Indication For Induction Of Labor Research Articles

Induction of labour at or beyond 37 weeks' gestation.

Induction of labour at or beyond 37 weeks' gestation.

COMPARISON OF PRE AND POST INDUCTION BISHOPS SCORE IMPROVEMENT IN INTRACERVICAL FOLEY’S CATHETER AND PGE2 GEL

Background: Aim-The success of labor induction depends on the cervical status at the time of induction. Objective- For effective cervical ripening both foley catheter and a dinoprostone gel are used. The aim of this study was to compare the efficacy and safety of the intracervical Foleys catheter and dinoprostone gel in cervical ripening for successful induction of labor.
 Methods: It was a randomized controlled study conducted in the obstetrics department at SMS Medical College, Jaipur. 100 Women were enrolled with a bishops score <5with various indication for induction of labour. They intracervical Foleys catheter insertion and group B received Dinoprostone gel 0.5mg instilleted intracervical. Maximum of 2 doses dinoprostone gel could be administered 6 hours apart. Primary efficacy parameter was change in Bishops score as compared to baseline.
 Results: The groups were comparable with respect to maternal age, gestation age, indication of induction and initial Bishop's score. Both the groups showed significant change in the Bishop's score at 12 hr,8.02 ± 3.22 and 7.1 ± 4.48 in Foleys catheter and Dinoprostone gel, respectively, But p value was not statistically significant(0.242).
 Conclusion- This study shows that both Foleys catheter and Dinoprostone are equally effective in cervical ripening.

A standardized labor induction protocol: impact on racial disparities in obstetrical outcomes

There are marked disparities between black and nonblack women in the United States in birth outcomes. Yet, there are little data on methods to reduce these disparities. Although the cause of racial disparities in health is multifactorial, implicit bias is thought to play a contributing role. To target differential management, studies in nonobstetrical populations have demonstrated disparity reduction through care standardization. With wide variation by site and provider, labor management practices are the ideal target for standardization. In this study, we aimed to evaluate the effect of a standardized induction of labor protocol on racial disparities in cesarean delivery rate and maternal and neonatal morbidity. We performed a prospective cohort study of women undergoing an induction from 2013 to 2015. Full-term (≥37 weeks' gestation) women carrying a singleton pregnancy with intact membranes and an unfavorable cervix (dilation ≤2 cm, Bishop score of ≤6) were included. We compared the cesarean delivery rate and maternal and neonatal morbidity between 2 groups stratified by race (black vs nonblack) as follows: (1) women induced in a randomized trial (n=491) that utilized an induction protocol with standardized recommendations for interventions such as oxytocin and amniotomy at particular time points and (2) women in an observational arm (n=364) enrolled at the same time whose induction and labor management occurred at provider discretion. Regression modeling was used to test an interaction between the induction protocol and race. A significant reduction in cesarean delivery rate in black women managed with the induction protocol was noted when compared with those in the observational group (25.7% vs 34.2%; P=.02), whereas there was no difference in cesarean delivery rate in nonblack women (34.6% vs 29.9%; P=.41). The induction protocol reduced the racial disparity in cesarean delivery rate (interaction term, P=.04), even when controlling for parity, body mass index, indication for labor induction, and Bishop score at induction start. In addition, a significant reduction in neonatal morbidity was found in black women managed with the induction protocol (2.9% vs 8.9%; P=.001), with no difference in nonblack women (3.6% vs 5.5%; P=.55). The induction protocol did not significantly affect maternal morbidity for either race. A standardized induction protocol is associated with reduced cesarean delivery rate and neonatal morbidity in black women undergoing induction. Further studies should determine whether implementation of induction protocols in diverse settings could reduce national racial disparities in obstetrical outcomes.

INDUCTION OF LABOUR- A COMPARITIVE STUDY BETWEEN VAGINAL MISOPROSTOL ALONE AND VAGINAL MISOPROSTOL AND TRANSCERVICAL FOLEY CATHETER COMBINATION

Introduction- High risk pregnancy forms the area of expertise for obstetricians. While dealing with high such high risk cases, obstetricians come across many such conditions and complications when induction of labour in not only indicated, but forms the cornerstone of management.Methods- In current study, we studied 72 patients. Out of those, 36 patients were randomly allocated to group A and 36 to group B. For group A only vaginal misoprostol was used as method of induction. For group B patients were induced by foley catheter inserted transcervically with vaginal misoprostol. There was no difference between age, gestestional age, pre induction bishop score etc. Results-The majority indications for inductions of labour were post dated pregnancy, PIH, oligohydroamnios or the combination of above. Both the groups were comparable in terms of indication for induction of labour Out of the 36 cases induced in each group, number of misoprostol tablet used (25 microgram ) was more in group A than in group B, and this difference was significant. Group A and B showed higher increment in bishop score after starting the procedure. This result was statistically significant. Induction to delivery time was significantly reduced in combination group. The incidence of use of oxytocin was similar in both groups. 70 Both groups had similar rates of vaginal delivery and ceserean section. Both groups had comparable outcome with indication for caesarean section and there was no significant difference. Incidence of maternal complications was similar in both groups. Group A had more number of patients who had tachysystole with foetal heart rate changes, but this was not statistically significant. Conclusion- There is need for large scale multicentre trial to know which method of induction is better, taking into account all the outcomes proposed.

Misoprostol administered sublingually at a dose of 12.5\u2009\u03bcg versus vaginally at a dose of 25\u2009\u03bcg for the induction of full-term labor: a randomized controlled trial

BackgroundLabor induction is defined as any procedure that stimulates uterine contractions before labor begins spontaneously. The vaginal and oral routes of administration of misoprostol are those most used for the induction of labor in routine practice, with the recommended dose being 25 μg. Nevertheless, the sublingual route may reduce the number of vaginal examinations required, increasing patient comfort and lowering the risk of maternal and fetal infection. Based on a previous systematic review, the objective of this study was to compare the frequency of tachysystole as the main outcome measure when misoprostol is administered sublingually at the dose of 12.5 μg versus vaginally at a dose of 25 μg to induce labor in a full-term pregnancy with a live fetus.MethodsA randomized, placebo-controlled, triple-blind clinical trial was conducted at two maternity hospitals in northeastern Brazil. Two hundred patients with a full-term pregnancy, a live fetus, Bishop score ≤ 6 and an indication for induction of labor were included. Following randomization, one group received 12.5 μg misoprostol sublingually and a vaginal placebo, while the other group received a sublingual placebo and 25 μg misoprostol vaginally. The primary outcome was the frequency of tachysystole. Student’s t-test, the chi-square test of association and Fisher’s exact test were used, as appropriate. Risk ratios and their 95% confidence intervals were calculated.ResultsThe frequency of tachysystole was lower in the group using 12.5 μg misoprostol sublingually compared to the group using 25 μg misoprostol vaginally (RR = 0.15; 95%CI: 0.02–0.97; p = 0.002). Failure to achieve vaginal delivery within 12 and 24 h was similar in both groups. Sublingual administration was preferred to vaginal administration by women in both groups; however, the difference was not statistically significant.ConclusionThe effectiveness of labor induction with low-dose sublingual misoprostol was similar to that achieved with vaginal administration of the recommended dose; however, the rate of tachysystole was lower in the sublingual group, and this route of administration may prove a safe alternative.Trial registrationRegistration number: NCT01406392, ClinicalTrials.gov. Date of registration: August 1, 2011.

Early versus delayed amniotomy after vaginal misoprostol for labor induction in nulliparous women

Objectives To compare between the effectiveness and safety of early versus delayed amniotomy after vaginal misoprostol for the induction of labor. Background The aim of successful induction of labor is to achieve vaginal delivery when continuation of pregnancy presents a threat to the life or well-being of the mother or fetus. The process of induction of labor should only be considered when vaginal delivery is felt to be the appropriate route of delivery. Patients and methods A randomized, clinical trial that included 80 nulliparous women with medical or obstetric indication for labor induction. They were randomly assigned into two equal groups, the first group for early amniotomy and the second group for late amniotomy after use of vaginal misoprostol. Data were collected and tabulated. Results There was significant difference in the duration of labor between the two groups of early and late amniotomy with aP value of 0.000.There was also no significant difference in the mode of delivery with aP value equal to 0.197. Conclusion In well-selected cases, vaginal misoprostol followed by early intervention with amniotomy for labor induction appears to be associated with higher successful vaginal delivery rate, shorter induction-delivery interval, and better neonatal outcome over standard care.

A comparative study of 25mcg of oral and vaginal misoprostol in induction of labour at term gestation in primigravida

Background: Labour induction is one of the common medical procedures in obstetrics. The aim is to end the pregnancy when continuity is a risk to mother or fetus. Prostaglandins have been used successively for cervical ripening and for induction of labour since early 1970’s.This comparative study is undertaken to evaluate the safety and efficacy of oral and vaginal routes of administation of misoprostol for induction of labor. Material and Methods: A prospective randomised controlled trial done on 196 Patients of admitted in Rajkiya Mahila chikitsalaya, JLN Medical College, Ajmer as per inclusion and exclusion criteria, informed consent was taken and randomization into two groups. The women in the oral group were 25 µg of misoprostol with a sip of water, and vaginal group had one 25 µg of misoprostol tablet inserted in the posterior vaginal fornix without use of lubricant (maximum upto 6 doses). Results: Our study showed that Full term (26.5%), followed by severe preeclampsia (24.4%), post-dated (16.3%), Mild PE (12.2%), Antepartum eclampsia (10.2%) and Polyhydramnios (10.2%) were indication for induction of labor. High rate of caesarean section in oral group than vaginal group 32 (32.6%) vs 16(16.3%). The commonest indication of caesarean section was fetal distress in both the groups. Failed induction was also higher in oral group than vaginal group 8(8.1%) vs 4(4%). Conclusion: Our study shows that for induction of labour vaginal route is preferable to oral route when used in equivalent dosage of 25 µg in primigravida. In vaginal route of administration compared to oral route number of dosage required is less, induction delivery interval is less, less incidence of failed induction, less rate of caesarean section, less requirement of oxytocin augmentation, less maternal side effects of the drug. The onset of uterine activity was earlier in oral group. Neonatal outcome is comparable in both groups. The increase efficacy associated with vaginal misoprostol raises the possibility of a local cervical effect with the vaginal administration.

Cervical ripening by prostaglandin E2 in patients with a previous cesarean section

ObjectiveTo assess the efficacy and safety of prostaglandin in inducing labor in pregnant women with one previous cesarean section. Secondly, to evaluate predictors of successful vaginal delivery in cervical ripening by prostaglandin in these women. Study designThis was an observational, retrospective, single-center study conducted in a type 3 maternity unit at Bicêtre University Hospital between January 1, 2013 and December 31, 2016. Patients with one previous cesarean section, a singleton pregnancy, a fetus in the cephalic presentation with a medical indication for induction of labor and an unfavorable cervix (Bishop score less than 6) were included in the study. Cervical ripening was performed using a dinoprostone intravaginal device for a duration of 24 h. ResultsA total of 153 patients were included in the study. The rate of vaginal delivery was 55.6 % (85/153) overall and 78.3 % (36/46) in the subgroup of 46 women with a previous vaginal delivery before or after the cesarean section.There was no difference in neonatal and maternal morbidity (defined by intraoperative wounds or postpartum hemorrhage or uterine rupture) and mortality between women who delivered vaginally and women who had a cesarean section. The two cases of complete uterine rupture have been reported for patients whose labor was induced by intravaginal prostaglandin followed by intravenous oxytocin. The total maternal morbidity rate was 11.8 % (n = 8/68) in the case of emergency cesarean section.Predictors of vaginal delivery were a history of vaginal delivery, the onset of labor following cervical ripening, and a higher Bishop score before and after the 24 h following the cervical ripening. ConclusionCervical ripening by prostaglandin after previous cesarean delivery has a 56 % success rate, with a 1.3 % risk of uterine rupture, especially when prostaglandin is combined with oxytocin. Low-risk patients should be identified to propose cervical ripening by prostaglandin.

ANZJOG turns 60!

<i>ANZJOG</i> turns 60!

A systematic scoping review of clinical indications for induction of labour.

BackgroundThe proportion of women undergoing induction of labour (IOL) has risen in recent decades, with significant variation within countries and between hospitals. The aim of this study was to review research supporting indications for IOL and determine which indications are supported by evidence and where knowledge gaps exist.MethodsA systematic scoping review of quantitative studies of common indications for IOL. For each indication, we included systematic reviews/meta-analyses, randomised controlled trials (RCTs), cohort studies and case control studies that compared maternal and neonatal outcomes for different modes or timing of birth. Studies were identified via the databases PubMed, Maternity and Infant Care, CINAHL, EMBASE, and ClinicalTrials.gov from between April 2008 and November 2019, and also from reference lists of included studies. We identified 2554 abstracts and reviewed 300 full text articles. The quality of included studies was assessed using the RoB 2.0, the ROBINS-I and the ROBIN tool.Results68 studies were included which related to post-term pregnancy (15), hypertension/pre-eclampsia (15), diabetes (9), prelabour rupture of membranes (5), twin pregnancy (5), suspected fetal compromise (4), maternal elevated body mass index (BMI) (4), intrahepatic cholestasis of pregnancy (3), suspected macrosomia (3), fetal gastroschisis (2), maternal age (2), and maternal cardiac disease (1). Available evidence supports IOL for women with post-term pregnancy, although the evidence is weak regarding the timing (41 versus 42 weeks), and for women with hypertension/preeclampsia in terms of improved maternal outcomes. For women with preterm premature rupture of membranes (24–37 weeks), high-quality evidence supports expectant management rather than IOL/early birth. Evidence is weakly supportive for IOL in women with term rupture of membranes. For all other indications, there were conflicting findings and/or insufficient power to provide definitive evidence.ConclusionsWhile for some indications, IOL is clearly recommended, a number of common indications for IOL do not have strong supporting evidence. Overall, few RCTs have evaluated the various indications for IOL. For conditions where clinical equipoise regarding timing of birth may still exist, such as suspected macrosomia and elevated BMI, researchers and funding agencies should prioritise studies of sufficient power that can provide quality evidence to guide care in these situations.

283: Labor induction at term and cesarean delivery rates – Earlier rather than later?

Mechanisms involved in parturition evolve throughout pregnancy, and therefore might be insufficiently mature for medically indicated induction of labor (IOL) during the different stages of pregnancy. We investigated labor induction failure rates (i.e. leading to cesarean delivery-CD) during the different stages of pregnancy. A population-based retrospective cohort analysis was performed, including all labor induction cases occurring at 32 to 44 gestational weeks, between 1991-2017, at a regional tertiary medical center. Congenital malformations, antepartum fetal demise, and multiple pregnancies were excluded. Rates of CD following IOL were assessed at different gestational weeks (GW). Term deliveries (≥37 weeks) following IOL were subdivided into separate GW. All post-term deliveries (≥42 weeks) following IOL were grouped together. A multivariable analysis was performed, assessing the independent association between IOL gestational age (within term) and failure rates, while adjusting for confounders. T The study population included 26,722 pregnancies involving IOL, 25,392 (95%) of which occurred at term. The trendline of CD rates according to gestational week demonstrated an "inverted J” shape, with a gradual decrease in CD rates as GA increased from 32 to 41 weeks (Figure, p< 0.001). A subsequent increase in CD rates was observed from 41 weeks and on. Among term pregnancies involving IOL, 73% were induced mechanically and the rest using prostaglandins, with a total CD rate of 16.8%. In the multivariate analysis, post-term IOL was independently associated with a higher CD rate (18.8%) as compared to IOL performed at 39 weeks’ gestation (17.4%, aHR 1.15, p=0.05, 95%CI 1.00-1.32, Table) while controlling for maternal age, IOL indication, previous CD, IOL method (mechanical vs. pharmacological) and birthweight. In this large cohort of IOL cases, CD rates are relatively low, and decrease as GA increases. Post-term deliveries involving IOL are independently associated with a higher CD risk as compared to deliveries following IOL at 39 weeks' gestation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

791: Influencing parameters affecting fetal pH taken from category II tracing

FHR (Fetal Heart Rate) monitoring during labor has been used extensively as a predictor of fetal well-being despite inaccuracy and a high false positive rate. ACOG defined categories to improve interpretation. Category II FHR is common and its clinical implication is not accurate. In this study we examined predictive factors in addition to category II FHR monitoring that might imply for of fetal acidosis and its risk of Asphyxia. This retrospective cohort study compared two groups of patients with Category II FHR monitoring that was considered significant by the care givers to perform a prompt delivery. Patients were divided into two groups based on fetal cord pH≤7.1 and pH >7.1. Demographics, medical history, delivery data and early neonatal outcome were reviewed. Cohort included 428 women who met the inclusion criteria. Forty-three of them (10%) were in the study group of cord PH < 7.1 and 385 (90%) in the control group. Background characteristiscs were similar in both groups. There were no differences between the groups in the rates or indications for labor induction, rates of non-reassuring fetal heart rate (NRFHR) at admission, duration of ruptured membranes (ROM), meconium stained amniotic fluid, maternal fever during labor and the duration of labor. As expected, more patients in the low pH group delivered by a cesarean section 39.8% vs 31.3%, p=0.04, both are significantly higher than the average rate of 18% cesarean in our institution. Five-minute Apgar scores were similar in both groups. In our retrospective study we could not detect a specific parameter that can help predict the prognosis. Since we only included patients that had a category II tracing which was worrying enough to lead to prompt delivery, it's reasonable to believe that this is an outcome of the patient selection, meaning that when the category II FHR leads to a clinical decision of prompt delivery, there is no added value for more clinical characteristics. The evaluation should be expended to all patients with category II tracing for better interpretation tools of category II FHR monitors.

Effectiveness of Sublingual Versus Oral Misoprostol for Induction of Labour at Term

Objective: To compare the efficacy and safety of 50microgram (mg) sublingual Misoprostol with 50 microgram (mg) oral misoprostol for labour induction at term. Method: One hundred twenty women with medical or obstetric indication for induction of labour at term with unfavorable cervix were randomized to receive 50mcg of misoprostol either orally or sublingually. Primary outcome was number of women delivering vaginally within 24hrs of induction. The need for oxytocin, mode of delivery, doses of Misoprostol required and neonatal outcomes were analyzed and compared between the groups. Results: Induction to vaginal delivery time was < 24hours in 43(71.7%) in sublingual group and 36(60%) women delivered vaginally in < 24hours in oral group. No significant difference was found in the number of women delivering vaginally within 24hrs of induction among both the groups.Time from administration of first dose to delivery in sublingual group was lesser compared to oral group. 46.7% of women required oxytocin in sublingual groups, whereas 75% in oral group which was statistically significant. Sublingual group had lesser number of women requiring more than 1 dose of misoprostol compared to the oral group. Conclusion: Sublingual misoprostol seems to be having better efficacy than the oral misoprostol and has lesser induction to delivery interval. Hence can be considered to induce labour at term for ripening of cervix.

Which level of risk justifies routine induction of labor for healthy women?

Although induction of labor can be crucial for preventing morbidity and mortality, more and more women (and their offspring) are being exposed to the disadvantages of this intervention while the benefit is at best small or even uncertain. Characteristics such as an advanced maternal age, a non-native ethnicity, a high Body Mass Index, an artificially assisted conception, and even nulliparity are increasingly considered an indication for induction of labor. Because induction of labor has many disadvantages, a debate is urgently needed on which level of risk justifies routine induction of labor for healthy women, only based on characteristics that are associated with statistically significant small absolute risk differences, compared to others without these characteristics. This commentary contributes to this debate by arguing why induction of labour should not routinely be offered to all women where there is a small increase in absolute risk, and no any other medical risks or complications during pregnancy. To underpin our statement, national data from the Netherlands were used reporting stillbirth rates in groups of women based on their characteristics, for each gestational week from 37 weeks of gestation onwards.

A comparison between labor induction with only Dilapan-S and a combination of mifepristone and Dilapan-S in nulliparous women: a prospective pilot study

Objective The aim of our study was to determine whether the combination of mifepristone and the osmotic dilator Dilapan-S improves the labor induction outcomes as compared to Dilapan-S alone. Methods This prospective comparative study included 127 eligible women, of whom 58 underwent cervical ripening with Dilapan-S (12-h exposure, the control group) and 69 with Dilapan-S, with a concurrent pretreatment of 200 mg oral mifepristone (the study group), 8 h before Dilapan-S insertion. Results The vaginal delivery rate in the control group and the study group was 60.3 and 76.8% (p = .045), respectively; the induction to delivery interval was 22.74 ± 3.01 h and 19,890 ± 2.42 h (p < .001), respectively; and the number of births within 24 h was 43.1 and 73.9% (p < .001), respectively. There was no difference in the rate of failed labor induction (6.9 versus 8.7%, p = .939). The Bishop’s score improved significantly after the combined treatment as compared to with Dilapan alone (3.10 ± 0.58 versus 4.03 ± 1.35, p < .001). Moreover, in the study group, labor started earlier and proceeded faster with a lower additional oxytocin usage for labor induction or augmentation. There were no differences in the operative delivery rate and the perinatal outcomes. There were no adverse side effects of both mifepristone and Dilapan-S. Conclusion Our study is the first one to show that in comparison to labor induction using only osmotic dilators Dilapan-S, the combination of mifepristone and Dilapan-S is more efficient in terms of improving cervical ripening and vaginal delivery rate and reducing labor duration and frequency of oxytocin augmentation. The results revealed that this combined method is safe and has no immediate adverse effects on newborns. More studies are needed to evaluate what clinical cases are the most appropriate for the application of this combined method, considering the parity, degree of cervical ripening, and indication for labor induction.

Double balloon catheter for labour induction at term after previous cesarean: a retrospective clinical research

Objective To determine the safety and effectiveness of double balloon catheter for labor induction in women with previous cesarean section. Methods This was a retrospective case-control study. Data from Shenzhen maternal and child healthcare hospital and Shenzhen Longgang District Maternal and Child Healthcare Hospital between 2015.01.01 to 2018.12.31 were used. A total of 156 term pregnant women, with previous one low segment cesarean section (CS) and balloon catheter for labour induction were included as case group. A total of 156 term pregnant women with previous one low segment CS and spontaneous onset of labor were included as control group. The vaginal delivery rate and maternal and infant outcomes were compared between the two groups. Results There was no significant difference in CS rate, vaginal assisted rate and vaginal spontaneous rate between the two groups (20.51% vs 15.38%, 8.97% vs 5.77%, 70.51% vs 78.85% respectively, P>0.05). And there were no significant difference in the rates of intrauterine infection, uterine rupture, postpartum hemorrhage, blood transfusion, maternal and infant mortality and neonatal transfer between the two groups. Conclusions Our study indicates that induction of labor with double balloon catheter is effective and safe in term pregnant women with previous one low segment CS. Women with previous CS and indications for labour induction should be informed about vaginal birth success rates and the alternative of elective repeat CS needs to be discussed. Key words: Labor, induced; Vaginal birth after cesarean; Catheterization

Oral Misoprostol Versus Vaginal Prostaglandin E2 Labor Induction Efficiency, Safety, and Labor Outcomes

BACKGROUNDProstaglandin E1 (oral misoprostol) and the other Prostaglandin E2 (Dinoprostone gel) are promising agents for cervical ripening and induction of labor.AIMS OF STUDYTo compare the efficiency and safety on maternal-fetal outcomes using 25 micrograms oral misoprostol PGE1 with 50 micrograms of intra-vaginal PGE2 for induction of labor.METHODSThis was a retrospective study design reviewing medical records of induced labor at Al Shifa hospital in Gaza Strip.RESULTSIn general, the results showed that women who used oral misoprostol with an age less than 30 years and parity less than 3 was effective for delivery and safe outcomes with an odds ratio (OR) of 15.8 (CI 6.9–39.8) and OR 29.2 (CI 10.7–80.3) respectively. The most common indication for labor induction in both methods was reputure of the membrane (ROM) more than 24 hours, postdates, and a medical disorder. However, the total interval hours for both methods was 8.4 hours. The mode of delivery was similar in both groups as vaginal delivery outcome was 73.6% for oral misoprostol E1 and 75% for prostaglandin E2 cases. However, PGE2 induction showed a higher cesarean delivery 25% rate versus 18.4%. Clinically the use of oral misoprostol showed a higher percentage of birth canal injury, failed induction, uterine rupture by 9.3%, 8%, 1.3% respectively. Fetal distress was found as the most common fetal complication and the most common cause for cesarean section.CONCLUSIONThe study recommended more research is needed as present evidence does not support use of oral misoprostol versus Prostaglandin E2.

Clinical and ultrasonographic parameters in assessment of labor induction success in nulliparous women

Purpose: Evaluation of simplified Bishop score and ultrasound cervicometry in the assessment of labor induction success in nulliparous women.Methods: Prospective cohort study included 146 nulliparous women with singleton pregnancy and indications for labor induction. Prior to labor induction, cervicometry and Bishop score were determined. Upon delivery, patients were classified as those delivered vaginally and by cesarean section (CS) after unsuccessful labor induction.Results: Bishop score >5 was found in 47.95% of vaginally delivered women and 12.33% of patients delivered by CS (p < .01). Cervicometry had appropriate findings in 34.2% of vaginally delivered women and 75.3% of those delivered by CS (p < .01). Bishop score (>5 versus ≤5) had lower sensitivity (52.05%) and specificity (12.33%) than cervicometry (good versus unfavorable findings) (sensitivity 65.75%, specificity 75.34%) for prediction of labor induction success. If Bishop score was ≤5, cervicometry had 50.0% sensitivity and 78.13% specificity, while if Bishop score was >5, 82.86% sensitivity and 55.56% specificity. Obtained model for predicting labor induction outcome in nulliparous women based on their clinical and ultrasonographical characteristics identified the Bishop score as the most important predictor.Conclusions: Study confirmed the usefulness of simplified Bishop score and ultrasound cervicometry in the assessment of labor induction success in nulliparous women.

The efficacy and safety of intravaginal misoprostol for the induction of labor in patients with obstetrical or medical indication for labor induction

Background: Labor induction is becoming one of the most frequent procedures in maternity hospitals. However, the optimal agent for labor induction has not yet been established. Misoprostol, a prostaglandin E1 analogue, is receiving much attention due to its labor induction properties. Objective: The aim of this study was to evaluate the efficacy and safety of 25 and 50 mcg of intravaginal misoprostol, every four hours, for the induction of labor. Materials and Methods: This was a randomized controlled study to compare two different regimens of vaginal misoprostol, in women with obstetrical or medical indication for induction of labor. Participants received either a 25- or 50-mcg dose of misoprostol inserted into the posterior vaginal fornix repeated every four hours (maximum six doses), until adequate labor was established. Close monitoring of uterine activity and fetal heart rate was performed in all patients. Data were collected prospectively on epidemiological, obstetric, and care aspects. Results: Both regimens of misoprostol were effective in the induction of labor and most of the women had normal vaginal deliveries (81.08%). Although the mean time intervals from induction to the onset of active labor, and from induction to vaginal delivery for the 50-mcg regimen were lower, there was no significant difference between the two regimens. There were very few complications, with one case of uterine tachysystole in each treatment regimen. Conclusion: The results of the present study show that both regimens of misoprostol appear to be effective for the induction of labor in patients with indication, with few fetal complications.

The outcome of induced labor after oxytocin infusion discontinuation in the active phase

Objective The objective was to determine whether discontinuation of oxytocin infusion after established active phase of induced labor gives good obstetric outcome without any adverse maternal and neonatal effect. Background Oxytocin is one of the most widely drugs used in induction of labor. Continuous infusion of oxytocin after establishment of the active phase of labor may lead to uterine atony and postpartum hemorrhage. Therefore, we should stop oxytocin infusion once the active phase has started. Patients and methods A total of 90 pregnant women who required labor induction and fulfilled the criteria of the study population were enlisted in this prospective controlled randomized clinical trial and then were assigned to either group A or B. In group A cases, infusion of oxytocin was started in incremental doses until 5 cm of cervical dilatation and to be maintained at that level throughout the labor, whereas in group B cases, infusion of oxytocin was started incrementally but discontinued when cervical dilatation reached 5 cm. Results This study showed that there was a statistically significant difference between group A and group B regarding the first stage of labor, uterine hyperstimulation, maximal and total doses of oxytocin, neonatal outcome, and incidence of postpartum hemorrhage. There was statistically insignificant difference between group A and group B regarding age, BMI, mean gestational age, parity, indications for induction of labor, detection of meconium upon rupture of membranes, and mode of delivery. Conclusion There is no need to continue oxytocin infusion after the establishment of active phase of labor.