Induction Of Labor In Pregnancies Research Articles

Induction of labour in pregnancies complicated by late-onset foetal growth restriction: an observational study on perinatal outcomes

Induction of labour in pregnancies complicated by late-onset foetal growth restriction: an observational study on perinatal outcomes

Developing a nomogram for estimating the risk of needing to perform a caesarean section after induction of labour in pregnancies using a COOK® Cervical Ripening Balloon.

Using a COOK® Cervical Ripening Balloon (CCRB) for cervical maturity has become a common clinical practice for the induction of labour (IOL). To develop and validate a predictive instrument that could estimate the risk of a caesarean after IOL in term pregnancies with CCRB treatment. The medical records of 415 pregnant women requiring IOL from January 2018 to October 2022 were retrospectively reviewed and randomly selected for training (290) and validation (125) sets in a 7:3 ratio. A model for predicting the risk of a caesarean was virtualised by a nomogram using logistic regression analysis. After completing the multivariate analysis, parity (odds ratio [OR] = 0.226; p= 0.017), modified Bishop score at induction (OR =0.688; p= 0.005) and the artificial rupture of membranes (OR = 0.436; p= 0.010) were identified as the predictors for implementing a caesarean delivery after IOL. The decision curve analysis showed that the model achieved a net benefit across all threshold probabilities. We successfully constructed a nomogram for caesarean delivery after IOL in pregnancies with CCRB treatment using factors including parity, modified Bishop score at induction and the artificial rupture of membrane.

Induction of labour in pregnancies with gestational diabetes mellitus, maternal and neonatal outcomes: a single centre experience

Induction of labour in pregnancies with gestational diabetes mellitus, maternal and neonatal outcomes: a single centre experience

Against Medical Advice for Induction of Labor Due to Post-term Pregnancies—The Impact on Pregnancy Outcome

ABSTRACT Postterm pregnancies are associated with adverse perinatal outcomes, including meconium and meconium aspiration syndrome, Apgar score <4 at 5 minutes, oligohydramnios, fetal macrosomia, and stillbirth. To prevent or minimize these complications in pregnancies >41 weeks of gestation, routine antenatal surveillance is recommended. In comparison to expectant management, most evidence supports benefits from induction of labor in pregnancies at 41 and 42 weeks of gestation. Yet, individuals with postterm pregnancies may decide to decline the medical recommendation for induction. Evidence on the outcomes associated with choosing care that is against medical advice (AMA) is scant in this population. The aim of this study was to examine the effect of refusing medical advice for labor induction in postterm pregnancies on maternal and neonatal outcomes. This was a retrospective cohort study of women with pregnancies >41 + 3 weeks' gestation who refused labor induction AMA. Included were healthy, adult women with low-risk, singleton pregnancies and cephalic presentation, who received care at a single tertiary hospital between 2017 and 2019. Excluded were those with a suspected small-for-gestational-age infant, as well as those in active labor or with premature rupture of membranes, nonreassuring fetal heart rate, hypertensive disorders, diabetes, or oligohydramnios. Women who refused induction AMA (study group) were compared with those who agreed to the medical recommendation (control group) in a 1:2 ratio. The analysis included 249 postterm women—83 in the study group and 166 in the control group. There were significantly higher rates of cesarean delivery (21.7% vs 10.2%, P = 0.04), longer postdelivery hospitalizations (2.9 vs 2.4 days, P < 0.05), and more advanced gestational age at delivery (41 + 6 vs 41 + 4 weeks, P < 0.05) in the study group versus the control group. Cesarean delivery also was indicated most often for nonreassuring fetal heart rate (77% vs 47%), followed by arrest of dilation and arrest of descent (16% vs 17.6%) and failure of induction of labor (5.5% vs 35.2%) in the study group. Among those who refused induction AMA, 67% returned to the hospital at the onset of active delivery, 24% chose to continue surveillance twice a week, and 8% were admitted upon their request for daily nonstress test and biophysical scoring. They also experienced significantly higher rates of meconium stained amniotic fluid (44% vs 15.7%, P < 0.01), admission to the neonatal intensive care unit (9.6% vs 5%, P < 0.01), and mechanical ventilation (4.81% vs 0.6%, P < 0.01). The composite of adverse maternal and neonatal outcomes was higher in the study group than the control group (25.3% vs 17.46%, P < 0.001). In conclusion, the risk of choosing to refuse induction AMA in postterm pregnancies is associated with increased risk of adverse maternal and neonatal outcomes, as well as cesarean delivery.

Importance of Intermittent Cardiotocographic Monitoring Prior to Misoprostol-Assisted Induction of Labour

Aim: To determine the importance of intermittent cardiotocographic monitoring during misoprostol-assisted induction of labour in pregnancies lasting weeks or more. Methods: This descriptive study was carried out in the Obstetrics and Gynecology department of Combined Military Hospital, Kharian Cantt for the duration from January 2022 to August 2022 among 130 primigravida patients underwent CTG before receiving transvaginal dose of misoprostol. Neonatal admissions, the mode of delivery, the Apgar score, and indications of induction were the variables examined. Results: Forty-two (70%) of the C-section patients had reassuring CTG and significantly low Apgar scores at 1 minute. Seven (8.5%) of the patients with thick meconium had non-reassuring CTG. Twelve neonates (9.2%) in total required resuscitation, 9 (75%) of whom had reassuring CTGs while 3(25%) had non-reassuring CTGs. The overall admission rate in NICU was 10%, and 38.5% of neonates that required resuscitation had non-reassuring CTG. Neonatal mortality was nil during the study time. Conclusions: Patients who had their labour induced with misoprostol had non-reassuring CTG among 50% of cases and had thick meconium stained liquor. Therefore, we can lower neonatal morbidity and mortality by early foetal impairment detection. Neonatal mortality was nil during the study time. Keywords: cardiotocography, induction, resuscitation, Apgar score and caesarean section

Pharmacokinetics of oral misoprostol for induction of labor in pregnancies complicated by obesity

Birthing parents with obesity have increased risk of medical and obstetric complications during pregnancy, often leading to a recommendation for induction of labor (IOL). Misoprostol is commonly used for IOL, however there is limited data on whether it’s pharmacokinetics (PK) are altered by body size. The objective of this study is to evaluate PK parameters of oral misoprostol in pregnancies complicated by obesity. Pilot, single-center, observational study of non-fasting, term, singleton pregnancies with body mass index (BMI) > 30.0 kg/m2 at time of IOL with 50 mcg oral misoprostol. Plasma concentrations of active metabolite misoprostol acid (MPA) were measured at four time points using liquid chromatography mass spectrometry. Plasma MPA-time data analyzed using a non-compartmental PK model to derive the area under the curve from the first time point to the last measured concentration (AUC0-t) using the trapezoidal rule. Terminal slope (λz) used to extrapolate plasma concentration to infinity (AUC0-∞). Maximum serum concentration (Cmax) and time to maximum plasma concentration (Tmax) also described. 26 plasma observations from 7 subjects were included (Table 1). Observed plasma concentrations over time (Figure 1) demonstrate median(range) Cmax 26.63 (7.18-56.24) pg/mL, AUC0-t 10.93 (2.43-24.64) pg-h/mL, λz 2.68 (2.00-3.07) h-1, AUC0-∞ 22.67 (12.09-30.60) pg-h/mL. Tmax observed at 0.25 hours. Prior study evaluating 50 mcg oral misoprostol in 12 subjects with normal BMI (mean 28.6 kg/m2) reports mean±SD Cmax 53.97±23.79 pg/mL, AUC0-t 55.02±28.80 pg-h/mL, λz 1.05±0.86 h-1, AUC0-∞ 66.63±33.22 pg-h/mL, Tmax 0.23±0.14 hours. To our knowledge, this study is the first examination of 50 mcg oral misoprostol PK parameters among parturients with obesity undergoing term IOL. Data show decreases in PK parameters in this population, however some results are still within reported margin of error and there is marked variance between subjects. A future, powered, comparative trial is necessary to confirm these findings as well as further investigate clinically relevant outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Factors associated with cesarean delivery following labor induction in pregnancies with preterm preeclampsia

Factors associated with cesarean delivery following labor induction in pregnancies with preterm preeclampsia

Comparison between Oxytocin and Dinoprostone in Labor Induction in Pregnancies with Premature Rupture of Membranes

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377 Risk of adverse perinatal outcome after labor induction in pregnancies complicated by gestational diabetes

Introduction: Gestational diabetes mellitus (GDM) is defined as diabetes with onset during pregnancy. It occurs in 17 % of all pregnancies. There are several complications related to GDM, like polyhydramnios, fetal growth abnormalities, maternal and infant birth trauma, operative delivery, perinatal mortality, neonatal respiratory problems, and metabolic complications. This study aimed to establish if labor induction in pregnancies with GDM results in adverse perinatal outcomes. Material and Methods: This is a single-center retrospective cohort study.

Induction of labor in pregnancies with small-for-gestational age - does the method affect pregnancy outcome?

We aimed to compare obstetric and neonatal outcomes in relation to placental histopathological findings between two groups of induction of labor (IOL) in pregnancies with small for gestational age (SGA) neonates.

Early planned labor induction vs expectant management in late preterm pre-labor rupture of membranes: maternal and neonatal outcomes.

To compare expectant management with early planned labor induction in pregnancies complicated by late preterm pre-labor rupture of membranes (PPROM). A retrospective file review was conducted in a single tertiary center from January 2015 to Sep-tember 2019. Singleton pregnancies complicated by late PPROM at 34-36 completed weeks of gestation were enrolled. We compared maternal and neonatal complications between expectant management and early planned labor induction. We retrospectively assigned 41 women to the expectant management group and 39 to the early planned labor induction group. No difference was found in the mode of delivery between the groups. Women in the expectant manage-ment group had a longer antepartum hospital stay compared with the induction group (median of three versus one day, p < 0.01). Neonates were delivered at a more advanced gestational age in the expectant management group compared with that in the induction group (35 5/7 versus 35 2/7 weeks, p < 0.01). In the induction group, 74.4% of the neonates were admitted to the intensive care unit (ICU), and 66.7% received antibiotics compared with 51.2% of neonates admitted to ICU and 29.3% receiving antibiotics in the expectant management group (p = 0.04 and p < 0.01, respectively). In pregnancies complicated by late PPROM, early labor induction was associated with a shorter antepartum maternal hospital stay but a higher neonatal ICU admission rate and more frequent antibiotic administration than expect-ant management. We consider expectant management to be an acceptable alternative to early labor induction in PPROM.

Addition of vaginal isosorbide mononitrate for labor induction in pregnancies complicated by hypertensive diseases of pregnancy: a randomized controlled trial

Pregnancies complicated by hypertensive disease of pregnancy often require labor induction. Rates of cesarean delivery range from 15% to 60% in this population. Nitric oxide deficiency has been shown to underlay the pathophysiology of preeclampsia, and nitric oxide promotes cervical ripening. We hypothesized that addition of vaginal isosorbide mononitrate for labor induction could decrease the rate of cesarean delivery in pregnancies with hypertensive disease of pregnancy. This study was a double-blind, placebo-controlled, randomized trial of patients with singleton pregnancy at ≥24 weeks' gestation undergoing labor induction for hypertensive diseases of pregnancy between November 2017 and February 2020. Participants were eligible if their Bishop score was <6 and if their cervical dilation was ≤2 cm. In addition, participants received up to 3 doses of 40 mg isosorbide mononitrate in addition to misoprostol for labor induction. Labor management was per healthcare provider preference. The primary outcome was rate of cesarean delivery. Secondary outcomes included the length of labor and frequency of intrapartum adverse events, including the use of intrapartum antihypertensive agents. 89 women were randomized to the isosorbide mononitrate group, and 87 women were randomized to the placebo group. Cesarean delivery rates were similar in both groups (32.6% vs 25.3%; relative risk, 1.29; 95% confidence interval, 0.81-2.06; P=.39). Maternal headache was increased in patients exposed to isosorbide mononitrate (42.7% vs 31%; relative risk, 1.52; 95% confidence interval, 1.04-2.23; P=.04). Clinical chorioamnionitis was increased in the placebo group (0% vs 8%; P=.02). Secondary outcomes were similar between groups. The addition of vaginal isosorbide mononitrate for labor induction in pregnancies complicated by hypertensive disease of pregnancy did not result in fewer cesarean deliveries.

52 Vaginal isosorbide mononitrate for labor induction in pregnancies complicated by hypertensive diseases of pregnancy

Pregnancies with hypertensive diseases of pregnancy (HDP) often require induction of labor to minimize maternal and fetal risks. There is no superior method of labor induction and rates of cesarean delivery (CD) range from 15-60% in this population. Nitric oxide donors decrease maternal blood pressure and soften the cervix without inducing uterine contractions. We hypothesized that addition of vaginal isosorbide mononitrate (IMN) to vaginal misoprostol for labor induction may decrease the rate of CD and need for intrapartum emergent antihypertensive therapy in pregnancies complicated by HDP. This was a double-blind, placebo-controlled, randomized trial of women with singleton pregnancy ≥24 weeks gestation with an induction of labor for HDP between 11/2017-2/2020. Participants were eligible if Bishop score less than 6 and cervical dilation ≤2cm. They received up to 3 doses of 40mg IMN and 25mcg vaginal misoprostol in addition to standard interventions for induction - foley and oxytocin. Primary outcome was rate of cesarean delivery. Secondary outcomes included indication for CD, length of labor, use of intrapartum emergent antihypertensives, and maternal and neonatal morbidities. A sample size of 176 women was needed to detect at least a 20% difference in the primary outcome (Power 0.8). 89 women were randomized to the IMN group and 87 to the placebo group. GA at delivery were similar between groups (37 [34-38] vs 37 [35-38]). CD rates were similar with between both (32.6% vs 25.3%; RR, 1.29; 95% CI, 0.81 to 2.06; P=0.39). Neither length of labor nor use of intrapartum emergent antihypertensives was significantly different. Maternal headache was more common in IMN group than placebo group (47.2% vs 27.0%; RR, 1.52; 95% CI, 1.04 to 2.23; P=0.04), whereas clinical chorioamnionitis was less common in the IMN group (0% vs 8%; P=0.02). Adding vaginal IMN to vaginal misoprostol for labor induction in pregnancies complicated by HDP did not result in fewer CD.

VP36.02: Dinoprostone versus mechanical induction of labour in pregnancies complicated by late fetal growth restriction: a multicentre study

VP36.02: Dinoprostone versus mechanical induction of labour in pregnancies complicated by late fetal growth restriction: a multicentre study

Characteristics Associated With Consent and Reasons for Declining in a Randomized Trial in Pregnancy.

To evaluate the maternal characteristics associated with consent to a randomized trial of labor induction in pregnancy. This is a secondary analysis of low-risk nulliparous women randomized to induction of labor at 39 weeks or expectant management. During the trial, the Data and Safety Monitoring Committee requested additional fields on the screening log, which already included race and ethnicity: maternal age, type of insurance, and the reason for declining consent if declined. From August 2016 (start of additional data collection) to August 2017, 1,965 (28%) of the 7,112 eligible women consented to the trial. Consent was more likely for Black women (41%, adjusted odds ratio [aOR] 1.47, 95% CI 1.24-1.74), and less likely for Asian women (15%, aOR 0.64, 95% CI 0.48-0.84), compared with White women (24%). Women without private insurance were more likely to consent (38%, aOR 1.55, 95% CI 1.34-1.79), compared with those with private insurance (22%). Younger women were also more likely to consent. Among eligible women who declined participation and provided a reason (68%), preference to be expectantly managed (85%) was most common, a response more common in Asian women (aOR 1.75, 95% CI 1.31-2.33) and less common in women without private insurance (aOR 0.60, 95% CI 0.51-0.70). Not wanting to participate in research was more common in Asian women (aOR 2.41, 95% CI 1.44-4.03). Declining consent because family or friends objected was more common in Asian women (aOR 2.51, 95% CI 1.27-4.95) and women without private insurance (aOR 1.68, 95% CI 1.10-2.59). Frequency of consent and reasons for declining consent were associated with age, type of insurance, and race and ethnicity. These findings should be considered when developing recruitment strategies that promote diverse participant representation. ClinialTrials.gov, NCT01990612.

Oxytocin in Induction of Labor in Pregnancy with Group B Streptococcal Portage

Abstract In the last two decades, group B streptococcus (GBS) infection has established itself as a major cause of perinatal morbidity and mortality. The purpose of this study is to identify if the electively induced labor with oxytocin in women with positive cultures of Streptococcus agalactiae, namely the group B streptococcus (GBS), helps the mother and fetus and decreases the risk associated with perinatal transmission of GBS compared with the spontaneous labor. Results associated with induction of labor with oxytocin compared with spontaneous labor in pregnant women who have GBS - positive cervical cultures, are also used to determine whether induction of labor decreases the risk of complications from GBS infection.

TO COMPARE THE EFFECTIVENESS OF EXTRA-AMNIOTIC SALINE INSTILLATION THROUGH FOLEY CATHETER PRIOR TO ORAL MISOPROSTOL WITH ORAL MISOPROSTOL ALONE IN INDUCING LABOUR IN PREGNANCIES &gt;28 WEEKS WITH INTRAUTERINE FOETAL DEATH- A RANDOMIZED CONTROLLED TRIAL AT TE

Background: The present study aims to compare the results of EASI followed by oral misoprostol and oral misoprostol alone for induction of labour in pregnancies of more than 28 weeks with intrauterine foetal death.&#x0D; Methods: The present observational and prospective study is an attempt to compare the efficacy of extra-amniotic saline instillation with Foley catheter prior to oral misoprostol and oral misoprostol alone in induction of labour of pregnancies more than 28 weeks with intrauterine fetal death.&#x0D; Results: Most of the cases delivered vaginally in both study groups. The mean induction delivery time in group I was higher than group II and the results were statistically significant on comparing both groups. In group I, 78% cases were delivered within 24 hours whereas in group II 96% cases delivered within 24 hours of induction. There was no significant difference in the mean number of required misoprostol in both groups (p&gt;0.05). Need of supplementation with oxytocin was more in group I as compared to group II and the p value is significant (p&lt;0.01). Mean birth weight in group I was 2.25±0.75 kg and in group II was 2.27±0.77 kg. Maximum number of babies had birth weight between 1.52-2.50 kg with 44% in group I and 40% in group II (p&gt;0.05). Only 4 cases had uterine tachysystole and only 1case had postpartum pyrexia. Very few complications were recorded in both the study groups (p&gt;0.05).&#x0D; Conclusion: We concluded that oral misoprostol tablet alone is more effective at inducing and setting up the active labour in pregnancies of &gt;28 weeks with intrauterine foetal death than EASI followed by oral misoprostol. It is inexpensive, has a long shelf life, can be easily stored at room temperature and patient remains ambulatory after induction with oral misoprostol. Oral misoprostol alone seems to have an edge over extra-amniotic saline instillation followed by oral misoprostol in all aspects.&#x0D; Keywords: Misoprostol, Extra-amniotic saline, Induction of labour.

Prostaglandin E2 induction of labor and cervical ripening for term isolated oligohydramnios in pregnant women with Bishop score ≤ 5

BackgroundWe aimed to evaluate the efficacy and safety of dinoprostone for cervical ripening and labor induction in patients with term oligohydramnios and Bishop score ≤ 5. MethodsThis was a prospective case–control study, which included 104 consecutive women with a Bishop score≤5. Participants were divided into two groups. Women with term isolated oligohydramnios and Bishop score≤5 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (prostaglandin E2; Group A, n=40). The control group, Group B, consisted of 64 cases of pregnancy with normal amniotic fluid volume (amniotic fluid index≥5 cm) and Bishop score≤5, and was matched for patient's age and parity. The primary outcome was time from induction to delivery; the secondary outcomes were the caesarean section (CS) rate, uterine hyperstimulation, rate of failed induction, and neonatal complications. ResultsThe mean time interval from induction to delivery was not different between the two groups (p=0.849), but there was a statistically significant difference between the groups in terms of the CS rate (p=0.005). There were no differences between the groups in neonatal outcome or perinatal morbidity or mortality. ConclusionDinoprostone appears to be a safe alternative for induction of labor in pregnancies with oligohydramnios. Induction of labor with dinoprostone in term pregnancies with isolated oligohydramnios is associated with increased rate of CS but there is no higher risk of perinatal complications.

Misoprostol versus Foley catheter insertion for induction of labor in pregnancies affected by fetal growth restriction

ObjectiveTo compare 25μg of vaginal misoprostol with a Foley catheter for induction of labor (IOL) for fetal growth restriction. MethodsA randomized controlled trial was conducted in a tertiary center in South India. Women with fetal growth restriction (n=100) were randomized to be induced with three doses of vaginal misoprostol (25μg) every 6hours or with an intracervical Foley catheter, inserted 12hours before rupture of membranes, and oxytocin if needed. The primary outcome was uterine tachysystole with fetal cardiotocography abnormalities. Secondary outcomes pertained to effectiveness, complications, and patient satisfaction. ResultsOne woman in the misoprostol group and none in the Foley catheter group had uterine tachysystole. The duration of labor from IOL to delivery was similar in both groups (P=0.416). More women in the misoprostol group had a vaginal delivery within 12hours (26.1% versus 5.6%; P=0.005). Women induced with misoprostol were less likely to deliver by lower-segment cesarean delivery (15.2% versus 29.6%; P=0.168) and to require oxytocin augmentation (60.9% versus 85.2%; P=0.007). Complications were few in both group. ConclusionFew women had uterine tachysystole with cardiotocography abnormalities. Vaginal misoprostol at 25μg was more effective than a Foley catheter for IOL in fetal growth restriction. Clinical Trials Registry India: CTRI/2014/02/004411.

Castor oil for induction of labour: Not harmful, not helpful

Castor oil is one of the most popular drugs for induction of labour in a non-medical setting; however, published data on safety and effectiveness of this compound to induce labour remain sparse. To assess the safety and effectiveness of castor oil for induction of labour in pregnancies with an ultrasound estimated gestational at birth of more than 40 weeks. Data were extracted from hospital-based records of all pregnant women who attended antenatal clinics on the Thai-Burmese border and who were more than 40 weeks pregnant. The effectiveness of castor oil to induce labour was expressed as time to birth and analysed with a Cox proportional hazards regression model. Measures associated with safety were fetal distress, meconium-stained amniotic fluid, tachysystole of the uterus, uterine rupture, abnormal maternal blood pressure during labour, Apgar scores, neonatal resuscitation, stillbirth, post-partum haemorrhage, severe diarrhoea and maternal death. Proportions were compared using Fisher's exact test. Of 612 women with a gestation of more than 40 weeks, 205 received castor oil for induction and 407 did not. The time to birth was not significantly different between the two groups (hazard ratio 0.99 (95% confidence interval: 0.81 to 1.20; n = 509)). Castor oil use was not associated with any harmful effects on the mother or fetus. Castor oil for induction of labour had no effect on time to birth nor were there any harmful effects observed in this large series. Our findings leave no justification for recommending castor oil for this purpose.