Labor In Term Pregnancies Research Articles

足月妊娠促宫颈成熟及引产方法研究进展

足月妊娠促宫颈成熟及引产方法研究进展

Role of dexamethazone on cervical ripening and induction of labor in term pregnancy

Background: labor induction between 41 and 42 weeks of gestation reduce the adverse perinatal risks. Aim of work: to determine the effect of intravenous dexamethazone administration on preparing the cervix and duration of labor induction in term pregnancy. Patients and Methods: this randomized Case control study on 52 women who were primparous, with a gestational age (40- 42)weeks and had Bishop Score 4 or less, who were admitted to obstetrics and gynecology department, zagazig university hospital during period from (April 2018 – April 2019) for the termination of their pregnancy. 6 hours before induction, experimental group (26 participants) was given 8mg intravenous dexamethasone while control group (26 participants) was given 2 ml saline intravenously. Six hours after the injection, the Bishop Score of participant was measured, and labor induction done by using oxytocin. Interval between induction initiation and starting of the active labor phase, duration of first and second stage of labor and the neonatal outcome of two groups were compared. Results: Bishop Score statistically differ between the studied groups after 6 hours of dexamethasone injection (5.88±1.18, vs. 5.19±0.85 respectively). The interval between induction initiation and beginning of active labor phase was shorter in the dexamethasone group compared to control group (90±26.3 minutes vs. 112.88±48.87 minutes). Dexamethasone group has shorter duration of first stage and second stage of labor than control group. Conclusions: The administration of dexamethasone can play a role in cervical ripening and progress of labor.

Effect of Combined Medical and Surgical Induction of Labour in Term Pregnancy at Rajshahi Medical College Hospital

This prospective clinical study was conducted in the Department of Obstetrics & Gynaecology in Rajshahi Medical College Hospital from January to December 2007. A total sample of about 100 selected primigravid women were divided into two groups. Group-I was given medical induction by misoprostol orally and Group-II by oral misoprostol followed by artificial rupture of membrane (ARM) for induction of labour. This study specifically evaluated the effect of oral misoprostol and the combined medical & surgical method, on unripe cervix of primigravid women with term pregnancies and has shown that combined method can successfully initiate labour and also lower the rate of caesarean section and significantly lowering the induction delivery time.
 TAJ 2018; 31(2): 17-20

The effect of hyoscine butyl bromide in shortening the duration of first stage of labor: A single-blind randomized control study

Background: Active management of labor reduces the number of prolonged labor and the duration of labor without having any adverse effects on the mother and the fetus. Intervention with drugs is among the options used for active management of labor. This includes use of analgesics, oxytocics, prostaglandins derivatives, and smooth muscle relaxants. The objectives of the study were to determine whether hyoscine N butyl bromide (HNBB) shortens the first stage of labor in term pregnancies, to compare the mean duration of labor between primigravidae and multigravidae in HBB group, to compare the maternal and fetal outcome between HBB and control group, and also to determine the side effects of HBB in parturients.Materials and Methods: The study was a single-blind randomized control study carried out in Usmanu Danfodiyo University Teaching Hospital (UDUTH) over 4-month period. A total of 204 pregnant women at term in spontaneous labor who presented in active phase of labor at UDUTH and have met the inclusion criteria were recruited and randomized into 102 women as case group and 102 women as control. The women in the case group received 40 mg (2 mls) of HBB, while those in the control group received 2 mls of normal saline. Data entry and analysis was done with IBM SPSS version 20. The duration and outcome was monitored.Results: The mean duration of labor in the first stage among the case group was 5:44 ± 2:11, while it was 6:52 ± 2:11 among the control group representing a decrease of 16.5%. This was statistically significant (P < 0.05). There was no difference in the duration of the second and third stages of labor among the two groups. There was no difference in the maternal and neonatal outcome among the two groups. Vomiting was the only maternal side effect that was statistically significant among the HBB group.Conclusion: HBB reduced the duration of first stage of labor in both primigravid and multigravid women without adverse maternal and neonatal complications. It is recommended that HBB to be given to women in active phase of labor to reduce the incidence of prolonged labor.

Outcomes of mifepristone usage for cervical ripening and induction of labour in full-term pregnancy. Randomized controlled trial

ObjectiveThe most commonly used approved indications for mifepristone in obstetrics include: termination of early pregnancy, cervical dilatation prior to abortion, labour induction in case of fetal death in utero. Fewer studies have been conducted on the effect of mifepristone on cervical ripening and induction of labour in term pregnancy with a live fetus. The aim of our study was to evaluate efficacy and safety of mifepristone use for cervical ripening and induction of labour versus expectant management in full-term pregnancy. Study designRandomized controlled trial. 149 women were randomized, 74 for cervical ripening and induction with mifepristone (200mg orally at the moment of enrollment and, if applicable, second dose after 24h), 75 – expectant management. Primary outcomes: gain in Bishop Score within 24 and 48-h of mifepristone; number of women going into spontaneous labor within 24, 48 and 72-h of mifepristone; rate of failed induction or expectant management. Secondary outcomes: enrollment-induction to delivery interval; mode of delivery; requirement of oxytocin augmentation, neonatal outcomes. ResultsAfter 48h from enrollment mean gain in Bishop score was 2.58±1.33 in the induction group and 1.15±0.97 in the expectant group (<0.001). Failed management rate was 5.41% and 2.67%, respectively. Significantly more mifepristone treated women had labour within 24, 48 and 72h from enrollment (RR 15.20 CI 95% 2.06–112.18; RR 6.08 CI 95% 2.73–13.57; RR 2.14 CI 95% 1.04–4.42) (p<0.05). Enrollment-induction to delivery interval was significantly shorter in mifepristone group: 2.69±2.06 vs 3.77±1.86days (p<0.001). Premature rupture of membranes, meconium-stained amniotic fluid were more common in expectant management, but regional analgesia and cephalopelvic disproportion – in induction group. There were no differences in mode of delivery, requirement of oxytocin augmentation and main neonatal outcomes. ConclusionMifepristone was efficient on inducing cervical ripening and labour in full-term pregnancy. There were no significant difference in main maternal and neonatal outcomes between mifepristone use and expectant management. There were no serious adverse side effects of mifepristone, but there were some features of the course of labor, like more painful uterine contractions and trend of higher rate of cephalopelvic disproportion, that might be directly related to the mifepristone action.

Beliefs and practices in using misoprostol for induction of labour among obstetricians in Zimbabwe

Background . Misoprostol is commonly used for induction of labour in term pregnancy. There are different routes and dosing schedules for administering the drug. Objectives . To describe the prescribing pattern (dose, route, duration), beliefs and factors affecting use of misoprostol for inducing term pregnancy among practising obstetricians in Zimbabwe. Methods . A cross-sectional descriptive survey was undertaken among practising obstetricians in Zimbabwe. A questionnaire was sent as an email, WhatsApp or short message service (SMS, or text) web link to all practising obstetricians in Zimbabwe using the SurveyMonkey online tool. All consenting practitioners were requested to respond online. The responses were analysed using the SurveyMonkey software. Results . There were 52 responses from the 63 questionnaires, a response rate of 82.5%. Seventy-six percent preferred oral misoprostol for induction of labour. The most common indication for induction was prolonged pregnancy accounting for 58% of respondents. The largest group of the practitioners who responded (36%) learnt their misoprostol dosing regimen from WHO/FIGO/NICE guidelines. A composite of highly variable dose regimens referred to as ‘other regimens’ was the dosing regimen preferred by 34% of respondents. Fiftyeight percent of practitioners used two cycles of misoprostol dosing before concluding that induction had failed and 52% would resort to caesarean section immediately if induction failed. Conclusion. The results show marked heterogeneity in the dosing schedules employed by obstetricians for induction of labour with the majority not following standard misoprostol guidelines for labour induction.

767: Cost-effectiveness of misoprostol alone versus misoprostol plus foley catheter for induction of labor in term pregnancies

767: Cost-effectiveness of misoprostol alone versus misoprostol plus foley catheter for induction of labor in term pregnancies

Sonographical predictive markers of failure of induction of labour in term pregnancy

Predictive markers of failure of induction of labour in term pregnancy were evaluated. A prospective study including 245 women attending induction of labour was performed. The inclusion criteria were singleton pregnancies, gestational age 37–42 weeks and the main outcomes were failure of induction, induction to delivery interval and mode of delivery. Women with a longer cervical length prior to induction (CLpi) had a higher rate of failure of induction (30.9 ± 6.8 vs. 23.9 ± 9.3, p < .001). BMI was higher and maternal height was lower in the group of caesarean section compared to vaginal delivery (33.1 ± 8 vs. 29.3 ± 4.6, 160 ± 5 vs. 164 ± 5, p < .001, respectively). A shorter CLpi correlated with a shorter induction to delivery interval (R Pearson .237, p < .001). In the regression analysis, for failure of induction the only independent predictor was the CL prior to induction. Therefore, the CLpi is an independent factor for prediction of failure of induction of labour.

Isolated Oligohydramnios at Term as an Indication for Labor Induction: A Systematic Review and Meta-Analysis

Objective: To investigate whether isolated oligohydramnios at term is associated with increased rates of perinatal morbidity and mortality and whether induction of labor in term pregnancies with isolated oligohydramnios is superior to conservative management in reducing perinatal morbidity and mortality. Study Design: We searched databases from inception to May 2015. We included studies that evaluated isolated oligohydramnios at term and perinatal outcome. Each outcome was analyzed separately, performing a comparative analysis between the study and control groups. Results: Twelve studies were included with 35,999 women: 2,414 (6.7%) with isolated oligohydramnios and 33,585 (93.29%) with normal amniotic fluid index. Patients with isolated oligohydramnios had significantly higher rates of labor induction [odds ratio (OR) 7.56, confidence interval (CI) 4.58-12.48] and Cesarean sections (OR 2.07, CI 1.77-2.41). There were higher rates of an Apgar score <7 at 1 and 5 min (OR 1.53, CI 1.03-2.26, and OR 2.01, CI 1.3-3.09, respectively) and admission to the neonatal intensive care unit (OR 1.47, CI 1.17-1.84). There were no significant differences in cord pH <7.1 and meconium-stained amniotic fluid. In the single randomized trial comparing induction of labor with expectant management, no differences were found in any significant maternal or neonatal outcomes. Conclusion: Isolated oligohydramnios at term is associated with significantly higher rates of labor induction, Cesarean sections, and short-term neonatal morbidity.

Comparison the Effect of Anethum graveolens and Oxytocin on Induction of Labor in Term Pregnancy: A Randomized Clinical Trial

Background: Oxytocin, the most common medicine for labor induction, has maternal and fetal side effects and sometimes is not effective. Herbal medicines are alternatively utilized as safe methods. Dill includes tannin, which is a polyphenol with contractile properties, is potentially supposed to be able to induce uterus contractions. Objectives: The current study aimed to test the effects of Anethum graveolens (dill) seeds on induction of labor and compare it with oxytocin in term pregnancy. Patients and Methods: A randomized clinical trial was conducted on 100 eligible participants without any delivery signs such as labor pain, rapture of membranes or bloody show. Participants were allocated to either the case or control group and receiving boiled Anethum graveolens seeds or induction with oxytocin, respectively. Therefore, 0.018 g/kg of dill seeds with a spoonful of sugar was solved in 250 mL of boiling water and brewed for about 10 minutes. Then it was filtrated. Subjects in the case group drank this solution only once after admission and they were infused with simple Ringer solution. The control group received standard protocol of labor induction with oxytocin. Participants were followed up to the delivery time. Results: Case group had a significantly better Bishop score following the intervention compared to the control group. The mean duration of active phase, second and third stages of labor were significantly lower in the case group. The control group had shorter latent phase than the case group. Conclusions: Results showed that the boiled Anethum graveolens seeds was effective on labor induction.

Trends in All-Cause Mortality across Gestational Age in Days for Children Born at Term.

BackgroundTerm birth is a gestational age from 259 days to 293 days. However trends in mortality according to gestational ages in days have not yet been described in this time period.Methods and FindingsBased on nation-wide registries, we conducted a population-based cohort study among all children born at term in Denmark from 1997 to 2004 to estimate differences in mortality across gestational ages in days among singletons born at term. We studied early-neonatal mortality, neonatal mortality, infant mortality, and five-year mortality. Children were followed from birth up to the last day of the defined mortality period or December 31, 2009. A total of 360,375 singletons born between 259 and 293 days of gestation were included in the study. Mortality decreased with increasing gestational age in days and the highest mortality was observed among children born at 37 week of gestation. A similar pattern was observed when analyses were restricted to children born to by mothers without pregnancy complications.ConclusionsThis study demonstrates heterogeneity in mortality rates even among singletons born at term. The highest mortality was observed among children born 37 weeks of gestation, which call for cautions when inducing labor in term pregnancies just reaching 37 weeks of gestation. The findings support that 37 weeks of gestation should be defined as early term.

Effect of hyoscine butylbromide on cervical dilation during labor

ObjectiveTo compare the effects of intravenous hyoscine butylbromide versus placebo on the duration of labor in term pregnancies. Materials and methods86 patients were selected and randomly assigned to receive intravenous hyoscine butylbromide (20mg twice) (n=43) or an intravenous placebo (saline solution 10cc) (n=43). We evaluated maternal adverse effects, effects on neonatal Apgar score, cervical dilatation 1h after drug administration and the interval between the onset of labor and delivery. ResultsNo significant differences were observed in the duration of phases of labor between the two groups. No significant differences were found between the groups in Apgar scores at 1 and 5min. No maternal adverse effects were observed or reported due to the use of hyoscine butylbromide or the placebo. On the first phase of primigravidas it shortens the first labor phase up to 159.1±84min vs. the control group (p=0.002). ConclusionHyoscine butylbromide oxytocin shortens the duration of labor in term primigravida pregnancies. No side effects were reported.

Does hyoscine butylbromide (spasmocin) shorten the first stage of labour in term pregnancies? Erratum

Does hyoscine butylbromide (spasmocin) shorten the first stage of labour in term pregnancies? Erratum

Does hyoscine butylbromide (spasmocin) shorten the first stage of labour in term pregnancies?

Does hyoscine butylbromide (spasmocin) shorten the first stage of labour in term pregnancies?

Does cervical membrane stripping in women with group B Streptococcus put the fetus at risk?

Evidence-based answer No direct evidence points to fetal harm from cervical membrane stripping (CMS) to induce labor in term pregnancies complicated by group B Streptococcus (GBS) colonization (strength of recommendation [SOR]: B, a Cochrane systematic review).

Efectos del butil bromuro de hioscina-oxitocina u oxitocina intravenosos en la duración del parto de embarazos a término

Objective To compare the effects of intravenous hyoscine butylbromide-oxytocin or oxytocin on the duration of labor in term pregnancies. Method Ninety patients were selected and randomly assigned to receive intravenous hyoscine butylbromide-oxytocin (n = 45) or intravenous oxytocin (n = 45). We evaluated maternal adverse effects, effects on neonatal Apgar score, cervical dilatation 1 hour after drug administration and the interval between the onset of labor and delivery. Results There were no significant differences between the two groups in maternal age, gestational age, or Bishop score at drug administration (p = ns). No significant differences were observed in the duration of the first, second or third phases of labor between the two groups (p = ns). No significant differences were found between the groups in Apgar scores at 1 and 5 minutes (p = ns). No maternal adverse effects were observed or reported due to the use of hyoscine-butylbromide or oxytocin. Conclusion The effect of hyoscine butylbromide-oxytocin on the duration of labour in term pregnancies is similar to that of oxytocin. The drug does not alter Apgar score or produce maternal adverse effects.

A randomized controlled trial of 24‐hour vaginal dinoprostone pessary compared to gel for induction of labor in term pregnancies with a Bishop score ≤ 4

To compare 24-hour controlled-release vaginal dinoprostone pessary vs. gel for induction of labor at term in women with an unfavorable cervix. Randomized controlled trial. University hospital. A total of 133 women with singleton pregnancies, fetal cephalic presentation, Bishop score < or = 4, gestational age of 37-42 weeks, no previous cesarean section and intact membranes admitted for induction of labor. Random allocation to either 24-hour 10-mg controlled-release vaginal dinoprostone pessary or repeat doses of 2 mg vaginal dinoprostone gel. Rate of spontaneous vaginal, operative vaginal and cesarean delivery. The rate of spontaneous vaginal delivery was significantly higher in the pessary group (72%) than in the gel group (54%), paralleled by a lower rate of operative vaginal deliveries (3 vs. 15%). The difference in cesarean section rate (25 vs. 31%) did not reach statistical significance. Both methods of induction of labor appeared to be safe, with no cases of 5-minute Apgar scores < 7 or episodes of uterine hyperstimulation in either group. The medication cost was lower in the pessary group, with a median saving of 50.20 euro compared to the gel group. Both the 24-hour dinoprostone vaginal pessary and the vaginal gel appear to be safe for labor induction. In women induced at term with a Bishop score < or = 4 the pessary achieved a significantly higher rate of spontaneous vaginal delivery.

Randomized Trial of Vaginal Prostaglandin E2 Versus Oxytocin for Labor Induction in Term Premature Rupture of Membranes

The aim of this study was to compare the efficacy and safety of a prostaglandin E(2) (PGE(2)) vaginal insert with those of oxytocin for labor induction. The present study also examined whether its use reduces the rate of cesarean delivery in term pregnancies with premature rupture of membranes (PROM) and low Bishop scores. A total of 240 women with singleton pregnancies at >or= 37 weeks, no prior uterine scar, vertex presentations, reactive nonstress tests, PROM for >or= 12 hours and Bishop scores of <or= 6 were randomly assigned to receive either oxytocin or vaginal PGE(2). The primary outcomes were time from induction to delivery and mode of delivery. The time from labor induction to active labor onset was significantly shorter in the oxytocin group than in the PGE(2) group (4.9 +/- 4.1 vs. 8.5 +/- 3.6 hours; p = 0.02). The time from induction to delivery was also significantly shorter in the oxytocin group (3.4 +/- 1.5 vs. 9.6 +/- 4.7 hours; p = 0.02). Cesarean delivery rates were statistically similar in the oxytocin and PGE(2) groups (18.3 vs. 20.0%; p = 0.81). Neonatal outcomes were comparable in both groups. Comparable results were observed for nulliparous women included in the study population. Oxytocin treatment seems to be superior to vaginal administration of PGE(2) to induce labor in term pregnancies complicated with PROM and unfavorable services.

Spontaneous uterine rupture during early labor in term pregnancy after laparoscopic radiofrequency myolysis

자연자궁파열은 드물게 발생하지만, 치명적인 산과 질환 (합병증)으로 모성과 태아의 질병 이환율 및 사망률이 높기 때문에 자궁파열을 의심할 수 있는 임상적 증상 및 징후를 보이는 경우 신속한 진단과 처치가 필요하다. 저자들은 복강경하 고주파 자궁근종용해술 후 만삭 초기 분만진통 중 발생한 자연자궁파열을 경험하였기에 보고하는 바이다.

291: Can C-reactive protein predict onset of labor in term pregnancies?

The objective of our study was to measure C-Reactive Protein (CRP) levels repeatedly during term pregnancies and to examine the hypothesis that an increase in CRP levels could be used to predict timing of onset of labor and/or PROM, as well as to assess possible correlation between increased CRP levels and intra/post partum fever.