Bishop Score Research Articles

Effect of Date Fruit Consumption in Later Pregnancy on Length of Gestation, Labour and Delivery of Nulliparous Women

Objective: To assess the effect of date fruit consumption in late pregnancy on the onset and progress of labour, the need for induction and augmentation, and delivery outcomes.
 Study Design: Randomized controlled trial (NCT05105893).
 Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2021.
 Methodology: One hundred and forty women were randomized into equal-strength Experimental and Control Groups (70 in each Group). The Experimental-Group included those pregnant females who were advised to consume seven dates per day from 35 weeks onwards till the spontaneous onset of labour. In contrast, the Control-Group comprised primigravidae who did not consume dates in later pregnancy.
 Results: Spontaneous onset of labour was reported in 59(84.2%) pregnant women of the Experimental-Group compared to 43(61.4%) of Control-Group. 55(78.5%) pregnant women who consumed date fruit had a spontaneous vaginal delivery,4(5.7%) required instrumental delivery, and 11(15%) ended up having a caesarean section, whereas 43 out of 70(61.4%) women of the Control-Group had a spontaneous vaginal delivery, 6(8.5%) had an instrumental vaginal delivery, and 21(30%) underwent a cesarean section.
 Conclusion: The patients who had consumed date fruit in later pregnancy had an improved Bishop score at the onset of labour, a shorter duration of labour, a lesser need for induction and augmentation of labour and more spontaneous vaginal deliveries.

Quantitative sonoelastography of the uterine cervix in predicting successful outcome of induction of labour.

The aim of the study was to evaluate the stiffness of cervix and determine its significance in predicting successful outcome of induction of labour. The primary objective was to determine the differences in elastography indices of different areas of cervix between the outcome groups of successful and failed induction of labour. A secondary objective was to find out the correlation of these elastography indices with Bishop's score and cervical length. This was a prospective, observational study conducted over a period of 6 months on pregnant women admitted in the labour room for induction of labour. Establishment of adequate regular uterine contractions - at least three contractions lasting 40-45 s in a 10-min period - was taken as end point for successful outcome of induction of labour. Even after 24 h of initiation of induction of labour, regular, adequate and painful uterine contractions were not established, then induction of labour was described as having failed. Prior to induction, cervical length measurement, Bishop's scoring and elastographic evaluation of the cervix were done by stress-strain elastography. A colour map was produced from purple to red and a five-step scale - the elastography index - was used to describe the various parts of the cervix. The differences between elastography indices of different parts of cervix were estimated using Mann-Whitney U test. Correlation of the indices with cervical length and Bishop's score was determined by Spearman's correlation coefficient. A total of 64 women were included in the study. A significant difference (p < 0.001) was found in the elastography index of internal os between the two outcome groups of success (1.76 ± 0.64) and failure (0.54 ± 0.18). However, the elastography index of central cervical canal, external os, anterior lip and posterior lips did not differ significantly across the outcome groups. A significant positive correlation was found between elastography index of internal os and cervical length (Spearman's correlation coefficient, r = 0.441, p < 0.001) and between elastography index of external os and cervical length (r = 0.347, p = 0.005), whereas a negative correlation was seen between elastography index of external os and Bishop's score (r = -0.270, p = 0.031). Elastography index of internal os can be used to predict outcome of induction of labour. Cervical elastography is a promising new technique for cervical consistency assessment. Further larger studies are required to determine some cut-off point for elastography index of internal os in prediction of outcome of induction of labour and to strongly establish the usefulness of cervical elastography for pregnancy management, preventing preterm delivery and establishment of cut-off points to determine successful induction.

The role of pre-induction transvaginal ultrasound assessment of cervix in prediction of labor induction success

Background: When the benefits to the mother or the foetus outweigh the risks of continuing the pregnancy, such as post-dated pregnancy, preeclampsia, or foetal growth restriction, induction of labour is indicated. Induction of labour is performed in approximately 20% of all pregnancies, and successful induction has been linked to cervical characteristics, or 'ripeness.' However, the Bishop score's assessment of the cervix's "favorability" prior to initiation is very subjective, and numerous investigations have indicated that it has a poor prognostic value, particularly for women with low Bishop Scores. The aim of this study: was to assess the accuracy of transvaginal and other ultrasonographic measures in predicting the outcomes of labor induction. Patients and Methods: In our research, 100 pregnancies between 37 and 42 weeks had labor induction. A digital check of the cervix was done before to induction, and the Bishop score was recorded. Transvaginal ultrasonography was used to measure cervical length. Results & conclusion: a statistically substantial negative link between Bishop Score and failure of induction and chance of C.S. and a statistical substantial positive connection between cervical length as evaluated by ultrasonography and those two outcomes.

“Bishop has left the building”-a randomized controlled trial to determine our modern induction needs

To compare the prediction value of full Bishop score to a “modified” Bishop score and cervical length measured by transvaginal sonography in nulliparous patients undergoing induction of labor at term. A prospective randomized controlled trial of patients admitted for labor induction at term at a single tertiary center between January 2019-December 2021. Patients were randomly assigned to one of the following groups: 1) induction based on full Bishop score; 2) induction based on cervical dilation and effacement alone (“modified” Bishop score); 3) induction based on sonographic cervical length measurements. We excluded patients from the final analysis if they were in active labor pre-induction, had a full Bishop score >5, >2 cm dilation or >80% effacement (“modified” Bishop score), or a cervical length< 20 mm, accordingly. The primary outcome was the rate of vaginal delivery. Secondary outcomes included induction to delivery interval, additional labor augmentation, pain assessment, and adverse maternal and neonatal outcomes. The final analysis included 758 patients. Vaginal delivery rate was similar in all three groups (84% vs. 81% vs 83%, P=0.68), along with the need for additional augmentation, and induction to delivery interval (71.4% vs. 72.3% vs. 70.3%, P=0.35, and 25.6±4.9 vs. 26.3±4.4 vs. 25.5±4.8, P=0.26, respectively). There were no significant differences in adverse maternal or neonatal outcomes between the groups. All 3 methods were similar as predictors of induction success (area under the curve 0.611 vs. 0.607 vs 0.615, P=0.023 vs. P=0.019 vs. P=0.017, respectively) with no significant difference between in test properties including sensitivity, specificity, positive and negative predictive values. Visual analogue scores were similar between the 3 tests (P=0.66). In nulliparous patients undergoing induction of labor, evaluating dilation and effacement alone is as efficient as full Bishop score or sonographic cervical length measurement in prediction of vaginal delivery success and induction to delivery interval with no significant difference in pain level.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Vaginal Birth after Cesarean Score for the Prediction of Successful Vaginal Birth after Cesarean Section – A Prospective Observational Study

Aim: The aim of this study was to evaluate the demographic and obstetrical factors affecting the chances of vaginal birth after cesarean (VBAC) delivery and to develop a scoring system for the prediction of same. Materials and Methods: It was a prospective observational study done over a period of 1 year. A total of 100 term pregnant women with previous one lower-segment cesarean section (LSCS) fulfilling the criteria for a trial of labor were recruited for the study. As 23 patients refused to undergo trial of labor after cesarean (TOLAC) in early labor, 77 women formed the study group. Parameters assessed to predict successful TOLAC were maternal age, body mass index (BMI), history of prior vaginal delivery, interdelivery interval, indication of previous cesarean section, gestational age, type of labor, Bishop's score, and expected baby weight. Scores 0–2 were given, and the mean score obtained was correlated with the outcome of TOLAC. Results: Successful vaginal delivery occurred in 57.14% (44/77) of women. BMI ≤30 kg/m2 (P = 0.004), parity ≤ 3 (P = 0.005), Bishop's score &gt;4 (P = 0.000), spontaneous onset of labor at the time of admission (P = 0.001), and nonrecurrent indication of previous LSCS (P = 0.029) were found to be significantly associated with the VBAC. The probability of having a successful VBAC was 83.3% and 100%, with the VBAC score value of more than 18 and 20, respectively. Conclusion: The mean VBAC score of 18–20 by the current scoring system is beneficial in predicting the outcome. This can help in counseling the patient, relatives as well as health professionals to undergo labor trial to decrease the cesarean section rate in the current era.

Labor outcome in women by measuring foetal head to perineal distance by transperineal ultrasound

Introduction: Some of the term gestations will need induction of labor due to various reasons. The outcome of these pregnancies is not known beforehand. Engagement of fetal head is assessed clinically by abdominal and vaginal examination, but clinical assessment is a poor predictor for the course of labor Per vaginal examinations are done after induction/active labor for assessment of progression of labor and bishop score calculation, but this score varies from examiner to examiner. With advancement in technology there are improved procedures to assess the progression of labor by measuring foetal head to perineal distance by trans perineal ultrasound. The Trans perineal ultrasound is simple easy, reliable and done only once prior to the induction or augmentation of labor. This can be used to remove the observer bias in per vaginal examination and also multiple per vaginal examinations can also be avoided. The aim of the study is to measure the foetal head to perineal distance by transperineal ultrasound prior to induction or augmentation of labor for better outcome.Methods & Methodology: Prospective study done over18 months with sample size of 150 pregnant women with singleton pregnancy in cephalic presentation at 38 or more than 38 weeks period of gestation planning for induction or in early labor at Dr. PSIMS & RF.Result: In our study 150 pregnant women with singleton pregnancy, cephalic presentation at or more than 38 weeks period of gestation prior to induction or augmentation of labor in patients with FHPD < 7cm 95.24% had vaginal deliveries and 4.76% has caesarean section in patients with FHPD > 7 cm had 22.2%vaginal deliveries, 55% caesarean section, 22.22% instrumental deliveries.Conclusion: In this study it is seen that FHPD has more predictability than bishop score when measured at 38 or more than 38 weeks period of gestation planning for induction or in early labor but Pelvic examinations are mandatory to rule out the colour of liquor in foetal distress or cord prolapse.In settings where the relevant technology and experience are available, foetal head to perineal distance can be utilised as an adjunct method to bishop score in predicting the mode of delivery and in selecting patients for trail of labour.

Comparative Study of the Effect of Vaginal use of Primrose Oil with Misoprostol on Cervical Preparation of Prim Gravid Women: A Double-blind Clinical Trial.

This study compares the effect of vaginal administration of evening primrose oil with misoprostol on cervical preparation in prim gravid women at ≥40 weeks gestation. This was a double-blind randomized clinical trial conducted in Isfahan, Iran during 2019-2020 on 110 prim gravid pregnant women with a gestational age of 40 weeks and more and cephalic presentation of the fetus with the obstetrical indication for pregnancy termination. After obstetric examinations to rule out cephalo pelvic disproportion and calculation of the Bishop score by the researcher, patients were randomized to receive 25 μg misoprostol tablets (n = 55) or 1000 mg evening primrose oil Pearls (n = 55) administrated vaginally by a midwife. We compared Bishop's score before and after the intervention, time of cervical ripening, a dose of intervention for cervical ripening, need to induce labor, the interval between cervical preparation and induction of labor, duration of oxytocin use, need for cesarean section, and its cause, Apgar score at 5 and 10 minutes, neonatal birth weight. Mean baseline Bishop Score was not significant between the groups (P = 0.45); after the intervention, it was significantly higher in the primrose oil group (P < .001). Significantly fewer patients required cesarean sections in the primrose oil group (P = 0.03). The other outcomes were. not significant between the groups (P > 0.05). Misoprostol and primrose oil administration appear to positively affect cervical readiness. Primrose oil resulted in significantly better Bishop Scores and fewer cesarean sections compared to misoprostol in pregnancy 40 weeks and more.

A Study of Maternal Outcomes in Post Dated Pregnancy

Background: Post-dated pregnancy may be associated with perinatal complications like fetal distress, meconiumaspiration syndrome and fetal asphyxia. This study was designed to study maternal outcomes in post datedpregnancy (or beyond 40 weeks gestation).Materials &amp; Methods: Real time ultrasound scanning was performed using (Philips EPIQ 5G, Philips EPIQ 7G andPhilips affinity 50 G model) 1-5 MHz biconvex probe and general survey of foetus was done. Total 114 pregnantwomen beyond 40 weeks of gestation were studied. A detailed clinical history like menstrual history, marital,family history of the pregnant women included in the study was taken. For induction, cervical ripening agents likedinoprostone gel or misoprostol tablets were used. Then the patients were observed for uterine contractions andstrict foetal heart rate monitoring was done.Results: In this study total 114 cases beyond 40 weeks of gestation were analyzed to know the maternal and foetaloutcome in post-dated pregnancies. Majority of the postdated pregnancies 102 (89.5%) were in between 40 weeks-40 weeks 6 days. Primigravida were 55.3% while only 44.7% were multigravida. Out of total 114 patients havingpregnancies beyond 40 weeks of gestation, 67.6% were delivered vaginally while 32.4% underwent lower segmentcaesarean section. Majority (65.8%) of patients had Bishops score &lt;=4, Bishops score &gt; 6 (20.2%), Bisops score inbetween 5-6 (14%). Incidence of meconium stained liquor was 6.1%.Conclusion: Post-dated pregnancy is a high risk pregnancy, so correct dating is done by early first trimester USGor by second trimester USG so that induction can be done at 40 weeks and timely detection of foetal distress andmanagement can be safely introduced.

The Effect of Using Dexamethasone Tablets Vaginally for Improving Cervical Bishop Score in Nulliparous Pregnant Women: A Randomized Clinical Trial

Cervix ripening and labor induction are common interventions in obstetrics. For optimal maternal health, labor may be induced under certain situations to improve fetal survival outcomes. Labor induction of an unripe cervix can lead to complications; therefore, several approaches can facilitate the ripening process. This randomized clinical trial was a triple-blind study that involved 84 pregnant nulliparous women enrolled between October 2019 and June 2021 in the labor ward of Kamali Hospital, Karaj, Iran. The pregnant women in the study underwent labor induction and were randomized into 2 groups: 1 group received vaginal dexamethasone and the other group was given a placebo. There was no significant difference between the groups regarding maternal age, demographic characteristics, and initial Bishop score. The median second Bishop score (6 hours after intervention) was 3.5 in dexamethasone recipients and 3 in placebo recipients (P = 0.48). The median labor latent phase duration was 4 hours in dexamethasone recipients and 5 hours in placebo recipients (P = 0.57). This randomized clinical trial demonstrated that administering dexamethasone tablets vaginally did not significantly improve cervical Bishop scores. (Curr Ther Res Clin Exp. 2023; 84:XXX-XXX). ClinicalTrials.gov identifier: NCT05070468.

Effect of Date Palm (Phoenix dactylifera) Fruits Consumption on Birth Delivery Outcome: Meta-Analysis

Background: The choice of cesarean section continues to increase in the world and is expected to continue to increase over the coming decades, which is almost a third of all deliveries in 2030. The benefits of dates for improving labor processes are considered to increase vaginal deliveries and also reduce the frequency of cesarean sections with the aim of reducing bigger complications. This study aims to analyze and estimate the influence of the consumption of dates on labor outcomes. Subjects and Method: This study is a systematic review and meta-analysis with PICO, P: Pregnant women, I: consumption of dates, C: No consumption dates, O: Bishop's score, length of labor, and postpartum hemorrhage. Data collection was obtained from databases, namely: PubMed, Science Direct, Springer Link, and Google Scholar. Keywords used “date fruit” OR “date palm” OR “phoenix dactylifera” AND “labor” AND “delivery”, AND “oxytocin” AND “hemorrhage”. The inclusion criteria used were full papers in English with the design of randomized controlled trials in 20002022. This study was analyzed using RevMan 5.3 software. Results: Meta-analysis was conducted on 4 primary studies from several countries such as Iran, Malaysia, and Saudi Arabia with a sample size of 603 pregnant women. The meta-analysis concluded that there was an effect of date consumption on cervical dilatation upon admission to the hospital (SMD= 0.73; CI 95%= 0.09 to 1.38; p=0.030). Consumption of dates also has an effect on the duration of active 1st stage labor (SMD= 0.46; CI 95%= 0.82 to 0.09; p= 0.010). Consumption of dates has a weak effect on the length of stage II labor (SMD= 0.05; 95% CI= 0.88 to 0.78; p= 0.910). In addition, the consumption of dates also has a weak effect on the length of stage III labor (SMD=0.16; CI95%=0.46 to 0.79; p=0.610). Conclusion: Consumption of dates has an influence on labor outcomes. Keywords: phoenix dactylifera, dates, labor, postpartum hemorrhage, Bishop score Correspondence: Ratna Purwani Siwi. Masters Program in Public Health, Universitas Sebelas Maret. Jalan Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: ratnapsiwi@yahoo.com. Mobile: 085602389598. Indonesian Journal of Medicine (2023), 08(01): 79-91 https://doi.org/10.26911/theijmed.2023.08.01.08

Assessing uterine electrophysiology prior to elective term induction of labor

ObjectiveThe purpose of this study was to determine if uterine electrophysiological signals gathered from 151 non-invasive biomagnetic sensors spread over the abdomen were associated with successful induction of labor (IOL). Study designUterine magnetomyogram (MMG) signals were collected using the SARA (SQUID Array for Reproductive Assessment) device from 33 subjects between 37 and 42 weeks gestational age. The signals were post-processed, uterine contractile related MMG bursts were detected, and parameters in the time and frequency domain were extracted. The modified Bishop score calculated at admission was used to determine the method of IOL. Wilcoxon's rank-sum test was used to compare IOL successes and failures for differences in gestational age (GA), parity, modified Bishop's score, maximum oxytocin, and electrophysiological parameters extracted from MMG. ResultsThe average parity was three times (3x) higher (1.53 versus 0.50; p = 0.039), and the average modified Bishop score was 2x higher (3.32 versus 1.63; p = 0.032) amongst IOL successes than failures, while the average GA and maximum oxytocin showed a small difference. For the MMG parameters, successful IOLs had, on average, 3.5x greater mean power during bursts (0.246 versus 0.070; p = 0.034) and approximately 1.2x greater mean number of bursts (2.05 versus 1.68; p = 0.036) compared to the failed IOLs, but non-significant differences were observed in mean peak frequency, mean burst duration, and mean duration between bursts. ConclusionThe study showed that inductions of labor that took less than 24 h to deliver have a higher mean power in the baseline electrophysiological activity of the uterus when recorded prior to planned induction. The results are indicative that baseline electrophysiological activity measured prior to induction is associated with successful induction.

Comparative study of induction of labour with oral mifepristone and intracervical dinoprostone in primigravida

Background: Mifepristone (RU-486) in doses of 200-400 mg has shown to improve cervical ripening. Hence the sequential use of Mifepristone followed by Dinoprostone is more effective in induction of labour with less chance of failed induction and thereby decreasing the caesarean delivery rate. Methods: A prospective comparative study was done for a period of 21 months from Oct 2021 to June 2020 in Dept. of OBG AIMS RC.170 primigravida with term gestation were included in the study.85 women (group A) were given 200 mg Mifepristone orally and 85 women (Group B) were induced with 0.5 mg intra cervical Dinoprostone gel. Bishop score was assessed after 6 hrs. Results: After the 1st assessment Bishop score was < 6 in 35.7% in group A, 28.8% in group B. Induction delivery interval was 9.61 hours in group A, 5.21 hours in group B (p≤0.001). 71.7% had vaginal delivery and 28.2% required LSCS in group A and 52.9% had vaginal delivery and 47.1% required LSCS in group B. There was no fetal mortality in both the groups Conclusion: Induction delivery interval was more in Group A compared to group B. However % of vaginal delivery was more in Group A compared to group B. Oral Mifepristone 200 mg can be used for cervical ripening during induction of labour, followed by intracervical Dinoprostone gel to reduce the number of caesarean deliveries.

Induction of Labor on Maternal Request: Do Not Refuse This Option to Women

Objective: To describe perinatal outcomes in a population of labour induction on maternal request, whatever the obstetrical conditions. Methods: This retrospective single-centre study included all women who underwent labour induction on maternal request between January 2019 and May 2020. The primary outcome was perinatal outcomes: data about maternal and fetal morbidity were collected. The secondary outcome was the cesarean rate. Data were compared according to the delivery outcome (“vaginal delivery” Vs “cesarean section” group) to identify risk factors for cesarean delivery. Multivariate analysis was performed by adjusting for confounding factors such as Bishop score, prior cesarean section, parity, BMI, maternal, fetal presentation, gestational age, method of ripening, and the number of ripening’s stages needed. Results: We included 86 women. There was no risk factor for poor perinatal outcomes. Vaginal delivery occurs in 96,3 % (n=78/86) of all women. In primiparous women and the “prior cesarean-section group”, this rate was 92,9% and 76,9%, respectively. We didn’t find any statistical difference between the “vaginal delivery” and “cesarean section” groups. Conclusion: Induction of labour on maternal request should be widely accepted regarding the low risk of cesarean section and the absence of predictive risk factor of it.

Manipal Cervical Scoring System by Transvaginal Ultrasound Versus Bishop Score in Predicting Successful Labour Induction

Manipal Cervical Scoring System by Transvaginal Ultrasound Versus Bishop Score in Predicting Successful Labour Induction

Comparison of Different Methods of Induction of Labour Methods; Khyber Pakhtunkhwa Perspective

Objectives: to compare the mechanical, pharmacological or combination of both in induction of labour. Methods: This comparative observational study was conducted in Department of Obs and Gynae, Lady Reading Hospital, from January 2019 to December 2019. In this study all women presenting to labor room with singleton pregnancy and gestational age &gt; 37 weeks and admitted for induction of labor were included. All those women with multiple pregnancies, premature rupture of membrane, malpresentation, and prior Cesareans section were excluded. Total 300 patients were included in the study period, Patients were divided into 4 groups, Group A (mechanical methods), Group B (prostaglandin E2), Group C (mechanical + PGE2), Group D (misoprostol). Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY). Results: In this study 300 patients were included, in mean age of 24.54±12 years, with age range of 16- 40 years. Majority were Primi gravida (167 (55.7%), and 99.7 had poor bishop score. Indication for induction of 109(36.3%) was due to eclampsia / pre-eclampsia, followed by postdate pregnancy 98(32.7%). In majority of cases 123(41%) time from induction to labour was 6-12 hours. prostaglandin group showed good success rate in term of normal vaginal delivery and low adverse effects and good maternal and neonatal outcomes, followed by misoprostol, lowest success rate was recorded in mechanical only group . (p&lt;0.001) Conclusion: Our study concludes that among different methods available for induction of labour, PGE2 is safe, effective and have goof maternal and fetal outcomes Keywords: induction, labour, PGE2, misoprostol

Pre- Induction Cervical Ripening with Unfavorable Bishop Score Using Two Different Dinoprostone Vaginal Preparation: A Prospective Randomized Comparative Study between Controlled Release Dinoprostone Gel & Dinoprostone Vaginal Insert

Pre- Induction Cervical Ripening with Unfavorable Bishop Score Using Two Different Dinoprostone Vaginal Preparation: A Prospective Randomized Comparative Study between Controlled Release Dinoprostone Gel & Dinoprostone Vaginal Insert

Parto vaginal exitoso y resultados maternos y perinatales en pacientes con antecedente de cesárea y prueba de trabajo de parto: estudio de corte transversal

To determine the proportion of successful vaginal deliveries in women with prior cesarean section; to describe maternal and perinatal complications; and to examine the factors associated with vaginal delivery. Descriptive cross-sectional study of women with a history of cesarean delivery, gestational age of more than 24 weeks, singleton live fetuses, with prior vaginal delivery who received care in a high complexity public institution in 2019. Patients with a history of more than one cesarean section or myomectomy were excluded. Consecutive sampling was used. Sociodemographic and obstetric variables, delivery route and maternal and perinatal complications were measured. A descriptive analysis as well as a multivariate exploratory analysis of the factors associated with successful vaginal delivery were carried out. Among 286 pregnant women included, the percentage of successful vaginal deliveries was 74.5 %. Maternal complications were identified in 3.2 % of vaginal delivery cases and in 6.8 % of cesarean births. Complications occurred in 1.3 % of all live neonates; there were 2 perinatal deaths. An association was found between successful vaginal delivery and a history of prior vaginal delivery (OR: 2.7; 95 % CI: 1.15-6.29); a Bishop score greater than 6 (OR: 2.2; 95 % CI: 1.03-4.56); spontaneous labor initiation (OR: 4.5; IC 95 % CI: 2.07-9.6); and maternal age under 30 years (OR:2.28; 95 % CI: 1.2-4.2). Vaginal delivery is a safe option to consider in patients with prior cesarean section, in particular in cases of spontaneous labor initiation or prior vaginal delivery. Prospective cohorts are needed in order to confirm these findings.

Comparison between Foley Catheter plus Oxytocin and Oxytocin Only For Induction of Labour after Membrane Rupture

Premature Rupture of Membranes (PROM) at term is defined as rupture of membrane at least 1 hour before the onset of uterine contractions at a gestational age of 37 weeks or more, it complicates 8% of all pregnancies [1]. It is associated with a risk of chorioamnionitis, which increases with duration of PROM, latency beyond 24 hours increases the incidence of chorioamnionitis and neonatal sepsis [2,3]. Spontaneous labour occurs in 60%–67% of these patients within 24 hours [2,4]. If no labour occurs, labour induction must be the best management for women with PROM at term. Labour induction is usually performed when the risks of continuing a pregnancy are more than the benefits of delivery as in PROM. Cervical ripening is an important factor for a successful induction. Unripe cervix with a lower Bishop score is associated with an increased risk of induction failure, while a favorable cervix significantly predicts a timely delivery [5]. Different methods are used for labour induction but none of the available methods of induction of labour is free of associated medical risks; therefore, labour should only be induced when there is a risk of the continuation of pregnancy. The agents used for induction should simulate spontaneous labour without causing excessive uterine activity. The most common methods of labour induction involve Pharmacological methods which include many agents, such as Prostaglandins (PGs (E2 orE1), progesterone receptor antagonists (mifepristone), oxytocin, and Nitric Oxide (NO) donors, but the most commonly used are PG and oxytocin) [6], and mechanical methods as Intracervical Foley catheter which is the most common mechanical method that was first described by Embrey and Mollison in 1967, where a Foley is inserted into the cervical canal and inflated just past the internal os with mild traction outward dilating the cervix directly, as well as indirectly stimulating (PGs) and oxytocin secretion [7-11]. The American College of Obstetricians and Gynecologists (2009) recommended using oxytocin for induction of labour in case of PROM at term, even if the cervix is unfavorable [12]. Several studies have evaluated the combination of oxytocin and mechanical devices, as oxytocin alone has not been shown to affect the risk of chorioamnionitis [13-15]. Induction of labour by mechanical device is accepted in cases with intact membrane, although mechanical treatment does not show any advantage over vaginal PGs regarding rates of chorioamnionitis, endometritis and neonatal infection [16]. In PROM, a concern with mechanical cervical ripening is increased risk of intraamniotic infection and other infection morbidity, which is not increased when membranes are intact [13]. Although the Foley catheter has been established as safe and effective in women with intact membranes, its efficacy has not been established in women with PROM. Chorioamnionitis was defined as temperature 38°C or greater with at least two of the following: uterine tenderness, maternal tachycardia, fetal tachycardia, foul odor of the amniotic fluid, or maternal leukocytosis (greater than 15,000 cells/mL3) [17].

Cervical change times during induction in nulliparas using vaginal or buccal misoprostol

Aim To determine if the time to cervical change and time to active labor were different when misoprostol was administered by a vaginal or buccal route for cervical ripening in nulliparas undergoing labor induction at term. Methods This was a secondary analysis of nulliparous participants in the IMPROVE Study—A comparison of vaginal versus buccal misoprostol for cervical ripening for labor induction at term: a triple-masked randomized controlled trial (NCT 02408315). The parent study was a non-inferiority randomized controlled trial in which patients beginning induction with a modified Bishop score ≤6 received either vaginal or buccal misoprostol and simultaneous placebo via the opposite route. The primary outcome of the parent study was time to delivery. Primary outcomes for this secondary analysis were the time to active labor (at least 6 cm dilated) and time to change in cervical dilation. Kaplan–Meier analysis was used to compare routes for time to active labor and multistate Markov modeling was used to compare sojourn times at each cervical dilation. Results Of the 300 participants enrolled in the parent trial, 124 (41.3%) were nulliparous; 59 (47.6%) nulliparous participants underwent induction with vaginal misoprostol and 65 (52.4%) received buccal dosing. Nulliparas receiving vaginal dosing required fewer doses of misoprostol to reach active labor (median 2 vs 3, p = .003). However, this did not result in shorter time to active labor (median vaginal 23.1 h, 95% CI = [21.6, 27.2 h]; buccal 25.6 h [21.5, 29.3 h], p = .45) or higher rate of vaginal delivery within 24 h; (33.9% vs 35.4%, p = .86). There was also no significant difference in time to active labor after adjusting for covariates (adjusted HR for dose route (buccal vs vaginal) = 0.91 [0.61, 1.36], p = .649). Among people that delivered vaginally, the mean sojourn times, measuring cervical dilation state change, were not significantly different, with mean duration to active labor of 20.5 [17.6, 24.5] h for buccal and 21.8 [17.7, 28.2] h for vaginal dosing (p = .092). Satisfaction and preference for dosing routes were not different between groups. Conclusion Buccal and vaginal dosing of misoprostol for cervical ripening in nulliparas appear to have similar times to active labor and progression of cervical change during ripening.

Single versus double application of vaginal dinoprostone: maternal factors affecting responsiveness

Purpose: The aim of our study was to identify maternal characteristics of women who are responsive to the second application of vaginal dinoprostone in a cohort of patients with a low Bishop Score. Secondarily, we compared the outcome of the patients’ response to a single application to that of the women’s response to a double application. Materials and methods: This was a retrospective observational cohort study. Patients undergoing preinduction of labor with dinoprostone 10mg controlled-release vaginal device were included. Results: Among 216 included patients, 192 women (88.9%) achieved a cervical ripening after a single application of dinoprostone, while 24 (11.1%) required a second application. Patients notresponding to the first application of dinoprostone had a significantly higher body mass index (27.4 ± 6.7 kg/m2 vs 24.9 ± 5.2 kg/m2; p < 0.05) and a significant increase in gestational weight gain (14 ± 5.2 kg vs 11.6 ± 6.1; p < 0.005). Double application of dinoprostone resulted in spontaneousdelivery in 58.4% of cases, but it was related to poorer neonatal outcome, compared to a single application. Conclusions: Obese women, not responding to the first application of dinoprostone could respond to the second application of this vaginal prostaglandin. However, data related to the use of a double application are still very limited to recommend its use as a standardized procedurefor not responsive patients.