Bishop Score Research Articles

Retracted Dilapan-s in a multiparous woman at term on induction of labour

The use of Dilapan-S as an agent of induction of labour has recently gained a lot of attention for its efficiency, safety profile and lack of foetal complications. However, one of its known complications is the retraction of the rods into the uterus. Fortunately, the incidence is very rare, but the mechanisms remain elusive and poorly understood. This paper is about a multiparous woman at 39 weeks with unfavourable cervix and a multiparous os who was admitted for IOL using Dilapan-S. During the digital insertion of the 5th rod, she spontaneously ruptured her membranes with retraction of four of the rods into the uterus. Soon after, she developed uterine contractions and was transferred into the delivery suite with an improved Bishop score and a cervical dilatation of 3 cm. An augmentation of labour was commenced with oxytocin but was later discontinued due to a suspicious CTG trace. She had an emergency caesarean section for maternal request with the delivery of a healthy baby and retrieval of the four Dilapan-S rods intra-operative.

Intra Cervical Foley’s Versus Combination Of Intra Cervical Foley’s And Extra Amniotic Saline Infusion As Cervical Ripening Agent For Induction Of Labor

Objective: To compare IntraCervical Foleys (ICF) and intracervical Foleys along with Extra Amniotic Saline Infusion (EASI) as a cervical ripening agent for Induction Of Labour(IOL). Methods: It was carried out at the Department of Obstetrics and Gynecology Holy Family Hospital, Rawalpindi. In this comparative study, we included 100 patients with singleton cephalic presentation, intact membranes and a BISHOP score ≤ 6. These were further subdivided into two groups, Group A (ICF) and Group B (ICF with EASI),50 in each group. In Group A, Foley’s catheter was placed cervically while in Group B extraamniotic saline infusion was also administered in the urine drainage port at midnight. PGE2/ Augmentation with syntocinon was considered according to the bishop score at 6 am. Improvement in BISHOP score, induction to delivery interval, and feto-maternal outcomes were noted in both groups. Results: Data analysis showed that the mean improvement in the BISHOP score of the patients in Group A was 3.78 ± 1.75 while that of Group B was 3.56 ± 1.79(pvalue = 0.508). The induction to delivery interval in group A patients was 14.6 ± 4.75 hours while that of group B was 13.22 ± 4.54 hours (p =0.103). Only 14/100 patients had failed IOL and underwent C- C-sections and 8/100 neonates had NICU admissions and were discharged later on. Conclusion: Both Intra Cervical Foley’s and a Combination Of Intra Cervical Foley’s And Extra Amniotic Saline Infusion are equally effective as cervical ripening agents for induction Of labour with high chances of successful vaginal delivery and good feto-maternal outcome. Keywords: Induction of labour, Intracervical folleys, Extra-amniotic saline infusion, BISHOP score.

Cervical ripening balloon compared with vaginal dinoprostone for cervical ripening in obese women at term: A prospective cohort study.

To evaluate vaginal delivery in obese women who underwent cervical ripening at term using a dinoprostone vaginal insert or a cervical ripening balloon (CRB), and to assess maternal and neonatal morbidity according to the method. A prospective cohort study including obese women with a live singleton fetus in cephalic presentation who required cervical ripening at term (≥37 weeks) for maternal and/or fetal disease using a dinoprostone vaginal insert or a CRB. The primary outcome was vaginal delivery. Secondary outcomes were a favorable cervix (Bishop score >6) after 24 h, the time from device insertion to delivery, and composite maternal and neonatal morbidity. In total, 135 consecutive women were analyzed (107 CRB, 79.3%; 28 dinoprostone vaginal insert, 20.7%). Vaginal delivery (86 [80.4%] after CRB vs 19 [67.9%] after dinoprostone vaginal insert; P = 0.248), favorable cervix within 24 h after device placement (52 [48.6%] vs 17 [60.7%]; P = 0.264), and maternal morbidity (12 [11.2%] vs 4 [14.3%]; P = 0.646) were similar between the groups. The time from device insertion to delivery also did not differ between the groups. Neonatal morbidity was significantly higher after the dinoprostone vaginal insert (11 [39.3%] vs 20 [18.7%]; P = 0.030). Cervical ripening using the dinoprostone vaginal insert, compared with the CRB, was significantly associated with neonatal morbidity (adjusted odds ratio 4.00, 95% confidence interval 1.34-12.5), but not with maternal morbidity (adjusted odds ratio 1.23, 95% confidence interval 0.30-4.38). Vaginal delivery, a favorable cervix after 24 h, the time from device insertion to delivery, and maternal morbidity did not significantly differ between the CRB and the dinoprostone vaginal insert for cervical ripening in obese women at term. Nevertheless, neonatal morbidity was significantly associated with the dinoprostone vaginal insert, compared with the CRB, among obese women who required cervical ripening at term.

Comparison of digital and speculum-guided methods of transcervical Foley catheter insertion in primigravida undergoing cervical ripening at term gestation: a noninferiority randomized clinical trial

BackgroundFoley catheter insertion is frequently utilized for cervical ripening during the induction of labour. However, the insertion failure, safety, maternal side effects, complications and satisfaction of digital compared to speculum-guided Foley catheter placement have not been evaluated in a large trial involving primigravida. ObjectivesThe study aimed to compare the insertion failure rate of digital and speculum-based transcervical Foley catheter placement in primigravida. The co-primary outcome was insertion-associated pain. The secondary outcomes were time required for successful insertion, maternal satisfaction, and maternal complications within 24 hours of Foley insertion. MethodsThis randomized, open-label, parallel-arm, non-inferiority clinical trial was performed in a large tertiary care university hospital. Primigravida >18 years of age with term gestation (≥37 weeks) were included in this study. Additional inclusion criteria for enrolment in this study were singleton pregnancy with a cephalic presentation, intact membrane, Bishop score ≤5 and reassuring pre-induction foetal heart rate tracing. All women planned for cervical ripening were assessed for eligibility and were randomized into digital or speculum arms. Foley catheter insertion was performed in a supine lithotomy position. Vaginal and cervical cleaning were performed before insertion. A 22-French Foley balloon catheter was guided digitally or via speculum to position the bulb at the level of the internal os using water-soluble lubricant. Insertion-associated pain was measured using visual numeric rating scale (VNRS) and maternal satisfaction was assessed using a set of questions. Results469 pregnant women were assessed for eligibility, and 446 patients were enrolled and randomized. The median age of the parturients was 24 (19-40) and 24 (18-38) years, respectively. The body mass index, gestational age at randomization, incidence of post-dated pregnancy and pre-randomization Bishop scores were comparable. Insertion failure was observed in 24 (10.8%) and 17 (7.6%) of women in digital and speculum arm, respectively (RR= 1.41; 95% CI, 0.78-2.55; P=0.25). Requirements of more than one attempt (5.4% vs 3.6%) followed by change in hands (3.6% vs 2.7%) were the most common reasons for insertion failure. The median (interquartile range) VNRS was comparable (6.00 (2-9) vs 5.00 (2-10); p=0.15). The time taken for successful insertion was similar (58 (12-241) vs 54 (10-281); p=0.30). 9.4% and 10.8% of women required additional methods of cervical ripening. More women in the speculum group (41.7% vs 33.2%; P=0.06) felt a medium level of discomfort than digital group. ConclusionInsertion failure and insertion-related pain in the digital approach were comparable to the speculum-guided approach for transcervical Foley catheter insertion in primigravida for cervical ripening. Nevertheless, maternal satisfaction was higher in the digital group due to a lesser level of discomfort.

Time matters: Cervical ripening balloon for 6 versus 12 h-Retrospective comparison between two protocols.

Recently, two randomized controlled trials compared removal of cervical ripening balloon (CRB) after 6 versus 12 h. Their results showed similar Bishop score changes in both groups and a shorter time to delivery in the 6-h group. Neither of the studies was powered to show difference in mode of delivery. The aim of this study was to compare mode of delivery when the CRB was removed after 6 versus 12 h. A historical control study comparing induction of labor with a CRB between two time periods, one in which the CRB was removed after 12 h (12-h group), and the other in which it was removed after 6 h (6-h group). We included term pregnancies with a singleton fetus in vertex presentation. We excluded patients with a previous cesarean delivery, failed ripening with prostaglandins prior to CRB insertion, and any contraindication for vaginal delivery. The primary outcome was mode of delivery. Secondary outcomes included delivery within 24 h and other maternal and neonatal outcomes. We included 1704 patients, 914 in the 12-h group, and 717 in the 6-h group. Removal after 6 h was associated with a lower rate of cesarean and instrumental deliveries (28.6% vs 22.5%, and 12% vs 6.2%, respectively) and a higher rate of vaginal delivery within 24 h. All differences were statistically significant. Removing a cervical ripening balloon after 6 rather than 12 h is associated with reduced cesarean and instrumental delivery rates, and should be considered as a reasonable, and potentially superior alternative in labor induction protocols with intracervical ripening balloon.

Establishment of Labor Epidural Analgesia Service and its Assessment: An Experience in a Hospital of a Middle-Income Country.

Even though the idea of painless birth is more than 100 years old, it is still underrepresented in some parts of the world despite progress in science, education, anesthesia, spinal and epidural needles, development of catheters, new drugs, and infusion pumps. Maternal care should basically be the safety of the patient (in this case two patients) and also provide all kinds of protection in the form of a multidisciplinary team with an anesthesiologist, especially when it comes to pain therapy and anesthesia for women in labor. In this direction, our hospital departments with low or moderate volume of annual births made the decision to educate ourselves for painless childbirth and contribute more to the care of women in labor. The enthusiasm and dedication of our clinical team prevailed and today we have a high standard of labor epidural service. The aim of this study was to evaluate the establishment of the epidural labor service by comparing the effects of epidural analgesia on labor pain and the course of labor. The secondary objectives were to compare satisfaction with epidural analgesia and the impact of epidural analgesia on the delivery mode. This was a prospective observational hospital-based study conducted on100 patients after the establishment of epidural service. Parturients who were signed to receive epidural analgesia formed Group A and parturients who did not request epidural analgesia formed Group B. All parturients are induced in the delivery room with a Bishop score of 5 or higher. Pain intensity measured through the visual analog scale of pain (VAS score) was significantly lower in Group A (n = 46) compared to Group B (n = 50) at measured points of time (p<0.001). There was a fall in the mean VAS score in Group A from 7.94 to 3.86 within 20 minutes of the bolus dose and starting a continuous infusion.Labor progress according to the Bishop score and till the end of the second stage of labor, or to the transfer to the operating theatre, according to the monitored time in Group A was 176 minutes and it was lower in Group B with 155 minutes; however, by test of linearity we do not gain significance(p = 0.2). There were eight parturients in each group(17% vs 16%) who were indicated for surgical delivery. According to Pearson's correlation test for the outcome of labor between parturients receiving epidural analgesia and parturients without epidural analgesia (p = 0.8), we cannot say that epidural analgesia in labor is correlated with the outcome of surgical delivery. Establishing a new hospital procedure such as an epidural painless service for childbirth in low or moderate-volume settings of annual births is very challenging. By evaluating epidural labor services in our hospital, we created the best environment for continuous improvement and long-term efficacy and safety of our analgesic techniques aimed at providing excellent care to mothers and their babies.

Clinical Efficacy and Nursing Efficiency Analysis of Jiuwei Zhusheng Decoction in Promoting Cervical Ripening in the Perinatal Midwifery Holistic Care

To evaluate the clinical efficacy of Jiuwei Zhusheng Decoction (JWZSD) and perinatal midwifery holistic nursing care in promoting cervical ripening, we conducted a randomized controlled trial involving 80 primiparous and full-term pregnant women with indications for labor induction. The participants were divided into a control group (n = 40) receiving intravenous oxytocin for labor induction and a study group (n = 40) receiving oral administration of JWZSD. Additionally, 30 female Wistar pregnant rats were randomly assigned to the blank group, oxytocin group, and traditional Chinese medicine (TCM) group to compare relevant indicators. In the clinical study, both groups showed significant increases in Bishop scores after treatment. However, the study group demonstrated significantly greater improvements compared to the control group. Moreover, the study group exhibited higher rates of clinical effectiveness and successful vaginal delivery than the control group. In the animal experiment, both the oxytocin and TCM groups displayed disorganized and relaxed cervical connective tissue with evident interstitial edema when compared to the blank group. Furthermore, rats in the TCM group exhibited significantly elevated serum levels of interleukin-8 (IL-8), matrix metalloproteinase-9 (MMP-9), prostaglandin E2 (PGE2), and cyclooxygenase-2 (COX-2) compared to those in the oxytocin group. The combination of JWZSD and perinatal midwifery holistic nursing care for labor induction can effectively enhance cervical ripening and reduce the incidence of cesarean section, potentially through the regulation of IL-8, MMP-9, COX-2, and PGE2 expression. However, further investigations are required to elucidate the underlying mechanisms.

Are Racial Disparities in Cesarean Due to Differences in Labor Induction Management?

While there are known racial disparities in cesarean delivery (CD) rates, the exact etiologies for these disparities are multifaceted. We aimed to determine if differences in induction of labor (IOL) management contribute to these disparities. This retrospective cohort study evaluated all nulliparous patients with an unfavorable cervix and intact membranes who underwent IOL of a term, singleton gestation at a single institution from October 1, 2018, to September 30, 2020. IOL management was at clinician discretion. Patients were classified as Black, Indigenous, and People of Color (BIPOC) or White based on self-report. Overall rates of CD were compared for BIPOC versus White race. Chart review then evaluated various IOL management strategies as possible contributors to differences in CD by race. Of 1,261 eligible patients, 915 (72.6%) identified as BIPOC and 346 (27.4%) as White. BIPOC patients were more likely to be younger (26 years interquartile range (IQR): [22-30] vs. 32 years IQR: [30-35], p < 0.001) and publicly insured (59.1 vs. 9.9%, p < 0.001). Indication for IOL and modified Bishop score also differed by race (p < 0.001; p = 0.006). There was 40% increased risk of CD for BIPOC patients, even when controlling for confounders (30.7 vs. 21.7%, p = 0.001; adjusted relative risk (aRR) = 1.41, 95% confidence interval (CI): [1.06-1.86]). Despite this difference in CD, there were no identifiable differences in IOL management prior to decision for CD by race. Specifically, there were no differences in choice of cervical ripening agent, cervical dilation at or time to amniotomy, use and maximum dose of oxytocin, or dilation at CD. However, BIPOC patients were more likely to undergo CD for fetal indications and failed IOL. BIPOC nulliparas are 40% more likely to undergo CD during IOL than White patients within our institution. These data suggest that the disparity is not explained by differences in IOL management prior to cesarean, indicating that biases outside of induction management may be important to target to reduce CD disparities. · The etiologies for racial disparities in cesarean are likely multifaceted.. · In this work, there were no differences by race in measures of labor induction management.. · Biases outside of induction management during labor may be targeted to reduce CD disparities..

The Use of Evening Primrose Oil for Cervical Ripening in Low-Risk Women with Term Pregnancy: A Randomized Double-Blinded Controlled Trial

Background: Several methods have been developed for cervical ripening. The data regarding the efficiency of evening primrose oil (EPO) are inconsistent. The purpose of this study was to investigate the outcomes of EPO use on cervical ripening in low-risk women with term pregnancy. Patients and Methods: Low-risk term pregnant women referred to the obstetrics clinic of Imam Hossein Hospital in Tehran who were eligible according to the inclusion were randomized either to the case or control group. The case group received 1,000 mg vaginal EPO capsule, and the other group received a vaginal placebo capsule daily, similar to the original drug. The primary outcome was Bishop score, while the duration of labor phases and the inducing procedures were the secondary outcomes. Results: Forty-eight participants were randomized to each group and were considered for data analysis. Although Bishop score was not statistically different before the intervention, it was significantly higher in case group compared to the placebo group after the intervention (EPO = 5.83 ± 1.68, placebo = 5.19 ± 1.52, p value = 0.002). Four participants in the case group and two in the control group underwent cesarean section (p value = 0.677). The need for labor induction was significantly higher in the placebo group than EPO group (oxytocin injection: 10.4% vs. 31.3%, p value = 0.012, amniotomy: 75% vs. 41.7, p value = 0.001). Conclusion: The vaginal use of EPO could be considered as a safe and efficient approach for cervical ripening in low-risk term pregnant women.

Comparing Transvaginal Ultrasound Measurements of Cervical Length to Bishop Score in Predicting Cesarean Section Following Induction of Labor: A Prospective Observational Study.

Bishop score (BS) has been used to see the favorability of the cervix for induction of labor (IOL), but it has limitations in today's diverse patient population.We aimed to assess the predictive value of transvaginal ultrasound (TVUS) measurements of cervical length (CL) compared to BS in determining the likelihood of cesarean section (CS) following IOL. A prospective observational study was conducted on 120 women requiring IOL in a tertiary care hospital in central India. The inclusion criteria of the study were antenatal women more than 18 years of age, in need of IOL, having a singleton pregnancy with a gestational age of > 37 weeks as determined from the date of the last menstrual period and confirmed by sonographic measurements in the first trimester, presenting with a cephalic presentation, and having intact fetal membranes. Women with prior uterine scars and those unwilling to IOL were excluded from the study. TVUS was done just before induction. Statistical analyses were done to compare the predictive abilities of CL and BS for CS. The mean age and gestation period were 25.96 years and 39 weeks 3 days, respectively. The majority of the study population comprised multigravida (69, 57.5%), followed by primigravida (47, 39.2%), and grand multigravida (≥ G5) (4, 3.3%). Post-maturity (34, 28.3%), preeclampsia (21, 17.5%), and intrahepatic cholestasis of pregnancy (17, 14.2%) were common indications for induction. The overall CS rate was 35.8% (43/120). Women with CS had lower BS (3.60 vs. 4.70,P= 0.010) and higher CL (31.5 mm vs. 23.4 mm, P < 0.001). CL exhibited an area under the curve (AUC) of 0.857, outperforming BS (AUC = 0.643) in predicting CS. Using a CL cutoff of 26.5 mm yielded sensitivity (79.1%), specificity (81.8%), and overall accuracy (80.8%). TVUS measurement of CL (>26.5 mm) demonstrated superior predictive ability for CS following labor induction compared to BS (≤5). This study highlights the potential of CL measurement as an objective and reliable tool for optimizing decision-making in labor induction.

Assessing the effectiveness of membrane sweeping combined with cervical massage for term pre-induction cervical ripening: A single experimental study

Massage of the cervical region entails applying light pressure to the cervix to trigger the uterine contractions. Membrane sweeping, often called cervical sweeping or membrane stripping, releases hormones that may start labor by removing the amniotic sac from the uterine wall. Although membrane sweeping is helpful in several clinical trials, no studies have examined how effective cervical massage is when combined with membrane sweeping.This research compared the effectiveness of membrane sweeping and cervical massage as cervical ripening techniques in post-dated pregnancies before labor induction in specialized clinics. A total of 150 low-risk singleton pregnancies with a Modified Bishop Score (MBS) of fewer than five at 38 weeks of gestation were included. The experimental group received membrane sweeping with cervical massage, and the control group, which just received membrane sweeping, was randomly allocated to the participants. 48 hours after the intervention, changes in the MBS were used to gauge cervical favorability. Neonatal morbidity, membrane rupture, intrapartum and postpartum infections, and other complications were assessed.The mean ages and MBS of the primigravidae in the two research groups at induction were similar. After the intervention, the trial group's mean MBS was significantly higher than the control groups. Because of this, primigravidae observed a substantial change in the MBS after the operation. The experimental group's adverse effects and neonatal morbidity were comparable, except cardiotocographic abnormalities were observed more often in the control group.In some cases, when membrane sweeping cannot be conducted because of a closed cervical os, cervical massage combined with membrane sweeping appears successful and secure. A significant choice for obstetric care, this technique may aid cervical softening in post-dated pregnancies.

Comparison of Misoprostol with Foley Catheter vs Misoprostol alone for Cervical Ripening and Induction of Labor in Patients with Premature Rupture of Membrane: A Randomized Clinical Trial Study.

This study evaluates the effect of misoprostol alone in comparison with misoprostol with Foley catheter in preparing the cervix for induction of labor in women with premature rupture of the amniotic sac. This randomized clinical trial study was performed from 2017 to 2019 on 206 pregnant women with singleton pregnancy and gestational age more than 36 weeks, whose rupture of the amniotic sac had occurred less than 12 hours and had a Bishop score less than 4. These women were randomly assigned to two groups of Foley catheters with misoprostol (intervention group, P = 103) or misoprostol alone (control group, P = 103) to induce labor. In both groups, sublingual misoprostol (25 micrograms) was administered at intervals of 4-6 hours. The collected data were analyzed by SPSS.21 software. There is no significant difference between age and Bishop score in the two groups (P = 0.19, P = 0.31, respectively). Lower doses (0 to 3) of misoprostol were used in the intervention group versus 0 to 5 doses in the control group (P = 0.001). Delivery time was shorter in the intervention group (10.83 hours vs. 13.10 hours in the control group, P = 0.001). Also, the probability of complications such as fever, tachysystole, and hospitalization of an infant in the neonatal intensive care unit (NICU) did not increase. An intracervical Foley catheter with misoprostol is more effective in inducing labor in pregnancies with premature rupture of the membranes than using misoprostol alone and can be a safe and effective option.

A cross-sectional study on incidence and indications for induction of labor and the factors associated with failure of induction

Background: Induction fails in about 20% of induced pregnancies and has no universally accepted definition. Failed induction is the failure to establish labor or inability to achieve the active stage of labor, considering the definition of induction of labor (IOL). It needs to be differentiated from the failure of progress of labor. There is no evidence to recommend treatment for failed induction, but usually, delivery by cesarean section will be required. Aims and Objectives: The study was designed to start induction for an indication that justifies operative delivery in cases of failure. Materials and Methods: A prospective observational study was done over a period of 1 year among antenatal women confirmed to be at term with cephalic presentation in the absence of active labor with unscarred uterus. Results: The incidence of IOL was found to be 25.97% and failure was observed in 50 (21.83%) of those included in the study. Among those with failure, failed pre-induction ripening was seen in 26 (11.3%) and failed induction in 24 (10.4%). Although many variables were found to be associated with the outcome of labor, a statistically significant association was observed with premature rupture of membranes, pre-induction Bishop score, and birth weight of the baby. Conclusion: The study helps in better clinical judgment of patients who will have a successful induction or a failed induction and the patients could be counseled accordingly. This judgment will also help to avoid unnecessary inductions in those who have the risk factors for failed induction unless the induction is absolutely necessary.

Incidence and Predictors of Successful Vaginal Birth Among Women With a History of Cesarean Section in Public Health Facilities of Southern Ethiopia in 2021

BACKGROUND:Even though a cesarean section (CS) performed greater than 15% has no significant association with a reduction in maternal and neonatal mortality, repeat elective CS continues to play a major role in unnecessary CS worldwide. Trial of labor after cesarean (TOLAC) is one of the strategies to reduce the rate of unnecessary CS. However, the selection of candidates for a TOLAC is not an easy task without evidence. This study was conducted to determine the incidence of successful vaginal birth after one CS and the associated factors in public health facilities in southern Ethiopia.METHODS:An institutional-based cross-sectional study was conducted from June 10, 2020, to December 10, 2021, on laboring women, and the data were collected using a pretested interviewer-administered questionnaire and a data extraction sheet. A binary logistic regression model was used to assess the factors associated with successful vaginal birth after cesarean (VBAC) section using SPSS version 25. Bivariate and multivariate analyses were performed, and independent variables withp&lt; .05 along with an odd ratio and 95% confidence interval (CI) declare the associated factors.RESULTS:A total of 417 women participated in this study making a response rate of 98.8%. The incidence of vaginal births after cesarean was 51.1% (CI, 46%–56%). The likelihood of successful VBAC was observed in women with a history of vaginal delivery before CS (AOR, 3.7, CI = 1.06, 13.19), favorable Bishop score at admission (AOR, 19.1, CI = 2.69, 134.98), greater than 4-cm cervical dilation at admission (AOR, 171.3, CI = 1.8, 16,722), and clear color of amniotic fluid (AOR, .096, CI = .02, .38).CONCLUSION:The incidence of VBAC in this study is promising and should be practiced. In choosing a woman for the TOLAC, health professionals might need to pay attention to intrapartum variables, such as cervical dilation, Bishop score, and color of the amniotic fluid.

COMPARING THE EFFICACY OF 30 ML AND 60 ML FOLEY'S CATHETER BALLOON INFLATION FOR INDUCTION OF LABOR IN TERM SINGLETON MULTIGRAVIDA PATIENTS: A RANDOMIZED TRIAL

Labour induction is a common obstetric technique, especially for term singleton multigravida patients. The Foley's catheter balloon inflation method is widely used, and the efficacy of this technique may be affected by differences in balloon capacity. Thus, this study aimed to compare the effectiveness of two balloon inflation volumes, 30 mL and 60 mL, for inducing labour in term singleton multigravida patients. This study was a prospective, randomized, parallel-group design conducted at Gajju Khan Medical College, Swabi, between September 2022 and September 2023 The study included 112-term singleton multigravida with a gestational age of 37 weeks or more, a single-fetus pregnancy, and prior pregnancies. Using computer-generated random numbers, participants were randomly assigned to Group A (30 mL) or Group B (60 mL). The results of the study showed that both groups had similar baseline characteristics. Group A had an average age of 28.5 years, while Group B had an average age of 29.2 years. Group A's mean gestational age was 39.1 weeks, while Group B's was 38.9 weeks. Patients in both groups were multiparous. The mean induction-to-delivery delay was 10.2 days for Group A and 12.8 days for Group B, with a statistically significant difference (p=0.034). After balloon inflation, Group A bishop scores improved from 4.2 to 7.8, and Group B bishop scores improved from 4.1 to 7.6 (p=0.498). The research shows that 60 mL of folleys catheter balloon inflation for cervical ripening in labour induction may shorten the induction-to-delivery period without compromising newborn outcomes.

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.

Efficacy and safety of oral and vaginal administration of misoprostol for induction of labor in high-risk obese pregnant women with hypertension or diabetes mellitus

Objective This study aims to compare the safety and efficacy of misoprostol administered orally and vaginally in obese pregnant women at term with either gestational hypertension or diabetes. Methods A total of 264 pregnant women were enrolled and categorized into two groups based on their primary condition: hypertension (134 cases) or diabetes mellitus (130 cases) and were further divided into subgroups for misoprostol administration: orally (Oral group) or vaginally (Vaginal group). The primary outcomes measured were changes in the Bishop score following treatment, induction of labor (IOL) success rates, requirement for oxytocin augmentation, duration of labor, mode of delivery, and cesarean section rates. Results Significant enhancements in Bishop scores, decreased cesarean section rates and increased success rates of IOL were noted in both administration groups. The incidence of vaginal delivery within 24 h was significantly higher in the Vaginal group compared to the Oral group. Adverse effects, including nausea, uterine overcontraction, hyperfrequency of uterine contraction and uterine hyperstimulation without fetal heart rate deceleration, were significantly more prevalent in the Vaginal group than in the Oral group. Conclusion Misoprostol administration, both orally and vaginally, proves effective for labor induction in obese pregnant women with hypertension or diabetes. However, the oral route presents a lower risk of adverse maternal and neonatal outcomes, suggesting its preference for safer labor induction in this demographic.

Is oral consumption of dates (Phoenix dactylifera L. fruit) in the peripartum period effective and safe integrative care to facilitate childbirth and improve perinatal outcomes: a comprehensive revised systematic review and dose-response meta-analysis

BackgroundRecent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this updated systematic review with meta-analysis sought to investigate the efficacy and safety of this integrated intervention in facilitating childbirth and improving perinatal outcomes.MethodsEight data sources were searched comprehensively from their inception until April 30, 2023. Parallel-group randomized and non-randomized controlled trials published in any language were included if conducted during peripartum (i.e., third trimester of pregnancy, late pregnancy, labor, or postpartum) to assess standard care plus oral consumption of dates versus standard care alone or combined with other alternative interventions. The Cochrane Collaboration’s Risk of Bias (RoB) assessment tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to evaluate the potential RoB and the overall quality of the evidence, respectively. Sufficient data were pooled by a random-effect approach utilizing Stata software.ResultsOf 2,460 records in the initial search, 48 studies reported in 55 publications were included. Data were insufficient for meta-analysis regarding fetal, neonatal, or infant outcomes; nonetheless, most outcomes were not substantially different between dates consumer and standard care groups. However, meta-analyses revealed that dates consumption in late pregnancy significantly shortened the length of gestation and labor, except for the second labor stage; declined the need for labor induction; accelerated spontaneity of delivery; raised cervical dilatation (CD) upon admission, Bishop score, and frequency of spontaneous vaginal delivery. The dates intake in labor also significantly reduced labor duration, except for the third labor stage, and increased CD two hours post-intervention. Moreover, the intervention during postpartum significantly boosted the breast milk quantity and reduced post-delivery hemorrhage. Likewise, dates supplementation in the third trimester of pregnancy significantly increased maternal hemoglobin levels. The overall evidence quality was also unacceptable, and RoB was high in most studies. Furthermore, the intervention’s safety was recorded only in four trials.ConclusionMore well-designed investigations are required to robustly support consuming dates during peripartum as effective and safe integrated care.Trial registrationPROSPERO Registration No: CRD42023399626

Comparison of two labor induction regimens with intravaginal misoprostol 25 μg and adverse perinatal outcomes.

The aim of the study was to compare two labor induction regimens (4 and 6 h), to determine predictors of successful labor induction with intravaginal misoprostol 25 μg tablets, and to evaluate the association with adverse perinatal outcomes. This was a retrospective cohort study that included singleton pregnancies undergoing induction of labor with an intravaginal misoprostol 25 μg tablet between 37 and 42 weeks of gestation. The pregnant women were divided into two groups: Group 1-intravaginal misoprostol 25 μg every 4 h and Group 2-intravaginal misoprostol 25 μg every 6 h. Pregnant women were divided into Group 1 (n=289) and Group 2 (n=278). Group 1 had a higher median number of intravaginal misoprostol 25 μg tablets (3.0 vs. 2.0 tablets, p<0.001), a lower prevalence of postpartum hemorrhage (7.6 vs. 32.7%, p<0.001), and a higher need for oxytocin (odds ratio [OR]: 2.1, 95%CI: 1.47-2.98, p<0.001) than Group 2. Models including intravaginal misoprostol 25 μg tablets every 4 and 6 h [x2(1)=23.7, OR: 4.35, p<0.0001], parity [x2(3)=39.4, OR: 0.59, p=0.031], and Bishop's score [x2(4)=10.8, OR: 0.77, p=0.019] were the best predictors of failure of labor induction. A statistically significant difference between groups was observed between the use of the first intravaginal misoprostol 25 μg tablet at the beginning (Breslow p<0.001) and the end of the active labor phase (Long Hank p=0.002). Pregnant women who used intravaginal misoprostol 25 μg every 4 h had a longer time from the labor induction to the beginning of the active phase of labor and higher rates of adverse perinatal outcomes than women who used intravaginal misoprostol 25 μg every 6 h.

Labor induction outcomes with vaginal misoprostol in high-risk pregnancies at a tertiary center in the metropolitan region of Rio de Janeiro, Brazil.

To analyze the main indications for induction of labor with vaginal misoprostol in high-risk pregnancies as well as the main variables associated with failed induction in a tertiary center in the metropolitan region of Rio de Janeiro, Brazil. A retrospective cohort study analyzed the medical records of pregnant women who underwent induction of labor. Inclusion criteria were singleton pregnancy, gestational age ≥ 34 weeks, Bishop score ≤ 6, fetuses in cephalic presentation, and no contraindications for the use of vaginal misoprostol. The labor induction protocol consisted of vaginal misoprostol 25 mcg every 6 hours, with a maximum of eight doses (200 mcg) to ripen the cervix if Bishop's score was ≤ 6. A total of 88 cases of labor induction were analyzed. Main indications for labor induction were preeclampsia and gestational hypertension (N = 28; 31.8%), chronic arterial hypertension (N = 19; 21.6%), and gestational diabetes mellitus (N = 12; 13.6%). We observed that vaginal delivery was associated with the number of vaginal misoprostol doses (P = 0.000348). The most common indications for cesarean section were failure of labor induction (N = 21; 40%) and suspected acute fetal distress (N = 17; 33%). We did not observe a statistical difference between indication of labor induction and mode of delivery. There were no fetal deaths. Six neonates were admitted to the neonatal intensive care unit (NICU), one for respiratory distress, one for preterm delivery, and four for hypoglycemia. There was no statistical difference in the rate of NICU admission between delivery modes (P = 0.692). The main indication for cesarean section in this study was induction failure, indicating the need to review and continuously monitor the protocol to increase success rates without compromising perinatal outcomes.