Failed Induction Of Labor Research Articles

Incidence of and Risk Factors for the Failed Induction of Labour-A Prospective Observational Study

Introduction: Induction of labor (IOL) is an artificial stimulation of uterine contraction at 28 or more weeks of gestation but before spontaneous onset of labor to achieve vaginal delivery and it is a common practice in current obstetrics. IOL is a life-saving obstetrical intervention indicated only when the benefits of discontinuing the pregnancy outweigh the risks of continuation. Objective: To study the incidence of and risk factors for the failed induction of labour. Methodology: This is a prospective observational study conducted at Dept. of Obst & Gynae, Shaheed Tazuddin Ahmad Medical College & Hospital, Gazipur, Bangladesh from January to June 2022. Total 120 woman who were induced with dinoprostone gel and who ended up with caesarian section were included in the study. Factors which might be responsible for the failed labor induction were assessed. Women who were taken up for caesarian section for fetal distress were excluded from the study. Results: Total 120 women with failed labour induction were included in the study, and we found that majority of the women were primiparous (75%), in the age group of 25 to 29 years (60.8%), and we found that most common indication of doing IOL is post-dated pregnancy (30%). Unfavorable cervix with bishop’s less than 5 was found in majority of the cases (28.3%). Other factors were gestational hypertension (19.1%), IUGR (10%), prolonged PROM (8.3%), gestational diabetes mellitus (8.3%), Rh negative pregnancy (3.3%). Conclusion: Induction of labour is an important obstetric procedure. There is a need to develop a protocol for the same. The success of induction of labour is determined by many maternal and fetal factors, which must all be taken into account to avoid unnecessary cesarean sections.

Vaginal Misoprostol Pharmacokinetic Changes in Obese Parturient Women Who Presented Labor Induction Failure.

Clinical experience shows an increased duration of labor in obese parturient women. It is unclear if this population should receive the same dose of vaginal misoprostol for induction of labor as non-obese parturient women. We investigate the influence of obesity on the pharmacokinetics and placental transfer of the metabolite misoprostol acid in parturient women. Parturient women (n = 40) were enrolled and received misoprostol 25 µg/6 h vaginally and were allocated into two groups according to the pre-pregnancy body mass index (BMI <30 kg/m2 non-obese, n = 18 or BMI >30 kg/m2 obese, n = 22) or according to the labor induction outcome (failure [n = 10] or success [n = 30]). Blood collection for pharmacokinetic study occurred after the first misoprostol dose. The pharmacokinetic parameters obtained in non-obese parturient women were not statistically different from those obtained in obese group (PValue > .05). However, when the parturient women were grouped by the labor induction outcome, the failed labor induction group presented a higher (median [interquartile range]) BMI (44.4 [34.6-47.9] vs 33.7 [28.9-36.5] kg/m2) (PValue = .0017), lower Cmax (11.5 [4.82-22.2] vs 22.8 [14.2-30.8] pg/mL) (PValue = .0308) and not statistically different AUC0-6 (31.8 [13.4-61.5] vs 53.4 [35.4-77.7]) pg·h/mL) (PValue = .0580) and tmax (2.50 [1.19-4.25] vs 3.00 (1.88-5.00) h (PValue = .3198) when compared with parturient women who presented successful labor induction. This data suggests a higher loading dose (higher volume of distribution) and unchanged maintenance dose (unchanged AUC0-6) of misoprostol for this population. Further studies are required to investigate the efficacy and safety of higher misoprostol loading doses for this population.

The effect of sweet almond oil vaginal suppository on the cervical ripening in nulliparous pregnant women: A randomized controlled trial

BackgroundThe failure of labor induction often occurs when the cervix is not ripe. To mitigate the side effects of chemical drugs, herbal medicines are now being considered for cervical ripening. This study aimed to investigate the impact of sweet almond oil vaginal suppositories on cervical ripening in nulliparous women. MethodsThis three-blinded clinical trial was conducted in 2023–2024 and involved 60 pregnant women who were referred to Shahid Hashmi-nejad Hospital in Mashhad. Women were randomly divided into two groups through a random sequence with a block size of 4, and then were given either a daily vaginal suppository of sweet almond oil or a placebo for up to one week from 40 weeks (0/7) of gestational age. The Bishop score was assessed before the intervention, 72 hours later, and four to seven days after the intervention. Data analysis was performed using SPSS 25, and the independent sample t-test, Mann-Whitney, and Wilcoxon tests were used. P value less than 0.05 was considered significant. ResultsThe intervention group and placebo group had a mean Bishop score of 1.7 ± 1.4 and 0.6 ± 0.8 respectively. After 72 hours, the mean scores for the intervention and placebo groups were 4.0 ± 2.5 and 0.9 ± 1.6, respectively and four to seven days after the intervention, the mean scores for the sweet almond oil and placebo groups were 4.5 ± 2.1 and 1.2 ± 2.1 respectively. The Mann-Whitney test demonstrated a significant difference in the Bishop scores during these three follow-ups (P < 0.001). ConclusionBased on the positive impact of sweet almond oil vaginal suppositories on increasing the Bishop score, it is recommended to utilize this affordable, safe, and accessible method for cervical ripening in nulliparous women.

Efficacy of Dilapan S compared to foley balloon in preinduction cervical ripening—a noninferiority trial

The need for induction of labor is increasing in present obstetric practice. The available non-pharmacological methods for cervical ripening at term are Foley balloon and Dilapan-S. With the gaining popularity of Dilapan-S worldwide, there are very few clinical trials conducted in India to evaluate its effectiveness. To compare the efficacy of Dilapan-S and Foley balloons for pre-induction cervical ripening. This single-center randomized non-inferiority trial included primi- and multi-gravida women between 37 and 41 weeks of gestation and unfavourable cervix with a Bishop's score between 0 and 2. Using a random number table, patients were assigned to study Group 1 Dilapan-S and to control Group 2 Foley balloon. Dilapan-S or Foley balloon was inserted intracervically and assessed for dilation after 12 hours. Patients with unfavourable dilatation were further provided prostaglandins (PgE 1 and 2) for further augmentation of induction. Primary outcome measures included improvement in Bishop's score, and mode of delivery, followed by time to delivery from intervention, use of other augmentation methods, and maternal and neonatal outcomes. After screening, 296 patients with Bishop score less than 2, (148 in each group) were enrolled in the study. The number of patients who had vaginal delivery was comparable between both groups (p=.72), and so were the maternal outcomes. Two cases of cord prolapse occurred with Foley balloon. Group 2 showed significant improvement in Bishop's score (p<.001), and Group 1 had a significantly higher use of augmentation with PgE1 (p-.01) and PgE2 (p<.001). The number of contractions was significantly lower in Group 1 (p<.001), and contraction intensity was higher in Group 2. There was no significant difference in cesarean delivery for failed induction of labor between the groups (p=.72). Based on the primary outcome measure, Dilapan-S was found to be non-inferior to the Foley balloon. Dilapan-S is non-inferior to Foley balloon in achieving pre-induction cervical ripening in term pregnancies, and therefore Dilapan-S can be suggested as an alternative in clinical practice with minimal risks.

Adherence to Labor Arrest and Failed Induction of Labor Guidelines: The Impact of a Quality-Improvement Educational Intervention.

Background/Objective: To evaluate adherence to labor arrest and failed induction of labor (IOL) criteria in nulliparous, term, singleton, and vertex (NTSV) cesarean deliveries at an academic medical center and to measure the impact of a quality-improvement educational initiative that focused on obstetric provider education of modern labor arrest and failed IOL criteria. Methods: This is a retrospective cohort study using electronic health record (EHR) data with a pre- (1 September 2018-30 September 2019) and post-intervention (1 October 2019-31 March 2020) study design of all NTSV cesarean deliveries for labor arrest or failed IOL performed at an academic medical center in the northeastern United States. The quality-improvement educational intervention consisted of the distribution of educational pocket cards outlining modern labor arrest and failed IOL criteria to obstetric providers. Outcomes included adherence to labor arrest and failed IOL criteria pre- and post-intervention with secondary outcomes evaluating adherence by provider type (Maternal-Fetal Medicine (MFM) or generalist obstetrician). Descriptive and bivariate statistics were used in the analysis. Results: Pre-intervention, 272 NTSV cesarean deliveries were performed for labor arrest or failed IOL versus 92 post-intervention. Adherence improved post-intervention amongst failed IOL (OR 6.5, CI 1.8-23.8), first-stage arrest (OR 4.5, CI 2.2-10.8) and second-stage arrest (OR 3.7, CI 1.5-9.4). When comparing provider type, MFM physicians were more likely to be adherent to labor arrest and failed IOL criteria compared to generalist obstetricians pre-intervention (OR 3.1, CI 1.7-5.5); however, post-intervention, there was no longer a difference in adherence (OR 3.3, CI 0.9-12.3). Conclusions: Adherence to labor arrest criteria was suboptimal in the pre-intervention period; however, a targeted quality-improvement educational intervention improved adherence rates to labor arrest and failed IOL criteria among obstetric providers.

Experience of dinoprostone vaginal insert using for cervical ripening and induction of labor

Introduction. Presently, preinduction and induction of labour is one of the approaches to improve maternal and perinatal outcomes. In this regard, the rate of labour induction is steadily increasing.Aim. To determine the efficacy and safety of dinoprostone vaginal insert for cervical ripening and labor induction.Materials and methods. The study included 81 women with a singleton pregnancy of 37 weeks. and more, cephalic presentation of the fetus, with the birth canal not ready and the presence of indications for induction of labor. Dinoprostone vaginal insert was placed for 24 hours or till onset of labor. After removal of the dinoprostone vaginal insert patient was undergoing cervical assessment by digital Bishop Score immediately. If labor didn’t start spontaneously, additional cervical ripening procedures may be considered or labor induction.Result. The Bishop score increased on average by 2 points after cervical ripening with dinoprostone vaginal insert. 77.78% of patients went into labor before dinoprostone vaginal insert removing. 71.6% of the women had the vaginal birth. The cesarean section rate was 29.6%. Failed labor induction was observed in 2.47% cases. All the children were born alive. The average weight of newborns corresponded to the general population. No infectious complications or significant side effects were recorded in the study.Conclusion. The use of dinoprostone vaginal insert is an effective method for cervical ripening (increase in Bishop score by an average of 2 points, p &lt; 0.05) and labor induction (onset of labor before removal of SVT in 78% of cases) with a good safety profile (there were no serious adverse or side effects).

Maternal and Neonatal Characteristics Associated With Failed Induction of Labor in Diabetic Mothers [ID 2683497

INTRODUCTION: Uncontrolled diabetes is a risk factor for cesarean delivery. Identifying and stratifying associated risk factors for failed induction of labor (IOL) may improve counseling and intrapartum care. This study aims at determining maternal and fetal factors that would predict the occurrence of failed IOL in diabetic mothers. METHODS: This is a retrospective study of 2,172 diabetic mothers who underwent IOL at a single university medical center between January 2013 and December 2021. Maternal and neonatal characteristics were obtained. Among the studied maternal characteristics were ethnicity, age, gestational age, medical comorbidities (including preeclampsia and essential hypertension), insulin administration, parity, and health insurance type (public versus private). Statistical analysis was performed using univariate and multivariate logistic regression. A value of P&lt;.05 was considered statistically significant. RESULTS: Our preliminary analysis showed that 567 out of 2,172 (26.1%) diabetic mothers failed IOL and delivered via cesarean pathway. Failed IOL was associated with nulliparity (P=.0001), preexisting diabetes (compared to gestational diabetes) (P=.001), control of diabetes by insulin (P=.001), maternal essential hypertension (P=.001), preeclampsia (P=.001), polyhydramnios (P=.001), prenatal diagnosis of fetal growth restriction (P=.008), and placental abnormalities (P=.027). Neonatal weight, large for gestational age, head circumference, and height were not statistically associated with failed induction of labor (all values of P&gt;.05). Failed IOL was associated with admission to neonatal intensive care unit (P=.001), hyperbilirubinemia (P=.001), lower APGAR score at 1 minute (P=.033), longer stay in the hospital (0.001). Failed IOL was not associated with lower APGAR score at 5 minutes, lower umbilical cord pH value, neonatal readmission or maternal ethnicity (all values of P&gt;.05). CONCLUSION: Failed IOL among diabetic mothers is associated with significant maternal and neonatal adverse outcomes. Our continued data analysis aims at assessing the role of optimal glucose control and other maternal factors in improving maternal and neonatal outcomes.

A missed mummified twin abdominal pregnancy: A case report

Background: Abdominal pregnancies are rare pathologic ectopic pregnancies that occur in 1:10,000-30,000 pregnancies. Implantation sites include the pelvic and abdominal peritoneum, uterine surface, omentum, and abdominal organs, including the intestine, liver, spleen, diaphragm, and large blood vessels. They are frequently missed antenatally, especially because there are no specific clinical signs and symptoms for abdominal pregnancy making diagnosis difficult. Diagnosis is often made during cesarean delivery. Ultrasonography modalities have high diagnostic errors between 50 and 90%. Case presentation: A 41-year-old presented with copious purulent vaginal discharge that was mixed with blood and was foul-smelling for two months as a referral to the Kenyatta National Hospital. Abdominopelvic computed tomography revealed a heterogeneous lesion in the left hemi abdomen. Her last menstrual period was December 2022 with DMPA in the same month. Her PDT was negative. She was sick-looking and had a purulent vaginal discharge. Intraoperatively, 500 mls of serous fluid was observed, and abdominal pregnancy, approximately 24–28 weeks of gestation with mummified skull bone, brain tissue, ribs, and long bones of the lower and upper limbs in their multiples suggestive of twin gestation. The patient’s postoperative period was uneventful, and she was later discharged in good condition. Conclusion: Proper and timely diagnosis of abdominal pregnancy is required to improve outcomes, especially maternal outcomes. In this case, the pregnancy was fatal to the fetus, although maternal mortality have been reported. The diagnosis may come as a surprise finding intraoperatively theatre-like in this case and in some cases postemergency cesarean delivery for failed labor induction. The diagnostic modality of choice is ultrasonography, although our patient had ultrasound and computed tomography but ended up with a misdiagnosis because of the complexity of the diagnosis of abdominal pregnancy.

Prevalence of failed induction of labor and associated factors among women who underwent induction of labor in Ethiopia: A systematic review and meta-analysis.

The occurrence of failed induction led to higher rates of health problems and death among mothers, mainly as a result of complications related to cesarean delivery, such as postpartum bleeding, morbidly adherent placenta and surgical site infection. Even though a systematic review and meta-analysis were done before July 2020 with limited studies, there were varies inconsistent studies after that and no updated summarize evidence about the issue as a nation. Therefore, this systematic review and meta-analysis aimed to assess the current pooled prevalence of failed induction and its associated factors in Ethiopia by including multiple inconsistent studies. Comprehensive literature was searched in PubMed, Google Scholar, and HINARI from January 1, 2013, to September 23, 2023. A random effect model was used to estimate pooled prevalence and adjusted odds ratio. Stata (version17.0) was used to analyze the data. Cochrane Q-test and I squared statistics were computed to assess heterogeneity among studies. A sub group analysis was done based on study region to minimize underling heterogeneity. Funnel plot and Eggers test were done to assess publication bias and corrected by trim and fill analysis. Overall, one thousand fifty-two articles were retrieved and finally twenty-eight studies were included in this systematic review, including 9757 participants. The pooled prevalence of failed induction of labor was 22.39% (95% CI: 21.57-23.21). Subgroup analysis showed that failed induction of labor was highest in Addis Ababa and lowest in Tigray region. Rural residence (AOR = 3.31, 95% CI: 2.39-4.57), nullipara women (AOR = 2.63, 95% CI: 2.14-3.24), unfavorable bishop score (AOR = 3.98, 95% CI: 2.19-7.08), hypertensive disorder during pregnancy (AOR = 3.63, 95% CI: 2.69-5.01) and premature rupture of membranes before the onset of labor (AOR = 2.51, 95% CI: 1.5-4.26) were significantly associated with failed induction of labor. The pooled prevalence of failed induction of labor in Ethiopia was high. Unfavorable bishop score, nulliparous, rural residence, women who had premature rupture of membrane and hypertensive disorder during pregnancy were significantly associated with failed induction of labor. Therefore, Healthcare providers or obstetricians should consider proper cervical assessment for bishop score before the initiation of induction. The Ministry of Health ought to create a distinct set of guidelines specifically addressing the cervical ripening and/or induction protocol for women who experienced premature rupture of membranes (PROM) and had a hypertensive disorder during pregnancy, especially those who were administered magnesium sulfate (MgSO4).

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.

A study of risk factors for the failed induction of labour

A study of risk factors for the failed induction of labour

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.

The Effect Of Maternal Body Mass Index On Duration Of Induced Labor

Background: Induction is the stimulation of uterine contractions to aid childbirth. Meanwhile, the prevalence of obesity is predicted to grow by 33% worldwide by the year 2030. Genetic, environmental, behavioral, and social elements all have a role in the development of obesity. The prevalence of obesity is highly associated with both ancestry and ethnicity. Numerous illnesses and malignancies are only a few of the many that can be exacerbated by obesity. Menstrual irregularities, infertility, and premature birth are just a few of the ways that obesity negatively affects a woman's ability to have healthy, natural children. Longer labors and more cesarean sections are directly related to the rising prevalence of maternal obesity, which also correlates with an increase in the use of labor induction. The present study aims to evaluate the effect of maternal body mass index on the duration of induction of labor. Methods: A prospective cohort study was conducted at AL-Zahraa Teaching Hospital from December 2022 to June 2023. It included 100 pregnant women divided into overweight/obese and non-obese groups. Prim and multi gravida term pregnant women with unfavorable cervix and not in labor were included. The collected data included demographical, menstrual, medical, and surgical history, and assessment of labor duration and success. Labor was induced by using PGE1 and oxytocin. Failed induction was defined as cervical dilatation &gt;4 cm not achieved after 12 ± 3 h of labor or ending with a cesarean section. Results: The study examined 100 women undergoing labor induction, finding a success rate of 80% for vaginal delivery and 20% ending in caesarean sections. Notably, failed inductions were associated with larger gestational age and higher Body Mass Index (BMI). In fact, 90% of those who had a failed induction of labor were obese (BMI &gt;30 kg/m²). Despite these findings, there were no significant variations in maternal age, gravidity, parity, and miscarriage rates between the successful and failed induction groups. Conclusion: Higher BMI increases the likelihood of failed labor induction but its impact on the duration of induction is not clearly established from the current data which may need further study with increasing sample size.

Failed induction of labor in term nulliparous women with an unfavorable cervix: Comparison of cervical ripening by two forms of vaginal prostaglandins (slow-release pessary and vaginal gel).

To compare the rate of failed induction after cervical ripening by two forms of vaginal prostaglandins. This two-year retrospective study (January 1, 2016, through December 31, 2017) in two tertiary maternity units included nulliparous women with a singleton fetus in cephalic presentation and an unfavorable cervix requiring labor induction for prolonged pregnancy. The principal endpoint was the rate of failed induction, defined by the performance of a cesarean delivery before 6 cm of dilation. Cervical ripening was initiated by prostaglandins for 24h, using a slow-release pessary (unit A) or a vaginal gel (unit B). The care protocol of the two groups after the first 24h were similar. The women's individual characteristics were compared between the two units. The rates of failed induction were then compared between the two units, first by univariate and then by multivariable analysis adjusted for the characteristics that differed significantly between the units. Among the 17,217 women delivered in the two maternity units during the study period, 178 met our inclusion criteria (125 in unit A (slow-release pessary) and 53 in unit B (vaginal gel)). The rate of failed induction was similar: 21.6% in unit A (slow-release pessary) and 17.0% in unit B (vaginal gel) (P=0.48). The multivariate analysis did not show any difference about failed induction, time from the onset of induction to delivery, and vaginal delivery rate within 24h. The rate of failed induction of labor did not differ between slow-release pessary and vaginal gel.

A Comparison of Two Dosing Regimens of Misoprostol in Labour Induction: A Randomised Controlled Trial

Objective: To compare the effectiveness and safety of 50μg of sublingual misoprostol administered six (6) hourly to that of 50μg of vaginal misoprostol administered four (4) hourly. Methodology: A non-blinded, randomized controlled trial conducted from Sept 1, 2014, to Nov 31, 2014, at a tertiary hospital in Ghana. Hundred and sixty women with medical or obstetric indications for labour induction were randomized into two groups. Results: The rate of vaginal delivery, caesarean section, uterine tachysystole and uterine hyperstimulation were similar in both groups. Sixty-three (78.8%) and 66 (82.5%) mothers in the vaginal and sublingual groups delivered vaginally. More (10.0%) mothers in the vagina group required emergency caesarean for foetal distress. Six (vaginal group) and 8 (sublingual group) of the mothers required emergency caesarean for cephalopelvic disproportion. Three mothers from each group had an emergency caesarean section due to failed labour induction. Almost the same number of mothers had uterine tachysystole in both groups. More (3.8%) mothers in the vaginal group had uterine hyperstimulation. Differences in the mean induction delivery interval and the need for oxytocin augmentation were not significant. No differences were found in the intrapartum passage of meconium, blood loss in the third stage of labour, 5-minute Apgar score &lt;7, and neonatal intensive care unit admissions. Conclusion: The sublingual regimen was as effective and safe as the vaginal regimen in achieving vaginal delivery.

Effect of Vaginal Washing before Intravaginal Prostaglandin Insertion on Induction of Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Saline vaginal douching prior to intravaginal prostaglandin application might increase the vaginal pH, leading to improvement of prostaglandin bioavailability, by which the outcomes of labor induction can be greatly improved. Thus, we aimed to evaluate the effect of vaginal washing with normal saline before insertion of vaginal prostaglandin for labor induction. A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI Web of Science from inception to March 2022. We selected randomized controlled trials (RCTs) that compared vaginal washing using normal saline versus no vaginal washing in the control group before intravaginal prostaglandin insertion during labor induction. We used RevMan software for our meta-analysis. Our main outcomes were the duration of intravaginal prostaglandin application, duration from intravaginal prostaglandin insertion to active phase of labor, duration from intravaginal prostaglandin insertion till total cervical dilatation, labor induction failure rate, incidence of cesarean section (CS), and rates of neonatal intensive care unit (NICU) admission and fetal infection postdelivery. Five RCTs were retrieved with a total number of 842 patients. Duration of prostaglandin application, duration from prostaglandin insertion to active phase of labor, and time interval from prostaglandin insertion to total cervical dilatation were significantly shorter among vaginal washing group (p < 0.05). Vaginal douching prior to prostaglandin insertion significantly decreased the incidence of failed labor induction (p < 0.001). After the removal of reported heterogeneity, vaginal washing was linked to a significant decline in CS incidence (p = 0.04). In addition, the rates of NICU admission and fetal infection were significantly lower in the vaginal washing group (p < 0.001). Vaginal washing with normal saline before intravaginal prostaglandin insertion is a useful and easily applicable method for labor induction with good outcomes. · Induction of labor is frequently used in the obstetrics field.. · We assessed vaginal washing impact before prostaglandin insertion for labor induction.. · Vaginal washing is an easily applicable method for labor induction with good outcomes..

Lower uterine segment thickness assessed by transvaginal ultrasound before labor induction: reproducibility analysis and relationship with delivery outcome.

To evaluate the reproducibility of lower uterine segment (LUS) thickness measurement before induction of labor (IOL), and to assess the relationship between LUS thickness and IOL outcomes. This was a prospective cohort study of pregnant women undergoing IOL at term, conducted in a single tertiary hospital between July 2014 and February 2017. Women with a singleton pregnancy at ≥ 37 weeks' gestation, with a live fetus in cephalic presentation and a Bishop score of ≤ 6, were eligible for inclusion. Both nulliparous and parous women, and those with a previous Cesarean section (CS), were eligible. All women underwent transvaginal ultrasound assessment before IOL admission, and cervical length and LUS thickness were measured offline after delivery. Maternal and obstetric characteristics and Bishop score were recorded. The main outcome was the overall rate of CS after IOL, and secondary outcomes were CS for either failure to progress in the active phase of labor or failed IOL, and CS for failed IOL only. Interobserver agreement for measurement of LUS thickness between two operators was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis with the ANOVA test to evaluate systematic bias. Univariable and multivariable analysis were employed to evaluate the relationship between clinical and sonographic characteristics and IOL outcomes. Of 265 women included in the analysis, 195 (73.6%) had a vaginal delivery and 70 (26.4%) required a CS after IOL. Reproducibility analysis showed excellent interobserver agreement for the measurement of LUS thickness (ICC, 0.96 (95% CI, 0.93-0.98)). On Bland-Altman analysis, the mean difference in LUS thickness between the two operators was 0.15 mm (95% limits of agreement, -1.84 to 2.14 mm), and there was no evidence of systematic bias (ANOVA test, P = 0.46). Univariable analysis showed that LUS thickness was associated significantly with overall CS (P = 0.002), CS for failure to progress in the active phase of labor or failed IOL (P = 0.03) and CS for failed IOL (P = 0.037). On multivariable logistic regression analysis, LUS thickness was an independent predictive factor for overall CS (odds ratio (OR), 1.149 (95% CI, 1.031-1.281)) and CS for failure to progress in the active phase of labor or failed IOL (OR, 1.226 (95% CI, 1.039-1.445)). In women undergoing IOL at term, measurement of LUS thickness is feasible and reproducible, and is associated significantly with IOL outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

The Association between Cervical Length and Successful Labor Induction: A Retrospective Cohort Study.

This study aimed to determine whether transvaginal sonographic measurement of cervical length before labor induction can predict successful induction. This retrospective study recruited 138 pregnant women who underwent labor induction at 37-41 weeks of gestation. Cervical length was measured using transvaginal ultrasonography before labor induction. Labor was induced according to the hospital protocol. Age, gestational age (GA), parity, body mass index (BMI), Bishop score, hemoglobin level, maternal disease, and epidural anesthesia were also recorded. Labor induction outcomes, including cesarean section for failed induction, time of induction, and the three labor stages, were assessed. From December 2018 to December 2021, 138 women were recruited for our study, including 120 and 18 women with successful and failed labor induction, respectively. Shorter cervical length (≤3.415 cm, OR = 6.22, 95% CI = 1.75-22.15) and multiparity (OR = 17.69, 95% CI = 2.94-106.51) were associated with successful induction. Higher BMI was associated with failed induction (OR = 0.87, 95% CI = 0.75-0.99). Age, GA, Bishop score, and fetal birth weight were not associated with successful labor induction. The ROC curve showed a cervical length cutoff value of 3.415 cm, revealing 76.8% of the area under the curve. In conclusion, a shorter cervical length (≤3.415 cm) was associated with a higher chance of successful labor induction (76.8%). This parameter might be used to predict the chance of successful labor induction. This information could help better inform clinician discussions with pregnant women concerning the chance of successful labor induction and consequent decision-making. Nevertheless, further large-scale clinical trials are warranted.

Maternal and perinatal outcomes of failed prostaglandin induction of labour: A retrospective cohort study

BackgroundInduction of labor is performed in up to 25% of pregnant women. When the cervix is unfavorable, cervical ripening may be safely and effectively performed using slow-release vaginal inserts of prostaglandin E2. However, the risk factors, management, and outcome of patients who fail to respond remain unclear. ObjectiveTo evaluate the outcomes of women who fail to respond to cervical ripening with prostaglandins. MethodsA retrospective cohort analysis (2013–2019) was conducted. Women with a singleton gestation who underwent induction of labor due to post-date pregnancy using a slow-release prostaglandin E2 vaginal insert for cervical ripening were included. Data on clinical and outcome factors were derived from the medical files, and findings were compared between patients who achieved ripening within 24 h of treatment onset and those who did not. The primary outcome measure was the vaginal delivery rate following the ripening process. Secondary outcome measures were adverse composite maternal and neonatal outcomes. A model combining maternal characteristics and response rates to ripening was constructed. ResultsThe final cohort included 1285 women: 1202 responded to cervical ripening (93.54%) and 83 (6.46%) did not. Compared to non-responders, responders had higher rates of vaginal delivery (96.51% vs. 66.27%, P < 0.001); lower rates of adverse maternal composite outcome (12.81% vs. 24.10%, P = 0.031) and adverse neonatal composite respiratory outcome (1.33% vs. 6.02%, P = 0.009). Responders were younger than non-responders (mean 30.03 years vs 31.73 years, P = 0.005) and had a lower nulliparity rate (50.99% vs 76.92%, P < 0.001). On multivariate analysis, failure to achieve cervical ripening was an independent risk factor for intrapartum cesarean delivery due to prolonged labor (aOR 11.90, 95% CI 6.13–23.25). ConclusionWomen who achieve cervical ripening with prostaglandin E2 vaginal inserts are younger and more often multiparous than women who fail to respond. Good response to the cervical ripening process is associated with lower rates of intrapartum cesarean delivery and of adverse outcomes.

Failed Induction of Labor and Associated Factors Among Women Who Undergone Induction of Labor in Jimma Medical Center, Ethiopia: A Hospital-Based Cross-Sectional Study

BACKGROUNDAlthough induction of labor is intended to achieve a safe vaginal delivery, its process is not always successful. Failed induction of labor leads to an increased risk of complication for both mother and fetus. Thus, this study aimed to assess the proportion of failed induction of labor and associated factors among women who undergone induction of labor from September 1, 2019 to August 31, 2020 in Jimma Medical Center (JMC), southwest Ethiopia.METHODSA hospital-based retrospective cross-sectional study was conducted on 243 charts of women who had induction of labor in JMC selected by a simple random sampling method from January 10 to 30, 2021. The collected data were entered into Epi-data version 4.2 and analyzed by SPSS version 23. Bivariate and multivariable logistic regression analyses were done to test the association. Adjusted odds ratio at 95% confidence interval (CI) andP-value &lt;.05 was used to ascertain statistical significance.RESULTSThe proportion of failed induction of labor in JMC was 16.9%. Maternal age ≥ 30 years (AOR 7.57; 95%CI = 2.88, 19.9) at (P-value = .000), elective induction (AOR .39; 95% CI = .16, .98) at (P-value = .045), and unfavorable bishop score (AOR 6.94; 95%CI = 2.35, 20.4) at (P-value = .000) were factors statistically significantly associated with failed induction of labor.CONCLUSIONSThe proportion of failed induction of labor was relatively low in the study area. Advanced maternal age, elective induction, and unfavorable bishop score were associated with failed induction of labor. Thus, the hospital should strictly follow the protocol for induction of labor, and candidates of emergency induction of labor should be counseled thoroughly so as to be well prepared psychologically for the labor thereby reducing the risk of failed induction.