Success Rate Of Vaginal Delivery Research Articles

Neonatal outcomes of planned vaginal delivery versus planned cesarean section for breech presentation at term: population-based study on 546,842 breech births across the United States between 2008 and 2017

IntroductionOver the last several decades, cesarean delivery has been recommended as the safest mode of delivery for breech presentations. The purpose of this study was to evaluate the outcomes of planned vaginal births with planned cesarean births in breech presenting fetuses. MethodsThis retrospective population-based cohort study utilized data from the United States’ Period Linked Birth-Infant Death Public Use Files from 2008-2017. All term singleton breech deliveries of a live baby without congenital anomalies were identified (n=546,842) and divided into two cohorts: women who had a planned vaginal birth (n=116,828), and women who had a planned cesarean section (n=430,014). Multivariate logistic regression models, adjusted for maternal baseline characteristics, examined the associations between the planned delivery method and neonatal outcomes. ResultsIt was observed that 26.14% of the planned vaginal birth cohort had a vaginal delivery. In adjusted analyses, undergoing a planned vaginal birth for breech delivery was associated with an increased risk of adverse neonatal outcomes including infant death, OR 1.32, 95% CI 1.16-1.52, admission to NICU,1.23, 1.19-1.27, ventilation support at < 6 hours of life, 1.47, 1.42-1.52, ventilation support at > 6 hours of life, 1.19, 1.08-1.31, and Apgar score of ≤3 at 5 min, 2.27, 2.06-2.50. ConclusionIn women carrying fetuses in breech presentation, having a planned vaginal birth had a low success rate and was associated with increased risk of neonatal morbidity and mortality. Women should be carefully counselled on the risks associated with breech vaginal delivery as well as the low success rate of vaginal delivery.

Correlative analysis of different treatments of persistent occipitotransverse position on the outcome for mother and infant.

To explore the clinical feasibility of different treatment methods for persistent occipitotransverse position and the influence on maternal and infant complications. During the trial of vaginal delivery from April 2020 to March 2023 in our hospital, the cervix was fully dilated and the presentation was located at +2 station. Ninety-six pregnant women with fetal presentation at +4 station, occipitotransverse fetal position, maternal complications, abnormalities in the second stage of labor, and or fetal distress were divided into two groups: 65 patients with Kielland forceps vaginal delivery and 31 patients underwent emergency cesarean section. The delivery time, vaginal laceration rate, postpartum blood loss volume, puerperal infection rate, neonatal birth injury rate, and neonatal 1 min Apgar scores were analyzed. The delivery outcomes and maternal and neonatal complications of 96 pregnant women were analyzed: the application of Kielland forceps delivery time was shorter, while the vaginal laceration rate, postpartum hemorrhage, puerperal infection rate were significantly lower than that of patients undergoing emergency cesarean section and the neonatal 1 min Apgar score was higher than that of emergency cesarean section group (p < 0.05). It was clinically appropriate to use Kielland forceps in vaginal delivery when the persistent occipitotransverse position was present and delivery needed to be expediated. Use of Kielland forceps can shorten the delivery time, improve the success rate of vaginal delivery and reduce the complications of mothers and infants.

Elective Induction of Labor Following Prior Cesarean Delivery.

Following the ARRIVE trial, induction of labor at 39 weeks has increased in the United States. The risk of uterine rupture and optimal timing of elective induction in those patients with a prior cesarean delivery is not well described, and they were not included in the original trial. We aim to determine the risk of uterine rupture in those patients undergoing elective induction of labor with prior cesarean delivery. This was a retrospective cohort of participants with prior cesarean delivery from 1996 to 2000. Participants were included if they had ≤ 2 prior cesareans. Participants were excluded if they had a history of an unknown prior incision, a classical incision, gestational age < 39 weeks, any diabetes, chronic hypertension, twin gestation, collagen or vascular disease, or HIV. Those undergoing expectant management were compared to those undergoing elective induction with no medical or obstetrical indications for delivery. Analysis was performed at three gestational age groups: 39 weeks, 40 weeks, and 41 weeks. The primary outcomes were uterine rupture, rates of successful vaginal delivery, and a composite major morbidity risk. Multivariable logistic regression was performed. At 39 weeks, 618 (10.3%) elective inductions were compared to 5365 (89.7%) undergoing expectant management; uterine rupture occurred more frequently (13 patients (2.1%) vs. 49 patients (0.9%); aOR, 2.5; 95% CI, 1.3 - 4.6) with fewer successful VBAC (66.8% vs. 75%; aOR, 0.6; 95% CI, 0.5 - 0.7). The risk of uterine rupture was similar between groups at 40 (5 patients (0.8%) vs. 21 patients (1.2%); P=0.387) and 41 weeks (7 patients (1.4%) vs. 2 patients (0.8%); P=0.448). Patients undergoing elective induction of labor with a prior cesarean scar had an increased risk of uterine rupture when compared to expectant management at 39 weeks, with fewer successful VBAC.

Trial of labor after 2 previous cesareans: a multicenter study

Trial of labor after cesarean after 2 cesarean deliveries is linked to a lower success rate of vaginal delivery and higher rates of adverse obstetrical outcomes than trial of labor after cesarean after 1 previous cesarean delivery. This study aimed to investigate the factors associated with failed trial of labor after cesarean among women with 2 previous cesarean deliveries. This was a multicenter retrospective cohort study, which included all women with singleton pregnancies attempting trial of labor after cesarean after 2 previous cesarean deliveries between 2003 and 2021. This study compared labor, maternal, and neonatal characteristics between women with failed trial of labor after cesarean and those with successful trial of labor after cesarean. Univariate analysis was initially performed, followed by multivariable analysis (adjusted odds ratios with 95% confidence intervals). The study included a total of 1181 women attempting trial of labor after cesarean after 2 previous cesarean deliveries. Among these cases, vaginal birth after cesarean was achieved in 973 women (82.4%). Women with failed trial of labor after cesarean had higher rates of maternal and neonatal morbidities. Several factors were found to be associated with failed trial of labor after cesarean, including longer interpregnancy and interdelivery intervals, lower gravidity and parity, lower rates of previous successful vaginal delivery, smoking, earlier gestational age at delivery (38.3±2.1 vs 39.5±1.3 weeks), late preterm delivery (34-37 weeks of gestation), lower cervical dilation on admission, no use of epidural, and smaller neonatal birthweight. Our multivariable model revealed that late preterm delivery (adjusted odds ratio, 3.79; 95% confidence interval, 1.37-10.47) and cervical dilation on admission for labor <3 cm (adjusted odds ratio, 2.58; 95% confidence interval, 1.47-4.54) were associated with higher odds of failed trial of labor after cesarean. In the investigated population of women with 2 previous cesarean deliveries undergoing trial of labor after cesarean, admission at the late preterm period with a cervical dilation of <3 cm, which reflects the latent phase, may elevate the risk of failed trial of labor after cesarean and a repeated intrapartum cesarean delivery.

Trial of labor following cesarean in patients with bicornuate uterus: a multicenter retrospective study.

This study aimed to evaluate whether a trial of labor after cesarean delivery (TOLAC) in women with a bicornuate uterus is associated with increased maternal and neonatal morbidity compared to women with a non-malformed uterus. A multicenter retrospective cohort study was conducted at two university-affiliated centers between 2005 and 2021. Parturients with a bicornuate uterus who attempted TOLAC following a single low-segment transverse cesarean delivery (CD) were included and compared to those with a non-malformed uterus. Failed TOLAC rates and the rate of adverse maternal and neonatal outcomes were compared using both univariate and multivariate analyses. Among 20,844 eligible births following CD, 125 (0.6%) were identified as having a bicornuate uterus. The overall successful vaginal delivery rate following CD in the bicornuate uterus group was 77.4%. Failed TOLAC rates were significantly higher in the bicornuate group (22.4% vs. 10.5%, p < 0.01). Uterine rupture rates did not differ between the groups, but rates of placental abruption and retained placenta were significantly higher among parturients with a bicornuate uterus (9.8% vs. 4.4%, p < 0.01, and 9.8% vs. 4.4%, p < 0.01, respectively). Neonatal outcomes following TOLAC were less favorable in the bicornuate group, particularly in terms of neonatal intensive care unit admission and neonatal sepsis. Multivariate analysis revealed an independent association between the bicornuate uterus and failed TOLAC. This study found that parturients with a bicornuate uterus who attempted TOLAC have a relatively high overall rate of vaginal birth after cesarean (VBAC). However, their chances of achieving VBAC are significantly lower compared to those with a non-malformed uterus. Obstetricians should be aware of these findings when providing consultation to patients.

Induction of labor in twin pregnancy in patients with a previous cesarean delivery

BackgroundTrial of labor after cesarean delivery (TOLAC) in twin gestations has been associated with decreased rates of successful vaginal delivery compared to singleton pregnancies, with mixed results regarding maternal and neonatal morbidity. However, induction of labor (IOL) in this unique population has not yet been fully evaluated.ObjectiveTo assess success rates and maternal and neonatal outcomes in women with a twin gestation and a previous cesarean delivery undergoing IOL.MethodsA retrospective cohort study including women with a twin gestation and one previous cesarean delivery undergoing a trial of labor between the years 2009–2020. Patients requiring IOL were compared to those with a spontaneous onset of labor.ResultsThere were 53 patients who met the inclusion criteria: 31 had a spontaneous onset of labor (58%) and 22 required an IOL. Baseline characteristics were comparable between the groups apart from a history of labor arrest which was more common in the IOL group (40.9% vs. 9.6%, P = 0.006). A successful vaginal delivery occurred in all (100%) women with a spontaneous labor compared to 81% in the IOL group (p = 0.02). Secondary outcomes were comparable. A history of no previous vaginal delivery, maternal obesity, and IOL were associated with TOLAC failure.ConclusionsIOL after cesarean delivery in twin gestation is associated with an increased risk of TOLAC failure compared to spontaneous onset of labor. However, no adverse neonatal or maternal outcomes were found. IOL in this high-risk population is feasible but patients should be counseled about the lower rate of success.

Comparison of Obstetric Outcomes Between Controlled-Release Dinoprostone Vaginal Delivery System (PROPESS) and Administration of Oral Dinoprostone for Labor Induction in Multiparous Women at Term.

The aim of this study was to compare the rate of vaginal delivery and adverse outcomes of a controlled-release dinoprostone vaginal delivery system (PROPESS) and the administration of oral dinoprostone for labor induction in multiparous women at term. This retrospective case-controlled study included 92 multiparous pregnant women (46 and 46 in the PROPESS and oral dinoprostone groups, respectively) who required labor induction at ≥37 weeks of gestation. The primary outcome was the success rate of vaginal delivery following the insertion of PROPESS only or the administration of oral dinoprostone (up to six tablets) only. The secondary outcomes were uterine tachysystole with non-reassuring fetal status, the proportion of cases requiring pre-delivery oxytocin, and the rate of cesarean delivery. The proportion of pregnant women who delivered vaginally as the primary outcome was significantly higher in the PROPESS group (33/46 [72%]) than in the oral dinoprostone group (16/46 [35%], p < 0.01). In the secondary outcomes, the proportion of cases requiring pre-delivery oxytocin in the PROPESS group was significantly lower than that in the oral dinoprostone group (24% vs. 57%, p < 0.01). In multiparous women at term, PROPESS may be able to induce labor and lead to a higher vaginal delivery rate without adverse outcomes compared to oral dinoprostone.

Is There an Age Limit for a Trial of Vaginal Delivery in Nulliparous Women?

The number of nulliparous women over the age of 35 is consistently increasing, and the optimal delivery strategy is a subject of ongoing discussion. This study compares perinatal outcomes in nulliparous women aged ≥35 years undergoing a trial of labor (TOL) versus a planned cesarean delivery (CD). A retrospective cohort study including all nulliparous women ≥ 35 years who delivered a single term fetus at a single center between 2007-2019. We compared obstetric and perinatal outcomes according to mode of delivery-TOL versus a planned CD, in three different age groups: (1) 35-37 years, (2) 38-40 years, and (3) >40 years. Out of 103,920 deliveries during the study period, 3034 women met the inclusion criteria. Of them, 1626 (53.59%) were 35-37 years old (group 1), 848 (27.95%) were 38-40 (group 2), and 560 (18.46%) were >40 years (group 3). TOL rates decreased as age increased: 87.7% in group 1, 79.3% in group 2, and 50.1% in group 3, p < 0.001. Rates of successful vaginal delivery were 83.4% in group 1, 79.0% in group 2, and 69.4% in group 3, p < 0.001). Neonatal outcomes were comparable between a TOL and a planned CD. Using multivariate logistic regression, maternal age was found to be independently associated with slightly increased odds for a failed TOL (aOR = 1.13, CI 95% 1.067-1.202). A TOL at advanced maternal age appears to be safe, with considerable success rates. As maternal age advances, there is a small additive risk of intrapartum CD.

EVALUATING THE SUCCESS RATE OF VAGINAL DELIVERY AFTER CAESAREAN SECTION

: The retrospective study was conducted in the Department of Gynecology Dr. Ruth K. M. Pfau Civil Hospital Karachi, from February 2021 to February 2022, for the evaluation of factors associated with the success of TOLAC (trial of labor after cesarean delivery) and to identify variables for predicting the success of TOLAC in subjects with prior Caesarean section (CS). A total of 315 women were included in the study. They were divided into the validation cohort (n=20, 63%) and the training cohort(n=295, 93.6%). The primary endpoint was the success rate of vaginal delivery. The results showed that of 315 participants, 264 (83.8%) women had successful TOLAC and vaginal delivery, and 51 (16.1%) had ERCS. According to multivariate analysis, BMI-estimated birth weight, gestational age &lt;41 weeks, rupture of membranes, and cervix Bishop score ≥5 was significantly associated with the success of TOLAC. Results suggest that TOLAC has a high success rate in women with a history of c-sections.

Efficacy of Prostaglandin Analogues for Induction of Labour and Associated Complications: A Retrospective Research Study conducted in Latifa Women and Children Hospital

Induction of labour has become a more common worldwide medical intervention during the last few years [1]. The ideal cervical ripening agent must be effective, safe, easy to be administered and acceptable for the pregnant woman. Utilizing prostaglandins (PG) for cervical ripening during induction of labour (IOL) was first described in the 1960s [2]. Since that time various types of prostaglandins including PGF2α, PGE2 (Dinoprostone) and PGE1 (Misoprostol) were extensively studied to elicit the best prostaglandin pharmacological agent for pre-induction cervical ripening [2]. Dinoprostone was found to be superior to the others, as it increased the rates of successful vaginal delivery within 24 h without increasing the operative delivery rates. Vaginal route was found to be a safe and effective approach of bringing on labor.

Trial of Labor after Three or More Previous Cesarean Sections: Systematic Review and Meta-Analysis of Observational Studies.

To assess the success rate and prevalence of maternal or neonatal complications in women undergoing a trial of labor after three or more (≥3) previous cesarean sections (CSs). A systematic literature review and meta-analysis was conducted from inception to May 2022 in Medline, Scopus, ENBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials and Reviews. Items detailing success rate and complications in women with a history of≥3 previous CSs were considered. Selected articles were evaluated for quality, heterogeneity, and publication bias. A pooled prevalence or odds ratio was calculated. Twelve articles were included for a total of 540 women with a history of≥3 CSs, accounting for the 2% (CI 95% 1-4%) of the whole cohort of trial of labor. Our findings show a 0.67 (CI 95% 0.53-0.78) rate of successful vaginal delivery. A higher success rate was observed in women having a history of a prior vaginal delivery (0.90, CI 95% 0.77-0.96) and when prostaglandins, peridural anesthesia or oxytocin were allowed (respectively 0.73, CI 95% 0.62-0.83, 0,73, CI 95% 0.57-0.85 and 0.73, CI 95% 0.64-0.81). Uterine rupture rate was 0.01 (CI 95% 0.00-0.01). No cases of fetal asphyxia or maternal or neonatal death were registered. The success rate and low frequency of severe complications observed seem to support a trial of labor in selected patients desiring a natural birth. However, a potential underestimation of serious maternal and neonatal complications should be considered in the decision-making process.

Factors Associated with Failed Trial of Labor after Cesarean, among Women with Twin Gestation-A Multicenter Retrospective Cohort Study.

Objective: Twin trial of labor after a cesarean section (TOLAC) is associated with a lower success rate of vaginal delivery than singleton TOLAC, and a higher rate of adverse outcomes in comparison to an elective repeat cesarean delivery. This study aims to investigate the factors associated with failed TOLAC, among women with twin gestation. Study design: A multicenter retrospective cohort study was undertaken. All women with twin pregnancies attempting a trial of labor after a previous cesarean in two university-affiliated obstetrical centers, between 2005 and 2021 were included. The study population included women with a twin gestation where twin A presented in the vertex position, a single previous low segment transverse section, and those who were eligible for a vaginal delivery. Labor, maternal, and neonatal characteristics were compared. A univariate analysis was undertaken, followed by multivariate analysis (aORs; [95% CI]). Results: A total of 160 women attempting a twin TOLAC were included. Vaginal birth after cesarean was achieved in 86.3% of these cases. Assisted reproductive technology (ART), the lack of oxytocin use for augmentation during labor, the lack of epidural analgesia, and preterm birth before 34, 32, and 28 gestational weeks were all found to be associated with failed TOLAC. In the multivariate analysis, cervical dilation on admission (aOR 0.6 [0.40–0.82], p < 0.01), no use of oxytocin (aOR 5.2 [1.36–19.73], p = 0.02), gestational age at delivery (aOR 0.8 [0.65–1.00], p = 0.047) and lack of epidural analgesia (aOR 4.5 [1.01–20.16], p = 0.049), were all found to be significantly associated with failed TOLAC. Conclusion: In the investigated population of women with twins undergoing TOLAC, the use of epidural analgesia, the use of oxytocin and increased cervical dilation to the delivery room are associated with a higher rate of vaginal delivery, and may reduce the risk of repeat cesarean delivery.

Mode of delivery, perinatal outcome and neurodevelopment in uncomplicated monochorionic diamniotic twins: a single-center retrospective cohort study

BackgroundThere is no agreement on the effect of planned mode of delivery in the perinatal morbidity and neurodevelopment in uncomplicated monochorionic diamniotic as well as regarding the safest mode of delivery. In this paper we have aimed to analyze the impact of the mode of delivery in uncomplicated monochorionic diamniotic twins ≥ 32 weeks of gestation.Material and methodsThis study included 72 women, followed and attended at our department, with uncomplicated monochorionic diamniotic pregnancies who had a birth between 32.0 and 37.6 weeks of gestation from January 2012 to December 2018. Outcomes were recorded in women who underwent planned vaginal delivery (induced or spontaneous onset of labor), and women who underwent a planned cesarean section for any reason that excluded vaginal delivery. Primary outcomes included: (1) A composite of any of the following: neonatal death, 5-min Apgar score < 4, respiratory distress syndrome, bronchopulmonary dysplasia, sepsis, periventricular leukomalacia, intraventricular hemorrhage, and necrotizing enterocolitis. (2) Neurodevelopmental status at 2 years of corrected age.ResultsIn this period, 42 women (58.3%) had a planned vaginal delivery, and 30 women (41.7%) had a planned cesarean section. In the first group, 64.3% had a vaginal delivery. The rate of successful vaginal delivery was similar regardless the onset of labor. We did not find a higher composite perinatal morbidity in the planned vaginal delivery group (planned vaginal delivery: 3.6% vs. planned cesarean section: 8.3%, aOR 1.36, 95% CI 0.24–7.81). Considering the onset of labor, it was more frequent in the spontaneous subgroup (8.3% vs. 0%). The rate of neurodevelopmental impairment was higher in the planned cesarean section group, without reaching statistical significance [10.2% vs. 4.9%, aOR 1.53 (95% CI 0.37–6.29)].ConclusionsIn uncomplicated monochorionic diamniotic twins at ≥ 32 weeks of gestation, when the first twin is in vertex presentation, our results suggest that planned vaginal delivery is safe, with a successful outcome as well as high vaginal delivery rate.

Factors associated with a failed trial of labor after cesarean among women with twin gestation

Twin trial of vaginal birth after a previous cesarean (TOLAC) is associated with a lower rate of successful vaginal delivery than singleton deliveries and a higher rate of adverse outcomes compared to elective repeat cesarean delivery. We aimed to investigate the factors associated with failed TOLAC among women with twin gestation.

Intravenous Dexamethasone Versus Vaginal Misoprostol in Enhancing Cervical Ripening and Labor Induction

Abstract Background Induction of labor is one of the most common procedures performed in the world of Obstetrics. Traditionally, labor induction is performed using prostaglandin and oxytocin. However, usage of corticosteroids nowadays is gaining a lot of interest regarding its effects on cervical ripening and shortening the physiological process of labor. Aim of work to evaluate the efficacy of intravenous dexamethasone versus vaginal misoprostol in enhancing cervical ripening and labor induction. Patients and Methods A randomized controlled clinical trial was carried out at Ain Shams University Maternity Hospital on (60) full term pregnant women between 39 – 42 weeks undergoing induction of labor, during a period from April 01, 2019 to November 30, 2019. Pregnant women were divided into two groups; vaginal misoprostol (control) group and intravenous dexamethasone (experimental) group (30 cases each). Results Our study showed that the mean time interval (hours) from initiation of labor induction to initiation of active phase was statistically significantly shorter among the dexamethasone (experimental) group 7.36 ± 2.23 versus 12.20 ± 4.92 hours among the vaginal misoprostol (control) group (p value &amp;lt; 0.001). Also, the mean time interval of the total duration between the induction of labor to successful vaginal delivery was statistically significantly shorter among the dexamethasone group 10.90 ± 4.17 versus 19.20 ± 5.62 hours among the vaginal misoprostol group (p value &amp;lt; 0.001). The results of this study showed the rate of initiation of active phase and rate of successful vaginal delivery were more in the experimental dexamethasone group than the control vaginal misoprostol control group. Conclusion Intravenous injection of 8 mg of dexamethasone before induction of labor is found to shorten the duration of labor induction by reducing the time interval between the initiation of labor induction and onset of active phase and the total duration from initiation of labor induction to delivery with no marked maternal or fetal complications. Recommendations Intravenous Dexamethasone can help cervical ripening and accelerate induction of labor. Further research should be taken in consideration with more population for more global evaluation.

Comparison of perinatal outcomes between controlled-release dinoprostone vaginal delivery system (PROPESS) and metreurynter for cervical ripening in labor induction: A retrospective single-center study in Japan.

This study aimed to compare the efficacy and safety of a controlled-release dinoprostone vaginal delivery system (PROPESS) and a metreurynter for labor induction. This retrospective case-controlled study included 117 pregnant women (51 and 66 in the PROPESS and metreurynter groups, respectively) who required labor induction after >37 weeks' gestation at Mie University Hospital between January 2018 and September 2020. The primary outcome was the success rate of vaginal delivery. The secondary outcomes were changes in the Bishop score from the first insertion of PROPESS or the metreurynter to removal, uterine hyperstimulation and non-reassuring fetal status during the first insertion, proportion of pregnant women who needed pre-delivery oxytocin after removal, time to vaginal delivery after the first insertion, proportion of pregnant women who delivered vaginally within 12 or 24 h after the first insertion, and neonatal outcomes. The proportion of pregnant women, especially primiparas, who delivered vaginally was significantly higher in the PROPESS group (26/34 [76.5%]) than in the metreurynter group (25/52 [48.1%]; p=0.01). Moreover, among multiparas in the PROPESS group who delivered vaginally, nine (56.3%) out of 16 women delivered vaginally within 3h of labor onset. PROPESS for cervical ripening may reduce the risk of undergoing cesarean section in pregnant women requiring labor induction, especially primiparas. It is important to consider the possibility of precipitate labor when using the PROPESS in multiparas.

Evaluation of the risk of umbilical cord prolapse in the second twin during vaginal delivery: a retrospective cohort study

ObjectiveThis study aimed to evaluate the success rate of vaginal delivery, the reasons for unplanned caesarean delivery, the rate of umbilical cord prolapse and the risk of umbilical cord prolapse...

Use of Intravenous Dexamethasone for Cervical Ripening and Labor Induction in Term Pregnancies with Pre-labour Rupture of Membranes: Randomized control trial

Abstract Background: During the first 36 to 38 weeks of normal gestation, the myometrium is in a preparatory yet unresponsive state. Concurrently, the cervix begins an early stage of remodeling yet maintains structural integrity. Induction of labour is a complex process involving cervical ripening which undergo extensive remodeling and dynamic changes controlled by hormonal, inflammatory changes, and other biological processes. Aim of the Work: to assess the effect of intravenous administration of dexamethasone on the induction delivery interval in term patients with prelabour rupture of membranes undergoing induction of labor. Patients and Methods: This randomized control trial was conducted at department of Obstetrics and Gynecology at Ain Shams University Maternity Hospital (ASUMH) in the period between August 2020 and January 2021. Participants of this study were 80 full term pregnant women with pre-labor rupture of membranes attended the labor ward in El Demerdash Maternity Hospital and scheduled for induction of labor by 8 mg dexamethasone IV before starting induction by PGE1, after 4 hours oxytocin was added by 1 IU/hr with the dose increasing by 1 IU every 30 minutes till optimal contractions were reached which were three uterine contractions in 10 minutes and each lasting for 40-50 seconds. Results: Fetal distress, arrest of delivery and indications of CS delivery were non-significantly less frequent among Dexamethasone group. Induction-active phase and active phase durations were significantly shorter among dexamethasone group than among control group. Second and third stages durations were non-significantly shorter among dexamethasone group than among control group. Total induction-delivery duration was significantly shorter and rate of vaginal delivery was significantly higher among dexamethasone group than among control group. Postpartum hemorrhage (PPH), postpartum endometritis, chorioamnionitis were not reported among the studied groups. No significant difference between Dexamaethasone and Control groups regarding neonatal condition Conclusion: Intravenous administration of dexamethasone in addition to labor induction protocol shortened the induction - active phase and active phase durations. It shortened the total induction-delivery duration and increased the rate of successful vaginal delivery. It has no effect on second and third stages durations with no increase in incidence of intrapartum, postpartum nor neonatal complications.

743 Mode of delivery in singleton stillbirths and associated risk factors

There are limited data to inform management of delivery for women with stillbirth. This study aims to examine mode of delivery among stillbirth pregnancies and to identify factors that influence the risk of cesarean delivery. We used the California Linked Birth File to identify singleton stillbirths delivered at 20-42 weeks gestation between 2007 and 2011. Mode of delivery and maternal characteristics were determined based on linked data from fetal death records and diagnosis/procedure codes in maternal hospital discharge records. The associations between various maternal characteristics and the likelihood of cesarean delivery were analyzed using univariate as well as multivariable logistic regression. Of the total sample of 9,554 stillbirths, 3,933 (41.2%) underwent induction of labor, 4,201 (44.0%) entered spontaneous labor, and 1,420 (14.9%) had a planned cesarean delivery. Among women who were induced, 95.9% delivered vaginally. In the overall sample, 1,756 women (18.4%) were delivered via cesarean. Of these, 959 (54.6%) had a prior cesarean delivery, 467 (26.6%) had malpresentation, 310 (17.7%) had a failed trial of labor, and 82 (4.7%) had placenta previa. Among 841 women who had a trial of labor after cesarean (TOLAC), 734 (87.3%) delivered vaginally. In multivariable logistic regression, performance of cesarean delivery was associated with previous cesarean, nulliparity, term gestation, higher body mass index, placenta previa, malpresentation, and hypertensive disorder (Table 1). One in every six women with a stillbirth underwent cesarean delivery and almost half of these were primary cesarean deliveries. The most common reasons for cesarean delivery were prior cesarean and malpresentation. Induction of labor and TOLAC were associated with high success rates of vaginal delivery.

562 Delivery outcomes in women with hypertensive disorders of pregnancy: comparing induction versus immediate cesarean delivery

To compare delivery outcome and associated maternal and neonatal complications in women with hypertensive disorders of pregnancy (HDP) who undergo induction of labor (IOL) versus immediate primary cesarean delivery (CD). This is a retrospective cohort study of nulliparous women with a singleton pregnancy at term delivering at NYU Langone Health and NYU Langone Hospital Brooklyn in 2018 with a diagnosis of HDP. Women who presented in labor (modified Bishop score >5) were excluded. Delivery outcomes and indication for CD were tabulated for the IOL group. A composite of maternal and fetal/neonatal complications occurring after the decision on delivery mode were compared between women who underwent IOL (defined as cervical ripening and/or oxytocin) versus immediate CD after diagnosis. Outcomes were analyzed using Chi-squared and Fischer’s exact test, with p<0.05 considered significant. 261 women met criteria for inclusion, including 241 (93.1%) who underwent IOL of labor and 18 (7.0%) with CD without labor. There was no difference between groups in severity of HDP diagnosis (p=0.66). Of those that underwent IOL, 140 (58.1%) had a vaginal delivery (VD). The most common indication for CD was labor arrest (67.9%), followed by fetal intolerance of labor (20.5%). Worsening HDP accounted for 3.6% of indications for CD. There was no difference between IOL and CD groups in rates of composite maternal complications (34.0% versus 33.3%, p=0.95, Table 1). There was no difference in fetal/neonatal composite complications between IOL and CD groups (21.2% versus 5.6%, p=0.11, Table 1). In nulliparous women with HDP at term, IOL is not associated with additional maternal or fetal/neonatal complications compared to immediate CD and is associated with a high rate of VD success. Understanding how the decision for IOL or CD influence maternal and neonatal complications in the setting of HDP will inform patient and provider counseling. Further studies should investigate how the rate of successful VD with IOL influences the risk/benefit balance for this decision.