Oxytocin For Induction Of Labor Research Articles

Impact of early versus late artificial rupture of membranes during oxytocin induction of labour on the incidence of chorioamnionitis: a randomised controlled trial (ARM trial)

BackgroundThe approach to induction of labour differs internationally, with timing of amniotomy being controversial. Some institutions favour performing artificial rupture of membranes prior to commencement of oxytocin infusion, with the belief that the labour will progress more efficiently. In other institutions, the approach recommended is for oxytocin infusion with intact amniotic membranes until the person has reached the active phase of labour, citing risk of infection with early amniotomy. Current evidence is inconclusive. We are performing a randomised controlled trial assessing whether delaying amniotomy until the active phase of labour can decrease the rate of chorioamnionitis.MethodsThis is a randomised controlled trial at a single centre in New Zealand. Pregnant people undergoing induction of labour at ≥ 37 weeks gestational age with intact membranes and a singleton gestation are eligible for the trial. Participants are randomised to ‘Early’ amniotomy, at the commencement of oxytocin infusion, or to ‘Late’ amniotomy, when they have reached a cervical dilation of 6 or more centimetres or when they have been receiving oxytocin infusion for 12 h. The primary outcome of the trial is chorioamnionitis. To detect a decrease in chorioamnionitis from 9 to 3% with a power of 80% and a 95% CI, we will require 488 participants in total, randomised in a 1:1 ratio.DiscussionIf delaying amniotomy reduces the rate of chorioamnionitis, this is important to inform future practice. Chorioamnionitis entails risk to both the pregnant person and the fetus and is an important contributor to neonatal sepsis, neonatal intensive care unit admission, maternal sepsis, caesarean, wound infection and postoperative infective complications. Conversely, if the rate of chorioamnionitis is not affected by timing of amniotomy, this will allow for safe individualization of care.Trial registrationThe trial is registered on the Australian and New Zealand Clinical Trials Registry, anzctr.org.au. Full registry title is ‘Impact of early versus late artificial rupture of membranes during oxytocin induction of labour on the incidence of chorioamnionitis: A randomised controlled trial’. Trial ID: ACTRN12621000405819. Date registered 14 April 2021.

Oxytocin with calcium vs oxytocin for induction of labor in women with term premature rupture of membranes: a randomized controlled trial

BackgroundIntravenous calcium administration has shown promise in enhancing uterine contractions and reducing blood loss during cesarean section, but this regimen has not been compared in vaginal labor induction. ObjectiveTo determine the efficacy of oxytocin combined with calcium versus oxytocin alone for inducing labor among women with term premature rupture of membranes (PROM). Study designThis single-blind, randomized control trial was conducted between October 2022 and May 2023 in a tertiary university hospital. Patients diagnosed with PROM were randomly allocated into two groups. The intervention group received a bolus of 10 mL of calcium gluconate followed by a continuous infusion of oxytocin via a pump (n = 210), whereas the control group received only oxytocin infusion (n = 218). The primary outcome was successful vaginal deliveries within 24 hours of labor induction. Secondary outcomes included the interval from labor induction to delivery, vaginal delivery blood loss, and maternal and neonatal complications. ResultsBaseline characteristics, including maternal age, BMI, Bishop score before labor induction, were comparable between groups. The rate of vaginal delivery within 24 hours of labor induction was statistically higher in the intervention group (79.52% vs. 70.64%; P = 0.04). Participants in intervention group experienced a shortened interval between induction and delivery (10.48 h vs. 11.25h; P = 0.037), and demonstrated a higher success rate in induction of labor assessed by the onset of active phase (93.80% vs. 87.61%; P = 0.04) without increasing the cesarean rate. Reduced hemorrhage was presented in the intervention group (242.5ml vs. 255.0ml; P = 0.0015) while the maternal and neonatal outcomes were comparable between groups. ConclusionThe co-administration of calcium and oxytocin in labor induction among pregnancies with PROM was more efficient and safer than oxytocin alone. Our research suggests that the combination therapy of calcium and oxytocin may offer significant advantages during the process of labor induction and result in better outcomes.

Double Balloon Combined with Oxytocin in Labor Induction: Analysis of Multivariate Factors Affecting the Efficacy of Cervical Ripening.

Labor induction during the late trimester of pregnancy is a common option of terminating pregnancy by inducing uterine contractions through medication or cervical mechanical dilation. However, there are few researches on the factors influencing the effectiveness of cervical ripening balloon combined with oxytocin in inducing labor. To explore factors affecting the efficacy of cervical ripening double balloon combined with oxytocin in labor induction. Using a convenient sampling method, this study retrospectively collected the clinical data of 230 pregnant women who underwent cervical ripening double balloon combined with oxytocin for labor induction in our hospital from September 2021 to August 2022. The included subjects were divided into a vaginal delivery group (n = 180) and a cesarean section group (n = 50) based on the delivery mode for comparing relevant indicators between the two groups. The presence of acute chorioamnionitis (OR = 1.456, 95% CI: 1.257-2.112), fetal distress (OR = 1.371, 95% CI: 1.331-2.633), and the placement of cervical ripening balloon catheter for >12h (OR = 1.563, 95% CI: 1.231-3.263) were risk factors for successful application of cervical ripening double balloon combined with oxytocin for labor induction in pregnant women; while multi-gravidity (OR = 0.736, 95% CI: 0.455-0.875) was a protective factor. In addition, evaluation of the predictive value revealed that acute chorioamnionitis, fetal distress, the placement of cervical ripening balloon catheter for >12h, and gravidity all had certain predictive value for the failure of cervical ripening double balloon combined with oxytocin for labor induction, with the highest predictive value found through joint predictive (AUC: 0.931, 95% CI: 0.714-0.811). Cervical ripening double balloon combined with oxytocin for labor induction may have a high success rate in multigravida. Acute chorioamnionitis, fetal distress, and prolonged placement of the balloon may have a negative impact on the success rate of cervical ripening double balloon combined with oxytocin for labor induction.

Impact of continuous labor companion- who is the best: A systematic review and meta-analysis of randomized controlled trials.

Continuous labor support is widely acknowledged for potentially enhancing maternal and neonatal outcomes, the physiological labor process, and maternal satisfaction with the labor experience. However, the existing literature lacks a comprehensive analysis of the optimal characteristics of labor companions, particularly in comparing the effects of trained versus untrained and familiar versus unfamiliar labor companions across diverse geographical regions, both pre-and post-millennial. This meta-analysis addresses these research gaps by providing insights into the most influential aspects of continuous labor support. A thorough search of PubMed, Google Scholar, Science Direct, International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Research4Life, and Cochrane Library was conducted from 25/06/2023 to 04/07/2023. Study selection utilized the semi-automated tool Rayyan. The original version of the Cochrane Risk of Bias tool was used to assess the quality of Randomized Controlled Trials (RCTs) while funnel plots gauged the publication bias. Statistical analysis employed RevMan 5.4, using Mantel-Haenszel statistics and random effects models to calculate risk ratios with 95% confidence intervals. Subgroup analyses were performed for different characteristics, including familiarity, training, temporal associations, and geographical locations. The study was registered in INPLASY (Registration number: INPLASY202410003). Thirty-five RCTs were identified from 5,346 studies. The meta-analysis highlighted significant positive effects of continuous labor support across various outcomes. The highest overall effect without subgroup divisions was the improvement reported in the 5-minute Apgar score < 7, with an effect size of 1.52 (95% Confidence Interval (CI) 1.05, 2.20). Familiar labor companions were better at reducing tocophobia, with an effect size of 1.73 (95% CI 1.49, 2.42), compared to unfamiliar companions, with an effect size of 1.34 (95% CI 1.14, 1.58). Untrained labor companions were the better choice in reducing tocophobia and the cesarean section rate compared to trained companions. For the analysis of tocophobia, the pooled effect sizes were 1.34 (95% CI 1.14, 1.57) and 1.84(95% CI 1.60, 2.12) in trained versus untrained subgroup comparisons. For the cesarean rate, they were represented as 1.22 (95% CI 1.05, 1.42) and 2.16 (95% CI 1.37, 3.40), respectively. The pooled effect size for the duration of labor was 0.16 (95% CI 0.06, 0.26) for the subgroup of RCTs conducted before 2000 and 0.53 (95% CI 0.30, 0.77) for the subgroup of RCTs conducted after 2000. A significant subgroup difference (<0.1) was found in relation to the duration of labor, cesarean section rate, oxytocin for labor induction, analgesic usage, and tocophobia in the subgroup analysis of geographical regions. The beneficial effects of a labor companion are well-established in the literature. However, studies systematically assessing the characteristics of labor companions for optimal beneficial effects are lacking. The current study provides insights into the familiarity, training, temporal association, and geographical settings of labor companions, highlighting the differing impact of these characteristics on measured outcomes by evaluating the current randomized controlled trials on the topic. There is insufficient evidence to define the 'best labor companion' owing to the heterogeneity of labor companions and outcome assessment across different studies. We encourage well-designed further research to fill the research gap.

Introducing the participant-generated experience and satisfaction (PaGES) index: a novel, longitudinal mixed-methods evaluation tool

BackgroundPatient-Reported Outcomes or Experience Measures (PROMS / PREMS) are routinely used in clinical studies to assess participants’ views and experiences of trial interventions and related quality of life. Purely quantitative approaches lack the necessary detail and flexibility to understand the real-world impact of study interventions on participants, according to their own priorities. Conversely, purely qualitative assessments are time consuming and usually restricted to a small, possibly unrepresentative, sub-sample. This paper, which reports a pilot study within a randomised controlled trial of induction of labour, reports the feasibility, and acceptability of the Participant-Generated Experience and Satisfaction (PaGES) Index, a new mixed qualitative / quantitative PREM tool.MethodsThe single-sheet PaGES Index was completed by hypertensive pregnant women in two hospitals in Nagpur, India before and after taking part in the ‘Misoprostol or Oxytocin for Labour Induction’ (MOLI) randomised controlled trial. Participants recorded aspects of the impending birth they considered most important, and then ranked them. After the birth, participants completed the PaGES Index again, this time also scoring their satisfaction with each item. Forms were completed on paper in the local language or in English, supported by Research Assistants. Following translation (when needed), responses were uploaded to a REDCap database, coded in Excel and analysed thematically. A formal qualitative evaluation (qMOLI) was also conducted to obtain stakeholder perspectives of the PaGES Index and the wider trial. Semi-structured interviews were conducted with participants, and focus groups with researchers and clinicians. Data were managed using NVivo 12 software and analysed using the framework approach.ResultsParticipants and researchers found the PaGES Index easy to complete and administer; mothers valued the opportunity to speak about their experience. Qualitative analysis of the initial 68 PaGES Index responses identified areas of commonality and difference among participants and also when comparing antenatal and postnatal responses. Theme citations and associated comments scores were fairly stable before and after the birth. The qMOLI phase, comprising 53 one-to-one interviews with participants and eight focus groups involving 83 researchers and clinicians, provided support that the PaGES Index was an acceptable and even helpful means of capturing participant perspectives.ConclusionsSubjective participant experiences are an important aspect of clinical trials. The PaGES Index was found to be a feasible and acceptable measure that unites qualitative research’s explanatory power with the comparative power of quantitative designs. It also offers the opportunity to conduct a before-and-after evaluation, allowing researchers to examine the expectations and actual experiences of all clinical trial participants, not just a small sub-sample. This study also shows that, with appropriate research assistant input, the PaGES Index can be used in different languages by participants with varying literacy levels.Trial registrationClinical Trials.gov (21/11/2018) (NCT03749902).

A randomized controlled trial of sequential vs simultaneous use of Foley balloon catheter and oxytocin for induction of labor in nulliparous pregnant women

Although recent evidence suggests the simultaneous approach use of oxytocin for induction of labor in nullipara, there is limited data from low-income settings that support this. This study aimed to determine whether induction of labor with simultaneous use of oxytocin and a Foley balloon catheter decreases the induction of labor to delivery interval in nulliparous women, compared with sequential use of a Foley balloon catheter followed by oxytocin. This was a randomized controlled trial of nulliparous women with singleton pregnancies presenting for induction of labor at >28 weeks of gestation at St. Paul's Hospital Millennium Medical College (Addis Ababa, Ethiopia). The participants were randomly assigned to either the simultaneous group (the use of oxytocin and a Foley balloon catheter for induction of labor) or the sequential group (overnight intracervical Foley balloon catheter placement followed by the use of oxytocin the next morning). The primary outcome was induction of labor to delivery interval. Comparisons between the groups were made using the Student t test or Wilcoxon rank-sum test and chi-square test on Stata (version 15; StataCorp LLC, College Station, TX). This study is registered with the Pan African Clinical Trials Registry (identifier: PACTR201709002509200). From November 2019 to March 2020, a total of 140 women were randomly assigned to the simultaneous group (70 women) or the sequential group (70 women). The median oxytocin initiation to delivery intervals were 6.09 hours (range, 4.03-10.7) in the sequential group and 8.1 hours (range, 4.7-11.6) in the simultaneous group (P=.46). The mean Foley balloon catheter insertion to delivery intervals were 16.09±5.7 hours in the sequential group and 8.06±4.2 hours in the simultaneous group (P<.001). Cesarean delivery rate, composite neonatal outcomes, and chorioamnionitis were not different between the 2 groups. In nulliparous pregnant women, induction of labor using the simultaneous approach did not shorten the oxytocin initiation to delivery interval compared with the sequential approach. Moreover, both approaches showed no difference in the rates of adverse maternal and neonatal outcomes.

High dose versus low dose oxytocin for induction of labor of nulliparous Robson group II women at term

High dose versus low dose oxytocin for induction of labor of nulliparous Robson group II women at term

Comparison between Foley Catheter plus Oxytocin and Oxytocin Only For Induction of Labour after Membrane Rupture

Premature Rupture of Membranes (PROM) at term is defined as rupture of membrane at least 1 hour before the onset of uterine contractions at a gestational age of 37 weeks or more, it complicates 8% of all pregnancies [1]. It is associated with a risk of chorioamnionitis, which increases with duration of PROM, latency beyond 24 hours increases the incidence of chorioamnionitis and neonatal sepsis [2,3]. Spontaneous labour occurs in 60%–67% of these patients within 24 hours [2,4]. If no labour occurs, labour induction must be the best management for women with PROM at term. Labour induction is usually performed when the risks of continuing a pregnancy are more than the benefits of delivery as in PROM. Cervical ripening is an important factor for a successful induction. Unripe cervix with a lower Bishop score is associated with an increased risk of induction failure, while a favorable cervix significantly predicts a timely delivery [5]. Different methods are used for labour induction but none of the available methods of induction of labour is free of associated medical risks; therefore, labour should only be induced when there is a risk of the continuation of pregnancy. The agents used for induction should simulate spontaneous labour without causing excessive uterine activity. The most common methods of labour induction involve Pharmacological methods which include many agents, such as Prostaglandins (PGs (E2 orE1), progesterone receptor antagonists (mifepristone), oxytocin, and Nitric Oxide (NO) donors, but the most commonly used are PG and oxytocin) [6], and mechanical methods as Intracervical Foley catheter which is the most common mechanical method that was first described by Embrey and Mollison in 1967, where a Foley is inserted into the cervical canal and inflated just past the internal os with mild traction outward dilating the cervix directly, as well as indirectly stimulating (PGs) and oxytocin secretion [7-11]. The American College of Obstetricians and Gynecologists (2009) recommended using oxytocin for induction of labour in case of PROM at term, even if the cervix is unfavorable [12]. Several studies have evaluated the combination of oxytocin and mechanical devices, as oxytocin alone has not been shown to affect the risk of chorioamnionitis [13-15]. Induction of labour by mechanical device is accepted in cases with intact membrane, although mechanical treatment does not show any advantage over vaginal PGs regarding rates of chorioamnionitis, endometritis and neonatal infection [16]. In PROM, a concern with mechanical cervical ripening is increased risk of intraamniotic infection and other infection morbidity, which is not increased when membranes are intact [13]. Although the Foley catheter has been established as safe and effective in women with intact membranes, its efficacy has not been established in women with PROM. Chorioamnionitis was defined as temperature 38°C or greater with at least two of the following: uterine tenderness, maternal tachycardia, fetal tachycardia, foul odor of the amniotic fluid, or maternal leukocytosis (greater than 15,000 cells/mL3) [17].

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 &gt;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.

High- vs low-dose oxytocin in lean and obese women: a double-blinded randomized controlled trial

Women with obesity are likely to experience longer lengths of labor and are at an increased risk of cesarean delivery. We hypothesized that high-dose oxytocin would decrease the time to delivery in a cohort of women with obesity undergoing induction of labor. This study aimed to assess whether women with obesity benefited from higher doses of oxytocin for induction of labor. A double-blinded randomized controlled trial was conducted to evaluate the effect of low-dose and high-dose oxytocin on length of labor. We recruited women who were undergoing induction of labor at ≥37 weeks of gestation. Patients were randomly assigned in a 1:1 ratio to receive low-dose or high-dose oxytocin stratified by obesity level (obese and lean). The primary outcome was length of time (minutes) to vaginal delivery. The secondary outcomes included overall cesarean delivery rate, cesarean delivery for labor arrest, maximum oxytocin infusion rate, oxytocin infusion discontinuation, oxytocin infusion decrease, blood loss, neonatal intensive care unit admission, and neonatal Apgar scores. A total of 140 patients were randomized into receiving low-dose and high-dose oxytocin stratified into obese and lean stratum (35 for all strata). The primary outcome, time to vaginal delivery, was similar between the low-dose and high-dose oxytocin groups in the lean stratum (796 [±411] vs 694 [±466] minutes; P=.363) and the stratum with obesity (715 [±497] vs 762 [±594] minutes; P=.733). Kaplan-Meier curves between the low-dose and high-dose oxytocin groups were not significantly different in the lean stratum (P=.391) and the stratum with obesity (P=.692). There were 5 cesarean deliveries (14.29%) in the low-dose oxytocin lean stratum vs 2 cesarean deliveries (5.71%) in the high-dose oxytocin lean stratum (P=.232). There were 4 cesarean deliveries (11.43%) in the low-dose oxytocin stratum with obesity vs 1 cesarean delivery (2.86%) in the high-dose oxytocin stratum with obesity (P=.164). There was no difference in the incidence of postpartum hemorrhage between the lean stratum (P=0.526) and the stratum with obesity (P=0.212). There was no difference in mean estimated blood loss between the lean stratum (P=.472) and the stratum with obesity (P=.215). There was no difference in time to delivery between the low-dose and high-dose oxytocin protocols in either the lean cohorts or cohorts with obesity undergoing induction of labor. We did observe a trend toward a lower rate of cesarean delivery in both lean women and women with obesity when high-dose oxytocin was used.

Labor induction with oxytocin in pregnant rats is not associated with oxidative stress in the fetal brain

Despite the widespread use of oxytocin for induction of labor, mechanistic insights into fetal/neonatal wellbeing are lacking because of the absence of an animal model that recapitulates modern obstetric practice. Here, we create and validate a hi-fidelity pregnant rat model that mirrors labor induction with oxytocin in laboring women. The model consists of an implantable preprogrammed microprocessor-controlled infusion pump that delivers a gradually escalating dose of intravenous oxytocin to induce birth at term gestation. We validated the model with molecular biological experiments on the uterine myometrium and telemetry-supported assessment of changes in intrauterine pressure. Finally, we applied this model to test the hypothesis that labor induction with oxytocin would be associated with oxidative stress in the newborn brain. Analysis of biomarkers of oxidative stress and changes in the expression of associated genes were no different between oxytocin-exposed and saline-treated pups, suggesting that oxytocin-induced labor was not associated with oxidative stress in the developing brain. Collectively, we provide a viable and realistic animal model for labor induction and augmentation with oxytocin that would enable new lines of investigation related to the impact of perinatal oxytocin exposure on the mother-infant dyad.

Perinatal outcomes of high dose versus low dose oxytocin regimen used for labor induction and factors associated with adverse perinatal outcome in four hospitals of Ethiopia: a multicenter comparative study

BackgroundThere is limited evidence on effect of high and low dose oxytocin used for labor induction on perinatal outcomes. We compared perinatal outcomes among pregnant mothers who received the two different oxytocin regimens and identified risk factors associated with adverse perinatal outcomes.MethodsFacility based comparative cross-sectional study was conducted in four hospitals of Ethiopia over eight month’s period during 2017/2018 year with 216 pregnant women who received high and low dose oxytocin for labor induction. Socio-demographics, reproductive characteristics of mothers and perinatal outcomes data were collected and entered into Epi-data version 3.1 and then exported to SPSS version 20 for cleaning and analysis. Chi-square test and logistic regression were done to see the effect of different oxytocin regimens on perinatal outcome. The result was presented using 95 % confidence interval of crude and adjusted odds ratios. P-value < 0.05 was used to declare statistical significance.ResultHigher adverse perinatal outcomes (29 % vs. 13.9 %, p = 0.005) and higher non-reassuring fetal heart rate pattern (23.1 % vs. 7.4 %, p = 0.001) was observed among mothers who received high dose oxytocin compared to mothers who received low dose oxytocin. Using high oxytocin dose [AOR = 2.4, 95 % CI: 1.1, 5.5], caesarean birth [AOR = 9.3, 95 %CI: 3.8, 22.5], instrumental birth [AOR = 7.7, 95 % CI: 2.1, 27.8], and antepartum hemorrhage [AOR = 17.8, 95 %CI: 1.9, 168.7] were risk factors of adverse perinatal outcomes.ConclusionsThere was significance difference in the occurrence of adverse perinatal outcomes among pregnant mothers who received high and low dose of oxytocin. Using high dose oxytocin, antepartum hemorrhage, caesarean birth and instrumental birth were associated with increased risk of adverse perinatal outcomes. We recommend using low dose oxytocin for better perinatal outcomes.

Oral Misoprostol alone versus oral misoprostol followed by oxytocin for labour induction in women with hypertension in pregnancy (MOLI): protocol for a randomised controlled trial

BackgroundEvery year approximately 30,000 women die from hypertensive disease in pregnancy. Magnesium sulphate and anti-hypertensives reduce morbidity, but delivery is the only cure. Low dose oral misoprostol, a prostaglandin E1 analogue, is a highly effective method for labour induction. Usually, once active labour has commenced, the misoprostol is replaced with an intravenous oxytocin infusion if ongoing stimulation is required. However, some studies have shown that oral misoprostol can be continued into active labour, a simpler and potentially more acceptable protocol for women. To date, these two protocols have never been directly compared.MethodsThis pragmatic, open-label, randomised trial will compare a misoprostol alone labour induction protocol with the standard misoprostol plus oxytocin protocol in three Indian hospitals. The study will recruit 520 pregnant women being induced for hypertensive disease in pregnancy and requiring augmentation after membrane rupture. Participants will be randomised to receive either further oral misoprostol 25mcg every 2 h, or titrated intravenous oxytocin. The primary outcome will be caesarean birth. Secondary outcomes will assess the efficacy of the induction process, maternal and fetal/neonatal complications and patient acceptability. This protocol (version 1.04) adheres to the SPIRIT checklist. A cost-effectiveness analysis, situational analysis and formal qualitative assessment of women’s experience are also planned.DiscussionAvoiding oxytocin and continuing low dose misoprostol into active labour may have a number of benefits for both women and the health care system. Misoprostol is heat stable, oral medication and thus easy to store, transport and administer; qualities particularly desirable in low resource settings. An oral medication protocol requires less equipment (e.g. electronic infusion pumps) and may free up health care providers to assist with other aspects of the woman’s care. The simplicity of the protocol may also help to reduce human errors associated with the delivery of intravenous infusions. Finally, women may prefer to be mobile during labour and not restricted by an intravenous infusion. There is a need, therefore, to assess whether augmentation using oral misoprostol is superior clinically and economically to the standard protocol of intravenous oxytocin.Trial registrationClinical Trials.gov, NCT03749902, registered on 21st Nov 2018.

COMPARISON OF OBSTETRICAL OUTCOME WITH LABOR INDUCTION AGENTS USED AT TERM

Background: Induction of labour has risen gradually in modern obstetrics all over the world. It is more predominant in developed countries (around 20%) than developing countries. Objectives: To evaluate the outcome of induction of labor in primiparous, multiparous women and the risk of cesarean delivery associated with induction. Patients and methods: This study included 200 patients attending to Obstetrics and Gynecological Department at Al-Hussein University Hospital for delivery and Al-Sinblawein General Hospital from September 2019 to April 2020. The patients were classified into two equal groups according to success of induction: Group 1 was given misoprostol vaginally after rupture of membrane, group 2 patients was give oxytocin by slow infusion after rupture of membrane. Patients with gestational age less than 37 weeks, previous cesarean delivery, with breech presentation and age above 40 years were excluded. Results: There was a statistically significant difference between group 1(misoprostol) and group 2 (oxytocin) regarding induction of labor with mean interval between hours was higher in group 2. Conclusion: Vaginal misoprostol was effective, easy to administer, safe method and superior to oxytocin for induction of labor.

Intracervical Foley catheter with and without oxytocin for labor induction with Bishop score ≤3: a secondary analysis

The combination method for cervical ripening with a Foley catheter and concurrent oxytocin administration has been shown to reduce the total time from induction to delivery when compared with a Foley catheter only in patients with an unfavorable cervix (Bishop score of <6). It is unclear if this is still effective for patients with a less favorable cervix as indicated by a Bishop score of ≤3. This study aimed to determine if inducing labor with a Foley catheter and concurrent oxytocin administration reduced the total time from induction to delivery in subjects with a Bishop score of ≤3 compared with those who only received a Foley catheter without oxytocin for cervical ripening. This was a secondary analysis of a randomized, multicenter trial of patients with a live singleton pregnancy at ≥24 weeks' gestation undergoing labor induction with a Foley catheter and a Bishop score of <6. This analysis included patients with a Bishop score of ≤3. Exclusions included >1 cesarean delivery, unexplained bleeding, nonreassuring fetal tracing, major fetal anomalies, or other contraindications for vaginal delivery. The subjects were randomized to receive an intracervical Foley catheter only or with concurrent oxytocin infusion. The primary outcome for this analysis was the time from induction to delivery. Secondary outcomes included delivery at ≤12 hours, time to delivery ≤24 hours, cesarean delivery, total time of oxytocin infusion, need for additional ripening agents, postpartum hemorrhage, chorioamnionitis, and neonatal intensive care unit admission. A total of 322 patients were enrolled in the primary trial; 151 subjects had an initial Bishop score of ≤3 and were included in the secondary analysis (n=77 for Foley catheter with oxytocin and n=74 for the Foley catheter only). The demographics were similar in both groups. Those with a Bishop score of ≤3 who received a Foley catheter with concurrent oxytocin administration had a shorter time from induction to delivery than those patients who received a Foley catheter only for cervical ripening (21.3 vs 27 hours; P=.005). The group with a Foley catheter and oxytocin administered concurrently also had a shorter time from induction to delivery after adjusting for body mass index, parity status, and first Bishop score (21.5 vs 26.7 hours; P=.007). They also were more likely to deliver within 24 hours (74% vs 46%; P=.001) and not to require additional ripening agents (4% vs 15%; P=.04). Patients with the Foley catheter only method were more likely to receive additional ripening agents, but had fewer hours of oxytocin infusion (19.1 vs 12.4 hours; P<.001). There was no difference in the rate of delivery at ≤12 hours, cesarean delivery, postpartum hemorrhage, chorioamnionitis, and neonatal intensive care unit admission. Concurrent Foley catheter and oxytocin infusion significantly reduced the time from induction to delivery in patients with a Bishop score of ≤3 when compared with a Foley catheter only, particularly in multiparous patients.

422 An RCT of sequential versus simultaneous use of foley balloon and oxytocin for labor induction

To determine whether the induction of labor with simultaneous use of oxytocin and decreases the time to delivery in nulliparous women as compared to sequential use of Foley balloon followed by oxytocin. We conducted a randomized clinical trial of nulliparous women presenting for induction of labor at Saint Paul’s Hospital. Nulliparous women with singleton pregnancies for whom ripening of the cervix followed by induction of labor with oxytocin was decided were recruited for the study. They were randomly assigned to either simultaneous or sequential groups. In the sequential group, oxytocin was started after the Foley catheter is expelled or was put in place for 12 hours whichever comes first. While in the simultaneous group oxytocin was started within one hour of the insertion of Foley catheter and the two groups were compared. The primary outcome was the induction to delivery time. Secondary outcomes included are cesarean delivery rate, rates of chorioamnionitis, and composite neonatal score. An intention-to-treat (ITT) analyses was used. A total of 140 women were recruited and 70 women were started on simultaneous trans-cervical Foley balloon insertion with oxytocin while the rest 70 were started with sequential mode. The median (interquartile range) of the oxytocin initiation to delivery time was 6.9 (4.3, 10.7) hrs and 8.1 (4.7, 11.6) hrs for the sequential and simultaneous group respectively (P-value= 0.46). There was no difference in the induction delivery time and the rate of the cesarean section between the two groups. Contrary to the previous studies the simultaneous initiation of oxytocin didn’t show a reduction in the Oxytocin to delivery time.

Use of oxytocin for induction of labour

No abstract available

Oxytocin in Induction of Labor in Pregnancy with Group B Streptococcal Portage

Abstract In the last two decades, group B streptococcus (GBS) infection has established itself as a major cause of perinatal morbidity and mortality. The purpose of this study is to identify if the electively induced labor with oxytocin in women with positive cultures of Streptococcus agalactiae, namely the group B streptococcus (GBS), helps the mother and fetus and decreases the risk associated with perinatal transmission of GBS compared with the spontaneous labor. Results associated with induction of labor with oxytocin compared with spontaneous labor in pregnant women who have GBS - positive cervical cultures, are also used to determine whether induction of labor decreases the risk of complications from GBS infection.

How does balloon induction compare with oxytocin for induction of labor?

How does balloon induction compare with oxytocin for induction of labor?

Comparative Study of Management of Intrauterine Fetal Death by Misoprostol versus Oxytocin

Background &amp; objective: Management of pregnancy with intrauterine fetal death (IUFD) is always puzzling to the obstetricians and mental agony to the patients. Intravenous oxytocin infusion was previously practiced for termination of pregnancy with IUFD. But recently misoprostol is claimed to be better than oxytocin in terms of its efficacy and safety. This prospective study was carried out to find which of these two drugs is suitable for termination of pregnancy with IUFD.&#x0D; Methods: Based on predefined criteria,a total of 100 singleton pregnant women with gestational age more than 22 weeks, ultrasonographically confirmed as having dead fetus in utero were included in the study and were randomly assigned to vaginal Misoprostol and Oxytocin infusion groups. The outcome was evaluated in terms of time required for induction of labor, induction to delivery time and complications encountered by each group.&#x0D; Result: The overall time required for induction to delivery was significantly shorter in Misoprostol group than that in Oxytocin group irrespective of their Bishop’s score (p &lt; 0.001). Even in patients in whom the cervix was unripe (Bishop's score &lt; 6), the mean time required from induction to delivery was much shorter in Misoprostol group (p &lt; 0.001), but in patients in whom the cervix was ripen, the mean time from induction to delivery in Misoprostol group was shorter, but the difference did not turn to significant (p = 0.079). Both nulliparous and multiparous women experienced significantly shorter durations of labor in the Misoprostol group than those in the Oxytocin group (p &lt; 0.001 and p = 0.001 respectively). Complications like hyperstimulation, retained placenta and postpartum hemorrhage all were somewhat higher in Misoprostol group than those in Oxytocin group, but the differences were not statistically significant (p = 0.357, p = 0.500 and p = 0.500 respectively).&#x0D; Conclusion: The use of vaginal misoprostol is more effective than intravenous infusion of oxytocin in induction of labor in patients with IUFD. The time required from induction to delivery is appreciably shorter when Misoprostol is used compared to that needed when oxytocin is used.&#x0D; Ibrahim Card Med J 2019; 9 (1&amp;2): 74-79