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Tian S, Wang L, Han YW, Liu YN, Li FQ, Jin XH. Efficacy and safety of oral and vaginal administration of misoprostol for induction of labor in high-risk obese pregnant women with hypertension or diabetes mellitus. J Matern Fetal Neonatal Med 2024; 37:2327573. [PMID: 38485520 DOI: 10.1080/14767058.2024.2327573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE This study aims to compare the safety and efficacy of misoprostol administered orally and vaginally in obese pregnant women at term with either gestational hypertension or diabetes. METHODS A total of 264 pregnant women were enrolled and categorized into two groups based on their primary condition: hypertension (134 cases) or diabetes mellitus (130 cases) and were further divided into subgroups for misoprostol administration: orally (Oral group) or vaginally (Vaginal group). The primary outcomes measured were changes in the Bishop score following treatment, induction of labor (IOL) success rates, requirement for oxytocin augmentation, duration of labor, mode of delivery, and cesarean section rates. RESULTS Significant enhancements in Bishop scores, decreased cesarean section rates and increased success rates of IOL were noted in both administration groups. The incidence of vaginal delivery within 24 h was significantly higher in the Vaginal group compared to the Oral group. Adverse effects, including nausea, uterine overcontraction, hyperfrequency of uterine contraction and uterine hyperstimulation without fetal heart rate deceleration, were significantly more prevalent in the Vaginal group than in the Oral group. CONCLUSION Misoprostol administration, both orally and vaginally, proves effective for labor induction in obese pregnant women with hypertension or diabetes. However, the oral route presents a lower risk of adverse maternal and neonatal outcomes, suggesting its preference for safer labor induction in this demographic.
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Affiliation(s)
- Shi Tian
- Department of Obstetrics, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Li Wang
- Department of Obstetrics, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Yi-Wei Han
- Department of Obstetrics, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Yan-Nan Liu
- Department of Obstetrics, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Feng-Qiu Li
- Department of Obstetrics, Haidian District Maternal and Child Health Hospital, Beijing, China
| | - Xiao-Hua Jin
- National Human Genetic Resources Center, National Research Institute for Family Planning, Beijing, China
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2
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Kadu NA, Shiragur S. Comparison of Intracervical Foley's Catheter With Vaginal Misoprostol Versus Intravaginal Misoprostol Alone for Cervical Ripening and Induction of Labor. Cureus 2023; 15:e44772. [PMID: 37809166 PMCID: PMC10557466 DOI: 10.7759/cureus.44772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Induction of labor implies stimulation of contractions before the spontaneous onset of labor, with or without membranes. Augmentation refers to the enhancement of spontaneous contractions that are considered inadequate because of failed cervical and fetal descent. This study compared the effectiveness of intracervical Foley catheter insertion and vaginal misoprostol versus only vaginal misoprostol in the induction of labor and other outcomes relted to it. Methods The present study was a randomized controlled trial that included 148 women divided into two groups: (i) Group A, which received intracervical Foley catheter insertion and vaginal misoprostol (25 µg), and (ii) Group B, which received intravaginal administration of tablet misoprostol (25 µg) alone. We compared the median time from the time of induction to vaginal delivery, incidence of cesarean delivery, chorioamnionitis, puerperal infection, uterine tachysystole, neonatal information at delivery, and discharge status (i.e., birth weight, neonatal intensive care unit (NICU) admission, and neonatal death) between groups. Results We found that the rates of puerperal infection (n=36; 48.6%) and meconium-stained amniotic fluid (n=45; 60.8%) were higher in Group B than in Group A (n=20; 27.0% and n=25; 33.8%, respectively), which were statistically significant differences (p=0.0066 and p=0.0009, respectively). In addition, NICU admission was higher in Group B (n=47; 63.5%) than in Group A (n=30; 40.5%), which was a statistically significant difference (p=0.0051). Conclusion An intracervical Foley catheter with 25 µg of misoprostol was more effective for induction of labor than 25 µg of intravaginal misoprostol alone every six hours for a maximum of four doses in terms of induction to delivery interval, meconium-stained amniotic fluid, mode of delivery, intrapartum complications, and puerperal infection.
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Affiliation(s)
- Nivedita A Kadu
- Department of Obstetrics and Gynaecology, Shri B.M. Patil Medical College, Hospital and Research Institute, Vijayapura, IND
| | - Shobha Shiragur
- Department of Obstetrics and Gynaecology, Shri B.M. Patil Medical College, Hospital and Research Institute, Vijayapura, IND
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Kao WH, Kuo CF, Chang CC, Liu YC, Wang CC, Hsu JT, Chuang YF. Cancer survivorship and risk of pregnancy complications, adverse obstetric outcomes, and maternal morbidities in female adolescents and young adults: a nationwide population-based study from Taiwan. Br J Cancer 2023; 129:503-510. [PMID: 37386137 PMCID: PMC10403515 DOI: 10.1038/s41416-023-02333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Cancer treatment in female adolescent and young adult (AYA) cancer survivors (i.e., those diagnosed between 15 and 39 years of age) may adversely affect multiple bodily functions, including the reproductive system. METHODS We initially assembled a retrospective, nationwide population-based cohort study by linking data from two nationwide Taiwanese data sets. We subsequently identified first pregnancies and singleton births to AYA cancer survivors (2004-2018) and select AYA without a previous cancer diagnosis matched to AYA cancer survivors for maternal age and infant birth year. RESULTS The study cohort consisted of 5151 and 51,503 births to AYA cancer survivors and matched AYA without a previous cancer diagnosis, respectively. The odds for overall pregnancy complications (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.01-1.18) and overall adverse obstetric outcomes (OR, 1.07; 95% CI, 1.01-1.13) were significantly increased in survivors compared with matched AYA without a previous cancer diagnosis. Specifically, cancer survivorship was associated with an increased risk of preterm labour, labour induction, and threatened abortion or threatened labour requiring hospitalisation. CONCLUSIONS AYA cancer survivors are at increased risk for pregnancy complications and adverse obstetric outcomes. Efforts to integrate individualised care into clinical guidelines for preconception and prenatal care should be thoroughly explored.
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Affiliation(s)
- Wei-Heng Kao
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Chia-Chun Chang
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Cheng Liu
- Department of Gynecology and Obstetrics, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of General Surgery, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Fang Chuang
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan.
- International Health Program, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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M K, Jain V, Arora A, Kumar J. Comparison of Vaginal Dinoprostone Pessary With Transcervical Balloon Catheter Plus Vaginal Misoprostol for Pre-induction Cervical Ripening: A Randomized Trial. Cureus 2023; 15:e42261. [PMID: 37605669 PMCID: PMC10440095 DOI: 10.7759/cureus.42261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/23/2023] Open
Abstract
Aims and Objectives To compare the safety and efficacy of dinoprostone pessary with Foley plus vaginal misoprostol for cervical ripening. Materials and Methods We randomized 115 women to the pessary or Foley plus misoprostol group. Pessary was inserted for 24 hours, and in the Foley plus misoprostol group, intravaginal misoprostol 25 mcg was administered along with trans-cervical Foley insertion and repeated every six hours to a maximum dose of 100 mcg. Singleton pregnancies requiring labor induction at more than 34 weeks with a Bishop score of <6 were included. Study outcomes included induction-delivery interval (IDI), mode of delivery, change in the Bishop score, need for oxytocin augmentation, and patient discomfort as assessed by visual analog score. Results The IDI was similar between the groups (pessary vs Foley plus misoprostol; 21.27 vs 21.10 hours, p = 0.9). The mean change in the Bishop score and need for augmentation with oxytocin was significantly more in the Foley plus misoprostol group compared to pessary (2.72 vs 1.94, p = 0.001; 89.7% vs 57.9%, p = 0.0001). Pessary was better tolerated compared to Foley plus misoprostol (VAS 7.8 vs 6.68, p = 0.0001). Mode of delivery and maternal and neonatal outcomes showed no difference. Conclusion There was no significant difference between pessary and Foley plus misoprostol in the IDI and mode of delivery. Pessary was better tolerated, and augmentation with oxytocin was required less often. Foley plus misoprostol caused a faster change in the Bishop score, but oxytocin augmentation was used more often. Maternal and neonatal outcomes were similar.
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Affiliation(s)
- Kanagavarshani M
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Vanita Jain
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Aashima Arora
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Jogender Kumar
- Pediatric Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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Teitler JO, Chegwin V, Li L, Liu K, Bearman PS, Gorney-Daley MA, Reichman NE. Trends in Elective Deliveries in California and New Jersey. AJPM FOCUS 2023; 2:100052. [PMID: 37789944 PMCID: PMC10546565 DOI: 10.1016/j.focus.2022.100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Cesarean section deliveries in the U.S. increased from 5% of births in 1970 to 32% in 2020. Little is known about trends in cesarean sections and inductions in low-risk pregnancies (i.e., those for which interventions would not be medically necessary). This study addresses the following questions: (1) what is the prevalence of elective deliveries at the population level?, (2) how has that changed over time?, and (3) to what extent do the rates of elective deliveries vary across the population? Methods We first documented long-term trends in cesarean sections in the U.S., California, and New Jersey. We then used linked birth and hospital discharge records and an algorithm based on Joint Commission guidelines to identify low-risk pregnancies and document trends in cesarean sections and inductions in low-risk pregnancies in California and New Jersey over a recent 2-decade period, overall and by maternal characteristics and gestational age. Results In low-risk pregnancies in California and New Jersey, rates of cesarean sections and inductions increased sharply from the early 1990s through the mid-2000s, peaked at 33% in California and 41% in New Jersey in 2007, and then declined somewhat, and the proportions of inductions that were followed by cesarean sections increased from fewer than 1 in 5 to about 1 in 4. More education, non-Hispanic White race/ethnicity, U.S.-born status, and non-Medicaid were associated with higher rates of interventions. Trends were similar across all socioeconomic groups, but differences have been narrowing in California. Among early-term (gestational age of 37-38 weeks) births in low-risk pregnancies, the rates of elective deliveries increased substantially in both states until the mid/late-2000s, peaked at about 35% in California and over 40% in New Jersey, and then decreased in both states to about 20%. Conclusions Given established health risks of nonmedically necessary cesarean sections, that a nontrivial share of induced deliveries in low-risk pregnancies result in cesarean sections, and that interventions in low-risk pregnancies have not substantially declined since their peak in the mid-2000s, the trends documented in this paper suggest that sustained, even increased, public health attention is needed to address the still-too-high rates of cesarean sections and inductions in the U.S.
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Affiliation(s)
| | | | - Linda Li
- School of Social Work, Columbia University, New York, New York
| | - Kayuet Liu
- Department of Sociology, University of California, Los Angeles, Los Angeles, California
- RIKEN Center for Brain Science (CBS), Wako-shi, Japan
| | - Peter S. Bearman
- Department of Sociology, Columbia University, New York, New York
| | | | - Nancy E. Reichman
- Rutgers, Robert Wood Johnson Medical School, The State University of New Jersey, New Brunswick, New Jersey
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Elpo JA, Araújo BDA, Volpato LK. Foley catheter plus misoprostol versus misoprostol alone for labor induction. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:119-123. [PMID: 36629651 PMCID: PMC9937608 DOI: 10.1590/1806-9282.20220897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study aimed to analyze the effects of Foley catheter combined with misoprostol in the labor induction process. METHODS This is a nonblinded, block randomized, controlled trial that compared the association between transcervical Foley catheter/vaginal misoprostol 25 μg combination and vaginal misoprostol 25 μg alone in normal-risk and healthy pregnant women undergoing labor induction in the south of Brazil. RESULTS A total of 230 patients with indications for labor induction were evaluated and classified into the "combined" group (Foley catheter plus misoprostol), consisting of 107 patients, and the "misoprostol" group (misoprostol only), consisting of 123 patients. The "combined" group was observed to have a shorter labor induction time (p=0.008). In addition, there was a lower need for misoprostol use for overall cervical ripening (p<0.001) and a lower relative risk of needing a second, third, or fourth misoprostol tablet in the "combined" group (risk ratio [RR] 0.80, 95% confidence interval [CI] 0.71-0.91; RR 0.41; 95%CI 0.31-0.56; and RR 0.29, 95%CI 0.17-0.52, respectively) (p<0.001). No statistically significant difference was found in induction failure rate, cesarean section rate, or perinatal outcomes. CONCLUSION A combination of methods leads to shorter labor induction, lower need for misoprostol doses, and lower risk of cesarean section, with no increase in the rate of perinatal complications. REBEC number is RBR-7xcjz3z.
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Affiliation(s)
- Jhonathan Alcides Elpo
- Hospital Universitário Prof. Polydoro Ernani de São Thiago, Department of Gynecology and Obstetrics – Florianópolis (SC), Brazil
| | - Bruna de Aguiar Araújo
- Hospital Regional de São Jose Dr Homero de Miranda Gomes, Gynecology and Obstetrics Service – São José (SC), Brazil
| | - Lia Karina Volpato
- Hospital Universitário Prof. Polydoro Ernani de São Thiago, Department of Gynecology and Obstetrics – Florianópolis (SC), Brazil.,Hospital Regional de São Jose Dr Homero de Miranda Gomes, Gynecology and Obstetrics Service – São José (SC), Brazil.,Corresponding author:
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Liu KY, Teitler JO, Rajananda S, Chegwin V, Bearman PS, Hegyi T, Reichman NE. Elective Deliveries and the Risk of Autism. Am J Prev Med 2022; 63:68-76. [PMID: 35367106 PMCID: PMC9232972 DOI: 10.1016/j.amepre.2022.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/04/2022] [Accepted: 01/19/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cesarean section and induced deliveries have increased substantially in the U.S., coinciding with increases in autism spectrum disorder. Studies have documented associations between cesarean section deliveries and autism spectrum disorder but have not comprehensively accounted for medical risks. This study evaluates the extent to which cesarean section and induced deliveries are associated with autism spectrum disorder in low-risk births. METHODS In this retrospective cohort study, California's birth records (1992-2012) were linked to hospital discharge records to identify low-risk births using a stringent algorithm based on Joint Commission guidelines. Autism spectrum disorder status was based on California Department of Developmental Service data. Logistic regression models were used to estimate associations between autism spectrum disorder and induced vaginal deliveries, cesarean section deliveries not following induction, and cesarean section deliveries following induction, with noninduced vaginal deliveries as the reference category. RESULTS A total of 1,488,425 low-risk births took place in California from 1992 to 2012. The adjusted odds of autism spectrum disorder were 7% higher for induced vaginal deliveries (AOR=1.07, 95% CI=1.01, 1.14), 26% higher for cesarean section deliveries not following induction (AOR=1.26, 95% CI=1.19, 1.33), and 31% higher for cesarean section deliveries following induction (AOR=1.31, 95% CI=1.18, 1.45) than for noninduced vaginal deliveries. Lower gestational age and neonatal morbidities did not appear to be important underlying pathways. The associations were insensitive to alternative model specifications and across subpopulations. These results suggest that, in low-risk pregnancies, up to 10% of autism spectrum disorder cases are potentially preventable by avoiding cesarean section deliveries. CONCLUSIONS After accounting for medical risks, elective deliveries-particularly cesarean section deliveries-were associated with a substantially increased risk of autism spectrum disorder.
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Affiliation(s)
- Ka-Yuet Liu
- Department of Sociology, College of Social Sciences, University of California, Los Angeles, Los Angeles, California; California Center for Population Research, College of Social Sciences, University of California, Los Angeles, Los Angeles, California; RIKEN Center for Brain Science (CBS), Wako, Japan.
| | | | - Sivananda Rajananda
- California Center for Population Research, College of Social Sciences, University of California, Los Angeles, Los Angeles, California
| | | | - Peter S Bearman
- Department of Sociology, Columbia University in the City of New York, New York, New York
| | - Thomas Hegyi
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Nancy E Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey; Child Health Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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Abu-Zaid A, Saeed Alshahrani M, Al-Matary A, Khadawardi K, Talat Miski N, Abuzaid M, Alrasheed MA, Baradwan A, Salem A, Salem R, Ismail Albadawi M, Ziad Jamjoom M, AMA Almubarki A, Ahmed Abdulmalik N, Almugbel M, Tulbah M, Baradwan S, Alomar O. Isosorbide mononitrate for cervical ripening during labour induction: a systematic review and meta-analysis of 23 randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2022; 276:38-46. [DOI: 10.1016/j.ejogrb.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
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La Verde M, Torella M, Riemma G, Narciso G, Iavarone I, Gliubizzi L, Palma M, Morlando M, Colacurci N, De Franciscis P. Incidence of gestational diabetes mellitus before and after the Covid-19 lockdown: A retrospective cohort study. J Obstet Gynaecol Res 2022; 48:1126-1131. [PMID: 35199420 PMCID: PMC9115303 DOI: 10.1111/jog.15205] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 01/04/2023]
Abstract
AIM To evaluate whether the first Covid-19 lockdown for Italian citizens (March to July 2021) might have altered the incidence of gestational diabetes mellitus (GDM). METHODS A retrospective single-center study in a tertiary referral center. Primary outcome was the incidence of GDM among pregnant women. GDM incidence, from June 11, 2019 to December 4, 2020, was compared by dividing the study time as follows: from the beginning of the study to before Covid-19 lockdown (from June 11, 2019, to March 9, 2020) and lockdown period (from March 10, 2020, to December 4, 2020). GDM was diagnosed with a 75-g, 2-h oral glucose tolerance test (OGTT) at 24-28 gestational weeks. RESULTS Concerning 1295 women, GDM incidence increased during the lockdown period (9.3% vs. 3.4%, p < 0.001). Higher pregnancy weight gain with an increased body mass index (BMI) at the delivery was reported during the lockdown (31.3 vs. 28.4 kg/m2 , p = 0.02 and mean weight gain of 9.3 vs. 6.6 kg, p = 0.007). There was no difference in other comorbidity incidence and OGTT values between the two groups. CONCLUSIONS Pregnant women during the Covid-19 lockdown might have experienced higher BMI and pregnancy weight gain with increased GDM diagnoses. This may be related to physical limitations and emotional distress experienced during the lockdown. However, evidence is limited due to restricted study duration and random variations of outcomes across time. More studies are needed to understand the dietary patterns and the physical activity changes during the Covid-19 lockdown and its impact on fetal outcomes.
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Affiliation(s)
- Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Giuliana Narciso
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Irene Iavarone
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Ligia Gliubizzi
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Marica Palma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Maddalena Morlando
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology UnitUniversity of Campania “Luigi Vanvitelli”NaplesItaly
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Abuzaid M, Baradwan S, Alkhamis WH, Alshahrani MS, Khadawardi K, Miski NT, Allam HS, Almubarki AA, Alhashimi E, Almugbel M, Tulbah M, Alomar O, Abu-Zaid A. Misoprostol plus isosorbide mononitrate versus misoprostol alone for cervical ripening during labor induction: A systematic review and meta-analysis of randomized controlled trials. J Gynecol Obstet Hum Reprod 2021; 51:102235. [PMID: 34583026 DOI: 10.1016/j.jogoh.2021.102235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022]
Abstract
AIM To conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that examined the maternal and neonatal outcomes of misoprostol+isosorbide mononitrate (ISMN) versus misoprostol alone (control) in promoting cervical ripening during labor induction. METHODS We searched five databases from inception until 05-May-2021. We assessed risk of bias of RCTs, meta-analyzed 23 endpoints, and pooled them as mean difference or risk ratio with 95% confidence interval. RESULTS Overall, five RCTs met the inclusion criteria, comprising 850 patients (426 and 424 patients were allocated to misoprostol+ISMN and misoprostol group, respectively). Overall, the RCTs had a low risk of bias. Pertaining to maternal delivery-related outcomes, there was no significant difference between both groups regarding the mean interval from drug administration to delivery, rate of vaginal delivery, rate of cesarean section delivery, and rate of need for oxytocin augmentation. Pertaining to maternal drug-related side effects, the rate of maternal headache was significantly higher in disfavor of the misoprostol+ISMN compared with misoprostol alone. However, the rates of maternal nausea, hypotension, flushing, palpitation, dizziness, postpartum hemorrhage, and uterine tachysystole did not differ between both groups. Pertaining to neonatal outcomes, there was no significant difference between both groups regarding rates of NICU admission, meconium-stained amniotic fluid, and Apgar score <7 at five minutes. CONCLUSION Compared with misoprostol alone, co-administration of misoprostol+ISMN did not correlate with superior maternal delivery-related outcomes. The rate of maternal headache was significantly higher in disfavor of the misoprostol+ISMN group. There was no significant difference between both groups regarding neonatal endpoints.
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Affiliation(s)
- Mohammed Abuzaid
- Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Waleed H Alkhamis
- Department of Obstetrics and Gynecology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Majed Saeed Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | - Khalid Khadawardi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Najlaa Talat Miski
- Department of Obstetrics and Gynecology, Faculty of Medicine at Rabigh, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Hassan Saleh Allam
- Department of Obstetrics and Gynecology, Faculty of Medicine at Rabigh, King Abdulaziz University, Rabigh, Saudi Arabia; Department of Obstetrics and Gynecology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Ebtisam Alhashimi
- Department of Obstetrics and Gynecology, Security Forces Hospital, Makkah, Saudi Arabia
| | - Maisoon Almugbel
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Maha Tulbah
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Osama Alomar
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmed Abu-Zaid
- Department of Obstetrics and Gynecology, Alfaisal University, Riyadh, Saudi Arabia; College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, United States of America.
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Macrosomía fetal: factores de riesgo y resultados perinatales. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Hemmatzadeh S, Abbasalizadeh F, Mohammad-Alizadeh-Charandabi S, Asghari Jafarabady M, Mirghafourvand M. Developing and validating the Caesarean risk assessment nomogram and comparing the effect of cervical ripening balloon, evening primrose oil and misoprostol on childbirth outcomes in term pregnancies: A study protocol. Nurs Open 2021; 8:2892-2900. [PMID: 33689238 PMCID: PMC8363412 DOI: 10.1002/nop2.846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/15/2021] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
AIM To develop and validate the nomogram for risk estimation of Caesarean delivery and to compare the effect of cervical ripening balloon, evening primrose oil (EPO) and misoprostol on Bishop Score and duration of the first stage of labour. DESIGN The first phase is a prospective study, and the second phase is a randomized controlled trial. METHODS In the first phase, the nomogram will be developed and validated over 300 participants, and in the second phase, the 90 participants will be allocated to three groups: vaginal 25mcg misoprostol, vaginal 4000mg EPO and double-balloon catheter, through block randomization method. The Bishop score will be evaluated every 4 hr, and if required the same dose will be repeated. Maximum waiting time for balloon is 12 hr if not effective, the catheter will be removed, and other interventions will be done according to guidelines. DISCUSSION The nomogram will help informed decision-making for women undergoing an induction with an unfavourable cervix and introducing effective low-complication methods of labour induction can improve the pregnancy outcomes.
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Affiliation(s)
- Shahla Hemmatzadeh
- Students' Research Committee, Midwifery Department, Tabriz University of Medical sciences, Tabriz, Iran
| | - Fatemeh Abbasalizadeh
- Department of Gynecology, Faculty of medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mohammad Asghari Jafarabady
- Mohammad Asghari, Faculty of health, Department of Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Coates D, Thirukumar P, Henry A. The experiences of shared decision-making of women who had an induction of labour. PATIENT EDUCATION AND COUNSELING 2021; 104:489-495. [PMID: 32843263 DOI: 10.1016/j.pec.2020.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/02/2020] [Accepted: 08/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The importance of shared decision-making (SDM) in relation to induction of labour (IOL) is recognised, little is known about women's experiences of and satisfaction with decision-making and how this can be improved. The aim of this study was to 1) gain insight into women's experiences of SDM in relation to IOL, 2) understand the factors associated with satisfaction versus dissatisfaction during SDM, and 3) identify recommendations for service improvement. METHODS Qualitative semi-structured telephone interviews were conducted with 32 women who had a recent IOL at one of eight public hospitals in Sydney, Australia. An inductive approach to coding and categorisation of themes was used. RESULTS While women reported varied experiences with SDM, many reported not feeling that they had a choice about IOL, not being presented with the risks and benefits of different birth options, and receiving insufficient information about the IOL process and methods. Satisfaction versus dissatisfaction with SDM appeared more closely related to a woman's willingness to have an IOL and their willingness to defer decision-making, rather than the process of SDM. Recommendations for improvement included improved SDM practices, access to guidelines and continuity of care. CONCLUSION There is a need to improve SDM processes around IOL. PRACTICE IMPLICATIONS Particular areas for improvement include more comprehensive discussions surrounding the pros and cons of different birth methods and the IOL process. Decision aids and clinician training may assist with SDM.
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Affiliation(s)
- Dominiek Coates
- University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, Sydney, Australia.
| | | | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, UNSW, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia; The George Institute for Global Health, UNSW Medicine, Australia
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Akyıldız D, Çoban A, Gör Uslu F, Taşpınar A. Effects of Obstetric Interventions During Labor on Birth Process and Newborn Health. Florence Nightingale Hemsire Derg 2021; 29:9-21. [PMID: 34263219 PMCID: PMC8137733 DOI: 10.5152/fnjn.2021.19093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 03/26/2020] [Indexed: 11/25/2022] Open
Abstract
AIM This study aimed to investigate the effects of the interventions in the delivery room on the delivery process and the newborn health. METHOD The analytical-cross-sectional study was carried out with 354 puerperal women who gave birth in hospital between December 2016 and June 2017 in a public hospital. The data were collected by the data collection form developed by the researchers. Data analysis was done by using descriptive statistics and chi-square test in SPSS 21.00 program. RESULTS The interventions were determined in continuous electro fetal monitoring (80.5%), oxytocin induction (79.9%), restriction of free movement (56.8%), amniotomy (49.7%), enema (44.1%), and movement restriction (56.8%). The intervention period of the second phase of delivery was longer and the rate of cesarean section was higher, and the need for NICU, suction difficulty, 5th APGAR score less than 7, trauma development, difficulty in suction, and higher trauma rates were found in infants. It was determined that the rate of oxygen need in puerperals admitted to the delivery room with cervical dilatation below five cm, vacuum and episiotomy applications in those who underwent amniotomy, and vacuum application rates in those undergoing oxytocin inductions were found to be high. In addition, the rate of fundal compression and episiotomy was significantly higher in patients who used continuous electro fetal monitoring, fundal compression and vacuum rate in patients who were administered analgesic drugs, and episiotomy rates in patients using analgesic drugs. CONCLUSION It has been concluded that interventions in the first phase of labor negatively affect the delivery process and neonatal health and increase the need for intervention in the second phase.
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Affiliation(s)
- Deniz Akyıldız
- Department of Midwifery, Kahramanmaras Sütçü İmam University, Faculty of Health Sciences, Kahramanmaraş, Turkey
| | - Ayden Çoban
- Department of Midwifery, Faculty of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey
| | | | - Ayten Taşpınar
- Department of Midwifery, Faculty of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey
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15
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Du H, Zhang N, Xiao CY, Sun GQ, Zhao Y. Effectiveness of Dinoprostone and Cook's Balloon for Labor Induction in Primipara Women at Term. Curr Med Sci 2020; 40:951-959. [PMID: 33123908 DOI: 10.1007/s11596-020-2274-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
Labor induction is commonly used for achieving successful vaginal delivery. This study aimed to compare the effectiveness of dinoprostone and Cook's balloon as labor-inducing agents in primipara women at term. A retrospective cohort study among primipara women was conducted in Hubei Maternity and Child Health Hospital. Basic clinical characteristics were collected. The main outcomes were vaginal delivery rate, cesarean section rate and forceps delivery rate. Obstetric and perinatal outcomes were also compared. Univariate and multivariate analyses were further performed to evaluate the predictors for vaginal delivery within 24 h. A total of 845 eligible primipara women undergoing labor induction were recruited. Of them, 141 women were induced with dinoprostone (dinoprostone group, DG), and 704 with Cook's balloon (Cook's balloon group, CG). Groups were homogeneous except more women with premature rupture of membranes in DG, with gestational hypertension in CG (P<0.05). The vaginal delivery rate within 12 h was 1.98% and 16.52% in CG and DG respectively (P=0.0001). Besides, the vaginal delivery rate within 24 h was 37.62% and 52.26% in CG and DG respectively (P=0.0079). DG showed the lower rate of oxytocin augmentation, artificial rupture of membrane and postpartum hemorrhage and the shorter interval from insertion to active labor than CG (P<0.05). Multivariate regression analysis revealed that abortion history, oxytocin augmentation, artificial rupture of membrane, and obstetric analgesia were independent predictors for vaginal delivery within 24 h. In conclusion, dinoprostone was more effective than Cook's balloon to induce labor and achieve vaginal birth in the sample of primipara women at term.
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Affiliation(s)
- Hui Du
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China.
| | - Na Zhang
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Chan-Yun Xiao
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Guo-Qiang Sun
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Yun Zhao
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
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Declercq E, Belanoff C, Iverson R. Maternal perceptions of the experience of attempted labor induction and medically elective inductions: analysis of survey results from listening to mothers in California. BMC Pregnancy Childbirth 2020; 20:458. [PMID: 32787802 PMCID: PMC7425604 DOI: 10.1186/s12884-020-03137-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/28/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The rate of induction of labor in the U.S. has risen from 9.6% in 1990 to 25.7% in 2018, including 31.7% of first-time births. Recent studies that have examined inductions have been small qualitative studies or relied on either medical records or administrative data. This study examines induction from the perspective of those women who experienced it, with a particular focus on the prevalence and predictors of inductions for nonmedical indications, women's experience of pressure to induce labor and the relationship between the attempt to medically initiate labor and cesarean section. METHODS Study data are drawn from the 2119 respondents to the Listening to Mothers in California survey who were planning to have a vaginal birth in 2016. Mothers were asked if there had been an attempt to medically initiate labor, if it actually started labor, if they felt pressured to have the induction, if they had a cesarean and the reason for the induction. Reasons for induction were classified as either medically indicated or elective. RESULTS Almost half (47%) of our respondents indicated an attempt was made to medically induce their labor, and 71% of those attempts initiated labor. More than a third of the attempts (37%) were elective. Attempted induction overall was most strongly associated with giving birth at 41+ weeks (aOR 3.28; 95% C.I. 2.21-4.87). Elective inductions were more likely among multiparous mothers and in pregnancies at 39 or 40 weeks. The perception of being pressured to have labor induced was related to higher levels of education, maternal preference for less medical intervention in birth, having an obstetrician compared to a midwife and gestational ages of 41+ weeks. Cesarean birth was more likely in the case of overall induction (aOR 1.51; 95% C.I. 1.11-2.07) and especially following a failed attempt at labor induction (aOR 4.50; 95% C.I. 2.93-6.90). CONCLUSION Clinicians counselling mothers concerning the need for labor induction should be aware of mothers' perceptions about birth and engage in true shared decision making in order to avoid the maternal perception of being pressured into labor induction.
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Affiliation(s)
- Eugene Declercq
- Community Health Sciences Department Boston University School of Public Health, 801 Massachusetts Ave., Boston, MA 02118 USA
| | - Candice Belanoff
- Community Health Sciences Department Boston University School of Public Health, 801 Massachusetts Ave., Boston, MA 02118 USA
| | - Ronald Iverson
- Department of Obstetrics and Gynecology, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118 USA
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Lou S, Carstensen K, Hvidman L, Jensen TF, Neumann L, Habben JG, Uldbjerg N. "I guess baby was just too comfy in there…": A qualitative study of women's experiences of elective late-term induction of labour. Women Birth 2020; 34:242-249. [PMID: 32404274 DOI: 10.1016/j.wombi.2020.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/05/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The frequency of induction of labour (IOL) in late-term pregnancy has increased significantly, but little is known about how women with uncomplicated pregnancies experience IOL for late-term indication alone. AIM To explore how women with uncomplicated pregnancies experienced late-term IOL. METHODS Qualitative interviews were conducted with 23 women who all had labour induced on late-term indication only. Participants were recruited from two Danish hospitals who offered an outpatient induction regime. The women were interviewed 4-8 weeks after birth. Data were analysed using thematic analysis. RESULTS All women had hoped for a spontaneous birth. Prolonged pregnancy was understood as the body/baby "not being ready", but generally, the women were not worried at that point. Most women felt adequately informed about the reasons for IOL, but some requested more information and time to consider their options. The majority considered IOL to be both an offer and a recommendation. One-third of the participants were initially hesitant but chose/accepted IOL because of weariness from pregnancy and the impatience to deliver a healthy child. The opportunity of outpatient induction was generally appreciated as it allowed the women to continue everyday activities while waiting for labour to begin. Nineteen women reported having a good birthing experience. Two women felt that negative birthing experiences were partly related to IOL. CONCLUSIONS Most women considered the late-term IOL to be a positive experience. Some women requested more information and time to consider alternatives. These women should be provided with supported opportunities to consider the options.
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Affiliation(s)
- Stina Lou
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark; Center for Fetal Diagnostics, Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
| | - Kathrine Carstensen
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Trine Fritzner Jensen
- Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark
| | - Lone Neumann
- Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark
| | - Joke-Gesine Habben
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Tarimo CS, Mahande MJ, Obure J. Prevalence and risk factors for caesarean delivery following labor induction at a tertiary hospital in North Tanzania: a retrospective cohort study (2000-2015). BMC Pregnancy Childbirth 2020; 20:173. [PMID: 32188409 PMCID: PMC7079438 DOI: 10.1186/s12884-020-02861-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Labor induction is among the common and widely practiced obstetric interventions aiming at achieving vaginal delivery. However, cesarean section (CS) delivery incidences have been reported following its use. This study aimed at determining the prevalence and risk factors for caesarean delivery following labor induction among women who gave birth at a tertiary hospital in north-Tanzania. METHODS A hospital-based retrospective cohort study was designed using maternally-linked data from Kilimanjaro Christian Medical Centre (KCMC) birth registry among women who gave birth to singleton babies from the year 2000 to 2015. All induced deliveries done in this period were studied. Women with multiple pregnancy, missing information on delivery mode and those with history of CS delivery were excluded. Relative risk and 95% Confidence Interval for risk factors for CS delivery following labor induction were estimated using log-binomial regression models. Robust variance estimation was used to account for repeated deliveries from the same subject. RESULTS A total of 1088 deliveries were analysed. The prevalence of CS following labour induction was 26.75%. Independent risk factors for CS delivery were; primiparity (RR = 1.46; 95% CI: 1.18-1.81), high birthweight (RR =1.28; 95% CI: 1.02-1.61), post-term pregnancy (RR = 1.45; 95% CI: 1.09-1.93), and urban residence (RR =1.29; 95%CI: 1.05-1.58). CONCLUSION In patients undergoing labor induction, primiparity, high birthweight, post dates and urban residence were found to associate with an elevated risk of caesarean delivery. Assessment of these factors prior to labor induction intervention is warranted to reduce adverse pregnancy outcomes associated with emergency caesarean delivery.
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Affiliation(s)
- Clifford Silver Tarimo
- Department of Science and Laboratory Technology, Dar es Salaam Institute of Technology, P.O. Box 2958, Dar es Salaam, Tanzania.
| | - Michael J Mahande
- Institute of Public Health, Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Tanzania
| | - Joseph Obure
- Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Tanzania
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Kierach R, Dąbrowski K, Grabarek BO, Kojs-Mrożkiewicz M, Boroń D. Is ursodeoxycholic acid therapy due to pregnant intrahepatic cholestasis change the adiponectin and fibroblast growth factor-21 levels?-Pilot study. Dermatol Ther 2020; 33:e13296. [PMID: 32149445 DOI: 10.1111/dth.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/04/2020] [Indexed: 11/28/2022]
Abstract
The main aim of the study was to assess changes in adiponectin and fibroblast growth factor 21 (FGF21) levels in pregnant women with intrahepatic cholestasis during ursodeoxycholic acid (UDCA) therapy. The study included 40 pregnant women with intrahepatic cholestasis (ICP) treated with UDCA. In the pregnant ICP group, material for further analysis was collected three times: before the first dose of drug T1, 4 weeks after the first dose of drug T2, 8 weeks after the first dose of drug T3, and 1 day after delivery T4 (P < .05). Regarding changes in the adiponectin concentration profile, three statistical significance (P < .05) was found: before the first dose and 8 weeks of treatment and 1 day after delivery, as well as between 4 and 8 weeks of UDCA acid therapy. In the fourth and eighth weeks of treatment, adiponectin levels reached a higher concentration than before the first dose of UDCA, but a decrease was observed 1 day after delivery. It has been confirmed that UDCA therapy has an impact on the dynamics of changes in adiponectin and FGF21 levels as well as indicators characterizing liver function.
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Affiliation(s)
- Rafał Kierach
- Department of Obsterics and Gynecology in Ruda Slaska, Medical University of Silesia, Ruda Slaska, Poland
| | - Krzysztof Dąbrowski
- Department of Obsterics and Gynecology in Ruda Slaska, Medical University of Silesia, Ruda Slaska, Poland
| | - Beniamin O Grabarek
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, Kraków, Poland.,Department of Histology, Cytophysiology and Emryology, University of Technology, Faculty of Medicine, Katowice, Poland
| | - Marta Kojs-Mrożkiewicz
- Department of Histology, Cytophysiology and Emryology, University of Technology, Faculty of Medicine, Katowice, Poland
| | - Dariusz Boroń
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, Kraków, Poland.,Department of Histology, Cytophysiology and Emryology, University of Technology, Faculty of Medicine, Katowice, Poland.,Faculty of Health Science, Public Higher Medical Professional School in Opole, Opole, Poland.,Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, Kraków, Poland
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Coates D, Donnolley N, Foureur M, Henry A. Women's experiences of decision-making and attitudes in relation to induction of labour: A survey study. Women Birth 2020; 34:e170-e177. [PMID: 32146087 DOI: 10.1016/j.wombi.2020.02.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND Rates of induction of labour have been increasing globally to up to one in three pregnancies in many high-income countries. Although guidelines around induction, and strength of the underlying evidence, vary considerably by indication, shared decision-making is increasingly recognised as key. The aim of this study was to identify women's mode of birth preferences and experiences of shared decision-making for induction of labour. METHOD An antenatal survey of women booked for an induction at eight Sydney hospitals was conducted. A bespoke questionnaire was created assessing women's demographics, indication for induction, pregnancy model of care, initial birth preferences, and their experience of the decision-making process. RESULTS Of 189 survey respondents (58% nulliparous), major reported reasons for induction included prolonged pregnancy (38%), diabetes (25%), and suspected fetal growth restriction (8%). Most respondents (72%) had hoped to labour spontaneously. Major findings included 19% of women not feeling like they had a choice about induction of labour, 26% not feeling adequately informed (or uncertain if informed), 17% not being given alternatives, and 30% not receiving any written information on induction of labour. Qualitative responses highlight a desire of women to be more actively involved in decision-making. CONCLUSION A substantial minority of women did not feel adequately informed or prepared, and indicated they were not given alternatives to induction. Suggested improvements include for face-to-face discussions to be supplemented with written information, and for shared decision-making interventions, such as the introduction of decision aids and training, to be implemented and evaluated.
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Affiliation(s)
- Dominiek Coates
- University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, Australia; Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) Australia; School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, Australia.
| | - Natasha Donnolley
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, UNSW, Sydney, Australia.
| | - Maralyn Foureur
- University of Newcastle, Faculty of Health and Medicine, Australia; Hunter New England Nursing and Midwifery Research Centre, Australia.
| | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia; The George Institute for Global Health, UNSW Medicine, Australia
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Coates D, Makris A, Catling C, Henry A, Scarf V, Watts N, Fox D, Thirukumar P, Wong V, Russell H, Homer C. A systematic scoping review of clinical indications for induction of labour. PLoS One 2020; 15:e0228196. [PMID: 31995603 PMCID: PMC6988952 DOI: 10.1371/journal.pone.0228196] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 01/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The proportion of women undergoing induction of labour (IOL) has risen in recent decades, with significant variation within countries and between hospitals. The aim of this study was to review research supporting indications for IOL and determine which indications are supported by evidence and where knowledge gaps exist. METHODS A systematic scoping review of quantitative studies of common indications for IOL. For each indication, we included systematic reviews/meta-analyses, randomised controlled trials (RCTs), cohort studies and case control studies that compared maternal and neonatal outcomes for different modes or timing of birth. Studies were identified via the databases PubMed, Maternity and Infant Care, CINAHL, EMBASE, and ClinicalTrials.gov from between April 2008 and November 2019, and also from reference lists of included studies. We identified 2554 abstracts and reviewed 300 full text articles. The quality of included studies was assessed using the RoB 2.0, the ROBINS-I and the ROBIN tool. RESULTS 68 studies were included which related to post-term pregnancy (15), hypertension/pre-eclampsia (15), diabetes (9), prelabour rupture of membranes (5), twin pregnancy (5), suspected fetal compromise (4), maternal elevated body mass index (BMI) (4), intrahepatic cholestasis of pregnancy (3), suspected macrosomia (3), fetal gastroschisis (2), maternal age (2), and maternal cardiac disease (1). Available evidence supports IOL for women with post-term pregnancy, although the evidence is weak regarding the timing (41 versus 42 weeks), and for women with hypertension/preeclampsia in terms of improved maternal outcomes. For women with preterm premature rupture of membranes (24-37 weeks), high-quality evidence supports expectant management rather than IOL/early birth. Evidence is weakly supportive for IOL in women with term rupture of membranes. For all other indications, there were conflicting findings and/or insufficient power to provide definitive evidence. CONCLUSIONS While for some indications, IOL is clearly recommended, a number of common indications for IOL do not have strong supporting evidence. Overall, few RCTs have evaluated the various indications for IOL. For conditions where clinical equipoise regarding timing of birth may still exist, such as suspected macrosomia and elevated BMI, researchers and funding agencies should prioritise studies of sufficient power that can provide quality evidence to guide care in these situations.
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Affiliation(s)
- Dominiek Coates
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Angela Makris
- Department of Medicine, Western Sydney University, Sydney, Australia
- Women’s Health Initiative Translational Unit (WHITU), Liverpool Hospital, Liverpool, Australia
| | - Christine Catling
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Amanda Henry
- School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, Australia
- Department of Women’s and Children’s Health, St George Hospital, Sydney, Australia
- The George Institute for Global Health, UNSW Medicine, Sydney, Australia
| | - Vanessa Scarf
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Nicole Watts
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Deborah Fox
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Purshaiyna Thirukumar
- School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Vincent Wong
- Liverpool Diabetes Collaborative Research Unit, Ingham Institute of Applied Research Science, University of New South Wales, Liverpool, Australia
| | - Hamish Russell
- South Western Sydney Local Health District, Sydney, Australia
| | - Caroline Homer
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
- Maternal and Child Health Program, Burnet Institute, Victoria, Australia
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23
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Blanc-Petitjean P, Schmitz T, Salomé M, Goffinet F, Le Ray C. Target populations to reduce cesarean rates after induced labor: A national population-based cohort study. Acta Obstet Gynecol Scand 2019; 99:406-412. [PMID: 31628852 DOI: 10.1111/aogs.13751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Great variations in cesarean rates after induction of labor exist and reasons for these disparities remain unclear. They may be explained by individual characteristics or obstetric practices. Ten-group classification systems have proved their utility to monitor cesarean rates in general population. We aimed to identify groups of women that account for most cesareans after induction of labor using the Nippita reproducible 10-group classification, specifically designed for induced population. MATERIAL AND METHODS A prospective population-based cohort study was performed in 94 French maternity units, including 3042 women undergoing induction of labor. Women were sorted according to 10 mutually exclusive groups based on parity, weeks of gestation, number of fetuses, fetal presentation and previous cesarean delivery. Relative size, cesarean delivery rate and contribution to the overall cesarean rate were described for each group. Cesarean rates were compared according to the Bishop score at the onset of labor induction. Indications for cesarean delivery were also described in the groups that contributed most to the overall cesarean rate. The MEDIP protocol was registered in ClinicalTrial (NCT02477085). RESULTS The overall cesarean rate was 21.0% among this population of induced women. Nulliparous women with a term singleton cephalic fetus (groups 1, 2 and 3; at 37-38, 39-40 and ≥41 weeks of gestation, respectively) accounted for two-thirds of the overall cesarean rate because they were the largest group (relative size of 10.6, 16.6 and 18.1%, respectively) and had higher cesarean rates (27.2, 30.9 and 33.0%, respectively). When the Bishop score was <6 (n = 2270/3042), cesarean delivery rates were higher (24.1 vs 10.7% if Bishop score ≥6, P < 0.01), in particular for group 1 (29.1 vs 12.5%, P = 0.02), and group 2 (33.3 vs 19.3%, P = 0.01). In groups 1, 2 and 3, which contributed most to the overall cesarean rate, a significant part of the cesareans were performed before 6 cm of cervical dilation for dystocia only (40.0, 16.7 and 17.6%, respectively). CONCLUSIONS Nulliparous women with a term singleton cephalic fetus and an unfavorable cervix represent the population to target for auditing induction practices. Specific actions could be implemented among this population to weigh the benefits and risks of induction and improve the management of labor induction.
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Affiliation(s)
- Pauline Blanc-Petitjean
- Center of Research in Epidemiology and Statistics (CRESS), INSERM, National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Department of Obstetrics and Gynecology, AP-HP, Louis Mourier Hospital, Université de Paris, Colombes, France
| | - Thomas Schmitz
- Center of Research in Epidemiology and Statistics (CRESS), INSERM, National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Department of Obstetrics and Gynecology, AP-HP, Robert Debré Hospital, Université de Paris, Paris, France
| | - Marina Salomé
- AP-HP, Cochin Hospital, Clinical Research Unit-Clinical Investigation Center (URC-CIC) Paris Descartes Necker/Cochin, Paris, France
| | - François Goffinet
- Center of Research in Epidemiology and Statistics (CRESS), INSERM, National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,AP-HP, Cochin Hospital, Port Royal Maternity Unit, Université de Paris, Paris, F-75014, France
| | - Camille Le Ray
- Center of Research in Epidemiology and Statistics (CRESS), INSERM, National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,AP-HP, Cochin Hospital, Port Royal Maternity Unit, Université de Paris, Paris, F-75014, France
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Abstract
The rate of labor induction is steadily increasing and, in industrialized countries, approximately one out of four pregnant women has their labor induced. Induction of labor should be considered when the benefits of prompt vaginal delivery outweigh the maternal and/or fetal risks of waiting for the spontaneous onset of labor. However, this procedure is not free of risks, which include an increase in operative vaginal or caesarean delivery and excessive uterine activity with risk of fetal heart rate abnormalities. A search for “Induction of Labor” retrieves more than 18,000 citations from 1844 to the present day. The aim of this review is to summarize the controversies concerning the indications, the methods, and the tools for evaluating the success of the procedure, with an emphasis on the scientific evidence behind each.
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Affiliation(s)
- Anna Maria Marconi
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milano, Milano, Italy
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25
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Hair cortisol levels, psychological stress and psychopathological symptoms prior to instrumental deliveries. Midwifery 2019; 77:45-52. [DOI: 10.1016/j.midw.2019.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 01/05/2023]
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Lou S, Hvidman L, Uldbjerg N, Neumann L, Jensen TF, Haben JG, Carstensen K. Women's experiences of postterm induction of labor: A systematic review of qualitative studies. Birth 2019; 46:400-410. [PMID: 30561053 DOI: 10.1111/birt.12412] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Over the last decade, induction of labor (IOL) in postterm pregnancies has increased. Studies have shown the medical advantages of postterm IOL, but less is known about the perspectives of the pregnant women. This review aimed to summarize the current qualitative evidence on women's experience of postterm IOL. METHODS A systematic literature search was performed in three databases. A total of 3193 publications were identified, but only eight studies met the inclusion criteria. Thematic analysis guided the data extraction and synthesis. The Confidence in the Evidence for Reviews of Qualitative research (CERQual) approach was used to assess confidence in the findings. RESULTS Three major findings were identified. First, for some women, IOL required a shift in expectations because the hope of spontaneous labor had to be given up. Second, the IOL decision was considered a recommendation from health care professionals and was experienced as a nondecision. Finally, the induction process was experienced as a sequential set of steps where the women were expected to fit into the existing hospital organization. The CERQual assessment suggested moderate confidence in all findings. DISCUSSION The negative experiences identified in this review can be greatly reduced by a communicative and patient-centered approach. To support informed choice and shared decision making, women need high-quality, unbiased information about IOL, alternative options, and potential outcomes, in addition to time for reflection on their personal values and preferences. Women may need a professionally initiated and supported opportunity to re-evaluate their hopes and expectations before IOL.
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Affiliation(s)
- Stina Lou
- DEFACTUM -Public Health and Health Services Research, Central Denmark Region, Aarhus, Denmark.,Center for Fetal Diagnostics, Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Neumann
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark
| | - Trine Fritzner Jensen
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark
| | - Joke-Gesine Haben
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Kathrine Carstensen
- DEFACTUM -Public Health and Health Services Research, Central Denmark Region, Aarhus, Denmark
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Ghi T, Dall’Asta A, Fieni S. Elective induction of labour in low risk nulliparous women at term: Caution is needed. Eur J Obstet Gynecol Reprod Biol 2019; 239:64-66. [DOI: 10.1016/j.ejogrb.2019.05.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/20/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
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28
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Induction of labor and postpartum blood loss. BMC Pregnancy Childbirth 2019; 19:265. [PMID: 31345178 PMCID: PMC6659310 DOI: 10.1186/s12884-019-2410-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/12/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To analyze blood loss after delivery in women with induction of labor compared to women with spontaneous onset of labor. METHODS In this secondary analysis of a prospective cohort study investigating postpartum hemorrhage, 965 deliveries were analyzed including 380 women with induction of labor (39%) between 2015 and 2016. Primary outcome parameters were rate of postpartum hemorrhage, estimated blood loss and post-partum decrease in hemoglobin. RESULTS Rates of postpartum hemorrhage and estimated blood loss were not significantly different in women with induction of labor. Women with induction of labor had a significantly reduced decrease in hemoglobin after delivery. In the multivariate linear regression analysis, induction of labor remained associated with reduced decrease in hemoglobin. Secondary maternal and neonatal outcomes were unaffected. CONCLUSIONS Induction of labor is not associated with increased blood loss after delivery and should not be regarded as a risk factor for postpartum hemorrhage.
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Induction of labour indications and timing: A systematic analysis of clinical guidelines. Women Birth 2019; 33:219-230. [PMID: 31285166 DOI: 10.1016/j.wombi.2019.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is widespread and some unexplained variation in induction of labour rates between hospitals. Some practice variation may stem from variability in clinical guidelines. This review aimed to identify to what extent induction of labour guidelines provide consistent recommendations in relation to reasons for, and timing of, induction of labour and ascertain whether inconsistencies can be explained by variability guideline quality. METHOD We conducted a systematic search of national and international English-language guidelines published between 2008 and 2018. General induction of labour guidelines and condition-specific guidelines containing induction of labour recommendations were searched. Guidelines were reviewed and extracted independently by two reviewers. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II Instrument. FINDINGS Forty nine guidelines of varying quality were included. Indications where guidelines had mostly consistent advice included prolonged pregnancy (induction between 41 and 42 weeks), preterm premature rupture of membranes, and term preeclampsia (induction when preeclampsia diagnosed ≥37 weeks). Guidelines were also consistent in agreeing on decreased fetal movements and oligohydramnios as valid indications for induction, although timing recommendations were absent or inconsistent. Common indications where there was little consensus on validity and/or timing of induction included gestational diabetes, fetal macrosomia, elevated maternal body mass index, and twin pregnancy. CONCLUSION Substantial variation in clinical practice guidelines for indications for induction exists. As guidelines rated of similar quality presented conflicting recommendations, guideline variability was not explained by guideline quality. Guideline variability may partly account for unexplained variation in induction of labour rates.
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30
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Induction of labour: Experiences of care and decision-making of women and clinicians. Women Birth 2019; 33:e1-e14. [PMID: 31208865 DOI: 10.1016/j.wombi.2019.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND There has been a rise in induction of labour over recent decades. There is some tension in the literature in relation to when induction is warranted and when not, with variability between guidelines and practice. Given these tensions, the importance of shared decision-making between clinicians and women is increasingly highlighted as paramount, but it remains unclear to what extent this occurs in routine care. METHOD Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question "What are the views, preferences and experiences of women and clinicians in relation to induction of labour more broadly, and practices of decision-making specifically?" To identify studies, the databases PubMed, Maternity and Infant Care, CINAHL and EMBASE were searched from 2008 to 2018, and reference lists of included studies were examined. FINDINGS 20 papers met inclusion criteria, in relation to (a) women's preferences, experiences and satisfaction with IOL; (b) women's experience of shared-decision making in relation to induction; (c) interventions that improve shared decision-making and (d) factors that influence decision-making from the perspective of clinicians. Synthesis of the included studies indicates that decision-making in relation to induction of labour is largely informed by medical considerations. Women are not routinely engaged in the decision making process with expectations and preferences largely unmet. CONCLUSION There is a need to develop strategies such as decision aids, the redesign of antenatal classes, and clinician communication training to improve the quality of information available to women and their capacity for informed decision-making.
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31
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Bahri Khomami M, Joham AE, Boyle JA, Piltonen T, Silagy M, Arora C, Misso ML, Teede HJ, Moran LJ. Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity-A systematic review, meta-analysis, and meta-regression. Obes Rev 2019; 20:659-674. [PMID: 30674081 DOI: 10.1111/obr.12829] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/29/2018] [Accepted: 12/06/2018] [Indexed: 01/21/2023]
Abstract
Polycystic ovary syndrome (PCOS) is associated with an increased risk of maternal pregnancy and delivery complications. However, the impact of clinical features of PCOS and other potential risk factors in PCOS is still unknown. We aimed to investigate the association of PCOS with maternal pregnancy and delivery complications with consideration of risk factors and potential confounders. The meta-analysis included 63 studies. PCOS was associated with higher miscarriage, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, induction of labour, and caesarean section. The association of PCOS with these outcomes varied by geographic continent, PCOS phenotypes, and study quality. Pre-eclampsia and induction of labour were not associated with PCOS on body mass index-matched studies. No outcome was associated with PCOS on assisted pregnancies. Age was significantly associated with higher miscarriage on meta-regression. There were no studies assessing perinatal depression. We confirm that PCOS is associated with an increased risk of maternal pregnancy and delivery complications. The association of PCOS with the outcomes is worsened in hyperandrogenic PCOS phenotypes, in specific geographic continents, and in the highest quality studies but disappears in assisted pregnancies. Future studies in PCOS are warranted to investigate proper timing for screening and prevention of maternal pregnancy and delivery complications with consideration of clinical features of PCOS.
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Affiliation(s)
- Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anju E Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Australia
| | - Terhi Piltonen
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Michael Silagy
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Australia
| | - Chavy Arora
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Australia
| | - Marie L Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia.,Monash Partners Academic Health Sciences Centre, Melbourne, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Kim MA, Han GH, Kim YH. Prediction of small-for-gestational age by fetal growth rate according to gestational age. PLoS One 2019; 14:e0215737. [PMID: 31026299 PMCID: PMC6485641 DOI: 10.1371/journal.pone.0215737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Small-for-gestational age (SGA) infants should be identified before birth because of an increased risk of adverse perinatal outcomes. The objective of this study was to assess the impact of fetal growth rate by gestational age on the prediction of SGA and to identify the optimal time to initiate intensive fetal monitoring to detect SGA in low-risk women. We also sought to determine which the ultrasonographic parameters that contribute substantially to the birthweight determination. METHODS This was a retrospective study of 442 healthy pregnant women with singleton pregnancies. There were 328 adequate-for-gestational age (AGA) neonates and 114 SGA infants delivered between 37+0 and 41+6 weeks of gestation. We compared the biparietal diameters (BPD), head circumferences (HC), abdominal circumferences (AC), femur lengths (FL), and estimated fetal weights (EFW) obtained on each ultrasound to determine which of these parameters was the best indicator of SGA. We created receiver operating characteristic curves, calculated the areas under the curves (AUCs), and analyzed the data using multivariable logistic regressions to assess the ultrasound screening performances and identify the best predictive factor. RESULTS Among the four ultrasonographic parameters, the AC measurement between 24+0~28+6 weeks achieved a sensitivity of 79.5% and a specificity of 71.7%, with an AUC of 0.806 in the prediction of SGA. AC showed consistently higher AUCs above 0.8 with 64~80% sensitivities as gestational age progressed. EFW measurements from 33+0~35+6 gestational weeks achieved a sensitivity of 60.6% and a specificity of 87.6%, with an AUC of 0.826. In a conditional growth model developed from the linear mixed regression, the value differences between AC and EFW in the SGA and AGA groups became even more pronounced after 33+0~35+6 weeks. CONCLUSION Healthy low-risk women with a low fetal AC after 24 weeks' gestation need to be monitored carefully for fetal growth to identify SGA infants with a risk for adverse perinatal outcomes.
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Affiliation(s)
- Min-A Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Gwan Hee Han
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Han Kim
- Department of Obstetrics and Gynecology, Severance Hospital, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Teitler JO, Plaza R, Hegyi T, Kruse L, Reichman NE. Elective Deliveries and Neonatal Outcomes in Full-Term Pregnancies. Am J Epidemiol 2019; 188:674-683. [PMID: 30698621 DOI: 10.1093/aje/kwz014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/12/2022] Open
Abstract
Cesarean and induced delivery rates have risen substantially in recent decades and currently account for over one-third and one-fourth of US births, respectively. Initiatives to encourage delaying deliveries until a gestational age of 39 weeks appear to have slowed the increases but have not led to declines. The rates are at historic highs and the consequences of these interventions when not medically necessary have not been systematically explored at the population level. In this study, we used population-level data on births in New Jersey (1997-2011) to document trends in elective deliveries (induced vaginal delivery, cesarean delivery with no labor trial, and cesarean delivery after induction) and estimate logistic and linear regression models of associations between delivery method and neonatal morbidities and cost-related outcomes in low-risk pregnancies. We found that elective deliveries more than doubled during the observation period and were associated with neonatal morbidities and cost-related outcomes even at gestational ages of 39 and 40 weeks. Findings suggest that delaying beyond 39 weeks and avoiding delivery interventions when not medically necessary would improve infant health and reduce health-care costs.
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Affiliation(s)
| | - Rayven Plaza
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas
| | - Thomas Hegyi
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Lakota Kruse
- New Jersey Department of Health, Trenton, New Jersey
| | - Nancy E Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
- Child Health Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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Tahmina S, Prakash S, Daniel M. Maternal and perinatal outcomes of induction of labor in oligohydramnios at term-a retrospective cohort study. J Matern Fetal Neonatal Med 2019; 33:2190-2194. [PMID: 30394156 DOI: 10.1080/14767058.2018.1543654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To evaluate the maternal and perinatal outcomes of labor induction in women at term with oligohydramnios.Methods: A retrospective cohort of women with a singleton pregnancy, who had oligohydramnios at or beyond term (37-42 weeks) and underwent induction of labor for oligohydramnios were studied. Antenatally diagnosed fetal anomalies and intrauterine fetal demise were excluded. The women were categorized into two groups: 1) women with isolated oligohydramnios (n = 166) and 2) women with oligohydramnios associated with other maternal or fetal complications (n = 43). Maternal and perinatal outcomes were collected from the records of all deliveries, data compiled, and appropriate statistical tests were applied.Results: The study included 209 women with mean gestational age of 38.76 ± 1.00 weeks and mean induction-delivery interval of 17.45 ± 8.70 hours (16.98 hours in group 1 versus 19.23 hours in group 2). Most (75%) women delivered vaginally. Only one of the neonates had an Apgar score of less than 7 at 5 min. Average neonatal ICU length of stay was 5.52 days (5.27 days in group 1 versus 6.17 days in group 2). Among all the maternal and neonatal outcomes studied, only the mean birth weights among the two groups was found to be statistically significant (p = 0.0017).Conclusions: Women with isolated oligohydramnios and their neonates were not found to suffer any additional harm due to labor induction at term than women who had oligohydramnios associated with other complications.
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Affiliation(s)
- S Tahmina
- Pondicherry Institute of Medical Sciences, Obstetrics & Gynaecology, Pondicherry, India
| | - Seethalakshmi Prakash
- Pondicherry Institute of Medical Sciences, Obstetrics & Gynaecology, Pondicherry, India
| | - Mary Daniel
- Pondicherry Institute of Medical Sciences, Obstetrics & Gynaecology, Pondicherry, India
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35
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Loktionov D, McCarthy CM, Skehan MC. Does an elective induction policy negatively impact on vaginal delivery rates? A 30-month review of an elective induction policy. Ir J Med Sci 2018; 188:563-567. [PMID: 30121814 DOI: 10.1007/s11845-018-1883-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The rate of induction of labour varies across Health Service Executive hospital regions in Ireland averaging at 23.3 per 100 deliveries in 2005-2009. The increasing rate of elective induction of labour in Ireland calls for more studies looking into associated maternal and/or neonatal outcomes. STUDY AIM The aim of this study is to show that an elective induction policy with management by a sole consultant obstetrician can decrease caesarean section rates as well as positively impact maternal and neonatal complications. METHODS We conducted a retrospective review of women attending a named obstetrician over a 1-year period. In total, 22 variables were collected, including basic patient demographics, mode of onset of labour, method of induction, mode of delivery, length of labour and neonatal outcomes. RESULTS In total, 583 patients were identified in the study period. One hundred twenty-six (21.6%) patients presented with a spontaneous onset of labour, and 405 (69.4%) of patients had an induction of labour. Relative risk of having an emergency caesarean section, if labour is induced, is 1.42 (95% CI 0.64 to 3.14), and no statistical significance was demonstrated (p = 0.38). There was a statistically significant difference in operative vaginal delivery versus standard vaginal delivery relative risk between women ≥ 35-year-old and < 35-year-old groups, 0.47 (95% CI 0.39-0.57), p < 0.0001. CONCLUSION Elective induction of labour is not associated with an increased risk of caesarean section or operative vaginal delivery in patients less than 35 years of age. This shows that elective induction is an appropriate intervention in selected scenarios without affecting mode of delivery.
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Affiliation(s)
- Dmitry Loktionov
- Department of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ennis Road, Limerick, Ireland.
| | - Claire M McCarthy
- Department of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ennis Road, Limerick, Ireland
| | - Mark C Skehan
- Department of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ennis Road, Limerick, Ireland
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Seijmonsbergen-Schermers AE, Zondag DC, Nieuwenhuijze M, Van den Akker T, Verhoeven CJ, Geerts C, Schellevis F, De Jonge A. Regional variations in childbirth interventions in the Netherlands: a nationwide explorative study. BMC Pregnancy Childbirth 2018; 18:192. [PMID: 29855270 PMCID: PMC5984340 DOI: 10.1186/s12884-018-1795-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/30/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although interventions in childbirth are important in order to prevent neonatal and maternal morbidity and mortality, non-indicated use may cause avoidable harm. Regional variations in intervention rates, which cannot be explained by maternal characteristics, may indicate over- and underuse. The aim of this study is to explore regional variations in childbirth interventions in the Netherlands and their associations with interventions and adverse outcomes, controlled for maternal characteristics. METHODS Childbirth intervention rates were compared between twelve Dutch regions, using data from the national perinatal birth register for 2010-2013. All single childbirths from 37 weeks' gestation onwards were included. Primary outcomes were induction and augmentation of labour, pain medication, instrumental birth, caesarean section (prelabour, intrapartum) and paediatric involvement. Secondary outcomes were adverse neonatal and maternal outcomes. Multivariable logistic regression analyses were used to adjust for maternal characteristics. Associations were expressed in Spearman's rank correlation coefficients. RESULTS Most variation was found for type of pain medication and paediatric involvement. Epidural analgesia rates varied from between 12 and 38% (nulliparous) and from between 5 and 14% (multiparous women). These rates were negatively correlated with rates of other pharmacological pain relief, which varied from between 15 and 43% (nulliparous) and from between 10 and 27% (multiparous). Rates of paediatric involvement varied from between 37 and 60% (nulliparous) and from between 26 and 43% (multiparous). For instrumental vaginal births, rates varied from between 16 and 19% (nulliparous) and from between 3 and 4% (multiparous). For intrapartum caesarean section, the variation was 13-15% and 5-6%, respectively. A positive correlation was found between intervention rates in midwife-led and obstetrician-led care at the onset of labour within the same region. Adverse neonatal and maternal outcomes were not lower in regions with higher intervention rates. Higher augmentation of labour rates correlated with higher rates of severe postpartum haemorrhage. CONCLUSIONS Most variation was found for type of pain medication and paediatric involvement, and least for instrumental vaginal births and intrapartum caesarean sections. Care providers and policy makers should critically audit remarkable variations, since these may be unwarranted. Limited variation for some interventions may indicate consensus for their use. Further research should focus on variations in evidence-based interventions and indications for the use of interventions in childbirth.
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Affiliation(s)
- A. E. Seijmonsbergen-Schermers
- Department of Midwifery Science, AVAG, Amsterdam Public Health research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - D. C. Zondag
- Department of Midwifery Science, AVAG, Amsterdam Public Health research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - M. Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
| | - T. Van den Akker
- Department of Obstetrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - C. J. Verhoeven
- Department of Midwifery Science, AVAG, Amsterdam Public Health research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, De Run 4600, PO Box 7777, 5500 MB Veldhoven, the Netherlands
| | - C. Geerts
- Department of Midwifery Science, AVAG, Amsterdam Public Health research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - F. Schellevis
- NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - A. De Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
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Jeong YA, Chung CW. Pregnant Women's Labor Progress, Childbirth Outcome, and Childbirth Satisfaction according to the Presence or Absence of Labor Induction. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2018; 24:58-70. [PMID: 37684913 DOI: 10.4069/kjwhn.2018.24.1.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 09/10/2023] Open
Abstract
PURPOSE To provide accurate information on induced labor and find strategies to enhance women's childbirth satisfaction. METHODS Participants were pregnant women expected to have normal vaginal delivery. A total of 113 women with induced labor and 61 women with spontaneous labor were surveyed. Data were collected using a questionnaire and electronic medical records. RESULTS The following variables related to labor progress showed significant differences between the induced labor group and the spontaneous labor group: length of the first stage of labor in primigravidas, use of analgesic, incidence of uterine hyperstimulation, incidence of fetal distress, and medical treatment for the expectant mother. Delivery type and the incidence of postpartum complications showed significant difference between the two groups. Induced labor women's childbirth satisfaction was mainly affected by the process of labor whereas spontaneous labor women's childbirth satisfaction was affected by the outcome of childbirth. CONCLUSION Medical staff should have accurate information on the risk of induced labor and the benefits of a natural delivery. Moreover, medical staff should provide necessary information and environment for women to participate in the decision-making process.
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Affiliation(s)
- Yun Ah Jeong
- Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
| | - Chae Weon Chung
- Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
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Salahuddin M, Davidson C, Lakey DL, Patel DA. Characteristics Associated with Induction of Labor and Delivery Route Among Primiparous Women with Term Deliveries in the Listening to Mothers III Study. J Womens Health (Larchmt) 2017; 27:590-598. [PMID: 29237138 DOI: 10.1089/jwh.2017.6598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Induction of labor (IOL) is increasingly common in the United States, yet characteristics associated with IOL among primiparous women delivering at term are not well understood. MATERIALS AND METHODS Data from the Listening to Mothers III study, a survey of women aged 18-45 with singleton deliveries in U.S. hospitals in 2011-2012, were utilized. Weighted logistic regression models examined predictors of IOL among 924 primiparous women with term deliveries. Associations of maternal characteristics with delivery route (cesarean and vaginal delivery) were examined among primiparous women induced at term. RESULTS Four hundred twenty-three (45.8%) primiparous women with term deliveries underwent IOL; subjective reasons were reported by 53% of induced women. Women who were married (odds ratios [OR] = 1.8, 95% confidence intervals [CI] 1.2-2.9), felt pressure from a provider for IOL (OR = 3.5, 95% CI 2.0-6.2), and whose provider was concerned about the size of the baby (OR = 1.9, 95% CI 1.2-2.9) were significantly more likely to undergo IOL. Nearly 30% of primiparous women who underwent IOL at term had a cesarean delivery (CD). Among the induced women, those who were overweight/obese (OR = 4.9, 95% CI 2.5-10.0), felt pressure from a provider for CD (OR = 8.6, 95% CI 3.5-21.2), and whose provider suspected the baby might be getting large near end of pregnancy (OR = 2.7, 95% CI 1.1-7.0) were significantly more likely to have CD. CONCLUSIONS In this study, nearly half of the primiparous women with term deliveries underwent IOL, with a sizeable proportion reporting subjective reasons for induction. A better understanding of the characteristics associated with IOL at term may help reduce unnecessary interventions and, ultimately, primary CD.
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Affiliation(s)
- Meliha Salahuddin
- 1 Texas Collaborative for Healthy Mothers and Babies (TCHMB) , Houston, Texas.,2 Population Health, Office of Health Affairs, Texas Collaborative for Healthy Mothers and Babies (TCHMB), University of Texas System , Austin, Texas.,3 School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth) , Austin, Texas
| | - Christina Davidson
- 1 Texas Collaborative for Healthy Mothers and Babies (TCHMB) , Houston, Texas.,4 Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine , Houston, Texas
| | - David L Lakey
- 1 Texas Collaborative for Healthy Mothers and Babies (TCHMB) , Houston, Texas.,2 Population Health, Office of Health Affairs, Texas Collaborative for Healthy Mothers and Babies (TCHMB), University of Texas System , Austin, Texas.,5 University of Texas Health Science Center at Tyler, Tyler, Texas
| | - Divya A Patel
- 1 Texas Collaborative for Healthy Mothers and Babies (TCHMB) , Houston, Texas.,2 Population Health, Office of Health Affairs, Texas Collaborative for Healthy Mothers and Babies (TCHMB), University of Texas System , Austin, Texas.,5 University of Texas Health Science Center at Tyler, Tyler, Texas
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El Sharkwy IAE, Noureldin EH, Mohamed EAE, Shazly SA. Sequential Versus Concurrent Use of Vaginal Misoprostol Plus Foley Catheter for Induction of Labor: A Randomized Clinical Trial. J Obstet Gynaecol India 2017; 68:408-413. [PMID: 30224847 DOI: 10.1007/s13224-017-1059-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 10/04/2017] [Indexed: 11/26/2022] Open
Abstract
Background To compare between the sequential and concurrent use of vaginal misoprostol plus Foley catheter for labor induction. Methods This single-center, non-blinded randomized study was conducted at the department of Obstetrics and Gynecology, Faculty of medicine, Zagazig University. A total of 160 women with full term singleton pregnancy, cephalic presentation and bishop score ≤ 6 were randomized for labor induction with either concurrent or sequential use of vaginal misoprostol plus Foley catheter (80 cases in each group). The primary outcome measured was induction-to-delivery interval and secondary outcomes mesaured were vaginal delivery within 24 h, number of doses needed to induce labor, need of oxytocin for augmentation of labor, cesarean section rate, maternal or neonatal complications. Results The mean induction-to-delivery interval was 22.33 ± 13.28 h versus 18.45 ± 14.34 h (p = 0.041) in sequential and concurrent group, respectively. The percentage of women who completed vaginal delivery within 24 h was 51% versus 61% (p = 0.046) in sequential and concurrent group, respectively. Other maternal and neonatal outcomes were similar in both groups. Conclusion Concurrent use of vaginal misoprostol plus Foley catheter for labor induction was associated with shorter induction-to delivery interval compared to sequential use, and it increases the rate of vaginal delivery in the first 24 h.
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Amorim MMR, Souza ASR, Katz L. Planned caesarean section versus planned vaginal birth for severe pre-eclampsia. Cochrane Database Syst Rev 2017; 10:CD009430. [PMID: 29058762 PMCID: PMC6485640 DOI: 10.1002/14651858.cd009430.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pre-eclampsia is a very frequent complication of pregnancy, and anticipation of birth is often necessary. However, the best mode of giving birth remains to be established, although observational studies suggest better maternal and perinatal outcomes with vaginal birth. OBJECTIVES To assess the effects of a policy of planned caesarean section versus planned vaginal birth for women with severe pre-eclampsia on mortality and morbidity for mother and baby. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (6 September 2017) and reference lists of retrieved studies. SELECTION CRITERIA We planned to include all randomised trials of planned caesarean section versus planned vaginal birth for pregnant women with severe pre-eclampsia. Quasi-randomised and non-randomised studies are not eligible for inclusion in this review.The focus of this review is severe pre-eclampsia; studies of planned caesarean section versus planned vaginal birth in pregnant women with eclampsia are not eligible for inclusion. DATA COLLECTION AND ANALYSIS We identified no studies that met the inclusion criteria. We excluded two studies. MAIN RESULTS There are no included studies in this review. AUTHORS' CONCLUSIONS There is a lack of robust evidence from randomised controlled trials that can inform practice regarding planned caesarean section versus planned vaginal birth for women with severe pre-eclampsia. There is a need for high-quality randomised controlled trials to assess the short- and long-term effects of caesarean section and vaginal birth for these women and their babies.
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Affiliation(s)
- Melania MR Amorim
- Instituto de Medicina Integral Prof. Fernando Figueira ‐ IMIPRua dos Coelhos, 300RecifePernambucoBrazil50070‐050
| | - Alex Sandro R Souza
- Instituto de Medicina Integral Prof. Fernando Figueira ‐ IMIPRua dos Coelhos, 300RecifePernambucoBrazil50070‐050
| | - Leila Katz
- Instituto de Medicina Integral Prof. Fernando Figueira ‐ IMIPRua dos Coelhos, 300RecifePernambucoBrazil50070‐050
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Efficacy and safety of misoprostol, dinoprostone and Cook’s balloon for labour induction in women with foetal growth restriction at term. Arch Gynecol Obstet 2017; 296:777-781. [DOI: 10.1007/s00404-017-4492-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/14/2017] [Indexed: 11/26/2022]
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Duration of labor and the risk of severe postpartum hemorrhage: A case-control study. PLoS One 2017; 12:e0175306. [PMID: 28384337 PMCID: PMC5383278 DOI: 10.1371/journal.pone.0175306] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/23/2017] [Indexed: 11/19/2022] Open
Abstract
Objective Our main objective was to investigate the association between duration of active labor and severe postpartum hemorrhage. We examined the effect of the total duration of active labor, the effect of each stage of active labor, and the gradient effect of duration of labor on severe postpartum hemorrhage. Methods A case-control study was generated from a source population of all women admitted for delivery at Oslo University Hospital and Drammen Hospital in Buskerud municipality during the time period January 1, 2008 to December 31, 2011. The study population included all cases of severe postpartum hemorrhage (n = 859) and a random sample of controls (n = 1755). Severe postpartum hemorrhage was defined as postpartum blood loss ≥1500 mL or need for blood transfusion. Prolonged labor was defined as duration of active labor >12 hours according to the definition of the World Health Organization. We used logistic multivariable regression in the analysis. Results We observed a significantly longer mean duration of labor in women who experienced severe postpartum hemorrhage compared to controls (5.4 versus 3.8 hours, p<0.001). Women with severe postpartum hemorrhage also had a longer duration of all stages of active labor compared to controls. The association between the duration of active labor and severe postpartum changed from a linear dose-response association to a threshold association after adjusting for augmentation with oxytocin, induction of labor, primiparity, and fever during labor. Compared to controls, women with severe postpartum hemorrhage were more likely to have a prolonged labor >12 hours (adjusted odds ratio = 2.44, 95% confidence interval: 1.69–3.53, p< 0.001). Conclusion Prolonged active labor (duration >12 hours) was associated with severe postpartum hemorrhage. Increased vigilance seems required when the labor is prolonged to reduce the risk of severe postpartum hemorrhage.
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Middleton P, Shepherd E, Flenady V, McBain RD, Crowther CA. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev 2017; 1:CD005302. [PMID: 28050900 PMCID: PMC6464808 DOI: 10.1002/14651858.cd005302.pub3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Prelabour rupture of membranes (PROM) at term is managed expectantly or by planned early birth. It is not clear if waiting for birth to occur spontaneously is better than intervening, e.g. by inducing labour. OBJECTIVES The objective of this review is to assess the effects of planned early birth (immediate intervention or intervention within 24 hours) when compared with expectant management (no planned intervention within 24 hours) for women with term PROM on maternal, fetal and neonatal outcomes. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (9 September 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials of planned early birth compared with expectant management (either in hospital or at home) in women with PROM at 37 weeks' gestation or later. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, extracted the data, and assessed risk of bias of the included studies. Data were checked for accuracy. MAIN RESULTS Twenty-three trials involving 8615 women and their babies were included in the update of this review. Ten trials assessed intravenous oxytocin; 12 trials assessed prostaglandins (six trials in the form of vaginal prostaglandin E2 and six as oral, sublingual or vaginal misoprostol); and one trial each assessed Caulophyllum and acupuncture. Overall, three trials were judged to be at low risk of bias, while the other 20 were at unclear or high risk of bias.Primary outcomes: women who had planned early birth were at a reduced risk of maternal infectious morbidity (chorioamnionitis and/or endometritis) than women who had expectant management following term prelabour rupture of membranes (average risk ratio (RR) 0.49; 95% confidence interval (CI) 0.33 to 0.72; eight trials, 6864 women; Tau² = 0.19; I² = 72%; low-quality evidence), and their neonates were less likely to have definite or probable early-onset neonatal sepsis (RR 0.73; 95% CI 0.58 to 0.92; 16 trials, 7314 infants;low-quality evidence). No clear differences between the planned early birth and expectant management groups were seen for the risk of caesarean section (average RR 0.84; 95% CI 0.69 to 1.04; 23 trials, 8576 women; Tau² = 0.10; I² = 55%; low-quality evidence); serious maternal morbidity or mortality (no events; three trials; 425 women; very low-quality evidence); definite early-onset neonatal sepsis (RR 0.57; 95% CI 0.24 to 1.33; six trials, 1303 infants; very low-quality evidence); or perinatal mortality (RR 0.47; 95% CI 0.13 to 1.66; eight trials, 6392 infants; moderate-quality evidence). SECONDARY OUTCOMES women who had a planned early birth were at a reduced risk of chorioamnionitis (average RR 0.55; 95% CI 0.37 to 0.82; eight trials, 6874 women; Tau² = 0.19; I² = 73%), and postpartum septicaemia (RR 0.26; 95% CI 0.07 to 0.96; three trials, 263 women), and their neonates were less likely to receive antibiotics (average RR 0.61; 95% CI 0.44 to 0.84; 10 trials, 6427 infants; Tau² = 0.06; I² = 32%). Women in the planned early birth group were more likely to have their labour induced (average RR 3.41; 95% CI 2.87 to 4.06; 12 trials, 6945 women; Tau² = 0.05; I² = 71%), had a shorter time from rupture of membranes to birth (mean difference (MD) -10.10 hours; 95% CI -12.15 to -8.06; nine trials, 1484 women; Tau² = 5.81; I² = 60%), and their neonates had lower birthweights (MD -79.25 g; 95% CI -124.96 to -33.55; five trials, 1043 infants). Women who had a planned early birth had a shorter length of hospitalisation (MD -0.79 days; 95% CI -1.20 to -0.38; two trials, 748 women; Tau² = 0.05; I² = 59%), and their neonates were less likely to be admitted to the neonatal special or intensive care unit (RR 0.75; 95% CI 0.66 to 0.85; eight trials, 6179 infants), and had a shorter duration of hospital (-11.00 hours; 95% CI -21.96 to -0.04; one trial, 182 infants) or special or intensive care unit stay (RR 0.72; 95% CI 0.61 to 0.85; four trials, 5691 infants). Women in the planned early birth group had more positive experiences compared with women in the expectant management group.No clear differences between groups were observed for endometritis; postpartum pyrexia; postpartum antibiotic usage; caesarean for fetal distress; operative vaginal birth; uterine rupture; epidural analgesia; postpartum haemorrhage; adverse effects; cord prolapse; stillbirth; neonatal mortality; pneumonia; Apgar score less than seven at five minutes; use of mechanical ventilation; or abnormality on cerebral ultrasound (no events).None of the trials reported on breastfeeding; postnatal depression; gestational age at birth; meningitis; respiratory distress syndrome; necrotising enterocolitis; neonatal encephalopathy; or disability at childhood follow-up.In subgroup analyses, there were no clear patterns of differential effects for method of induction, parity, use of maternal antibiotic prophylaxis, or digital vaginal examination. Results of the sensitivity analyses based on trial quality were consistent with those of the main analysis, except for definite or probable early-onset neonatal sepsis where no clear difference was observed. AUTHORS' CONCLUSIONS There is low quality evidence to suggest that planned early birth (with induction methods such as oxytocin or prostaglandins) reduces the risk of maternal infectious morbidity compared with expectant management for PROM at 37 weeks' gestation or later, without an apparent increased risk of caesarean section. Evidence was mainly downgraded due to the majority of studies contributing data having some serious design limitations, and for most outcomes estimates were imprecise.Although the 23 included trials in this review involved a large number of women and babies, the quality of the trials and evidence was not high overall, and there was limited reporting for a number of important outcomes. Thus further evidence assessing the benefits or harms of planned early birth compared with expectant management, considering maternal, fetal, neonatal and longer-term childhood outcomes, and the use of health services, would be valuable. Any future trials should be adequately designed and powered to evaluate the effects on short- and long-term outcomes. Standardisation of outcomes and their definitions, including for the assessment of maternal and neonatal infection, would be beneficial.
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Affiliation(s)
- Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Emily Shepherd
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Vicki Flenady
- Mater Research Institute ‐ The University of Queensland (MRI‐UQ)Stillbirth Research TeamLevel 2 Aubigny PlaceMater Health ServicesBrisbaneQueenslandAustralia4101
| | - Rosemary D McBain
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Caroline A Crowther
- The University of AucklandLiggins InstitutePrivate Bag 9201985 Park RoadAucklandNew Zealand
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Razavi AS, Chasen ST. Low PAPP-A: the impact of ultrasound to evaluate fetal growth. Prenat Diagn 2015; 36:112-6. [PMID: 26552045 DOI: 10.1002/pd.4723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/22/2015] [Accepted: 11/03/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Our objective was to describe utilization and impact of sonographic growth assessment in pregnancies with low pregnancy-associated plasma protein-A (PAPP-A). METHODS Singleton pregnancies with PAPP-A ≤5th percentile and no other risk factors for fetal growth restriction from January 2011-June 2013 were included. Antepartum and delivery data were obtained by reviewing medical records. Outcomes of pregnancies referred for sonographic growth assessment were compared with those not referred for ultrasound. Fisher's exact test, chi-square analysis, and Mann-Whitney U were used for statistical comparison. RESULTS Two hundred ninety-five patients were included. Of 285 pregnancies reaching the third trimester, 77.5% were referred for ultrasound, with the initial scan at a median gestational age of 28 weeks [26-29]. Referral for growth scans was associated with earlier gestational age at delivery and higher rates of delivery for fetal indications. Those who did not undergo growth scans were more likely to deliver a small for gestational age infant at term, 20.7% versus 35.0% (p = 0.04). There was one third-trimester fetal demise, occurring in a patient who had been undergoing growth scans. CONCLUSION Growth scans in those with low PAPP-A were associated with delivery at earlier gestational age, with higher rates of delivery for fetal indications and lower rates of small for gestational age newborns at term. No significant differences in neonatal outcomes were observed.
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Affiliation(s)
- Armin S Razavi
- Department of Obstetrics and Gynecology, Weill Cornell Medical Center, New York, NY, USA
| | - Stephen T Chasen
- Department of Obstetrics and Gynecology, Weill Cornell Medical Center, New York, NY, USA
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Riddell CA, Hutcheon JA, Dahlgren LS. Differences in obstetric care among nulliparous First Nations and non-First Nations women in British Columbia, Canada. CMAJ 2015; 188:E36-E43. [PMID: 26527824 DOI: 10.1503/cmaj.150223] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Canada's Aboriginal population faces significantly higher rates of stillbirth and neonatal and postnatal death than those seen in the general population. The objective of this study was to compare indicators of obstetric care quality and use of obstetric interventions between First Nations and non-First Nations mothers in British Columbia, Canada. METHODS We linked obstetrical medical records with the First Nations Client File for all nulliparous women who delivered single infants in British Columbia from 1999 to 2011. Using logistic regression models, we examined differences in the proportion of women who received services aligned with best practice guidelines, as well as the overall use of obstetric interventions among First Nations mothers compared with the general population, controlling for geographic barriers (distance to hospital) and other relevant confounders. RESULTS During the study period, 215,993 single births occurred in nulliparous women in British Columbia, 9152 of which were to members of our First Nations cohort. First Nations mothers were less likely to have early ultrasonography (adjusted risk difference = 10.2 fewer women per 100 deliveries [95% confidence interval {CI} -11.3 to -9.3]), to have at least 4 antenatal care visits (3.6 fewer women per 100 deliveries [95% CI -4.6 to -2.6]), and to undergo labour induction after prolonged (> 24 hours) prelabour rupture of membranes (-5.9 [95% CI -11.8 to 0.1]) or at post-dates gestation (-10.6 [95% CI -13.8 to -7.5]). Obstetric interventions including epidural, labour induction, instrumental delivery and cesarean delivery were used less often in First Nations mothers. INTERPRETATION We identified differences in the obstetric care received by First Nations mothers compared with the general population. Such differences warrant further investigation, given increases in perinatal mortality that are consistently shown and that may be a downstream consequence of differences in care.
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Affiliation(s)
- Corinne A Riddell
- Department of Epidemiology, Biostatistics, and Occupational Health (Riddell), McGill University, Montréal, Qué.; Department of Obstetrics and Gynecology (Hutcheon, Dahlgren), University of British Columbia, Vancouver, BC
| | - Jennifer A Hutcheon
- Department of Epidemiology, Biostatistics, and Occupational Health (Riddell), McGill University, Montréal, Qué.; Department of Obstetrics and Gynecology (Hutcheon, Dahlgren), University of British Columbia, Vancouver, BC
| | - Leanne S Dahlgren
- Department of Epidemiology, Biostatistics, and Occupational Health (Riddell), McGill University, Montréal, Qué.; Department of Obstetrics and Gynecology (Hutcheon, Dahlgren), University of British Columbia, Vancouver, BC
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Abstract
Active management of labor (AML) is an obstetric technology developed in Ireland in the 1970s to accelerate labor in nulliparous women. This technology achieved rapid success in Great Britain and in English-speaking countries outside America, which adopted it before many other states around the world. In this article, I explore AML's technical and social characteristics when it was first designed, and then examine its local inflections in a Jordanian and a Swiss maternity hospital to shed light on the ways its transnational circulation modifies its script. I argue that its application is shaped by local material constraints and specific sociocultural configurations, gender regimes, and hospital cultures. Finally, I make a comparative analysis of AML practices in these two settings and in the foundational textbook to disentangle the technical and sociocultural components modeling its local applications.
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Affiliation(s)
- Irene Maffi
- a Department of Anthropology , Institute of Social Sciences, University of Lausanne , Lausanne , Switzerland
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Foley Catheter versus Vaginal Misoprostol for Labour Induction. Int J Reprod Med 2015; 2015:845735. [PMID: 26557725 PMCID: PMC4628666 DOI: 10.1155/2015/845735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/20/2015] [Accepted: 09/29/2015] [Indexed: 12/03/2022] Open
Abstract
Objectives. To compare the efficacy and safety of intravaginal misoprostol with transcervical Foley catheter for labour induction. Material and Methods. One hundred and four women with term gestation, with Bishop score < 4, and with various indications for labour induction were randomly divided into two groups. In Group I, 25 μg of misoprostol tablet was placed intravaginally, 4 hourly up to maximum 6 doses. In Group II, Foley catheter 16F was placed through the internal os of the cervix under aseptic condition and then inflated with 50 cc of sterile saline. Statistical analysis was done using SPSS software. Results. The induction to delivery interval was 14.03 ± 7.61 hours versus 18.40 ± 8.02 hours (p < 0.01). The rate of vaginal delivery was 76.7% versus 56.8% in misoprostol and transcervical Foley catheter group, respectively. Uterine hyperstimulation was more common with misoprostol. Neonatal outcome was similar in both the groups. Conclusion. Intravaginal misoprostol is associated with a shorter induction to delivery interval as compared to Foley's catheter and it increases the rate of vaginal delivery in cases of unripe cervix at term. Transcervical Foley catheter is associated with a lower incidence of uterine hyperstimulation during labour.
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Chopra S, SenGupta SK, Jain V, Kumar P. Stopping Oxytocin in Active Labor Rather Than Continuing it until Delivery: A Viable Option for the Induction of Labor. Oman Med J 2015; 30:320-5. [PMID: 26421111 PMCID: PMC4576386 DOI: 10.5001/omj.2015.66] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/04/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Induction of labor (IOL), using intravenous oxytocin, is the artificial initiation of labor before its spontaneous onset for the purpose of delivery of the fetoplacental unit. Although there are various studies looking at dosages of oxytocin, only a few have addressed the issue of discontinuation of oxytocin in the active stage of labor. Thus, our study was conducted to evaluate the need for continuation versus discontinuation of oxytocin during active labor. METHODS This prospective, randomized controlled trial included 106 women who needed IOL. Oxytocin infusion was initiated at a rate of 3mIU/min and was incremental until 4-6cm cervical dilation. At this point the patients were randomly assigned into one of two groups. In group one, oxytocin was discontinued, and infusion was continued with 0.9% sodium chloride solution. In group two, oxytocin was continued at the same dose until delivery. RESULTS The duration of oxytocin infusion was 5.5 hours in the oxytocin discontinuation group and 11.0 hours in oxytocin continuation group (p<0.001). The total dose of oxytocin was significantly higher in group two (6.1 units vs. 16.5 units; p=<0.001). The induction-delivery interval was significantly less in group one (9.1 and 11.2 hours in group one and group two, respectively; p=0.023). CONCLUSION Oxytocin discontinuation in the active stage of labor did not prolong the active stage. The total duration of labor and total oxytocin dose were significantly less in the oxytocin discontinuation group. Our results suggest that oxytocin discontinuation is an alternative and viable option particularly in resource poor and economically challenged settings. It not only reduces the need for intense monitoring and prolonged oxytocin use-associated dangers but reduces the total cost of labor management.
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Affiliation(s)
- Seema Chopra
- Department of Obstetrics & Gynaecology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sandip K. SenGupta
- Department of Obstetrics & Gynaecology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics & Gynaecology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Parveen Kumar
- Department of Obstetrics & Gynaecology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Jou J, Kozhimannil KB, Johnson PJ, Sakala C. Patient-Perceived Pressure from Clinicians for Labor Induction and Cesarean Delivery: A Population-Based Survey of U.S. Women. Health Serv Res 2015; 50:961-81. [PMID: 25250981 PMCID: PMC4545342 DOI: 10.1111/1475-6773.12231] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine whether patient-perceived pressure from clinicians for labor induction or cesarean delivery is significantly associated with having these procedures. DATA SOURCES/STUDY SETTING Listening to Mothers III, a nationally representative survey of women 18-45 years who delivered a singleton infant in a U.S. hospital July 2011-June 2012 (N = 2,400). STUDY DESIGN Multivariate logistic regression analysis of factors associated with perceived pressure and estimation of odds of induction and cesarean given perceived pressure. PRINCIPAL FINDINGS Overall, 14.8 percent of respondents perceived pressure from a clinician for labor induction and 13.3 percent for cesarean delivery. Women who perceived pressure for labor induction had higher odds of induction overall (adjusted odds ratio [aOR]: 3.51; 95 percent confidence interval [CI]: 2.5-5.0) and without medical reason (aOR: 2.13; 95 percent CI: 1.3-3.4) compared with women who did not perceive pressure. Those perceiving pressure for cesarean delivery had higher odds of cesarean overall (aOR: 5.17; 95 percent CI: 3.2-8.4), without medical reason (aOR: 6.13; 95 percent CI: 3.4-11.1), and unplanned cesarean (aOR: 6.70; 95 percent CI: 4.0-11.3). CONCLUSIONS Patient-perceived pressure from clinicians significantly predicts labor induction and cesarean delivery. Efforts to reduce provider-patient miscommunication and minimize potentially unnecessary procedures may be warranted.
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Affiliation(s)
- Judy Jou
- Address correspondence to Judy Jou, M.A., Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, MMC 729, Minneapolis, MN 55455; e-mail:
| | - Katy B Kozhimannil
- Katy B. Kozhimannil, Ph.D., M.P.A., is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
- Pamela Jo Johnson, Ph.D., M.P.H., is with the Center for Spirituality & Healing and the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
- Carol Sakala, Ph.D., is with the National Partnership for Women and Families, Washington, DC
| | - Pamela Jo Johnson
- Katy B. Kozhimannil, Ph.D., M.P.A., is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
- Pamela Jo Johnson, Ph.D., M.P.H., is with the Center for Spirituality & Healing and the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
- Carol Sakala, Ph.D., is with the National Partnership for Women and Families, Washington, DC
| | - Carol Sakala
- Katy B. Kozhimannil, Ph.D., M.P.A., is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
- Pamela Jo Johnson, Ph.D., M.P.H., is with the Center for Spirituality & Healing and the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
- Carol Sakala, Ph.D., is with the National Partnership for Women and Families, Washington, DC
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Joutsiniemi T, Timonen S, Linden M, Suvitie P, Ekblad U. Intrahepatic cholestasis of pregnancy: observational study of the treatment with low-dose ursodeoxycholic acid. BMC Gastroenterol 2015; 15:92. [PMID: 26215400 PMCID: PMC4517361 DOI: 10.1186/s12876-015-0324-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/20/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To exam the biochemical, obstetric management and pregnancy outcome in women with intrahepatic cholestasis of pregnancy (ICP) and treatment with ursodeoxycholic acid (UDCA). METHODS Pregnancy outcome in patients with ICP (N = 307) was studied and patients treated with UDCA (N = 208) vs. no UDCA were compared. The data of the antenatal visits, deliveries and neonatal outcome of 307 pregnancies with ICP was collected from the hospital computerized delivery room log book. UDCA was used in 208 pregnancies. The diagnosis was made by maternal pruritus and elevation of total fasting bile acid (BA) (>6 μmol/l) and elevation of serum alanine aminotransferases (ALT) (>45 U/l). Maternal and neonatal data was analysed and data of the patients who used UDCA during pregnancy was analysed separately and compared with the data from patients without medication. RESULTS UDCA was well tolerated. Mothers receiving UDCA had ICP diagnosed five weeks earlier than mothers without medication. At the diagnosis, levels of total BA and ALT were higher in the group using UDCA compared to the group without medication. Most deliveries were induced and perinatal outcome was good. Apgar scores at 5 min were significantly lower in UDCA group (p < 0.05), but fetal umbilical artery pH values were similar in both groups (p > 0.05). There were 30 patients with total BA > 40 μmol/l at diagnosis, 24 with UDCA and 6 without medication and those deliveries were induced soon after diagnosis. The preterm labour was also more common in these patents (p < 0.05). Women with preterm babies had significantly early onset pruritus and ICP was diagnosed earlier. Serum ALT and total BA levels were significantly higher in those pregnancies at diagnosis and also at first control. CONCLUSIONS Preterm labour was associated in severe ICP (total BA > 40 μmol/l), ALT levels were also significantly higher and ICP was diagnosed earlier (p < 0.05). Apgar scores were lower in preterm babies (p < 0.05), but umbilical artery pHvalues were not significantly lower. UDCA was well tolerated by pregnant women. With low-dose UDCA treatment the obstetric outcome was good. We still recommend careful obstetrical follow-up.
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Affiliation(s)
- Titta Joutsiniemi
- Department of Obstetrics and Gynaecology, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Susanna Timonen
- Department of Obstetrics and Gynaecology, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Maria Linden
- Department of Obstetrics and Gynaecology, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Pia Suvitie
- Department of Obstetrics and Gynaecology, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Ulla Ekblad
- Department of Obstetrics and Gynaecology, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
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