Uterine Tachysystole Research Articles

Tachysystole Following Cervical Ripening and Induction of Labor Is Not Associated with Adverse Outcomes

Purpose: This study was aimed at determining if significant uterine tachysystole was associated with adverse fetal or neonatal outcomes during cervical ripening and induction of labor. Methods: Women undergoing cervical ripening and subsequent labor induction (n = 905) were assessed for tachysystole, defined as ≥6 contractions in each of 2 consecutive 10-minute windows. Women with ≥3 episodes of tachysystole were compared to women with no tachysystole. Results: Over a 5-year period, 70% of the 905 participants (n = 631) had no tachysystole, 143 had 1 or 2 episodes whereas 131 or 15% had ≥3 episodes (p = 0.991). The cesarean delivery rate was lower among those with tachysystole (28.2 vs. 34.1%), but the difference was not significant (p = 0.197). Non-reassuring fetal tracings were more common in the tachysystole group (14.4 vs. 21.4%, p = 0.017), but the Apgar scores at 5 min and the umbilical cord pH and base excess were similar between the 2 groups (p = 0.502, p = 0.435, and p = 0.535, respectively). Conclusions: Tachysystole was not associated with adverse perinatal outcomes when compared to women with no tachysystole during cervical ripening and induction of labor.

External Cephalic Version: Some Tricks of the Trade.

External Cephalic Version: Some Tricks of the Trade.

A randomised double-blind placebo-controlled trial comparing stepwise oral misoprostol with vaginal misoprostol for induction of labour.

A comparison of induction of labour (IOL) using three doses of 25 µg vaginal misoprostol inserted at intervals of 4 h or more with a stepwise oral regime starting with 50 µg followed by two doses of 100 µg was studied in a double-blind placebo-controlled trial in a tertiary centre in South India. Primary outcome was vaginal delivery in 24 h. Significantly more women in the first group required oxytocin augmentation and a third dose of the drug than women in the second group. Uterine tachysystole and other maternal and neonatal complications were similar. Thus it is concluded that women induced with oral, as compared to vaginal misoprostol are more likely to labour without oxytocin.

Discontinuation of intravenous oxytocin in the active phase of induced labour

Background In most Western countries, obstetricians and midwives induce labour in about 25% of pregnant women. Oxytocin is an effective drug for this purpose, but associated with serious adverse effects of which uterine tachysystole, fetal distress and the need for immediate delivery are the most common. Various administration regimens such as reduced or pulsatile dosing have been suggested to minimise these. Discontinuation in the active phase of labour, i.e. when contractions are well‐established and the cervix is dilated at least 5 cm is another method which may reduce adverse effects.

Induction of labour with retrievable prostaglandin vaginal inserts: outcomes following retrieval due to an intrapartum adverse event.

ObjectiveTo assess adverse event (AE) resolution, delivery mode and neonatal outcomes after misoprostol or dinoprostone vaginal insert (MVI or DVI) retrieval due to AE during induction of labour (IOL).DesignRandomised, double‐blind trial, EXPEDITE.SettingThirty five obstetric departments, USA.PopulationConsisted of 1358 pregnant women with modified Bishop score ≤4 eligible for pharmacological IOL.Methods Post hoc analysis.Main outcome measures AEs prompting insert retrieval, times to AE resolution, delivery, delivery mode and neonatal intensive care unit (NICU) admissions.Results77/678 (11.4%) and 27/680 (4.0%) women had MVI and DVI retrieved due to AE, respectively (P < 0.001). The most common AEs prompting retrieval were uterine tachysystole with fetal heart rate (FHR) involvement and category II/III FHR pattern. Time to AE resolution varied for both treatments depending on the type of AE. For uterine tachysystole with FHR involvement, median resolution times were 1 hour 34.5 minutes (n = 36) and 8.5 minutes (n = 8) for MVI and DVI, respectively. Caesarean delivery occurred in a high proportion of women with insert retrieved due to AE (MVI: 44/77 (57.1%); DVI: 19/27 (70.4%)); the majority of caesareans were performed at least several hours after insert retrieval. Median times from retrieval to any delivery were not increased for women with insert retrieved due to AE. NICU admissions were 8/77 (10.4%) and 1/27 (3.7%) for MVI and DVI, respectively (P = 0.440).Conclusions AEs leading to insert retrieval were primarily uterine tachysystole with FHR involvement and category II/III FHR patterns. Insert retrieval due to an AE did not prolong time to delivery for either prostaglandin insert.Tweetable abstractInduction with prostaglandin vaginal inserts: outcomes following retrieval due to intrapartum adverse event.

Current Resources for Evidence-Based Practice, July/August 2016

Evidence-Based Use of Oral Misoprostol for Labor Induction In the United States, nearly half of nulliparous women and more than one-third of multiparous women have their labors induced, and more than half of all inductions require cervical ripening (Laughon et al., 2012). These numbers reflect the sharp rise in the rate of induction during the past few decades (Hamilton, Martin, Osterman, Curtin, & Matthews, 2015). However, labor inductions are likely to become even more frequent in the coming years if investigators of ongoing clinical trials such as the ARRIVE study find neonatal or maternal benefits associated with elective induction at 39 weeks gestation (Eunice Kennedy Shriver National Institute of Child Health and Human Development, 2013). When performed incorrectly, labor induction can result in a range of poor maternal and neonatal outcomes, including cesarean birth, uterine tachysystole with fetal heart rate changes, uterine rupture, and postpartum hemorrhage (Stephenson & Wing, 2015). Thus, it is particularly important that practitioners induce labor using the most up-to-date and evidence-based strategies. Unfortunately, the medication that has been used most successfully for labor induction is at the heart of a controversy that has raged for more than 20 years (Goldberg & Wing, 2003).

Uterine tachysystole in spontaneous labor at term

Objectives: The objective of this study is to determine the incidence of uterine tachysystole and its association with spontaneous labor at term.Methods: A retrospective cohort study of 8008 women in spontaneous labor (without prostaglandins or oxytocin). Fetal heart tracings and uterine activity were recorded every 15 min. Primary outcome: occurrence of tachysystole (> 5 uterine contractions /10 min over 30 min periods). Secondary outcomes: non-reassuring fetal heart tracings (NRFHT), NICU admissions, and cesarean deliveries.Results: About 890 patients (11.1 %) had at least one episode of tachysystole. Non-whites have higher incidence of uterine tachysystole; adjusted odds ratio (aOR) was 1.66 for Hispanics (95% CI 1.28–2.05), 1.58 for African Americans (95% CI 1.05–2.38), and 1.51 for Asians (95% CI = 1.13–2.0). The use of epidural analgesia was higher in the tachysystole group (62.2% versus 40.9%, aOR 1.89, CI 1.58–2.26; p < 0.001). Tachysystole was more frequent among nulliparous women and in women carrying higher weight fetuses. Oligohydramnios (aOR 1.62, CI 0.70–3.72; p < 0.004), and NRFHT were more common in the tachysystole group (4.2% versus 2.5%, p = 0.002). Newborns in the tachysystole group were two times more likely to be admitted to NICU (30 /890 [3.4%] versus 122 /7118 [1.7%], OR = 2, p=0.001). There was no difference in the frequency of meconium-stained amniotic fluid or Apgar scores <7 at 5 min.Conclusion: Uterine tachysystole occurs in more than 10% of spontaneous labors and is associated with NRFHR, increased rate of caesarean deliveries and NICU admissions. It is not associated with low Apgar scores or meconium-stained amniotic fluid.

Can Intrapartum Cardiotocography Predict Uterine Rupture among Women with Prior Caesarean Delivery?: A Population Based Case-Control Study.

ObjectiveTo compare cardiotocographic abnormalities recorded during labour in women with prior caesarean delivery (CD) and complete uterine rupture with those recorded in controls with prior CD without uterine rupture.Study DesignWomen with complete uterine rupture during labour between 1997 and 2008 were identified in the Danish Medical Birth Registry (n = 181). Cases were validated by review of medical records and 53 cases with prior CD, trial of labour, available cardiotocogram (CTG) and complete uterine rupture were included and compared with 43 controls with prior CD, trial of labour and available CTG. The CTG tracings were assessed by 19 independent experts divided into groups of three different experts for each tracing. The assessors were blinded to group, outcome and clinical data. They analyzed occurrence of defined abnormalities and classified the traces as normal, suspicious, pathological or pre-terminal according to international guidelines (FIGO).ResultsA pathological CTG during the first stage of labour was present in 77% of cases and in 53% of the controls (OR 2.58 [CI: 0.96–6.94] P = 0.066). Fetal tachycardia was more frequent in cases with uterine rupture (OR 2.50 [CI: 1.0–6.26] P = 0.053). Significantly more cases showed more than 10 severe variable decelerations compared with controls (OR 22 [CI: 1.54–314.2] P = 0.022). Uterine tachysystole was not correlated with the presence of uterine rupture.ConclusionA pathological cardiotocogram should lead to particular attention on threatening uterine rupture but cannot be considered a strong predictor as it is common in all women with trial of labour after caesarean delivery.

Dinoproston Vajinal Ovül ile Doğum İndüksiyonu; Erken Membran Rüptürlü Term Gebelikte Güvenli ve Etkili midir?

Amaç: Bu çalışmada amacımız, Erken Membran Rüptürü (EMR) ve intakt membranlı hastalarda kontrollü salınımlı dinoproston vajinal ovülün güvenilirliğini ve etkinliğini karşılaştırmaktır. Gereç ve Yöntemler: Bishop skoru ≤5, baş geliş, önceden uterin skarı olmayan 86 term tekil gebe çalışmaya alındı. Hastalar EMR (n:27) ve intakt membranlı olarak (n:59) iki gruba ayrıldı. Tüm vakalara kontrollü salınımlı dinoproston ile doğum indüksiyonu uygulandı. Gruplar servikal olgunlaşma, induksiyon başarısı, olumsuz yenidoğan sonuçları ve anneye ait yan etkiler açısından karşılaştırıldı. Bulgular: EMR ve membranları sağlam grupta, servikal olgunlaşma sırasıyla 4 ve 6. saatlerde tamamlandı (p=0,01 and p=0,001). Aktif doğum fazının ortalama başlama süresi EMR grubunda 6,63 saat ve membranları sağlam grupta 7,81 saaatidi (p=0,1). Düşük 1. ve 5. dakika Apgar skoru, düşük umblikal arter pH, yenidoğan yoğun bakım ünitesine başvuru ve operatif vajinal doğumda iki grup arasında istatistiksel fark yoktu. Annede kusma, diyare, uterin taşisistol gözlenmedi ve maternal neonatal ölüm olmadı. Sonuç: Bu veriler kontrollü salımlı dinoproston ovül kullanımının intakt membranlı hastalarda olduğu gibi EMR hastalarda da etkili ve güvenli olduğunu göstermektedir. Objective: Our aim in this study is to compare the efficacy and safety of controlledrelease dinoprostone vaginal insert in patients with intact membranes and premature rupture of membranes (PROM). Material and Methods: Eighty-six term pregnants with singleton pregnancy, with no prior uterine scar, vertex presentation, bishop score ≤ 5, were included in the study. Patients were divided into two groups as PROM patients (n:27) and patients with intact membranes (n:59). Labor induction with controlled-release dinoprostone vaginal insert was performed to all cases. The groups were compared with each other in terms of cervical ripening, success of the induction, adverse neonatal outcomes and presence of maternal side effects. Results: In the PROM group and the intact membrane group, the cervical ripening was completed at 4th hours and at 6 th hours, respectively (p=0.01 and p=0.001). The mean time to onset of active labor was 6,63 hours in the PROM group and 7,81 hours in the intact membranes group (p=0.1). There was no significant difference in low 1. and 5. minute Apgar scores, low umbilical artery pH, administration to neonatal intensive care unit, and operative vaginal delivery between the two groups. Maternal vomiting, diarrhea, uterine tachysystole were not observed and there was no case of maternal or neonatal death. Conclusion: These data overall suggest that controlled-release dinoprostone insert use is effective and safe in patients with PROM just like in patients with intact membranes.

Prophylactic intravenous ephedrine to minimize fetal bradycardia after combined spinal-epidural labour analgesia: a randomized controlled study.

The combined spinal-epidural (CSE) technique for relief of labour pain offers both rapid onset and superior first-stage analgesia. Nevertheless, the known increased risk for early profound fetal bradycardia (EPFB) following CSE continues to be a concern that often limits its use. The purpose of this study was to determine if giving prophylactic intravenous ephedrine at the time of CSE administration would reduce EPFB. We conducted this clinical trial at a large community hospital and enrolled healthy patients requesting epidural analgesia for labour. Patients were randomly assigned to receive either normal saline placebo or ephedrine 10 mg iv at the time of CSE. The primary outcome of EPFB (defined as bradycardia < 90 beats·min(-1) for > two minutes and occurring within the first 30 min after CSE) was compared between groups. The secondary outcomes included the incidence of urgent cesarean delivery, the requirement for additional doses of ephedrine, maternal blood pressure, uterine hypertonus and tachysystole, and abnormal fetal heart rate (FHR) patterns before and after CSE. There were 299 women randomized to the ephedrine (EPH) group and 297 randomized to the normal saline placebo (NS) group. There was no difference between groups in the incidence of EPFB (2.7% EPH group vs 4.7% NS group; relative risk, 0.57; 95% confidence interval, 0.24 to 1.33; P = 0.184). There was also no difference between groups in the incidence of urgent cesarean delivery, uterine hypertonus, uterine tachysystole, and abnormal FHR patterns. We conclude that prophylactic intravenous ephedrine administration at the time of CSE during labour was ineffective at reducing the risk for EPFB associated with CSE. Nevertheless, a lower than expected rate of EPFB resulted in the trial being underpowered. This trial was registered at ClinicalTrials.gov, identifier: NCT02062801.

Misoprostol versus Foley catheter insertion for induction of labor in pregnancies affected by fetal growth restriction

ObjectiveTo compare 25μg of vaginal misoprostol with a Foley catheter for induction of labor (IOL) for fetal growth restriction. MethodsA randomized controlled trial was conducted in a tertiary center in South India. Women with fetal growth restriction (n=100) were randomized to be induced with three doses of vaginal misoprostol (25μg) every 6hours or with an intracervical Foley catheter, inserted 12hours before rupture of membranes, and oxytocin if needed. The primary outcome was uterine tachysystole with fetal cardiotocography abnormalities. Secondary outcomes pertained to effectiveness, complications, and patient satisfaction. ResultsOne woman in the misoprostol group and none in the Foley catheter group had uterine tachysystole. The duration of labor from IOL to delivery was similar in both groups (P=0.416). More women in the misoprostol group had a vaginal delivery within 12hours (26.1% versus 5.6%; P=0.005). Women induced with misoprostol were less likely to deliver by lower-segment cesarean delivery (15.2% versus 29.6%; P=0.168) and to require oxytocin augmentation (60.9% versus 85.2%; P=0.007). Complications were few in both group. ConclusionFew women had uterine tachysystole with cardiotocography abnormalities. Vaginal misoprostol at 25μg was more effective than a Foley catheter for IOL in fetal growth restriction. Clinical Trials Registry India: CTRI/2014/02/004411.

Successful IT Initiative to Reduce the Rate of Excessive Uterine Contractions During Labor

Introduction/aims Oxytocin, an effective drug to increase the rate and strength of uterine contractions, is used in more than half of all labors. Intravenous infusions are adjusted frequently at the bedside because the uterine response can vary greatly. Clinical protocols recommend discontinuing oxytocin in the presence of overly frequent contractions because they can decrease oxygen delivery to the fetus and result in brain injury. Despite well-established guidelines, incautious use of oxytocin is reported in 45-71% of births with severe asphyxia and subsequent litigation. In 2011 Medstar Franklin Square Medical Center introduced specialized obstetrical software (PeriCALM Patterns V2.01 PeriGen, Cranbury, NJ) with electronic fetal monitor (EFM) pattern recognition and display features specifically designed to assist in the prompt recognition of uterine tachysystole. Uterine tachysystole (UT) is defined as the presence of more than 5 contractions per 10 minutes, averaged over a 30-minute period. The objective of this study was to compare the rates of UT in the periods “Before” and “After” the introduction of this software in women with induction or augmentation of labor. Methods/process/procedures Inclusion criteria were labors with live singleton cephalic-presenting babies at term with EFM recordings. The “Before” group comprised 6728 births (3869 with induction or augmentation) from February 2006 to February 2010. The “After” group included 3790 births (1988 with induction or augmentation) from January 2012 to December 2013. Induction or augmentation status was ascertained by automated review of the electronic medical record database searching for evidence of interventions or oxytocin use to induce or enhance labor. Each EFM record was analyzed by PeriCALM Patterns software to determine contraction counts in 30 minute segments. Results As a result of early detection and prompt remediation, very substantial reductions were observed in a variety of UT-related measures. In women with induction or augmentation the rate of tachysystole fell from 22.7% to 17.3% (p<0.0001). When UT did occur, the average duration fell from 64 minutes to 54 minutes (p=0.0039). In those who experienced UT, the total percentage of time spent in UT decreased by 36.5% over the course of this study (p<0.0001). There were also decreases in the percentages of babies with severe neonatal depression, but the small numbers precluded statistical significance. Discussion/outcomes This is the first report of a large and systematic review on the effect of efforts to reduce uterine tachysystole. We observed a very substantial and sustained reduction in both the incidence and duration of UT in patients with augmentation or induction of labor. The 36.5% reduction in the total percentage of time spent in UT reflects a marked changed in clinical behavior. We attribute this marked improvement to the coexistence of several essential factors present in IT initiatives that actually change behavior: 1. Objective computations at the point of care that are personalized to the individual patient; 2. Continuous trend analysis and feedback showing the patient’s situation related to expected norms; 3. Clearly established clinical policies regarding expected therapeutic actions; 4. Active quality improvement follow up.

Randomized Comparison of Isosorbide Mononitrate and PGE2 Gel for Cervical Ripening at Term including High Risk Pregnancy.

Aims. Prostaglandin E2 is the most commonly used drug for cervical ripening prior to labour induction. However, there are concerns regarding uterine tachysystole and nonreassuring fetal heart (N-RFH). Isosorbide mononitrate (IMN) has been used successfully for cervical ripening. The present study was conducted to compare the two drugs for cervical ripening at term in hospital. Methods. Two hundred women with term pregnancies referred for induction of labour with Bishop score less than 6 were randomly allocated to receive either 40 mg IMN tablet vaginally (n = 100) or 0.5 mg PGE2 gel intracervically (n = 100). Adverse effects, progress, and outcomes of labour were assessed. Results. PGE2 group had significantly higher postripening mean Bishop score, shorter time from start of medication to vaginal delivery (13.37 ± 10.67 hours versus 30.78 ± 17.29 hours), and shorter labour-delivery interval compared to IMN group (4.53 ± 3.97 hours versus 7.34 ± 5.51 hours). However, PGE2 group also had significantly higher incidence of uterine tachysystole (15%) and N-RFH (11%) compared to none in IMN group, as well as higher caesarean section rate (27% versus 17%). Conclusions. Cervical ripening with IMN was less effective than PGE2 but resulted in fewer adverse effects and was safer especially in high risk pregnancies.

Clinical associations with uterine tachysystole

Objectives: To determine the incidence of uterine tachysystole (UT) and its association with neonatal depression or metabolic acidemia (DEP).Methods: This retrospective study comprised all 6234 women at ≥37 weeks’ gestation who were monitored during the last 4 hours of tracings before birth in an academic community hospital. DEP was defined by an umbilical artery base deficit value ≥10 mmol/L or a 5-minute Apgar ≤6 and included 77 births. UT was defined by >15 contractions in 30 minutes.Results: The overall incidence of UT was 18.3% (1139/6234). In 4.2% (260/6234) UT persisted for >60 min. The rate of UT was similar in births with DEP (14.3%, 11/77) compared to those without DEP (18.3%, 1128/6157; p = 0.45). In births with UT, only 1.0% (11/1139) developed DEP. The DEP group had more decelerations at almost every level of contractions and a higher cesarean rate of 49.4% (38/77) compared to 24.0% (1468/6124); p = <0.001 in the group without DEP.Conclusions: UT was common, occasionally prolonged and almost always benign. Fetuses with DEP had no more UT than those without DEP. Many babies with DEP declared their vulnerability with decelerations at contraction rates below UT levels and the great majority of them never experienced UT.

How common is uterine tachysystole with fetal heart rate abnormalities when inducing labor with misoprostol?

How common is uterine tachysystole with fetal heart rate abnormalities when inducing labor with misoprostol?

Uterine Tachysystole Rates and Survival of the Fittest Effect

Childbearing Paper Presentation Objective To determine incidence of uterine tachysystole and its association with decelerations and cesarean birth. Design Retrospective. Setting Suburban hospital in a mid‐Atlantic city. Sample Women (6,234) with singleton cephalic presenting infants at a gestational age of 37 weeks or more, who were monitored electronically in the last 4 hours prior to delivery. Methods Clinical data were obtained from an institutional perinatal database that extracts data from the electronic medical record (PeriBirth, Princeton, NJ). The digital tracings were analyzed using PeriCALM Patterns (Princeton, NJ). We divided each tracing into 10‐minute segments that were numbered according to proximity to birth, 0 representing the last 10 minutes before birth and 24 occurring 240 minutes earlier. We counted the number of contractions and decelerations in each time segment Results In this study, 18.0% of women experienced at least one episode of uterine tachysystole. The incidence of uterine tachysystole was around 2.7% at 4 hours prior to delivery and rose to 8.0% times close to delivery. Continuous uterine tachysystole for more than 120 minutes was very uncommon. Persistent uterine tachysystole was not associated with more decelerations (R = .28) or with higher cesarean rates (R = .23). Only 55% or 0.88% of women in this study met the criteria for labor intolerance. These women had fewer episodes of high contraction rates. In contrast, they showed a much higher deceleration response to contractions especially at very low contraction rates. Overall, the rate of cesarean was positively associated with rising rates of decelerations per contractions (R = .92). Conclusion/Implications for Nursing Practice We can conclude that some infants tolerate uterine tachysystole well, and some do so for very prolonged periods. These findings are consistent with the principle underlying the contraction stress test (CST), in which a controlled stress via induced contractions was used to determine fetal well‐being antepartum. Labor is the ultimate CST, and this analysis showed that infants with the low tolerance to labor demonstrated strong deceleration responses to even small amounts of contraction stress, whereas others tolerated long periods of uterine tachysystole.

Incidence of Uterine Tachysystole in Women Induced with Oxytocin

To determine the incidence of uterine tachysystole (UT) using nomenclature defined by the American College of Obstetricians and Gynecologists (ACOG) and Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). Cohort study using retrospective chart reviews and concomitant independent analyses of fetal monitor strips. A 10-bed labor and delivery unit in a community hospital with an average of 400 deliveries monthly. Of 346 total deliveries in October 2009, 55 patients qualified for this study. Inclusion criteria were women with a singleton, viable fetus in vertex presentation and who received oxytocin infusion for induction of labor. We analyzed 798.5 hours of fetal monitor strips in 30-minute increments according to each of four UT criteria. We collected data on the dose of oxytocin, the National Institute of Child Health and Human Development (NICHD) fetal heart rate categories, maternal age, parity, pregnancy risk factors, indication for induction, mode of delivery, birth weight, and Apgar scores. We identified 661 incidences of UT out of 1,597 increments with an overall UT rate of 41%. Fifty-four of 55 patients (98%) demonstrated one or more occurrences of UT. Interrater reliability achieved an 86.3% correlation (718 vs. 698 occurrences). Results of this study highlight the need for careful titration of oxytocin and prompt management of UT. This increased awareness can enhance the health, safety, and well-being of pregnant women and their fetuses.

Induction of labor using double balloon cervical device in women with previous cesarean section: Experience and review

Induction of labour remains one of the most challenging interventions in current obstetrics. Different pharmaceuticals have been used for cervical ripening such as prostaglandins; however they can lead to a number of potential inconvenient risks namely uterine tachysystole and pathological fetal cardiotocography (CTG). In cases of women with previous caesarean births, using prostaglandins would pose even higher risks such as uterine rupture and perinatal mortality. A mechanical method of cervical ripening could represent an alternative for these women. We report the use of the extra-amniotic double balloon cervical device (Cook’s device) for ripening of unfavourable cervix in seventeen women attempting vaginal birth after cesarean section (VBAC). Using Bishop scoring system to assess cervical dilatetion, position, consistency, fetal station and effacement, the unfavourable cervix is the cervix that scores less than 6. We review the relevant literature discussing this method of induction focusing on its effectiveness, simplicity, safety and efficacy, low cost and any associated serious side effects. Conclusion: Success was estimated to be over 50% with no serious life threatening maternal or fetal complications. We considered the process satisfactory and practical. We recommend larger studies to assess safety and efficacy of Cook’s device in vaginal birth after caesarean section before embarking on routine elective caesarean delivery. Objectives: To estimate success rate for vaginal delivery after previous caesarean section using cervical double balloon device (Cook’s device). Design: Three-year observational study. Setting: Maternity unit in district general hospital, UK. Population: Women who had one previous lower segment caesarean section and unfavourable cervix identified as having Bishop Score less than 6. Methods: Data were obtained from the birth registry over 3 years from January 2008 until December 2010. Main outcome: Measure successful vaginal delivery. Results: Out of 25 cases that had induction of labour with history of one previous lower segment caesarean section, 17 patients did fit in the inclusion criteria and were studied. 53% had a successful vaginal delivery while 47% had to have cesarean section either due to failure to progress or pathological cardiotocography. 82% required to have syntocinon infusion for augmentation as per local unit protocol. All newborn babies were in good condition and did not require admission to neonatal intensive care unit.

Comparative Study of Oral and Vaginal Misoprostol for Induction of Labour, Maternal and Foetal Outcome

Misoprostol is a new promising agent for cervical ripening and induction of labour .The ideal dose, route and frequency of administration of misoprostol are still under investigation. Although, vaginal application of misoprostol has been validated as a reasonable mean of induction, there is a patient resistance to digital examination and there is a risk of ascending infection. For this reason, oral administration of misoprostol for cervical ripening and labour induction has been tried. To compare 50μg of oral misoprostol versus 25μg of intravaginal misoprostol for induction of labour at term and maternal, foetal outcomes. Two hundred women who were at term, with indication for induction of labour and Bishop scores of ≤5 were randomly assigned to receive misoprostol 50μg or 25μg intravaginal, every 4-6 hours, for a maximum of 5 doses. In either group, pregnant females with inadequate uterine contractions despite being given maximum 5 doses of misoprostol, were augmented using oxytocin. The primary outcome measure was time-interval from induction to vaginal delivery and vaginal delivery rate within 24 hours. The median induction to vaginal delivery time in oral group (12.92h) and vaginal group (14.04 h) was not significant. Oral misoprostol resulted in more number of vaginal deliveries as compared to vaginal misoprostol (94% as compared to 86%), which was not significant. There was a significantly higher incidence of uterine tachysystole in the vaginal group, as compared to oral group. There were no significant differences between the groups with respect to oxytocin augmentation, caesarean section rate, analgesic requirement and neonatal outcome. Oral misoprostol is as efficacious as vaginal misoprostol because of shorter induction delivery interval, lower caesarean section rates, and lower incidence of failed induction rates. Lower incidence of foetal distress and easy intake are observed if the drug is administered orally.

Dinoprostone vaginal pessary for induction of labour: Safety of use for up to 24 h

Cervidil(®) (dinoprostone) intravaginal pessaries are used for induction of labour and maintain serum prostaglandin levels for up to 24 h. The Therapeutic Goods Administration approves Cervidil(®) for 12-h use. However, twenty-four-hour use of Cervidil(®) is supported in Europe, New Zealand, America and some Australian hospitals. To assess the safety of Cervidil(®) use for up to 24 h for induction of labour in nulliparous women. A retrospective cohort study of 269 consecutive women receiving Cervidil(®) at the Royal Brisbane and Women's Hospital (RBWH) between July 2007 and December 2008 was performed. The primary outcome measures were frequency of, and time to, uterine tachysystole with or without fetal heart rate (FHR) changes. Secondary outcome measures included frequency of maternal (intrapartum temperature, postpartum haemorrhage) and neonatal (low Apgars, resuscitation, nursery admission) morbidity. Morbidity outcomes of those who received Cervidil(®) for less than or equal to 12 h were compared with those who received Cervidil(®) for more than 12 h. Uterine tachysystole occurred in 9.3% of patients receiving Cervidil(®) , with a mean time to tachysystole of 10 h. The majority of cases (68%) occurred within 12 h of use. There was no increase in maternal or neonatal morbidity for those who received Cervidil(®) for longer than 12 h. Twenty-four-hour use of Cervidil(®) is likely as safe as 12-h use for induction of labour in nulliparous women.