Rate Of Labor Induction Research Articles

Pre-Induction and Intrapartum Correlates of Successful Induction Of Labour Using Oxytocin and Misoprostol in Abakaliki, Nigeria

Context: Induction of labour (IOL) is a therapeutic challenge and an alternative to Caesarean section. Objectives: To evaluate the success rate of IOL and its determinants at the Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki. Methods: A retrospective study involving 251 parturients who had induction of labour over a five-year period. Results: IOL accounted for 2.9% of the 8,676 deliveries during the study period. The overall success rate for labour induction in EBSUTH was 83.1%. Multiparous women achieved a success rate of 91.4%, grandmultipara 95.7%, and primigravida 58.2%. IOL using Misoprostol had a success rate of 83.1% and Oxytocin titration with synchronous fore water amniotomy 83.1%. Common indications for IOL included prolonged pregnancy (69.0%), and hypertensive disorders in pregnancy (15.7%). Factors influencing outcome included parity, booking status, gestational age, pre-induction cervical status and latent period interval. Conclusion: Induction of labour EBSUTH had a high success rate of 83.1%. Booking status, pre induction cervical Bishop's score ans parity amongst others significantly influenced the success rate in this study.Key Words: Induction, labour, oxytocin, misoprostol, EBSUTH, outcome.

Randomized clinical trial evaluating the frequency of membrane sweeping with an unfavorable cervix at 39 weeks

Background:Despite the widely accepted use of membrane sweeping to prevent postmaturity pregnancies, the optimal frequency for this procedure has not been established.Aim:To determine if the frequency of membrane sweeping in women with an unfavorable cervix at term results in fewer labor inductions.Methods:This was a randomized trial of women with an unfavorable cervix (Bishop’s score of ≤4) at 39 weeks randomized into three groups: control, once-weekly membrane sweeping, and twice-weekly membrane sweeping.Results:Between January 2005 and June 2008, 350 women were randomized into the study (groups: control [n = 116], once weekly [n = 117], and twice weekly [n = 117]). Randomization of Bishop’s score was different between groups (P = 0.019), with 67%, 71%, and 83% of control, once-, and twice-weekly groups, respectively, having scores of 3–4. There was no difference in the unadjusted rate of labor induction between the groups (35% versus 27% versus 23%, P = 0.149), and after the adjustment for the randomization of Bishop’s score (adjusted odds ratio [OR] = 0.73, 95% confidence interval [CI] 0.41–1.29 and OR = 0.65, 95% CI 0.36–1.18 for once- and twice-weekly groups, respectively). A Bishop’s score of 3–4 at randomization was the only statistically significant factor that decreased the likelihood of induction at 41 weeks (OR = 0.42, 95% CI 0.25–0.69).Conclusion:Frequency of membrane sweeping does not influence the likelihood of remaining undelivered at 41 weeks of pregnancy. The Bishop’s score at around 39 weeks is the important factor as a predictor of the duration of pregnancy, and further studies would be required to determine whether membrane sweeping influences pregnancy duration.

Perinatal outcome in pregnancies complicated by isolated oligohydramnios diagnosed before 37 weeks of gestation

To analyze pregnancy outcome in cases of isolated oligohydramnios at preterm. A retrospective cohort study of singleton pregnancies diagnosed with isolated oligohydramnios at preterm (n = 108). Pregnancy outcome was compared with a matched control group of low-risk preterm pregnancies with normal levels of amniotic fluid in a 3:1 ratio (n = 324). Pregnancies complicated by isolated oligohydramnios were characterized by a higher rate of preterm deliveries (26.9% vs 12.3%, P < .001), most of which were iatrogenic, and a higher rate of labor induction and cesarean delivery. Neonates with isolated oligohydramnios were characterized by a lower birthweight and a higher rate of neonatal morbidity. These differences were eliminated when the analysis was limited to the subgroup of pregnancies with isolated oligohydramnios that were managed expectantly and delivered spontaneously at term. Adverse pregnancy outcome in cases of isolated oligohydramnios diagnosed at <37 weeks appears to be related to a considerable degree to iatrogenic prematurity.

The influence of hospital type on induction of labor and mode of delivery

The purpose of this study was to compare labor induction and cesarean delivery rates at term in community vs university hospitals. A population-based retrospective cohort study of births was performed. Primary outcomes were term gestation at <39 weeks, labor induction, and cesarean delivery. After we adjusted for comorbidities, malpresentation, and previous cesarean delivery, logistic regression assessed the association between hospital type and primary outcomes. Births occur less often in week 37 (n = 24390 [11%] vs 4006 [13%]; adjusted odds ratio [OR], 0.9; 95% confidence interval [CI], 0.8-0.9) and are similar in week 38 in community vs university hospitals. Inductions occur more commonly in community vs university settings at 37 weeks (n = 6440 [27%] vs 757 [19%]; adjusted OR, 1.7; 95% CI, 1.5-1.8) and at 38 weeks (n = 16586 [31%] vs 1530 [21%]; adjusted OR, 1.8; 95% CI, 1.7-1.9). Cesarean rates are no different between hospital types. Induction is 70-80% more likely at community vs university hospitals before the optimal gestational age of ≥ 39 weeks, but cesarean delivery rates do not differ at term.

Maternal obesity and labour complications following induction of labour in prolonged pregnancy

ObjectiveTo investigate the effect of maternal obesity on mode of delivery following induction of labour (IOL) for prolonged pregnancy and subsequent intrapartum and neonatal complications.DesignRetrospective (historical) cohort study.SettingLiverpool Women's Hospital NHS Foundation Trust, UK.PopulationA total of 29 224 women with singleton pregnancies between 2004 and 2008 of whom 3076 had a prolonged pregnancy (defined as ≥290 days or 41+3 weeks of gestation) and received IOL.MethodsKruskal–Wallis test, chi-square test and multivariable logistic regression.Main outcome measuresMode of delivery and risk of delivery and neonatal complications in obese verses non-obese women following IOL.ResultsObese women had a significantly higher rate of IOL ending in caesarean section compared with women of normal weight following IOL (38.7% versus 23.8% primiparous; 9.9% versus 7.9% multiparous women, respectively); however, length of labour, incidence of postpartum haemorrhage and third-degree tear, rate of low cord blood pH, low Apgar scores and shoulder dystocia were similar in all body mass index categories. Complications included a higher incidence of fetal macrosomia and second-degree, but not third-degree, tear in primiparous women.ConclusionsHigher maternal body mass index at booking is associated with an increased risk of prolonged pregnancy and increased rate of IOL. Despite this, more than 60% of obese primiparous and 90% of multiparous women with prolonged pregnancies who were induced achieved vaginal delivery and labour complications in the obese women with prolonged pregnancies were largely comparable to those of normal weight women with prolonged pregnancies. Our data suggest that IOL for prolonged pregnancy in obese women is a reasonable and safe management option.

Decreased Term and Post-term Birthweight in the United States: Impact of Labor Induction

Changes in birthweight (BW) and gestational age (GA) at delivery are important measures that affect maternal and neonatal outcomes. Increases in both mean BW and rates of macrosomia occurred from the early 1970s to the early 1990s in the United States and several Western nations, despite a continuing rise in the rate of preterm birth. However, in recent years, the rate of macrosomia has fallen in the United States. Simultaneously, the rate of labor induction has doubled, due in large part to an increase in the rate of elective induction since the 1990s. These investigators observed the recent trend toward decreased BW in the United States and speculated that it might not be solely due to increases in preterm (<37 weeks) birth, but might be due in part to the increased rate of labor induction and cesarean delivery. This ecological study investigated the association between the rising rates of labor induction and temporal changes in BW and GA at delivery by examining temporal trends in these parameters among US non-Hispanic white singleton live births ≥37 weeks of gestation. Data on live birth cohorts for the study period (1992 through 2003) were obtained from US vital statistics. The independent association between the change in rates of labor induction and changes in mean BW, mean GA at delivery, and rates of macrosomia was estimated using ecological linear regression analysis. During the 12-year study period, mean BW decreased by 37 g, mean GA at delivery declined by 3 days, and there was a 25% relative reduction in the rate of macrosomia. Simultaneously, rates of labor induction nearly doubled, rising from 14% to 27%. Linear regression analysis showed a significant association between the increased rate of induction and reduced mean BW (r = −0.54 [95% confidence interval (CI), −0.71 to −0.29), reduced mean GA at delivery (r = −0.44 [95% CI, −0.65 to −0.17]), and lower macrosomia rates (r = −0.55 [95% CI, −0.74 to −0.32]). These findings suggest that increasing use of elective induction may be responsible for the observed recent decline in both GA and BW.

Degree of cervical shortening after initial induction of labor as a predictor of subsequent successful induction

To evaluate whether the degree of cervical length shortening is valuable in predicting the success of serial induction of labor on the second day in women in whom it failed on the first day, and to compare its performance with that of cervical length. This was a prospective observational study. We enrolled 92 consecutive women with singleton gestations at > 34.0 weeks' gestation who failed labor induction on the first day of serial induction. Transvaginal sonographic measurement of cervical length and determination of the Bishop score were undertaken before performing each labor induction on the first and second days. The overall success rate of labor induction performed on the second day was 65% (60/92). Multiple logistic regression analysis demonstrated that the degree of cervical length shortening and cervical length were significantly associated with the successful induction of labor after adjustment for body mass index, parity, use of prostaglandin and Bishop score. There were no significant differences between areas under the ROC curves for degree of cervical length shortening and cervical length. The degree of cervical length shortening is valuable in predicting the success of induction of labor on the second day in women in whom induction failed on the first day. However, compared with sonographic cervical length it is no better at predicting the success of subsequent induction of labor.

Rates of labor induction and primary cesarean delivery do not correlate with rates of adverse neonatal outcome in level I hospitals

Objective. To determine whether variation in rates of labor induction (IOL) and primary cesarean delivery (PCD) among level I hospitals is associated with differences in neonatal outcomes.Methods. A birth certificate database was used to calculate crude and adjusted rates of IOL and PCD among 10 regional hospitals. Adjustment via logistic regression controlled for differences in medical and demographic factors. Linear regression assessed the relationship of crude and adjusted IOL and PCD rates to rates of three neonatal outcomes.Results. IOL and PCD rates varied widely among hospitals (1.79- and 1.72-fold, respectively); variation increased following adjustment (1.93- and 1.86-fold, respectively). Rates of adverse neonatal outcomes varied by year and hospital, but not by IOL or PCD rates (p ≥ 0.05).Conclusions. Crude and adjusted rates of labor induction and PCD vary among level I hospitals, but with no consistent effect on neonatal outcome.

Rates of labor induction without medical indication are overestimated when derived from birth certificate data

The purpose of this study was to determine the rates of late preterm inductions without a medical indication from birth certificate data and to compare them with rates that were obtained from medical charts. The Ohio Perinatal Quality Collaborative, which comprises 20 hospitals in Ohio that came together in 2008 for the purpose of decreasing nonmedically indicated scheduled deliveries, abstracted data on all scheduled births between 36 weeks and 38 weeks 6 days of gestation. We compared labor inductions with "elective" documented or no indication documented in charts to birth certificate data for inductions with no maternal or fetal complications recorded. Birth certificates overestimate rates of induction without medical indication compared with chart abstraction (11% vs 1%; P < .0001). The monthly difference between chart abstraction and birth certificates averages 10.1%. Birth certificates overestimate nonmedically indicated inductions by 11-fold. Until birth certificate data improve, nonmedically indicated induction rates that are calculated from birth certificates should be interpreted with caution.

Size matters – but how good are clinicians at identifying SFGA and LFGA fetuses?

Detection of the small for gestational age (SFGA) or large for gestational age (LFGA) fetus is important because they are associated with poor perinatal outcome. Ultrasound can be used to...

Pregnancy related pelvic girdle or back pain: does it affect obstetric outcome?

Pregnancy related pelvic girdle pain (PGP) and/or low back pain (LBP) is common, affects mobility and is distressing to women1. They and healthcare professionals may be concerned about their ability...

Women with BMI over 35, aspects of care and obstetric outcomes

IntroductionThe risk of maternal and fetal morbidity and mortality is well recognised in pregnancies complicated by obesity. Work is currently ongoing by CEMACE (Centre for Maternal and Child Enquiries (CHACE)...

Induction of labour and its outcome in a teaching hospital

<strong><em>Introduction</em></strong><em>: </em>A new guideline and a strict protocol of oxytocin infusion administered via an infusion pump was adopted for induction of labour (IOL) in the University Obstetric Unit, Teaching Hospital, Mahamodara, Galle, in 2006. <br /> <strong><em>Objective: </em></strong>To describe IOL and its outcome before and after adopting this new guideline and strict protocol of oxytocin infusion at the University Obstetric Unit, Teaching Hospital, Mahamodara, Galle. <strong><em><br />Methods: </em></strong>A prospective descriptive study. Using a pretested form data collected from 322 consecutive women who had IOL during a period of nine months commencing 15th June 2006, were compared with those obtained in the Teaching Hospital, Mahamodara, Galle in 2003 before the new guideline and strict protocol was implemented in the University Obstetric Unit, Galle. <br /> <strong><em>Results: </em></strong>In the University Obstetric Unit the rate of IOL was 8.5% in 2006. The leading indications for IOL were past dates (45.8% in 2003 and 45% in 2006) and pre labour rupture of membranes (28.2% in 2003 and 35.4% in 2006). Successful vaginal deliveries showed a possible increase from 84.7% in 2003 to 90.4% in 2006 and failed inductions showed a possible reduction from 3.8% in 2003 to 2.2% in 2006 ( p = 0.09). The mean induction delivery interval for a successful vaginal delivery was significantly shorter (318 min 95% CI 307 - 327, p < 0.04) in 2006 compared to that of 2003 ( 343 min 95% CI 333 - 370) . The mean dose of oxytocin used for a successful vaginal delivery showed a possible increase from 6.7 units (95% CI 5.8 - 7.4, p = 0.11) in 2003 to 10.4 units (95% CI 6.7 - 16.2 ) in 2006. Mean duration prior to a diagnosis of a failed induction markedly decreased from 932 min (95% CI 790 - 1073) in 2003 to 699 min (95% CI 590 - 809, p= 0.005) in 2006. Mean number of oxytocin units prior to a diagnosis of a failed induction markedly increased from 15 units (95% CI = 15) in 2003 to 25.8 units (95% CI 21-30, p < 0.001) in 2006. Caesarean sections after IOL showed a possible reduction from 15.3% in 2003 to 9.6% in 2006 (p=0.09). There was no significant change in neonatal outcome from 2003 to 2006. <br /> <strong><em>Conclusion: </em></strong>After the adoption of the new guideline and oxytocin infusion protocol in 2006, IOL and its outcome have improved in the University Obstetric Unit, Galle. <strong>Key words</strong>: Induction of labour; labour outcomes. DOI: 10.4038/sljog.v31i2.1753 <em></em> <em>Sri Lanka</em><em> Journal of Obstetrics and Gynaecology</em> 2009; <strong>31</strong>: 97-103

Maternal Obesity and its Relationship With Spontaneous and Oxytocin-Induced Contractility of Human Myometrium In Vitro

Maternal obesity is associated with increased rates of labor induction, dysfunctional labor requiring intrapartum cesarean delivery, and postpartum hemorrhage, implying that maternal obesity has an inhibitory effect on myometrial function and its ability to respond to oxytocin. This study aimed to use an in vitro model to investigate the relationship between maternal body mass index (BMI) and the ability of myometrium to contract spontaneously and in response to oxytocin. Linear mixed effects regression modeling was applied to contractile data from 609 strips from 85 women. No correlation was found between maternal BMI and any indices of spontaneous myometrial activity. A single addition of oxytocin increased contractility, however, this was not related to maternal BMI. Similarly, oxytocin concentration-response curves were unrelated to BMI. Overall, the results from this in vitro study suggest that the observed implications of obesity on parturition in vivo cannot be explained by a direct effect on myometrial contractile mechanisms per se.

Indications for Induction of Labour : (as in Common Practice)

Background: Rates of labour induction are increasing. Objective: To make a list of common indications of induction. Design: Prospective observational study. Setting: Gynecology unit of D.H.Q teaching hospital, Sargodha for a period of 1 year from March 2008 - March 2009. Patients and Methods: Patients admitted in the labour room through emergency or through OPD who were planned to have induction of labour, were included in the observation. Their age, parity, duration of pregnancy and the particular condition for which she was induced labour, was recorded. All essential points of examination and required investigations for the mother and the foetus were recorded. Outcome: At the end of induction in the form of mode of delivery was recorded whether spontaneous, instrumental or operative delivery. Results: Out of 400 patients 158 were primi gravidas and rest of 242 were G 2 to G 9 . 342 had alive foetuses and 58 had I.U.F.D. (Intra uterine foetal death). Duration of pregnancy ranged from 28 to 41 wks. Indications for induction of labour were prolonged pregnancy, (36). Pre-eclampsia, (46) I.U.G.R. (16). Placental abruption (32) PROM (20) foetal anomalies (20), I.U.F.D (58), gestational diabetes (10) and non-medical indications (108). Spontaneous vaginal deliveries (242) Instru-mental deliveries (60) and C - sections - (98). Conclusion: The most common was non-medical indications for induction of labour. Key Words: Indications. Induction of labour.

Evaluation of length, volume and gray-scale histogram of the cervix as predictors of successful induction

Objective: The aim of this study was to evaluate whether the Bishop score, length, volume and gray-scale histogram of the cervix has a predictive value of assessing the rate of success in trial of induction. Methods: Forty-one nulliparous patients with its Bishop score six or less were enrolled for this prospective study. All were on prostaglandin (, Propess ; Controlled Therapeutics Ltd) pessary. Three-dimensional transvaginal ultrasound scans of the cervix were performed on the ACCUVIX XQ (Medison) to measure length, volume, and gray-scale histogram. Bishop score was determined by digital examination. The successful induction was defined as the ability to achieve the active phase of labor corresponding to a cervical dilatation of 4 cm within 12 hours of removing the pessary. The receiver operating characteristics (ROC) curves were also used to estimate an optimal cutoff point for the Bishop score, length, volume, and gray-scale histogram of the cervix. Logistic regression analysis was used for statistical analyses. Results: The overall successful rate of labor induction was 73.2% (30/41). Multiple logistic regression analyses demonstrated that the value of anterior lip histogram was significantly associated with the successful labor induction. ROC curve for anterior lip histogram value in predicting success of induction indicated a significant relationship with successful induction. The best cutoff value was 69.4. Conclusion: The value of anterior lip histogram associates significantly with the prediction of successful induction in nulliparous women. But, Bishop score and other sonographic measurement of cervical length, volume, and posterior lip histogram have no predictive values for successful induction.

Active management of risk in nulliparous pregnancy at term: association between a higher preventive labor induction rate and improved birth outcomes

Active management of risk in nulliparous pregnancy at term: association between a higher preventive labor induction rate and improved birth outcomes

326: Lack of association between early term preventive labor induction and higher neonatal intensive care unit admission rates

326: Lack of association between early term preventive labor induction and higher neonatal intensive care unit admission rates

Serial Membrane Sweeping at Term in Planned Vaginal Birth After Cesarean

To estimate the effect of serial membrane sweeping on the onset of labor in women who planned vaginal birth after cesarean (VBAC). Women at term with one transverse lower segment cesarean delivery who were suitable for and who planned VBAC were approached to participate. Participants were randomly assigned to weekly membrane sweeping or weekly vaginal assessment for Bishop score until delivery. Participants and delivery providers were blinded to the allocated treatment. Standard obstetric care was given to all participants. The primary outcome was onset of labor which was defined as the presence of spontaneous regular and painful contractions that cause cervical dilation to at least 3 cm or prelabor rupture of membranes. Secondary outcomes included induction of labor and repeat cesarean delivery. One hundred eight women were randomly assigned to membrane sweeping and 105 to control. The spontaneous labor rate was 78.5% compared with 72.1% (relative risk [RR] 1.1, 95% confidence interval [CI] 0.9-1.3; P=.34), the induction of labor rate was 12.1% compared with 9.6% (RR 1.3, 95% CI 0.6-2.8; P=.66), and the all-cause cesarean delivery rate was 40.2% compared with 44.2% (RR 0.9, 95% CI 0.7-1.2; P=.58) for the membrane sweeping and control groups, respectively. Gestational age at delivery (mean+/-standard deviation) of 39.6+/-1.0 weeks for the membrane sweeping group compared with 39.6+/-0.9 weeks for the control group (P=.84) was no different. Serial membrane sweeping at term in women who planned VBAC has no significant effect on the onset of labor, pregnancy duration, induction of labor, or repeat cesarean delivery. ISRCTN, isrctn.org, ISRCTN55163179. I.

Labor Induction with 25-μg Misoprostol Vaginal Capsules

Aim: To evaluate the success rate and the safety profile of labor induction with a new misoprostol formulation – vaginal capsules of 25 μg of misoprostol. Methods: Labor induction was performed in 250 singleton term pregnancies; 149 (59.6%) were nulliparous. Vaginal capsules of 25 μg of misoprostol were placed in the posterior vaginal fornix every 6 h. Success rate, contractility and fetal heart rate abnormalities and fetal outcomes were evaluated. Results: The success rate of labor induction was 97.6%. The average number of vaginal administrations was 1.5. The mean interval between induction and active labor was 10 h and 20 min and the average length of labor was 15 h and 35 min. The cesarean section rate was 18.8%. There were 15 cases of tachysystole, 3 cases of hypertonus and 1 case of hyperstimulation syndrome. There were no adverse neonatal outcomes. Conclusions: This study allowed to conclude that labor induction with vaginal capsules of 25 μg of misoprostol is associated with an excellent success rate and safety profile.