Bishop Score Research Articles

Outcomes and Associated Factors of Induction of Labor in East Gojjam Zone, Northwest Ethiopia: A Multicenter Cross-Sectional Study.

Induction of labor is the initiation of uterine contractions by artificial methods once the fetus has reached viability and prior to spontaneous onset of labor with the aim of achieving vaginal delivery. Although induction of labor is a critical life-saving intervention that potentially reduces adverse pregnancy outcomes, sometimes it has undesirable consequences for the health of the mother and/or the fetus. Hence, this study aimed to evaluate the outcomes and associated factors of labor induction. An institution-based cross-sectional study was conducted from February 25 to May 25, 2020, among women undergoing induction at East Gojjam zone public hospitals in northwest Ethiopia. A structured interviewer-administered questionnaire was used to collect data from a sample of 411 mothers who were selected using a systematic random sampling technique. Stata/se™ Version 14 statistical software was used to analyze the data. Multivariable binary logistic regression was used to determine the potential factors affecting successful labor induction. Adjusted odds ratios with their 95% CI intervals were used to declare the strength of the association, and a variable with p value <0.05 was considered to have statistical significance. The prevalence of successful induction of labor was 70.3% (65.6, 74.7). The favorable Bishop score ((CI 3.90, 1.63-9.29); p value = 0.002), the intermediate Bishop score ((CI 3.53, 2.15-5.82); p value = 0.001), labor induction using oxytocin with cervical ripening ((CI 2.60, 1.21-5.63); p value = 0.015), and urban residence ((CI 0.48, 0.30-0.78); p value = 0.003) were associated with successful induction of labor. These findings strongly suggest that cervical conditions are important determinants for the success of labor induction. Therefore, healthcare providers should confirm the favorability of the cervical status (using Bishop score) as a strict prerequisite before actual labor induction, and special consideration should be given to those pregnant women who reside in urban areas.

The prevalence and associated factors of success of labor induction in Hargeisa maternity hospitals, Hargeisa Somaliland 2022: a hospital-based cross-sectional study

BackgroundThe induction of labor is an artificial initiation of labor and has become one of the most common interventions in modern obstetrics to improve maternal and neonatal health. Understanding the prevalence and pregnancy outcomes following labor inductions is crucial in regions with high rates of maternal mortality and morbidity because of insufficient access to comprehensive emergency obstetric care. Therefore, this study aimed to assess the prevalence and associated factors of the success of induction of labor in Hargeisa maternity hospital Somaliland.MethodsA hospital-based cross-sectional study was employed among 453 women in Hargeisa maternity hospitals, Somaliland from January 1st to March 30th, 2022. Data were entered using Epi data version 4.6 and analyzed by using SPSS version 25. Bivariable and multivariable logistic regression were used to identify the associated factors with the success of labor induction and an odds ratio with a 95% confidence interval was used to measure the strength of the association. A P-value of ≤ 0.05 was considered statistically significant in multivariate analysis.ResultsOf a total of 453 study participants who had undergone induction of labor, 349 (77%) of them had successful induction of labor with a 95% CI: 73%, 81%. Favorable Bishop score (AOR = 3.45, 95% CI: 1.98, 5.99), time from the start of induction to delivery < 12 h (AOR = 4.01, 95% CI: 2.16, 7.450), non-reassuring fetal heart rate pattern (AOR = 0.42, 95% CI: 0.22, 0.78) and amniotic fluid change to meconium (AOR = 0.43, 95% CI: 0.23, 0.79) were significantly associated with the success of labor induction.ConclusionThis study implies that three out of four women who underwent induction had successful induction of labor. Favorable bishop score, time from the start of induction to delivery < 12 h, non-reassuring fetal heart rate pattern, and amniotic fluid change to meconium were significantly associated with the success of labor induction. The hospital should establish a clear bishop scoring system and there should be a strict follow-up on the condition of the fetal heartbeat and take corrective actions as needed. The factors related to healthcare facilities and providers need to be addressed by additional prospective studies.

Can Transvaginal Cervical Elastography predict the success of induction of labor with oxytocin?

We aimed to show whether elastography can be analternative, although the Bishop score used in the follow-up of labor induction success with oxytocin is a relative concept. This prospective case-control study includes 56 cases admitted to a tertiary maternity hospital for induction between March and June 2019. Cervical elastography was applied to patients before induction. Induction success in pregnant women who underwent induction with oxytocin was accepted to be greater than Bishop 9. The cases were divided into two groups as successful (n=28) and unsuccessful (n=28) induction, and their elastosonographic findings were compared. In 28 cases with successful induction (Bishop >9, and vaginal delivery occurred in 28), the mean stiffness of the cervix in measurements from four regions was 13.6 ±3.7 kPa in the measurement of the cervix with the elastography method before induction was started, while this value was measured as 14.9 ± 3.1 in cases where induction was unsuccessful (t- value: -1.321, p=0.194). Our study showed that pre-induction stiffness of the cervix cannot predict the success of labor induction with oxytocin. More studies with larger samples are needed to arrive at a decent conclusion. In addition, results can be more assuring with the developing technique and sensitivity of elastography.

Predictors of vaginal delivery following balloon catheter for labor induction in women with one previous cesarean

BackgroundThe aim of this study was to estimate predictors for vaginal birth following balloon catheter induction of labor (IOL) in women with one previous cesarean section (CS) and an unfavorable cervix.MethodsThis 4-year retrospective cohort study was conducted in Longhua District Central Hospital in Shenzhen China, between January 2015 and December 2018. Patients with one previous CS and a current singleton-term pregnancy who underwent balloon catheter cervical ripening and IOL were enrolled. Univariate analysis was used to identify predictive factors associated with vaginal birth after cesarean section (VBAC). Binary logistic regression was further used to identify which factors were independently associated with the outcome measure. The primary outcome was VBAC, which was a successful trial of labor after cesarean delivery (TOLAC) following IOL.ResultsA total of 69.57% (208/299) of the women who planned for IOL had VBAC. In the final binary logistic regression equation, lower fetal weight (< 4000 g) (odds ratio [OR]5.26; 95% confidence interval [CI] 2.09,13.27), lower body mass index (BMI,<30 kg/m2) (OR 2.27; CI 1.21, 4.26), Bishop score after cervical ripening > 6 (OR 1.94; CI 1.37, 2.76) remained independently associated with an increased chance of VBAC.ConclusionsThe influencing factors of VBAC following IOL were fetal weight, BMI, and Bishop score after cervical ripening. Adequate individualized management and assessment of the IOL may help improve the VBAC rate.

Prediction of Successful Induction of Labour jointly using Bishop Score and Transvaginal Sonography in Primigravida Women in Pakistan

Objective: To assess the diagnostic efficacy of the Bishop Score and Transvaginal Ultrasonography (TVS) in predicting successful labor induction in primigravida women in a peri-urban population in Islamabad. Additionally, the study aimed to evaluate the effectiveness of combining the predictions from both methods to enhance accuracy in predicting successful labor induction. Methodology: A prospective comparative study was conducted at the Departments of Obstetrics and Gynecology, Rawal Institute of Health Sciences, and Farooq Hospital, Islamabad, from December 2021 to December 2022. A total of 520 pregnant, primigravida women undergoing labor induction were included, and they were randomly divided into two groups for assessment using either the Bishop Score or Transvaginal ultrasonography. The outcome of interest was documented as the initiation of active labor within 24 hours. The efficacy of each method was validated separately and jointly, and the predictive accuracy of all three predictors was compared. Results: The two groups demonstrated that both TVS and the Bishop Score were individually effective at predicting successful labor induction (p&lt;0.00001 for both methods). TVS outperformed the Bishop Score in several key predictive measures, such as accuracy and the F1 Score. However, combining predictions from both the Bishop Score and TVS significantly improved both positive and negative predictive values (by more than 10% for each metric), resulting in a more reliable prediction. Conclusion: Both the Bishop Score and TVS are effective methods for predicting successful labor induction in the peri-urban population of Islamabad, Pakistan. While TVS showed significant quantitative advantages over the Bishop Score, combining both predictors yielded even better performance, suggesting that using both methods together should be prioritized for prediction.

Using dinoprostone slow release vaginal insert for cervical ripening in term-pregnancy with oligohydramnios.

The study purposed to evaluate the success rate of cervical ripening using dinoprostone controlled-release vaginal insert and reveal some factors relating to successful cervical ripening. This cross-sectional study was conducted at Tu Du Hospital in Vietnam from December 2021 to August 2022. The study enrolled 200 pregnant women with gestational age ≥37 weeks diagnosed with oligohydramnios. These candidates underwent dinoprostone cervical ripening (DCR) according to the local protocol. The Bishop score ≥7 after 24 h was determined for the successful cervical ripening (SCR). In total, the success rate of DCR achieved at 57.5% and the cesarean delivery rate was 46.5%. None of the severe side-effects and complications was present. Using multivariable logistic regression, the study found that the body mass index ≥25 kg/m2 and oxytocin infusion drip related to SCR with adjusted odds ratio (aOR): 3.67 (95% confidence intervals [CI]: 1.78-7.57) and aOR: 4.68 (95% CI: 1.84-11.93), p < 0.001. Using the Kaplan-Meier curve, the present study revealed a significant difference between Bishop <3 and ≥3 following the duration time of cervical ripening, with hazard ratio: 1.38 (95% CI: 1.19-1.59), p < 0.001. The time duration of cervical ripening was not significantly different following amniotic fluid index from 3 to 5 cm. Cervical ripening using a dinoprostone vaginal insert is a potentially acceptable method in term pregnancy accompanying with oligohydramnios. The probability of SCR can be predicted on a careful assessment of relative factors by obstetricians. Further studies are required to strengthen these findings.

Predictive Value of Cervical Shear Wave Elastography in the Induction of Labor in Late-Term Pregnancy Nulliparous Women: Preliminary Results.

The prediction of induction of labor continues to be a paradigm nowadays. Bishop Score is the traditional widely spread method but with a low reliability. Ultrasound cervical assessment has been proposed as an instrument of measurement. Shear wave elastography (SWE) should be a promising tool in the prediction of the success of labor induction in nulliparous late-term pregnancies. Ninety-two women with nulliparous late-term pregnancies who were going to be induced were included in the study. A shear wave measurement of the cervix divided into six regions (inner, middle and outer in both cervical lips), cervical length and fetal biometry was performed by blinded investigators prior to routine hand cervical assessment (Bishop Score (BS)) and induction of labor. The primary outcome was success of induction. Sixty-three women achieved labor. Nine women did not, and they underwent a cesarean section due to failure to induce labor. SWE was significantly higher in the inner part of the posterior cervix (p < 0.0001). SWE showed an area under the curve (AUC): 0.809 (0.677-0.941) in the inner posterior part. For CL, AUC was 0.816 (0.692-0.984). BS AUC was 0.467 (0.283-0.651). The ICC of inter-observer reproducibility was ≥0.83 in each region of interest (ROI). The cervix elastic gradient seems to be confirmed. The inner part of the posterior cervical lip is the most reliable region to predict induction of labor results in SWE terms. In addition, cervical length seems to be one of the most important procedures in the prediction of induction. Both methods combined could replace the Bishop Score.

Is mifepristone a game changer in induction of labour..?

: Induction of labor is defined as artificially stimulating the uterus to start labor. Mifepristone is a synthetic steroid hormone analog that has both anti-progesterone and anti-glucocorticoid activities. This study aimed to study the efficacy of mifepristone in the induction of labor and cervical ripening.: This study was conducted in Gandhi Hospital from August 2022 to November 2022. A total of 100 antenatal cases were admitted for safe confinement after 37 completed weeks and given oral mifepristone 200 mg and assessed for cervical ripening and need for further augmentation and the outcome was studied based on improvement in bishops score assessed after 24 hours of intake of oral mifepristone. It was observed that there was a significant improvement in the bishop’s score 24 hours after giving mifepristone. Out of 100 women who were given mifepristone, 79% delivered vaginally and 21% delivered through emergency cesarean section. The major indication for emergency cesarean section was fetal distress. The majority of patients had good neonatal outcomes and there were no serious maternal complications. Mifepristone is an effective and safe method of induction of labor with significant improvement in Bishop's score within 24 hours of administration.

Diagnostic accuracy of posterior cervical angle, and cervical length in Prediction of Successful labor induction

Objective: To study the evaluation of the value of the posterior cervical angle, and cervical length, measured by transvaginal ultrasonography, compared with the Bishop Score in the prediction of successful labor induction.

Quantitative Fetal Fibronectin to Predict Prolonged Induction of Labor [ID: 1371638

INTRODUCTION: Prolonged induction of labor is problematic for patients and providers alike, but we lack clinical tools to help predict time to delivery. We hypothesize quantitative fetal fibronectin may function as a tool to predict prolonged induction. METHODS: We performed a prospective observational study of low-risk patients undergoing induction of labor at 39 0/7 to 41 0/7 weeks. Prior to induction, fetal fibronectin (fFN) sampling (off-label use) and transvaginal cervix length were completed. Median fFN values were compared to time-to-delivery using 12-, 24-, and 36-hour thresholds. Delivery within these thresholds was modeled using logistic regression after controlling for parity, Bishop score, cervical length, and gestational age. Continuous log time-to-delivery was modeled using linear regression. Arrowhead Regional Medical Center IRB granted approval Protocol #21–29. RESULTS: Of 95 patients enrolled, 35 (37%), 70 (74%), and 80 (84%) patients delivered within 12, 24, and 36 hours. Unadjusted tests for differences in median fFN in these groups were nonsignificant. Cervical length and gestational age were removed from adjusted models because of nonsignificance. Regression models showed a significant relationship between fFN and delivery time within 24 hours, but not within 12 or 36 hours. Each 50 ng/mL increase in fFN was associated with 25% higher odds of delivering within 24 hours (adjusted odds ratio [aOR] 1.25, 95% CI 1.01–1.54, P=.04) with a 3.7% decrease in labor time (53-minute reduction in a 24-hour labor) (aOR 0.963, 95% CI 0.929–0.097, P=.04). CONCLUSION: Our findings suggest fFN maybe a useful tool to identify patients who will deliver within 24 hours of induction initiation.

Efficacy of Transcervical Balloon Catheter Versus Hygroscopic Dilator for Outpatient Prelabor Cervical Ripening [ID: 1382587

INTRODUCTION: Outpatient preinduction cervical ripening with mechanical agents has been associated with reduced length of stay and cesarean delivery rates. This study aimed to demonstrate equivalence in efficacy and patient satisfaction between balloon catheter and hygroscopic dilators for outpatient cervical ripening. METHODS: This randomized control equivalence trial compared the 30-cc silicone Foley catheter (off-label) to Dilapan-S. Inclusion criteria were elective induction, low risk, group B streptococcus negative, and Bishop score of less than 6. The primary outcome was time from admission to delivery. Secondary outcomes included cesarean delivery rates, pain scores, and patient satisfaction. A power calculation determined 150 patients per arm were needed. Ochsner Health IRB approved CR00003326. RESULTS: Between March 1, 2019, and May 31, 2021, 8,150 deliveries occurred, with 1,605 patients meeting screening criteria and 175 completing the study. Time from admission to delivery for balloon was 17.7 hours versus 17.9 hours for dilators. The mean time difference was −0.1524 hours (90% CI –2.4617 to 2.1569), which was statistically significantly equivalent within the specified symmetrical 3-hour equivalence margin (P=.0215). Pain scores with insertion were 3.52 with balloon versus 3.87 with dilators. Satisfaction with outpatient cervical ripening was 91.7% with balloon versus 97.4% with dilators. Cesarean delivery rate of primiparous patients was 31% with balloon versus 25.3% with dilators. CONCLUSION: Although the enrollment goal was unmet, metrics suggested outpatient cervical ripening with balloon catheter and hygroscopic dilators were equivalent in time from admission to delivery and patient-reported pain scores. Further research is needed to assess a potential trend toward improved satisfaction and cesarean delivery rate with dilators.

Outpatient Cervical Ripening Program Evaluation: A Comparison of Osmotic Cervical Dilators and Foley Balloon [ID: 1377400

INTRODUCTION: With increased demand for elective and medically indicated inductions of labor, outpatient cervical ripening programs have the potential to increase clinical efficiency, decrease costs, and promote patient satisfaction. This study describes patient characteristics, process, and outcome measures for an outpatient cervical ripening program. METHODS: This retrospective cohort study examined low-risk women (39–40 6/7 weeks) undergoing outpatient cervical ripening with osmotic cervical dilators (Dilapan-S) or Foley balloon from March 2020 to March 2022. Outcomes included mode of delivery, obstetric complications, and changes in cervical dilation and simplified Bishop score (SBS) (a 0- to 9-point scoring system based on dilatation, effacement, and station). RESULTS: One hundred twenty patients completed outpatient cervical ripening (80 osmotic dilators, 40 Foley). Foley patients were less likely to be White and had higher SBS at insertion. 16.7% (n=20) of patients returned before scheduled induction, primarily because of contractions. Device expulsion prior to admission was more common among Foley patients (27.5%) than osmotic dilators (6.3%). Mean time from insertion to admission was 17.5 hours for osmotic dilators and 13.6 hours for Foley. The mean SBS change was 1.78, and mean dilation change was 1.83 cm with no differences by device type. Mean time from admission to delivery was 20.96 (15.36) hours, and 74.2% of patients delivered vaginally, with no difference by device type in adjusted models. Rates of infection (4.2%), and postpartum hemorrhage (2.3% vaginal, 32% cesarean) did not differ by device. CONCLUSION: Outpatient cervical ripening with osmotic cervical dilators or Foley improves SBS on admission with low complications and no significant differences in outcomes by device.

Reduction of Cesarean Delivery Rates in South Florida: The MSMC Experience [ID: 1370319

INTRODUCTION: Mount Sinai Medical Center (MSMC) in Miami Beach, Florida, is home to a diverse and international obstetric population. In 2017, the state of Florida had a cesarean delivery (CD) rate for nulliparous, term, singleton, vertex (NTSV) of 31.1%, the highest in the nation. Mount Sinai Medical Center had a NTSV CD rate of 38.3%. The national rate of NTSV CD in 2017 was 26%. Mount Sinai Medical Center joined PROVIDE (Promoting Primary Vaginal Deliveries), a statewide initiative by the Florida Perinatal Quality Collaborative with the goal of improving maternal and newborn outcomes by applying evidence-based interventions and reducing NTSV CD rates. METHODS: The implementation of an obstetrics and gynecology residency program and monthly grand rounds contributed to an effort of evidence-based medicine. The interventions implemented were nurse education of labor positioning from Bundle Births and Spinning Babies, nursing recognition as “Vaginal Queen of the Month,” Bishop score documentation added to H&amp;P, obstetric physicians assigned “Badge Buddies” next to their hospital ID cards disclosing their personal NTSV CD rate, and a pre-cesarean checklist for labor dystocia or failed induction. RESULTS: After 2 years of multifaceted interventions, MSMC had decreased its cesarean delivery rate for NTSV patients from 38.3% in 2017 to 27.7% in 2019. The average rate in Florida overall was 29.7% in 2019 and the national rate of CD in NTSV patients was 25.6% in 2019 (data source: FPQC Perinatal Indicator System). CONCLUSION: With continued interventions, we hypothesize that we will meet the healthy people 2030 target CD for NTSV rate of 23.6% as the initiative enters its sustainability phase.

Prediction of an effective cervical ripenning in the induction of labour using vaginal dinoprostone

To develop a predictive model for successful cervical ripening in women that undergo induction of labour by means of a vaginal prostaglandin slow-release delivery system (Propess®). Prospective observational study on 204 women that required induction of labour between February 2019 and May 2020 at “La Mancha Centro” hospital in Alcázar de San Juan, Spain. The main variable studied was effective cervical ripening (Bishop score > 6). Using multivariate analysis and binary logistic regression, we created three initial predictive models (model A: Bishop Score + Ultrasound cervical length + clinical variables (estimated fetal weight, premature rupture of membranes and body mass index)); model B: Ultrasound cervical lenght + clinical variables; and model C: Bishop score + clinical variables) to predict effective cervical ripening. All three predictive models obtained (A, B and C) presented good predictive capabilities, with an area under the ROC curve ≥ 0.76. Predictive model C, composed of the variables: gestational age (OR 1.55, 95% CI 1.18–2.03, p = 0.002), premature rupture of membranes (OR 3.21 95% CI 1.34–7.70, p = 0.09) body mass index (OR 0.93, 95% CI 0.87–0.98, p = 0.012), estimated fetal weight (OR 0.99, 95% CI 0.99–1.00, p = 0.068) and Bishop score (OR 1.49 95% CI 1.18–1.81, p = 0.001), is presented as the model of choice with an area under the ROC curve of 0.76 (95% CI 0.70–0.83, p < 0.001). A predictive model composed of the variables: gestational age, premature rupture of membranes, body mass index, estimated fetal weight and Bishop score upon admission presents good capabilities in predicting successful cervical ripening following administration of prostaglandins. This tool could be useful in making clinical decisions with regard to induction of labour.

Double balloon catheter versus vaginal prostaglandins for induction of labor: an observational ambidirectional cohort study

Aim: To compare effectiveness and safety of double balloon catheter and prostaglandins for induction of labor. Methods: an observational ambidirectional cohort study was conducted at a tertiary care university hospital. A total of 666 women with a Bishop score ≤6 requiring labor induction were included. A cohort of 418 patients with double balloon catheter were compared with a retrospective cohort of 248 women induced with prostaglandins, either misoprostol or dinoprostone. Perinatal outcomes were compared between groups, with a p&lt;0.05 considered statistically significant. Results: The cesarean-section rate was 27% in the double balloon group, compared with 27.8% in the prostaglandin group (p=0.352). The mean induction time-to-delivery was longer in the double balloon group as compared to the prostaglandin group (26.6±9.3 hrs vs 19.1±8.6 hrs, p&lt;0.001). Hyperdynamia and umbilical-cord arterial pH&lt;7.1 rates were significantly lower with the mechanical method compared to prostaglandins (p&lt;0.001 and p=0.043, respectively). Other maternal and neonatal outcomes were similar between the groups. Conclusions: Double balloon catheter has similar effectiveness in terms of cesarean-section rate compared to prostaglandins, but with a better safety profile. However, the balloon catheter is associated with a longer time-to-delivery compared to prostaglandins.

Prediction of vaginal birth after cesarean in China.

This study aimed to develop and validate a prediction model of vaginal birth after cesarean delivery (VBAC) in China. A nomogram for effective prediction of VBAC of singleton, cephalic and one previous low-transverse cesarean section deliveries was created by comparing the combinations of ultrasonographic and non-ultrasonographic factors from five hospitals between 2018 and 2019. A total of 1066 women were included. Of the women who underwent trial of labor after cesarean (TOLAC), 854 (80.1%) had a VBAC. Ultrasound factors included reached a higher area under the curve (AUC) combined with non-ultrasonographic factors. Of the three ultrasonographic factors analyzed, the best predictive factor for successful TOLAC was fetal abdominal circumference. A nomogram was generated with eight validated factors, including maternal age, gestational week, height, previous vaginal delivery, Bishop score, dilatation of the cervix at the time of admission, body mass index at delivery, and fetal abdominal circumference by ultrasound. The trained and validated AUC were 0.719 (95% confident interval 0.674-0.764) and 0.774 (95% confident interval 0.712-0.837), respectively. Our VBAC nomogram based on obstetric factors and fetal abdominal circumference obtained by ultrasound could be used to counsel women who are considering TOLAC.

Impact of misoprostol in inducing labor in patients having intrauterine foetal death

Background: The most detrimental outcome of pregnancy, intrauterine foetal death (IUFD), causes psychological suffering to the expectant mother and the entire family. Objective: The purpose of this study was to evaluate the effectiveness as well as safety of misoprostol for labour induction in IUFD. Methods: The Department of Obstetrics and Gynecology at the MTI-HMC, Peshawar, conducted this clinical research on 120 women who had IUFD from 09 September 2020 to 09 March 2021. With the patient's informed agreement, labour was induced with vaginal misoprostol pills at a dose of 50 mcg four times per day. Results: In research including 120 women, the majority of the women (n=55; 45.83%) were between the ages of 21 and 30, with a median gestational age of 37.61 ± 4.17 weeks. The majority of patients (n=83; 69.17%) did not have appointments, were from rural areas (n=79; 65.83%), and had no formal education (n=91; 75.83%). In our study, 49 women (40.83%) were primigravidas, whereas 71 women (59.17%) were multigravidas. Following misoprostol introduction, the average Bishop's score increased to 6.89 ± 2.3 from 2.32 ± 1.28 at baseline, a difference of 4.57 on average.

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

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

Oxytocin versus prostaglandins for labour Induction of women with an unfavourable cervix after 24 hours of cervical ripening (OPIC): protocol for an open multicentre randomised non-inferiority trial

IntroductionIt remains uncertain whether the most appropriate management for women with an unfavourable cervix after 24 hours of cervical ripening is repeating the ripening procedure or proceeding directly to induction...

Mode of delivery after labor induction with vaginal dinoprostone versus oral misoprostol for women with unfavorable cervix at term

ObjectiveTo compare the delivery mode after labor induction with 10 mg vaginal dinoprostone insert versus oral misoprostol 50 µg/4 h for women with an unfavorable cervix. Material and methodsThis is a retrospective observational study comparing the before/after introduction of oral misoprostol for labor induction, conducted at the Saint-Étienne University Hospital on a cohort of 396 women with a Bishop score <6. One hundred and twelve women (28.3%) were treated with a 10 mg vaginal dinoprostone insert versus 284 (71.7%) with oral misoprostol 50 µg/4 h. The primary outcome was the cesarean section rate. ResultsLabor induction with vaginal dinoprostone was independently associated with an increased rate of cesarean sections compared to oral misoprostol (aOR = 2.44; CI95% from 1.35 to 4.40; p = 0.003). The use of vaginal dinoprostone increased the induction rate during more than 48 h (18.8% versus 9.9%; p = 0.02), and the occurrence of fetal heart rate changes (34.8% versus 21.1%; p = 0.005). The maternofetal morbidity was similar. ConclusionLabor induction with vaginal dinoprostone was independently associated with an increased rate of cesarean sections compared to oral misoprostol in women with an unfavorable cervix.