprostone gel group compared with EASI (15.44 ± 8.41 vs 3.88 ± 3.67; p &lt; 0.001), but mean induction to delivery time was comparable (p = 0.086). Significantly higher numbers of vaginal deliveries were noted in dinoprostone group (91.43%; p = 0.001). The neonatal outcomes, i.e., birth weight, mean birth weight, appearance, pulse, grimace, activity, and respiration score at 1 and 5 minutes, and neonatal intensive care unit admission, were comparable (p = 0.570). Conclusion Dinoprostone gel and EASI using Foley’s catheter appear to be effective methods for cervical ripening and labor induction, but dinoprostone gel yielded significantly higher rate of vaginal delivery. How to cite this article Rodrigues SV, Swamy MK, Jadhav N. A Randomized Controlled Trial of Extra-amniotic Saline Infusion vs Intracervical Dinoprostone Gel for Induction of Labor. Int J Gynecol Endsc 2017;1(1):11-17