Unfavorable Bishop Score Research Articles

Induction of labor after one previous cesarean: Predictors of vaginal birth

ObjectiveTo identify independent predictors for vaginal delivery after induction of labor after one cesarean (IOLAC). Study designIn this retrospective cohort study, the electronic medical record of 19064 women who delivered from January 2018–September 2022 in a university hospital in Malaysia were individually searched to identify cases of IOLAC. Preselected data points on characteristics and the outcome of mode of delivery were retrieved. Bivariate analysis was performed to identify predictor characteristics for the dichotomous outcomes of vaginal delivery vs unplanned cesarean delivery. Variables with crude p < 0.05 were incorporated into a multivariable binary logistic regression analysis to identify independent predictors of vaginal delivery after IOLAC. Results819 IOLAC cases were identified. There were 465/819 (56.5 %) unplanned cesareans deliveries. Of the 14 selected characteristics, eight had p < 0.05 on bivariate analysis. After adjustment, six characteristics, body mass index, height, ethnicity, parity, previous cesarean indication and Bishop score were independently predictive of vaginal birth but not maternal age or method of labor induction. Birthweight, labor induction indication, gestational age, haemoglobin level, diabetes and hypertension in pregnancy were not significant at the level of bivariate analysis. ConclusionObesity, short stature, no prior vaginal delivery, previous cesarean indicated by failure to progress, unfavorable Bishop score and ethnicity were independent predictors for unplanned cesarean after IOLAC. These predictors should help guide women and their care providers in their shared decision-making about IOLAC.

Labor induction with a combined method (pharmacologic and mechanical): A randomized controlled trial

IntroductionThe aim of this study was to compare the effectiveness of a combined misoprostol-Foley catheter induction of labor protocol against the current guidelines of our department. Material and methodsA randomized trial was conducted comparing two cervical ripening study groups: combined misoprostol-cervical Foley and the current department practice (misoprostol alone or dinoprostone alone). Women were stratified randomly according to parity for the two intervention groups. The primary outcome was defined as time to delivery (in hours). Secondary outcomes were cesarean delivery rate, time to active labor (defined as dilatation 6 cm or greater), delivery within 12 h, delivery within 24 h, maternal length of stay and indication for cesarean delivery. A composite of maternal morbidity and neonatal morbidity were also analyzed. Results142 women were randomized into one of the two groups (74 for treatment group and 68 for control group). Demographic and clinical characteristics were similar among the two groups. The primary outcome, the average time to delivery, was faster in the treatment group (22.7 h vs 27.2 h, p = 0.03) and this difference was higher in the nulliparous subgroup (24.2 h vs 29.2 h, p = 0.03). Active phase of labor was achieved faster in the treatment group (17.9 h vs 22.7 h, p = 0.008). The risk for cesarean section was similar in both groups (OR 0.801 (0.527–1.217) vs OR 1.203 (0.871–1.662), p = 0.278). ConclusionsOur study suggests that the combined method of cervical Foley with vaginal misoprostol for women presenting to induction of labor with unfavorable Bishop scores reduces time to delivery safely. The risk for cesarean section was similar in both groups.

Prevalence of Delivery Through C-Section Followed by the Induction of Labour in Nulliparous Patients Showing Undesirable Bishops Score

Background: Inducing labour means induction of uterine contractions before natural labour, in order to deliver the fetus vaginally. It is done because birth through a C-section is riskier compared to vaginal delivery. For the purpose of induction and management of labour, Prostaglandins are used. Objective: The present study aims the determination the incidence of delivery by C-section in nulliparous pregnant women showing undesirable bishop's scores. Study design: A cross-sectional study Place and Duration: This study was conducted at Timergarah Teaching Hospital Dir Lower Timergarah from January 2021 to January 2022 Methodology: A total of 150 nulliparous women were included in this study. The age of the patients ranged between 18 years to 35 years. All of the patients had singleton pregnancies having a cephalic presentation. The gestational ages of the patients ranged from 37 weeks to 42 weeks. All the patients had unfavourable bishop's score which was equal to or less than 5. The patients showing reactive fetal heart rates were added to the study. None of the patients had any contraindications of vaginal delivery. Results: The present study included a total of 150 patients and 127 (84.67%) of them were in the age group between 18 years to 25 years. Overall68 (45.33%) of the patients were in the 40th week of pregnancy. The most common indication seen for the induction of labour was post-dated gestation in 70 (46.66%) patients. The incidence of C-section delivery was seen in 42 (28%) patients and the most common indication observed in these patients was the secondary arrest of labour. Keywords: Nulliparous, Dinoprostone gel, Induction of Labour, Bishop’s score

Induction of Labor in Women with Previous Cesarean Section and Unfavorable Cervix: A Retrospective Cohort Study.

Background: The efficacy and safety of a cervical ripening balloon (CRB) in women with a previous cesarean section (CS) and unfavorable Bishop score are still controversial. Methods: A retrospective cohort study was performed across six tertiary hospitals from 2015 to 2019. Women with one previous transverse CS, singleton cephalic term pregnancy and BS < 6 were included if submitted to labor induction with a CRB. The main outcome was the rate of vaginal birth after cesarean (VBAC) after CRB ripening. Secondary outcomes were abnormal composite fetal and maternal outcomes. Results: Of the 265 women included, 57.3% had successful vaginal birth. Augmentation improved vaginal delivery (32.2% vs. 21.2%). Intrapartum analgesia was associated with an increased VBAC rate (58.6% vs. 34.5%). Maternal BMI ≥30 and age ≥40 years increased emergency CS rate (11.8% vs. 28.3% and 7.2 vs. 15.9%). Composite adverse maternal outcome occurred in 4.8% of CRB group women and increased to 17.6% when associated with oxytocin. Uterine rupture occurred in one case (0.4%) in the CRB-oxytocin group. Poorer fetal outcome occurred after emergency CS, if compared to successful VBAC (12.4% vs. 3.3%). Conclusions: In women with a previous CS and unfavorable Bishop score, induction of labor with a CRB can be considered safe and effective.

Pre- Induction Cervical Ripening with Unfavorable Bishop Score Using Two Different Dinoprostone Vaginal Preparation: A Prospective Randomized Comparative Study between Controlled Release Dinoprostone Gel & Dinoprostone Vaginal Insert

Pre- Induction Cervical Ripening with Unfavorable Bishop Score Using Two Different Dinoprostone Vaginal Preparation: A Prospective Randomized Comparative Study between Controlled Release Dinoprostone Gel & Dinoprostone Vaginal Insert

Failed Induction of Labor and Associated Factors Among Women Who Undergone Induction of Labor in Jimma Medical Center, Ethiopia: A Hospital-Based Cross-Sectional Study

BACKGROUNDAlthough induction of labor is intended to achieve a safe vaginal delivery, its process is not always successful. Failed induction of labor leads to an increased risk of complication for both mother and fetus. Thus, this study aimed to assess the proportion of failed induction of labor and associated factors among women who undergone induction of labor from September 1, 2019 to August 31, 2020 in Jimma Medical Center (JMC), southwest Ethiopia.METHODSA hospital-based retrospective cross-sectional study was conducted on 243 charts of women who had induction of labor in JMC selected by a simple random sampling method from January 10 to 30, 2021. The collected data were entered into Epi-data version 4.2 and analyzed by SPSS version 23. Bivariate and multivariable logistic regression analyses were done to test the association. Adjusted odds ratio at 95% confidence interval (CI) andP-value &lt;.05 was used to ascertain statistical significance.RESULTSThe proportion of failed induction of labor in JMC was 16.9%. Maternal age ≥ 30 years (AOR 7.57; 95%CI = 2.88, 19.9) at (P-value = .000), elective induction (AOR .39; 95% CI = .16, .98) at (P-value = .045), and unfavorable bishop score (AOR 6.94; 95%CI = 2.35, 20.4) at (P-value = .000) were factors statistically significantly associated with failed induction of labor.CONCLUSIONSThe proportion of failed induction of labor was relatively low in the study area. Advanced maternal age, elective induction, and unfavorable bishop score were associated with failed induction of labor. Thus, the hospital should strictly follow the protocol for induction of labor, and candidates of emergency induction of labor should be counseled thoroughly so as to be well prepared psychologically for the labor thereby reducing the risk of failed induction.

Predictability of Successful Induction of Labour with Poor Bishop Score

Aim: To determine the percentage of successful induction of labour in patients with poor Bishop Score at PAC Hospital Kamra. Study design: Prospective Observational Study. Setting &amp; duration: Pakistan Aeronautical Complex Hospital Kamra, four years from 01.01.2016 till 31.12.2019. Methods: All booked pregnant women including Primigravidaeand Multigravidae were offered induction of labour regardless of Bishop Score to assess the predictability of successful induction. Results: All pregnant ladies booked at Pakistan Aeronautical Complex were induced at term regardless of favourability of Bishop Score and parity. Total number of patients included in the study over four years was 403.Out of these 1280(32%) were primigravidae and 2723(67%) were multigravidae. Successful induction was achieved in 883(68.5%) of primigravidae and was even higher in multigravidae where it was 2205(78.25%). It was found that the success rate of induction in case of favorable and unfavorable bishop score was not significantly different. Out of 665 primigravidae with favorable bishop score 521 delivered which makes 78.3% while 362 out of 615 primigravidae with unfavorable bishop score delivered successfully which makes 58.8%. Conclusion: We offered Induction of labour to all pregnant women regardless of Bishop Score and parity. A Bishop score of seven or less is considered unfavorable whereas a Bishop score of eight or more is considered favorable for induction of labor. Keywords: Induction of Labor, Bishop Score, normal vaginal delivery.

Prevalence and factors associated with failed induction of labor in Worabe Comprehensive Specialized Hospital, Southern Ethiopia.

BackgroundInduction of labor is one of the most used obstetric procedures in the world. It is performed in around 20% of all pregnancies. Failed induction of labor, on the other hand, has been associated with poorer mother and newborn health outcomes. Besides, there is a scarcity of data on the current burden and drivers. Therefore, this study aimed to assess the prevalence and factors associated with failed induction in Worabe Comprehensive Specialized Hospital, Southern Ethiopia.MethodsA retrospective cross-sectional study was conducted on medical records of mothers who delivered through induction of labor during September 1st, 2018 to August 30th, 2020. The samples were collected using a systematic sampling technique. The data was extracted using a checklist. Data were entered into EpiData (version 3.1) and analyzed using SPSS (version 24). Multivariable logistic regression analyses were used to decide the association of explanatory variables with the outcome variable. Odds ratio with their 95% CI were calculated to identify the presence and strength of an association. A p-value of < 0.05 was used to declare statistical significance.ResultsIn this study, the prevalence of failed induction was observed to be 22.2%. The associated factors included rural residence (AOR = 5.7, 95% CI: 3.12–11.02), primiparity (AOR = 8.4, 95% CI: 2.72–22.36) and unfavourable bishop score (AOR = 5.9, 95% CI: 4.52–16.12).ConclusionsIn comparison to the rate reported in developed countries, the study area had a high rate of failed induction. Being rural residence, primiparity and unfavourable bishop score were the associated factors of failed induction. Therefore, to reduce of the rate of failed induction, health care practitioners should analyze cervical status (using Bishop Score) to decide the possibility of successful induction, with a focus on associated factors like parity.

The magnitude of failed induction and associated factors among women admitted to Adama hospital medical college: A cross-sectional study.

IntroductionInduction of labor is a medical iatrogenic stimulation of uterine contraction before the spontaneous onset of labor to achieve vaginal delivery. It is an increasingly being done obstetric procedure throughout the world and associated with poorer outcomes when compared with spontaneous labor. The published evidence is limited in Ethiopia including the study area. Therefore, this study was aimed at assessing the magnitude of failed induction and associated factors among pregnant women who were admitted to the labor ward of Adama hospital medical college.MethodsInstitution-based cross-sectional study was conducted among 293 women who were eligible for induction using systematic random sampling. The data were collected from 1st January to 30th April 2020 by face-to-face interview using a structured questionnaire and extraction from a maternal chart. Then data was entered into Epi-data version 4.6 and analyzed using Statistical Product and Service Solution version 23. Descriptive statistics were performed to describe the study population. Logistic regression (bivariate and multivariable) analysis was conducted to identify associated factors. The association was expressed in odds ratio with 95% confidence interval and P-value <0.05 was used as cut-off points to declare significance in the final model.ResultsThis study showed that the prevalence of failed induction was 20.5% (95% CI: (15.7–25.3%)). The odds of failed induction in unfavorable bishop score were 4.05 higher than the odds in favorable bishop [AOR = 4.05 95%CI (1.19–13.77)]. The odds of failed induction in an intact membrane were 2.05 higher than the ruptured membrane. [AOR = 2.05, 95%CI (1.06–3.98)]. The odds of failed induction in primigravida were 2.33 higher than the odds in the multiparous women [AOR = 2.33, 95%CI (1.26–4.29)].ConclusionsThis study revealed that the magnitude of failed induction was higher when compared to other similar findings. Bishop scores, membrane status, and parity were significantly associated factors with failed induction. Preparation of the cervix before commencing induction is recommended to improve induction success.

Proportion and Outcome of Induction of Labor Among Mothers Who Delivered in Teaching Hospital, Southwest Ethiopia.

Background: Despite the induction of labor (IOL) having had some undesired consequences, it also has several benefits for maternal and perinatal outcomes. This study aimed to assess the proportion and outcome of IOL among mothers who delivered in Teaching Hospital, southwest Ethiopia.Methods: A retrospective cross-sectional study was conducted from June 10 to June 20, 2019, among 294 mothers who gave birth between November 30, 2018, and May 30, 2019, by reviewing their cards using a structured checklist to assess the prevalence, outcome, and consequences of induction of labor. A binary logistic regression analysis was computed to look for the association between outcome variables and independent variables.Results: The prevalence of labor induction was 20.4%. The most commonly reported cause of induction was preeclampsia (41.6%). The factors associated with IOL were mothers aged 25–34 years [AOR = 2.55, 95% CI (1.18–5.50)] and ≥35 years [AOR = 10.6, 95% CI (4.20–26.9)], having no history of antenatal care [AOR = 2.12, 95% CI (1.10–4.07)], and being Primipara AOR = 2.33, 95% CI (1.18–3.24)]. Of the 60 induced mothers, 23.3% had failed induction. The proportion of mothers with dead fetal outcomes and maternal complications was 5 and 41.7%, respectively. The unfavorable Bishop Score before induction [AOR = 1.85, 95% CI (1.32–4.87)] and induction using misoprostol [AOR = 1.48, 95% CI (1.24–5.23)] were the factors associated with failed induction of labor.Conclusion: The prevalence of induced labor was considerably higher than rates in other Ethiopian studies; however, the prevalence of induction failure was comparable to other studies done in Ethiopia. The study found that Bishop's unfavorable score before induction and induction using misoprostol was the factor associated with unsuccessful induction. Therefore, the health professionals should confirm the favorability of the cervical status before the IOL to increase the success rate of induction of labor.

Facteurs associés à une durée de travail prolongée en cas d’interruption médicale de grossesse aux 2e et 3e trimestres

ObjectiveIn the context of a medical termination of pregnancy, prolonged labor may accentuate the difficulty of women's experience and increase the risk of associated complications. The factors associated with prolonged labor are not known. Reducing the duration of labor could limit these complications. Determining the relevant factors associated with prolonged labor defined as a delay between the onset of induction and delivery greater than or equal to 12hours and comparing the complications rates between the two groups. MethodWe conducted a retrospective study at Port Royal Maternity Hospital from 2017 to 2019, including medical terminations of pregnancy by vaginal delivery in the 2nd and 3rd trimesters for fetal or maternal reasons. ResultsTwo hundred twenty-seven patients were included and divided into two comparative groups based on the duration of labor: labor <12h (n=173) and labor ≥12h (n=54). The mean maternal age was 33.7 years. Forty-four percent of patients were nulliparous, 15.8 % had a history of cesarean section. The average gestational age was 20+2 weeks of gestation. The average duration of labor was 9.7hours. The duration of labor was greater than 24hours in 3% of cases (7/227). Advanced gestational age (22+3 vs. 20+5 p=0,04) and nulliparity (p=0.01) were associated with prolonged labor. Two other intermediate factors, not independent of the duration of labor, were significant: long time to rupture of membranes (239min vs. 427min p<0,01) and an unfavorable Bishop score at rupture (p=0,003). In both groups, the complications were placental retention and the occurrence of fever during labor. ConclusionTwo main factors affecting labor duration were identified in this study (term and nulliparity). This knowledge could allow women to be better informed about the expected time of labor and the potential associated risks.

Risk factors for failed induction of labor among pregnant women with Class III obesity.

Our aim was to identify risk factors for failed induction in morbidly obese patients undergoing the induction of labor at term. This was a retrospective multicenter study on a cohort of 235 patients with a body mass index greater than 40kg/m2 and giving birth to a singleton in cephalic presentation, who had an induction of labor from 38weeks of amenorrhea. Scheduled cesareans and spontaneous vaginal deliveries were excluded. Maternal, peri-partum and neonatal characteristics were analyzed according to the delivery route. In all, 235 patients were included. Of these, 62.5% patients delivered vaginally and 37.5% by cesarean section. The frequency of nulliparity was greater in patients who had a cesarean section (56 [interquartile range, IQR, 38.1] vs 56 [IQR 63.6], P<.001). In multivariate analysis, nulliparity (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.58-4.97], P<.001), low Bishop's score (OR .794, 95% CI .70-.90, P<.001) and weight gain (OR 1.04, 95% CI 1.01-1.08, P=.033) were independent risk factors for failed induction. Umbilical cord pH at birth lower than 7 (0 vs 7 [IQR 8.0], P<.001) and lower than 7.20 (36 [IQR 24.5] vs 35 [IQR 39.8], P=.014) as well as the Apgar at 1minute (14 [IQR 9.5] vs 17 [IQR 19.3], P=.032) was significantly higher in infants born by cesarean section. In this cohort, 63% of women with Class III obesity had successful inductions of labor; risk factors for failed induction include nulliparity and unfavorable Bishop score.

Maternal and perinatal outcomes after elective induction of labor at 39 weeks in uncomplicated singleton pregnancy: a meta-analysis.

The rate of maternal and perinatal complications increases after 39 weeks' gestation in both unselected and complicated pregnancies. The aim of this study was to synthesize quantitatively the available evidence on the effect of elective induction of labor at 39 weeks on the risk of Cesarean section, and on maternal and perinatal outcomes. PubMed, US Registry of Clinical Trials, SCOPUS and CENTRAL databases were searched from inception to August 2018. Additionally, the references of retrieved articles were searched. Eligible studies were randomized controlled trials of singleton uncomplicated pregnancies in which participants were randomized between 39 + 0 and 39 + 6 gestational weeks to either induction of labor or expectant management. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool. The overall quality of evidence was assessed according to the GRADE guideline. Primary outcomes included Cesarean section, maternal death and admission to the neonatal intensive care unit (NICU). Secondary outcomes included operative delivery, Grade-3/4 perineal laceration, postpartum hemorrhage, maternal infection, hypertensive disease of pregnancy, maternal thrombotic events, length of maternal hospital stay, neonatal death, need for neonatal respiratory support, cerebral palsy, length of stay in NICU and length of neonatal hospital stay. Pooled risk ratios (RRs) were calculated using random-effects models. The meta-analysis included five studies (7261 cases). Induction of labor was associated with a decreased risk for Cesarean section (moderate quality of evidence; RR 0.86 (95% CI, 0.78-0.94); I2 = 0.1%), maternal hypertension (moderate quality of evidence; RR 0.65 (95% CI, 0.57-0.75); I2 = 0%) and neonatal respiratory support (moderate quality of evidence; RR 0.73 (95% CI, 0.58-0.95); I2 = 0%). Neonates born after induction weighed, on average, 81 g (95% CI, 63-100 g) less than those born after expectant management. No significant effects were found for the other outcomes with the available data. The main limitation of our analysis was that the majority of data were derived from a single large study. A second limitation arose from the open-label design of the studies, which may theoretically have affected the readiness of the attending clinician to resort to Cesarean section. Elective induction of labor in uncomplicated singleton pregnancy at 39 weeks' gestation is not associated with maternal or perinatal complications and may reduce the need for Cesarean section, risk of hypertensive disease of pregnancy and need for neonatal respiratory support. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Césarienne après déclenchement du travail : facteurs de risque et score de prédiction

ObjectivesThe objective of the study is to determine the risk factors for caesarean section at the time of labor induction, to establish a prediction algorithm, to evaluate its relevance and to compare the results with observation. MethodsA retrospective study was carried out over a year at Nantes University Hospital with 941 cervical ripening and labor inductions (24.1%) terminated by 167 caesarean sections (17.8%). Within the cohort, a case-control study was conducted with 147 caesarean sections and 148 vaginal deliveries. A multivariate analysis was carried out with a logistic regression allowing the elaboration of an equation of prediction and an ROC curve and the confrontation between the prediction and the reality. ResultsIn univariate analysis, six variables were significant: nulliparity, small size of the mother, history of scarried uterus, use of prostaglandins as a mode of induction, unfavorable Bishop score<6, variety of posterior release. In multivariate analysis, five variables were significant: nulliparity, maternal size, maternal BMI, scar uterus and Bishop score. The most predictive model corresponded to an area under the curve of 0.86 (0.82–0.90) with a correct prediction percentage (“well classified”) of 67.6% for a caesarean section risk of 80%. ConclusionThe prediction criteria would make it possible to inform the woman and the couple about the potential risk of Caesarean section in urgency or to favor a planned Caesarean section or a low-lying attempt on more objective, repeatable and transposable arguments in a medical team.

A Prediction Model for Severe Maternal Morbidity in Laboring Patients at Term

To determine the factors associated with severe maternal morbidity in a modern cohort of women laboring at term and to create a prediction model. This is a retrospective cohort study of all term, laboring patients with live births at a single tertiary care center from 2004 to 2014. The primary outcome was composite maternal morbidity including organ failure, amniotic fluid embolism, anesthesia complications, sepsis, shock, thrombotic events, transfusion, or hysterectomy. Multivariable logistic regression was used to identify independent risk factors. Antepartum, intrapartum, and combined risk scores were created and test characteristics were analyzed. Among 19,249 women delivering during the study period, 323 (1.68%) patients experienced severe morbidity, with blood transfusion the most common complication (286, 1.49%). Factors in the antepartum model included advanced maternal age, race, hypertension, nulliparity, history of cesarean delivery, smoking, and unfavorable Bishop score. Intrapartum factors included mode of delivery, use of cervical ripening agents or oxytocin, prolonged second stage, and macrosomia. The combined model had an area under the curve of 0.76 (95% confidence interval [CI], 0.73, 0.79). This three-part risk scoring system can help clinicians counsel patients and guide clinical decision making for anticipating severe maternal morbidity and necessary resources.

Predictors of perinatal outcomes and economic costs for late-term induction of labour

ObjectiveWe aimed to predict the perinatal outcomes and costs of health services following labour induction for late-term pregnancies. Materials and methodsWe conducted a cohort study of 245 women who underwent labour induction during their 41st week of gestation. The cervical condition was assessed upon admission using the Bishop score and ultrasound cervical length measurements. We estimated the direct costs of labour induction, and a predictive model for perinatal outcomes was constructed using the decision tree analysis algorithm and a logit model. ResultsA very unfavourable Bishop score at admission (Bishop score <2) (OR, 3.43 [95% CI, 1.77–6.59]), and a history of previous caesarean section (OR, 7.72 [95% CI, 2.43–24.43]) or previous vaginal delivery (OR, 0.24 [95% CI, 0.09–0.58]) were the only variables with predictive capacity for caesarean section in our model. The mean cost of labour induction was €3465.56 (95% confidence interval [CI], 3339.53–3591.58). Unfavourable Bishop scores upon admission and no history of previous deliveries significantly increased the cost of labour induction. Both of these criteria significantly predicted the likelihood of a caesarean section in the decision tree analysis. ConclusionThe cost of labour induction mostly depends on the likelihood of successful trial of labour. Combined use of the Bishop score and previous vaginal or caesarean deliveries improves the ability to predict the likelihood of a caesarean section and the economic costs associated with labour induction for late-term pregnancies. This information is useful for patient counselling.

Effect of fetal gender on induction of labor failure rates

Purpose: To evaluate gender effect on induction of labor (IoL) failure rates stratified by indication to delivery.Methods: Retrospective cohort analysis of singleton pregnancies 34–42 weeks undergoing cervical ripening using controlled-release PGE2 vaginal insert. IoL Indications were divided into: (1) maternal; (2) hypertensive disorders; (3) premature rupture of membrane or (4) fetal (growth abnormalities, oligohydramnios, postdate, etc,). IoL failure was defined as: (1) Bishop-score ≤7 after 24 hours of PGE2; (2) cesarean delivery due to failed induction; (3) fetal distress followed by PGE2 removal and emergent cesarean. IoL failure rates were stratified by neonatal gender and indication to induction. Logistic regression analysis was utilized to control outcomes to potential confounders.Results: Overall, 1062 pregnancies were included – 521 (49%) had male fetuses. IoL indications did not differ by gender. IoL failure rate was 20.1% (213/1062) – 76% for unfavorable Bishop-score after PGE2 removal; 5.2% for failed induction and 18.8% for fetal-distress while on PGE2. Overall, 14.3% delivered by cesarean section. There were no differences in IoL failure as a group or by indications to induction stratified by fetal gender (21.7% vs. 18.5%, male vs. females, p < 0.05).Conclusions: IoL failure rate is not affected by fetal gender regardless of indication to induction.

Strip of the Month: Maternal Fever in Labor

Strip of the Month: Maternal Fever in Labor

Timing of delivery and pregnancy outcomes in women with gestational diabetes

Women with gestational diabetes mellitus (GDM) commonly undergo induction of labor (IOL) at term, but the risks and benefits of IOL are incompletely understood. We examined the relationship among gestational age, IOL, and the rate of cesarean delivery (CD) in women with GDM. We identified 863 women with GDM who underwent either IOL or spontaneous labor ≥37 0/7 weeks. Demographic, cervical favorability, and outcome data were abstracted from the medical record. We compared the CD rate in women undergoing IOL at each week of gestation with expectant management to a later gestational age. When compared to women who were expectantly managed, IOL at 37 weeks (adjusted odds ratio [aOR], 1.53; 95% confidence interval [CI], 0.76-3.06; P= .23), 38 weeks (aOR, 2.07; 95% CI, 0.89-4.80; P= .09), and 39 weeks (aOR, 0.79; 95% CI, 0.44-1.42; P= .43)) was associated with similar risk for CD as expectant management after adjustment for nulliparity, body mass index, baseline simplified Bishop score, and maternal age. CD rates were higher in nulliparous women, but did not differ significantly in those undergoing IOL or expectant management. In multiparous women, IOL was significantly associated with an increased risk for CD at 38 weeks (aOR, 7.47; 95% CI, 1.6-34.8; P= .01) and rates of CD (17.39% vs 2.2%, P= .001) were significantly higher in multiparous women with an unfavorable Bishop score induced <39 weeks. Neonatal morbidity was similar across gestational ages after adjustment for maternal body mass index and maternal glycemic control. IOL results in similar risk for CD as expectant management between 37-40 weeks of gestation. Rates of CD differed based on cervical exam and parity. These findings suggest that gestational age alone does not significantly impact maternal and neonatal outcomes, but that decisions regarding delivery in women with GDM should take into account cervical exam and parity.

Prevalence of Failed Induction of Labor and Associated Factors Among Women Delivered in Hawassa Public Health Facilities, Ethiopia, 2015

Background: Induction of labor is an increasingly being done obstetric procedure throughout the world. It is carried out in approximately 20% of all pregnancies. It is associated with poorer outcomes when compared with spontaneous labor. Method: Institutional based cross sectional study was made on medical records of 294 women admitted for induction of labor in Hawassa public health facilities from 1st Jan, to 31st Dec, 2014. Systematic sampling technique was used to select samples. Data was collected by structured questionnaire and edited, then entered into Epi-Data version 3.1. Data was analyzed with Statistical Package for Social Science, version 21. First percentage, frequency and mean were calculated. Then, multivariable logistic regression analysis was done to evaluate the possible association of all variables that were candidate after binary logistic regression analysis. P-value of less than 0.05 in multivariable logistic regression was considered as statistically significant. Finally the result is summarized and presented in texts and charts. Result: The prevalence of failed induction of labor was 17.3%. Multivariable logistic regression analysis showed that advanced maternal age [AOR 9.21 (2.70-31.35)], Nulliparity [AOR 3.11 (1.01-9.62)], poor Bishop Score [AOR 4.54 (1.56-13.19)], greater for gestation [AOR 6.57 (2.18-19.72)], bad obstetric history [AOR 5.60 (1.35-23.29)], post term [AOR=4.52 (1.20-17.00)] and premature rapture of membrane [AOR 5.66 (1.96-16.32)] were significantly associated with failed induction of labor. Conclusion: Advanced age, Primiparity, unfavorable bishop score, premature rupture of membrane, greater for gestation and bad obstetric history had positive association with failed induction of labor. Developing practice guidelines may help to prevent unwarranted case selection and help to reduce the current high failure rates.