Induction Of Labor In Term Pregnancies Research Articles

Is the Increasing Prevalence of Labor Induction Accompanied by Changes in Pregnancy Outcomes? An Observational Study of All Singleton Births at Gestational Weeks 37-42 in Norway During 1999-2019

(Acta Obstet Gynecol Scand. 2023;102:158–173) While induction of labor (IOL) is implemented with the goal to reduce the risk of maternal and perinatal adverse outcomes, it is uncertain whether risks are decreased. The aim of this study was to determine whether prevalence of IOL in term pregnancies (37 to 42 wk gestation) is accompanied by adverse outcomes or delivery mode.

Evaluation of the effect of dinoprostone vaginal ovule for cervical maturation and labor induction in term pregnancies on the duration of the third stage of labor and amount of postpartum bleeding

Background/Aim: Postpartum bleeding is a leading preventable cause of maternal death. Prolonged 3rd stage duration of labor and induction agents can increase postpartum bleeding. This study evaluated the effect of using a dinoprostone (PGE2) vaginal insert, a cervical ripening and labor induction agent, on the 3rd stage duration of labor and the amount of postpartum bleeding. Methods: This prospective cross-sectional study involved 301 patients with vaginal delivery between 01.10.2020 and 30.06.2021. Patients were separated into two groups: PGE2+oxytocin (Group A) and only oxytocin (Group B). They were compared in terms of prepartum and postpartum data, 3rd stage duration of labor, and the amount of blood loss in the first 18 h postpartum. Results: The median 3rd stage duration of labor was 8 min in Group A and 7 min in Group B (P=0.009). No significant differences were found between the groups in the amount of postpartum blood loss, percentage changes in hemoglobin and hematocrit values, or when patients were analyzed based on 3rd stage duration of labor (≤10 vs. >10 min). Severe postpartum hemorrhage (≥1000 ml) was associated with decreased gravida, increased body mass index, longer oxytocin use, and prolonged 3rd stage duration of labor in all patients. In Group A, severe postpartum hemorrhage was associated with decreased gravida, increased body mass index, and longer duration of PGE2 use. Conclusion: PGE2 prolonged the 3rd stage duration of labor, but this did not increase postpartum bleeding compared to oxytocin. However, an increase in the duration of PGE2 use was associated with postpartum hemorrhage. Therefore, shortening the duration may be considered in patients with additional risk for postpartum hemorrhage.

Vaginal prostaglandin E2 versus oxytocin for induction of labor in women with prelabor rupture of membranes at term

Aims: Majority of women with prelabor rupture of membranes (PROM) at term will go in to labor within 24 hours. However early delivery will reduce the maternal and fetal infection and reduce the need for antibiotics for newborn. It will also increase maternal satisfaction. Oxytocin is being used for several decades for induction of labor in PROM. Prostaglandin E2 (PGE2) has shown promising results for the same purpose. A randomized controlled trial carried out to determine the effectiveness and acceptability of vaginal prostaglandin E2 for induction of labor in women with PROM at term. Methods: A total of 162 women with singleton pregnancies at >37 weeks, cephalic presentations, Bishop scores of and#60;6 were randomly allocated to receive either oxytocin or vaginal PGE2. The primary outcome measure was induction to delivery interval. Secondary outcomes were caesarean section rate, postpartum maternal fever, neonatal fever, and special care baby unit (SCBU) admissions. Results: The induction to delivery interval was not significantly different (p -0.558) in oxytocin group (630.9 + 31.1 min) as compared to PGE2 group (635.2 + 27.1 min). Incidence of postpartum maternal fever, neonatal fever, and SCBU admission were almost similar in both groups. Uncomplicated vaginal delivery rates 2022were almost same in both groups (65.3% in PG group and 62.5% in oxytocin group). Conclusion: Vaginal PGE2 appears to be as efficient as oxytocin for labor induction in term pregnancies with PROM and unfavorable cervices. However PGE2 doesn’t have additional advantages over oxytocin. As vaginal PGE2 is more expensive, it is rational to opt for oxytocin infusion to induce labor in term prelabor rupture of membranes accompanied with low Bishop’s scores.

Effects of Misoprostol and Evening Primrose Extracts on Cervix Preparation for Labor Induction in Term Pregnancies

Background: Ripening is the process of preparing the cervix for induction of labor and is crucial to identify a low-complication, low-cost, and safe method of inducing labor before spontaneous labor begins. Therefore, this study aimed to demonstrate the impact of the evening primrose capsule on inducing labor, as well as to compare its effect to that of misoprostol. Methods: This prospective clinical trial study was performed on 200 low-risk pregnant women candidate for delivery in an academic hospital in Tehran from 2018 to 2020. Patients were randomly divided into two groups to receive 25 µg misoprostol vaginally or 500 mg evening primrose vaginal capsule to induce labor and repeated every three hours until reaching the bishop score > 4 in case of no effective up to three doses. The total drug dose, as well as maternal and neonatal outcomes evaluated and compared between groups. Results: Although misoprostol was significantly more effective than evening primrose in increasing cervical bishop score in the inactive phase of labor, the active phase and delivery time were not different between the groups. Also, there was no significant difference between the two groups in the cesarean section rate. Maternal complications, including uterine hyperstimulation, headache, or gastrointestinal complications in the group receiving misoprostol were significantly higher in misoprostol group, but fetal complications, including Apgar score, pH, hospitalization, and meconium excretion, were not significantly different between the two groups. Conclusions: Evening primrose capsules are safe and can be used to induce labor because of the lower risk of hyperstimulation of the uterus and the higher tolerance. There should be more research done to see if this medicine can be used alone or in conjunction with misoprostol or mechanical dilators or if it can be administered at home rather than in the hospital.

Comparison of intracervical and intravaginal prostaglandin E2 for induction of labor in term pregnancies with unfavorable cervix: Randomized controlled trial

ObjectiveThe aim of this study was to compare intracervical (IC) and intravaginal (IV) application of prostaglandin E2 (PGE2) for labor induction in term pregnancies with unfavorable cervix. Study designThis prospective randomized trial included 212 pregnant women with term pregnancy and unfavorable cervix randomly assigned for labor induction with either IC (0.5 mg) or IV (2 mg) PGE2 formulation. Main outcome measured was time interval from labor induction to delivery. Difference in mode of delivery and adverse perinatal outcomes between two studied groups was also investigated. Significance was set at p < 0.05. ResultsStudied groups did not significantly differ regarding main characteristics such as age, parity, body mass index or Bishop score. Women in IV group compared to those in IC group had shorter induction to delivery time interval (p < 0.001) and induction to active phase time interval (p = 0.001), higher prevalence of vaginal delivery within 24 h of labor induction (63,3% vs 40,6%, p = 0.002) and higher prevalence of successful induction of labor (95,9% vs. 86,5%, p = 0.020). The analysis did not reveal significant difference in mode of delivery between groups (p = 0.453) or other adverse perinatal outcomes. ConclusionIV application of PGE2 compared to IC application is more efficacious and comparably safe for labor induction in term pregnancies with unfavorable cervix and should be the method of choice for labor induction.

Use of Intravenous Dexamethasone for Cervical Ripening and Labor Induction in Term Pregnancies with Pre-labour Rupture of Membranes: Randomized control trial

Abstract Background: During the first 36 to 38 weeks of normal gestation, the myometrium is in a preparatory yet unresponsive state. Concurrently, the cervix begins an early stage of remodeling yet maintains structural integrity. Induction of labour is a complex process involving cervical ripening which undergo extensive remodeling and dynamic changes controlled by hormonal, inflammatory changes, and other biological processes. Aim of the Work: to assess the effect of intravenous administration of dexamethasone on the induction delivery interval in term patients with prelabour rupture of membranes undergoing induction of labor. Patients and Methods: This randomized control trial was conducted at department of Obstetrics and Gynecology at Ain Shams University Maternity Hospital (ASUMH) in the period between August 2020 and January 2021. Participants of this study were 80 full term pregnant women with pre-labor rupture of membranes attended the labor ward in El Demerdash Maternity Hospital and scheduled for induction of labor by 8 mg dexamethasone IV before starting induction by PGE1, after 4 hours oxytocin was added by 1 IU/hr with the dose increasing by 1 IU every 30 minutes till optimal contractions were reached which were three uterine contractions in 10 minutes and each lasting for 40-50 seconds. Results: Fetal distress, arrest of delivery and indications of CS delivery were non-significantly less frequent among Dexamethasone group. Induction-active phase and active phase durations were significantly shorter among dexamethasone group than among control group. Second and third stages durations were non-significantly shorter among dexamethasone group than among control group. Total induction-delivery duration was significantly shorter and rate of vaginal delivery was significantly higher among dexamethasone group than among control group. Postpartum hemorrhage (PPH), postpartum endometritis, chorioamnionitis were not reported among the studied groups. No significant difference between Dexamaethasone and Control groups regarding neonatal condition Conclusion: Intravenous administration of dexamethasone in addition to labor induction protocol shortened the induction - active phase and active phase durations. It shortened the total induction-delivery duration and increased the rate of successful vaginal delivery. It has no effect on second and third stages durations with no increase in incidence of intrapartum, postpartum nor neonatal complications.

Comparison between Insulin-like Growth Factor Binding Protein-1 Level and Bishop Score as Predictor of Successful Labor Induction in Full Term Pregnancy with Preeclampsia

Introduction: preeclampsia/eclampsia contributed to 30% of maternal mortality in RSUP Dr. Kariadi. Pre-induction bishop score assessment is a standard for cervical maturity estimation. Other predictors currently being developed, including insulin-like growth factor binding protein-1 (IGFBP-1). However, there is no cut-off point for IGFBP-1 examination in full term pregnancy, especially with preeclampsia and its complications. Objective: to find IGFBP-1 levels and Bishop Score differences in preeclampsia women with induction labor.Methods: this prospective observational cohort study was conducted in preeclampsia women with gestational age ≥37 weeks planned labor induction at Obstetrics and Gynecology Ward RSUP Dr. Kariadi Semarang and networking hospital during study period (n=66). History taking, physical examination, proteinuria, cervical mucus IGFBP-1, and bishop score calculation was performed. Statistical analysis was performed with paired-t test, followed by ROC for cut-off value of successful induction prediction, and logistic regression to determine confounding variables effect on IGFBP-1 levels.Results: The average Bishop score of 66 subjects was 2.5±1.81 and 2.6±1.8 for women who deliver ≤24 labor and in labor for ≤12 hours, respectively. Although the bishop score was higher in the successful labor group, there was no significant difference between groups. Mean IGFBP-1 value was 8.29±5.033 mcg/L with median value of 10.8 mcg/L. Successful induction had significant higher IGFBP-1 levels with area-under-curve (AUC) 0.76 and 8.145 cutoff value (p=0.002, RR=5.1).Conclusion: IGFBP-1 level with cutoff point 8.145 can be used as predictor of successful labor induction in term pregnancy with preeclampsia.

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.

Synthetic Osmotic Dilator Prior to Induction of Labor: Outcomes From International Observational E-Registry [13C

INTRODUCTION: To determine rate of cesarean delivery (CD) and maternal/neonatal adverse outcomes associated with use of synthetic osmotic dilator prior to labor induction. METHODS: This is a multicenter international post-marketing observational study of a synthetic osmotic dilator (Dilapan-S) for cervical ripening prior to labor induction in term pregnancies. Our primary outcome was rate of CD. Data were obtained in a standardized fashion and entered into a centralized electronic data capture system for analysis. RESULTS: Between May 2015 and July 2016, 343 term pregnant women undergoing cervical ripening prior to labor induction were included. Median maternal age was 30 (IQR18-45) years, and average BMI was 27. 68% of participants were nulliparous, 23% had a previous vaginal delivery and 9% had previous cesarean section. The majority (64%) of women received 4-5 dilators and the CD rate was 32%. Bishop score gain was 3.7 (95% CI [3.4-3.9]) with the use of the dilator. There were no cases of uterine tachysystole or FHR abnormalities. Maternal discomfort was reported by 9% of women and the rate of chorioamnionitis was 1.5%. Meconium stained amniotic fluid was present in 11% of patients. All newborns had an Apgar score at 5 minutes ≥ 7. Arterial pH &lt; 7.1 and neonatal intensive care admissions were &lt; 1%. CONCLUSION: Compared to other cervical ripening methods, the use of synthetic osmotic dilators appears to be safe and efficient method of cervical ripening for induction of labor in term pregnant women. Randomized clinical trials are needed to compare its efficacy to other methods of cervical ripening.

Intravaginal Misoprostol for Cervical Ripening and Labor Induction in Nulliparous Women

Background:In China, no multicenter double-blinded prospective randomized controlled study on labor induction has been conducted till now. This study is to evaluate the efficacy and safety of intravaginal accurate 25-μg misoprostol tablets for cervical ripening and labor induction in term pregnancy in nulliparous women.Methods:This was a double-blinded, prospective randomized controlled study including nulliparous women from 6 university hospitals across China. Subjects were randomized into misoprostol or placebo group with the sample size ratio set to 7:2. Intravaginal 25-μg misoprostol or placebo was applied at an interval of 4 h (repeated up to 3 times) for labor induction. Primary outcome measures were the incidence of cumulative Bishop score increases ≥3 within 12 h or vaginal delivery within 24 h. Safety assessments included the incidences of maternal morbidity and adverse fetal/neonatal outcomes.Results:A total of 173 women for misoprostol group and 49 women for placebo were analyzed. The incidence of cumulative Bishop score increases ≥3 within 12 h or vaginal delivery within 24 h was higher in the misoprostol group than in the placebo (64.2% vs. 22.5%, relative risk [RR]: 2.9, 95% confidence interval [CI]: 1.4–6.0). The incidence of onset of labor within 24 h was significantly higher in the misoprostol group than in the placebo group (48.0% vs. 18.4%, RR: 2.6, 95% CI: 1.2–5.7); and the induction-onset of labor interval was significantly shorter in the misoprostol group (P = 0.0003). However, there were no significant differences in the median process time of vaginal labor (6.4 vs. 6.8 h; P = 0.695), incidence (39.3% vs. 49.0%, RR: 0.8, 95% CI: 0.4–1.5) and indications (P = 0.683) of cesarean section deliveries, and frequencies of maternal, fetal/neonatal adverse events between the groups.Conclusion:Intravaginal misoprostol 25 μg every 4 h is efficacious and safe in labor induction and cervical ripening.

Is low dose vaginal misoprostol better than dinoprostone gel for induction of labor: a randomized controlled trial.

To compare the efficacy and safety profile of low dose vaginal misoprostol with dinoprostone gel for induction of labor in term pregnancies. The study was conducted at Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital on 100 pregnant women with term pregnancy after application of inclusion and exclusion criteria. The women were randomized in 2 groups of 50 women each. Group I received misoprostol 25μg at every six hour vaginally for a maximum of five doses for induction of labor; while group II received dinoprostone gel 0.5 mg every six hourly for a maximum of three doses. Maternal outcomes such as mode of delivery and induction delivery interval; and fetal outcomes such as APGAR score and incidence of NICU admission were assessed in both the groups. Statistical analysis was done using student t-test and chi-square test. There was no significant difference in the mean induction to delivery interval in both the groups (14.32±0.13 hours in Group I and 14.92±0.18 hours in Group II, p=0.75), mode of delivery, indication of cesarean section and perinatal outcome. However, significant difference was observed in requirement of oxytocin augmentation in both the groups (32% in Group I and 68% in Group II, p=0.005). Vaginal misoprostol in low doses is similar in efficacy and safety to dinoprostone gel for cervical ripening and labor induction in term pregnancy.

Safety and effectiveness of oral misoprostol versus oxytocin for labor induction in term pregnancy

Background & Objectives: The usual method for inducing labor in Iran is the use of oxytocin (Syntocinon). Oxytocin, however, has been shown to be less effective than misoprostol. The aim of the present study was to evaluate the effectiveness and the safety of orally administered misoprostol for labor induction in term pregnant women and to compare it with intravenously infused oxytocin. Material & Methods: This random clinical trial was carried out between 2009 and 2010. A total of 130 term pregnant women whom were candidate for vaginal delivery assessed for eligibility to enter the study and randomly assigned into one of two groups according to the method of treatment, misoprostol or oxytocin. The misoprostol was prescribed orally 25 µg every two hours. The oxytocin group received an infusion of 10 IU which was gradually increased. The time from induction to delivery , induction to the beginning of the active phase , successful inductions within 12, 18, and 24 hours and caesarean section indication were recorded Statistical analysis was performed using the SPSS 16.0 presented with Mann-Whitney U test, chi-square and t-test. Results: Failure of induction, leading to caesarean section was 32.3% and 63.1% in misoprostol versus oxytocin groups respectively. The mean time intervals from induction to active phase and labor in misoprostol group were significantly greater than oxytocin group. Maternal (except gastrointestinal problem) and fetal complications were not comparable between the two groups. Conclusions: Misoprostol is as a safe drug as oxytocin with low complications for the induction of labor

Comparative efficacy and safety of vaginal misoprostol versus dinoprostone vaginal insert in labor induction at term: a randomized trial

To compare efficacy and safety of vaginal misoprostol (PGE(1) analog) with dinoprostone (PGE(2) analog) vaginal insert for labor induction in term pregnancies. A total of 112 women with singleton pregnancies of > or =37 weeks of gestation, and low Bishop scores underwent labor induction. The subjects were randomized to receive either 50 mug misoprostol intravaginally every 4 h to a maximum of five doses or a 10 mg dinoprostone vaginal insert for a maximum of 12 h. Time interval from induction to vaginal delivery, vaginal delivery rates within 12 and 24 h, requirement of oxytocin augmentation, incidence of tachysystole and uterine hyperstimulation, mode of delivery, rate of cesarean section due to fetal distress and neonatal outcome were outcome measures. Student's t test, Chi square test, Fischer's exact test were used for statistical analysis. Time interval from induction to vaginal delivery was found to be significantly shorter in misoprostol group when compared to dinoprostone subjects (680 +/- 329 min vs. 1070 +/- 435 min, P < 0.001). Vaginal delivery rates within 12 h were found to be significantly higher with misoprostol induction [n = 37 (66%) vs. n = 25 (44.6%); P = 0.02], whereas vaginal delivery rates in 24 h did not differ significantly between groups [n = 41 (73.2%) vs. n = 36 (64.2%); P = 0.3]. More subjects required oxytocin augmentation in dinoprostone group [n = 35 (62.5%) vs. n = 20 (35.7%), P = 0.005] and cardiotocography tracings revealed early decelerations occurring more frequently with misoprostol induction (10.7 vs. 0%, P = 0.03). Tachysystole and uterine hyperstimulation, mode of delivery, rate of cesarean sections due to fetal distress and adverse neonatal outcome were not demonstrated to be significantly different between groups (P = 1, P = 0.5, P = 0.4, P = 0.22, P = 0.5). Using vaginal misoprostol is an effective way of labor induction in term pregnant women with unfavorable cervices, since it is associated with a shorter duration of labor induction and higher rates of vaginal delivery within 12 h. Misoprostol and dinoprostone are equally safe, since misoprostol did not result in a rise in maternal and neonatal morbidity, namely, tachysystole, uterine hyperstimulation, cesarean section rates and admission to neonatal intensive care units as reported previously in literature.

Misoprostol for labor induction in term pregnancy

Misoprostol has been used off-label for labor induction for many years. A large number of randomized controlled studies have assessed the efficacy and safety of misoprostol in different dose ranges between 10 and 100 mcg, with different dose intervals and different administration routes including oral, intravaginal, rectal, sublingual, and buccal administration. Currently, registration trials are underway, and misoprostol for registered indication of labor induction might be available in several European countries in the near future. Meanwhile, guidelines for off-label use should be provided by authorities or OB/GYN associations.

P11.08: Mifepristone is an effective ripening agent in postdates primips with cervical length ≥ 2.5 cm, but mode of delivery correlates with birthweight: a randomised, placebo controlled double blind study

height, maternal age, and birth weight, but not cervical length and Bishop score, were significantly associated with cesarean delivery for failure to progress. Conclusions: Transvaginal sonographic measurement of cervical length is a useful and independent predictor of failed labor induction in term pregnancy and appears to be a better predictor than the Bishop score. Both ultrasonographically measured cervical length and Bishop score appear to be of poor predictive value for the likelihood of caesarean delivery for failure to progress in women undergoing induction of labor.

Labor induction with misoprostol

Misoprostol, a prostaglandin E 1 analog, is widely used in the United States for cervical ripening and labor induction. Its use for these indications is not approved by the US Food and Drug Administration. The only Food and Drug Administration–approved indication in the product labeling is the treatment and prevention of intestinal ulcer disease resulting from nonsteroidal anti-inflammatory use. Multiple trials have proved that misoprostol is an effective agent for cervical ripening and labor induction in term pregnancy; however, investigations continue regarding the optimal dose, dosing regimen, and route of administration. Uterine contraction abnormalities are often found in association with higher misoprostol doses. Some trials also indicate increased frequencies of meconium passage, neonatal acidemia, and cesarean delivery for fetal distress in women receiving higher doses of misoprostol. Overall, most trials fail to demonstrate a significant change in the cesarean delivery rate with the use of this agent. Misoprostol is an effective agent for cervical ripening and labor induction when used in a judicious and cautious fashion. (Am J Obstet Gyneol 1999;181:339-45.)

Induction of labor with intravaginal administration of misoprostol

Objective: The purpose of this study was to evaluate the efficacy and safety of intravaginal misoprostol for labor induction. Methods: 110 singleton term pregnancies with or without rupture of membranes were enrolled. Fractionated doses of misoprostol were applied (50–100 μg), every 6 h until a maximum of three doses or beginning of labor. Results: The average interval (±S.D.) from vaginal application to the beginning of active labor and to delivery were, respectively, 9.5±5.7 h and 14.8±9.5 h. Failed labor induction was observed in two cases (2%). Cesarean section rate was 14%. The incidence of tachysystole was 18% and hypersystole 4%, but these situations were associated with abnormal fetal heart rate pattern (hyperstimulation) in only 3%. No maternal side effects and neonatal adverse effects were noted. Conclusions: Intravaginal misoprostol administration with low doses is an effective and safe method for labor induction in term pregnancies, with or without rupture of membranes.