Bishop Score Research Articles

Isosorbide Mononitrate Versus Dinoprostone for Cervical Ripening During Labor Induction: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

The objective of this study was to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated isosorbide mononitrate (ISMN) versus dinoprostone, a prostaglandin E2 (PGE2) analogue, in promoting cervical ripening during labor induction. We searched five major databases from inception till 02 May 2021. We assessed the risk of bias of included studies. We meta-analyzed various endpoints (n=12) and pooled the endpoints as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI). Overall, 4 RCTs met the inclusion criteria, comprising 818 patients; equally 409 patients were allocated to ISMN and PGE2 groups. Overall, the RCTs had a low risk of bias. The mean change in Bishop score at 24 h was significantly lower in disfavor of the ISMN group. The mean time from drug administration to delivery was significantly longer in disfavor of the ISMN group. The rate of oxytocin need was significantly higher in disfavor of the ISMN group. The rate of vaginal delivery at 24 h was significantly lower in disfavor of the ISMN group. The rates of headache and palpitations were significantly higher in disfavor of the ISMN group. The rate of abnormal fetal heart rate was significantly lower in favor of the ISMN group. There was no significant difference between both groups with regard to rates of cesarean delivery, postpartum hemorrhage, uterine hyperstimulation, and NICU admission. Compared with PGE2, ISMN appeared less effective for cervical ripening prior to labor induction and correlated with higher drug-related maternal toxicities.

Assessment of the risk of spontaneous preterm birth in pregnant women with the Dr. Arabin cervical pessary

BACKGROUND: Preterm birth has a multifactorial etiology, including both maternal and fetal complications, amid the effect of functionally impaired variants of multiple genes. Preterm birth is therefore considered as the major obstetric syndrome. One of the anatomical components of this syndrome is a short cervix, and a cervical pessary is used as a prevention of preterm birth in these patients.
 AIM: The aim of this study was to identify risk factors for spontaneous preterm birth in pregnant women who received a cervical pessary.
 MATERIALS AND METHODS: This prospective, open, randomized cohort study included 189 women with a singleton pregnancy and a short cervix (25 according to the Salomon scale) and a threatened miscarriage / preterm birth in the second and third trimesters trimester, who received the Dr. Arabin cervical pessary. We analyzed 183 parameters and identified the main risk factors leading to spontaneous preterm birth based on pregnancy outcomes.
 RESULTS: Based on the pregnancy outcomes, all patients were categorized into two main groups: group I included 167 women with term birth and group II consisted of 19 pregnant women with spontaneous preterm birth. The main risk factors for spontaneous preterm birth in singleton pregnancies in descending order were: the Bishop score 7 points (p = 0.00032, OR 12.38, 95 % CI [3.5043.87]), the modified Steinberg score 8 points (p = 0.00056, OR 10.55, 95% CI [3.0936.03]), cervical length 15 mm by transvaginal cervicometry (p 0.001, OR 7.94, 95% CI [2.8322.26]), history of preterm birth (p = 0.00128, OR 6.91, 95% CI [2.3220.56]), chronic placental insufficiency (p = 0.00307, OR 5.06, 95 % CI [1.8214.01]), genital anomalies (p = 0.07452, OR 5.03, 95% CI [1.1522.06]), and history of surgical manipulations on the cervix (p = 0.07003, OR 2.90, 95% CI [1.058.00]). In multivariate analysis, the risk of spontaneous preterm birth was five times higher in pregnant women with the concomitant presence of three risk factors: cervical length 15 mm, the modified Steinberg score 8 points, and the Bishop score 7 points (83.33% of spontaneous preterm birth compared to 16.67% of term birth; p 0.05, OR 59.29, 95% CI [6.47543.29]).
 CONCLUSIONS: Among patients with a short cervix and the Dr. Arabin cervical pessary, we have identified groups at higher risk for spontaneous preterm birth.

Use of Vaginal Dinoprostone (PGE2) in Patients with Premature Rupture of Membranes (PROM) Undergoing Induction of Labor: A Comparative Study.

Purpose: To evaluate the effect and safety of vaginal dinoprostone in pregnant women with PROM who undergo induction of labor (IoL). Materials and Methods: Prospective observational study conducted at La Mancha Centro hospital from 1 February 2019, to 30 August 2020. Obstetric and neonatal variables of 94 pregnant women with PROM who underwent IoL with vaginal dinoprostone were analyzed, and the results were compared with 330 patients without PROM who also underwent IoL. Bivariate and multivariate analyses were performed using binary and multiple linear regression. Results: A total of 424 women were included in this study. A greater response to cervical ripening (Bishop score > 6) with PGE2 was observed in the PROM group (odds ratio (OR) 2.73, 95% confidence interval (CI) 1.50–4.99, p = 0.001), as well as a shorter total duration of IoL (mean difference (MD) 2823.37 min (min), 95% CI 1257.30–4389.43, p < 0.001). Cesarean sections were performed in 28.7% (n = 27) of patients in the PROM group vs. 34.2% (n = 113) of patients in the non-PROM group, with no significant differences (OR 0.87%, 95% CI 0.47–1.60, p = 0.652). There were no significant differences in changes in the cardiotocographic record (CTG), postpartum hemorrhage (PPH), uterine rupture, or adverse neonatal outcomes between the two groups. Conclusions: The use of vaginal dinoprostone in pregnant women undergoing IoL with PROM is safe for the mother and the fetus, shortens the total delivery time, and does not increase the risk of cesarean section compared with pregnant women undergoing IoL without PROM.

Vaginal Dinoprostone Insert versus Cervical Ripening Balloon for Term Induction of Labor in Obese Nulliparas-A Randomized Controlled Trial.

Data regarding the preferred induction method in women with obesity is scarce. The current study was aimed at comparing pharmacological and mechanical induction in this population. This prospective randomized controlled trial was conducted between 2016–2020, in nulliparas with a pre-pregnancy body mass index >30. Inclusion criteria were singleton-term pregnancies, bishop score < 5, and indication for induction. Patients were randomized to induction by a cervical ripening balloon (CRB) or a 10 mg vaginal dinoprostone insert. The primary outcome was delivery rate within 24 h. Secondary outcomes included time to delivery, cesarean section rate, maternal and neonatal outcomes, satisfaction, and anxiety. The study population comprised of 83 women in the CRB group and 81 in the dinoprostone group. There was a significant difference in delivery rates within 24 h and time to delivery between the dinoprostone and CRB groups (45% vs. 71%, p = 0.017 and 49.3 ± 6.8 h vs. 23.5 ± 5.9 h, p = 0.003, respectively). There were no differences in cesarean delivery rates or maternal and neonatal outcomes, though CRB induction was associated with a significantly lower rate of tachysystole. Induction with CRB was accompanied by higher satisfaction and lower anxiety. In summary, CRB induction is associated with shorter time to delivery, higher satisfaction, and lower anxiety compared to PGE2 in women with obesity, without compromising maternal or neonatal outcomes.

Evening primrose oil for cervical ripening prior to labor induction in post-term pregnancies: A randomized controlled trial

Cervical ripening can be induced using a variety of methods. It is used in cases where the cervix is in an unfavorable state prior to the start of the labor induction. The purpose of this study was to investigate how vaginal administration of evening primrose oil (EPO) affects cervical ripening in women who were scheduled for labor induction. This randomized controlled trial was conducted from November 2018 to December 2019. The inclusion criteria were as follows: age 18-35 years old, first pregnancy, a live singleton baby with a cephalic presentation, gestational age≥ 41 weeks, intact membranes, normal cardiotocography, and a Bishop score of ≤ 4. Two hundred women were randomly assigned to a single vaginal dose of 1000 mg evening primrose oil (n=100) or placebo (n=100). Any change in Bishop score was considered the primary outcome variable in the efficacy evaluation. Of 200 eligible women, 25 women were excluded for various reasons. Finally, statistical analysis was performed on 175 women (88 women in the experimental group and 87 in the control group). At baseline there was no significant difference between the two groups in Bishop score. However, after the intervention, this score was significantly higher in the experimental group than in the control group (Mean Difference: 3.29, 95% Confidence Interval: 3.51 to 1.18). No adverse effects were observed or reported. Vaginal application of EPO at a single dose of 1000 mg at 41 weeks gestation improved Bishop score and reduced parturition time in post-term pregnancies. Iranian Registry of Clinical Trials (IRCT20181107041585N3).

Comparative study of Foley’s catheter and prostaglandin E2 gel for pre-induction cervical ripening

Background: Induction of labor is a crucial and customary clinical procedure in obstetrics. It is arguably one of the most abused procedures. Cervical ripening determines the success of delivery. The availability of newer oxytocics and induction techniques which are simpler and also more predictable has significantly modified our traditionally conservative attitude toward induction of labor. Aims and Objectives: The objective of this study was to determine the effectiveness of Foleys catheter against prostaglandin E2 (PGE2) gel for pre-induction cervical ripening. Materials and Methods: Women attending hospital for induction of labor, with a Bishop’s score &lt;6, were allocated randomly to Foley’s group (Group F) and PGE2 gel group (Group P). Fifty women were allocated to Foley’s group (Group F) and 50 were allocated to gel group (Group P). The Foley’s group had a number 18 Foley catheter inserted into cervix, bulb inflated and placed on traction. Further augmentation was done, after Foleys extrusion or 6 h after gel, either with PGE2 gel or oxytocin solution depending on Bishops score. Results: The Foley’s group had significantly higher change in Bishop’s score (3.12 vs. 2.66, P=0.04). The Foleys group required lesser number of further doses of gel as compared to gel group. No differences were found between the two groups with respect to induction to delivery interval, mode of delivery, non-reassuring fetal heart rate patterns, or baby weight. Conclusion: Foleys catheter was associated with greater change in Bishops score as compared to intracervical PGE2 gel. It was not associated with any side effect during induction process.

RISK FACTORS FOR CAESAREAN DELIVERY IN INDUCED LABOR AT TERM

Background: Labor inductions have increased steadily over the past two decades and caesarean delivery in induced labour is seen more over the general caesarean cases. This study was designed to assess the factors which are associated with greater risk of cesarean delivery when induced at term. Methodology: This prospective observational study was carried out at department of Obstetrics and Gynecology in our hospital between March 2018- December 2020 in 120 pregnant women. Induction of labor by cervical ripening with Prostaglandin E2 gel ( 0.5 mg in 3ml) instilled intracervically followed by reassessment after 6 hours. If progress was not satisfactory, repeat gel induction was done after 24 hours, maximum of 3 doses of Prostaglandin E2 gels were used. Results:The cesarean delivery rate in the study was 39% which was greater than the general cesarean rate. Patients with poor Bishop score, obesity, gestational diabetes, IUGR and cholestasis were at high risk for emergency cesarean section. Conclusion: It can be concluded that a number of factors are implicated in increased cesarean rate after induction of labor. Unnecessary cesarean sections should therefore be avoided.

Endoscopic versus open in situ decompression for the management of cubital tunnel syndrome.

This study aimed to compare the results of endoscopic in situ decompression (EISD) versus open in situ decompression (OISD) in the management of cubital tunnel syndrome (CUTS). In this retrospective study, 32 patients who underwent either OISD or EISD for the treatment of CUTS between 2012 and 2019 were identified and divided into one of the two groups: Group I consisted of 13 patients undergoing EISD and group II consisted of 19 patients receiving OISD. Patients were queried regarding the presence of preoperative and postoperative paresthesia. Electromyography (EMG) was performed on all patients preoperatively and at the final control. Preoperative and postoperative pain with palpation were evaluated over the cubital tunnel. The Dellon classification was used for preoperative evaluation of patient symptoms, and the Bishop classification was used for postoperative evaluation. Hand grip strength was measured with a dynamometer. At the preoperative and postoperative final follow-up, the palmar, key, and tip pinches were measured with a pinchmeter. The surgical incision length was measured with a ruler at the end of the operation in all patients. The operation duration was recorded as the time interval between the beginning of the incision and the end of the tourniquet. The overall mean age was 43.8 (range; 22 to 66) years. Nine patients were female, and 23 patients were male. No Dellon I patients were present in either group. Overall, 68.75% of the patients were Dellon II and 31.25% were Dellon III. According to the Bishop score, excellent and good results were obtained in 84.6% of the patients in Group I and 73.7% of the patients in Group II. The final follow-up examination found continued paraesthesia in 6 (18.75%) patients. Comparison of the improvement in the postoperative NCV value showed a statistically significantly superior improvement in Group I compared to Group II. The postoperative palmar pinch and tip pinch tests results were statistically significantly better in group I than in group II. Although EISD had better results clinically, no statistically significant difference was found between the two techniques in terms of Bishop scores and complications. Examination of the electrophysiological results suggested a better outcome in patients who underwent EISD. Level III, Therapeutic Study.

A randomized trial of synthetic osmotic cervical dilator for induction of labor vs dinoprostone vaginal insert

Induction of labor is a commonly performed obstetrical intervention. Vaginal prostaglandin E2 (dinoprostone) is a first-choice agent. Mechanical methods of induction are slower in achieving cervical ripening but have a lower risk of adverse effects. This study aimed to compare the efficacy, maternal and neonatal safety, and maternal satisfaction of a synthetic osmotic cervical dilator (Dilapan-S) with those of dinoprostone. This was an open-label superiority randomized controlled trial in 4 English hospitals. Eligible participants were women ≥16 years of age undergoing induction of labor for a singleton pregnancy at ≥37 weeks' gestation with vertex presentation and intact membranes. The women were randomly assigned to receive either Dilapan-S or dinoprostone using a telephone randomization system minimized by hospital, parity, body mass index, and maternal age. The induction agent was replaced as required until the cervix was assessed as favorable for labor by the Bishop score. The primary outcome was failure to achieve vaginal delivery (ieor a cesarean delivery being performed). The secondary outcome measures included maternal and neonatal adverse events. Analysis was by intention-to-treat, adjusting for design variables where possible. Between December 19, 2017 and January 26, 2021, 674 women were randomized (337 to Dilapan-S, and 337 to dinoprostone). The trial did not reach its planned sample size of 860 participants because of restrictions on research during the COVID-19 pandemic. The primary outcome was missing for 2 women in the dinoprostone group. Failure to achieve vaginal delivery (or a cesarean delivery being performed) occurred in 126 women (37.4%) allocated to Dilapan-S and in 115 (34.3%) women allocated to dinoprostone (adjusted risk difference, 0.02; 95% confidence interval, -0.05 to 0.10). There were similar maternal and neonatal adverse events between the groups. Women undergoing induction of labor with Dilapan-S have similar rates of cesarean delivery and maternal and neonatal adverse events compared with dinoprostone.

Predictor Factors in the Success of Slow-Release Dinoprostone Used for Cervical Ripening in Pregnancies with Premature Rupture of Membranes.

The study aimed to evaluate the factors affecting successful vaginal delivery in induction with slow-release dinoprostone at term pregnancy with premature rupture of membranes. Pregnancies between 370/7 and 416/7 gestation weeks with premature rupture of membranes in which slow-release dinoprostone was used for cervical ripening were sought for inclusion in the study. Pregnancies with previous uterine surgery, multiple fetal gestations, chorioamnionitis, non-cephalic presentation, fetal distress at the time of admission, HIV positivity, and estimated fetal weight >4500 on ultrasonographic evaluation were excluded. The primary outcome of measures were factors affecting the success of vaginal delivery including maternal age, gestational weeks at delivery, initial Bishop score, parity, induction time, and induction-delivery time interval. To reduce the risk of overfitting in the study, penalized maximum likelihood estimation was performed instead of traditional logistic regression in the statistical analysis. A total of 1266 participants who met the study criteria were included in the study. Among the parameters evaluated for the prediction of successful vaginal delivery in cases with premature rupture of membranes, maternal age (P < .001), Bishop score (P < .001), parity (P=.01), induction time (P < .001), and induction-delivery time interval (P < .001) had an impact on success. The mean gestational week of the participants who had cesarean deliveries was lower than in those who had vaginal deliveries (P=.03); however, this was not a predictor factor of penalized maximum likelihood estimation (P=.70). Basic parameters such as maternal age, induction time, parity, and Bishop score can be used to predict successful vaginal birth following dinoprostone slow-release vaginal insert administration.

Mechanical Methods for the Induction of Labour After Previous Caesarean Section - An Updated, Evidence-based Review.

There are currently no up-to-date evidence-based recommendations on the preferred method to induce labour after previous Caesarean section, especially for patients with unripe cervix, as randomised controlled studies are lacking. Intravenous oxytocin and misoprostol are contraindicated in these women because of the high risk of uterine rupture. In women with ripe cervix (Bishop Score > 6), intravenous administration of oxytocin is an effective procedure with comparable rates of uterine rupture to those with spontaneous onset of labour. Vaginal prostaglandin E 2 (PGE 2 ) and mechanical methods (balloon catheters, hygroscopic cervical dilators) are effective methods to induce labour in pregnant women with unripe cervix and previous Caesarean section. According to current guidelines, the administration of PGE 2 is associated with a higher rate of uterine rupture compared to balloon catheters. Balloon catheters are therefore a suitable alternative to PGE 2 to induce labour after previous Caesarean section, even though this is an off-label use. In addition to two meta-analyses published in 2016, 12 mostly retrospective cohort/observational studies with low to moderate levels of evidence have been published on mechanical methods of cervical ripening after previous Caesarean section. But because of the significant heterogeneity of the studies, substantial differences in study design, and insufficient numbers of pregnant women included in the studies, it is not possible to make any evidence-based recommendations based on these studies. According to a recent meta-analysis, the average rate using balloon catheters is approximately 53% and the average rate after spontaneous onset of labour is 72%. The uterine rupture rate was 0.2–0.9% for vaginal PGE 2 and 0.56–0.94% for balloon catheters and is therefore comparable to the uterine rupture rate associated with spontaneous onset of labour. According to the product informations, hygroscopic cervical dilators (Dilapan-S) are currently the only method which is not contraindicated for cervical ripening/induction of labour in women with previous Caesarean section, although data are insufficient. Well-designed, randomised, controlled studies with sufficient case numbers comparing balloon catheters and hygroscopic cervical dilators with mechanical methods and vaginal prostaglandin E 2 /oral misoprostol are therefore necessary to allow proper decision-making.

Clinical Factors and Perinatal Outcomes Associated With Short Latency Period in Twin Pregnancies With Preterm Premature Rupture of Membranes Before 34 Weeks: A Retrospective Study.

BackgroundThere is a lack of literature on short latency period (SLP) in twin pregnancies with preterm premature rupture of membranes (PPROM). Thus, the aim of this study was to identify the clinical factors and perinatal outcomes associated with SLP in twin pregnancies with PPROM and to establish a predictive model to identify SLP.MethodsTwin pregnancies with PPROM between 24 0/7 and 33 6/7 weeks were included and a retrospective analysis was performed. Patients were divided into two groups based on the latency period after PPROM: Group 1 ≤24 h (defined as SLP) and Group 2 >24 h (defined as long latency period, LLP), the clinical factors and perinatal outcomes were compared between the two groups. Binary logistic regression and receiver operating characteristic curve analyses were used to identify the independent clinical factors associated with latency period after PPROM and assess the predictive accuracy for SLP.Results98 and 92 pregnant women had short and long latency period, respectively. Prolonged latency significantly increased the occurrence of chorioamnionitis. Neonatal outcomes were not affected by latency duration after PPROM. Binary regression analysis revealed that higher gestational age (GA) at PPROM (P = 0.038), presence of uterine contractions (P < 0.001), Bishop score > 4 (P = 0.030), serum procalcitonin levels ≥0.05 ng/mL upon admission, and absence of use of tocolytic agents (P < 0.001) were significant independent predictors of a SLP. A predictive model developed using these predictors had an area under the curve (AUC) of 0.838, and the presence of uterine contractions alone had an AUC of = 0.711.ConclusionUterine contraction was the most important prognosticator for a SLP. A latency period of >24 h was associated with chorioamnionitis, but adverse neonatal outcomes were not observed.

Failed induction of labor and associated factors among women undergoing induction at University of Gondar Specialized Hospital, Northwest Ethiopia

BackgroundInduction of labor is a process of artificially initiating labor to attain vaginal birth. Despite its vital role in the reduction of maternal mortality, the failure rate of induction and its contributing factors were not well studied in Ethiopia; particularly there was a limited study in the study area. This study aimed to assess the prevalence and factors associated with failed induction of labor among women undergoing induction at University of Gondar Specialized Hospital, Northwest Ethiopia.MethodsAn institution-based retrospective cross-sectional study was conducted among 743 women undergoing induction at University of Gondar Specialized Hospital. A systematic random sampling method was used to draw a sample and the data were retrieved from the maternity registration books and medical records. Data were cleaned and entered into EpiData version 3.1 and SPSS version 20 used for analysis. Frequencies, proportions, and summary statistics were used to describe the study population and a multivariable logistic regression model was fitted to identify factors contributing to failed induction of labor. Odds ratio with 95% confidence interval computed and level of significance declared at P-value< 5%.ResultsThe prevalence of failed induction of labor was 24.4% (95% CI: 21.4, 27.9). Age ≤ 30 years (AOR = 3.7, 95% CI: 2.2,6.2), rural residence (AOR = 3.7, 95% CI: 2.4,5.8), being nulliparous (AOR = 2.1, 95% CI: 1.2,3.7), 5 or less Bishop Score (AOR = 3.4, 95% CI: 2.2,5.4), premature rupture of membrane (AOR = 2.7, 95% CI: 1.5,4.6), having pregnancy-induced hypertension (AOR = 4.0, 95% CI: 2.3,7.1), and artificial rupture of membrane with oxytocin (AOR = 0.2, 95% CI: 0.1, 0.4) were associated with failed induction of labor.ConclusionsOne-fourth of women undergoing induction at University of Gondar Specialized Hospital had failed induction of labor. Age, residence, parity, bishop score, premature-rupture of the membrane, pregnancy-induced hypertension, and method of induction were independent predictors for failed induction of labor. The combination method of ARM with oxytocin, early detection and treatment of pregnancy-induced hypertension and premature rupture of the membrane are highly recommended for reducing failed induction of labor.

Predictors of successful vaginal birth after a caesarean in women with a previous single caesarean delivery.

The aim of our study was to present our case series of the trial of labor after a caesarean (TOLAC) and determine significant predictors for a successful vaginal birth after a caesarean (VBAC). Women with previous single caesarean deliveries who underwent TOLAC between January 2016-December 2019 were included in the study (n = 474). All files were analyzed in terms of demographic characteristics, obstetric history, history of index pregnancy and medical characteristics of previous caesarean delivery. For each current pregnancy, we recorded time from the previous delivery, the BISHOP and TOLAC scores at admission, induction of labor, gestational age at delivery, estimated fetal weight, intrapartum characteristics, mode of delivery and intra-operative findings. Among 474 women who had a previous caesarean delivery and gave consent for TOLAC, 216 resulted in a successful vaginal delivery, whereas 258 underwent repeat caesarean delivery.One hundred and seventy-nine women gave up trial of vaginal delivery during labor. The success rate of VBAC after exclusion of caesarean cases due to maternal requests was 73.2%. The induction rate was significantly higher in cases with successful VBAC (40% vs. 29.1%). The risk of uterine rupture was 0.42%in cases with labor induction. ROC analysis showed significant predictive values of the TOLAC score, body mass index (BMI), the number of previous VBACs and the number of previous vaginal deliveries, birth weight and the BISHOP score at admission. Our data showed us that major determinants for successful VBAC following labor are the BISHOP score at admission, number of previous vaginal deliveries, body mass index, birth weight and the TOLAC score calculated at admission.

The use of ultrasound, fibronectin and other parameters to predict the success of labour induction.

Induction of labour is a common obstetrical procedure and is undertaken when the benefits of delivery are considered to outweigh the risks of continuation of pregnancy. However, more than one-fifth of induction cases fail to result in vaginal births and lead to unplanned caesarean deliveries, which compromise the birth experience and have negative clinical and resource implications. The need for accurate prediction of successful labour induction is increasingly recognised and many researchers have attempted to evaluate the potential predictability of different factors including maternal characteristics, Bishop score, various biochemical markers and ultrasound markers and derive predictive models to address this issue.

Edible Medicinal Plants on Facilitating Childbirth: A Systematic Review.

Despite advances and the availability of newer drugs to facilitate childbirth, the interest in using natural treatments is on the rise. More than 20 percent of pregnancies require induction of labor, which is associated with side effects and increased risk of cesarean surgery. For this reason, the use of medicinal plants is considered healthier. The present study is a systematic review of the role of oral herbs in facilitating childbirth. This review was conducted via searching the Medline/PubMed, Google Scholar, Scopus, and SID databases. The review began systematically and with no time constraints. It lasted until December 29, 2020. Twenty clinical trials investigated the impact of edible plants on increasing cervical readiness, stimulating labor onset, reducing pain intensity, and shortening the duration of labor. Five studies have revealed the positive impact of saffron. Two studies reported the same effect by chamomile. Three studies showed the positive impact of boiled dill seeds, and two studies showed the impact of date and date syrup. Another study reported the impact of Descurainia Sophia, and six studies also showed the positive effect of castor oil on uterine stimulation, strengthening and relieving labor pains, which eventually lead to facilitating labor. One study also showed no improvement in bishop score after consumption of primrose capsules. The positive effect of edible medicinal plants on facilitating childbirth has been shown in the mentioned studies. However, more studies with a larger sample size are needed, and there is also a need for a more detailed study of the possible mechanisms of plant effects.

COMPARISON OF PERINATAL MORTALITY IN BREECH PRESENTATION DELIVERED VAGINALY VERSUS CAESARIAN SECTION

Introduction: Breech presentation is commonest malpresentation, occurs in 3–4% of term deliveries. Breech presentation is a longitudinal lie of the fetus with the caudal pole (buttock or lower extremity) occupying the lower part of the uterus and cephalic pole in the uterine fundus. Aims: A comparative study of the perinatal mortality in breech delivery between vaginal versus C section. Result: It was found that Antenatal work-up 1st visit was less in VD compared to LSCS which was statistically signicant and antenatal work-up was signicantly associated with VD. Antenatal work-up last visit was less in VD compared to LSCS which was statistically signicant. In our study, Good bishop score was more in VD compared to LSCS which was statistically signicant. We found that birth trauma was more in VD compared to LSCS which was statistically signicant. It was found that asphyxia was more in VD compared to LSCS which was statistically signicant. Vaginal maternal complications were more in VD compared to LSCS which was statistically signicant. Neonate NICU admission was more in LSCS compared to VD though it was not statistically signicant. Neonate duration of NICU stay was more in VD compared to LSCS which was statistically signicant. Poor APGAR SCORE was observed in VD compared to LSCS which was statistically signicant. Neonate neurological morbidity was higher in VD compared to LSCS which was statistically signicant. Neonate birth trauma was higher in VD compared to LSCS which was statistically signicant. Conclusion: We concluded that birth trauma birth asphyxia, maternal complications, Neonate NICU admission, Neonate birth trauma and neurological morbidity were more in VD compared to LSCS in breech presentation.

Predictability of Successful Induction of Labour with Poor Bishop Score

Aim: To determine the percentage of successful induction of labour in patients with poor Bishop Score at PAC Hospital Kamra. Study design: Prospective Observational Study. Setting &amp; duration: Pakistan Aeronautical Complex Hospital Kamra, four years from 01.01.2016 till 31.12.2019. Methods: All booked pregnant women including Primigravidaeand Multigravidae were offered induction of labour regardless of Bishop Score to assess the predictability of successful induction. Results: All pregnant ladies booked at Pakistan Aeronautical Complex were induced at term regardless of favourability of Bishop Score and parity. Total number of patients included in the study over four years was 403.Out of these 1280(32%) were primigravidae and 2723(67%) were multigravidae. Successful induction was achieved in 883(68.5%) of primigravidae and was even higher in multigravidae where it was 2205(78.25%). It was found that the success rate of induction in case of favorable and unfavorable bishop score was not significantly different. Out of 665 primigravidae with favorable bishop score 521 delivered which makes 78.3% while 362 out of 615 primigravidae with unfavorable bishop score delivered successfully which makes 58.8%. Conclusion: We offered Induction of labour to all pregnant women regardless of Bishop Score and parity. A Bishop score of seven or less is considered unfavorable whereas a Bishop score of eight or more is considered favorable for induction of labor. Keywords: Induction of Labor, Bishop Score, normal vaginal delivery.

A Comparative Study on the Effects of Vaginal Misoprostol and Vaginal Misoprostol Plus Estradiol on Labor Induction

Background: Cervical ripening is an important factor in predicting successful labor induction. In an unfavorable cervix, ripening should be done before induction. In this study, the effect of misoprostol and that of misoprostol plus estradiol on cervical ripening were compared. Methods: This randomized, double-blinded study included a total of 190 pregnant women who were identified for pregnancy termination due to maternal or fetal cause at 37 weeks with Bishop score of less than 4. The patients were assessed between April 2015 to April 2016 in two university hospitals at northeast Iran (Omol-Banin Hospital and Emam Reza Hospital, Mashhad). The patients who met the inclusion criteria were randomly assigned to two groups: the intervention group (Group A), who received 25 micrograms of vaginal misoprostol plus 50 micrograms of estradiol, and the control group (Group B), who received 25 micrograms of vaginal misoprostol only. Misoprostol was administered at 4-hour intervals until cervical ripening (Bishop score ? 8) or upon initiation of active phase in both the groups. The maximum dosage of misoprostol was three doses, whereas estradiol was administered only once. Results: In this study, the main causes of pregnancy termination were ROM and post-term. There was no significant statistical difference in the Bishop score between the two groups (P = 0.13). In addition, no significant difference was observed in the duration of time for cervical ripening (Bishop ? 8) between the two groups (P = 0.7). The duration between drug administration to the initiation of active phase and also from active phase to delivery showed no significant differences between the two groups (P = 0.49 and 0.24, respectively). There was also no significant difference in the delivery route (operative vaginal delivery or Cesarean section) (P = 0.2 and P = 0.91, respectively). Conclusion: From this study, the use of misoprostol plus estradiol did not improve cervical ripening or decrease the induction time. Further studies are recommended to investigate complementary results.

Effect of vaginal washing before Misoprostol insertion on cervical ripening before induction of labor: A randomized single-blind clinical trial.

BackgroundVaginal pH is acidic in pregnancy, but there is no information about pH changes in pregnancy, and contradictory results have been reported from the effectiveness of Misoprostol at different vaginal pH. This study aimed to evaluate the effect of vaginal washing before Misoprostol insertion on cervical ripening before induction of labor in comparison with the control group.MethodsThis randomized single‐blind clinical trial was performed on 148 pregnant women who were candidates for induction of labor. Subjects were randomly divided into two groups of intervention (vaginal washing with 20 cc of normal saline 0.9% before Misoprostol insertion) and the control group (without vaginal washing). Vaginal pH and Bishop scores were measured before and after the intervention. The two groups were compared in demographic‐obstetric variables, the success rate of induction of labor, maternal and neonatal outcomes, and Misoprostol dose.ResultsAfter the intervention, there was no statistically significant difference between the pH before and after in the group with vaginal washing. There was no significant difference between the two groups in the type and duration of labor, and maternal and neonatal outcomes (P > .05). The frequency of normal delivery less than 12 hours in the intervention group was higher than in the control group. Although this difference was not statistically significant due to the small number of subjects, it is clinically significant.ConclusionThe results of the present study showed that vaginal washing with normal saline before Misoprostol insertion for induction of labor did not affect the success of induction and duration of labor.