Induction In Women Research Articles

(321) Enhanced secondary hyperalgesia following a pain catastrophizing induction in women with chronic low back pain

(321) Enhanced secondary hyperalgesia following a pain catastrophizing induction in women with chronic low back pain

Anti-Mullerian hormone levels do not predict response to pulsatile GnRH in women with hypothalamic amenorrhea

Pulsatile GnRH is used to induce ovulation in women with hypothalamic amenorrhea (HA), but tools to predict response are lacking. We assessed whether baseline AMH levels are associated with response to pulsatile GnRH in 16 women with HA. AMH levels were compared between non-responders and women who achieved follicular development or pregnancy. Median AMH for the cohort was 2.2 ng/mL. AMH levels were undetectable or low in four women, normal in nine and high in three. Follicular development was observed in 13 (81%) women (82% of cycles) and pregnancy achieved in 10 (63%) women (29% of cycles). All four women with low or undetectable AMH had follicular response and three achieved pregnancy. Of the 12 women with normal or high AMH, 10 had a follicular response and seven achieved pregnancy. Median AMH levels were comparable in those who achieved follicular development and those who did not (2.2 ng/mL versus 1.3 ng/mL, p = 0.78) and in those who became pregnant and those who did not (2.2 ng/mL versus 1.9 ng/mL, p = 0.52). In summary, low AMH does not preclude response to ovulation induction in women with HA, suggesting that ovarian potential may not be the primary determinant of AMH concentrations in this population.

Randomized Trial of Labor Induction in Women 35 Years of Age or Older

BackgroundThe risk of antepartum stillbirth at term is higher among women 35 years of age or older than among younger women. Labor induction may reduce the risk of stillbirth, but it also may increase the risk of cesarean delivery, which already is common in this older age group.MethodsWe conducted a randomized, controlled trial involving primigravid women who were 35 years of age or older. Women were randomly assigned to labor induction between 39 weeks 0 days and 39 weeks 6 days of gestation or to expectant management (i.e., waiting until the spontaneous onset of labor or until the development of a medical problem that mandated induction). The primary outcome was cesarean delivery. The trial was not designed or powered to assess the effects of labor induction on stillbirth.ResultsA total of 619 women underwent randomization. In an intention-to-treat analysis, there were no significant between-group differences in the percentage of women who underwent a cesarean section (98 of 304 women in the induction group [32%] and 103 of 314 women in the expectant-management group [33%]; relative risk, 0.99; 95% confidence interval [CI], 0.87 to 1.14) or in the percentage of women who had a vaginal delivery with the use of forceps or vacuum (115 of 304 women [38%] and 104 of 314 women [33%], respectively; relative risk, 1.30; 95% CI, 0.96 to 1.77). There were no maternal or infant deaths and no significant between-group differences in the women’s experience of childbirth or in the frequency of adverse maternal or neonatal outcomes.ConclusionsAmong women of advanced maternal age, induction of labor at 39 weeks of gestation, as compared with expectant management, had no significant effect on the rate of cesarean section and no adverse short-term effects on maternal or neonatal outcomes. (Funded by the Research for Patient Benefit Programme of the National Institute for Health Research; Current Controlled Trials number, ISRCTN11517275.)

Circulating anti-mullerian hormone as predictor of ovarian response to clomiphene citrate in women with polycystic ovary syndrome

BackgroundTo investigate the impact of high circulating AMH on the outcome of CC ovulation induction in women with PCOS.MethodsThis prospective cohort observational study included 81 anovulatory women with PCOS who underwent 213 cycles of CC ovarian stimulation. Serum AMH concentrations were measured on cycle day 3 before the commencement of CC in the first cycle, which were compared between responders and CC-resistant anovulation (CRA). Logistic regression analysis was applied to study the value of serum AMH for the prediction of ovarian responsiveness to CC stimulation. The receiver-operating characteristic (ROC) curve was used to evaluate the prognostic value of circulating AMH.Main outcome measuresSerum AMH levels.ResultsWomen who ovulated after CC therapy had a significantly lower AMH compared with the CRA (5.34 ± 1.97 vs.7.81 ± 3.49, P < 0.001). There was a significant gradient increase of serum AMH levels with the increasing dose of CC required to achieve ovulation (P < 0.05). In multivariate logistic regression analysis, AMH was an independent predictor of ovulation induction by CC in PCOS patients. ROC curve analysis showed AMH to be a useful predictor of ovulation induction by CC in PCOS patients, having 92 % specificity and 65 % sensitivity when the threshold AMH concentration was 7.77 ng/ml.ConclusionSerum AMH may be clinically useful to predict which PCOS women are more likely to respond to CC treatment and thus to direct the selection of protocols of ovulation induction.

Baseline AMH Level Associated With Ovulation Following Ovulation Induction in Women With Polycystic Ovary Syndrome

Baseline AMH Level Associated With Ovulation Following Ovulation Induction in Women With Polycystic Ovary Syndrome

The effect of clomiphene citrate versus tamoxifen versus letrozol on endometrial thickness and blood flow in ovulation induction in women with polycystic ovaries

Aim of Work: To compare between the effects of clomiphene citrate, tamoxifen and letrozol as ovulation induction agents on endometrial thickness and blood flow as non-invasive parameters of endometrial receptivity in women with polycystic ovaries. Patients and Methods: One hundred and fifty cases meeting the selection criteria were prospectively randomized into three groups 1st Group took 100 mg clomiphene citrate, 2nd Group took 5 mg letrozol and 3rd group took 40 mg tamoxifen. Transvaginal ultrasound and Doppler were done to measure endometrial thickness and endometrial blood flow both pulsatility index (PI) and resistance index (RI) at the day of the maximum follicular growth or at day 20 in the absence of the dominant follicle in the three groups. Results: Significantly thinner endometrium in the clomiphene citrate group as compared to the other two groups and lower impedance in the spiral arteries in both letrozol and tamoxifen groups (P value less than 0.001). Conclusion: Endometrium was thicker with lower impedance in the spiral arteries in both letrozol and tamoxifen groups as compared to clomiphene citrate group. Ovulation and pregnancy rates were not significantly different. Other studies are needed to measure the cumulative results of six cycles, increasing the dose in non-responders and the incidence of miscarriage.

A prospective, randomized trial comparing the effects of letrozole versus clomiphene citrate for induction of ovulation and pregnancy rate in women with polycystic ovary syndrome

Objective: To compare the effects of letrozole and clomiphene citrate (CC) for ovulation induction in women with polycystic ovary syndrome (PCOS).Design: Prospective, randomized, not blinded, controlled trial.Materials and Methods: This prospective, randomized clinical trial included 127 patients of infertile women with PCOS. The first group comprised 66 patients who received letrozole (2.5–5 mg) daily and the second group 61 patients who received (50–100 mg) CC daily for 5 days starting on day 3 of menses. Both the groups were followed by ultrasound until the dominant follicle reached a diameter ≥18 mm, human chorionic gonadotropin (hCG) 10,000 IU was given, and timed intercourse was advised. The treatment continued for three cycles in both the groups.Main Outcome Measures: Occurrence of ovulation, endometrial thickness, and pregnancy rate.Results: The mean age, duration of infertility, body weight, body mass index, and endocrine status in both the groups were similar at baseline. The total number of follicles during stimulation was statistically significantly greater in the letrozole group (6.81 ± 1.0 vs. 6.1 ± 1.5; P = 0.002). The number of follicles ≥18 mm was statistically significantly higher in the letrozole group compared with the CC group. There was no statistically significant difference in pretreatment endometrial thickness between the two groups, but endometrial thickness at the time of hCG administration was statistically significantly greater in the letrozole group (9.82 ± 0.7 vs. 8.13 ± 0.56; <0.0001). Ovulation occurred in 25 subjects (37.87%) in the letrozole group and 13 (19.67%) in the CC group, with a statistically significant difference between the two groups (P = 0.024). Serum E2 concentrations were statistically significantly lower in the letrozole group (P = 0.001).Conclusion: The effect of letrozole showed a better endometrial response and ovulation rate compared with CC. Letrozole may have a role as a first-line treatment for anovulatory patients with PCOS.

Induction of labor in women with a uterine scar

Objective: To evaluate the frequency of uterine rupture following induction of labor in women with a previous cesarean section. Misoprostol was compared to other methods of induction.Methods: A retrospective cohort study of 208 women attempting induction of labor after one previous cesarean section. Delivery data were collected retrospectively and compared. Group 1(2009–2010) was compared with Group 2 (2012–2013). In Group 1, the main method of induction was vaginal PGE2 (prostaglandin-E2), amniotomy, oxytocin or a balloon catheter. In Group 2, the dominant method of induction was an oral solution of misoprostol. Main outcome measures: frequency of uterine rupture in the two groups.Results: Nine cases (4.3%) of uterine rupture occurred. There was no significant difference in the frequency of uterine rupture following the change of method of induction from PGE2, amniotomy, oxytocin or mechanical dilatation with a balloon catheter to orally administered misoprostol (4.1 versus 4.6%, p = 0.9). All ruptures occurred in women with no prior vaginal delivery.Conclusion: The shift to oral misoprostol as the primary method of induction in women with a previous cesarean section did not increase the frequency of uterine rupture in the cohort studied.

Clomiphene stair-step protocol for ovulation induction in women with polycystic ovarian syndrome

The objective of this study is to evaluate the efficacy of the clomiphene stair-step protocol to induce ovulation in women with polycystic ovarian syndrome (PCOS) compared to traditional protocol. This single center randomized controlled trial was undertaken. A 140-patients who met all of the inclusion criteria were divided into two main groups and induction of ovulation for both protocols was performed. Follow up of follicular maturation is done by transvaginal ultrasound. The time to ovulation with the stair step protocol was 21-28 days as compared with the traditional protocol which was 42-70 days. The dose dependent ovulation rate was 43% at 100 mg with the stair step protocol compared with 25.3% with the traditional regimen and the ovulation rate at 150 mg was 21.6% with the stair step protocol compared with 14.7% with the traditional protocol while the clomiphene citrate resistance rate was higher with the traditional protocol 38.7% as compared to the stair step method which was 20% which are statistically significant. This randomized controlled trial suggests that clomiphene stair step protocol decreases the time to ovulation and may improve ovulation rates in clomiphene-resistant women.

Foley catheter for induction of labor: potential barriers to adopting the technique.

To evaluate if a learning curve exists for cervical Foley placement for labor induction in women with unfavorable cervices and whether labor curves differ compared with the dinoprostone insert (PGE2). We conducted a secondary analysis of a multicenter randomized controlled trial. For Foley and PGE2, successful placement occurred in 157/185 (85%) and 188/191 (98%) women (P<0.001). Unsuccessful Foley placements decreased over time (P=0.005); all occurred at the site previously using PGE2 preferentially. In women with allocated agent placed successfully who achieved complete cervical dilation, median progress with Foley (n=112), compared with PGE2 (n=123), was: 1-3 cm (6.2 vs 14.1 h; P<0.001), 3-6 cm (11.1 vs 6.7 h; P<0.001) and 6-10 cm (1.9 vs 1.5 h; P=0.14). There is a learning curve for placing cervical Foley catheters. Despite faster times to delivery, Foley is associated with slower dilation from 3 to 6 cm compared with PGE2.

Gonadotrophins for ovulation induction in women with polycystic ovarian syndrome.

Ovulation induction with follicle stimulating hormone (FSH) is the second-line treatment in women with polycystic ovary syndrome (PCOS) who do not ovulate or conceive on clomiphene citrate (CC). To compare the effectiveness and safety of gonadotrophins as a second-line treatment for ovulation induction in women with CC-resistant PCOS. We searched the Menstrual Disorders & Subfertility Group's Specialist Register of controlled trials, the Cochrane Central Register of Controlled Trials, MEDLINE (1966 to October 2014), EMBASE (1980 to October 2014), CINAHL (1982 to October 2014), National Research Register and web-based trials databases such as Current Controlled Trials. There was no language restriction. All randomised controlled trials reporting data on comparing clinical outcomes in women with PCOS who did not ovulate or conceive on CC, and undergoing ovulation induction with urinary FSH (uFSH: FSH-P or FSH-HP), HMG/HP-HMG or recombinant FSH. We included trials reporting on ovulation induction followed by intercourse or intrauterine insemination. We excluded studies that used co-treatment with CC, metformin, LH or letrozole. Three review authors (NW, MN and MvW) independently selected studies for inclusion, assessed study quality and extracted study data. Primary outcomes were live birth rate per woman (effectiveness outcome) and incidence of ovarian hyperstimulation syndrome (OHSS) per woman (safety outcome). Secondary outcomes were clinical pregnancy, miscarriage, multiple pregnancy, total gonadotrophin dose and total duration of stimulation per woman. We combined data using a fixed-effect model to calculate the odds ratio (OR). We summarised the overall quality of evidence for the main outcomes using GRADE criteria. The review includes 14 trials with 1726 women. Ten trials compared rFSH versus urinary-derived gonadotrophins (three rFSH versus HMG and seven rFSH versus FSH-HP), four trials compared FSH-P with HMG. We found no trials that compared FSH-HP with FSH-P.We found no evidence of a difference in live birth for rFSH versus urinary-derived gonadotrophins (OR 1.26, 95% CI 0.80 to 1.99, 5 trials, 505 women, I² = 0%, low-quality evidence) or clinical pregnancy rate (OR 1.08, 95% CI 0.83 to 1.39, 8 trials, 1330 women, I² = 0, low-quality evidence). This suggests that for the observed average live birth per woman with urinary-derived FSH of 16%, the chance of live birth following rFSH is between 13% and 26%.For the comparison HMG or HP-HMG versus FSH-P there was also no difference in the evidence on live birth rate (OR 1.36, 95% CI 0.58 to 3.18, 3 trials, 138 women, I² = 0%, low-quality evidence). This suggests that for a woman with a live birth rate of 18% with HMG or HP-HMG, the chance of live birth following uFSH is between 9% and 37%.Trial authors used various definitions for OHSS. Pooling the data, we found no evidence of a difference for rFSH versus urinary-derived gonadotrophins (OR 1.52, 95% CI 0.81 to 2.84, 10 trials, 1565 women, I(2) = 0%, very low-quality evidence) and for HMG or HP-HMG versus FSH-P (OR 9.95, 95% CI 0.47 to 210.19, 2 trials, 53 women, I² = 0%, very low-quality evidence). In women with PCOS and CC resistance or CC failure, we found no evidence of a difference in live birth and OHSS rates between urinary-derived gonadotrophins and rFSH or HMG/HP-HMG. Evidence for all outcomes was of low or very low quality. We suggest weighing costs and convenience in the decision to use one or the other.

WITHDRAWN: Recombinant FSH versus urinary gonadotrophins or recombinant FSH for ovulation induction in subfertility associated with polycystic ovary syndrome.

Reason for Withdrawal This review has been replaced by a review entitled 'Gonadotrophins for ovulation induction in women with polycystic ovarian syndrome'. To view the published versions of this article, please click the 'Other versions' tab.

Comparison of oral misoprostol and oxytocin for labor induction in prelabor rupture of membranes at term

Objective This study aims to compare the efficacy and safety of oral misoprostol with oxytocin infusion for induction of labor in women with prelabor rupture of membranes (PROM) at term. Background PROM at term is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality, particularly if it is associated with a prolonged latency period from membranes rupture to delivery. Patients and methods This prospective randomized study included 100 pregnant women admitted to the Department of Obstetrics and Gynecology at El-Mahalla General Hospital presenting with PROM at term. The women were assigned randomly to one of the two equal groups (groups A or B): group A, which received 100 mg oral misoprostol every 4 h for a maximum of three doses, and group B, which received an intravenous infusion of oxytocin starting with a dose of 4 mU/min with an incremental increase of 4 mU/min every 30 min until a maximum dose of 32 mU/min. The primary outcome variable was time from induction to vaginal delivery. The secondary outcomes were mode of delivery, maternal, and neonatal outcomes. Results The study showed that the time intervals from induction to delivery were significantly shorter in the misoprostol group than in the oxytocin group (6.59 ± 1.91 and 9.30 ± 2.58 h, respectively; P Conclusion Oral misoprostol at a dose of 100 mg every 4 h was not only as successful as oxytocin for labor induction in women presenting with PROM at term but also reduced the duration of labor in nulliparous women. Oral misoprostol was safe in terms of maternal and neonatal outcomes.

Dehydroepiandrosterone as an adjunct to gonadotropins in infertile Indian women with premature ovarian aging: A pilot study.

BACKGROUND:Dehydroepiandrosterone (DHEA) supplementation is a relatively recent development that augments ovarian responsiveness in patients with poor ovarian reserve and premature ovarian aging (POA).AIMS:To evaluate the efficacy of DHEA supplementation prior to gonadotropins for ovulation induction in women with POA.DESIGN:Prospective randomized controlled study.METHODS:Fifty infertile women with POA were randomized into two groups of 25 each. Group 1 received tablet DHEA 25 mg while group 2 received placebo thrice daily for 6 months. After 3 months, gonadotropin induction with intrauterine insemination was done.STATISTICAL ANALYSIS:Groups were compared using t-test and Mann–Whitney U-test as appropriate. Pre- and post-parameters were compared using t-test -paired and Wilcoxon signed-rank tests as appropriate.RESULTS:Of 50 patients, 62% (31/50) presented with primary and 38% (19/50) with secondary infertility. The mean age was 32.1 ± 4.7 years. Serum antimullerian hormone levels (1.5 ± 0.6–1.9 ± 0.4 ng/ml vs. 1.4 ± 0.5–1.5 ± 0.6 ng/ml) and antral follicle count (3.2 ± 1.0–9.3 ± 3.1 vs. 3.3 ± 1.1–3.4 ± 1.4) improved significantly in DHEA group after 3 months. Serum follicular stimulating hormone and estradiol levels though showed significant intra-group improvement (16.9 ± 5.5 mIU/ml to 14.7 ± 6.2 mIU/ml and 86.6 ± 57.5 pg/ml to 105.6 ± 54.3 pg/ml, respectively) with DHEA, the inter group difference was not significant. Ovulation increased from 48% to 86.3% in DHEA group versus 44–66% in placebo group. Six women (24%) conceived after DHEA in comparison to none in the placebo group.CONCLUSIONS:DHEA supplementation may have a beneficial role as an adjunct to gonadotropins in the treatment of infertility with POA, but further evidence is required.

English

Labour Induction with intravaginal Misoprostol versus Oxytocin in Term Premature Rupture of Membranes. OBJECTIVES: To compare the safety and efficacy of misoprostol with oxytocin for labour induction in women with premature rupture of membranes beyond 36 weeks gestation. METHODS: 65 subjects with rupture of membranes without labour were assigned to receive. vaginally administered misoprostol 50 ug, every 4 hrs. and another 65 subjects with rupture of membranes at term received intravenous oxytocin infusion and we compared the duration of labour, intrapartum complications, mode of delivery and the maternal and neonatal outcomes in the two groups. RESULTS: Results of the 130 subjects studied, 65 received misoprostol and 65 oxytocin infusion. The average interval, from start of induction vaginal delivery was significantly shorter (660 minutes) in the misoprostol group than the oxytocin group (1105 min). Oxytocin administration was necessary in 13 (20%) subjects receiving misoprostol. There was increased incidence of tachysystole in misorpostol group 22 (33.8%) compared to the oxytocin group 9 (13.8%) No significant difference was found in the mode of delivery neonatal and maternal outcomes in the two groups. CONCLUSION: Vaginal administration of misorpostol is safe and effective alternative to oxytocin infusion for labour

Aromatase inhibitors for subfertile women with polycystic ovary syndrome: summary of a Cochrane review

Polycystic ovary syndrome (PCOS) is a common cause of anovulatory subfertility. We evaluated the effectiveness and safety of aromatase inhibitors compared with other methods of ovulation induction in women with anovulatory PCOS.

Predictors of success of laparoscopic ovarian drilling in women with polycystic ovary syndrome: an evidence-based approach.

Laparoscopic ovarian drilling (LOD) is currently recommended as a successful second-line treatment for ovulation induction in women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). To provide a comprehensive review of the current evidence regarding different clinical, biochemical and ultrasonographic parameters that help in predicting ovulation and or pregnancy after LOD. A PubMed search of published studies on LOD and reproductive outcome was conducted using defined keywords. Abstracts of 121 articles were screened and relevant articles were identified. Clinical studies were included with priority for level I evidence, i.e., randomized controlled trials (RCTs) followed by other levels. Based on the current evidence, LOD could be predicted to result in poor reproductive outcome in women with CC-resistant PCOS when they are obese (BMI>25kg/m(2)), long duration of infertility>3years, low basal LH levels<10IU/L, marked biochemical hyperandrogenism (testosterone levels≥4.5nmol/L, free androgen index>15) and high basal AMH≥7.7ng/mL. Setting eligibility criteria based on the existing evidence concerning predictors of success of LOD is critical not only for improving its outcome, but also to avoid unnecessary surgery with possible risk of impairment of ovarian reserve and other complications.

Oral misoprostol for induction of labour.

Misoprostol is an orally active prostaglandin. In most countries misoprostol is not licensed for labour induction, but its use is common because it is cheap and heat stable. To assess the use of oral misoprostol for labour induction in women with a viable fetus. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 January 2014). Randomised trials comparing oral misoprostol versus placebo or other methods, given to women with a viable fetus for labour induction. Two review authors independently assessed trial data, using centrally-designed data sheets. Overall there were 76 trials (14,412) women) which were of mixed quality.In nine trials comparing oral misoprostol with placebo (1109 women), women using oral misoprostol were more likely to give birth vaginally within 24 hours (risk ratio (RR) 0.16, 95% confidence interval (CI) 0.05 to 0.49; one trial; 96 women), need less oxytocin (RR 0.42, 95% CI 0.37 to 0.49; seven trials; 933 women) and have a lower caesarean section rate (RR 0.72, 95% CI 0.54 to 0.95; eight trials; 1029 women).In 12 trials comparing oral misoprostol with vaginal dinoprostone (3859 women), women given oral misoprostol were less likely to need a caesarean section (RR 0.88, 95% CI 0.78 to 0.99; 11 trials; 3592 women). There was some evidence that they had slower inductions, but there were no other statistically significant differences.Nine trials (1282 women) compared oral misoprostol with intravenous oxytocin. The caesarean section rate was significantly lower in women who received oral misoprostol (RR 0.77, 95% CI 0.60 to 0.98; nine trials; 1282 women), but they had increased rates of meconium-stained liquor (RR 1.65, 95% CI 1.04 to 2.60; seven trials; 1172 women).Thirty-seven trials (6417 women) compared oral and vaginal misoprostol and found no statistically significant difference in the primary outcomes of serious neonatal morbidity/death or serious maternal morbidity or death. The results for vaginal birth not achieved in 24 hours, uterine hyperstimulation with fetal heart rate (FHR) changes, and caesarean section were highly heterogenous - for uterine hyperstimulation with FHR changes this was related to dosage with lower rates in those with lower doses of oral misoprostol. However, there were fewer babies born with a low Apgar score in the oral group (RR 0.60, 95% CI 0.44 to 0.82; 19 trials; 4009 babies) and a decrease in postpartum haemorrhage (RR 0.57, 95% CI 0.34 to 0.95; 10 trials; 1478 women). However, the oral misoprostol group had an increase in meconium-stained liquor (RR 1.22, 95% CI 1.03 to 1.44; 24 trials; 3634 women). Oral misoprostol as an induction agent is effective at achieving vaginal birth. It is more effective than placebo, as effective as vaginal misoprostol and results in fewer caesarean sections than vaginal dinoprostone or oxytocin.Where misoprostol remains unlicensed for the induction of labour, many practitioners will prefer to use a licensed product like dinoprostone. If using oral misoprostol, the evidence suggests that the dose should be 20 to 25 mcg in solution. Given that safety is the primary concern, the evidence supports the use of oral regimens over vaginal regimens. This is especially important in situations where the risk of ascending infection is high and the lack of staff means that women cannot be intensely monitored.

Efficacy and safety of labour induction in patients with a single previous Caesarean section: a proposal for a clinical protocol

To evaluate the efficacy and safety of induction in women with a single prior Caesarean section. This was a cohort study in which we included all singleton pregnancies in patients with a single prior Caesarean who delivered between 2007 and 2012. Methods of induction were ocytocic infusion plus amniotomy (if Bishop score ≥6) or insertion of a Foley catheter (Bishop <6). Of the 2,075 patients included, 806 (38.8%) had an elective repeat Caesarean, 1,045 (50.4%) went into spontaneous labour, 89 (4.3%) were induced by artificial rupture of the membranes and infusion of ocytocics and 135 (6.5%) were induced using a Foley catheter. Rates of vaginal delivery were 79.2, 79.8 and 43.7%, respectively. Six cases of uterine rupture were reported in the group of patients who went into spontaneous labour. There was no difference between groups with regard to neonatal morbidity. On multivariate analysis, risk factors for Caesarean delivery were macrosomia (OR 2.04, 95% CI 1.31-3.18) and induction by Foley catheter (OR 3.73, 95% CI 2.47-5.62); protective factors were previous vaginal delivery (OR 0.41, 95% CI 0.29-0.57) and cervical dilatation (OR 0.84, 95% CI 0.78-0.91). Uterine induction after a single Caesarean section with ocytocic infusion and amniotomy where the cervix is favourable does not appear to entail any significant added risk in terms of maternal or foetal morbidity. Foley catheter induction is a reasonable option if the cervix is not ripe.

Intracervical Foley Catheter Versus Vaginal Isosorbid Mononitrate for Induction of Labor in Women With Previous One Cesarean Section

Background: To compare the efficacy, safety and acceptability of intracervical Foley catheter versus vaginal isosorbid mononitrate (IMN) for induction of labor in women with previous one caesarean section at term. Methods: A prospective clinical trial including 80 term pregnant women who were assigned randomly to receive either intracervical Foley catheter or moistened one tablet of IMN 40 mg vaginally was carried out. Induction to delivery interval and outcomes of labor, adverse effects and acceptability were assessed. Results: There was shorter induction to delivery interval in the catheter group (22.2 ± 4.99 h) when compared to the IMN group (26.1 ± 3.98 h) (P < 0.05). There was a significant headache in the IMN group (10, 25%) in comparison to the catheter group (3, 7.5%). There was a significant maternal pyrexia in catheter group (12, 30%) when compared to IMN group (5, 12.5%). There was no difference between both groups regarding mode of delivery, neonatal outcome and method acceptability. Conclusion: Intracervical Foley catheter is effective, safe and acceptable for labor induction in women with previous one lower segment caesarean section at term when compared to vaginal IMN but, with more maternal pyrexia. J Clin Gynecol Obstet. 2014;3(2):55-61 doi: http://dx.doi.org/10.14740/jcgo243w