Labor In Post-term Pregnancy Research Articles

To examine the outcomes of induction of labour in post term pregnancy presenting at a tertiary care hospital

To examine the outcomes of induction of labour in post term pregnancy presenting at a tertiary care hospital

Effect of Intravenous Dexamethasone on the Duration of Labor Induction: A Randomized Controlled Trial

Abstract Background Induction of labor is one of the most common interventions practiced in modern obstetrics. In the developed World, the ability to induce labor has contributed to the reduction in maternal and perinatal mortality and morbidity. Aim of the work to establish whether Dexamethasone plays a role in shorting the duration interval between initiation of labor induction and beginning of true contraction of labor in post-term pregnancy, so shorting the duration of labor. Patients and Methods This randomized controlled trial study was conducted in the labor ward of Ain Shams University Maternity Hospital on one hundred thirty five pregnant women with full term pregnancy divided into the following: Group I (Dexamethasone group) injected with 2 ml (8 mg) of the product (dexamethasone) 4 hours before initiation of labor induction and Group II (Control group) received 2 ml saline (as a placebo). Results There was a non-significant statistical difference between the two studied groups as regards the age, gestational age on admission, body mass index (BMI), Bishop Score, mode of delivery and Apgar score. There was a high significant statistical difference between the two studied groups as regards Induction- delivery interval, induction-contraction, contraction – delivery interval were shorter in cases of study than control. Conclusion From the above data we can conclude that the intravenous administration of dexamethasone appear to shorten labor duration.

Течение родов у монгольских женщин при переношенной беременности

Течение родов у монгольских женщин при переношенной беременности

Potency of Dexamethasone in Labor Induction

Induction of labor is one of the most common interventions practiced in modern obstetrics. In the developed world, the ability to induce labor has contributed to the reduction in maternal and perinatal mortality and morbidity.

Comparative Study Between Sublingual and Vaginal Misoprostol for Induction of Labor in Post Term Pregnant Patients with Unfavourable Cervix

Background: Pharmacological studies suggest that sublingual route might be the optimal route of administration for PGE1 analogue misoprostol because the avoidance of the first pass hepatic circulation would yield bioavailability like that achieved with the vaginal route along with an earlier onset of action and a prolonged activity. Objective: The aim of this study was to compare the efficacy and the safety of vaginal misoprostol with sublingual misoprostol for induction of labor in post-term pregnancy. Subjects and Methods: This study included 50 cases, each with a singleton post-term pregnancy and a live fetus requiring induction of labor were allocated to sublingual and vaginal administration of misoprostol. Outcome measures related to labor and maternal and fetal side effects were compared between the 2 groups and evaluated using Chi square test. Results: The sublingual route of misoprostol was associated with a reduced risk of failed induction, reduced time from initiation to induction, reduced induction to delivery interval and a higher incidence of maternal and fetal side effects. However, the differences were not statistically significant. Conclusion: The sublingual route of administration of misoprostol is comparable in efficacy and safety to the vaginal route for induction.

Comparative Study Between Sublingual and Vaginal Misoprostol for Induction of Labor in Post Term Pregnant Patients with Unfavourable Cervix

Background: Pharmacological studies suggest that sublingual route might be the optimal route of administration for PGE1 analogue misoprostol because the avoidance of the first pass hepatic circulation would yield bioavailability like that achieved with the vaginal route along with an earlier onset of action and a prolonged activity. Objective: The aim of this study was to compare the efficacy and the safety of vaginal misoprostol with sublingual misoprostol for induction of labor in post-term pregnancy. Subjects and Methods: This study included 50 cases, each with a singleton post-term pregnancy and a live fetus requiring induction of labor were allocated to sublingual and vaginal administration of misoprostol. Outcome measures related to labor and maternal and fetal side effects were compared between the 2 groups and evaluated using Chi square test. Results: The sublingual route of misoprostol was associated with a reduced risk of failed induction, reduced time from initiation to induction, reduced induction to delivery interval and a higher incidence of maternal and fetal side effects. However, the differences were not statistically significant. Conclusion: The sublingual route of administration of misoprostol is comparable in efficacy and safety to the vaginal route for induction.

Repeat induction of labour for post-term pregnancy

Background: A previous post-term pregnancy is thought to influence the gestation of a subsequent pregnancy. Adverse maternal and perinatal outcomes are associated with post-term pregnancy and routine induction of labour by 42+0 weeks is advised to reduce these complications.Objective: To determine the recurrence rate of a post-term pregnancy and the need for repeat induction of labour.Methods: This observational cohort study featured women with a first and second singleton pregnancy, based on data recorded in the Aberdeen Maternity and Neonatal Databank (1986–2012). Term and post-term pregnancies were defined as ≥37+0 – 40+6 and ≥41+0 weeks, respectively. The exposure was a post-term pregnancy and the control a term pregnancy. Logistic regression was used to assess post-term recurrence and repeat induction of labour.Results: The study population consisted of 25,669 women with 33% of the women delivering post-term in their first pregnancy. In these women, the rate of a subsequent post-term pregnancy was 35.7% compared to 18.6% for women with an initial term pregnancy (adjusted odds ratio (aOR) 2.27, 95% confidence interval (CI) 2.11–2.44). Compared to women who had spontaneous term deliveries in both pregnancies, women who were induced post-term in the second pregnancy had increased odds of having been induced post-term in their first pregnancy. The adjusted odds ratio was found to be 6.08 (95% CI 5.30–6.98).Conclusions: Women with a first post-term pregnancy are less likely to labour spontaneously and more likely to have a second post-term pregnancy with a higher risk of repeat induction of labour, than women who have previously delivered at term. These findings could be useful in the counselling of women with a previous post-term pregnancy. Given that these women are less likely to labour spontaneously, the offer of an elective induction could also be considered to potentially improve maternal and perinatal outcomes.

Factors Associated with the Failed Induction of Labour in Post-Term Pregnancy at a Tertiary Care Hospital in Karachi, Pakistan

Objective: To determine the factors associated with failed induction of labour in post-term pregnancies attending a tertiary care hospital in Karachi, Pakistan.Mehtods: This cross-sectional study was conducted at the Department of Gynecology and Obstetrics, Unit II, Civil Hospital, Karachi. During January to July, 2016. Women with a gestational age of 40 weeks + 6 days to 41weeks + 0 days were included in the study. Obstetric history, maternal age, BMI, gestational age, Bishop score, induction to delivery interval and mode of delivery were noted. Failed induction of labour was considered when patients delivered abdominally. Descriptive statistics werecalculated and chi-square test was applied post stratification where p-value 5 was in 81.4%. BMI > 24.9 was in 47.1%. Spontaneous rupture of membrane (SROM) was in 27.1%.Conclusion: Induction of labour failed in 78.6% of post-term pregnancies in our study. A prolonged latent phase of the first stage of labour showed a significant association with failed induction of labour.

Onset of Labor in Post-Term Pregnancy by Chamomile.

BackgroundPost-term pregnancy is an important factor in perinatal mortality and morbidity. Generally, to reduce perinatal mortality in pregnancy, the delivery is done before adverse perinatal morbidity occurs. To prevent prolonged pregnancy, labor is induced with chemical drugs and complementary therapies. Due to the side effects and contraindications of chemical medicine, the use of herbs has been investigated in the induction of labor in post-term pregnancy.ObjectivesThis study was done to identify the effect of chamomile on inducing labor in women with post-term pregnancy of Shahid Akbarabadi hospital in Tehran in 2013.Patients and MethodsThis double-blind clinical trial study was performed in Iran on 80 post-term pregnant women with a gestational age of 40 weeks or more, a single pregnancy, 18 - 35 years old, cephalic presentation, an estimated fetal weight of 2500 - 4000 grams, an absence of uterine contraction, a cervical Bishop score of less than 4, the safety of the membrane, and low-risk pregnancy; they were randomly assigned to one of two groups of 40 women. Each of the participants was given a bottle containing 42 capsules (500 mg each) and took 2 capsules every 8 hours. The data were collected through the questionnaire of demographic observational, and examinal characteristics. Descriptive statistics, independent samples t-test, and Fisher’s exact test using SPSS (16/win) were used to determine and compare the effects of drugs on inducing labor in the groups.ResultsAfter a week of using the first dose, the results showed that in 92.5% of the chamomile group and 62.5% in the placebo group, delivery symptoms started after taking the oral capsules, and there were significant statistical differences between the two groups for the onset of labor (P = 0.003) There was a noticeable statistical difference between the two groups regarding the mean interval time to the onset of labor pain after taking the capsules (P = 0.000).ConclusionsIn this study¸ chamomile stimulated labor in post-term pregnancy. With further studies, chamomile, which has no chemical side effects, can be suggested for stimulating labor in post-term pregnancy.

Comparison of Vaginal and Oral Doses of Misoprostol for Labour Induction in Post-Term Pregnancies.

Considering maternal complications, it is preferred to induce labour after 40 weeks. Labour induction is a procedure used to stimulate uterine contractions during pregnancy before the beginning of the labour. The aim of this study was to compare oral misoprostol with vaginal misoprostol for induction of labour in post-term pregnancies. This double blind clinical-trial study was performed on 180 post-term pregnant women who were admitted to the labour ward of Besat Hospital Sanandaj, Iran in 2013-2014. Participants were equally divided into three groups using block randomization method. The induction was performed for the first group with 100 μg of oral misoprostol, for the second group with 50 μg of oral misoprostol, and for the third group with 25 μg of vaginal misoprostol. Vaginal examination and FHR was done before repeating each dose to determine Bishop Score. Induction time with misoprostol to the start of uterine contractions, induction time to delivery, and mode of delivery, systolic tachycardia, hyper stimulation and fetal outcomes were studied as well. First minute Apgar scores and medication dosage of the study groups were significantly different (p=0.0001). But labour induction, induction frequency, mode of delivery, complications, and 5 minutes Apgar score in the groups had no significant difference (p>0.05). The risk of fetal distress and neonatal hospitalization of the groups were statistically significant (p=0. 02). There was no significant difference between the three groups in terms of mean time interval from the administration of misoprostol to the start of uterine contractions (labour induction), the time interval from the start of uterine contractions to delivery and taking misoprostol to delivery. From the administration of misoprostol to start of the uterine contractions the mean difference between time intervals in the three groups were not statistically significant. Based on our findings it can be concluded that prescribing 100μg oral misoprostol is effective than 50 μg oral or 25 μg vaginal misoprostol in terms of induction time, maternal and neonatal outcomes in post- term pregnancy. However, the best dose and route should be decided according to evidence based information.

Earlier induction of labour in post term pregnancies—A historical cohort study

Objectiveto evaluate a change of guideline for earlier induction of labour in post term pregnancies and its possible impact on selected birth interventions and outcome of the newborn. Designa historical cohort study. SettingsDepartment of Obstetrics at Aarhus University Hospital in Denmark. Participants18,247 women giving birth between 1 January 2009 and 12 December 2012. Methodsto compare induction of labour in two consecutive time periods before and after implementation of a new guideline on induction of labour (42 weeks versus 41 weeks plus five days gestational age) in post term pregnancy. t-Test and χ2 were used to calculate means of gestational age and relative risk (RR) of selected birth and newborn outcomes. Stratification by Mantel–Haenszel-analysis was used to adjust for possible confounders. Robson׳s classification system ‘Ten Group Classification System’ was used to create comparable groups within the performed analysis. Findingsa difference in means of three gestational days after implementation of the new guideline on earlier induction of labour was found together with an overall unadjusted decrease in emergency caesarean section rate of 30% (RR 0.70, 95% CI; 0.54–0.91). Stratified analysis on parity showed a reduction in emergency caesarean section but only in nulliparous women (RR 0.78, 95% CI; 0.66–0.92), whereas the analysis in multiparous women showed a non-statistically significant increased risk of emergency caesarean section (RR 1.39, 95% CI; 0.89–2.18). No differences were found in assisted vaginal childbirths and outcome in newborns concerning Apgar score, pH and standard base excess in women induced in 42 weeks versus 41 weeks plus five days gestational age. Conclusionthe findings of this study suggest that earlier induction of labour due to post term pregnancy has a positive influence, but only in nulliparous women, by lowering the risk of emergency caesarean section evidently without increasing the risk on adverse outcome in newborns.

Skin conductance activity in post-term pregnancies

Objective: The pain threshold in humans rises during late pregnancy, and the woman becomes less sensitive to stress. The aim of this study was to investigate whether monitoring the sympathetic nervous system response to stimuli by skin conductance activity might be a useful predictor of spontaneous onset of labour in post-term pregnancies.Study design: A prospective observational study. Fifty-two healthy pregnant women were consecutively asked for inclusion in the study at their post-term pregnancy examination. Initially, a Ctg (cardiotocography) registration was performed, followed by 5 min of skin conductance measurement including a “cold pressor test”. Finally, a vaginal examination with a cervical assessment were performed according to clinical guidelines.Results: A statistically significant lower pain reaction during the period of provocation was seen in deliveries close to spontaneous onset of labour compared with induced deliveries with an non-spontaneous onset of labour before 294 days (p = 0.02). Sixty-three per cent (19/30) of the women with spontaneous onset had a negative value at provocation compared with 30% (6/20) in the induced group.Conclusions: Decreased response to pain stimuli, as an indication of decreased activity in the sympathetic nervous system, has a correlation to spontaneous onset of labour in post-term pregnancies.

671: Prevalence of and risk factors for pica among pregnant women in Chhattisgarh, India

670 Racial disparities in perinatal mortality at 40, 41 and 42 weeks of gestation Anita C.J. Ravelli, Jelle Schaaf, Martine Eskes, Esteriek de Miranda, Ameen Abu Hanna, Ben Willem J. Mol Academic Medical Center, Medical Informatics, Amsterdam, Netherlands, Academic Medical Center, Obstetrics and Gynecology, Amsterdam, Netherlands, Academic Medical Center, Medical Informatics, Amsterdam, Netherlands, Academic Medical Center, Obstetrics & Gynaecology, Amsterdam, Netherlands, Academic Medical Center, Obstetrics & Gynecology, Amsterdam, Netherlands OBJECTIVE: Normal duration of pregnancy has long been thought to have a uniform distribution over all different racial groups. We hypothesize that the normality of pregnancy duration is race specific, which urges the need of a tailored approach of the management post term pregnancy. STUDY DESIGN: We used data from the nation wide Perinatal Registry Netherlands from 1999 till 2008. All singleton infants born from 40 0/7 weeks of gestation onwards without congenital anomalies of the four main racial groups were included. We used logistic regression analysis to assess both crude and adjusted perinatal mortality, which is a combination of fetal and neonatal mortality within 7 days after birth. RESULTS: The overall perinatal mortality was 1586 in 755,615 infants; 2.1 per 1000. Perinatal mortality risk was 1.9 per 1000 at 40 weeks and increased to 2.4 at 41 weeks and 2.3 at 42 weeks, which was significantly different from 40 weeks (p 0.001). Overall, the South Asian, African/Creole and Mediterranean women had increased risk of perinatal mortality compared to Caucasian women (adjusted odds ratios 2.5 95% CI 1.5-4.2, 1.8 95% CI 1.2-2.8 and 1.6 95% CI 1.3-2.1, respectively). South Asian and African women delivered earlier than Caucasian women (p 0.001). South Asian women had significantly increased risks of perinatal mortality especially at 41 weeks of gestation (9.2 per 1000). African/Creole women risks were increased at both 40 and 41 weeks (2.6 and 4.4 per 1000 respectively). Mediterranean women had significantly increased risk of perinatal mortality at both 41 and 42 weeks (4.3 and 2.7 per 1000 respectively). When the analysis was restricted to spontaneous onset of labor the same patterns emerged (see figure). CONCLUSION: South Asian, African/Creole and Mediterranean women have increased risk of perinatal mortality from 40 weeks onwards. South Asian and African/Creole have a shorter duration of pregnancy as compared to Caucasian women. These data suggest that induction of labor for post term pregnancy should be considered at a younger gestational age for non-Caucasian women. 671 Prevalence of and risk factors for pica among pregnant women in Chhattisgarh, India Adeline Boatin, Blair Wylie, Mrigendra Pal Singh, Neeru Singh, Kojo Yeboah-Antwi, Davidson Hamer Massachusetts General Hospital, OB/GYN, Boston, MA, Massachusetts General Hospital, Department of Obstetrics and Gynecology, Boston, MA, National Institute for Malaria Research Field Station, National Institute for Malaria Research Field Station, Madhya Pradesh, India, Center for Global Health and Development, Center for Global Health and Development, Boston, MA OBJECTIVE: Pica refers to the ingestion or craving for nonfood items such as soil, clay or chalk. Reported prevalence in pregnancy has varied widely (e.g., 0.02% Denmark; 74% Kenya). Studies have demonstrated an association between pica and iron deficiency anemia although whether pica is a cause or consequence remains uncertain. An increase in parasitic infections, electrolyte disturbances and gastrointestinal complications has also been linked with pica. We sought to determine the prevalence of pica, identify risk factors, and evaluate the association with anemia among pregnant women in India. STUDY DESIGN: In 2 districts in Chhattisgarh, India, 2386 pregnant women were enrolled during routine antenatal visits over 12 months (2007-08) to assess malaria prevalence. Information about pica was collected and blood was obtained by fingerstick for hemoglobin (Hgb) determination. RESULTS: Approximately one-quarter (637/2386, 27%) of the subjects reported the consumption of chalk, mud-pot or raw rice during pregnancy. Moderate to severe anemia (Hgb 9 g/dL) was quite common in the population (23%) but significantly higher among those with pica (30.9% vs 20.5%, p 0.0001). Risk factors for pica included fewer years of education (p 0.001), engagement in agricultural work (p 0.01), and membership among historically disadvantaged castes (Scheduled Caste, Scheduled Tribals) (p 0.0001). In addition, pica was more frequent among women who chewed tobacco compared with those who did not (46.5% vs 24.6%, p 0.0001). Age, parity, home ownership, use of iron supplements, malaria parasitemia, chronic disease, and smoking were not associated with pica. CONCLUSION: Pica was relatively common among this cohort of Indian pregnant women and significantly associated with anemia. Identified risk factors suggest a link with socioeconomic status. Given these findings, further observational and qualitative research is needed to clarify maternal behaviors and the potential impact of pica on maternal and fetal health.

Cervical insulin‐like growth factor binding protein‐1 (IGFBP‐1) to predict spontaneous onset of labor and induction to delivery interval in post‐term pregnancy

To evaluate whether insulin-like growth factor binding protein-1 (IGFBP-1) assessed in cervical secretion can predict successful induction and spontaneous onset of labor in post-term pregnancy, compared to ultrasound measurement of cervical length and Bishop score. Cohort study, originating from a randomized controlled trial. Obstetric department of a university and tertiary referral hospital, Norway. Five hundred and eight post-term women who had been randomized to induction of labor or expectant management 1 week beyond estimated day of delivery (289 [±2] days of gestation). Time to delivery was related to presence of IGFBP-1 in cervical secretion, Bishop score and ultrasound measurement of cervical length recorded at inclusion. Spontaneous onset of labor and delivery within 3 days in the expectant management, and delivery within 24 hours of induction in the induction group. Test characteristics (sensitivity, specificity and negative and positive values and likelihood ratios) for IGFBP-1, Bishop score and cervical length were calculated. Logistic regression and Cox regression were used to account for parity and body mass index. With expectant management, IGFBP-1 predicted spontaneous labor onset and delivery within 72 hours with low sensitivity and high specificity (0.45 and 0.80, respectively), as did Bishop score (0.24, 0.92). Cervical length was more sensitive (0.67, 0.58). IGFBP-1 predicted successful induction within 24 hours with low sensitivity and high specificity (0.30, 0.85), such as Bishop score (0.06, 1.00) and cervical length (0.45, 0.76). Parity enhanced successful induction. IGFBP-1 predicts both spontaneous labor onset and successful induction in post-term pregnancy. Bishop score and cervical length performed equally well.

Biochemical and biophysical predictors of the response to the induction of labor in nulliparous postterm pregnancy

The objective of the study was to evaluate the clinical, sonographic, and hormonal variables that influence the success of labor induction in nulliparous postterm pregnancies. Fifty nulliparous women with a single postterm pregnancy receiving a slow-release prostaglandin estradiol pessary were prospectively enrolled, and clinical characteristics were analyzed in relation to success of induction of labor. Clinical, sonographic, and hormonal variables were analyzed by univariate statistical analysis and multivariate logistic regression for the prediction of successful induction. The group of patients delivering within 24 hours differed significantly from the remaining patients by higher Bishop scores, body mass indices, estradiol serum concentrations, estriol to estradiol ratios, and shorter cervices. The combination of cervical length and estriol to estradiol ratio achieved a sensitivity of 100% (95% confidence interval, 71.3-100%) and a specificity of 94.1% (95% confidence interval, 80.3-99.1%). Cervical length and the estriol to estradiol ratio represent good predictive indicators of the response to the induction of labor in postterm pregnancies.

270: Ultrasonic alteration of the estimated date of delivery increases caesarean delivery rates among induced labors for post term pregnancy

70 ULTRASONIC ALTERATION OF THE ESTIMATED DATE OF DELIVERY INCREASES CAESAREAN DELIVERY RATES AMONG INDUCED LABORS FOR POST TERM PREGNANCY. RHONA MAHONY, ERINA SASAKI, TILOTTAMA NANDY, FIONNUALA MCAULIFFE, COLM O’HERLIHY, MICHAEL FOLEY, Department of Obstetrics, Dublin, Ireland, National Maternity Hopsital, University College Dublin, Dublin, Ireland, Society for Maternal-Fetal Medicine, Dublin, Ireland, UCD School of Medicine and Medical Science, Dublin, Ireland, UCD School of Medicine and Medical Science, Dublin 2, Ireland OBJECTIVE: To record the frequency of sonographic reassignment of the EDD and to assess the effect of this on obstetric outcome in women delivering beyond 41 weeks= gestation. STUDY DESIGN: A consecutive observational cohort study over 12 months to June 2008, of singleton cephalic nulliparas after 41 weeks= gestation (term plus 7 days). Dates were assigned following a scan performed around 20 weeks= gestation. Induction of labor was offered at 42 weeks= gestation. . RESULTS: Among 4233 primiparas ( 37 weeks), 1000, 23.6% delivered after 41 weeks= gestation. Overall the EDD was reassigned in 406 cases ( 40.6%); put back in 297 cases (29.7%) and brought forward in 109 cases (10.9%). A potential indication for alteration of the EDD pertained in 497 cases (49.7%) resulting in a reassignment in 352 cases (72%) compared with 8.5% (43 of 505) among those with certain dates. Labor was spontaneous in 594 cases (59.4%), at a rate of 10 % per day after 41 weeks= gestation and the caesarean rate (13.6%; 81 of 594) was constant. Among those whose labor was induced for post-term pregnancy, the overall caesarean delivery rate was 33.7% (126/373) and was greater among those with altered dates (36% 52/144 vs. 32.3%: 74/229) P 0.5 and highest 51 %( 21/41) when the EDD was brought forward, compared with those put back (29% 30/103; P 0.01). The onset of labor was not influenced by maternal age, BMI or birth weight. CONCLUSION: The EDD was reassigned sonographically in a relatively high proportion of all cases (40.6%) but did not affect the caesarean rate among women who labored spontaneously (13.6%). The caesarean delivery rate for induced labor (33.7%) was higher and particularly when the EDD had been altered. Caution should be exercised when planning induction of labor for uncomplicated post term pregnancy when dates have been reassigned by mid-trimester ultrasound.

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POST-TERM PREGNANCY

The effects of post-term pregnancy on fetal and neonatal survival have been analyzed in 5 596 single pregnancies, including 275 post-term pregnancies, during the five-year period from January 1, 1962 to December 31, 1966 at the Department of Obstetrics and Gynaecology, Osaka National Hospital. The perinatal mortality rate at term was 0.7% and post-term was 2.2%. The increased perinatal mortality characteristic of post-term pregnancy could not be explained. No significant improvement in fetal outcome is achieved by induction of labour in post-term pregnancy. It would not appear to be justifiable, on the strength of the data presented here, to perform induction of labour solely because pregnancy is prolonged or in the absence of other generally accepted obstetrical indications.