Amniotomy Research Articles

Maternal and Neonatal Consequences of Early Augmentation of Labor Among Women With Spontaneous Onset of Labor: A National Population-Based Study.

While some labor interventions are essential in preventing maternal and neonatal morbidity, there is little evidence to support systematic early augmentation of labor (EAL). Our objective was to assess the association between EAL and cesarean delivery rate, postpartum hemorrhage and adverse neonatal outcomes. Population-based study using data from the 2016 French Perinatal Survey. Women with a singleton cephalic fetus, delivering at term after a spontaneous labor were included. "EAL" was defined by artificial rupture of the membranes (AROM) and/or oxytocin within 1 h of admission and/or duration between interventions of less than 1 h. Women without EAL were women without labor augmentation or without EAL. The primary endpoint, cesarean delivery and the secondary endpoints were compared between women with and without EAL using univariate analysis. A multivariable logistic regression was adjusted on the suspected confounders and a propensity score approach was then performed. Among the 7196 women included, 1524 (21.2%) had EAL. Cesarean delivery rates were significantly higher in the EAL group compared with the no EAL group, 8.40% versus 6.15% (p < 0.01). EAL was associated with cesarean delivery in the multivariable analysis aOR 1.45 95% CI [1.15-1.82] and in the cohort matched on the propensity score, OR 1.56 [1.17-2.07]. EAL was not associated with severe postpartum hemorrhage, low 5-min Apgar score, low neonatal cord pH or transfer to NICU. EAL is frequent, involving one in five spontaneous laboring women in France. This practice is associated with an increased cesarean delivery risk.

Induction of Labour: What to Consider

Induction of Labour (IOL) is a method of artificially providing stimulus to the uterus to start the process of labour.1 It utilises iatrogenic therapies such as a synthetic oxytocin, cervical ripening medications, in conjunction with the artificial rupture of membranes, to imitate the physiology of labour and childbirth.2 The indication for IOL is dependent on the clinical need to optimise maternal, fetal and neonatal outcomes, juxtaposed with the potential adverse effects of the IOL process. Indications include uterine, placental and fetal growth disorders, hypertensive conditions and diabetes.3 For example, the National Institute for Clinical Excellence (NICE) recommend IOL between 37 and 38 plus six weeks for pregnant populations who have type 1 or type 2 diabetes, to prevent stillbirth and associated complications.4 The absolute effectiveness of IOL intervention in preserving maternal and fetal health is evident5 however, the World Health Organization (WHO) endorses the consideration of choice of IOL method.6

Developing a nomogram for estimating the risk of needing to perform a caesarean section after induction of labour in pregnancies using a COOK® Cervical Ripening Balloon.

Using a COOK® Cervical Ripening Balloon (CCRB) for cervical maturity has become a common clinical practice for the induction of labour (IOL). To develop and validate a predictive instrument that could estimate the risk of a caesarean after IOL in term pregnancies with CCRB treatment. The medical records of 415 pregnant women requiring IOL from January 2018 to October 2022 were retrospectively reviewed and randomly selected for training (290) and validation (125) sets in a 7:3 ratio. A model for predicting the risk of a caesarean was virtualised by a nomogram using logistic regression analysis. After completing the multivariate analysis, parity (odds ratio [OR] = 0.226; p= 0.017), modified Bishop score at induction (OR =0.688; p= 0.005) and the artificial rupture of membranes (OR = 0.436; p= 0.010) were identified as the predictors for implementing a caesarean delivery after IOL. The decision curve analysis showed that the model achieved a net benefit across all threshold probabilities. We successfully constructed a nomogram for caesarean delivery after IOL in pregnancies with CCRB treatment using factors including parity, modified Bishop score at induction and the artificial rupture of membrane.

Oral misoprostol alone, compared with oral misoprostol followed by oxytocin, in women induced for hypertension of pregnancy: A multicentre randomised trial.

To assess whether, in those requiring continuing uterine stimulation after cervical ripening with oral misoprostol and membrane rupture, augmentation with low-dose oral misoprostol is superior to intravenous oxytocin. Open-label, superiority randomised trial. Government hospitals in India. Women who were induced for hypertensive disease in pregnancy and had undergone cervical ripening with oral misoprostol, but required continuing stimulation after artificial membrane rupture. Participants received misoprostol (25 micrograms, orally, 2-hourly) or titrated oxytocin through an infusion pump. All women had one-to-one care; fetal monitoring was conducted using a mixture of intermittent and continuous electronic fetal monitoring. Caesarean birth. A total of 520 women were randomised and the baseline characteristics were comparable between the groups. The caesarean section rate was not reduced with the use of misoprostol (misoprostol, 84/260, 32.3%, vs oxytocin, 71/260, 27.3%; aOR 1.23; 95% CI 0.81-1.85; P = 0.33). The interval from randomisation to birth was somewhat longer with misoprostol (225 min, 207-244 min, vs 194 min, 179-210 min; aOR 1.137; 95% CI 1.023-1.264; P = 0.017). There were no cases of hyperstimulation in either arm. The rates of fetal heart rate abnormalities and maternal side effects were similar. Fewer babies in the misoprostol arm were admitted to the special care unit (10 vs 21 in the oxytocin group; aOR 0.463; 95% CI 0.203-1.058; P = 0.068) and there were no neonatal deaths in the misoprostol group, compared with three neonatal deaths in the oxytocin arm. Women's acceptability ratings were high in both study groups. Following cervical preparation with oral misoprostol and membrane rupture, the use of continuing oral misoprostol for augmentation did not significantly reduce caesarean rates, compared with the use of oxytocin. There were no hyperstimulation or significant adverse events in either arm of the trial.

Clinical analysis of 102 cases of labor induction in the third trimester on twin pregnancy

Objective: To investigate the clinical characteristics of induced labor in twin pregnancy and the related factors of induced labor failure. Methods: The clinical data of twin pregnant women who underwent induced labor in Peking University Third Hospital from January 2016 to December 2022 were retrospectively analyzed. According to whether they had labor or not after induction, pregnant women were divided into the success group (pregnant women who had labor after induction, 72 cases) and the failure group (pregnant women who did not have labor after induction, 30 cases). Logistic regression was used to analyze the related factors of induction failure in twin pregnant women. Results: The parity and cervical Bishop score in the failure group were significantly lower than those in the success group, while the proportion of dichorionic diamniotic twins, assisted reproductive technology pregnancy and cervical Bishop score <6, postpartum hospital stay and total hospital stay in the failure group were significantly higher than those in the success group (all P<0.05). The proportion of induced labor by artificial rupture of membranes ± oxytocin intravenous infusion in the success group was 72.2% (52/72), which was significantly higher than that in the failure group (46.7%, 14/30; P=0.030). There were no significant differences between the two groups in the gestational age at delivery, the incidence of severe postpartum hemorrhage and blood transfusion, the amount of postpartum hemorrhage, the neonatal weight of two fetuses, the incidence of neonatal asphyxia, and the proportion of neonates admitted to the neonatal intensive care unit (all P>0.05). There were no severe perineal laceration and hysterectomy in all pregnant women. Multivariate logistic regression analysis showed that primipara (OR=3.064, 95%CI: 1.112-8.443; P=0.030) and cervical Bishop score <6 (OR=5.208, 95%CI: 2.008-13.508; P=0.001) were the independent risk factors for induction failure in twin pregnancy. Conclusions: Elective induction of labor in twin pregnancy is safe and feasible. It is helpful to improve the success rate of induction of labor by strictly grasping the timing and indications of termination of pregnancy, choosing the appropriate method of induction according to the condition of the cervix, and actively promoting cervical ripening.

Just Pop It: Early AROM After Cervical Ripening Reduces the Time to Delivery.

In pregnant patients at term undergoing induction of labor, early time-based artificial rupture of membranes (AROM) within 1 hour of Foley bulb expulsion results in a shorter duration of labor by nearly 9 hours with no significant difference in cesarean delivery rates or maternal or neonatal adverse outcomes.1.

Influencing factors of intrapartum fever after epidural labor analgesia.

The objective of this study was to investigate factors influencing intrapartum fever in parturients receiving epidural labor analgesia. This study included 410 parturients who received epidural labor analgesia at the authors' hospital between February 2022 and February 2024. Participants were divided into a fever group (>37.5℃) and a control group (<37.5℃) based on their body temperature post-analgesia. General data, gestational comorbidities, and intrapartum-related conditions were compared. Influencing factors were analyzed using the chi-squared test and logistic regression. Intrapartum fever occurred in 90 parturients (22.0%). Univariate analysis indicated that maternal age (p=0.046), parity (p=0.042), oxytocin use (p=0.041), and timing of analgesia (p<0.001) were associated with intrapartum fever. Multivariate analysis revealed that the timing of analgesia (OR 3.612, 95%CI 1.533-8.510) and amniotic fluid contamination degrees I (OR 1.072, 95%CI 1.012-3.082) and II (OR 2.874, 95%CI 1.901-9.092) were independent risk factors. No significant differences were found between the fever and control groups in body mass index, gestational age, gestational comorbidities, and artificial membrane rupture (p>0.05). Intrapartum fever increased the rate of neonatal fever within 2 h after birth (41.7 vs 18.6%, p<0.05) but did not significantly affect other neonatal health indicators. Timing of analgesia and amniotic fluid contamination are significant factors influencing intrapartum fever in parturients receiving epidural labor analgesia.

How COVID-19 pandemic affected clinical exposure of final year medical students: A comparison study of portfolio assessments

Background and Objective COVID-19 restrictions had a major impact on the academic sector globally. The aim of this study was to compare the clinical exposure of final year medical students at the professorial unit of Obstetrics and Gynaecology of Colombo South Teaching Hospital during the COVID-19 pandemic with those who attended clinical training prior to the pandemic. Methods Systematic sampling of 66 medical students belonging to two clinical groups, who had completed their professorial Obstetrics and Gynaecology appointment during the pandemic, was done, using their student portfolios recording the clinical skills and procedures performed during the appointment. The pre-COVID-19 data were gathered from a previous study carried out in the same unit in 2018. Results Most students managed to complete both the Gynaecological and the Obstetrics Mini–Clinical Evaluation Exercise (62.1% and 56.1% respectively) but, compared to the pre-pandemic era, a higher percentage presented only one case or none. All students completed the Objective Structured Assessment of Technical Skills in episiotomy suturing (100%) and a majority (90.9%) performed artificial rupture of membranes (ARM). However, only 36.4% had the opportunity to perform a PAP smear independently. Majority (95.1%) of the cases were presented to the registrars attached to the unit while only a minority was evaluated by a consultant (3.8%). The Obstetric and Gynaecological clinical procedures and skill acquisition showed slightly lower percentages than in the pre-COVID-19 period with the means and the medians lying in between the 1st and 2nd quartiles of the distribution. Conclusion On average, there was a slight decrease in the clinical exposure to procedures and skills during the COVID-19 outbreak compared to the non-COVID-19 period. Additionally, the opportunity of the medical students to be supervised by a consultant Obstetrician and Gynaecologist reduced drastically during the pandemic.

Evaluation of labor management practices during spontaneous labor

IntroductionIn 2017, the French national authority for health issued national guidelines to support physiologic labor and reduce medical interventions. This study's primary aim was to evaluate the association between the publication of these guidelines and the vaginal delivery rate in a type IIb perinatal center. The secondary objectives were to evaluate the implementation of these guidelines, their association with the duration of labor, and the rates of postpartum hemorrhage and adverse neonatal outcomes. Material and methodsA before-and-after, retrospective, single-center study comparing a "before" group (2016) and an "after" group (2018), one year after the recommendations were published. Women were eligible if they had no prior cesarean delivery and gave birth after 37 weeks of gestation to a singleton fetus in cephalic presentation after spontaneous labor. The analysis was stratified by parity. ResultsOxytocin administration decreased between the two periods (48% vs 35 %, P < 0.0001), as did the frequency of amniotomies (artificial rupture of membranes) (39.5 % vs 27.7 %, P < 0.0001). The duration of labor was significantly prolonged (360 vs 390 min, P < 0.0001), especially in nulliparous women (465 min vs 562 min, P<0.0001). The frequency of vaginal delivery rose between the two periods (94.6 % vs 96 %, P = 0.05), and the postpartum hemorrhage rate fell (6 % vs 4.5 %, P = 0.04). The numbers of neonates with an umbilical artery pH< 7.10 and of neonatal transfers also decreased. ConclusionsThe reduction of active interventions during labor is associated with a longer duration of labor and a decrease in the rates of cesarean births, postpartum hemorrhages, and neonatal transfers.

L’accouchement des femmes enceintes de jumeaux : les enseignements de l’étude nationale observationnelle prospective comparative JUMODA

ObjectivesTo summerize the results of the JUMODA study (JUmeaux MODe d’Accouchement) on the planned mode of delivery of twin pregnancy and the management of second twin delivery. MethodsJUMODA was a national observational prospective comparative study that took place between february 2014 and march 2015 in 176 french maternity units performing more than 1500 deliveries per year. Its main objectives were the comparison of neonatal and maternal morbidity according to the planned mode of delivery and the determination of the managements of second twin delivery associated with the best neonatal outcomes. To control for potential confounding factors and indication biases, statistical analyses comprized multivariate logistic regressions and matching on propensity scores. ResultsThe JUMODA study recruited 8823 women with twin delivery at or beyond 22 weeks of gestation. For twin pregnancies with a cephalic first twin at 32 weeks of gestation and beyond, severe neonatal morbidity was higher in the planned cesarean (150/2908 (5.2 %) than in the planned vaginal delivery group (199/8922 (2.2 %), aOR 1.56, 95 % CI 1.19-2.04). Increased neonatal morbidity in the planned cesarean delivery group was explained by higher severe morbidity in neonates born preterm (aOR 1.64, 95 % CI 1.13-2.39, for deliveries between 32+0 and 34+6 weeks of gestation, aOR 2.04, 95 % CI 1.22-3.41, for deliveries between 35+0 SA and 36+6 weeks of gestation) but not in neonates born at term (aOR 1.19, 95 % CI 0.58-2.44). In comparison with planned cesarean delivery, planned vaginal delivery was not associated with increased severe neonatal morbidity in case of breech presenting first twin after 32 weeks of gestation or with decreased survival witout severe neonatal morbidity in case of delivery before 32 weeks of gestation whatever the first twin presentation. In comparison with planned vaginal delivery, planned cesarean delivery was associated with increased severe maternal morbidity only in women aged 35 and higher. Delivery of non cephalic second twin was associated with similar severe neonatal morbidity rate than delivery of cephalic second twin. Finally, in case of cephalic second twin, internal version followed by total breech extraction was associated with less cesarean for the second twin but with higher severe neonatal morbidity in case of preterm birth in comparison with pushing efforts, ocytocin perfusion and artificial rupture of membranes. ConclusionsPlanned vaginal delivery is the planned mode of delivery to encourage for the majority of pregnant women with twins, whatever first twin presentation and gestational age at delivery. No management of cephalic second twin appears better than an other, its choice will rest on obstetrician preferences.

Normal birth rates before and after the merging of mixed-risk and low-risk maternity wards in Iceland: A retrospective cohort study on the impact of inter-professional preventative measures.

In 2014, the National University Hospital of Iceland (NUHI) merged a mixed-risk birth unit and a midwifery-led low-risk unit into one mixed-risk unit. Interprofessional preventative and mitigating measures were implemented since there was a known threat of cultural contamination between mixed-risk and low-risk birth environments. The aim of the study was to assess whether the NUHI's goal of protecting the rates of birth without intervention had been achieved and to support further development of labor services. A retrospective cohort study of all women who had singleton births at NUHI birth units in two 2-year periods, 2012-2013 and 2015-2016. The primary outcome variables, birth without intervention, with or without artificial rupture of membranes (AROM), were adjusted for confounding variables using logistic regression analysis. Secondary outcome variables (individual interventions and maternal and neonatal complications) were analyzed using descriptive statistics, t test, and Chi-square test. The rate of births without interventions, both with and without AROM, increased significantly after the unit merger and accompanying preventative measures. The rates of AROM, oxytocin augmentation, episiotomies, and epidural analgesia decreased significantly. The rate of induction increased significantly. There were no significant differences in maternal or neonatal complication rates. Interprofessional preventative measures, implemented alongside a mixed-risk and low-risk birth unit merger, can increase rates of births without interventions in a mixed-risk hospital setting. However, it is necessary to maintain awareness of the possible effects of a mixed-risk birth environment on the use of childbirth interventions and examine the long-term effects of preventative measures.

Inpatient vs outpatient management of pregnancies with vasa previa: A historical cohort study.

Vasa previa, a condition where unprotected fetal blood vessels lie in proximity to the internal cervical opening, is a potentially lethal obstetric complication. The precarious situation of these vessels increases the risk of fetal hemorrhage with spontaneous or artificial rupture of membranes, frequently causing fetal/neonatal demise or severe morbidity. As a result, in many centers, inpatient management forms the mainstay when vasa previa is diagnosed antenatally. This study aimed to determine whether a subpopulation of pregnancies diagnosed antenatally with vasa previa could be safely managed as outpatients. We reviewed all cases of vasa previa in singleton pregnancies, with no fetal anomalies, diagnosed at Mount Sinai Hospital, Toronto, from January 2008 to December 2017. Cases were categorized into three arms for analysis: outpatients (OP), asymptomatic hospitalized (ASH) and symptomatic hospitalized (SH). The SH arm included patients admitted with any antepartum bleeding or suspicious fetal non-stress test. Those that presented with symptomatic uterine activity/threatened preterm labor and delivered within 7 days of diagnosis were excluded from the study. Records were analyzed for details on hospitalization, antenatal corticosteroid administration, cervical length measurements, and fetal/neonatal mortality and morbidity. Of the 84 antenatally-diagnosed cases of vasa previa, 47 fulfilled eligibility criteria. A total of 15 cases were managed as OP, 22 as ASH and 10 as SH. Unplanned cesareans were highest in the SH arm (40% vs. 0% ASH vs. 13.3% OP). Those in the SH arm delivered earliest (median 33.8 weeks, interquartile range (IQR) 33.2-34.3 weeks). Of the asymptomatic patients, those in the ASH arm delivered earlier than those in the OP arm (35.3 [34.6-36.2] weeks vs. 36.7 [35.6-37.2] weeks, p = 0.037). There were no cases of fetal/neonatal death, anemia or severe neonatal morbidity and no significant differences between groups based on cervical length or antenatal corticosteroid administration. Our study suggests that asymptomatic women with an antenatal diagnosis of vasa previa, singleton pregnancies, and at low risk for preterm birth may safely managed as outpatients, as long as they are able to access hospital promptly in the event of antepartum bleeding or early labor.

Direct Observation of Procedural Skills: A Formative Assessment Tool for Postgraduate Training in Obstetrics and Gynecology

Background: Direct observation of procedural skills (DOPS), a method of workplace-based assessment helps the students to shape their learning. DOPS requires direct observation and assessment of students while performing in a real-life setting using a structured checklist with constructive feedback for improvement. Most of the medical institutes in India still assess the students on the basis of traditional methods, where theoretical knowledge is mainly assessed as a summative assessment. This study was conducted to bridge this gap by introducing DOPS as a formative assessment tool for PG students in obstetrics and gynecology and to explore the perspectives of faculty and students for DOPS as a formative assessment tool. Materials and Methods: In the department of obstetrics and gynecology at a tertiary care teaching institute in Central India, this prospective interventional research was conducted for a period of 1 year. Eighteen 2nd year and final year postgraduate students and nine faculty from the obstetrics and gynecology specialty were identified for inclusion in this study using convenient sampling. IEC approval (NKPSIMS and RC and LMH/IEC/09/2021) and informed consent were taken. Postgraduate students were assessed for 5 procedures using a validated structured checklist: (1) per speculum and per vaginal examination, (2) Pap’s smear collection, (3) conduction of artificial rupture of membrane, (4) introduction of intrauterine contraceptive device, and (5) episiotomy repair. Feedback after assessment was given by the faculty. There were 3 DOPS assessment sessions for each procedure. Perception of students and faculty was collected using a prevalidated questionnaire using 3-point Linkert’s scale. Descriptive statistics of response was considered to calculate percentages. Using thematic analysis, the responses of open-ended questions were analyzed based on the quantitative data form. Results: Perception of students were positive as effective teaching learning tool (94%), skill improvement (100%), constructive feedback (100%), time provided for feedback (100%), confidence gain (100%), assessment in nonthreatening environment (100%), motivation (94%), Faculty responded positively regarding improved attitude toward teaching (100%), in depth assessment of skill (78%), useful teaching learning tool (100%), improves student–teacher relationship (78%), identifies developmental needs of student (100%). Themes identified were DOPS provide more systematic learning, personal attention to each student, better understanding, learn proper steps of procedure, one on one interactive method of learning, improvement of clinical skills, and more confident. Challenges perceived by students were time constraint and person who grades is not the same teacher and by faculty were more time and dedication needed and more paper work is required. Conclusion: DOPS was considered as an effective teaching learning and assessment tool and can be incorporated as a formative assessment tool during residency in Obstetrics and Gynecology (OBGY) by both faculty and students. Time for assessment is a challenge considered by Faculty as well as by students.

A 31-Year-Old Woman With Postpartum Abdominal Pain and Fever

(N Engl J Med. 2022;387:2367–2375) This case presented 15 days after the patient’s vaginal delivery of a healthy baby, when she was admitted to the hospital with abdominal pain and fever. Sixteen days prior, spontaneous labor had been augmented by artificial membrane rupture (showing clear, odorless fluid) and oxytocin infusion. An elevated white-cell count was noted (13,800/mL, 4500 to 11,000/mL reference range) and intravenous penicillin was administered. Hemoglobin was noted to be 14.0 g/dL (12.0 to 16.0 g/dL reference range). Delivery occurred 6 hours later, followed immediately by uterine atony hemorrhage with 500 mL of blood loss. Hemostasis was achieved by bimanual massage of the uterus, and administration of oxytocin and methylergonovine. A routine repair of a perineal laceration was also performed. The patient discharged from the hospital on postpartum day 1.

P106 OAA Survey 1040: Anaesthetic management of artificial rupture of membranes in theatre

P106 OAA Survey 1040: Anaesthetic management of artificial rupture of membranes in theatre

Effectiveness of dinoprostone gel, misoprostol vaginal insert and dinoprostone vaginal insert for induction of labour in twin pregnancies

ObjectivesTo compare the effectiveness and safety of Dinoprostone Gel (DG), Misoprostol Vaginal Insert (MVI) and Dinoprostone Vaginal Insert (DVI) for induction of labour (IOL) in twin pregnancies. Study DesignRetrospective cohort study of twin pregnancies > 34 + 0 weeks gestation that underwent induction of labour (IOL) with DG, MVI or DVI between December 2016 and November 2019 in a Tertiary NHS hospital, North West England, UK. Delivery characteristics, maternal complications and neonatal outcomes were compared between the three groups. ResultsA total of 87 twin pregnancies were included for analysis. 27 women received DG, 34 received MVI and 26 DVI. The MVI cohort had a higher proportion of nulliparous women (55.9%) compared to the DG and DVI cohorts, 29.6% and 38.5% respectively. No other differences amongst demographic characteristics were considered clinically significant.DG demonstrated a significantly quicker time to delivery (minutes) compared to DVI (1021 ± 556 versus 1649 ± 852; P = 0.0026). Significantly fewer women required terbutaline for hyperstimulation/tachysystole in the DG group compared to MVI (0% vs 32%; RR 0.05; 95% CI 0.003–0.88). Both DG and MVI groups required significantly less oxytocin following artificial rupture of membranes compared to DVI (33% vs 65%; RR 0.51; 95% CI 0.28–0.93) and (29% vs 65%; RR 0.45; 95% CI 0.25–0.81). There were no significant differences in mode of delivery, maternal complications and neonatal outcomes. ConclusionOur data suggests that for women with a twin pregnancy considering a planned labour that induction with DG, MVI and DVI appear to be equally safe and effective IOL methods. These results should be interpreted with caution due to the study being underpowered to detect significant adverse outcomes. In order to determine the optimal method of IOL in twins, direct randomised comparison is needed.

Outpatient balloon catheter vs inpatient prostaglandin for induction of labor: a randomized trial

Approximately 1 in 4 pregnant women undergo induction of labor. Meta-analyses have shown that mechanical methods of induction of labor are safe and effective, as is starting induction in an outpatient setting. However, few studies have evaluated outpatient balloon catheter induction in comparison with pharmacologic methods. This study aimed to determine whether women who underwent outpatient induction of labor with a balloon catheter would have a lower cesarean delivery rate than women who underwent inpatient induction of labor with vaginal prostaglandin E2 without an increase in adverse maternal or neonatal events. This was a superiority randomized controlled trial. The eligibility criteria were pregnant women (nullipara and multipara) with a live singleton fetus in vertex presentation with any medical comorbidity who underwent planned induction of labor at term and who had an initial modified Bishop Score of 0 to 6 at 1 of 11 public maternity hospitals in New Zealand. The intervention groups were outpatient single balloon catheter induction in comparison with inpatient vaginal prostaglandin E2 induction. The primary hypothesis was that participants who started their induction at home with a balloon catheter would have a lower risk for cesarean delivery than participants who started their induction with prostaglandins and remained in hospital throughout. The primary outcome was cesarean delivery rate. Participants were randomized using a centralized secure online randomization website in a 1:1 ratio, stratified by parity and hospital. The participants and outcome assessors were not blinded to group allocation. An intention-to-treat analysis with adjustment for stratification variables was used. A total of 539 participants were randomized to outpatient balloon catheter induction, and 548 participants were randomized to inpatient prostaglandin induction; the mode of birth was reported for all participants. The cesarean delivery rate was 41.0% among participants allocated to outpatient balloon induction and 35.2% among those allocated to inpatient prostaglandin induction (adjusted odds ratio, 1.27; 95% confidence interval, 0.98-1.65). Women in the outpatient balloon catheter group were more likely to have artificial rupture of membranes and to received oxytocin and an epidural. No differences were found in the rates of adverse maternal or neonatal events. Outpatient balloon catheter induction was not found to reduce the cesarean delivery rate when compared with inpatient vaginal prostaglandin E2 induction. However, the use of balloon catheters in an outpatient setting does not seem to increase the rate of adverse events for mothers or babies and can be offered routinely.

Vaginal Delivery in a Primipara with Glanzmann Thrombasthenia

Vaginal Delivery in a Primipara with Glanzmann Thrombasthenia

Success rate of repeated cycles of induction in labour in a UK clinical setting: A cohort study

Background: Births are increasingly started artificially using medications such as prostaglandin, oxytocin, or other mechanical methods, a process known as induction of labour (IOL). The aim of the study was to identify the success rate of a repeat cycle of induction of labour (IOL) with prostaglandins, and any association between smoking and patient response to prostaglandin. Methods: This was a retrospective cohort study set in Basildon and Thurrock University Hospital, UK. IOL data from patients were collected between 1 January 2021 and 30 March 2021. Data were retrieved from hospital records and categorised by prostaglandin cycle(s), administration of oxytocin, artificial rupture of membranes (ARM), spontaneous rupture of membranes (SROM), smoking status, patient BMI, age, ethnicity, gestation age, Bishop score, and delivery method (assisted, unassisted, or Caesarean (C-)section). The data were analysed using Chi-square, binomial and multinomial logistic regression. The success rate was interpreted from relative frequencies of delivery method (unassisted, assisted or C-section). Results: Unassisted vaginal delivery (n =121; 48.0%) was the most common outcome with prostaglandin IOL followed by C-section (n = 105 41.7%). Only 10.3% had an assisted vaginal delivery. Of those who had a repeated IOL cycle, 85.7% had a C-section. There was no difference in prostaglandin administration by smoking status or any association between smoking status and mode of delivery in IOL. Conclusions: Repeat cycle of IOL does not enhance the vaginal delivery with only 14.3% unassisted vaginal births. There was no evidence that smoking impacted on response to prostaglandins or method of delivery.

Effects of epidural analgesia at 1 cm cervical dilatation on labor interventions in full-term primigravida: A retrospective cohort study.

This study aimed to investigate the effects of epidural analgesia administered as early as cervical dilatation of 1 cm on labor interventions and maternal and neonatal outcomes. This retrospective research recruited 1007 full-term primigravidas, who were distributed to two separate cohorts for eligibility: epidural analgesia 1 (cervical dilatation = 1 cm) and epidural analgesia 2 (cervical dilatation >1 cm). Labor interventions (artificial rupture of membranes and oxytocin administration) and duration of labor were the primary outcomes. The effect of initiation timing of epidural analgesia on artificial membrane rupture was not statistically significant (adjusted odds ratio [OR]: 0.85 [0.58-1.24], p > 0.05). Less oxytocin was used in the epidural analgesia 2 group compared with the epidural analgesia 1 group (the adjusted OR: 0.68 [0.49-0.95], p < 0.05). There were no significant differences in the median time to latent phase of labor, active phase of labor, second, and third stages of labor (p > 0.05). There were no significant differences in maternal and neonatal outcomes between the epidural analgesia 1 group and the epidural analgesia 2 group. Epidural analgesia could be administered at cervical dilatation = 1 cm.