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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Suzuki S. Comparison of Labor Curves Between Spontaneous and Induced Labor. Obstet Gynecol 2024; 143:e142. [PMID: 38636090 DOI: 10.1097/aog.0000000000005560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Shunji Suzuki
- Nippon Medical School, Nihon Ika Daigaku, Bunkyo-ku, Tokyo, Japan
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3
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Kehl S. Obesity at term: What to consider? How to deliver? Arch Gynecol Obstet 2024; 309:1725-1733. [PMID: 38326633 DOI: 10.1007/s00404-023-07354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/17/2023] [Indexed: 02/09/2024]
Abstract
Obesity presents significant challenges during pregnancy, increasing the risk of complications and adverse outcomes for both mother and baby. With the rising prevalence of obesity among pregnant women, questions arise regarding optimal management, including timing of delivery and choice of delivery mode. Labour induction in obese women may require a combination of mechanical and pharmacological methods due to increased risk of failed induction. Caesarean section in obese women presents unique challenges, requiring comprehensive perioperative planning and specialized care to optimize outcomes. However, specific guidelines tailored to obese patients undergoing caesarean sections are lacking. Postpartum care should include vigilant monitoring for complications. Addressing obesity in pregnancy necessitates a multidisciplinary approach and specialized care to ensure the best outcomes.
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Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Universitätsstr. 21-23, 91054, Erlangen, Germany.
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Hu Y, Homer CSE, Ellwood D, Slavin V, Vogel JP, Enticott J, Callander EJ. Likelihood of primary cesarean section following induction of labor in singleton cephalic pregnancies at term, compared with expectant management: An Australian population-based, historical cohort study. Acta Obstet Gynecol Scand 2024; 103:946-954. [PMID: 38291953 PMCID: PMC11019518 DOI: 10.1111/aogs.14785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/27/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION There has been increased use of both induction of labor (IOL) and cesarean section for women with term pregnancies in many high-income countries, and a trend toward birth at earlier gestational ages. Existing evidence regarding the association between IOL and cesarean section for term pregnancies is mixed and conflicting, and little evidence is available on the differential effect at each week of gestation, stratified by parity. MATERIAL AND METHODS To explore the association between IOL and primary cesarean section for singleton cephalic pregnancies at term, compared with two definitions of expectant management (first: at or beyond the week of gestation at birth following IOL; and secondary: only beyond the week of gestation at birth following IOL), we performed analyses of population-based historical cohort data on women who gave birth in one Australian state (Queensland), between July 1, 2012 and June 30, 2018. Women who gave birth before 37+0 or after 41+6 weeks of gestation, had stillbirths, no-labor, multiple births (twins or triplets), non-cephalic presentation at birth, a previous cesarean section, or missing data on included variables were excluded. Four sub-datasets were created for each week at birth (37-40). Unadjusted relative risk, adjusted relative risk using modified Poisson regression, and their 95% confidence intervals were calculated in each sub-dataset. Analyses were stratified by parity (nulliparas vs. parous women with a previous vaginal birth). Sensitivity analyses were conducted by limiting to women with low-risk pregnancies. RESULTS A total of 239 094 women were included in the analysis, 36.7% of whom gave birth following IOL. The likelihood of primary cesarean section following IOL in a Queensland population-based cohort was significantly higher at 38 and 39 weeks, compared with expectant management up to 41+6 weeks, for both nulliparas and paras with singleton cephalic pregnancies, regardless of risk status of pregnancy and definition of expectant management. No significant difference was found for nulliparas at 37 and 40 weeks; and for paras at 40 weeks. CONCLUSIONS Future studies are suggested to investigate further the association between IOL and other maternal and neonatal outcomes at each week of gestation in different maternal populations, before making any recommendation.
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Affiliation(s)
- Yanan Hu
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Caroline S. E. Homer
- Maternal, Child and Adolescent Health ProgrammeBurnet InstituteMelbourneVictoriaAustralia
| | - David Ellwood
- School of Medicine & DentistryGriffith UniversityGold CoastQueenslandAustralia
- Gold Coast University Hospital, Gold Coast Hospital and Health ServiceSouthportQueenslandAustralia
| | - Valerie Slavin
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- Gold Coast University Hospital, Gold Coast Hospital and Health ServiceSouthportQueenslandAustralia
- School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health ProgrammeBurnet InstituteMelbourneVictoriaAustralia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Emily J. Callander
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- School of Public HealthUniversity of Technology SydneySydneyNew SouthAustralia
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5
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Boie S, Glavind J, Bor P, Steer P, Riis AH, Thiesson B, Uldbjerg N. Continued versus discontinued oxytocin stimulation in the active phase of labour (CONDISOX): individual management based on artificial intelligence - a secondary analysis. BMC Pregnancy Childbirth 2024; 24:291. [PMID: 38641779 PMCID: PMC11027395 DOI: 10.1186/s12884-024-06461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/28/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Current guidelines regarding oxytocin stimulation are not tailored to individuals as they are based on randomised controlled trials. The objective of the study was to develop an artificial intelligence (AI) model for individual prediction of the risk of caesarean delivery (CD) in women with a cervical dilatation of 6 cm after oxytocin stimulation for induced labour. The model included not only variables known when labour induction was initiated but also variables describing the course of the labour induction. METHODS Secondary analysis of data from the CONDISOX randomised controlled trial of discontinued vs. continued oxytocin infusion in the active phase of induced labour. Extreme gradient boosting (XGBoost) software was used to build the prediction model. To explain the impact of the predictors, we calculated Shapley additive explanation (SHAP) values and present a summary SHAP plot. A force plot was used to explain specifics about an individual's predictors that result in a change of the individual's risk output value from the population-based risk. RESULTS Among 1060 included women, 160 (15.1%) were delivered by CD. The XGBoost model found women who delivered vaginally were more likely to be parous, taller, to have a lower estimated birth weight, and to be stimulated with a lower amount of oxytocin. In 108 women (10% of 1060) the model favoured either continuation or discontinuation of oxytocin. For the remaining 90% of the women, the model found that continuation or discontinuation of oxytocin stimulation affected the risk difference of CD by less than 5% points. CONCLUSION In women undergoing labour induction, this AI model based on a secondary analysis of data from the CONDISOX trial may help predict the risk of CD and assist the mother and clinician in individual tailored management of oxytocin stimulation after reaching 6 cm of cervical dilation.
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Affiliation(s)
- Sidsel Boie
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark.
| | - Julie Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Pinar Bor
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Philip Steer
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | | | | | - Niels Uldbjerg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Yilmaz G, Neselioglu S, Aydogdu FE, Erel O, Uzunlar O, Moraloglu Tekin O. The effect of slow-release vaginal dinoprostone on maternal and fetal oxidative stress in term pregnancies complicated by oligohydramnios: Prospective cohort study. J Chin Med Assoc 2024; 87:410-413. [PMID: 38376193 DOI: 10.1097/jcma.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND To evaluate changes in oxidant status using thiol/disulfide homeostasis in mothers and fetuses after induction of labor with slow-release vaginal dinoprostone inserts. METHODS A total of 70 pregnant women were divided into two groups. Thirty-five women in whom labor was induced with slow-release vaginal dinoprostone inserts (10 mg of prostaglandin E2, group A) were compared before and after the administration. The other 35 women, who were followed up spontaneously during labor (group B), were included as a control group. Both groups were diagnosed with isolated oligohydramnios without signs of placental insufficiency. The thiol/disulfide homeostasis parameters were calculated before medical induction and after removal of the insert at the beginning of the active phase of labor. Maternal and cord blood values were measured in both groups. RESULTS Although the balance shifted to the antioxidant side after the slow-release vaginal dinoprostone insert was applied, there was no significant difference in maternal oxidative load compared to the pre-application status (5.32 ± 014/5.16 ± 0.15, p = 0.491). Despite the shift toward the antioxidant side, maternal antioxidants were still significantly lower in the group that received slow-release vaginal dinoprostone at the beginning of the active phase of labor than in the control group (295.98 ± 13.03/346.47 ± 12.04, respectively, p = 0.009). There was no statistically significant difference in terms of oxidative balance or newborn Apgar score ( p > 0.05). CONCLUSION Induction of labor with slow-release vaginal dinoprostone inserts in pregnancies with isolated oligohydramnios does not cause further oxidative stress and is safe for both mothers and neonates in terms of oxidant load by thiol/disulfide homeostasis.
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Affiliation(s)
- Gamze Yilmaz
- Department of Obstetrics and Gynecology, Republic of Turkey Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Salim Neselioglu
- Department of Medical Biochemistry, University of Health Sciences, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Fatma Ece Aydogdu
- Department of Obstetrics and Gynecology, Republic of Turkey Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozcan Erel
- Department of Medical Biochemistry, University of Health Sciences, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozlem Uzunlar
- Department of Obstetrics and Gynecology, Republic of Turkey Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynecology, Republic of Turkey Ministry of Health Ankara City Hospital, Ankara, Turkey
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Greenberg JT, Cross SN, Raab CA, Pettker CM, Illuzzi JL. Adherence to Definitions of Labor Arrest Influence on Primary Cesarean Delivery Rate. Am J Perinatol 2024; 41:618-627. [PMID: 35045572 DOI: 10.1055/a-1745-1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The cesarean delivery rate in the United States is 31.9%. One of the leading indications for primary cesarean delivery is labor arrest. A modern understanding of the labor curve supports more time prior to the diagnosis of labor arrest. We conducted this study to examine the impact of adherence to the modern criteria for labor arrest and failed induction on rates of primary cesarean delivery and to identify predictors of meeting these criteria. STUDY DESIGN We analyzed rates of primary cesarean deliveries overall and primary cesarean deliveries occurring due to arrest of dilation, arrest of descent, and failed induction among the 17,877 live births at a large academic center from 2010 through 2013. Multiple logistic regression modeling identified predictors of meeting the new criteria for these indications based on guidelines published by the 2012 National Institute of Child Health and Human Development. RESULTS The primary cesarean delivery rate decreased from 23.5 to 21.1% (p = 0.026) from 2010 to 2013. Primary cesarean delivery rate for labor arrest and failed induction decreased from 8.5 to 6.7% (p = 0.005). The percentage of primary cesarean deliveries meeting the 2012 criteria for labor arrest increased from 18.8 to 34.9% (p = 0.002), and the rate of primary cesarean deliveries due to arrest of dilation decreased from 5.1 to 3.4% (p < 0.0005). The percentage of cases meeting the 2012 criteria for arrest of descent increased from 57.8 to 71.0% (p < 0.007), while primary cesarean delivery rate due to arrest of descent remained relatively unchanged, 3.1 to 2.6% (p = 0.330). CONCLUSION A decrease in the primary cesarean rate was attributable to a decrease in cesarean for arrest of dilation in the setting of a significant increase in meeting the 2012 criteria for arrest of dilation. At the end of the study period, 65.2% of cesareans still did not meet the criteria for arrest of dilation. Greater rates of adherence to these guidelines may yield further reductions in the cesarean rate. KEY POINTS · Primary cesarean delivery for labor arrest was decreased.. · Meeting criteria for labor arrest increased.. · A hospitalist provider increased odds of meeting criteria..
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Affiliation(s)
- Jessica T Greenberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, Connecticut
| | - Sarah N Cross
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota
| | - Cheryl A Raab
- Women's Service, Yale New Haven Hospital, New Haven, Connecticut
| | - Christian M Pettker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Jessica L Illuzzi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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8
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Sileo FG, Tramontano AL, Sponzilli A, Facchinetti F. Prelabour rupture of the membranes at term: antibiotic overuse in Italy. Minerva Obstet Gynecol 2024; 76:135-141. [PMID: 35829626 DOI: 10.23736/s2724-606x.22.05145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The proper management of women with premature rupture of membrane (PROM) and not spontaneously entering in labour remains controversial. The aim of this study was to identify the current management for women with PROM at term according to the Group B Streptococcus (GBS) status across different Italian hospitals. METHODS Anonymous online survey evaluating: the current practice of women with PROM in terms of management (expectant management vs. induction of labour) and antibiotic prophylaxis according to GBS status. RESULTS In case of negative GBS status, the 82.4% of respondents wait until 24 hours before labour induction. Antibiotics are administered for prophylaxis in 35.3%, 27.5% and 2% at 18, 12 and 24 hours respectively. The remaining 35.3% of respondents are divided between those using antibiotics only with signs of infections or according to different risk factors (i.e. meconium-stained amniotic fluid or suspected infection). Neonates born from a mother with negative GBS status almost never (90.2%) receive prophylactic antibiotics. In case of positive GBS status, induction is started as soon as possible by 49.1% of respondents; the remnants choose to wait 6 (15.7%), 12 (17.6%), 18 (3.9%) and 24 (13.7%) hours. Antibiotics are administered as soon as possible by 78.4% of clinicians. In the neonates, 51% of neonatologist administer antibiotics upon clinical indications (suspected sepsis); 15.7% use antibiotics routinely or with a short interval between maternal antibiotics and delivery (17.6%). CONCLUSIONS The management after PROM is highly heterogeneous with an inappropriate extension of antibiotic prophylaxis in cases with negative GBS status.
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Affiliation(s)
- Filomena G Sileo
- Unit Prenatal Medicine, Division of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
- International Doctorate School in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna L Tramontano
- Division of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Sponzilli
- Division of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Division of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy -
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9
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McAdow ME, Tortal D, Shabanova V, Son M. Nipple stimulation therapy promotes uterine contractions at lower plasma oxytocin concentration than intravenous oxytocin during labor induction. Am J Obstet Gynecol MFM 2024; 6:101307. [PMID: 38331190 DOI: 10.1016/j.ajogmf.2024.101307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Molly E McAdow
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510.
| | - Danna Tortal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Biostatistics, Yale University School of Medicine, New Haven, CT
| | - Moeun Son
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
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10
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Ayala NK, Rouse DJ. Failed induction of labor. Am J Obstet Gynecol 2024; 230:S769-S774. [PMID: 36848041 DOI: 10.1016/j.ajog.2021.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
Induction of labor is a widely used practice. From 2016 to 2019, >1 in 3 women giving birth in the United States did so after undergoing labor induction. The obvious goal of labor induction is vaginal birth with minimal maternal or neonatal morbidity. To achieve this goal, criteria for failed labor induction are needed. Herein, we provide an evidence-based approach to safely prevent unnecessary cesarean deliveries for failed induction. Although there are no randomized trials comparing failed labor induction criteria, the observational data have been consistent: if the status of the mother and the fetus permits, at least 12 to 18 hours of oxytocin should be administered after membrane rupture before deeming an induction of labor to have failed because of nonprogression to the active phase of labor.
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Affiliation(s)
- Nina K Ayala
- Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI.
| | - Dwight J Rouse
- Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI
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11
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Liu CH, Lee NR, Wang PH. Choices of cervival ripening agents for elective induction in low-risk nulliparous women at term. Taiwan J Obstet Gynecol 2024; 63:152-153. [PMID: 38485306 DOI: 10.1016/j.tjog.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Na-Rong Lee
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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12
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Kelly C, Whitten M, Kennedy S, Lanceley A, Nicholls J. Women's experiences of consent to induction of labour: A qualitative study. Sex Reprod Healthc 2024; 39:100928. [PMID: 38056385 DOI: 10.1016/j.srhc.2023.100928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Induction of labour (IOL) does not require formal written consent, and little is known about how consent operates in this context. This prospective study explores pregnant women's experiences of the IOL consent process. METHODS Qualitative study using semi-structured, interviews with thirteen women admitted to hospital for IOL. Data were analysed using thematic analysis. RESULTS Three themes emerged: 1) Voluntary nature of consent: Some women experienced genuine choice; others perceived pressure to prioritise their baby. 2) Understanding the why and how, risks and benefits: Information provision and explanation was often minimal, particularly regarding risks and alternatives to induction. The possibility of IOL failing was not discussed 3) Non-personalised information process: Few women received information specific and relevant to their circumstance. PRACTICE IMPLICATIONS There is an urgent need for healthcare professionals to be supported in actively facilitating consent consultations which enable women undergoing IOL to make a fully autonomous, informed choice. CONCLUSIONS Women did not always experience choice about whether to be induced. This sense of disempowerment was sometimes exacerbated by inadequate information provision. The study reveals a practice imperative to address consent in IOL and we suggest there is an urgent need for HCPs to be offered high quality training specific to IOL.
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Affiliation(s)
- Clodagh Kelly
- University College London Medical School, Institute for Women's Health, 74 Huntley Street, London WC1E 6AU, UK
| | - Melissa Whitten
- University College London Medical School, Institute for Women's Health, 74 Huntley Street, London WC1E 6AU, UK; UCLH, Division of Women's Health, 235 Euston Road, London NW1 2BU, UK
| | - Sophie Kennedy
- University College London Medical School, Institute for Women's Health, 74 Huntley Street, London WC1E 6AU, UK
| | - Anne Lanceley
- University College London Medical School, Institute for Women's Health, 74 Huntley Street, London WC1E 6AU, UK
| | - Jacqueline Nicholls
- University College London Medical School, Institute for Women's Health, 74 Huntley Street, London WC1E 6AU, UK.
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13
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Uvnäs-Moberg K. The physiology and pharmacology of oxytocin in labor and in the peripartum period. Am J Obstet Gynecol 2024; 230:S740-S758. [PMID: 38462255 DOI: 10.1016/j.ajog.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 03/12/2024]
Abstract
Oxytocin is a reproductive hormone implicated in the process of parturition and widely used during labor. Oxytocin is produced within the supraoptic nucleus and paraventricular nucleus of the hypothalamus and released from the posterior pituitary lobe into the circulation. Oxytocin is released in pulses with increasing frequency and amplitude in the first and second stages of labor, with a few pulses released in the third stage of labor. During labor, the fetus exerts pressure on the cervix of the uterus, which activates a feedforward reflex-the Ferguson reflex-which releases oxytocin. When myometrial contractions activate sympathetic nerves, it decreases oxytocin release. When oxytocin binds to specific myometrial oxytocin receptors, it induces myometrial contractions. High levels of circulating estrogen at term make the receptors more sensitive. In addition, oxytocin stimulates prostaglandin synthesis and release in the decidua and chorioamniotic membranes by activating a specific type of oxytocin receptor. Prostaglandins contribute to cervical ripening and uterine contractility in labor. The oxytocin system in the brain has been implicated in decreasing maternal levels of fear, pain, and stress, and oxytocin release and function during labor are stimulated by a social support. Moreover, studies suggest, but have not yet proven, that labor may be associated with long-term, behavioral and physiological adaptations in the mother and infant, possibly involving epigenetic modulation of oxytocin production and release and the oxytocin receptor. In addition, infusions of synthetic oxytocin are used to induce and augment labor. Oxytocin may be administered according to different dose regimens at increasing rates from 1 to 3 mIU/min to a maximal rate of 36 mIU/min at 15- to 40-minute intervals. The total amount of synthetic oxytocin given during labor can be 5 to 10 IU, but lower and higher amounts of oxytocin may also be given. High-dose infusions of oxytocin may shorten the duration of labor by up to 2 hours compared with no infusion of oxytocin; however, it does not lower the frequency of cesarean delivery. When synthetic oxytocin is administered, the plasma concentration of oxytocin increases in a dose-dependent way: at infusion rates of 20 to 30 mIU/min, plasma oxytocin concentration increases approximately 2- to 3-fold above the basal level. Synthetic oxytocin administered at recommended dose levels is not likely to cross the placenta or maternal blood-brain barrier. Synthetic oxytocin should be administered with caution as high levels may induce tachystole and uterine overstimulation, with potentially negative consequences for the fetus and possibly the mother. Of note, 5 to 10 IU of synthetic oxytocin is often routinely given as an intravenous or intramuscular bolus administration after delivery to induce uterine contractility, which, in turn, induces uterine separation of the placenta and prevents postpartum hemorrhage. Furthermore, it promotes the expulsion of the placenta.
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Affiliation(s)
- Kerstin Uvnäs-Moberg
- Department of Animal Environment and Health, Swedish University of Agriculture, Uppsala, Sweden.
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Saucedo AM, Bromwich K, Alvarez M, Ghartey J, Harper LM, Levine L, Raghuraman N, Cahill AG. Group B streptococcus colonization and risk of infection with Foley catheter inductions. Am J Obstet Gynecol MFM 2024; 6:101311. [PMID: 38342308 DOI: 10.1016/j.ajogmf.2024.101311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Affiliation(s)
- Alexander M Saucedo
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX.
| | - Kira Bromwich
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Miriam Alvarez
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Jeny Ghartey
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Lorie M Harper
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Lisa Levine
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nandini Raghuraman
- Maternal-Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Alison G Cahill
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX
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Taylor B, Cross-Sudworth F, Rimmer M, Quinn L, Morris RK, Johnston T, Morad S, Davidson L, Kenyon S. Induction of labour care in the UK: A cross-sectional survey of maternity units. PLoS One 2024; 19:e0297857. [PMID: 38416750 PMCID: PMC10901341 DOI: 10.1371/journal.pone.0297857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/10/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES To explore local induction of labour pathways in the UK National Health Service to provide insight into current practice. DESIGN National survey. SETTING Hospital maternity services in all four nations of the UK. SAMPLE Convenience sample of 71 UK maternity units. METHODS An online cross-sectional survey was disseminated and completed via a national network of obstetrics and gynaecology specialist trainees (October 2021-March 2022). Results were analysed descriptively, with associations explored using Fisher's Exact and ANOVA. MAIN OUTCOME MEASURES Induction rates, criteria, processes, delays, incidents, safety concerns. RESULTS 54/71 units responded (76%, 35% of UK units). Induction rate range 19.2%-53.4%, median 36.3%. 72% (39/54) had agreed induction criteria: these varied widely and were not all in national guidance. Multidisciplinary booking decision-making was not reported by 38/54 (70%). Delays reported 'often/always' in hospital admission for induction (19%, 10/54) and Delivery Suite transfer once induction in progress (63%, 34/54). Staffing was frequently reported cause of delay (76%, 41/54 'often/always'). Delays triggered incident reports in 36/54 (67%) and resulted in harm in 3/54 (6%). Induction was an area of concern (44%, 24/54); 61% (33/54) reported induction-focused quality improvement work. CONCLUSIONS There is substantial variation in induction rates, processes and policies across UK maternity services. Delays appear to be common and are a cause of safety concerns. With induction rates likely to increase, improved guidance and pathways are critically needed to improve safety and experience of care.
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Affiliation(s)
- Beck Taylor
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Fiona Cross-Sudworth
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Michael Rimmer
- Medical Research Council Centre for Reproductive Health, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Laura Quinn
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - R. Katie Morris
- Professor of Obstetrics and Maternal Fetal Medicine, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Tracey Johnston
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Sharon Morad
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Louisa Davidson
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Sara Kenyon
- Professor of Evidence Based Maternity Care, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Melia L, Sulukhia R, Pkhaladze L, Davidova N, Khomasuridze A. MIFEPRISTON IN OBSTETRICS - WHY NOT? Georgian Med News 2024:11-14. [PMID: 38609105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Cervical ripening is a critical component of normal parturition. There are substantial variations in labour induction (IOL) techniques around the world. Mifepristone causes the termination of unwanted pregnancies, but there is a lack of consensus on its use for labour induction. The purpose of our study was to compare the combination of Mifepristone and Misoprostol with the combination of a Foley balloon and Misoprostol for labour induction. The study included 175 pregnant women, with gestational age 37-42 weeks. In the study group - 88 pregnant aged 21-35 (28.56±3.23), a combination of Mifepristone-Misoprostol was used. A combination of Foley catheter and Misoprostol was used in the control group - 87 pregnant aged 21-35 (29.48±3.03). The outcomes were assessed. In the study group the rate of vaginal delivery was higher and the frequency of cesarean section was lower compared to the control group (75 vs. 72, and 13 vs. 15, respectively); The total duration of labour was shorter in the study group (p<0,05); There was no difference between groups in the incidences of neonatal morbidity on the first and the fifth minute of life (p>0,05); The pain level was significantly low in the study group compared to the control group (5±0,75 vs. 8±0,96) and no cervical laceration was revealed in the study group. The Mifepristone - Misoprostol combination has advantages over the Foley balloon - Misoprostol combination for induction of labour regarding reduction in pain intensity, duration of labour, and cervical laceration.
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Affiliation(s)
- L Melia
- 1Department of Obstetrics and Gynecology of European University, Tbilisi; 2Department of Obstetrics and Gynaecology, Gudushauri National Medical Centre, Tbilisi, Georgia
| | - R Sulukhia
- 2Department of Obstetrics and Gynaecology, Gudushauri National Medical Centre, Tbilisi; 3Ivane Javakhishvili Tbilisi State University, Georgia
| | - L Pkhaladze
- 4Prof. Zhordania and Prof. Khomasuridze Institute of Reproductology, Tbilisi, Georgia
| | - N Davidova
- 3Ivane Javakhishvili Tbilisi State University; 5Department of Reproductology and Gynaecology, Prof. Zhordania and Prof. Khomasuridze Institute of Reproductology, Tbilisi, Georgia
| | - A Khomasuridze
- 4Prof. Zhordania and Prof. Khomasuridze Institute of Reproductology, Tbilisi; 6Department of Reproductology, Obstetrics and Gynaecology, Ivane Javakhishvili Tbilisi State University, Georgia
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Yenuberi H, Mathews J, George A, Benjamin S, Rathore S, Tirkey R, Tharyan P. The efficacy and safety of 25 μg or 50 μg oral misoprostol versus 25 μg vaginal misoprostol given at 4- or 6-hourly intervals for induction of labour in women at or beyond term with live singleton pregnancies: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024; 164:482-498. [PMID: 37401143 DOI: 10.1002/ijgo.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Misoprostol is widely used for cervical ripening and labour induction as it is heat-stable and inexpensive. Oral misoprostol 25 μg given 2-hourly is recommended over vaginal misoprostol 25 μg given 6-hourly, but the need for 2-hourly fetal monitoring makes oral misoprostol impractical for routine use in high-volume obstetric units in resource-constrained settings. OBJECTIVES To compare the efficacy and safety of oral misoprostol initiated at 25 or 50 μg versus 25 μg vaginal misoprostol given at 4- to 6-hourly intervals for labor induction in women at or beyond term (≥ 37 weeks) with a single viable fetus and an unscarred uterus. SEARCH STRATEGY We identified eligible randomized, parallel-group, labor-induction trials from recent systematic reviews. We additionally searched PubMed, Cochrane CENTRAL, Epistemonikos, and clinical trials registries from February 1, 2020 to December 31, 2022 without language restrictions. Database-specific keywords for cervical priming, labor induction, and misoprostol were used. SELECTION CRITERIA We excluded labor-induction trials exclusively in women with ruptured membranes, in the third trimester, and those that initiated misoprostol at doses not specified in the review's objectives. The primary outcomes were vaginal birth within 24 h, cesarean section, perinatal mortality, neonatal morbidity, and maternal morbidity. The secondary outcomes were uterine hyperstimulation with fetal heart rate changes, and oxytocin augmentation. DATA COLLECTION AND ANALYSIS Two or more authors selected studies independently, assessed risk of bias, and extracted data. We derived pooled weighted risk ratios with 95% confidence intervals (CIs) for each outcome, subgrouping trials by the dose and frequency of misoprostol regimens. We used the I2 statistic to quantify heterogeneity and the random-effects model for meta-analysis when appropriate. We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach to assess certainty (confidence) in the effect estimates. MAIN RESULTS Thirteen trials, from Canada, India, Iran, and the US, randomizing 2941 women at ≥37 weeks of gestation with an unfavorable cervix (Bishop score <6), met the eligibility criteria. Five misoprostol regimens were compared: 25 μg oral versus 25 μg vaginal, 4-hourly (three trials); 50 μg oral versus 25 μg vaginal, 4-hourly (five trials); 50 μg followed by 100 μg oral versus 25 μg vaginal, 4-hourly (two trials); 50 μg oral, 4-hourly versus 25 μg vaginal, 6-hourly (one trial); and 50 μg oral versus 25 μg vaginal, 6-hourly (two trials). The overall certainty in the evidence ranged from moderate to very low, due to high risk of bias in 11/13 trials (affecting all outcomes), unexplained heterogeneity (1/7 outcomes), indirectness (1/7 outcomes), and imprecision (4/7 outcomes). Vaginal misoprostol probably increased vaginal deliveries within 24 h compared with oral misoprostol (risk ratio [RR] 0.82, 95% CI 0.70-0.96; 11 trials, 2721 mothers; moderate-certainty evidence); this was more likely with 4-hourly than with 6-hourly vaginal regimens. The risk of cesarean sections did not appreciably differ (RR 1.00, 95% CI 0.80-1.26; 13 trials, 2941 mothers; very low-certainty evidence), although oral misoprostol 25 μg 4-hourly probably increased this risk compared with 25 μg vaginal misoprostol 4-hourly (RR 1.69, 95% CI 1.21-2.36; three trials, 515 mothers). The risk of perinatal mortality (RR 0.67, 95% CI 0.11-3.90; one trial, 196 participants; very low-certainty evidence), neonatal morbidity (RR 0.84, 95% CI 0.67-1.06; 13 trials, 2941 mothers; low-certainty evidence), and maternal morbidity (RR 0.83, 95% CI 0.48-1.44; 6 trials; 1945 mothers; moderate-certainty evidence) did not differ appreciably. The risk of uterine hyperstimulation with fetal heart rate changes may be lower with oral misoprostol (RR 0.70, 95% CI 0.52-0.95; 10 trials, 2565 mothers; low-certainty evidence). Oxytocin augmentation was probably more frequent with oral compared with vaginal misoprostol (RR 1.29, 95% CI 1.10-1.51; 13 trials, 2941 mothers; moderate-certainty evidence). CONCLUSIONS Low-dose, 4- to 6-hourly vaginal misoprostol regimens probably result in more vaginal births within 24 h and less frequent oxytocin use compared with low-dose, 4- to 6-hourly, oral misoprostol regimens. Vaginal misoprostol may increase the risk of uterine hyperstimulation with fetal heart changes compared with oral misoprostol, without increasing the risk of perinatal mortality, neonatal morbidity, or maternal morbidity. Indirect evidence indicates that 25 μg vaginal misoprostol 4-hourly may be more effective and as safe as the recommended 6-hourly vaginal regimen. This evidence could inform clinical decisions in high-volume obstetric units in resource-constrained settings.
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Affiliation(s)
- Hilda Yenuberi
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Jiji Mathews
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Anne George
- Department of Community Health, Christian Medical College, Vellore, India
| | - Santosh Benjamin
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Swati Rathore
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Richa Tirkey
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Prathap Tharyan
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
- Clinical Epidemiology Unit, Christian Medical College, Vellore, India
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Hadhoum S, Ghesquière L, Drumez E, Subtil D, Garabedian C. [Comparison of vaginal prostaglandins with oral misoprostol as a second line of cervical ripening after using a cervical balloon catheter]. Gynecol Obstet Fertil Senol 2024; 52:68-73. [PMID: 37995911 DOI: 10.1016/j.gofs.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To compare vaginal prostaglandins with oral misoprostol as a second line of cervical ripening after using a cervical balloon catheter. MATERIAL AND METHODS This is a retrospective monocentric study (Lille, France), according to a "before"/"after" design. The inclusion criteria were a singleton pregnancy, with a fetus in cephalic presentation, a term >37 WA, with a cervix having a Bishop score lower than 6 after a first line of maturation by cervical balloon catheter. Two groups were formed: "before" corresponding to the continuation of maturation by vaginal prostaglandins, from March 2019 to November 2019, and "after": corresponding to the continuation of maturation by oral misoprostol, from June 2020 to December 2020. The primary outcome was vaginal delivery rate. RESULTS One hundred women were included in each group. The rate of vaginal delivery was similar between the 2 groups (76% vs 81%, p=0.39), as were the times between the start of induction and the birth and between the start of induction and the transition to birth room. There was no difference in the indication for caesarean section, with in particular an identical rate of caesarean sections for induction failure (p=0.52). Subgroup analysis in obese women showed a significantly higher rate of vaginal delivery in the "after" group (OR=4.17;95% CI [1.02;17.07]). CONCLUSION The vaginal delivery rate is similar when using vaginal prostaglandins or oral misoprostol as second line cervical ripening after use of a cervical balloon catheter.
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Affiliation(s)
- S Hadhoum
- Service de gynécologie obstétrique, CHU Lille, avenue Eugène-Avinée, 59000 Lille, France.
| | - L Ghesquière
- Service de gynécologie obstétrique, CHU Lille, avenue Eugène-Avinée, 59000 Lille, France; University Lille, ULR 2694-METRICS, 59000 Lille, France
| | - E Drumez
- University Lille, ULR 2694-METRICS, 59000 Lille, France; Département de biostatistiques, CHU Lille, 59000 Lille, France
| | - D Subtil
- Service de gynécologie obstétrique, CHU Lille, avenue Eugène-Avinée, 59000 Lille, France; University Lille, ULR 2694-METRICS, 59000 Lille, France
| | - C Garabedian
- Service de gynécologie obstétrique, CHU Lille, avenue Eugène-Avinée, 59000 Lille, France; University Lille, ULR 2694-METRICS, 59000 Lille, France
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Ekoh A, Ebeigbe PN, Mofon C. A Comparison of the Efficacy and Safety of Mifepristone and Misoprostol Versus Misoprostol alone for Induction of Labour in Nigerian Women with Intrauterine Fetal Death: A Triple Blind Randomized Controlled Trial. Niger J Clin Pract 2024; 27:159-166. [PMID: 38409142 DOI: 10.4103/njcp.njcp_786_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 10/25/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Intrauterine foetal death (IUFD) is an unpleasant pregnancy outcome and prompt delivery of the dead foetus is usually desired by mothers. Unfortunately, spontaneous labour and delivery may not occur early and prolonged retention of the dead foetus in utero is life-threatening. Many of the agents currently used for the induction of labour may result in a prolonged delivery process. OBJECTIVES To compare the efficacy and safety of mifepristone and misoprostol versus misoprostol alone for induction of labour in women with intrauterine foetal death. MATERIALS AND METHODS This was a triple-blind randomized controlled trial. Eighty women were randomized into two groups. The intervention group received a single oral dose of 200 mg mifepristone, followed by 6-hourly 50 μg misoprostol vaginal insertion, after 24-hour intervals. The control group received a placebo, followed by 6-hourly 50 μg misoprostol vaginal insertion, after 24-hour intervals. The primary outcome measure was the induction to delivery interval. RESULTS Maternal age, gestational age, parity and pre-induction bishop's score were comparable between the two groups. The mean induction to the delivery interval in the intervention group was significantly less in the intervention group than the control group (18.78 ± 6.51 hours versus 37.10 ± 10.10; P < 0.001). The total dose of misoprostol required for induction of labour; the need for oxytocin augmentation of labour; and the observed side effects of misoprostol were all significantly less in intervention group than control group (P < 0.001; P < 0.01; and P = 0.03, respectively). CONCLUSION The combination of mifepristone and misoprostol has greater efficacy and better safety profile than the use of misoprostol alone for induction of labour. This combination should be considered when induction of labour is indicated for IUFD.
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Affiliation(s)
- A Ekoh
- Department of Obstetrics and Gynaecology, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | - P N Ebeigbe
- Department of Obstetrics and Gynaecology, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | - C Mofon
- Department of Obstetrics and Gynaecology, Asaba Specialist Hospital, Asaba, Delta State, Nigeria
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Chua JYX, Choolani M, Lalor JG, Yi H, Chong YS, Shorey S. Perceptions of healthcare professionals regarding labour induction and augmentation: A qualitative systematic review. Women Birth 2024; 37:79-87. [PMID: 37718194 DOI: 10.1016/j.wombi.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Labour induction and augmentation procedures are commonly used in maternity units with or without medical indications. Research shows that healthcare professionals play a significant role in women's childbirth decisions. AIM To consolidate healthcare professionals' perceptions about labour induction and augmentation. METHODS Seven electronic databases were searched from their inception dates till January 2023: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ProQuest Dissertations, and Theses Global. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Sandelowski and Barroso's guidelines guided this review. Included studies' quality was appraised by the Critical Appraisal Skills Program tool. Data were thematically synthesised. Review findings were assessed using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. FINDINGS Three main themes were identified from the 17 included studies: 1) Making sense of the phenomenon, 2) Two sides of the coin, and 3) The enlightened path ahead. DISCUSSION Healthcare professionals' labour induction and augmentation decisions were affected by personal (knowledge and moral philosophies), and external factors (women, community members, colleagues, and healthcare institutions). Some clinicians were unfamiliar with the proper labour induction/augmentation procedures, while others were worried about their decisions and outcomes. CONCLUSION Suggestions for improvement include conducting labour induction/augmentation training for clinicians, having sufficient resources in facilities, and developing appropriate labour induction/augmentation clinical guidelines. Women and their partners, community members, and traditional healers could benefit from receiving labour induction/augmentation education. To improve health outcomes, healthcare professionals could deliver woman-centred care and collaborate.
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Affiliation(s)
- Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | | | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Yuan L, Peng J, Yang L, Zhao Y. Efficacy and safety of double balloon catheter and dinoprostone for labor induction in multipara at term. Arch Gynecol Obstet 2024; 309:533-540. [PMID: 36801968 PMCID: PMC10808154 DOI: 10.1007/s00404-022-06891-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/13/2022] [Indexed: 02/23/2023]
Abstract
PURPOSE The aim of this study was to comparatively assess the efficacy and safety of double balloon catheter (DBC) and dinoprostone as labor-inducing agents just for multipara at term. METHODS A retrospective cohort study was conducted among multipara at term with a Bishop score < 6 who needed planned labor induction from January 1, 2020, to December 30, 2020 in Maternal and Child Health Hospital of Hubei province, Tongji Medical College, Huazhong University of Science and Technology. They were divided into DBC group and dinoprostone group, respectively. Baseline maternal data, maternal and neonatal outcomes were recorded for statistical analysis. Total vaginal delivery rate, rate of vaginal delivery within 24 h, rate of uterine hyperstimulation combined with abnormal fetal heart rate(FHR) were regarded as the primary outcome variables. The difference between groups was considered statistically significant when p value < 0.05. RESULTS A total of 202 multiparas was included for analysis (95 women in DBC group vs 107 women in dinoprostone group). There were no significant differences in total vaginal delivery rate and rate of vaginal delivery within 24 h between groups. Uterine hyperstimulation combined with abnormal FHR occurred exclusively in dinoprostone group. CONCLUSION DBC and dinoprostone seem to be equally effective, while, DBC seems to be safer than dinoprostone.
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Affiliation(s)
- Lu Yuan
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Jing Peng
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Lijun Yang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China.
| | - Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China.
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Cadish LA, Shepherd JP, Bretschneider CE. Projecting future prolapse outcomes with induction of labor at 39 weeks: a decision analysis. Int Urogynecol J 2024; 35:311-317. [PMID: 37646803 DOI: 10.1007/s00192-023-05637-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/17/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION AND HYPOTHESIS In 2018, the ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management) concluded that routine induction of labor (IOL) at 39 weeks gestation decreases cesarean delivery risk, with slightly lighter birthweight infants. We debated whether routine IOL would improve, worsen, or not change POP risk compared with expectant management (EM). METHODS We constructed a decision analysis model with a lifetime horizon where nulliparous women reaching 39 weeks underwent IOL or EM. Subsequent vaginal versus cesarean delivery varied based on prior deliveries for up to four births. Subsequent delivery prior to 39 weeks and distribution of gestational age, birthweight, and delivery mode between 24 and 39 weeks was modeled from national data. We modeled increased POP risk with increasing vaginal parity, forceps delivery, and weight of largest infant delivered vaginally, accounting for differential infant weights in each strategy. RESULTS IOL and EM have similar population-wide POP risk (15.9% and 15.7% respectively). Among women with only spontaneous vaginal deliveries that reached 39 weeks or beyond, the prevalence of POP was 20% after one delivery and 29% after four deliveries, with no difference between groups. The cesarean rate was lower with IOL (27.8% versus 29.8%). Sensitivity analysis revealed no meaningful thresholds among the variables, supporting model robustness. CONCLUSION While routine induction of labor at 39 weeks results in a meaningfully higher vaginal delivery rate, there was no increase in POP, possibly due to the protective effect of lower birthweight.
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Affiliation(s)
- Lauren A Cadish
- Urogynecology, Department of Obstetrics and Gynecology, Providence Saint John's Health Center, 2001 Santa Monica Blvd, Suite 680W, Santa Monica, CA, 90404, USA.
| | - Jonathan P Shepherd
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Hartford, CT, USA
| | - C Emi Bretschneider
- Division of Urogynecology, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
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23
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Roth LA, Kreiger-Benson E, Friedman S, Gossett DR, Shanahan L. Time from insertion to expulsion of cervical ripening balloon in preterm versus term inductions of labor. Arch Gynecol Obstet 2024; 309:515-521. [PMID: 36806766 DOI: 10.1007/s00404-023-06961-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/01/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE Preterm induction of labor can be necessary for maternal and fetal wellbeing. Duration of cervical ripening balloon (CRB) use has been studied in only term inductions. Our study investigated duration of time in hours for CRB expulsion and vaginal delivery in preterm inductions of labor. METHODS This was a single-institution retrospective cohort study of preterm (< 37 weeks) and term (≥ 37 weeks) inductions with CRB between 2010 and 2021. Cesarean deliveries were excluded. Primary outcome was insertion to expulsion time of CRB. Secondary outcomes included induction to delivery time, cervical dilation after expulsion, misoprostol, and Pitocin use. Institutional review board (IRB) approval was obtained prior to the study. RESULTS Ninety-eight patients with vaginal delivery after preterm CRB use were identified and matched 1:1 on baseline characteristics (p > 0.05) to term patients with vaginal delivery after CRB use. Mean insertion to expulsion time was significantly shorter for term than preterm inductions (mean 7.2 ± 3.09 h versus 8.5 ± 3.38 h; p < 0.01). Mean induction to delivery time was significantly shorter for term than preterm inductions (18.4 ± 7.6 h versus 22.5 ± 9.01 h; p < 0.01). Increased use of misoprostol, Pitocin, and second CRB were noted among the preterm cohort. Among term patients, more CRB placement at start of induction and greater cervical dilation post-balloon were found in comparison to preterm patients. CONCLUSION Among patients undergoing preterm induction, longer insertion to expulsion time of CRB, longer induction to delivery time, and increased interventions should be expected. Different standards for labor management should be considered for achieving vaginal delivery in preterm inductions.
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Affiliation(s)
- Lindsey A Roth
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, 10012, USA.
| | - Elana Kreiger-Benson
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, 10012, USA
| | - Steven Friedman
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Dana R Gossett
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, 10012, USA
| | - Lisa Shanahan
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, 10012, USA
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Mohan S, Koziatek C, Su MK. Response to Comment on "Induction of Labor at Term for Severe Antenatal Lead Poisoning". J Med Toxicol 2024; 20:74. [PMID: 37816940 PMCID: PMC10774460 DOI: 10.1007/s13181-023-00969-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Affiliation(s)
- Sanjay Mohan
- Division of Medical Toxicology, Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, 270-05 76th Avenue, Queens, NY, 11040, USA.
| | - Christian Koziatek
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark K Su
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
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25
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Yared G, Tachdjian A, El Kazwini MEJ, Azzi J, El Hajjar C, Ghazal K. A case study on using an intrauterine foley catheter to reduce postpartum bleeding in a patient with hemophilia. Int J Gynaecol Obstet 2024; 164:347-348. [PMID: 37753875 DOI: 10.1002/ijgo.15123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/17/2023] [Accepted: 08/27/2023] [Indexed: 09/28/2023]
Abstract
SynopsisCase of a pregnant patient suffering from severe hemophilia A who had effective uterine foley tamponade to treat postpartum hemorrhage.
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Affiliation(s)
| | - Annie Tachdjian
- Obstetrics and Gynecology Department, Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | | | - Joelle Azzi
- Pharmacist Department, Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Charlotte El Hajjar
- Obstetrics and Gynecology Department, Rafik Hariri Hospital University Medical Center, Beirut, Lebanon
- Obstetrics and Gynecology Department, Al Zahraa Hospital University Medical Centre, Beirut, Lebanon
| | - Kariman Ghazal
- Obstetrics and Gynecology Department, Al Zahraa Hospital University Medical Centre, Beirut, Lebanon
- Obstetrics and Gynecology Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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26
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Pradhan P, Amin DP, Routsolias JC. Comment on "Induction of Labor at Term for Severe Antenatal Lead Poisoning". J Med Toxicol 2024; 20:72-73. [PMID: 37801275 PMCID: PMC10774462 DOI: 10.1007/s13181-023-00968-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023] Open
Affiliation(s)
- Priyanka Pradhan
- Department of Emergency Medicine, Cook County Health, 1950 West Polk Street, 7th Floor EM Admin, Chicago, IL, 60612, USA
| | - Dhara P Amin
- Department of Emergency Medicine, Cook County Health, 1950 West Polk Street, 7th Floor EM Admin, Chicago, IL, 60612, USA
| | - Joanne C Routsolias
- Department of Emergency Medicine, Cook County Health, 1950 West Polk Street, 7th Floor EM Admin, Chicago, IL, 60612, USA.
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27
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Zambrano Guevara LM, Buckheit C, Kuller JA, Gray B, Dotters-Katz S. Evidence Based Management of Labor. Obstet Gynecol Surv 2024; 79:39-53. [PMID: 38306291 DOI: 10.1097/ogx.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
Importance Induction of labor (IOL) is a common obstetric intervention. Augmentation of labor and active management of the second stage is frequently required in obstetric practice. However, techniques around labor and induction management vary widely. Evidence-based practice regarding induction and labor management can reduce birth complications such as infection and hemorrhage and decrease rates of cesarean delivery. Objective To review existing evidence on IOL and labor management strategies with respect to preparing for induction, cervical ripening, induction and augmentation, and second stage of labor techniques. Evidence acquisition Review of recent original research, review articles, and guidelines on IOL using PubMed (2000-2022). Results Preinduction, pelvic floor training and perineal massage reduce postpartum urinary incontinence and perineal trauma, respectively. Timely membrane sweeping (38 weeks) can promote spontaneous labor and prevent postterm inductions. Outpatient Foley bulb placement in low-risk nulliparous patients with planned IOL reduces time to delivery. Inpatient Foley bulb use beyond 6 to 12 hours shows no benefit. When synthetic prostaglandins are indicated, vaginal misoprostol should be preferred. For nulliparous patients and those with obesity, oxytocin should be titrated using a high-dose protocol. Once cervical dilation is complete, pushing should begin immediately. Warm compresses and perineal massage decrease risk of perineal trauma. Conclusion and relevance Several strategies exist to assist in successful IOL and promote vaginal delivery. Evidence-based strategies should be used to improve outcomes and decrease risk of complications and cesarean delivery. Recommendations should be shared across interdisciplinary team members, creating a model that promotes safe patient care.
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Affiliation(s)
- Linda M Zambrano Guevara
- Resident, New York University Langone Health, Department of Obstetrics and Gynecology, New York, NY
| | - Caledonia Buckheit
- Former Resident, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC; Physician, Kamm McKenzie OBGYN, Raleigh, NC
| | | | - Beverly Gray
- Associate Professor, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Sarah Dotters-Katz
- Associate Professor, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
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28
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Akar AN, Ceyhan V, Cundubey CR. The effect of preinduction cervical length measurement with three different ultrasonographic methods on predicting delivery time. J Obstet Gynaecol Res 2024; 50:47-54. [PMID: 37916525 DOI: 10.1111/jog.15820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
AIM This study aimed to evaluate the effect of preinduction cervical length (CL) measurement by transvaginal (TV), transperineal (TP), and transabdominal (TA) ultrasonography (USG) on the time of delivery and to compare these three sonographic methods in terms of superiority over one another. METHODS This study included TV, TP, and TA CL measurements in pregnant women who were planned to undergo induction of labor at 37 weeks' gestation or later. The correlations between the said three methods and BISHOP scores were evaluated. These three methods were compared in terms of superiority in predicting the time of delivery. RESULTS Pregnant women at 37-42 weeks' gestation undergoing labor induction were included, and all three methods were used for CL measurements. Three methods were correlated with each other (p < 0.001) and with BISHOP scores (p < 0.001). CONCLUSION The correlation between all three methods and BISHOP scores indicates that TP and TA USG can be used instead of TV USG. On the other hand, while TA USG did not give a clear result in the accurate estimation of vaginal delivery time, TP, and TV USG gave both accurate and close results. When all these data are evaluated, it is concluded that TPU can be used safely instead of TVU, especially in patients receiving induction.
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Affiliation(s)
- Ayca Nazli Akar
- Department of Obstetrics and Gynecology, Kayseri City Education and Research Hospital, Kayseri, Turkey
| | - Venhar Ceyhan
- Department of Obstetrics and Gynecology, Kayseri City Education and Research Hospital, Kayseri, Turkey
| | - Cevat Rifat Cundubey
- Department of Obstetrics and Gynecology, Kayseri City Education and Research Hospital, Kayseri, Turkey
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29
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David M, Paule Gueye H, Moustapha Drame M, Sibiude J, Penager C, Janky E, Mandelbrot L, Hcini N. Twice-daily versus once-daily vaginal dinoprostone gel for induction of labor at term: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2024; 292:107-111. [PMID: 37992422 DOI: 10.1016/j.ejogrb.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/01/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE The aim of this study was to compare twice-daily versus once-daily administration of intravaginal PGE2 for induction of labor at term. Efficacy, safety, and patient satisfaction were evaluated. STUDY DESIGN For this single-center, randomized, comparative, open-label, two-arm, and parallel study, pregnant women with term singleton live pregnancies ≥ 37 weeks of gestation, medical indications for induction of labor, and Bishop score ≤ 6 were randomized to either the control group (induction of labor with PGE2 gel with repeat dose after 24 h) or the experimental group (repeat dose after 12 h). The primary outcome was induction-to-delivery interval time. Secondary outcomes were maternal and neonatal outcomes and patient satisfaction. RESULTS In total, 246 women were randomized to the control (n = 121) or experimental groups (n = 125). The mean time for initiation of induction to delivery was 9.4 h shorter in the experimental group compared to controls (p = 0.007). For control vs experimental, there were no differences in tachysystole (19/121, 15.7 % vs 21/124, 16.9 %, respectively; p = 0.79), cesarean section rate (18/121, 14.9 % vs 28/124, 22.6 % respectively; p = 0.12), or other main obstetrical or neonatal outcomes. Patients in the experimental group reported higher satisfaction with their induction (48/96, 50 % with once-daily vs 60/86, 69.8 % with twice-daily; p = 0.010). CONCLUSION Among women admitted for induction of labor at term, closer interval of vaginal PGE2 administration was associated with a significantly shorter induction-to-delivery time without increasing maternal or neonatal morbidity. Furthermore, the reduction in induction time was associated with improved patient experience of delivery.
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Affiliation(s)
- Marion David
- Department of Obstetrics and Gynaecology, Maison de la Femme de la Mère et de l'Enfant, Fort-de-France, Martinique, France
| | - Henriette Paule Gueye
- Department of Obstetrics and Gynaecology, Maison de la Femme de la Mère et de l'Enfant, Fort-de-France, Martinique, France
| | - M Moustapha Drame
- Department of Clinical Research and Innovation, University Hospital of Martinique, Fort-de-France, Martinique, France
| | - Jeanne Sibiude
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, FHU PREMA, Hôpital Louis- Mourier, Colombes, France; Université Paris Cité, Paris, France
| | - Cécile Penager
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, FHU PREMA, Hôpital Louis- Mourier, Colombes, France
| | - Eustase Janky
- Gynaecology, Obstetrics Department, University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, FHU PREMA, Hôpital Louis- Mourier, Colombes, France; Université Paris Cité, Paris, France
| | - Najeh Hcini
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, French Guyana. CIC Inserm 1424 et DFR Santé Université Guyane, ST Laurent du Maroni, France.
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30
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Yi J, Chen L, Meng X, Chen Y. The infection, cervical and perineal lacerations in relation to postpartum hemorrhage following vaginal delivery induced by Cook balloon catheter. Arch Gynecol Obstet 2024; 309:159-166. [PMID: 36607435 DOI: 10.1007/s00404-022-06861-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/12/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To identify whether infection, cervical laceration and perineal laceration are associated with postpartum hemorrhage in the setting of vaginal delivery induced by Cook balloon catheter. MATERIALS AND METHODS The retrospective study included 362 women who gave birth vaginally at or beyond 37 weeks of gestation with a diagnosis of postpartum hemorrhage between February 2021 to May 2022, of which including 216 women with induction of labor (Cook balloon catheter followed by oxytocin or oxytocin) and 146 women with spontaneous delivery. Risk factors for postpartum hemorrhage were collected and compared. RESULTS 362 women were divided into three groups, group 1 with spontaneous delivery, group 2 with oxytocin, group 3 with Cook balloon catheter followed by oxytocin. There was no significant difference in incidence of infection within three groups (P > 0.05). The rate of cervical laceration and perineal laceration was significantly higher in group 3 compared with groups 2 and 1 (P < 0.05); Multivariate logistic regression analysis found that compared with group 1, either group 3 or group 2 was associated with increased risks of cervical laceration and perineal laceration (P < 0.05), and compared with group 2, group 3 was not associated with increased risks of cervical laceration and perineal laceration (P > 0.05). CONCLUSION Infection, cervical laceration and perineal laceration are identified not to be independent risk factors for postpartum hemorrhage for women undergoing labor with Cook balloon catheter; Cervical laceration and perineal laceration increase the risk of postpartum hemorrhage in women with labor induction.
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Affiliation(s)
- Jiao Yi
- Department of Obstetrics and Gynecology, Maternal and Child health care hospital affiliated With Anhui Medical University, Anhui Maternal and Child health care Hospital, NO 15 Yimin Street, Hefei, 230000, China.
| | - Lei Chen
- Department of Obstetrics and Gynecology, Maternal and Child health care hospital affiliated With Anhui Medical University, Anhui Maternal and Child health care Hospital, NO 15 Yimin Street, Hefei, 230000, China
| | - Xianglian Meng
- Department of Obstetrics and Gynecology, Maternal and Child health care hospital affiliated With Anhui Medical University, Anhui Maternal and Child health care Hospital, NO 15 Yimin Street, Hefei, 230000, China
| | - Yi Chen
- Department of Obstetrics and Gynecology, Maternal and Child health care hospital affiliated With Anhui Medical University, Anhui Maternal and Child health care Hospital, NO 15 Yimin Street, Hefei, 230000, China
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31
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Glavind J, Boie S. Continued versus discontinued oxytocin stimulation in active labour and neonatal morbidity. Lancet 2023; 402:2048-2049. [PMID: 37952546 DOI: 10.1016/s0140-6736(23)02017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/16/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Julie Glavind
- Department of Clinical Medicine, Obstetrics and Gynecology, Aarhus University Hospital, 8200 Aarhus N, Denmark.
| | - Sidsel Boie
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
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Girault A, Sentilhes L, Desbrière R, Berveiller P, Korb D, Bertholdt C, Carrara J, Winer N, Verspyck E, Boudier E, Barjat T, Levy G, Roth GE, Kayem G, Massoud M, Bohec C, Guerby P, Azria E, Blanc J, Heckenroth H, Rousseau J, Garabedian C, Le Ray C. Impact of discontinuing oxytocin in active labour on neonatal morbidity: an open-label, multicentre, randomised trial. Lancet 2023; 402:2091-2100. [PMID: 37952548 DOI: 10.1016/s0140-6736(23)01803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Oxytocin is effective in reducing labour duration but can be associated with fetal and maternal complications that could potentially be reduced by discontinuing the treatment during labour. We aimed to assess the impact of discontinuing oxytocin during active labour on neonatal morbidity. METHODS STOPOXY was a multicentre, randomised, open-label, controlled, superiority trial conducted in 21 maternity units in France. Participants who received oxytocin before 4 cm dilation were randomly assigned 1:1 to either discontinuous oxytocin (oxytocin infusion stopped beyond a cervical dilation equal to or greater than 6 cm) or continuous oxytocin (administration of oxytocin continued until delivery). Randomisation was stratified by centre and parity. The primary outcome, neonatal morbidity, was assessed at birth using a composite variable defined by an umbilical arterial pH at birth less than 7·10, a base excess greater than 10 mmol/L, umbilical arterial lactates greater than 7 mmol/L, a 5-min Apgar score less than 7, or admission to the neonatal intensive care unit. Efficacy and safety was assessed in participants who were randomly assigned (excluding those who withdrew consent or were deemed ineligible after randomisation) and had reached a cervical dilation of at least 6 cm. This trial is registered with ClinicalTrials.gov, NCT03991091. FINDINGS Of 2459 participants randomly assigned between Jan 13, 2020, and Jan 24, 2022, 2170 were eligible to receive the intervention and were included in the final modified intention-to-treat analysis. The primary outcome occurred for 102 (9·6%) of 1067 participants (95% CI 7·9 to 11·5) in the discontinuous oxytocin group and for 101 (9·2%) of 1103 participants (7·6 to 11·0) in the continuous oxytocin group; absolute difference 0·4% (95% CI -2·1 to 2·9); relative risk 1·0 (95% CI 0·8 to 1·4). There were no clinically significant differences in adverse events between the two groups of the safety population. INTERPRETATION Among participants receiving oxytocin in early labour, discontinuing oxytocin when the active phase is reached does not clinically or statistically significantly reduce neonatal morbidity compared with continuous oxytocin. FUNDING French Ministry of Health and the Département de la Recherche Clinique et du Développement de l'Assistance Publique-Hôpitaux de Paris.
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Affiliation(s)
- Aude Girault
- Université Paris Cité, Inserm UMR 1153, Equipe EPOPé, Paris, France; Department of Obstetrics and Gynecology, Port-Royal Maternity Hospital, AP-HP, Cochin Hospital, FHU PREMA, Paris, France.
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Raoul Desbrière
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, Marseille, France
| | - Paul Berveiller
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Poissy/Saint-Germain-en-Laye, Rue du Champ Gaillard, Poissy Cedex, France
| | - Diane Korb
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris, France
| | - Charline Bertholdt
- University of Lorraine, CHRU NANCY, Obstetrics and Gynecology Department, NANCY, France
| | - Julie Carrara
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, AP-HP, Paris, France; Paris Saclay University, Paris, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Hospital of Nantes, Nantes, France
| | - Eric Verspyck
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Eric Boudier
- Department of Obstetrics and Gynecology, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Tiphaine Barjat
- Department of Obstetrics and Gynecology, Saint Etienne University Hospital, Saint Etienne, France
| | - Gilles Levy
- Department of Obstetrics and Gynecology, Hôpital Nord Franche Comté, Belfort, France
| | - Georges Emmanuel Roth
- CHU de Strasbourg, Pôle de Gynécologie-Obstétrique et Fertilité, Université de Strasbourg, Strasbourg, France
| | - Gilles Kayem
- Université Paris Cité, Inserm UMR 1153, Equipe EPOPé, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Sorbonne University, APHP, Paris, France
| | - Mona Massoud
- Hospices Civils de Lyon, Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Caroline Bohec
- Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Infinity CNRS Inserm UMR 1291, CHU Toulouse, Toulouse, France
| | - Elie Azria
- Université Paris Cité, Inserm UMR 1153, Equipe EPOPé, Paris, France; Maternity Unit, Groupe Hospitalier Paris Saint Joseph, FHU PREMA, Paris, France
| | - Julie Blanc
- Department of Obstetrics and Gynecology, Nord Hospital, APHM, Marseille, France
| | - Hélène Heckenroth
- Department of Gynaecology and Obstetrics, Gynépole, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Jessica Rousseau
- Clinical Research Unit, Center for Clinical Investigation P1419, AP-HP, Paris, France
| | - Charles Garabedian
- CHU Lille, Department of Obstetrics, Lille, France; Univ Lille, ULR 2694-METRICS, Lille, France
| | - Camille Le Ray
- Université Paris Cité, Inserm UMR 1153, Equipe EPOPé, Paris, France; Department of Obstetrics and Gynecology, Port-Royal Maternity Hospital, AP-HP, Cochin Hospital, FHU PREMA, Paris, France
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McCoy JA, Bromwich K, Gerson KD, Levine LD. Association between intrapartum antibiotic prophylaxis for Group B Streptococcus colonization and clinical chorioamnionitis among patients undergoing induction of labor at term. Am J Obstet Gynecol 2023; 229:672.e1-672.e8. [PMID: 37352908 PMCID: PMC10733553 DOI: 10.1016/j.ajog.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Rectovaginal colonization with Group B Streptococcus during pregnancy has historically been shown to be associated with an increased risk of clinical chorioamnionitis and peripartum infectious morbidity. OBJECTIVE Newer observational data in the era of intrapartum antibiotic prophylaxis suggest a possible reversal of this association; however, it is unclear if this is related to differences in labor management for those with and without Group B Streptococcus colonization. We therefore sought to assess the association between intrapartum antibiotic prophylaxis for Group B Streptococcus colonization and clinical chorioamnionitis within the context of a randomized induction of labor trial with a standardized labor protocol. STUDY DESIGN We performed an exploratory secondary analysis of a randomized trial of patients undergoing term induction at a tertiary care center. Patients received third trimester Group B Streptococcus screening and intrapartum antibiotic prophylaxis as routine care. Group B Streptococcus detection was performed using a carrot broth-enhanced subculture to Group B Streptococcus Detect approach (Hardy Diagnostics, Santa Maria, CA). Labor management was protocolized per the trial. Patients with unknown Group B Streptococcus status or who did not receive intrapartum antibiotic prophylaxis, if indicated, were excluded. The primary outcome was diagnosis of clinical chorioamnionitis, compared between patients who received intrapartum antibiotic prophylaxis for known Group B Streptococcus positive status (by culture, history, or Group B Streptococcus bacteriuria) and those who were Group B Streptococcus negative and did not receive intrapartum antibiotic prophylaxis. Secondary outcomes included postpartum endometritis, wound infection, a composite maternal peripartum infectious morbidity, and neonatal outcomes. RESULTS A total of 491 patients were enrolled in the trial. Of these, 466 had a known Group B Streptococcus status and received or did not receive intrapartum antibiotic prophylaxis accordingly and were included in this analysis: 292 (62.7%) were Group B Streptococcus negative and did not receive intrapartum antibiotic prophylaxis, and 174 (37.3%) were Group B Streptococcus positive and received intrapartum antibiotic prophylaxis. The majority of patients were Non-Hispanic Black (78.1%) and nulliparous (59.7%). There were no differences in demographic, clinical, induction or labor characteristics between groups. Patients who were Group B Streptococcus positive had a 49% lower rate of clinical chorioamnionitis (8.1% vs 14.7%, odds ratio, 0.51; P=.03) and a lower rate of peripartum infectious morbidity (8.1% vs 15.8%, odds ratio, 0.47; P=.02) compared to those who were Group B Streptococcus negative. Infants born to patients who were Group B Streptococcus positive were significantly less likely to be admitted to the neonatal intensive care unit (3.4% vs 15.1%, P<.001). CONCLUSION Although Group B Streptococcus colonization has historically been considered a risk factor for clinical chorioamnionitis, in the era of universal antibiotic prophylaxis for Group B Streptococcus positive patients, our findings support the point that intrapartum antibiotic prophylaxis for Group B Streptococcus positivity is associated with lower rates of clinical chorioamnionitis and peripartum infectious morbidity among patients undergoing induction with protocolized labor management. These findings demonstrate that intrapartum antibiotic prophylaxis for Group B Streptococcus may protect against perinatal infectious morbidity, a phenomenon that warrants further investigation.
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Affiliation(s)
- Jennifer A McCoy
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
| | - Kira Bromwich
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kristin D Gerson
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lisa D Levine
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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John S, Alsweiler J, Wise MR. Barriers and enablers to implementing an induction of labour guideline: A clinician survey. Aust N Z J Obstet Gynaecol 2023; 63:768-773. [PMID: 37317622 DOI: 10.1111/ajo.13718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Clinical guidelines improve outcomes, but poor compliance with recommendations is common. Insight into perceived barriers and enablers to the implementation of guidelines can engage maternity care providers and inform strategies for effective implementation. AIM To identify the perceived barriers and enablers to implementing the 2020 'Induction of Labour [IOL] in Aotearoa New Zealand; a Clinical Practice Guideline.' MATERIALS AND METHODS Electronic anonymous survey of clinical leaders in midwifery, obstetrics, and neonatology in New Zealand, from August to November 2021. Recruitment of participants was initially through provided lists of national clinical leads, followed by chain sampling. RESULTS There were 32 of 89 surveys returned (36%). The most frequently identified enablers were implementation tools such as 'standardised IOL request form' and 'peer review process,' and administrative support and dedicated time. Six maternity hospitals already had peer review in place, whereby IOL requests that did not adhere to guidelines were reviewed by a multidisciplinary group of senior colleagues or peers, with individual feedback to the referring clinician. Attitudes in the form of 'existing systems, routines and culture' was the most frequently identified barrier, followed by external barriers such as 'lack of human resources.' CONCLUSIONS Overall, few barriers were identified to implementing this guideline, and some of the key enablers were already in place. The identified enablers warrant future research to develop and evaluate effectiveness in improving outcomes.
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Affiliation(s)
- Savesh John
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michelle R Wise
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Saini A, Sarkar A, Ahuja M. Tafoxiparin, a novel drug candidate for cervical ripening and labor augmentation: a letter. Am J Obstet Gynecol 2023; 229:700-701. [PMID: 37336254 DOI: 10.1016/j.ajog.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/14/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Abhishek Saini
- Department of Obstetrics and Gynecology, ESIC Medical College and Hospital, Faridabad, Haryana 121001, India
| | - Avir Sarkar
- Department of Obstetrics and Gynecology, ESIC Medical College and Hospital, Faridabad, Haryana 121001, India.
| | - Maninder Ahuja
- Director Ahuja Healthcare and Infertility Center, Faridabad, Haryana, India
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Holmes J. A Revised Moral Appraisal of Early Induction of Labor in Cases of Anencephaly. HEC Forum 2023; 35:389-406. [PMID: 35212854 DOI: 10.1007/s10730-022-09475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
The central concern of this article is whether early induction of labor for an anencephalic fetus can ever be morally justified, particularly by a Catholic healthcare ethics committee. By revisiting and refining arguments in articles by Drane (1992) and Bole (1992) published in this journal, a revised argument - consistent with the Catholic moral tradition - can seemingly be constructed that a Catholic healthcare ethics committee might use to justify early induction of labor in some pregnancies involving an anencephalic fetus. Such a revised argument depends upon two central claims; first, that the anencephalic fetus in question is necessarily in the process of dying when early induction of labor occurs, and second, that the fetus is judged to be undergoing extraordinary or disproportionate means of preserving their life as a result of receiving ongoing maternal support of a mother's womb. The revised argument developed in this article aims to utilize the doctrine of double effect in conjunction with these two central claims to justify early induction of labor for anencephalic fetal persons in some circumstances. Unfortunately, the revised argument - if successful - would be at odds with a stance taken in the United States Conference of Catholic Bishops (USCCB) 1996 statement "Moral Principles Concerning Infants with Anencephaly." However, there is reason to believe the revised argument offered in this article is well aligned with other guidance from the USCCB, contained in the publication Ethical and Religious Directives for Catholic Healthcare Services (2018). This article concludes by noting some important limitations of the argument and offering hope that consideration of the argument ultimately helps to strengthen the Catholic moral tradition.
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Affiliation(s)
- John Holmes
- Ethics Educator, Mission Services, PeaceHealth, Vancouver, WA, USA.
- Adjunct Instructor of Philosophy, Portland Community College, Portland, OR, USA.
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Onishi K, Huang JC, Kawakita T. Comparison of Labor Curves Between Spontaneous and Induced Labor. Obstet Gynecol 2023; 142:1416-1422. [PMID: 37826850 DOI: 10.1097/aog.0000000000005407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/17/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To compare the labor curve between individuals with induced labor and those undergoing spontaneous labor. METHODS This was a secondary analysis of the Consortium on Safe Labor database, including nulliparous and multiparous individuals with singleton vertex pregnancy who delivered vaginally after spontaneous labor or induction of labor at term. Labor that resulted in uterine rupture and neonates with a 5-minute Apgar scores less than 7, birth injury, or neonatal intensive care unit admission was excluded. We modeled the course of cervical dilation using repeated-measures analysis with a polynomial function. We compared traverse time , defined as the elapsed time between two given dilation measures, between induced and spontaneous labor using interval-censored regression. RESULTS Of 46,835 nulliparous individuals, 18,576 and 28,259 underwent induced and spontaneous labor, respectively. Of 77,503 multiparous individuals, 29,684 and 47,819 underwent induced and spontaneous labor, respectively. The start of the active phase on the labor curve was 6 cm in induced labor, regardless of parity. In nulliparous individuals, induced labor compared with spontaneous labor had a significantly shorter traverse time from 6 to 10 cm (median 1.8 hours [5th-95th percentile 0.4-8.6 hours] vs 2.3 hours [5th-95th percentile 0.6-9.4 hours]; P <.01). In multiparous individuals, induced labor compared with spontaneous labor had a significantly shorter traverse time from 6 to 10 cm (median 0.9 hours [5th-95th percentile 0.1-6.0 hours] vs 1.4 hours [5th-95th percentile 0.3-7.9 hours]; P <.01). CONCLUSION Similar to spontaneous labor, the start of the active phase of induced labor was at 6 cm of dilation. Comparatively, induced labor had a shorter active phase than spontaneous labor. These findings suggest that the current criteria for active phase arrest provided by the American College of Obstetricians and Gynecologists do not need to be lengthened for individuals in induced labor.
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Affiliation(s)
- Kazuma Onishi
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia; and the Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Abstract
OBJECTIVE Our prior work demonstrated decreased birth satisfaction for Black women undergoing labor induction. We aimed to determine if implementation of standardized counseling around calculated cesarean risk during labor induction could reduce racial disparities in birth satisfaction. STUDY DESIGN We implemented use of a validated calculator that provides an individual cesarean risk score for women undergoing induction into routine care. This prospective cohort study compared satisfaction surveys for 6 months prior to implementation (preperiod: January 2018-June 2018) to 1 year after (postperiod: July 2018-June 2019). Women with full-term (≥37 weeks) singleton gestations with intact membranes and an unfavorable cervix undergoing induction were included. In the postperiod, providers counseled patients on individual cesarean risk at the beginning of induction using standardized scripts. This information was incorporated into care at patient-provider discretion. The validated 10-question Birth Satisfaction Scale-Revised (BSS-R) subdivided into three domains was administered throughout the study. Patients were determined to be "satisfied" or "unsatisfied" if total BSS-R score was above or below the median, respectively. In multivariable analysis, interaction terms evaluated the differential impact of the calculator on birth satisfaction by race (Black vs. non-Black women). RESULTS A total of 1,008 of 1,236 (81.6%) eligible women completed the BSS-R (preperiod: 330 [79.7%] versus postperiod: 678 [82.5%], p = 0.23), 63.8% of whom self-identified as Black. In the preperiod, Black women were 50% less likely to be satisfied than non-Black women, even when controlling for differences in parity (Black: 39.0% satisfied vs. non-Black: 53.9%, adjusted odds ratio [aOR] = 0.49, 95% confidence interval [CI]: 0.30-0.79). In the postperiod, there was no difference in satisfaction by race (Black: 43.7% satisfied vs. non-Black: 44.0%, aOR = 0.97. 95% CI: 0.71-1.33). Therefore, disparities in birth satisfaction were no longer present at postimplementation (interaction p = 0.03). CONCLUSION Implementation of standardized counseling with a validated calculator to predict cesarean risk after labor induction is associated with a decrease in racial disparities in birth satisfaction. KEY POINTS · Preintervention, Black women were less likely to have above-median birth satisfaction.. · We implemented standardized counseling around cesarean risk with labor induction.. · Implementation was associated with reduced racial disparities in birth satisfaction scores..
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Affiliation(s)
- Rebecca F Hamm
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sindhu K Srinivas
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer Mccoy
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lisa D Levine
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Wang J, Cao Y, Chen L, Tao Y, Huang H, Miao C. Influence factor analysis and prediction model of successful application of high-volume Foley Catheter for labor induction. BMC Pregnancy Childbirth 2023; 23:776. [PMID: 37946140 PMCID: PMC10633906 DOI: 10.1186/s12884-023-06101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND This study aimed to establish a clinical-based nomogram for predicting the success rate of high-volume Foley catheterization for labor induction. METHODS This retrospective study included 1149 full-term pregnant women who received high-volume Foley catheterization for labor induction from January 2019 to December 2021 in Changshu No.1 People's Hospital. Univariate and multivariate logistic regression analyses were performed, in which the labor induction success was set as dependent variables and the characteristics (including age, height, weight, BMI, gravidity, parity, gestational age, uterine height, abdominal circumference, cervical Bishop score, amniotic fluid index, cephalic presentation, neonatal weight, pregnancy complications, etc.) were set as independent variables. A nomogram scoring model was established based on these risk factors, and a calibration curve was plotted to verify the predictive accuracy of the model. RESULTS The success rate of labor induction was 83.55% (960/1149). Univariate analysis revealed that the risk factors associated with the success rate of high-volume Foley catheterization for labor induction were height, pregnancy, birth, age, weight, BMI, uterine height, abdominal circumference, and hypertension. Multivariate logistic regression analysis showed that age (OR = 0.950; 95% CI: 0.904 ~ 0.998), height (OR = 1.062; 95% CI: 1.026 ~ 1.100), BMI (OR = 0.871; 95% CI: 0.831 ~ 0.913), and parity (OR = 8.007; 95% CI: 4.483 ~ 14.303) were independent risk factors for labor induction success by high-volume Foley catheterization. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve in the prediction model was 0.752 (95% CI 0.716 ~ 0.788). A nomogram was constructed based on the final multivariate analysis with a corrected C-index of 0.748, which indicated that the model was calibrated reasonably. CONCLUSION Four risk factors were used to construct a nomogram to evaluate the success rate of high-volume Foley catheterization for labor induction. The nomogram provides a visual clinical tool to assist in the selection of the most appropriate mode of labor induction for pregnant women of different risk levels.
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Affiliation(s)
- Jia Wang
- Department of Gynecology and Obstetrics, Changshu No.1 People's Hospital, Suzhou, 215500, China
| | - Yu Cao
- Department of Gynecology and Obstetrics, Changshu No.1 People's Hospital, Suzhou, 215500, China
| | - Lu Chen
- Department of Gynecology and Obstetrics, Changshu No.1 People's Hospital, Suzhou, 215500, China
| | - Yan Tao
- Department of Gynecology and Obstetrics, Changshu No.1 People's Hospital, Suzhou, 215500, China
| | - Huanhuan Huang
- School of Biotechnology and Food Engineering, Changshu Institute of Technology, Suzhou, 215500, China
| | - Chunju Miao
- Department of Gynecology and Obstetrics, Changshu No.1 People's Hospital, Suzhou, 215500, China.
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Nien YC, Kung HF, Chen MJ, Chen WC. Dinoprostone tablet versus continuous vaginal insert (Propess®) for elective induction in low-risk nulliparous women at term. Taiwan J Obstet Gynecol 2023; 62:858-862. [PMID: 38008505 DOI: 10.1016/j.tjog.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of dinoprostone tablet and continuous vaginal insert (Propess®) in low-risk nulliparous women at term with insufficient cervical ripening receiving elective induction. MATERIALS AND METHODS A retrospective study was conducted between March 2020 and February 2022 and included 230 women who underwent elective induction with dinoprostone tablet or vaginal insert. The primary endpoint was failure of induction. Secondary endpoints included time to vaginal delivery, vaginal delivery rate, as well as maternal and neonatal complications and adverse outcomes. RESULTS No statistically significant differences were found between the two groups regarding the main outcome measures; however, the high responders had a significant higher proportion of hyperstimulation and non-reassuring fetal status. The high responder in the Propess group was statistically significant younger (31.68 ± 4.73 vs. 33.82 ± 4.39, p = 0.027), while they had a significantly lower BMI at delivery time of the tablet group (24.49 ± 2.24 vs. 27.42 ± 4.32, p = 0.024). Factors associated with success of vaginal delivery within 24 h (p = 0.015, OR = 0.9, 95%CI = 0.82-0.98) and the Cesarean section (p < 0.001, OR = 1.17, 95%CI = 1.08-1.27) was BMI at delivery time. CONCLUSION Slow-release vaginal insert and dinoprostone tablet had similar efficacy and safety for elective induction in low risk nulliparous women at term. Women with younger maternal age or lower BMI at delivery time may have a better response to dinoprostone and had a significantly higher proportion of hyperstimulation and non-reassuring fetal status.
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Affiliation(s)
- Yu-Cheng Nien
- Department of Obstetrics, Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsiao-Fan Kung
- Department of Obstetrics, Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Ming-Jer Chen
- Department of Obstetrics, Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Chi Chen
- Department of Obstetrics, Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
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Aaron BL, Neff KE, Wu J, Cai F, Swartz JJ, Burns LP. Labor induction in the age of TikTok: what are influencers teaching patients about oxytocin infusion? Am J Obstet Gynecol MFM 2023; 5:101138. [PMID: 37619780 PMCID: PMC10683515 DOI: 10.1016/j.ajogmf.2023.101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Bryan L Aaron
- University of Michigan Medical School, Ann Arbor, MI.
| | | | - Jenny Wu
- Department of Obstetrics and Gynecology, Duke University, Durham, NC
| | - Fei Cai
- Division of Perinatology, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Jonas J Swartz
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Luke P Burns
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Abstract
OBJECTIVE The aim of this study was to compare duration of labor induction between diabetic and nondiabetic women receiving dinoprostone vaginal insert (10 mg). STUDY DESIGN This is a secondary analysis of two large randomized controlled trials using dinoprostone vaginal inserts for labor induction. We compare time to active labor, overall delivery, and vaginal delivery between diabetic and nondiabetic women undergoing induction of labor with a 10-mg dinoprostone vaginal insert. RESULTS Diabetic women receiving dinoprostone vaginal insert had a longer time to onset of active labor, overall delivery, and vaginal delivery than their nondiabetic counterparts. There was no difference in abnormal labor affecting fetal heart rate pattern in diabetic women compared with nondiabetic women. The rates of neonatal hyperbilirubinemia were higher in diabetic women. CONCLUSION Diabetes may represent an independent factor associated with prolonged induction among women undergoing induction of labor with dinoprostone. Dinoprostone is well tolerated in both diabetic and nondiabetic women. KEY POINTS · Diabetic women receiving DVI have slower labor curves than nondiabetic women.. · Nulliparous diabetic women took longer to achieve active labor, overall delivery, and vaginal delivery than nondiabetic women.. · Parous diabetic women took longer to achieve vaginal delivery than nondiabetic women..
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Affiliation(s)
- Jennifer Y Duffy
- Department of Obstetrics and Gynecology, University of California, San Francisco, California
- Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, California
| | - Cindy Chau
- Magella Medical Group, Miller Children's and Women's Hospital, Long Beach, California
| | | | - Olof Rugarn
- Ferring Pharmaceuticals, Copenhagen, Denmark
| | - Deborah A Wing
- Department of Academic Medicine and Health Sciences Practice, WittKieffer, Oak Brook, Illinois
- Division of Maternal-Fetal Medicine, Department of Obstetrics-Gynecology, University of California, Orange, California
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Runyon MC. Induction of Labor Education and Advocacy. MCN Am J Matern Child Nurs 2023; 48:349. [PMID: 37840209 DOI: 10.1097/nmc.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Affiliation(s)
- Maggie C Runyon
- Maggie C. Runyon is Co-Founder, Trauma-Informed Birth Nurse, Your BIRTH Partners, Doylestown, PA. The author can be reached via email at
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Sullivan MV, Young AJ, Pawar P, Lewis MW, Mackeen AD, Paglia MJ. Induction of labor with prostaglandins for pregnancies with small for gestational age neonates. Am J Obstet Gynecol MFM 2023; 5:101169. [PMID: 37777069 DOI: 10.1016/j.ajogmf.2023.101169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Maranda V Sullivan
- Department of Maternal-Fetal Medicine, Geisigner Medical Center, Danville, PA 17822.
| | - Amanda J Young
- Department of Population Health Sciences, Geisinger Medical Center, Danville, PA
| | - Priyanka Pawar
- Department of Population Health Sciences, Geisinger Medical Center, Danville, PA
| | - Meredith W Lewis
- Department of Population Health Sciences, Geisinger Medical Center, Danville, PA
| | - A Dhanya Mackeen
- Department of Maternal-Fetal Medicine, Geisigner Medical Center, Danville, PA
| | - Michael J Paglia
- Department of Maternal-Fetal Medicine, Geisigner Medical Center, Danville, PA
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Vuković M, Nosek I, Vuković J, Ilić Đ, Kozić D, Boban J. Case Report: Labor induced coccydynia associated with Modic I changes successfully treated with platelet-rich plasma. Front Immunol 2023; 14:1239741. [PMID: 37965319 PMCID: PMC10642930 DOI: 10.3389/fimmu.2023.1239741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/04/2023] [Indexed: 11/16/2023] Open
Abstract
Imaging can aid in determining potential causes of coccygeal pain and therefore guide clinicians to carry out individualized treatment. We represent a case of postpartum coccydynia treated by platelet-rich plasma (PRP) which was assessed and followed by MRI. A primipara with uncomplicated labor developed coccygeal pain after delivery that significantly limited her postpartum recovery. On the first MR scan, recorded 6 months after delivery, there were edematous changes of the vertebral endplates of Co1-4 level (Modic type I) with the presence of pronounced precoccygeal venous drainage. Degenerative changes with signs of edema in the area of the pubic symphysis were recorded. The sacroiliac joints had regular morphological features. Since the patient was breastfeeding, PRP therapy was applied with a total of three injections in the area of the coccyx subcutaneously, once every 3 months. The subjective feeling of pain reduction after each injection was about 30%, with the complete withdrawal of pain after one year and still pain-free at the two-year follow-up. One year after the initial MR imaging, a follow-up MR examination was performed, where almost complete resolution of edematous changes in the previously present zones was observed, with residual minor edema of the vertebral endplates at the Co2-3 level. Edema of the pubic bones in the area of the pubic symphysis also subsided. A case of labor-induced coccydynia that was represented as Modic type I changes without neither fracture or luxation was successfully treated with PRP with complete resolution of symptoms.
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Affiliation(s)
- Miloš Vuković
- Department of Radiology, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Department for Radiology Diagnostics, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Igor Nosek
- Department of Radiology, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Department for Radiology Diagnostics, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Jelena Vuković
- Department of Gynaecology and Obstetrics, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Obstetrics and Gynaecology Clinic, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Đorđe Ilić
- Department of Gynaecology and Obstetrics, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Obstetrics and Gynaecology Clinic, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Duško Kozić
- Department of Radiology, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Department for Radiology Diagnostics, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Jasmina Boban
- Department of Radiology, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Department for Radiology Diagnostics, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
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Khan H, McCaffrey C, Gagnon LH, Hui D, Sobel M, Shore EM. Letter: Evaluating the Impact of a Teaching Video on Medical Students' Knowledge of Induction of Labour: A Pilot Project in Undergraduate Obstetrics Education. J Obstet Gynaecol Can 2023; 45:102156. [PMID: 37230225 DOI: 10.1016/j.jogc.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Haniya Khan
- Department Obstetrics and Gynecology, University of Toronto, Toronto, ON
| | - Carmen McCaffrey
- Department Obstetrics and Gynecology, University of Toronto, Toronto, ON; Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Louise-Helene Gagnon
- Department Obstetrics and Gynecology, University of Toronto, Toronto, ON; Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| | - Dini Hui
- Department Obstetrics and Gynecology, University of Toronto, Toronto, ON; Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| | - Mara Sobel
- Department Obstetrics and Gynecology, University of Toronto, Toronto, ON; Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON
| | - Eliane M Shore
- Department Obstetrics and Gynecology, University of Toronto, Toronto, ON; Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, ON.
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Mohan S, Mahonski S, Koziatek C, Cohen ET, Smith S, Su MK. Induction of Labor at Term for Severe Antenatal Lead Poisoning. J Med Toxicol 2023; 19:401-404. [PMID: 37365427 PMCID: PMC10522539 DOI: 10.1007/s13181-023-00955-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Antenatal lead exposure is associated with multiple adverse maternal and fetal consequences. Maternal blood lead concentrations as low as 10 µg/dL have been associated with gestational hypertension, spontaneous abortion, growth retardation, and impaired neurobehavioral development. Current treatment recommendations for pregnant women with a blood lead level (BLL) ≥ 45 µg/dL include chelation. We report a successful case of a mother with severe gestational lead poisoning treated with induction of labor in a term infant. CASE REPORT A 22-year-old G2P1001 female, at 38 weeks and 5 days gestation, was referred to the emergency department for an outpatient venous BLL of 53 µg/dL. The decision was made to limit ongoing prenatal lead exposure by emergent induction as opposed to chelation. Maternal BLL just prior to induction increased to 70 µg/dL. A 3510 g infant was delivered with APGAR scores of 9 and 9 at 1 and 5 min. Cord BLL at delivery returned at 41 µg/dL. The mother was instructed to avoid breastfeeding until her BLLs decreased to below 40 µg/dL, consistent with federal and local guidelines. The neonate was empirically chelated with dimercaptosuccinic acid. On postpartum day 2, maternal BLL decreased to 36 µg/dL, and the neonatal BLL was found to be 33 µg/mL. Both the mother and neonate were discharged to an alternative lead-free household on postpartum day 4.
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Affiliation(s)
- Sanjay Mohan
- Division of Medical Toxicology, Department of Emergency Medicine, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 270-05 76th Avenue, Queens, NY, 11040, USA.
| | - Sarah Mahonski
- Department of Emergency Medicine, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Christian Koziatek
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York City, NY, USA
| | - Emily T Cohen
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Silas Smith
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark K Su
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
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İleri A, Yıldırım Karaca S, Gölbaşı H, Adıyeke M, Budak A, Özer M, İleri H, Biçer M, Şenkaya AR, Arı SA, Çeliker Tosun Ö, Karaca İ. Diagnostic accuracy of pre-induction cervical elastography, volume, length, and uterocervical angle for the prediction of successful induction of labor with dinoprostone. Arch Gynecol Obstet 2023; 308:1301-1311. [PMID: 37210702 DOI: 10.1007/s00404-023-07076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE The study's aim is to define among a group of ultrasonographic cervical measurements a candidate parameter predictive of successful of induction of labor in term pregnancies with unfavorable cervix. METHODS This prospective observational study included 141 pregnant women at term with an unfavorable cervix (Bishop score ≤ 6). All patients underwent clinical and ultrasonographic cervical evaluation before dinoprostone induction. Pre-induction cervical assessments included the Bishop score, cervical length, cervical volume, uterocervical angle, and cervical elastographic parameters. Vaginal delivery (VD) was accepted as successful dinoprostone induction. Multivariate logistic regression was conducted to identify the potential risk factors significantly associated with CS while controlling for possible confounding variables. RESULTS The vaginal delivery rate was 74% (n = 93) and the cesarean section (CS) rate was 26% (n = 32). Sixteen patients who had a cesarean section due to fetal distress before the active phase of labor were excluded from the study. The mean induction-to-delivery interval was 1176.1 ± 352 (540-2150) for VD and 1359.4 ± 318.4 (780-2020) for CS (p = 0.01). Bishop score was lower in women with cesarean section (p = 0.002). When both groups were compared in terms of delivery type, no difference was found between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. Multivariable logistic regression model failed to show significant differences between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. CONCLUSION Cervical length, cervical elastography, cervical volume, and uterocervical angle measurements did not provide a clinically useful prediction of outcomes following labor induction in our study group with unfavorable cervix. Cervical length measurements significantly predicted the time interval from induction to delivery.
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Affiliation(s)
- Alper İleri
- Department of Obstetrics and Gynaecology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey.
| | - Suna Yıldırım Karaca
- Department of Obstetrics and Gynaecology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey
| | - Hakan Gölbaşı
- Department of Perinatology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey
| | - Mehmet Adıyeke
- Department of Obstetrics and Gynaecology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey
| | - Adnan Budak
- Department of Obstetrics and Gynaecology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey
| | - Mehmet Özer
- Department of Perinatology, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey
| | - Hande İleri
- Department of Family Medicine, Health Sciences University Tepecik Education and Research Hospital, İzmir, Turkey
| | - Merve Biçer
- Private Clinic, Obstetrics and Gynecology, İzmir, Turkey
| | - Ayse Rabia Şenkaya
- Çiğli Education and Research Hospital, Department of Obstetrics and Gynaecology, İzmir Bakircay University, İzmir, Turkey
| | - Sabahattin Anıl Arı
- Çiğli Education and Research Hospital, Department of Obstetrics and Gynaecology, İzmir Bakircay University, İzmir, Turkey
| | - Özge Çeliker Tosun
- Department of Physical Therapy and Rehabilitation, Dokuz Eylul University, İzmir, Turkey
| | - İbrahim Karaca
- Çiğli Education and Research Hospital, Department of Obstetrics and Gynaecology, İzmir Bakircay University, İzmir, Turkey
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Imai K, Nozaki Y, Ushida T, Tano S, Kajiyama H, Kotani T. Comparison of the efficacy between controlled-release dinoprostone delivery system (PROPESS) and Cook's double balloon catheter plus oxytocin: A retrospective single-center study in Japan. J Obstet Gynaecol Res 2023; 49:2317-2323. [PMID: 37385818 DOI: 10.1111/jog.15734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
AIMS To compare the efficacy of the controlled-release dinoprostone delivery system (PROPESS) and Cook's double balloon catheter (DBC) plus oxytocin as induction treatment. METHODS A total of 197 term pregnant women with unfavorable cervix were admitted for scheduled induction and enrolled retrospectively (PROPESS, 113; Cook's DBC plus oxytocin, 84). The main birth outcomes were cervical ripening at the treatment-end and 24 h after the treatment-start, and rate of vaginal birth. Logistic regression and propensity score matching analyses were performed to evaluate the association between the outcomes and clinical characteristics including which treatment was selected. RESULTS The choice of PROPESS was associated with the success of cervical ripening at 24 h after (adjusted odds ratio (OR) 2.17, 95% confidence interval (CI) 1.11-4.26, p = 0.024) and increased the rate of vaginal birth (adjusted OR 2.03, 95% CI 1.04-3.98, p = 0.039). Similar trends in the association between PROPESS and birth outcomes were maintained after adjusting for propensity scores (p = 0.072 and p = 0.163, respectively). However, some of the women with gestational age of early 39 weeks and low Bishop scores could achieve cervical ripening at 24 h after using Cook's DBC plus oxytocin, and none by PROPESS. CONCLUSION Our findings suggest the possibility of slight advantages of PROPESS for scheduled induction of labor. In women with early term and extremely low Bishop scores, Cook's DBC plus oxytocin may be a superior or alternative treatment to PROPESS. Therefore, the optimal choice of induction treatment should be managed on an individual basis.
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Affiliation(s)
- Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi Prefecture, Japan
| | - Yuki Nozaki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi Prefecture, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi Prefecture, Japan
| | - Sho Tano
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi Prefecture, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi Prefecture, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi Prefecture, Japan
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Jangra H, Bagga R, Kalra J, Jain V, Saha SC, Kumar P. Expediting labor induction in severe pre-eclampsia by earlier initiation of oxytocin after cervical ripening: A randomized study from India. Pregnancy Hypertens 2023; 33:1-7. [PMID: 37229912 DOI: 10.1016/j.preghy.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/19/2023] [Accepted: 05/19/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To observe whether induction of labor (IoL) among women with severe pre-eclampsia (PE) can be expedited by initiating oxytocin early (after 6 h) than after 12 h following cervical ripening with a combined method. METHODS Women with severe PE and Bishop's < 6 (n = 96) were randomized into two groups. All women received cervical ripening with a combined method (intracervical Foley's plus dinoprostone gel 0.5 mg) following which Group 1 women received oxytocin after 6 h (with Foley's in-situ) and Group 2 after 12 h (after removing Foley's) RESULTS: Majority were nulliparous (63% in group 1 and 77% in group 2) and the mean gestation was similar (35.3 ± 2.98 weeks in group 1 and 35.5 ± 3.09 in group 2). Nearly half the women had partial HELLP/ HELLP (47.9% and 54.1%; in groups 1 and 2, respectively). The induction-delivery interval (IDI) was significantly reduced in group 1 (16 h 6 min vs 22 h 6 min in group 2; p = 0.001). The cesarean section (CS) rate was 37.5% in group 1 and 31.3% in group 2 (p = 0.525), but the study was underpowered to assess this outcome. The neonatal outcome was similar, 92/96 neonates were discharged after a hospital stay of 3-52 days. There were 4 neonatal deaths (1 in group 1 and 3 in group 2) of extreme or very preterm neonates (27-30 + 6 wks) with birth weight of 735-965 gm. CONCLUSION Among women with severe PE undergoing IoL, initiating oxytocin 6 h after cervical ripening with a combined method reduced the IDI significantly as compared to initiating it after 12 h, with a similar CS rate and neonatal outcome.
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Affiliation(s)
- Himani Jangra
- Department of Obstetrics & Gynaecology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Rashmi Bagga
- Department of Obstetrics & Gynaecology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India.
| | - Jasvinder Kalra
- Department of Obstetrics & Gynaecology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Vanita Jain
- Department of Obstetrics & Gynaecology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Subhas Chandra Saha
- Department of Obstetrics & Gynaecology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Praveen Kumar
- Department of Paediatrics, Division of Neonatology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
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