Proportion Of Vaginal Deliveries Research Articles

The impact of expedited third trimester viral load testing on the proportion of vaginal deliveries in HIVpositive pregnant women in the Dominican Republic

The impact of expedited third trimester viral load testing on the proportion of vaginal deliveries in HIVpositive pregnant women in the Dominican Republic

The impact of expedited third trimester viral load testing on the proportion of vaginal deliveries in HIVpositive pregnant women in the Dominican Republic

The impact of expedited third trimester viral load testing on the proportion of vaginal deliveries in HIVpositive pregnant women in the Dominican Republic

The Delivery of Grand Multiparas in a Semi-Rural Setting: A Cross-Sectional Descriptive Study at the Ayos Locality of Cameroon

Introduction: Grand multiparity is a known risk factor for maternal and fetal complications. Materials and Methods: We carried out a cross-sectional descriptive study on the delivery of grand multiparas at the maternity of the regional hospital annex of Ayos, a semi-rural locality in the Center region of Cameroon. The study covered the period from January 2012 through December 2020, and the objective was to assess the frequency, the determinants and the outcome of delivery in grand multiparas. Results: We recorded 1384 deliveries and enrolled 137 cases of delivery of grand multiparas. This gives a frequency of grand multipara delivery of 9.89%. The mean age of the women was 34.96 ± 4.45 years. Married parturients accounted for 65% of the cases and 16.8% were HIV positive. Delivery occurred at term in 89.9%. In 35.8%, no antenatal consultation was done. The use of the partograph during labor was reported in 11.7%. Per vaginal delivery was noted in 88.3%, emergency cesarean in 10.2% and elective cesarean in 1.5%. The most frequent maternal complications included post-partum hemorrhage (19.9%), genital tract tears (12.4%), endometritis (9.5%) and surgical wound infection (8.7%). No maternal death was recorded. The mean birth weight of the newborns was 3336.8 ± 550 g. Fetal complications were mostly represented by neonatal infection (20.1%), perinatal death (7.9%) and neonatal asphyxia (9.5%). Conclusion: The frequency of grand multiparous delivery in the semi-rural locality of Ayos, Cameroon, was 9.89%. The mean age of parturients was 38.96 years and the proportion of vaginal delivery was 88.3%.

Obstetric Outcomes of Obese Primigravida with Spontaneous Onset of Labour at Term

INTRODUCTION: Obesity has reached pandemic level with higher prevalence among women. Obese pregnant women have higher risk of comorbidities, maternal and fetal complications. This study aimed to determine the prevalence of vaginal delivery and pregnancy outcomes of obese primigravida presented with spontaneous labour at term. MATERIALS AND METHODS: This prospective cohort study was conducted in a tertiary hospital in Perak involving 250 obese primigravida (BMI ≥27.5kg/m2) and 250 non-obese primigravida. Data collected from August 2020 till January 2021 and analyzed using descriptive statistics, independent T-test and Mann-Whitney U test by SPSS version 23.0. RESULTS: Our study found that there were no significant differences in the proportion of vaginal delivery and caesarean delivery between obese and non-obese primigravida [72.0% vs. 78% (vaginal delivery) and 28% vs. 22% (caesarean delivery)] with spontaneous onset of labour at term. No difference in complications of labour such as PPH and OASIS (p=0.187), with high successful delivery without complications. Obese women presented with cervical dilatation of 4cm had longer delivery interval [5.82(2.97) vs. 4.75(2.71), p=0.013] but shorter delivery interval at 6cm [2.41(1.58) vs. 3.61(1.78), p=0.026] compared to non-obese. They also had higher caesarean rate indicated for abnormal labour progress [28(71.8) vs. 11(28.2), p=0.019] and higher comorbidities [149(72.3) vs. 57(27.7), p=<0.001]. There was no difference in the fetal outcome (p=0.311). CONCLUSION: After careful selection, obese women with spontaneous labour at term are safe for vaginal delivery as they have similar risk of labour augmentation, duration of active labour, caesarean delivery, PPH and OASIS despite higher comorbidities.

Cervical balloon combined with oxytocin improves clinical efficacy and safety for induction of labor with scarred uterus

Background: To evaluate cervical balloon combined with oxytocin improves clinical efficacy and safety for induction of labor with scarred uterus. Methods: The clinical data of pregnant women undergoing vaginal trial delivery after cesarean section in Huai’an Maternal and Child Health Hospital, from January 2020 to January 2021 were retrospectively analyzed. Among them, 80 pregnant women with scarred uterus who were induced by cervical balloon combined with oxytocin were considered as CBO group. 80 pregnant women with natural delivery scar uterus were considered as control, who were matched to CBO group for age, gestational age, and pre-pregnancy BMI. In CBO group, Bishop score before and after induction of labor was compared. Between the CBO and control groups, mode of delivery and duration of labor were analyzed, and maternal and infant outcomes were compared. Results: The overall effective rate of cervical maturation after labor induction was 88.8%, and the proportion of vaginal delivery in the CBO group were significantly higher than that in the control group. Besides, the induced labor time, first stage of labor time and the total stage of labor time in the CBO group were significantly shorter than those in the control group. There was no significant difference in maternal and infant outcomes between the two groups. Conclusion: Cervical balloon combined with oxytocin could significantly improve the clinical effect of parturients with scar uterine without increasing maternal and infant complications, which is a safe and effective strategy that can be applied in clinical practice.

Group B streptococcus neonatal umbilical colonization managed by dry cord care in nurseries: A retrospective cohort study

Screening-based intrapartum antibiotic prophylaxis (IAP) has reduced the prevalence of early-onset group B Streptococcus (GBS) infection in newborns. Nevertheless, early-onset disease still occurs despite IAP, and IAP is not effective in preventing late-onset disease. This study aimed to determine the prevalence and risk factors of GBS neonatal umbilical colonization managed by dry cord care in Japan. Of 735 healthy newborns in the well-baby nursery at Saitama City Hospital, 353 from whom umbilical bacterial swabs were obtained before discharge were included in the analysis. Maternal and neonatal clinical characteristics were retrospectively reviewed. GBS was detected in 4.2% (15/353) of umbilical swabs; 13/15 (86.8%) were born to GBS-negative mothers. The median (IQR) age at umbilical swab collection was 4.0 (4.0-5.0) days. Comparison of clinical characteristics between GBS-positive and negative neonates revealed a significant difference in the proportion of vaginal deliveries (15/15 [100%] in GBS-positive neonates vs. 115/338 [34.0%] in GBS-negative neonates, p<0.0001). Of 15 GBS-positive neonates, 10 (66.7%) were also co-colonized with other enteric bacteria such as Escherichia coli. Vaginal delivery was a risk factor associated with GBS neonatal umbilical colonization in Japanese neonates. Co-colonization with multiple enteric bacterial species implicates vertical transmission of GBS from undetected carrier mothers during passage through the birth canal.

The rates and medical necessity of cesarean delivery in China, 2012\u20132019: an inspiration from Jiangsu

BackgroundThe World Health Organization (WHO) in 2015 stated that every effort should be made to provide cesarean delivery (CD) for women in need. In China, the two-child policy largely prompts the number of advanced age childbirth, which raises the possibility of an increasing number of women who need a c-section. The aim of this study was to assess the trends in the overall and medical indication-classified CD rates in the era of the two-child policy in Jiangsu, China.MethodsA retrospective cross-sectional study of 291,448 women who delivered in 11 hospitals in Jiangsu province between 2012 and 2019 was conducted. Medical cesarean indication for each woman was ascertained by manually reviewing the medical records. The 291,448 women were divided into two subgroups according to the presence of the indications: the indicated group (7.80%) and the non-indicated group (92.20%). We then fitted joinpoint regression and log-binomial regression models to estimate trends in the CD rates across the study period.ResultsThe overall CD rate was observed with a declining trend from 52.51% in 2012–2015 to 49.76% in 2016–2019 (adjusted RR, 0.92; 95% CI, 0.91–0.93; P < 0.001), along with an annual percentage change (APC) to be − 1.0 (95% CI, − 2.1 to 0.0) across the period. The participants were then divided into two subgroups according to the presence of medical CD indications: the indicated group (7.80%) and the non-indicated group (92.20%).We found the declining trend was most pronounced in the non-indicated group, with the CD rates decreased from 50.02% in 2012–2015 to 46.27% in 2016–2019 (adjusted RR, 0.90; 95% CI, 0.89–0.90; P < 0.001). By contrast, we observed a steady trend in the CD rate of the indicated group, which maintained from 87.47% in 2012–2015 to 86.57% in 2016–2019 (P = 0.448). In the indicated group, a higher risk of adverse pregnancy outcomes was revealed for those women who delivered vaginally as compared with those who received c-section. We further investigated that women with following specific indications had a higher proportion of vaginal delivery, i.e., pregnancy complications, fetal macrosomia, and pregnancy complicated with tumor (34.70%, 10.84%, and 16.34%, respectively). Women with the above 3 indications were observed with a higher risk of adverse pregnancy outcomes if delivered vaginally. The incidence rates of the medical indications among the general population increased considerably over the 8-year period (P < 0.001).ConclusionsAlthough the overall CD rate apparently decreased in the recent years, along with the decline of the unnecessary CD rate, a considerable proportion of indicated women were not provided with CD service in Jiangsu, China. Instead of targeting the overall CD rate, we need to take actions to reduce unnecessary CD rate and provide adequate c-section service for women with indications, particularly for those with underlying diseases and suspected fetal macrosomia.

Slow-release vaginal insert of misoprostol versus orally administrated solution of misoprostol for the induction of labour in primiparous term pregnant women: a randomised controlled trial.

To compare the World Health Organization (WHO) recommended orally administrated dosage of misoprostol (25μg) with a vaginal slow-release (7μg/hour) insert of misoprostol regarding time from induction to delivery and safety of the method. Open label, Randomised controlled trial (RCT). Delivery ward at a secondary referral hospital in Stockholm, Sweden, from 1 October 2016 to 21 February 2018. One hundred and ninety-six primiparous women with singletons in cephalic presentation at ≥37weeks of gestation and with a Bishop score of ≤4. Women were randomised to an oral solution of misoprostol (Cytotec® n=99) or vaginal slow-release misoprostol (Misodel® [MVI] n=97). Primary outcome: time from induction to vaginal delivery. mode of delivery; proportion of vaginal deliveries within 24hours (VD24); neonates with an Apgar score of <7 at 5minutes; pH<7.10; postpartum haemorrhage (PPH) of >1000ml; hyperstimulation; and women's delivery experience (VAS). There was no difference in the time to delivery [corrected] (median 21.1hours in the MVI group and 23.2hours in the oral group; Kaplan-Mayer log rank P=0.31). There was no difference regarding the proportion of VD24 (50.5 versus 55.7%, P=0.16). Hyperstimulation with non-reassuring cardiotocography (CTG) was more common in the MVI group (14.4 versus 3.0%, P<0.01). Terbutaline (Bricanyl® ) was used more often for hyperstimulation in the MVI group (22.7 versus 4.0%, P<0.01). There was no difference in the numbers of children admitted to the neonatal intensive care unit (NICU). Vaginal delivery after induction of labour (IOL) with slow-release misoprostol did not result in a shorter time from induction to vaginal delivery, compared with oral misoprostol solution, but was associated with a higher risk for hyperstimulation and fetal distress. There were no differences in mode of delivery or neonatal outcome. IOL with MVI was similar to oral solution of misoprostol but hyperstimulation and fetal distress were more common.

Strategies for Prevention of Mother-to-Child Transmission Adopted in the "Real-World" Setting: Data From the Italian Register for HIV-1 Infection in Children.

Strategies for prevention of HIV-1 mother-to-child transmission (PMTCT) have been continuously optimized. However, cases of vertical transmission continue to occur in high-income countries. To investigate changes in PMTCT strategies adopted by Italian clinicians over time and to evaluate risk factors for transmission. Data from mother-child pairs prospectively collected by the Italian Register, born in Italy in 1996-2016, were analyzed. Risk factors for MTCT were explored by logistic regression analyses. Six thousand five hundred three children (348 infections) were included. In our cohort, the proportion of children born to foreign mothers increased from 18.3% (563/3078) in 1996%-2003% to 66.2% (559/857) in 2011-2016 (P < 0.0001). Combination neonatal prophylaxis use significantly (P < 0.0001) increased over time, reaching 6.3% (56/857) after 2010, and it was largely (4.2%) adopted in early preterm infants. The proportion of vaginal deliveries in women with undetectable viral load (VL) increased over time and was 9.9% (85/857) in 2011-2016; no infection occurred among them. In children followed up since birth MTCT, rate was 3.5% (96/2783) in 1996-2003; 1.4% (36/2480) in 2004-2010; and 1.1% (9/835) in 2011-2016. At a multivariate analysis, factors associated with MTCT were vaginal delivery with detectable or missing VL or nonelective caesarean delivery, prematurity, breastfeeding, lack of maternal or neonatal antiretroviral therapy, detectable maternal VL, and age at first observation. Previously described increased risk of offspring of immigrant women was not confirmed. Risk of MTCT in Italy is ongoing, even in recent years, underling the need for implementation of the current screening program in pregnancy. Large combination neonatal prophylaxis use in preterm infants was observed, even if data on safety and efficacy in prematures are poor.

Quality of care for labor and childbirth in a public hospital network in a Brazilian state capital: patient satisfaction

The study assessed the quality of care for labor and childbirth in the public hospital system in the city of Recife, Pernambuco State, Brazil, according to the mothers' satisfaction, using a cross-sectional exploratory study in all the public hospitals in the network, grouped according to type of hospital management and interviews with 1,000 mothers. Quality of care was measured according to management strata and the following dimensions of quality: reception; respect for individual rights; prenatal and childbirth care; and ambience. The results' significance was analyzed with the Pearson and Friedman chi-square test. There was high prenatal coverage, not linked to childbirth care, and intense migration of deliveries. Waiting time for care by the healthcare team was long, the proportion of vaginal deliveries in the municipal maternity services was 80%, and only 16% of the deliveries included skin-to-skin contact with the newborn; breastfeeding occurred in the birthing room in 11% of the deliveries. Among the various management modalities, the charitable hospital rated highest. The target dimension showed significant differences, with higher satisfaction rates for the following: respect (88.2%), kindness (86.7%), physicians' work (85.2%), and trust in the healthcare staff (84.3%). The highest rates of dissatisfaction were for: temperature on the ward (62.2%), possibility of lodging complaints (48.1%), quantity and quality of hospital clothing and bedding (49.2%), and privacy (43%). Despite positive strides, the findings show the need for reorganization of obstetric care policy, with regionalization, regulation, consolidation of networks of care, and interventions in the healthcare setting, aimed at consolidating the humanization of care.

Effect of self-efficacy intervention on pregnancy outcome and psychological status of elderly puerperal

Objective To explore the effect of self efficacy intervention on pregnancy outcome and psychological status of elderly women. Methods From July 2015 to July 2016, 96 cases of elderly puerperal were selected as the research objects. They were randomly divided into control group and observation group, 48 cases in each group. Puerperal in the control group were treated with routine clinical nursing intervention; Puerperal in the observation group received self-efficacy intervention on the basis of routine nursing. The differences of SAS, SDS score, duration of labor, CBSEI-C32, OE-16, EE-16 scale scores, mode of delivery and neonatal outcomes before and after intervention were observed between the two groups. Results After the intervention, the scores of SAS and SDS in the control group and the observation group were significantly lower than those before the intervention (P<0.05) ; The SAS and SDS scores of the observation group were significantly lower than those of the control group (t=6.293, 4.807; P<0.05) ; The proportion of vaginal delivery was higher than that of the control group, and the proportion of cesarean section was lower than that of the control group (χ2=4.165, 7.247; P<0.05) ; After the intervention, the OE-16 score, EE-16 score and CBSEI-C32 score were significantly higher than those before intervention (P<0.05) . Conclusions Self efficacy intervention can significantly reduce the elderly maternal psychological anxiety and depression, improve fetal vaginal delivery rate, reduce the incidence of adverse neonatal outcomes and improve pregnancy outcome. Key words: Pregnancy outcome; Elderly puerperal; Self-efficacy; Psychological status

Trend of caesarean section rate and puerpera characteristics: based on Robson classification

Objective: To analyze the trend in caesarean section rate and puerpera characteristics in hospital, and provide valuable information for maternal and child health policy making and clinical practice. Methods: A total of 12 041 women who delivered in the affiliated Chaohu Hospital of Anhui Medical University from October 1, 2010 to September 30, 2016 were selected. Based on Robson classification system, changes in the rate of caesarean delivery as well as its relationship with two-child policy and infant sex ratio were analyzed. Results: The overall caesarean section rate gradually decreased from 66.9% to 44.2% during the past six years. Respectively, the caesarean section rate in primiparae with singleton term babies decreased to 32.1% and the rate in multiparas without uterine scar decreased to 14.2%, and the rate in premature delivery decreased to 22.9%, the differences were significant (P<0.01). The proportion of vaginal delivery (R1, R3), multiparas with uterine scar (R5) and twins pregnancy (R8) increased. the differences were significant (P<0.01). The annual overall newly-born sex ratio ranged from 110∶100 to 128∶100. In group R1, more babies were girls, the proportion was stable, more women with premature delivery and multiparas had boy babies, but the boy babies by multiparas without uterine scar obviously decreased in the last 2 years. Conclusions: Primiparae with singleton head birth, multipara without uterine scar and women with premature deliveries are the key population in the effort of reduction of caesarean section rate. The caesarean section rate and proportion were unstable in multiparas with uterine scar, breech deliveries and twin deliveries. The application of Robson classification system can improve the comparability of the surveillance data.

Study of the Feto-maternal Outcome in Occipito-posterior Position at the Onset of Labor

Introduction: Childbirth is considered one of the most rewarding and memorable experiences in a woman’s life. Labour is the process that leads to childbirth. Difficult labor, characterized by abnormally slow labor progress, is known as dystocia. Malposition refers to any position of the vertex other than flexed occipito-anterior (OA) one. It is a common obstetric belief that progression of labour is underpinned by fetal position. Material and Methods: 100 term antenatal patients, 50 with occipito-posterior (OP), and 50 with an OA position, were included in the study admitted in the labor room from December 2015 to March 2017. After the recruitment of patients, detailed history, examination: general physical, per abdominal and per vaginal was done. All patients underwent ultrasonography to confirm the fetal position at the onset of labor. They were then followed up until birth to determine the outcome. The neonatal outcome was analyzed by Apgar score at 1,5 minutes of delivery, presence of caput succedaneum, and molding. Results: Among total 100 cases, the proportion of vaginal delivery was more in OA group (74%) in comparison with OP group (42%). 40% of patients of OP group landed into cesarean delivery against 18% of patients of the OA group. 8% percent of patients had face to pubis delivery. The mean duration of labor is prolonged in study group i.e., 473.2 ± 1.84 minutes in the first stage, 29.4 ± 7.67 minutes in second stage and 5.70 ± 1.75 minutes in third stage vs. i.e., 376.8 ± 1.26 minutes in first stage, 24.79 ± 9.77 minutes in second stage and 5.20 ± 3.22 minutes in third stage of labor of control group. Conclusion: The group with malposition showed prolongation of labor in comparison to OA position. A higher rate of cesarean delivery was observed in the study group because of preference for cesarean over instrumental delivery. The neonatal outcome was comparable in both groups. Only a few instrumental deliveries were noted because the art of instrumental delivery is dying in modern obstetrics.

OC-085 Endoanal ultrasound findings and corresponding cleveland clinic faecal incontinence scores following a third or fourth degree perineal tear

Introduction Third and fourth degree perineal tears will occur in a small proportion of vaginal deliveries. When found at the time of delivery, they are typically repaired primarily. Patients may subsequently suffer from faecal incontinence. Method All patients with a third and fourth degree tear were referred for assessment. This included endoanal ultrasonography and estimation of incontinence with the Cleveland Clinic faecal incontinence score. Data from 2001 to 2013 were analysed. Results 888 patients were included. Of these, 551 (62%) were found to have a sphincter defect. 333 (38%) had intact sphincters. The majority of these had normal looking sphincters on ultrasonography. The mean (SD) incontinence score for those with a defect was 4.3 (5.5). The mean incontinence score for those with no defect was 4.2 (5.8). Conclusion The majority of patients had a sphincter defect. This suggests that there is a high failure rate from the primary repair. The high proportion of normal looking sphincters suggests that third and fourth degree tears may be over diagnosed. Despite the ultrasound findings, the incontinence scores for both groups were comparable. Disclosure of interest None Declared.

Impact of the introduction of neuraxial labor analgesia on mode of delivery at an urban maternity hospital in China

ObjectiveTo evaluate the association between the introduction of neuraxial (epidural) labor analgesia and mode of delivery in a large urban maternity hospital in China. MethodsA single-intervention impact study was conducted at Shijiazhuang Obstetrics and Gynecology Hospital in Shijiazhuang. Baseline data collection occurred between August 1 and December 31, 2009, when no analgesic method was routinely employed during labor. An intervention was then implemented, consisting of a neuraxial labor analgesia service. The service was fully operational from September 1, 2010, and data were collected to August 31, 2011. The mode of delivery was compared between the different periods. ResultsNeuraxial analgesia rate was used in none of the 3787 deliveries during the baseline period and 3429 (33.5%) of 10 230 in the implementation period. Cesareans were performed in 1533 (40.5%) deliveries in the baseline period and 3441 (33.6%) in the implementation period (difference –6.8%, 99.8% confidence interval [CI] –9.7% to –3.9%; P<0.0017). The proportion of vaginal deliveries in which forceps were used was unchanged (difference –0.8%, 99.8% CI –0.7% to 2.2%; P=0.92). ConclusionThe introduction of epidural analgesia reduced the frequency of cesarean delivery, which improved obstetric and neonatal outcomes.

British HIV Association guidelines for the management ofHIVinfection in pregnant women 2012

British HIV Association guidelines for the management of<scp>HIV</scp>infection in pregnant women 2012

Maternal complications related to the mode of delivery in pregnant women with heart disease in a specialist high risk delivery hospital in Fortaleza, CE

To determine the association between maternal complications and type of delivery in women with heart disease and to identify the possible clinical and obstetrical factors implicated in the determination of the route of delivery. This was a retrospective and descriptive study of the medical records of pregnant women with heart disease admitted to a tertiary reference hospital in the municipality of Fortaleza, Ceará, from 2006 to 2007. The study population included all pregnant women with an antepartum diagnosis of heart disease admitted for delivery, while women who received a diagnosis of heart disease after delivery were excluded, regardless of age and gestational week. A semi-structured questionnaire regarding sociodemographic, clinical and obstetrical variables was used. A descriptive analysis was first performed based on simple frequencies and proportions of the sociodemographic variables. Next, possible associations between clinical and obstetrical aspects and type of delivery were analyzed, with the verification of association between maternal complications and type of delivery. The Fisher exact test was applied for this analysis, with the level of significance set at p<0.05. The collected data were processed and analyzed using the Epi-InfoTM software version 6.04 (Atlanta, USA). Seventy-three pregnant women with heart disease were included in the study. Interatrial communication was the condition most frequently observed among congenital diseases (11.0%) and mitral calcification among the acquired ones (24.6%). The proportion of cesarean deliveries was higher than the proportion of vaginal deliveries, except for women with acquired heart disease. An association was detected between type of heart disease and type of delivery (p=0.01). There were 13 cases of maternal complications (17.8%). Among them, ten (76.9%) occurred during cesarean section and three during vaginal delivery. No association mas detected between maternal complications and type of delivery in pregnant women with heart disease (p=0.74). There was no association between the occurrence of maternal complications and route of delivery among pregnant women with heart disease.

Misoprostol Vaginal Insert for Successful Labor Induction

To compare three doses of misoprostol vaginal insert for successful labor induction measured by the proportion of vaginal deliveries within 24 hours. A total of 374 women with modified Bishop scores of 4 or lower before induction of labor were randomly assigned to receive misoprostol vaginal insert (MVI) 100 (n=118), MVI 150 (n=125), or MVI 200 (n=131) micrograms. The insert was removed for onset of active labor or adverse event. The primary outcome was proportion of vaginal deliveries within 24 hours. The comparison group was MVI 100. Safety was assessed by comparing rates of cesarean deliveries and adverse events. Twenty-four percent of women receiving MVI 200 failed to achieve vaginal delivery within 24 hours compared with 36.3% of those receiving MVI 100 (P=.057, relative risk [RR] 0.66, 95% confidence interval [CI] 0.42-1.04). Compared with MVI 100, MVI 200 reduced median time to vaginal delivery (1,181 compared with 1,744 minutes, P=.02) and need for oxytocin (48.9% compared with 70.9%, P<.001, RR 0.70, 95% CI 0.56-0.85). The cesarean rates for women assigned to MVI 200 and 100 were 22.9% (30/131) and 31.4% (37/118) (P=.15, RR 0.73, 95% CI 0.48-1.10). Misoprostol vaginal insert 200 was associated with an increased rate of tachysystole (41.2%) compared with MVI 100 (19.5%) (P<.001, RR 2.11, 95% CI 1.39-3.22). Compared with MVI 100, MVI 200 was associated with a significant reduction in time to vaginal delivery, but did not improve proportion with vaginal delivery by 24 hours. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00828711.

Efficacy and safety of six hourly vaginal misoprostol versus intracervical dinoprostone: a randomized controlled trial

To compare the efficacy and safety of intravaginal misoprostol versus dinoprostone cervical gel for cervical ripening and labour induction. We carried out an experimental clinical trial in which we enrolled 130 cervical consecutive patients with cervical ripening, randomly assigned to one of the following two treatment groups: (1) intravaginal misoprostol and (2) intracervical dinoprostone gel. A total of 50 microm of misoprostol was placed in the posterior vaginal fornix every 6 h for a maximum period of 24 h and 0.5 mg of dinoprostone was administrated in the uterine cervix every 6 h, for a maximum period of 24 h. The primary outcome measure was the number (rate) of women who went to vaginally deliver within 24 h of the protocol initiation. Among 130 patients evaluated, 65 were allocated to the misoprostol group and 65 to the dinoprostone group. The proportion of vaginal delivery within 24 h was significantly higher in the misoprostol group (75%) than in the dinoprostone group (53.8%) (RR = 1.40, 95% CI [1.07-1.45], P = 0.02). There was no significant difference between the mean time interval of delivery in the misoprostol group and the dinoprostone group (14.9 vs.15.8 h) (P = 0.51). The Bishop score was significantly higher in the misoprostol group, 6 h after the onset of the study (1.38; relative risk, 95% CI [1.02-1.85], P = 0.03). The Caesarean delivery rate for fetal distress was higher in the dinoprostone group (21 vs. 10.8%, P = 0.15). The tachysystole (Misoprostol 6.1% vs. dinoprostone 4.6%, relative risk 1.15, 95% CI [0.6-2.24]) and hyperstimulation syndrome rates (Misoprostol 7.6% vs. dinoprostone 4.6%, relative risk 1.26, 95% CI [0.72-2.24]) were slightly increased in the misoprostol group than in the dinoprostone group without reaching the level of statistical signification. Misoprostol as used in this protocol is more effective than cervical dinoprostone gel application in the cervical ripening and labour induction. There is a tendency for an increase in the rate of tachysystole and hyperstimulation syndrome.

Cesarean Delivery in the United Kingdom

To estimate recent temporal trends in delivery by cesarean during the past decade and the proportion of vaginal deliveries after prior caesarean in the United Kingdom. We conducted a cohort study using information from the General Practice Research Database. We identified all women with 1 or more deliveries between January 1990 and December 1999 and determined the method(s) of delivery. We estimated the proportion of women with vaginal delivery after cesarean in a subcohort who had at least 3 years of follow-up. We identified 39,938 cesareans among 271,663 deliveries (14.7%), with an increase from 12.5% in 1990 to 18.3% in 1999. The proportion of cesarean deliveries increased with age and increased over time in all age groups except women aged younger than 20 years. Among 26,480 women with a caesarean delivery between 1990 and 1996, 7,649 (28.9%) had a subsequent delivery. The proportion of vaginal delivery after prior cesarean decreased from 45% in 1991 to 37% in 1999. Cesarean deliveries increased as a proportion of all deliveries in the United Kingdom during the past decade, and the proportion of vaginal delivery after prior cesarean decreased. Still, the proportion of cesarean deliveries is lower and the proportion of vaginal deliveries after prior cesarean is higher in the United Kingdom than in the United States. II-2.