Labor In High-risk Pregnancies Research Articles

Misoprostol with balloon vs oxytocin with balloon in high-risk pregnancy induction: a randomized controlled trial

Pregnancies at high risk for maternal, fetal, or placental complications often necessitate induction of labor in the late preterm or early term period for delivery. Limited data exist on the safest method of induction to use in this specific patient population. This study aimed to compare the combination of oxytocin plus a Cook balloon vs misoprostol plus a Cook balloon for induction of labor in high-risk pregnancies. We conducted an open-label, randomized controlled trial at a single institution from July 2020 to May 2022. The study was approved by the institutional review board and registered with ClinicalTrials.gov (NCT04492072). Individuals with a high-risk pregnancy, at least ≥22 weeks' gestation, with a singleton in cephalic presentation, Bishop score ≤6, and intact membranes were offered enrollment. A high-risk pregnancy was defined as a pregnancy with any of the following complications: hypertensive disease of pregnancy, fetal growth restriction, oligohydramnios, suspected placental abruption requiring delivery, uncontrolled pregestational diabetes, or abnormal biophysical profile or nonstress test requiring delivery. The primary outcome was the rate of cesarean delivery. Secondary maternal outcomes included induction to delivery interval, number of vaginal deliveries within 24 hours, rates of uterine tachysystole, intraamniotic infection, operative vaginal delivery, and postpartum hemorrhage. Secondary fetal outcomes included fetal heart rate abnormalities, stillbirth, Apgar scores <7 at 5 minutes, admission to the neonatal intensive care unit, arterial umbilical blood pH <7.1, sepsis, and neonatal death. A subgroup analysis was planned for the primary outcome to assess the different indications for cesarean delivery. An intent-to-treat analysis was performed. During the 22 months of the trial, a total of 150 patients were randomized, and 73 (49%) of those were induced with oxytocin and a Cook balloon and 77 (51%) were induced with misoprostol and a Cook balloon. There was no significant difference in the overall rate of cesarean delivery between the study groups, (21.9% vs 31.1%; relative risk, 0.70; 95% confidence interval, 0.41-1.21), nor among those for which the cesarean delivery was performed for a specific indication. There were no differences in the secondary maternal and fetal or neonatal adverse outcomes. In high-risk pregnancies, the rate of cesarean delivery and adverse maternal and fetal outcomes were similar for induction of labor with oxytocin and a Cook balloon and for induction with misoprostol and a Cook balloon.

Erroneous Recording of Maternal Heart Rate as Fetal Heart Rate During Second Stage of Labour: Isn’t it Time to Stop this?

Electronic Fetal Heart Rate (FHR) monitoring is recommended to assess fetal well-being during labour in high risk pregnancies. This Cardiotocograph (CTG) monitoring relies on the ultrasound technology with the limitation of signal loss in 15% to 40% of the cases [1]. In the earlier versions of these CTG monitors, fetal heart tracings were generally of reasonable quality with many artefacts and some degree of occasional large signal noise. Subsequent models were improved by signal modulation and autocorrelation. Although, these new methodologies of signal processing have reduced the signal loss, the issues of inadvertent monitoring of the maternal heart rate as fetal heart rate and inaccurate evaluations of baseline fetal heart rate (i.e. doubling or halving) continue to pose difficulties during intrapartum fetal heart rate monitoring.

A study on the role of partograph in monitoring labour in high risk pregnancies

Background: The progress of labour can be graphically represented using the WHO partogragh, which helps in early detection and prevention of complication of labour, thus resulting in a better feto-maternal outcome especially in high risk cases.Methods: The study was undertaken at Hitech Medical College and Hospital, Bhubaneswar from March 2017 to February 2019 on 200 high risk patients. The progress of labour was plotted and assessed on Modified WHO partograph.Results: Majority of the cases were referred cases. Augmentation of labour was carried out in 56 cases. The mean duration of labour in the first stage was 5.4 hours and 4.1 hours in primi and multigravidas, whereas that of the second stage of labour are 37.5 minutes and 26.3 minutes respectively. 51 cases had prolonged labour and 15 cases had arrest of labour in the second stage. Maximum number of cases underwent LSCS due to abnormal labour progression. 8.7% of the cases had PPH and 2.3% had puerperal sepsis. Neonatal asphyxia was seen in 13.6% cases and 2.8% had early neonatal death.Conclusion: The results conclude that the WHO modified partograph is an inexpensive useful tool in monitoring the progress of labour and reducing foeto maternal morbidity in high risk groups.

Ultrasound detection of nuchal cord prior to labor induction and the risk of Cesarean section

To investigate the ability of ultrasound to detect the presence of a nuchal cord immediately prior to induction of labor and the association of its presence with delivery by Cesarean section. A transabdominal ultrasound scan using gray-scale and color Doppler imaging was performed immediately prior to induction of labor in 289 women in a prospective study to assess the presence of a nuchal cord. The presence of a nuchal cord was classified as present, absent or uncertain. The outcomes of labor, delivery and the neonates were obtained from the patient notes after delivery. A nuchal cord was present at 18% of deliveries. The incidence was not affected by parity, fetal position or reduced amniotic fluid volume. The sensitivity of ultrasound in diagnosing a nuchal cord was 37.5%, with specificity, positive and negative predictive values of 80%, 29% and 85%, respectively. The presence of a nuchal cord did not significantly increase the risk of delivery by Cesarean section (35% vs. 28%; relative risk = 1.22; 95% CI, 0.80-1.87), instrumental delivery for fetal distress, an abnormal cardiotocograph in labor or at delivery, an Apgar score < 7 at 1 min, arterial cord pH < 7.1 or neonatal unit admission. The sensitivity of the ultrasound diagnosis of a nuchal cord is low prior to induction of labor at term. A nuchal cord does not appear to increase the risk of Cesarean section or of poor neonatal outcome. The low ultrasound detection rate of a nuchal cord limits its use in decision making prior to induction of labor in high-risk pregnancies.