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Ma K, Yang M, Feng X, Liu L, Li L, Li Y. Predictors of vaginal delivery following balloon catheter for labor induction in women with one previous cesarean. BMC Pregnancy Childbirth 2023; 23:417. [PMID: 37277699 DOI: 10.1186/s12884-023-05734-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The aim of this study was to estimate predictors for vaginal birth following balloon catheter induction of labor (IOL) in women with one previous cesarean section (CS) and an unfavorable cervix. METHODS This 4-year retrospective cohort study was conducted in Longhua District Central Hospital in Shenzhen China, between January 2015 and December 2018. Patients with one previous CS and a current singleton-term pregnancy who underwent balloon catheter cervical ripening and IOL were enrolled. Univariate analysis was used to identify predictive factors associated with vaginal birth after cesarean section (VBAC). Binary logistic regression was further used to identify which factors were independently associated with the outcome measure. The primary outcome was VBAC, which was a successful trial of labor after cesarean delivery (TOLAC) following IOL. RESULTS A total of 69.57% (208/299) of the women who planned for IOL had VBAC. In the final binary logistic regression equation, lower fetal weight (< 4000 g) (odds ratio [OR]5.26; 95% confidence interval [CI] 2.09,13.27), lower body mass index (BMI,<30 kg/m2) (OR 2.27; CI 1.21, 4.26), Bishop score after cervical ripening > 6 (OR 1.94; CI 1.37, 2.76) remained independently associated with an increased chance of VBAC. CONCLUSIONS The influencing factors of VBAC following IOL were fetal weight, BMI, and Bishop score after cervical ripening. Adequate individualized management and assessment of the IOL may help improve the VBAC rate.
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Affiliation(s)
- Kaidong Ma
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Ming Yang
- Obstetrics department, The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, China
| | - Xiaoling Feng
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Liyuan Liu
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Liangliang Li
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Yunxiu Li
- Obstetrics department, Shenzhen Longhua District Central Hospital, Shenzhen, China.
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Laikemariam M, Aklilu A, Waltengus F, Addis M, Gezimu W, Baye F, Getaneh T. Adverse neonatal outcomes and associated factors among mothers who gave birth through induced and spontaneous labor in public hospitals of Awi zone, Northwest Ethiopia: a comparative cross-sectional study. BMC Pregnancy Childbirth 2023; 23:307. [PMID: 37131132 PMCID: PMC10152696 DOI: 10.1186/s12884-023-05631-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 04/21/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Adverse neonatal outcomes are one of the most common causes of neonatal mortality and morbidity. Empirical evidence across the world shows that induction of labor potentiates adverse neonatal outcomes. In Ethiopia, there has been limited data that compares the frequency of adverse neonatal outcomes between induced and spontaneous labor. OBJECTIVES To compare the prevalence of adverse neonatal outcomes between induced and spontaneous labor and to determine associated factors among women who gave birth in public hospitals of Awi Zone, Northwest Ethiopia. METHODS A comparative cross-sectional study was conducted at Awi Zone public hospitals from May 1 to June 30, 2022. A simple random sampling technique was employed to select 788 (260 induced and 528 spontaneous) women. The collected data were analyzed using statistical package for social science (SPSS) software version 26. The Chi-square test and an independent t-test were used for categorical and continuous variables, respectively. A binary logistic regression was used to assess the association between the outcome and explanatory variables. In the bivariate analysis, a p-value ≤ 0.2 at a 95% confidence interval was used to consider the variables in the multivariate analysis. Finally, statistical significance was stated at a p-value of less than 0.05. RESULT The adverse neonatal outcomes among women who gave birth through induced labor were 41.1%, whereas spontaneous labor was 10.3%. The odds of adverse neonatal outcomes in induced labor were nearly two times higher than in spontaneous labor (AOR = 1.89, 95% CI: 1.11-3.22). No education (AOR = 2.00, 95% CI: 1.56, 6.44), chronic disease (AOR = 3.99, 95% CI: 1.87, 8.52), male involvement (AOR = 2.23, 95% CI: 1.23, 4.06), preterm birth (AOR = 9.83, 95% CI: 8.74, 76.37), operative delivery (AOR = 8.60, 95% CI: 4.63, 15.90), cesarean section (AOR = 4.17, 95% CI: 1.94, 8.95), and labor complications (AOR = 5.16, 95% CI: 2.90, 9.18) were significantly associated factors with adverse neonatal outcomes. CONCLUSION AND RECOMMENDATION Adverse neonatal outcomes in the study area were higher. Composite adverse neonatal outcomes were significantly higher in induced labor compared to spontaneous labor. Therefore, it is important to anticipate the possible adverse neonatal outcomes and plan management strategies while conducting every labor induction.
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Affiliation(s)
- Melaku Laikemariam
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
| | - Almaz Aklilu
- Department of Midwifery, School of Health Sciences, College of Medicine and Health Science, Bahr Dar University, Bahr Dar, Ethiopia
| | - Fikadu Waltengus
- Department of Midwifery, School of Health Sciences, College of Medicine and Health Science, Bahr Dar University, Bahr Dar, Ethiopia
| | - Melkamu Addis
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Wubishet Gezimu
- Department of Nursing, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Fekadu Baye
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Temesgen Getaneh
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Moon H, Lee JH, Kim EH. Maternal and neonatal morbidities associated with cesarean delivery without labor compared with induction of labor around term. Obstet Gynecol Sci 2022; 66:11-9. [PMID: 36530057 DOI: 10.5468/ogs.22248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE We aimed to compare the maternal and neonatal morbidities associated with elective cesarean delivery (CD) without labor and those associated with induction of labor (IOL) at ≥38 weeks of gestation. METHODS This retrospective observational study from 2013 to 2020 included singleton pregnancies in nulliparous women at ≥38 weeks of gestation. Maternal and neonatal morbidities associated with elective CD without labor were compared with those associated with IOL. RESULTS Altogether, 395 women were recruited. Among these, 326 underwent delivery through IOL, while 69 underwent elective CD. The elective CD group exhibited higher maternal age, lower gestational age at birth, and lower neonatal birth weight than the IOL group (P<0.001). Moreover, the elective CD group exhibited longer hospital stay, higher rate of uterotonic agent usage, and lower rate of antibiotic usage after discharge. However, no differences were observed in postpartum bleeding, readmission, or number of outpatient visits (>3) after discharge between the groups. Perinatal morbidities were similar between the groups except the incidence of meconium-stained amniotic fluid. Elective CD exhibited similar rates of complications related to composite maternal morbidity when compared with IOL, but had a lower risk of complications related to composite neonatal morbidity (relative risk, 0.45; 95% confidence interval, 0.24-0.85). CONCLUSION Elective CD and IOL had similar rates of composite maternal morbidity but the former exhibited some benefits against obstetric wound infection. The elective CD group exhibited a decreased risk of composite neonatal morbidity despite lower gestational age at birth and higher maternal age.
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Shibahara M, Shibata E, Kinjo Y, Tomonaga C, Sakuragi T, Amimoto S, Mori H, Aramaki S, Yoshino K. Impact of the Induction of Labor on Hemophilia Carriers and Their Newborn Infants. J Med Cases 2021; 12:5-8. [PMID: 34434418 PMCID: PMC8383639 DOI: 10.14740/jmc3597] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022] Open
Abstract
Hemophilia is a risk for severe hemorrhage in newborns during the perinatal period and excessive postpartum hemorrhage (PPH) in hemophilia carriers. Vacuum extraction or use of forceps should be avoided to prevent neonatal intracranial hemorrhage (ICH). Optimal modes of delivery such as vaginal or cesarean section are open to debate. The safety of the induction of labor is also worthy of investigation. Here we ask if labor induction is a safe delivery mode for pregnant women who are hemophilia carriers and their infants. We looked at 13 deliveries by hemophilia carriers at our hospital from 2005 to 2018. Two of the five male neonates complicated by hemophilia suffered ICH complications (40%). Both were delivered by induced labor. No deliveries by carriers had PPH which required treatment. Our data indicate that the induction of labor may provoke ICH in infants with hemophilia. We suggest that induction of labor is not a preferable delivery method for hemophilia carriers to avoid neonatal ICH.
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Affiliation(s)
- Mami Shibahara
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Eiji Shibata
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasuyuki Kinjo
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Chiharu Tomonaga
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshihide Sakuragi
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shoko Amimoto
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hiroshi Mori
- Department of Perinatal Medical Center, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Satoshi Aramaki
- Department of Perinatal Medical Center, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
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Skeith L, Le Gal G, de Vries JIP, Middeldorp S, Goddijn M, Kaaja R, Gris JC, Martinelli I, Schleußner E, Petroff D, Langlois N, Rodger MA. The risk of cesarean delivery after labor induction among women with prior pregnancy complications: a subgroup analysis of the AFFIRM study. BMC Pregnancy Childbirth 2019; 19:455. [PMID: 31783795 PMCID: PMC6884748 DOI: 10.1186/s12884-019-2615-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background To determine the risk of cesarean delivery after labor induction among patients with prior placenta-mediated pregnancy complications (pre-eclampsia, late pregnancy loss, placental abruption or intrauterine growth restriction). Methods The AFFIRM database includes patient level data from 9 randomized controlled trials that evaluated the role of LMWH versus no LMWH during pregnancy to prevent recurrent placenta-mediated pregnancy complications. The primary outcome of this sub-study was the proportion of women who had an unplanned cesarean delivery after induction of labor compared to after spontaneous labor. Results There were 512 patients from 7 randomized trials included in our sub-study. There was no difference in the risk of cesarean delivery between women with labor induction (21/148, 14.2%) and spontaneous labor (79/364, 21.7%) (odds ratio (OR) 0.60, 95% CI, 0.35–1.01; p = 0.052). Among 274 women who used LMWH prophylaxis during pregnancy, the risk of cesarean delivery was lower among those that underwent labor induction (9.8%) compared to spontaneous labor (22.4%) (OR 0.38, 95% CI, 0.17–0.84; p = 0.01). Conclusions The risk of cesarean delivery is not increased after labor induction among a higher risk patient population with prior pregnancy complications. Our results suggest that women who receive LMWH during pregnancy might benefit from labor induction.
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Affiliation(s)
- Leslie Skeith
- Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, C210 Foothills Medical Centre, 1403 29th Street, NW, Calgary, Alberta, T2N 2T9, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Grégoire Le Gal
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Johanna I P de Vries
- Department of Obstetrics and Gynecology, VU Medical Center, Amsterdam, the Netherlands
| | - Saskia Middeldorp
- Academic Medical Center, Department of Vascular Medicine, Amsterdam, the Netherlands
| | - Mariëtte Goddijn
- Academic Medical Center, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Risto Kaaja
- Department of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jean-Christophe Gris
- Department of Hematology, Nimes University Hospital and University of Montpellier, Montpellier, France
| | - Ida Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Ekkehard Schleußner
- Department of Obstetrics and Gynecology, Jena University Hospital Friedrich Schiller University, Jena, Germany
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Nicole Langlois
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marc A Rodger
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
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Worda K, Bancher-Todesca D, Husslein P, Worda C, Leipold H. Randomized controlled trial of induction at 38 weeks versus 40 weeks gestation on maternal and infant outcomes in women with insulin-controlled gestational diabetes. Wien Klin Wochenschr 2019; 129:618-624. [PMID: 28168363 DOI: 10.1007/s00508-017-1172-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the impact of induction of labor at 38 weeks of gestation with the induction of labor at 40 weeks of gestation in women with insulin-treated gestational diabetes on maternal and fetal outcome. STUDY DESIGN In this study 100 pregnant women with insulin-treated gestational diabetes were randomized to either induction of labor at 38 (group I) or 40 weeks (group II) to evaluate the rate of large for gestational age newborns, neonatal hypoglycemia, success rate of deliveries within 48 h and cesarean section rate after induction in both groups. RESULTS The difference of large for gestational age newborns was not significant between the two groups (6.8% vs. 12.8%, p = 0.49), 16 (36.4%) newborns in group I and 8 (17.0%) newborns in group II developed hypoglycemia <35 mg/dl (p = 0.04). The success rate for deliveries within 48 h after induction of labor for groups I and II was 77.3% and 92.3%, respectively (p = 0.25). The cesarean section rate after induction of labor was not significantly different between the two groups (24.1% vs. 18.7%, p = 0.49). CONCLUSION In a cohort of women with insulin-treated gestational diabetes, induction of labor at 38 weeks did not significantly reduce the rate of large for gestational age newborns compared to induction at 40 weeks but seems to increase the rate of neonatal hypoglycemia.
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MESH Headings
- Adult
- Bilirubin/blood
- Blood Glucose/metabolism
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes, Gestational/blood
- Diabetes, Gestational/drug therapy
- Female
- Fetal Macrosomia/blood
- Fetal Macrosomia/etiology
- Gestational Age
- Glycated Hemoglobin/metabolism
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/blood
- Infant, Newborn, Diseases/etiology
- Insulin/therapeutic use
- Intensive Care Units, Neonatal
- Labor, Induced
- Patient Admission
- Patient Outcome Assessment
- Pregnancy
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Affiliation(s)
- Katharina Worda
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | | | - Peter Husslein
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Christof Worda
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Heinz Leipold
- Department of Obstetrics and Gynecology, General Hospital of Klagenfurt, St. Veiterstraße 47, 9020, Klagenfurt, Austria.
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Kim HI, Choo SP, Han SW, Kim EH. Benefits and risks of induction of labor at 39 or more weeks in uncomplicated nulliparous women: a retrospective, observational study. Obstet Gynecol Sci 2019; 62:19-26. [PMID: 30671390 DOI: 10.5468/ogs.2019.62.1.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/15/2018] [Accepted: 07/31/2018] [Indexed: 11/18/2022] Open
Abstract
Objective To critically compare the benefits and risks of labor induction versus spontaneous labor in uncomplicated nulliparous women at 39 or more weeks of gestation. Methods We conducted a retrospective, observational study of 237 nulliparous women who were at 39 or more weeks of a singleton pregnancy with vertex presentation and intact membranes. We compared maternal outcomes including the Cesarean section rate and neonatal outcomes in the induced labor and spontaneous labor groups. Results Among the 237 women, 199 delivered vaginally (84.0%). The spontaneous labor group and induced labor group had a similar incidence of Cesarean delivery (17.7% vs. 12.3%, P=0.300). The length of stay and blood loss during delivery were also similar between the groups (4.3±1.5 vs. 3.9±1.5 days and 1.9±1.3 vs. 1.8±1.0 mg/sL, respectively; all P>0.05). Regarding neonatal outcomes, the rate of meconium-stained amniotic fluid, Apgar score <7 at 5 minutes, and intubation rate were similar between the groups (18.9% vs. 24.7%, 7.9% vs. 4.1%, and 6.1% vs. 4.4%, respectively, all P>0.05). Only the neonatal intensive care unit admission rate was significantly lower in the induction group than in the spontaneous labor group (28.0% vs. 13.2%, P=0.001). Conclusion Maternal adverse outcomes of labor induction at 39 weeks of gestation were similar to those in a spontaneous labor group in uncomplicated nulliparous women. Neonatal adverse events were also similar between the groups. It may be acceptable to schedule labor induction as long as 7 days before the estimated date, even when the indication is only relative.
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Bhat CS, Amin SV, Adiga P, Pandey D. Fetal Adrenal Gland Volume a Novel Predictor of Onset of Labor. J Obstet Gynaecol India 2018; 69:252-257. [PMID: 31178641 DOI: 10.1007/s13224-018-1187-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction There is a definite need to find a highly sensitive and specific, noninvasive, and cost-effective marker for prediction of preterm labor. We hypothesize that a measurement of adrenal gland volume can predict a preterm as well as a term labor. Materials and Methods Two hundred and sixty-eight pregnant women were enrolled in the study at 28-34 weeks' antenatal visit. Final analysis was done in 204. All of them were subjected to 2D ultrasonographic measurement of the corrected fetal adrenal gland volume (cFAGV) and fetal adrenal zone parameters including the width ratio and depth ratio. The cohort was followed up to term, and a reassessment of cFAGV and fetal adrenal zone parameters was repeated between 37 and 39 weeks. Women who presented with features of preterm labor had a scan at the time of presentation to record cFAGV and fetal adrenal zone parameters. Results Women, who developed features of preterm labor eventually, had a significantly high cFAGV (404.70 mm3/kg body weight) during the first scan compared to those who reached term asymptomatically (241.35 mm3/kg body weight). A cutoff value of 271.16 mm3/kg body weight showed 90% sensitivity and 81.9% specificity. Fetal adrenal gland width ratio had the best efficacy (sensitivity 96.67%, specificity 86.2%) followed by cFAGV (sensitivity 96.67%, specificity 83%) for predicting preterm delivery. Conclusion 2D ultrasound measurement of fetal adrenal gland parameters can be used as a marker for prediction of preterm delivery. cFAGV at term can also be used to predict the possibility of spontaneous onset of labor.
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Affiliation(s)
- Chandana S Bhat
- 1Department of OBG, KMC Manipal, Manipal University, Manipal, Karnataka India.,Bangalore, Karnataka India
| | - Sapna Vinit Amin
- 1Department of OBG, KMC Manipal, Manipal University, Manipal, Karnataka India
| | - Prashanth Adiga
- 1Department of OBG, KMC Manipal, Manipal University, Manipal, Karnataka India
| | - Deeksha Pandey
- 1Department of OBG, KMC Manipal, Manipal University, Manipal, Karnataka India
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Breton A, Gueudry P, Branger B, Le Baccon FA, Thubert T, Arthuis C, Winer N, Dochez V. [Comparison of obstetric prognosis of attempts of breech delivery: Spontaneous labor versus induced labor]. ACTA ACUST UNITED AC 2018; 46:632-638. [PMID: 30170864 DOI: 10.1016/j.gofs.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Delivery mode in breech presentation (BP) is often controversial. Spontaneous labor, when vaginal birth seems safe, allows to better estimate uterus contractility, fetus' accommodation to maternal pelvis and optimize monitoring with a partograph. Induced labor in BP was usually contra-indicated. Lack of strong scientific evidence on this matter has permitted a progressive and careful evolution in obstetrical management, with the introduction of induced labor in BP. The aim of our study is to compare vaginal birth rates when labor is induced versus when spontaneous in BP. Maternal and fetal morbidity and mortality parameters were also evaluated. METHODS In this retrospective study were included 206 patients carrying fetuses in BP, between June 2012 and June 2017. 182 of them had spontaneous labor and 24 experienced induced labor. Inclusion criteria were singleton pregnancy, BP after 34 weeks of gestation and vaginal delivery authorized by a senior obstetrician. Multiple pregnancy, birth before 34 weeks of gestation, uterine scar, planned caesarian section for BP, intra-uterine fetal death and medical termination of pregnancy were excluded. Induction of labor was performed for medical reason on a favorable cervix. RESULTS There was no significant difference in cesarean section rates between the two "induced" and "spontaneous" labor groups in BP (OR=1.69 [CI95%: 0.71-4.04]). We observed no difference between the two groups in neither perineum trauma nor post-partum hemorrhage. No difference was found between the two groups in rates of Apgar score<7 5minutes after birth, neonatal transfer, fetal trauma and pH at birth. CONCLUSION Despite our small population, it seems acceptable to propose induced labor for medical reason if cervix is favorable in BP if a protocol is available stating acceptability criteria for vaginal birth. It can avoid unnecessary caesarian section and allow better obstetrical outcome. It would be interesting to study fetal and maternal morbidity and mortality criteria in induced labor versus planned cesarean section when patients could be eligible for induced labor in BP.
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Affiliation(s)
- A Breton
- Service de gynécologie-obstétrique, hôpital mère-enfant-maternité, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - P Gueudry
- Service de gynécologie-obstétrique, hôpital mère-enfant-maternité, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - B Branger
- Réseau sécurité naissance des pays de la Loire, 44000 Nantes, France
| | - F-A Le Baccon
- Service de gynécologie-obstétrique, CHU de Rennes, 35033 Rennes, France
| | - T Thubert
- Service de gynécologie-obstétrique, hôpital mère-enfant-maternité, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - C Arthuis
- Service de gynécologie-obstétrique, hôpital mère-enfant-maternité, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - N Winer
- Service de gynécologie-obstétrique, hôpital mère-enfant-maternité, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - V Dochez
- Service de gynécologie-obstétrique, hôpital mère-enfant-maternité, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France.
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Wang YQ, Xi YJ, Wang YY, Ma X, Ma YY. [Contrast study of double-balloon catheter with and without oxytocin for cervical ripening]. Zhonghua Yi Xue Za Zhi 2018; 98:2015-2018. [PMID: 29996603 DOI: 10.3760/cma.j.issn.0376-2491.2018.25.010] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the efficacy and related issues for cervical ripening by double-balloon catheter with and without oxytocin. Methods: The prospective non-randomly control research was conducted from March 2015 to June 2017 in Yuquan Hospital of Tsinghua University. The primipara with induced labor indications and balloon placement conditions were divided into two groups. Seventy-eight cases were in the balloon with oxytocin group, in which oxytocin was used if there were no contraction 1 hour after balloon placement. Meanwhile, 220 cases were in the single balloon group. Before and after balloon placement, the changes of cervical Bishop Scores and delivery outcome were compared between the groups. Results: The effective rate of cervical ripening in the balloon with oxytocin group was higher than that in the balloon group[92.3% (72/78) vs 82.7% (182/220), P<0.05], the proportion of parturiency within 12 hours was as well[15.4% (12/78) vs 7.3% (16/220), P<0.05]. The effective rate of cervical Bishop score 4-5 points was further improved in the balloon with oxytocin group[95.7%(66/69) vs 85.1% (165/194), P<0.05]. Taken out balloon, the cervical Bishop scores (8.1±1.1) points in the balloon with oxytocin group were higher than (6.5±1.2) points in the balloon group (P<0.05). For the maternal without parturiency in the balloon with oxytocin group, the cervical Bishop score reduced from (7.7±0.9) points to (6.6±0.6) points after removal balloon for 12 hours (P<0.05). The cesarean section proportion for intrauterine infection in the balloon with oxytocin group was higher than that of the balloon group ( P<0.05), but the placental pathological diagnosis proportion was no significant difference ( P>0.05). In the two groups, the cesarean section rate, the first labor stage, the episiotomy rate, the postpartum hemorrhage rate, neonatal weight, the neonatal asphyxia and referral rate showed no significant differences (P>0.05, respectively). Conclusions: The double-balloon catheter with oxytocin can further improve the efficiency of patients with cervical Bishop score 4-5 points for cervical ripening , and increase the chance of labor in 12 hours.
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Affiliation(s)
- Y Q Wang
- Obstetric & Gynecologic Department, Tsinghua University Yuquan Hospital, Beijing 100040, China
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Jeong YA, Chung CW. Pregnant Women's Labor Progress, Childbirth Outcome, and Childbirth Satisfaction according to the Presence or Absence of Labor Induction. Korean J Women Health Nurs 2018; 24:58-70. [PMID: 37684913 DOI: 10.4069/kjwhn.2018.24.1.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 09/10/2023] Open
Abstract
PURPOSE To provide accurate information on induced labor and find strategies to enhance women's childbirth satisfaction. METHODS Participants were pregnant women expected to have normal vaginal delivery. A total of 113 women with induced labor and 61 women with spontaneous labor were surveyed. Data were collected using a questionnaire and electronic medical records. RESULTS The following variables related to labor progress showed significant differences between the induced labor group and the spontaneous labor group: length of the first stage of labor in primigravidas, use of analgesic, incidence of uterine hyperstimulation, incidence of fetal distress, and medical treatment for the expectant mother. Delivery type and the incidence of postpartum complications showed significant difference between the two groups. Induced labor women's childbirth satisfaction was mainly affected by the process of labor whereas spontaneous labor women's childbirth satisfaction was affected by the outcome of childbirth. CONCLUSION Medical staff should have accurate information on the risk of induced labor and the benefits of a natural delivery. Moreover, medical staff should provide necessary information and environment for women to participate in the decision-making process.
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Affiliation(s)
- Yun Ah Jeong
- Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
| | - Chae Weon Chung
- Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
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Vilchez G, Nazeer S, Kumar K, Warren M, Dai J, Sokol RJ. Contemporary epidemiology and novel predictors of uterine rupture: a nationwide population-based study. Arch Gynecol Obstet. 2017;296:869-875. [PMID: 28864930 DOI: 10.1007/s00404-017-4508-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/23/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE In spite of several policies aiming to decrease cesarean rates and related complications such as uterine rupture, data show that uterine rupture and associated morbidity are increasing along the years. Whether previously unidentified risk factors are currently playing an important role on these trends is unknown. We analyze current risks of uterine rupture and main preceding factors from more recent years compared to former data. METHODS All uterine rupture cases in the US from 2011-2012 were selected, with matched non-uterine rupture cases selected as controls. Variables considered for analysis included demographics, maternal morbidity, and obstetric complications. Likelihood forward selection was used to identify main risk factors of uterine rupture. Medians of main factors identified were used to simulate groups at risk and calculate odds ratios of uterine rupture. RESULTS From ~8 million births, 1925 presented uterine rupture. In patients with no prior cesarean delivery, multiple gestation, chronic hypertension and chorioamnionitis presented the highest odds of uterine rupture, with the combination of these factors increasing the odds of rupture 59 times (~1%). In women with prior cesarean delivery, induction/augmentation and chorioamnionitis were the most significant predictors, with the combination increasing the odds 33 times (~3%). CONCLUSIONS Despite policies implemented and changes in clinical practice, uterine rupture remains an important issue. Previously unidentified risk factors are playing now an important role, information that should be considered during patient counseling and clinical practice. Combinations of some of these factors may increase the risk of uterine rupture significantly enough to modify clinical care.
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Papoutsis D, Antonakou A, Gornall A, Tzavara C, Mohajer M. The SaTH risk-assessment tool for the prediction of emergency cesarean section in women having induction of labor for all indications: a large-cohort based study. Arch Gynecol Obstet 2016; 295:59-66. [PMID: 27671013 DOI: 10.1007/s00404-016-4209-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 06/15/2016] [Accepted: 09/20/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE To develop a risk-assessment model for the prediction of emergency cesarean section (CS) in women having induction of labor (IOL). METHODS This was an observational cohort study of women with IOL for any indication between 2007 and 2013. Women induced for stillbirths and with multiple pregnancies were excluded. The primary objective was to identify risk factors associated with CS delivery and to construct a risk-prediction tool. RESULTS 6169 women were identified with mean age of 28.9 years. Primiparity involved 47.1 %, CS rate was 13.3 % and post-date pregnancies were 32.4 %. Risk factors for CS were: age >30 years, BMI >25 kg/m2, primiparity, black-ethnicity, non post-date pregnancy, meconium-stained liquor, epidural analgesia, and male fetal gender. Each factor was assigned a score and with increasing scores the CS rate increased. The CS rate was 5.4 % for a score <11, while for a score ≥11 it increased to 25.0 %. The model had a sensitivity, specificity, negative predictive value and positive predictive value of 75.8, 65.1, 93.8 and 25.0 %, respectively. CONCLUSION We have constructed a risk-prediction tool for CS delivery in women with IOL. The risk-assessment tool for the prediction of emergency CS in induced labor has a high negative-predictive value and can provide reassurance to presumed low-risk women.
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Affiliation(s)
- Dimitrios Papoutsis
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals, NHS Trust, Apley Castle, Grainger Drive, Telford, TF16TF, UK.
| | - Angeliki Antonakou
- Department of Midwifery, Midwifery School, 'Alexander' Technological Educational Institute of Thessaloniki, Thessaloniki, Greece
| | - Adam Gornall
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals, NHS Trust, Apley Castle, Grainger Drive, Telford, TF16TF, UK
| | - Chara Tzavara
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Michelle Mohajer
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals, NHS Trust, Apley Castle, Grainger Drive, Telford, TF16TF, UK
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Jahromi BN, Poorgholam F, Yousefi G, Salarian L. Sublingual versus Vaginal Misoprostol for the Induction of Labor at Term: A Randomized, Triple-Blind, Placebo-Controlled Clinical Trial. Iran J Med Sci 2016; 41:79-85. [PMID: 26989277 PMCID: PMC4764971] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND We sought to compare the effectiveness and safety of sublingual versus vaginal misoprostol for the termination of pregnancy with a live full-term fetus. METHODS This randomized, triple-blind, placebo-controlled clinical trial was performed on 200 primiparous women with normal, singleton, full-term pregnancies candidated for the induction of labor. Sublingual and vaginal tablets containing misoprostol (25 mcg) or placebo in similar shapes were administered every 4 hours until the Bishop score reached above 8. Maternal and neonatal complications and outcomes were compared. RESULTS There were 100 parturient women in each group. The mean maternal age, gestational age, and Bishop score at the commencement of misoprostol had no statistical differences between the sublingual and vaginal groups. The mean time interval between misoprostol commencement and delivery was 497.10±291.49 and 511.67±08.46 minutes for the sublingual and vaginal groups, correspondingly. Twenty-two women had Cesarean deliveries in the sublingual group versus 14 in the vaginal group. Meconium-stained amniotic fluid was seen in 12 women in the sublingual group and 4 in the vaginal group (P=0.03). Late fetal heart rate deceleration was observed in 8 women in the sublingual group and 4 in the vaginal group (P=0.22). The mean neonatal birth weight, blood gas value at birth, Apgar score, and length of admission time in the neonatal intensive care unit were not different between the 2 groups. CONCLUSION Sublingual and vaginal misoprostol had similar effectiveness; however, meconium-stained liquor was observed considerably more frequently with sublingual misoprostol than with vaginal misoprostol. TRIAL REGISTRATION NUMBER IRCT201402096541N3.
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Affiliation(s)
- Bahia Namavar Jahromi
- Maternal-Fetal Medicine Research Center, Infertility Research Center, Department of Gynecology and Obstetrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Bahia Namavar Jahromi, MD; Maternal-Fetal Medicine Research Center, Infertility Research Center, Department of OB/GYN, Shahid Faghihi Hospital, Shiraz, Iran Tel: +98 917 3158723 Fax: +98 71 32332365
| | - Foroogh Poorgholam
- Student Research Center, Department of Gynecology and Obstetrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhossein Yousefi
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Salarian
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Marques RMCDP, Souza ASR, Costa AARD, Feitosa FEDL, Amorim MMR. Factors associated with vaginal delivery in hypertensive and normotensive pregnant women submitted to labor induction with misoprostol: a cohort study. Hypertens Pregnancy 2014; 34:153-70. [PMID: 25549056 DOI: 10.3109/10641955.2014.988351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the factors associated with vaginal delivery in hypertensive and normotensive pregnant women submitted to induction of labor with misoprostol. METHODS A cohort study. RESULTS The factors associated with vaginal delivery in both normotensive and hypertensive women were, respectively, Bishop score ≥ 4 (OR = 1.87; 95% CI: 1.06-3.29; p = 0.03) and (OR = 2.31; 95% CI: 1.25-4.28; p = 0.008) and parity ≥ 1 (OR = 4.36; 95% CI: 2.16-8.80; p < 0.0001) and (OR = 2.61; 95% CI: 1.36-5.04; p = 0.004). CONCLUSION The factors associated with vaginal delivery were Bishop score ≥ 4 and parity ≥ 1 irrespective of whether or not the women were hypertensive.
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Souza ASR, Feitosa FEL, Costa AAR, Pereira APR, Carvalho AS, Paixão RM, Katz L, Amorim MMR. Titrated oral misoprostol solution versus vaginal misoprostol for labor induction. Int J Gynaecol Obstet 2013; 123:207-12. [PMID: 24112746 DOI: 10.1016/j.ijgo.2013.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 06/13/2013] [Accepted: 08/28/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of a titrated oral misoprostol solution compared with vaginal misoprostol tablets for labor induction. METHODS A randomized, triple-blind, multicenter clinical trial was conducted between March 2010 and June 2011. Women with a single gestation (n=200) were randomized to receive a titrated oral misoprostol solution (initial misoprostol dose 20 μg/hour; dose increased by 20 μg/hour every 6 hours up to 80 μg/hour for a maximum of 48 doses) or vaginal misoprostol tablets (25 μg of misoprostol every 6 hours for a maximum of 8 doses). Risk ratios (RR) and 95% confidence intervals (CIs) were calculated for maternal and perinatal outcomes. RESULTS The frequencies of vaginal delivery not achieved within 12 hours (RR 0.87; 95% CI, 0.62-1.22) and within 24 hours (RR 1.11; 95% CI, 0.83-1.49) were similar in the 2 groups. No differences were found in terms of uterine hyperstimulation, unfavorable cervix at 12 and 24 hours, oxytocin augmentation, tachysystole, epidural analgesia, adverse effects, and perinatal outcome. Approximately 70% of the women preferred the oral solution. CONCLUSION A titrated oral misoprostol solution was as effective and safe for labor induction as vaginal misoprostol tablets. ClinicalTrial.gov: NCT00 992524.
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Affiliation(s)
- Alex S R Souza
- Department of Maternal and Child Health, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil; Emergency Obstetric Care, Policlínica e Maternidade Prof. Arnaldo Marques, Recife, Brazil; Department of Maternal and Child Health, Universidade Federal de Pernambuco, Recife, Brazil; Research Department, Instituto de Pesquisa Prof. Joaquim Amorim Neto, Campina Grande, Brazil; Emergency Obstetric Care, Hospital Barão de Lucena, Recife, Brazil.
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