Indication For Induction Of Labor Research Articles

Induction of labor in late-term pregnancy: amniotomy plus early oxytocin perfusion versus amniotomy plus oxytocin perfusion delayed by 24 h

ObjectiveTo assess the maternal and fetal benefits of delaying oxytocin perfusion by 24 h following labor induction by amniotomy after 41 weeks of gestation (WG). MethodsWe performed a retrospective review including all women with a vertex presentation fetus who had an indication for labor induction by amniotomy with or without oxytocin after 41 WG between 2015 and 2022. Patients who underwent an IOL by amniotomy followed by oxytocin perfusion within 0 to 4 hours (early oxytocin group: EO group) were compared with patients who underwent an IOL by amniotomy alone or followed by an oxytocin perfusion after an expectant period for up to 24 hours in the absence of a spontaneous onset of labor (delayed oxytocin group: DO group). The primary outcome was the rate of vaginal delivery (natural or operative). The secondary outcomes were maternal and neonatal complications. ResultsWe included 363 patients: 103 patients in the EO group and 260 in the DO group. Only 47 of the women in the DO group (18%) required oxytocin. The proportion of vaginal deliveries was significantly higher in the DO group (248 patients, 95.4%) than in the EO group (85 patients, 82.55%) (p<0.01). Maternal morbidity did not differ significantly between groups. Fewer babies displayed severe newborn acidemia or required transfer to the neonatal intensive care unit in the DO group (p<0.05). ConclusionDelaying oxytocin administration by 24 hours after amniotomy was associated with a significantly higher rate of vaginal delivery. These results required confirmation in prospective randomized studies.

Vaginal dinoprostone insert compared with two different oral misoprostol regimens for labor induction in nulliparous and multiparous women.

Labor induction exhibits considerable variations in protocols and medication regimens. Limited studies compare vaginal dinoprostone inserts with different oral misoprostol dosages, considering parity influence. This study explores the distinctions among 10 mg vaginal dinoprostone inserts and oral misoprostol 25 μg every 2 and every 4 h for labor induction, stratified by parity. This retrospective cohort study involved 607 participants across two hospitals. The primary outcome, time from induction to delivery, and secondary outcomes, including mode of delivery and maternal and fetal safety, were assessed. Patient characteristics revealed differences in indication for labor induction, with the dinoprostone cohort having fewer post-term and premature rupture of membranes cases but more intrauterine growth restriction/small-for-gestational age. Both oral misoprostol regimens showed a shorter time to delivery interval compared to the dinoprostone cohort (median: 1380 min [IQR 1381.0] and 1127.0 min [IQR 1214.0] versus 1631.5 [IQR 1736.2], p < 0.001 and p = 0.014). Only the difference between oral misoprostol q2h and vaginal dinoprostone remained significant for nulliparous but not multiparous women, losing significance over all the population after adjusting for confounding factors. The proportion of women giving birth within 24 h did not significantly differ between misoprostol q2h and dinoprostone after adjusting for confounders. When comparing misoprostol q4h with dinoprostone after confounder adjustment, an increased time to delivery interval for misoprostol q4h was found (p = 0.001). Both oral misoprostol regimens exhibited fewer meconium-stained liquor (miso q4h: OR 0.44, miso q2h: OR 0.34) and cesarean sections (miso q4h: OR 0.48, miso q2h: OR 0.53) compared to dinoprostone, even after adjustment for confounders. Our study suggests that oral misoprostol 25 μg q4h is less effective than 10 mg vaginal dinoprostone for labor induction if parity and indication for induction are adjusted for, particularly in multiparous women. In terms of side effects, oral misoprostol regimens seem superior to vaginal dinoprostone. Our data support the individualized use of different agents for labor induction according to parity, indication for induction, bishop score, and women's preference.

Induction of Labour: What to Consider

Induction of Labour (IOL) is a method of artificially providing stimulus to the uterus to start the process of labour.1 It utilises iatrogenic therapies such as a synthetic oxytocin, cervical ripening medications, in conjunction with the artificial rupture of membranes, to imitate the physiology of labour and childbirth.2 The indication for IOL is dependent on the clinical need to optimise maternal, fetal and neonatal outcomes, juxtaposed with the potential adverse effects of the IOL process. Indications include uterine, placental and fetal growth disorders, hypertensive conditions and diabetes.3 For example, the National Institute for Clinical Excellence (NICE) recommend IOL between 37 and 38 plus six weeks for pregnant populations who have type 1 or type 2 diabetes, to prevent stillbirth and associated complications.4 The absolute effectiveness of IOL intervention in preserving maternal and fetal health is evident5 however, the World Health Organization (WHO) endorses the consideration of choice of IOL method.6

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).

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..

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.

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.

Comparison of Dinoprostone versus Oxytocin with Dinoprostone for the Induction of Labour: A Retrospective Case-control Study in a Tertiary Clinic in Türkiye

Aim: Even though the number of inductions is still rising, limited information is available about the results of subsequent pregnancies following induction. The current study was aimed at comparing the effectiveness of dinoprostone and low-dose oxytocin with dinoprostone in the induction of labour for term pregnancies to assess the need for additional uterotonic agents. Material and methods:In this retrospective study, 99 patients with full-term pregnancies (completed 37 weeks or more of pregnancy) who had unripe cervixes underwent labour induction for different reasons were evaluated. BISHOP score was performed to predict the patient who required labour induction. All participants were given either only a sustained-release dinoprostone vaginal insert or low-dose administration of oxytocin to the dinoprostone. Two patient groups’ clinical characteristics were compared. Results: No statistically significant differences were found between the two groups based on age, gravity, parity, and gestation weeks. However, there was a significant difference between the two groups in terms of the duration of the active phase of labour and time from admission until the end of the second stage of labour (p=0.04). Labour and birth occurred in a significantly shorter time in the dinoprostone + oxytocin group. Common indications for induction of labour were post-term pregnancy (77.14%). The cesarean section ratio was found to be similar in both groups (p=0.084). There was no statistically significant difference between the two groups in terms of adverse events such as tachysystole and hyperstimulation of the uterus and infant outcomes (p&gt;0.05). Conclusion: Sustained-release dinoprostone and dinoprostone with low-dose oxytocin were both found to be effective augmentations in the management of delay in labour. Our results supported that administration of oxytocin with dinoprostone vaginal insert dramatically shortened induction to delivery times, and no significant increase of cesarean section rate had been found.

Efficacy of Foley Catheter Bulb with Intracervical Dinoprostone Gel versus Dinoprostone Gel Alone for Cervical Ripening and Induction of Labour: An Observational Study

Introduction: One of the most common obstetrical interventions is the induction of labour. Cervical ripening drugs are typically used before conventional methods of induction since they are linked to an increased risk of protracted labour, chorioamnionitis, and Caesarean Sections (CS) during labour induction when an unfavourable cervix is present. The two major techniques for cervical ripening are mechanical interventions, such as the insertion of balloon catheters, and the application of pharmacologic agents, such as prostaglandins. It is widely accepted that the induction of labour, which ultimately leads to vaginal delivery, is largely dependent on the condition of the uterus’ cervix. Aim: To compare the efficacy of a combination of Foley bulb catheter and intracervical Dinoprostone and intracervical Dinoprostone alone for the induction of labour. Materials and Methods: A prospective observational study was performed over 150 pregnant mothers from May 2018 to April 2019. in the labour room of North Bengal Medical College and Hospital, a tertiary care institution in Darjeeling, West Bengal, India. The pregnant women were divided into two groups: intracervical Dinoprostone gel alone (Group-1) and a combination of intracervical Foley catheter and intracervical Dinoprostone gel (Group-2) with n=75 patients in each group. Group-1 received intracervical Dinoprostone gel 0.5 mg, which was repeated every 6 hours, a maximum of three doses, or until she went into active labour, whichever occurred earlier. In Group-2, a 16 F Foley catheter was inserted into the cervix, inflated, and a single dose of intracervical Dinoprostone gel 0.5 mg was given alongside it. Participant demographic characteristics, medical and pregnancy history, indication for labour induction, labour course, and outcomes were collected. The collected data were analysed with the mean and standard deviation for numerical variables and counts and percentages for categorical variables. Odds ratio was calculated where deemed relevant. Results: The induction to delivery time was considered the primary outcome and was shorter in Group-2 by 28 minutes (p=0.342). Among the secondary outcomes, the duration of the latent phase of labour was shorter in Group-2 by 57 minutes, and the proportion of patients delivering within 12 hours was also higher (28%) but statistically insignificant (p&gt;0.05). The rates of CS were unaffected by the mode of induction. None of the two methods were found to be inferior to the other in respect to neonatal outcomes or complications of labour like chorioamnionitis and postpartum haemorrhage. Conclusion: The combination of Foley catheter with intracervical Dinoprostone gel did not prove to be more efficient than intracervical Dinoprostone alone for labour induction in the current study

Twice-daily versus once-daily vaginal dinoprostone gel for induction of labor at term: A randomized controlled trial

ObjectiveThe aim of this study was to compare twice-daily versus once-daily administration of intravaginal PGE2 for induction of labor at term. Efficacy, safety, and patient satisfaction were evaluated. Study designFor this single-center, randomized, comparative, open-label, two-arm, and parallel study, pregnant women with term singleton live pregnancies ≥ 37 weeks of gestation, medical indications for induction of labor, and Bishop score ≤ 6 were randomized to either the control group (induction of labor with PGE2 gel with repeat dose after 24 h) or the experimental group (repeat dose after 12 h). The primary outcome was induction-to-delivery interval time. Secondary outcomes were maternal and neonatal outcomes and patient satisfaction. ResultsIn total, 246 women were randomized to the control (n = 121) or experimental groups (n = 125). The mean time for initiation of induction to delivery was 9.4 h shorter in the experimental group compared to controls (p = 0.007). For control vs experimental, there were no differences in tachysystole (19/121, 15.7 % vs 21/124, 16.9 %, respectively; p = 0.79), cesarean section rate (18/121, 14.9 % vs 28/124, 22.6 % respectively; p = 0.12), or other main obstetrical or neonatal outcomes. Patients in the experimental group reported higher satisfaction with their induction (48/96, 50 % with once-daily vs 60/86, 69.8 % with twice-daily; p = 0.010). ConclusionAmong women admitted for induction of labor at term, closer interval of vaginal PGE2 administration was associated with a significantly shorter induction-to-delivery time without increasing maternal or neonatal morbidity. Furthermore, the reduction in induction time was associated with improved patient experience of delivery.

The use of virtual reality during extra-amniotic balloon insertion for pain and anxiety relief—a randomized controlled trial

Background: Induction of labor with extra-amniotic balloon (EAB) catheter is a procedure commonly associated with maternal discomfort, pain, and anxiety. Objective(s): We aimed to investigate the distractive effect of virtual reality (VR) technology on pain and anxiety- in pregnant patients who undergo Induction of labor with EAB.Study design: In this randomized controlled trial, pregnant patients intended for Induction of labor with EAB at term, for various obstetric indications, were recruited and randomized in a 1:1 ratio into two groups. Patients in the VR group were exposed to a VR technology clip (using SootheVR All-In-One VR care system for pain and anxiety) during the entire EAB insertion while patients in the control group received the institutional standard care for EAB insertion. Pain scores expressed by Visual Analog Scale (VAS) and maternal hemodynamic parameters, were obtained before, during, and after EAB insertion. Anxiety was evaluated by the validated State-Trait Anxiety Inventory Scale (STAI-S) before and after the procedure. Maternal satisfaction from the VR technology was also recorded. The primary outcome was the change in VAS score before and during EAB insertion. Among the secondary outcomes was the change in Anxiety levels before and after EAB insertion. The study was powered to detect a 25% decrease in the primary outcome.Results: A total of 132 pregnant patients were recruited (66 in each group). There were no differences between groups in terms of age, BMI, gestational age at enrollment, indication for Induction of labor, and pre-procedural VAS score and anxiety levels. The change in VAS score (maximal VAS score during the procedure subtract the initial VAS score before the procedure, i.e the primary outcome) was significantly lower in the VR group compared to the control group (2.78±3.0 vs 4.09±2.99, p=0.01). In addition, the VR group benefited a higher rate of anxiety relief expressed by the difference between pre-procedure and post-procedure STAI score, (-6.46 ± 9.6 vs -2.01 ± 9.11, P=0.007). Patients in the VR group reported an overall very high (94%) satisfaction score.Conclusions: In this randomized controlled trial, we demonstrated that the use of VR technology in patients undergoing Induction of labor with EAB was associated with lower VAS scores during the procedure and significant anxiety reduction compared to patients who received standard care. There was also a very high satisfaction rate from the use of VR technology.

Obstetric Outcome of Induction of Labour in a Tertiary Hospital in Nigeria: A Five-Year Retrospective Cross-Sectional Study.

Induction of labour has remained one of the most valuable interventions in obstetric practice. Over the years, the proportion of women undergoing induction of labour (IOL) has been on a steady increase. The significance to obstetrics practice as well as its maternal and perinatal outcomes are sacrosanct, hence the need for its periodic review. To determine the obstetric outcomes of induction of labour. A five-year retrospective study of all cases of induction of labour at the maternity unit of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria between January 1st 2017 and 31st December 2021. The labour ward's records were assessed to determine the total number of women who had induction of labour during the study period. Women whose case files could be not retrieved were excluded. The folder numbers of the patients were extracted and their case files retrieved from the medical records department of the hospital. The primary outcomes measures were the indications and the methods of induction of labour, while the secondary outcome measures were the mode of delivery, cause of failed induction, and the perinatal outcome. Data were obtained using proformas and analysed using statistical packages for social sciences (SPSS) version 26.0 IBM corporation. A total of 3,638 deliveries were taken during the period under review and 168 patients had induction of labour giving an overall prevalence of 4.6% (46/1000 deliveries). Induction of labour was successful in 71.2% of cases. Misoprostol was used in 90.4% of cases as an induction agent. The commonest indication for induction of labour was postdate pregnancy (53.8%). Failed induction was due to fetal distress, poor progress of labour from cephalopelvic disproportion/malposition and failed cervical ripening. In about 72% of deliveries, there was good perinatal outcome, 10.3% of babies had moderate to severe asphyxia while 1.3% had neonatal death. Induction of labour is a safe and beneficial procedure in obstetrics. However, it can be associated with adverse obstetric outcomes.

The Use of Virtual Reality During Extraamniotic Balloon Insertion for Pain and Anxiety Relief: A Randomized Controlled Trial [ID: 1376399

INTRODUCTION: Induction of labor (IOL) with extraamniotic balloon (EAB) catheter is a procedure commonly associated with maternal discomfort, pain, and anxiety. We aimed to investigate the distractive effect of virtual reality (VR) technology on pain and anxiety in pregnant women who undergo IOL with EAB. METHODS: In this randomized controlled trial, pregnant women intended for IOL with EAB at term, were recruited, signed a consent form, and randomized into two groups. The control group received the institutional standard care for EAB insertion, while women in the VR group were exposed to a VR clip during the procedure. Pain scores (expressed by Visual Analog Scale [VAS]) were obtained before, during, and after EAB insertion. Anxiety levels (expressed by validated State-Trait-Anxiety Inventory Scale [STAI-S]) were obtained before and after the procedure. Maternal satisfaction was also recorded. The primary outcome was the VAS score during EAB insertion. RESULTS: Total of 145 women were recruited 1:1 ratio. There were no differences between groups in terms of age, body mass index, gestational age at enrollment, indication for IOL, or preprocedural VAS score and anxiety levels. VAS score during the procedure was significantly lower in the VR group compared to the control group (4.62±2.89 versus 5.95±3.18, P=.04). In addition, the VR group benefited from a higher rate of anxiety relief expressed by the difference between preprocedure and postprocedure STAI score (7.09±10.45 versus 2.84±8.65, P=.039). Women in the VR group reported an overall very high (93%) satisfaction score. CONCLUSION: In this randomized controlled trial, we demonstrated that the use of VR technology in women undergoing IOL with EAB was associated with lower VAS scores during the procedure, with significant anxiety reduction, and a higher satisfaction score, compared to women who received standard care.

Induction of labor at the 39th week and cesarean delivery: a retrospective study in a Shanghai-based maternity hospital.

This study aimed at exploring the association between labor induction at the 39th week and CD in the setting where the baseline cesarean delivery rate is high. A retrospective cohort study was conducted during a 50-month period at a Shanghai-based secondary maternity hospital. A comparison was made of the maternal and neonatal outcomes, including the CD rate, between the women who underwent labor induction at the 39th week and those who were managed expectantly. A total of 4,975 deliveries were included, which had been made by the low-risk nulliparous women beyond 39 weeks. The CD rate was 41.6% and 42.2% in the induction group (n = 202) and the expectant management group (n = 4,773), respectively (relative risk, 0.99; 95% CI, 0.83 to 1.17). Induction of labor at the 39th week increased the risk of postpartum hemorrhage ≥ 500 ml in 24 hours (adjusted relative risk, 2.32; 95% CI, 1.12 to 4.78) and intrapartum fever ≥ 37.5℃ (adjusted relative risk, 4.73; 95% CI, 2.13 to 10.49). Differences in other maternal and neonatal outcomes were of no clinical significance. When stratified by the indications for labor induction, CDs performed because of non-reassuring fetal heart rate were more prevalent among the women who were induced for the same reason than those who were not. As compared with that in the expectant management, labor induction at the 39th week does not seem to have an impact on CD within the setting of a high CD rate.

Dinoprostone Gel versus Intra-cervical Foley’s Catheter for Pre-induction Cervical Ripening: An audit

Background One of the common practices in modern obstetrical care is labour induction when foetal and maternal complications arise. We endeavoured to compare the efficacy and safety of the inexpensive mechanical method of induction Foley’s catheter to the more established pharmacological agent Intracervical Prostaglandin E2 gel&#x0D; Method The present prospective randomised control study was carried out on 200 women with a term singleton pregnancy in cephalic presentation, with an unfavourable cervix and a valid indication for induction of labour. The patients were randomly allocated using the chit method to either Foley’s catheter [group A, n=100] or PGE2 gel [group B, n=100] . Augmentation with oxytocin was done if required and labor was closely monitored till delivery and the perinatal outcome and maternal side effects was recorded Quantitative variables were compared using unpaired t-test/Mann-Whitney Test and qualitative variables were compared using Chi-Square test /Fisher’s exact test. Analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0&#x0D; &#x0D; RESULTThe caesarean section rate did not show a significant difference between the Foley’s group(18%) and PGE2 group(11%) The incidence of fetal distress, Meconium stained liquor and APGAR score &lt;7 at 5 minutes was significantly with PGE2 as compared to group A. (P&lt;.05) Incidence of hyperstimulation of uterus was reported in 6% women who received PGE2 as compared to none in Foley’s group. The induction delivery interval did not show any significant difference between the two groups.&#x0D; &#x0D; CONCLUSION In women undergoing induction of labour at term in resource constraint set ups like ours, Foley catheter is a good alternative to the more established prostaglandin E2 gel, with good efficacy and better neonatal and maternal safety profile.&#x0D; &#x0D; Keywords: cervical ripening; dinoprostone; obstetric labor, induced

The influence of various induction methods on adverse outcomes in small for gestational age neonates: A secondary analysis of the PROBAAT 1 and 2 trials

ObjectiveTo evaluate the safety aspects of different induction methods in pregnancies with small-for-gestational-age neonates. Study designThis was a secondary analysis of two previously reported multicenter, randomized controlled trials conducted in the Netherlands. In the original trials, women were randomized to either a 30 cc Foley catheter, vaginal prostaglandin E2 (PROBAAT-1) or oral misoprostol (PROBAAT-2). A total of 425 patients with a term, singleton pregnancy in cephalic presentation with an indication for labor induction and a small-for-gestational-age neonate were included in this secondary analysis. Our primary outcome was a composed adverse neonatal outcome of Apgar score < 7 after 5 min and/or a pH in the umbilical artery < 7.05 and/or NICU admission. Secondary outcomes were mode of birth, operative birth for fetal distress and pH < 7.10 in the umbilical artery. For these outcome measures, multivariate as well as bivariate analyses were performed. ResultsAn adverse neonatal outcome occurred in 4.7 % (10/214) induction with a Foley catheter, versus 12.8 % (19/149) after misoprostol (RR 0.36; 95 % CI 0.17–0.76) and 4.7 % (3/64) after Prostaglandin E2 (RR 0.98; 95 %CI 0.28–3.51).For individual components of the composed outcome of adverse events, a difference was found between a Foley catheter and misoprostol for Apgar score < 7 at 5 min (0.5 % versus 3.4; RR 0.14; 95 %CI 0.02–1.16) and NICU admission (1.9 % versus 6.1 %; RR 0.31; 0.10–0.97). No differences were found for mode of birth. ConclusionsFor women who gave birth to a small-for-gestational-age neonate, a Foley catheter is probably a safer induction method compared to oral misoprostol.

A Comparison of Misoprostol and Dinoprostone Gel for Induction and Cervical Ripening

Introduction: Labour induction at term is a universal conventional obstetric interference with an objective to stimulate uterine contractions artificially to attain a spontaneous vaginal delivery. The current study was aimed to compare the efficacy and safety profile of low dose vaginal Misoprostol with Dinoprostone gel for induction of labour in term pregnancies with unfavorable cervix and intact membranes.&#x0D; Methodology: This Randomized Controlled Trial was conducted among pregnant women with term pregnancy with obstetrical or medical indication for induction of labour after institutional ethical committee approval. A detailed history, complete physical examination and investigations were done for all patients.&#x0D; Result: Misoprostol and Dinoprostone gel are equally effective inducing agents. Both are equally effective in Primigravida and Multigravida. Failure of induction rate for Misoprostol and Dinoprostone was statistically not significant. The need of Oxytocin augmentation, maternal complication rate, NICU admission rate, caesarean section rate and occurrence of meconium-stained liquor are statistically not significant in both the study groups. Our study was unable to demonstrate superiority of any single drug compared to other. Only the difference is cost, induction with&#x0D; Conclusion: considering the easy to preserve and administer, we recommend use of Misoprostol as a safe, effective, cheaper, and more convenient drug for induction of labour.

Induction of labor: reviewing the past to improve the future

Women undergoing induction of labor should be empowered with accurate information. This study aimed to examine the characteristics of and indications for induction of labor and delivery outcomes to help inform practice and counseling. We conducted a retrospective cohort study of all singleton pregnancies undergoing induction of labor over a 3-month period in a tertiary-level hospital in the Republic of Ireland. Data were obtained from paper and electronic registries. Descriptive and inferential statistics were performed on data collected. There were 1084 women delivered, with an induction rate of 46.0% (n=499). Primiparous women were more likely to be induced compared with multiparous women (51.4%; n=254/494 vs 41.5%; n=245/590; P<.001), and were more likely to be induced for postmaturity (30.7%; n=78/254 vs 23.6%; 58/245; P≤.001). More than half (50.3%; 251/399) were induced before 40 weeks' gestation, irrespective of parity. Multiparous women and those induced for maternal medical indications had a shorter overall time to delivery interval (21.7 hours [standard deviation, 13.0] vs 13.8 hours [standard deviation, 11.2]; P<.001 and 18.3 hours [standard deviation, 12.7] vs 14.7 hours [standard deviation, 12.4]; P<.01). Information on induction of labor can aid in the guidance and education of women undergoing the process, educate clinicians for appropriate counseling, and facilitate shared decision-making.

Trends in labor induction indications: A 20-year population-based study.

Use of labor induction has increased rapidly in most middle- and high-income countries over the past decade. The reasons for the stark rise in labor induction are largely unknown. We aimed to assess the extent to which the rising rate of labor induction is explained by changes in rates of underlying indications over time. The study was based on nationwide data from the Icelandic Medical Birth Register on 85 620 singleton births from 1997 to 2018. The rate of labor induction and indications for induction was calculated for all singleton births in 1997-2018. Change over time was expressed as relative risk (RR), using Poisson regression with 95% confidence intervals (CI) adjusted for maternal characteristics and indications for labor induction. The crude rate of labor induction rose from 12.5% in 1997-2001 to 23.9% in 2014-2018 (crude RR=1.91, 95% CI 1.81-2.01). While adjusting for maternal characteristics had little impact, adjusting additionally for labor induction indications lowered the RR to 1.43 (95% CI 1.35-1.51). Induction was increasingly indicated from 1997-2001 to 2014-2018 by gestational diabetes (2.4%-16.5%), hypertensive disorders (7.0%-11.1%), prolonged pregnancy (16.2%-23.7%), concerns for maternal wellbeing (3.2%-6.9%) and maternal age (0.5%-1.2%). No indication was registered for 9.2% of inductions in 2014-2018 compared with 16.3% in 1997-2001. Our results show that the increase in labor induction over the study period is largely explained by an increase in various underlying conditions indicating labor induction. However, indications for 9.2% of labor inductions remain unexplained and warrant further investigation.