Medical Induction Of Labor Research Articles

FETOMATERNAL OUTCOME IN SPONTANEOUS VERSUS INDUCED LABOR

Background and Objectives: The medical induction of labour at term gestation has always been controversial and is based on conicting evidences.The present study is an attempt to assess the feto-maternal outcome of induced labour compared to spontaneous onset labour. Type of study:It was a prospective comparative study conducted at a tertiary care hospital, Lalla Ded Hospital Srinagar. Materials and methods:Atotal of 200 patients participated in this study. 100 women who had indicated induction of labour (study group) were compared with 100 women with spontaneous onset labour in active phase with cervix atleast 4 cm dilated (control group). Results: Vaginal delivery was 66% in the study group compared to 88% in the control group. Induced labour was associated with a signicantly higher caesarean section rates (P< 0.001 ). Maternal complications include primary postpartum haemorrhage, perineal lacerations and puerperal pyrexia. The study group had longer duration of hospital stay compared to the control (P <0.001).The neonatal Apgar scores at 1 and 5 min were comparable between both groups and showed no statistically signicant difference. Conclusion:Induction of labour is associated with increased risk of caesarean delivery

Outcome of Medical Induction of Labour in Postdated Pregnancy

Background: WHO and the International Federation of Gynecology and Obstetrics recognise the words "post maturity," "post term," "postdate," and "prolongedpregnancy" to describe pregnancies that continue beyond their intended end points (expected date of delivery). As much as 10% of pregnancies become more complicated due to a pregnancy that lasts longer than expected, and this poses risks to both the mother and the unborn child. Objective: To study of medical induction of labour in post-dated pregnancy. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, Abdul Malek Ukil Medical College, Noakhali, Bangladesh from January to June 2022. 100 patients included in our study. Labour induction in post-dated pregnancy was performed only after appropriate assessment of the mother and foetus. The inclusion criteria were intact membrane, cephalic presentation, singleton pregnancies, low Bishop score in post-dated pregnancies. Absolute contraindications to induction of labour include contracted pelvis, placenta previa, unexplained vaginal bleeding, presentation other than head and previous caesarean section were excluded from the study. This study shows that the main method was oxytocin drip and second method was ARM+oxytocin in drip, some cases induced by using oral prostaglandin and very few cases induced by intra cervical prostaglandin. Results: During the study 21-31 years age group, 60%. 42% were in oxytocin drip followed by 38% were in ARM + Oxytocin drip, 14% were in misoprostol in oxytocin drip 30% were failed cases followed by in ARM + Oxytocin drip it was 25%, in misoprostol it was 14%. Majority had Spontaneous vaginal delivery followed by 15% had Delivery by Caesarean section and 10% had Delivery with the aid of Forceps. 13% had foetal distress and 5% had unfavorable cervix. 75% were healthy baby and 20% were distress baby. Conclusion: Successful birth outcomes are strongly correlated with labor starting at the optimal time. An accurate diagnosis of postdatism is crucial. Mothers' worries and issues related to postdatism may be reduced with the help of sound guidance and close observation from healthcare providers. Due to technical constraints in foetal monitoring and oxytocin titration, caesarean section is often used to terminate most post-dated pregnancies in various hospitals throughout the nation. When a mature cervix and optimal fetal presentation are present, inducing labor seems to be safe for both the woman and the baby.

Feto-Maternal Outcomes of Medical Induction of Labour in Post-Dated Pregnancies

Objective: To determine the frequency of feto-maternal outcomes of medical induction of labor in post-dated pregnancies. Patients and Methods: A total number 216 pregnant females with post-dated pregnancy were included in this study. Data regarding baseline study variables such as age, and BMI was collected for each patient. In all patients, medical induction of labor was done. Induction of labor was done using amniotomy, oxytocin or prostaglandins were given as per-local protocol. Feto-maternal outcomes in-terms of perineal lacerations, cesarean section, PPH, APGAR and NICU admission were measured. Results: Mean age of patients included in this study was 29.10±4.78 years. Mean body mass index (BMI) of patients was 25.82±5.04 kg/m2. Vaginal delivery was done in 142 (65.74%) and C-section was done in 74 (34.26%) patients. Perineal laceration was occurred in 118 (54.63%) patients, PPH in 06 (2.78%), APGAR score < 7 in 08 (3.70%) and 17 (7.87%) neonates were admitted it NICU. Conclusion: Medical induction of labor in post-dated pregnancies is a valuable option. It is associated with minimal feto-maternal complications in these patients. Keywords: Post-dated pregnancies, feto-maternal outcomes, induction of labour.

Castor oil Induces Morphological Changes in Endometrium and Biochemical Parameters in Pregnant Wistar Rats

Background: Misoprostol is a synthetic prostaglandin E1 analogue, used for the management of miscarriages and labour. Castor oil is a natural plant extract that has been reported to have some abortifacient Properties Objectives: This study investigated the labour induction and abortifacient properties of castor oil, as well as possible effects on the electrolytes and hormones that regulate pregnancy, as well as to compare these effects with a standard labour inducing drug misoprostol, in Wistar rats. Methods: The study was conducted out in 2 phases. The pregnant rats were administered varying Castor oil doses of low (12.4ml/kg), medium (18.6ml/kg) and high (24.8ml/kg), which were compared with misoprostol group as well as a control group. All animals were euthanized on gestational day 15 and day 20 respectively for the two phases and blood samples collected via cardiac puncture from the apex of the heart for hormonal assay, electrolyte and kidney function tests. The uterus was also removed for histological processing. Results: The abortifacient effect of castor oil is dose dependent with high dose castor oil group seen to have significantly reduced serum progesterone level (32.8±4.25 and 40.8±0.70 compared with 51.0±2.00 of controls), resulted in weight loss and interference with kidney function (increase in serum potassium while decrease in sodium electrolytes). Castor oil also exhibited labor inducing properties. Conclusion: Castor oil has the potential to induce abortion. This study has demonstrated a possible usage of castor oil in medical induction of labor in rats as it exerted uterotonic principle on the uterus.

Medical versus elective induction of labor resulted in comparably low cesarean rates in single center

Medical induction of labor (mIOL) is generally associated with high risk of Cesarean Delivery (CD) and performed under non ideal circumstances. We sought to compare the rate of primary CD in women requiring mIOL to women undergoing elective induction of labor (eIOL) at term in viable pregnancies.

Clinical analysis of second-trimester pregnancy termination after previous caesarean delivery in 51 patients with placenta previa and placenta accreta spectrum: a retrospective study

BackgroundsPregnancy termination during the second trimester in patients with placenta previa and placenta accreta spectrum (PAS) is a complex and challenging clinical problem. Based on our literature review, there has been a relative increase in the number of such cases being treated by hysterotomy and/or local uterine lesion resection and repair. In the present study, a retrospective analysis was conducted to compare the clinical outcomes when different management strategies were used to terminate pregnancy in the patients with placenta previa and PAS.MethodsA total of 51 patients who underwent pregnancy termination in the second trimester in Beijing Obstetrics and Gynecology Hospital between June 2013 and December 2018 were retrospectively analyzed in this study. All patients having previous caesarean delivery (CD) were diagnosed with placenta previa status and PAS.Results① Among the 51 patients, 16 cases received mifepristone and misoprostol medical termination, 15 cases received mifepristone and Rivanol medical termination, but 1 of them was transferred to hysterotomy due to failed labor induction, another 20 cases were performed planned hysterotomy. There was no placenta percreta cases and uterine artery embolization (UAE) was all performed before surgery.② There were 31 cases who underwent medical termination and 30 cases were vaginal delivery. Dilation and evacuation (D&E) were used in 20 cases of medical abortion failure and in all 30 cases of difficult manual removal of placental tissue. ③ A statistically significant difference was found among the three different strategies in terms of gestational weeks, the type of placenta previa status, main operative success rate and β-HCG regression time (P < 0.05). ④ There were 4(7.8%) cases who were taken up for hysterectomy because of life-threatening bleeding or severe bacteremia during or after delivery and hysterotomy. The uterus was preserved with the implanted placenta partly or completely left in situ in 47(92.2%) cases. Combined medical and/or surgical management were used for the residual placenta and the time of menstrual recovery was 52(range: 33 to 86) days after pregnancy termination.ConclusionsTerminating a pregnancy by vaginal delivery through medical induction of labor may be feasible if clinicians have an overall understanding of gestational age, the type of placenta previa status, the type of placenta accreta, and patients concerns about preserving fertility. A collaborative team effort in tertiary medical centers with a very experience MDT and combined application of multiple methods is required to optimize patient outcomes.

P11 Review of pregnancy outcomes in patients with ankylosing spondylitis presenting to the Bart's Health High Risk Antenatal clinic: results of clinical audit and recommendations

Abstract Background Most patients with ankylosing spondylitis are diagnosed in their reproductive years and pregnancy can pose a challenge for the physician. Referral for preconception counselling, monitoring and management of these patients is best done in a multidisciplinary specialist clinic. To date, literature does not associate AS with adverse effects on pregnancy outcome. Patients can have unchanged, improved or active disease during pregnancy, however, postpartum flare is common. Methods We conducted a retrospective audit looking at pregnancy outcomes in patients referred to the High Risk Antenatal Clinic (HR-ANC) in our Trust between January 2014 and September 2019. Results A total of 18 patients with 22 pregnancies were found on our electronic system. Analysis showed an average number of visits to the clinic of 3.4 visits per patient with a median of 4. Only 45% had some form of preconception counselling prior to referral. 41% of the pregnancies were not exposed to any regular medications prior to conception. All other patients had their medications stopped after conception. 59% of pregnancies had medical induction of labour, 23% had a caesarian section. Median delivery was 39 weeks. The average birth weight was 3,022 grams, median 3,205 grams. 59% of the patients had antenatal disease flare and 45% had a postpartum flare. 32% of pregnancies did not have postpartum follow up. Conclusion Appropriate and thorough counselling should be offered to all patients with emphasis on disease course and management, safety of medications and neonatal vaccinations. Patients should be aware of a high chance of having active disease during pregnancy and the postpartum period. The rate of caesarian section in our patient cohort was not increased compared to the local rates in low risk pregnancies. These findings of disease activity in the antenatal and postpartum periods are consistent with published data. Good monitoring in a multidisciplinary clinic can lead to a successful outcome. Based on our findings, we are setting up a formal preconception counselling clinic for patients with AS with the following aims: 1. Family planning, including contraception advice. 2. Advice regarding medication use in the preconception, antenatal and postpartum periods. 3. Advice regarding disease course and expectations. 4. Advice regarding neonatal vaccinations, especially in patients on biological treatment. 5. Hot line for unplanned pregnancy and advice regarding medications and referral to the HR-ANC. Disclosures M. Khudadah None. S. Jansz None. A. Saeed None. M. Bickerstaff None.

Successful Pregnancy after Previous Uterine Rupture

Uterine rupture is a rare and catastrophic incidence with high maternal and fetal morbidity rates. It is most commonly seen in the scarred uterus. The unscarred uterus is least susceptible to rupture with the incidencebeing 1 in 8000 deliveries. In the past, pregnancy after uterine rupture was not widely advised and patients underwent hysterectomy or tubal ligation but with the evolving practice, women are motivated for pregnancy which can be successful with proper obstetric care and emphasis on time and mode of delivery. Here we present a case of 31 years old female, gravida-2 para-1 living 0 with previous uterine rupture after medical induction of labor with stillbirth 4 years ago. She underwent emergency laparotomy with the repair. The patient spontaneously conceived and had close antenatal care throughout the pregnancy. The patient was admitted at 34 weeks of gestation and kept under close surveillance. Corticosteroid was administered. She underwent spontaneous labor at 37 weeks of gestation and emergency cesarean section was planned, delivered via a breech presentation to a live baby of 2.4 kg, APGAR score of 8/10, 9/10 at 1 and 5 minutes.

Induction of labour in nulliparous women- quick or slow: a cohort study comparing slow-release vaginal insert with low-dose misoprostol oral tablets

BackgroundThis study was undertaken with the objective of comparing efficacy and safety for two different regimens using misoprostol for induction of labour.MethodsThe study was set in two different hospitals in the region of Zeeland, Denmark, and designed as a prospective cohort study. Nulliparous women with unripe cervix, eligible for vaginal delivery and medical induction of labour were included. Exclusion criteria were a previous uterine scar, suspicion of growth restriction of the fetus and prelabour rupture of membranes.One department used 25 mcg oral misoprostol tablets and the other department used 200 mcg slow-release misoprostol vaginal insert, for induction of labour.Primary outcomes were predefined as frequency of cesarean section, tachysystole and delivery within 24 h. Secondary outcomes were: time from induction to delivery, use of additional methods for induction, postpartum hemorrhage, anal sphincter rupture, epidural, pyrexia (rectal temperature > 38.5 °C), prolonged rupture of membranes, and use of tocolysis.ResultsNo significant differences in women achieving vaginal delivery was found. However, a significantly increased risk of tachysystole for the vaginal administration route was observed; 28.4% compared with 2.3%. There were no events of serious neonatal asphyxia. Half of the women induced with vaginal insert delivered within 24 h, compared with 16.8% of the women induced with oral misoprostol.ConclusionsInduction with vaginal slow-release misoprostol leads to quicker delivery with an increased risk of tachysystole but with similar perinatal outcomes and rates of cesarean sections. Low-dose oral misoprostol appears to be safe, however it leads to an increased use of secondary methods and a tendency of more intrapartum pyrexia.Trial registrationClinicaltrials.gov ID: NCT02693587 on February 262,016.EudraCT number 2020–000366-42 on 23 January 2020, retrospectively registered.

Effect of mifepristone-misoprostol versus misoprostol in the management of intrauterine fetal death: A comparative study

Background and Aim: The most undesirable consequence of pregnancy is intrauterine fetal death (IUFD) which causes a lot of emotional and medical distress for which medical induction of labor, by routinely used prostaglandins, is recommended. Therefore, the main aim of the study was to determine the management of IUFD using misoprostol alone and mifepristone-misoprostol combination. Materials and Methods: The study included 57 women of gestational age >24 weeks with IUFD, who were divided into two groups. Women between 24–34 and >34 weeks of gestation received 200 μg and 100 μg of misoprostol, respectively. Group A received misoprostol alone and Group B received oral mifepristone (200 mg), 24 h prior to receiving misoprostol. IUFD duration, number of misoprostol doses, induction-delivery interval (IDI), and bishop score were recorded. A majority of 23 patients in Group A had a bishop score

Outcome of medical induction of labour in postdated pregnancy

Induction of labour in postdated pregnancy is an important issue in modern obstetric practice. It might play a great role to reduce maternal and perinatal mortality and morbidity. The study aims to determine the outcome of medical induction of labour in postdated pregnancy. It is a cross sectional study carried out in the Department of Obstetrics and Gynaecology, Chittagong Medical College Hospital, Chattogram, Bangladesh from October 2018 to April 2019. In this study among primi gravida 40% patient had vaginal delivery &amp; 60% needed caesarean section, whereas 90% multigravida patient delivered vaginally &amp; 10% needed caesarean section. 48% patient had favourable cervix &amp; induced by oxytocin and remaining 52% patient having unfavourable cervix induced by prostaglandin followed by oxytocin. 55% caesarean section was done for fetal distress and 45% for abnormal uterine action and maternal complication occurred in 28% patient. Among the delivered baby 80% were healthy and 16% were asphyxiated. Oxytocin was found most effective in case of favorable cervix and prostaglandin in unfavorable cervix.

Double-balloon catheter for induction of labor in 362 women with and without prior cesarean section.

ObjectiveBalloon catheter is the preferred method for induction of labor in women with prior cesarean section. We sought to evaluate the rate of vaginal delivery, induction-delivery time and outcome predictors after induction with double-balloon catheter.Study designWe conducted a retrospective cohort study including women with prior cesarean section undergoing induction of labor with a double-balloon catheter during the period January 2007–June 2014 at a large, tertiary Danish university hospital. For comparison, we included women with no prior cesarean section undergoing induction with double-balloon catheter after failed medical induction. Inclusion criteria were singleton pregnancy, an unfavorable cervix, intact membranes, cephalic presentation and either previous cesarean section or failed medical induction of labor. Exclusion criteria included contraindications for vaginal delivery, severe fetal malformation and stillbirth. Study subjects were identified in a local computerized system and data extracted from the medical records.ResultsWomen with prior cesarean section (n = 304) induced with double-balloon catheter had a vaginal delivery rate of 50.3% (95% CI 44.7–55.9) compared to 51.7% (95% CI 39.2–64.1) in women with no prior cesarean section but preceding failed medical induction of labor (n = 58) (p = 0.85). BMI≥30 was associated with increased frequency of cesarean section. Median time from induction to vaginal delivery was 27.1(20.4–31.1) hours and 28.4(25.5–36.1) hours, respectively (p = 0.05). The rate of complete uterine rupture was 1.0%.ConclusionsSimilar success rates of approximately 50% for vaginal delivery were observed after induction of labor with a double-balloon catheter in women with and without prior caesarean section. A BMI ≥ 30 was associated with an increased frequency of caesarean section.

Foetal Morbidity Depending on the Day and Time of Delivery.

Introduction It is known that perinatal mortality is increased with births at night and at the weekend. The aim of the study was to investigate whether there is also an association between the time of delivery (weekday, night, weekend) and perinatal morbidity. Material and Methods All births at Hannover Medical College between 2000 and 2014 were included in a retrospective data analysis. Multiple births, primary sections, severe foetal malformations and intrauterine deaths were not included. A 5-minute Apgar score ≤ 5 and cord arterial pH < 7.10 were defined as perinatal morbidity. Besides the time of delivery, different variables that are regarded as risk factors for increased perinatal morbidity were studied. Univariate logistical regression analysis was performed, followed by multivariate analysis. Results 18 394 deliveries were included in the study. Pathological prepartum Doppler, medical induction of labour and delivery at night and/or at the weekend significantly increased the probability of an Apgar score ≤ 5 after 5 minutes. The probability that a child will have cord arterial pH < 7.1 post partum is significantly increased with a BMI > 25 before pregnancy, primiparity, medical induction of labour, peripartum administration of oxytocic agents, when the delivery took place at night and weekend combined, but also when the delivery took place at night or at the weekend/on a public holiday. Multivariate regression analysis showed that a time of delivery at night and/or at the weekend or on a public holiday is not a prognostic factor for a 5-minute Apgar score ≤ 5 (p = 0.2377) but is a prognostic factor for cord arterial pH < 7.1 (p = 0.0252). Conclusion The time of delivery at night or at the weekend/on a public holiday increases the risk for cord arterial pH < 7.1 by ~ 30% compared with delivery on a weekday. However, the time of delivery at night or at the weekend/on a public holiday does not increase the risk for the baby of having a 5-minute Apgar score ≤ 5.

Functional State of Young Children Bodies in Connection with Characteristics of Labor

Goal of research - the study aims to compare and evaluate of the functional state of the bodies of young children who were born with the help of medical labor induction and surgical delivery.Materials and methods. The authors conducted a complex clinical and instrumental examination of 150 young children of different sex, born via medical labor induction and surgical delivery. Modern clinical and physiological and experimental methods were used in the study. Results. The study revealed adverse functional changes in children′s health due to the characteristics of delivery. Children born via medical labor induction showed more pronounced changes in the functional state of the body compared with the children born via surgical delivery.Conclusion. The results of the correlation analysis showed that in comparison with the operative delivery, medical labor induction leads to stronger and more numerous interrelations between the factors of the functional state of children′s bodies, which is an unfavorable sign.

RISK FACTORS AND OUTCOME OF LABOR AT ILL-TIMED DISCHARGE OF AMNIOTIC FLUID

Aim. To study anamnestic data and characteristics of gestation course and labor of patients with preterm rupture of membranes and ill-timed discharge of amniotic fluid. Materials and methods . Analysis of 68 case reports. 48 case reports of women with preterm discharge of amniotic fluid (PDAF) at full-term pregnancy were included into the study group, 20 case reports of women with timely discharge of amniotic fluid at full-term pregnancy (TDAF) − control group. Results . The prevalence of abortion, miscarriage, gynecological and extragenital pathology in past medical history was revealed in patients with ill-timed discharge of amniotic fluid. In women with this pathology an operative maternity aid and medical induction of labor were often applied. Conclusion. Our results indicate the need to consider the impact of not only individual risk factors on pathologic rupture of membranes and discharge of amniotic fluid, but the complex influence of risk factors. The findings also suggested that careful pre-conceptional preparation and the timely detection and prevention of complications in pregnancy, and treatment of extragenital pathology, can lead to a decrease in serious complications such as preterm rupture of membranes and thereby reduce the percentage of operative maternity aid.

Maternal–Fetal Conflict and Periviability

A recent statement of consensus held that the principle of double effect would allow the induction of a previable fetus in order to eliminate a grave and present danger to the life of a mother suffering from peripartum cardiomyopathy. The author responds to this declaration, points out some limitations preventing it from being a vehicle for broader agreement, and offers an alternative, namely, medical induction of labor in cases of maternal–fetal vital conflict can be justified if the fetus has at least a fair chance of survival. This support of induction in cases of periviability considers the interests of both fetus and mother and, unlike the earlier consensus statement, can be defended by those who hold that one’s moral intention includes both the ultimate and proximate ends, or the immediate consequences of one’s act.

The postnatal morbidity associated with second-trimester miscarriage

Objective(s): To describe the complications, and their incidence, associated with the management and delivery of a distinct second-trimester miscarriage cohort. Methods: A retrospective cohort study was undertaken in a large, tertiary-referral university hospital (8500 deliveries per annum). All cases of pregnancy loss occurring between 14+0 and 23+6 were identified from July 2009 to June 2013 (n = 181). Medical notes were reviewed and the number of complications among this cohort was identified. Logistic regression was conducted to assess associations with clinical presentation and management. Results: The mean gestation of loss was 18+2 weeks (SD: 2+2). 64.6% (n = 117) of the total losses were of intrauterine fetal demise (IUFD) with 17.7% (n = 32) following preterm premature rupture of membranes (PPROM) and 17.7% (n = 32) following preterm labour (PTL). All women required inpatient admission with 59.1% (n = 107) undergoing medical induction of labour. PPROM cases, compared with cases of IUFD, had increased odds of requiring antibiotic therapy (OR 13.75, 95% CI: 4.88–38.72) and readmission (OR OR 4.15, 95% CI 1.12–15.36). Conclusion: These women represent a small proportion of the obstetric population but remain a distinct cohort whose management is complicated by high rates of morbidity requiring medical intervention. An awareness of these risks should inform future clinical practice.

Medical termination of a partial hydatidiform mole and coexisting fetus during the second trimester: A case report.

Partial hydatidiform mole and coexisting fetus (PHMCF) is a rare condition that presents a dilemma for physicians and the parents of the fetus, particularly when PHMCF is detected during the second trimester of pregnancy. The present study reports a case of PHMCF terminated by induction of labor via administration of Rivanol at 17 weeks. Follow-up measurements of serum β-human chorionic gonadotropin (β-HCG) levels, as well as imaging studies, indicated the presence of persistent trophoblastic disease (PTD) and lung metastases. The patient was therefore admitted for three courses of chemotherapy. Subsequently, the metastases receded and β-HCG levels decreased to within the normal range. The patient demonstrated no disease recurrence for 1 year. Following a review of the relevant literature, to the best of our knowledge, all PHMCF cases terminated by medical induction of labor during the second trimester resulted in the development of PTD and lung metastases. However, three cases of PHMCF that were terminated by caesarean section during the third trimester did not develop PTD or metastases. The present study therefore hypothesized that medical termination may not be a safe therapeutic strategy for the treatment of PHMCF during the second trimester, and that pregnancy should be allowed to continue empirically.

Diagnostic accuracy of cervical elastography in predicting labor induction success: a systematic review and meta-analysis.

To determine the accuracy of cervical elastography in predicting labor induction success. A systematic search, review, and meta-analysis of observational studies published in English language between January 2000 and October 2014 was performed. It included studies considering cervix sonoelastography as the index test and successful labor or vaginal delivery as the reference standard. As cervix length and Bishop score were considered comparator tests, the quality of the included studies was assessed using quality assessment tool for diagnostic accuracy studies (QUADAS) tool. A total of four studies assessing 323 women before medical induction of labor were included. Cervical elastography, cervical length, and Bishop score showed a diagnostic odds ratio (DOR) with 95% confidence interval (CI) for successful labor prediction of 3.50 (1.93-6.35), 3.35 (1.94-5.77), and 1.45 (0.33-6.41), respectively. In addition, cervical elastography, cervical length, and Bishop score showed a DOR with 95% CI for successful vaginal delivery prediction of 5.24 (3.23-8.50), 4.94 (2.72-8.98), and 4.62 (0.69-30.94), respectively. Considering the summary of receiver operating characteristic curves we show that cervical elastography or length are similarly reliable, and both are more reliable to predict successful labor than the Bishop score. Two studies were excluded because it was not possible to retrieve data for the meta-analysis. Among the excluded studies, one found no significant contribution from elastography for prediction of successful labor induction. Even though there is a limited number of studies included and the heterogeneity of the methods used, cervical elastography seems to be a promising tool for predicting successful labor induction and vaginal delivery in women treated by medical induction of labor.

Building a Prediction Model for Vacuum-Assisted Operative Vaginal Delivery Risk

Aim: The objective of this study was to evaluate the risk factors for operative vaginal delivery and to propose a new nomogram for predicting the risk. Methods: We retrospectively analyzed the data of 1,955 pregnancies that occurred in our clinic between the years 2007 and 2008. Included were singleton pregnancies with labor diagnosis after the 36th gestational week in which spontaneous or operative vaginal deliveries occurred. In this study, the operative delivery was carried out exclusively by vacuum extraction. Results: After univariate analysis and multivariate logistic regression stepwise model selection, maternal age, nulliparity, medically assisted procreation, gestational age at birth, male fetus, epidural analgesia and medical induction of labor were found to be the most predictive variables for operative vaginal delivery. Considering these factors we propose a new nomogram for an objectified determination of the risk of operative vaginal delivery. Conclusions: The new nomogram we propose could be an important tool for an objectified determination of the risk of operative vaginal delivery by vacuum extraction in individualized patient counseling.