Ultrasound Assessment of Foetal Head–Perineum Distance Prior to Induction of Labour as a Predictor of Successful Vaginal Delivery

Background: Induction of labour is an iatrogenic deliberate attempt to terminate the pregnancy in order to achieve vaginal delivery in cases of valid indication. It should be carefully supervised as it is a challenge to the clinician, mother and the fetus. Aim of this study was to find out common indications for IOL in a tertiary care teaching centre and its feto-maternal outcome.Methods: An institutional based retrospective observational study was conducted to describe the prevalence of labour induction and factors associated with its outcome, during the time-period of one year from January 2018 to December 2018, at SRMS IMS, Bareilly. Logistic regression analysis was employed to assess the relative effect of determinants and statistical tests were used to see the associations.Results: Most of the patients were primigravidas of younger age-group. Idiopathic oligohydramnios and postdatism were the commonest indications for induction of labour and Misoprost was the commonest drug used for it. Though majority had vaginal delivery, as the method was changed to combined method it was significantly associated with increased likelihood of LSCS. Similarly there was increased association with maternal cervico-vaginal tear / lacerations as the method was changed to combined type. However there were no association between post-partum hemorrhage, meconium stained liquor or fetal distress.Conclusions: Common indications for induction of labour were oligohydramnios and postdatism. Misoprost can be safely used for induction of labour without any increased risk for LSCS or any fetal / neonatal risks.

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Evaluation of induction of labour in a tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201055 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1361

Author(s):

Janupalli Kiran Poornima ◽

Vijayalakshmi K. ◽

Anuradha C. R. ◽

Famida . ◽

Sai Latha R.

Keyword(s):

Vaginal Delivery ◽

Apgar Score ◽

Induction Of Labour ◽

Delivery Rate ◽

Normal Vaginal Delivery ◽

Care Hospital ◽

Normal Delivery ◽

Operative Vaginal Delivery ◽

Misoprostol Group ◽

Oxytocin Augmentation

Background: The objective is to evaluate the preferred methods for labor induction, including incidence of caesarean section, operative and normal vaginal delivery rate, need for oxytocin augmentation, and Apgar score at 1 and 5 min.Methods: This was a hospital-based study carried out in 110 inductions of labour during the study period. misoprostol 50 mcg was inserted in posterior fornix of vaginal in cases with PROM and intracervical 0.5 mg Dinoprostone for other causes in whom induction was decided. Maternal and neonatal outcomes were observed. collected data were analyzed using SPSS and MS excel.Results: Most preferred methods of induction of labour were observed to be Dinoprostone and Misoprostol, augmentation was done by oxytocin. normal delivery rate was 54% in Dinoprostone gel and 58.3% in misoprostol group. Caesarean and operative vaginal delivery rates were 42.8%, 3% in Dinoprostone gel group and 33.3%, 8.3% respectively in misoprostol group. Mean Apgar scores were observed to be similar in both methods of induction at 1st and 5th minutes.Conclusions: It was found that misoprostol had higher percentage of normal and operative vaginal delivery and need for oxytocin augmentation than Dinoprostone. Neonatal outcome as predicted by Apgar score were similar in both groups.

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Evaluation of pre induction scoring by clinical examination vs transvaginal sonography

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20164664 ◽

2016 ◽

Vol 6 (1) ◽

pp. 228

Author(s):

Sonali Kaur Sharma ◽

Madhu Nagpal ◽

CL Thukral

Keyword(s):

Vaginal Delivery ◽

Transvaginal Ultrasound ◽

Cervical Length ◽

Induction Of Labour ◽

Labour Induction ◽

Transvaginal Sonography ◽

Bishop Score ◽

Unfavourable Cervix ◽

Successful Induction ◽

Singleton Pregnancies

Background: The aim of the study was to find out pre-induction cervical length by TV Sonography, determine Bishops score and to co-relate the obstetric outcome with these two variables.Methods: A study was done on 100 women with singleton pregnancies at 37-42 weeks of gestation, admitted for induction of labour in the Department of Obstetrics and Gynaecology at SGRDIMSR, Vallah, Amritsar, Punjab, India. All women underwent cervical assessment by both transvaginal ultrasound and Bishop Score and the outcome of labour induction was determined.Results: Of the 100 women, 53 women had vaginal delivery and 47 landed into LSCS. Bishop score < 6 and cervical length > 3 cm are cut off values of cervical unfavourablity. Successful induction was achieved among 87.5% and 78% women with favorable cervix according to Bishop Score and Cervical length respectively .Among the 92 and 50 women with unfavourable cervix according to Bishop score and cervical length, 48 (52.17%) and 14 (28%) had vaginal delivery respectively.Conclusions: Hence, cervical length by transvaginal ultrasound is a better predictor for the success of induction of labour as compared with assessment by Bishop Score alone.

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Oral and vaginal route of misoprostol for induction of labour: a comparative study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191950 ◽

2019 ◽

Vol 8 (5) ◽

pp. 1956

Author(s):

Deepti D. Sharma ◽

Kavita A. Chandnani

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Induction Of Labour ◽

Vaginal Route ◽

Oral Misoprostol ◽

Group A ◽

The Mean ◽

Vaginal Misoprostol ◽

Group B ◽

To Receive

Background: Induction of labour can be defined as “Artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods, for purpose of vaginal delivery.” The key factor for a successful induction is the status of cervix, its form, consistency and dilatation which is determined by the Bishop score. In case of unfavourable cervix or in the pregnancies remote from the term; prostaglandins are more effective than any other method of induction. Introduction of misoprostol, PGE1 analogue, for the induction of labour in 1993 and its approval for clinical use by ACOG (American College of Obstetrics and Gynecology) in 1999 has been the most significant advancement. It is the latest drug for induction of labour which is cheap and stable at room temperature and is being used worldwide in different doses and by various routes. We compared the most commonly preferred two routes; vaginal and oral in terms of success of induction and noted the adverse events and side effects in both routes.Methods: This was a prospective comparative study carried out at SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, Vadodara, Gujarat, 200 patients who required induction of labour were recruited after applying inclusion and exclusion criteria and were randomly divided in two groups- Group A meant to receive 50µg oral misoprostol, Group B - meant to receive 25µg vaginal misoprostol repeated 4 hourly up to maximum of five doses. Progress of labour was charted on the partograph. The mean induction delivery interval, mode of delivery, maternal and neonatal outcomes and complications were observed.Results: The mean induction to delivery interval was significantly less in vaginal group than oral (23.3±12.4 hours in oral vs. 17.3±10 hours in vaginal). Vaginal delivery and cesarean section rates were comparable in both groups (76% in Group A vs. 72% in Group B for vaginal delivery, 18% vs. 20% for Cesarean section, respectively). 58% patients in Group A required more than two doses as compared to 39% in group B, though the difference was statistically not significant. Significant number of patients required added oxytocin administration in Group A (72%). No major complications or adverse events were observed. Neonatal hyperbilirubinemia was seen more in Group A.Conclusions: Both Oral misoprostol in a dose of 50μg and vaginal misoprostol 25 μg every four hours, to a maximum of five doses, have the potential to induce labour safely and effectively. The vaginal route however is beneficial in effecting delivery in lesser time with few numbers of doses as compared to oral route.

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Clinical predictive factors for vaginal delivery following induction of labour among pregnant women in Jordan

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04151-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rawan A. Obeidat ◽

Mahmoud Almaaitah ◽

Abeer Ben-Sadon ◽

Dina Istaiti ◽

Hasan Rawashdeh ◽

...

Keyword(s):

Regression Analysis ◽

Pregnant Women ◽

Cesarean Delivery ◽

Vaginal Delivery ◽

Induction Of Labour ◽

Labour Induction ◽

Bishop Score ◽

Nulliparous Women ◽

Multiparous Women ◽

The Mean

Abstract Background Induction of labour (IOL) is an important and common clinical procedure in obstetrics. In the current study, we evaluate predictors of vaginal delivery in both nulliparous and multiparous women in north Jordan who were induced with vaginal prostaglandins. Method A prospective study was conducted on 530 pregnant women at King Abdullah University Hospital (KAUH) in north Jordan. All pregnant mothers with singleton live fetuses, who had induction of labour (IOL) between July 2017 and June 2019, were included in the study. Mode of delivery, whether vaginal or caesarean, was the primary outcome. Several maternal and fetal variables were investigated. The safety and benefit of repeated dosage of vaginal prostaglandin E2 (PGE2) tablets, neonatal outcomes and factors that affect duration of labour were also evaluated. Pearson χ2 test was used to investigate the significance of association between categorical variables, while student’s t-test and ANOVA were applied to examine the mean differences between categorical and numerical variables. Linear regression analysis was utilized to study the relation between two continuous variables. A multivariate regression analysis was then performed. Significance level was considered at alpha less than 0.05. Results Nulliparous women (N = 254) had significantly higher cesarean delivery rate (58.7% vs. 17.8%, p < 0.001) and longer duration of labour (16.1 ± 0.74 h vs. 11.0 ± 0.43 h, p < 0.001) than multiparous women (N = 276). In nulliparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop score; the mean Bishop score was 3.47 ± 0.12 in nulliparous women who had vaginal delivery vs. 3.06 ± 0.10 in women who had cesarean delivery (Adjusted odds ratio (AOR) = 1.2, 95% CI: 1.03–1.28, p = 0.03). In multiparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop scores and lower in women with higher body mass index (BMI). The mean Bishop score was 3.97 ± 0.07 in multiparous women who had vaginal delivery vs. 3.56 ± 0.16 in women who had cesarean delivery (AOR = 1.5, 95% CI: 1.1–2.1, p = 0.01). The mean BMI was 30.24 ± 0.28 kg/m2 in multiparous women who had vaginal delivery vs. 32.36 ± 0.73 kg/m2 in women who had cesarean delivery (AOR = 0.89, 95% CI: 0.84–0.96, p = 0.005). 27% of nulliparous women who received more than two PGE2 tablets and 50% of multiparous women who received more than two PGE2 tablets had vaginal delivery with no significant increase in neonatal morbidity. Conclusion Parity and cervical status are the main predictors of successful labour induction. Further studies are required to investigate the benefit of the use of additional doses of vaginal PGE2 above the recommended dose for IOL.

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Mifepristone as pre-induction cervical ripening agent: a review article

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194914 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4636

Author(s):

Nikita . ◽

Seetesh Ghose ◽

Setu Rathod

Keyword(s):

Adverse Effects ◽

Vaginal Delivery ◽

Perinatal Outcome ◽

Neonatal Outcome ◽

Mode Of Delivery ◽

Review Article ◽

Induction Of Labour ◽

Present Review ◽

Cervical Ripening ◽

Successful Induction

Induction of labour after the period of viability by any methods medical, surgical or combined, for the purpose of vaginal delivery. The success of induction, to a great extent, depend upon pre-induction cervical status i.e. cervical ripening. So, ripening of cervix prior to induction i.e. pre-induction cervical ripening is one of the important steps for successful induction of labour. There are different methods for cervical ripening like prostaglandins (PGE). However, use of prostaglandins (PGE) and oxytocin as labour inducing agent has its own adverse effects on maternal and perinatal outcome. So, constant efforts are made for the less use of uterotonins. The present review aims to study the efficacy of oral Mifepristone for improvement in Bishop’s score, requirement of additional uterotonics, induction delivery interval, mode of delivery and neonatal outcome. Electronic databases were searched by using keywords ‘Mifepristone, RU486, PGE2 gel, Cervical ripening, Bishop’s score and Induction of labour’ and eleven articles were found from 2009 to 2018 which fulfils our study criteria and thus they were taken for review. Based on all the studies, Mifepristone appears to be effective cervical ripening in comparison to other agents with significant improvement in Bishop’s score, higher vaginal delivery rate, shorter induction delivery interval and good neonatal outcome.

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Outcome of induction of labour using maternal characteristics, ultrasound assessment and biochemical state of the cervix

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.3109/14767051003678135 ◽

2010 ◽

Vol 23 (12) ◽

pp. 1406-1412 ◽

Cited By ~ 18

Author(s):

Chun Wai Cheung ◽

Tak Yeung Leung ◽

Daljit Singh Sahota ◽

Oi Ka Chan ◽

Lin Wai Chan ◽

...

Keyword(s):

Induction Of Labour ◽

Maternal Characteristics ◽

Ultrasound Assessment ◽

Biochemical State

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OASIS: clinical audit in a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181937 ◽

2018 ◽

Vol 7 (5) ◽

pp. 1958

Author(s):

Sruthy Soman ◽

Sobha S. Nair ◽

Janani J. N. ◽

Radhamany K. ◽

Ann John Kurien

Keyword(s):

Epidural Analgesia ◽

Vaginal Delivery ◽

Anal Sphincter ◽

Gestational Age ◽

Rectal Mucosa ◽

Shoulder Dystocia ◽

Induction Of Labour ◽

Normal Vaginal Delivery ◽

Perineal Tear ◽

Vertex Presentation

Background: Obstetric anal sphincter injury involves injury to the anal sphincter and rectal mucosa sustained at time of vaginal delivery and can result in significant long-term morbidity. These injuries have been defined as 3rd and 4th degree lacerations that involve disruption of the anal sphincter and rectal mucosa respectively. Objectives of this study were to find out the incidence of obstetrical anal sphincter injuries, to identify the risk factors for of OASIS and the outcome of primary repair in terms of anal incontinence and its associated complications.Methods: We did a descriptive study of OASIS by retrospective analysis of the labour case records. The study period was 1 year between August 2016 to July 2017. Inclusion criteria were singleton pregnancy, vertex presentation, instrumental and normal vaginal delivery. Exclusion criteria were multiple pregnancy, non-vertex presentation and caesarean section. Proforma was developed to capture the age, parity, gestational age in weeks, induction of labour, epidural analgesia, delivery duration, type of episiotomy, instrumentation, shoulder dystocia, occipito posterior position,manual support, weight of the baby, suturing method. Postnatal evaluation after 6 weeks and 6 months for perineal discomfort, pain, incontinence, wound infection, breakdown, fistula were noted. Results: The incidence of OASIS was 1.4%. 81.8% women had 3rd degree perineal and 18.1% had 4th degree perineal tear. The mean age of the patients were 27.9 years, gestational age of 39.45 weeks, 72.7% were primiparous. Induction of labour with prostaglandins was done in 36.36% and Pitocin augmentation for 81.81%. The duration of second 36.36% had 60-89 min and 27.27% had duration more than 90 min. 54.54% had epidural analgesia, 36.36% had shoulder dystocia, 36.36% had instrumental delivery. 72.72% babies had birth weight between 3-3.5 kg, 9% between 3.5-4 kg. Ano vaginal fistula developed in 9%.Conclusions: Appropriate training, anticipating and identifying major degrees of perineal tear helps in reducing the complications. Anovaginal fistula is distressing and disabling the patient and to her near ones.

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Induction of Labour Using Oral Prostaglandin E2 Tablets

Journal of International Medical Research ◽

10.1177/030006057500300502 ◽

1975 ◽

Vol 3 (5) ◽

pp. 300-303 ◽

Cited By ~ 5

Author(s):

M G Elder ◽

M Stone

Keyword(s):

Side Effects ◽

Prostaglandin E2 ◽

Vaginal Delivery ◽

Maximum Dose ◽

Induction Of Labour ◽

Prostaglandin E ◽

Bishop Score ◽

Gastrointestinal Side Effects ◽

Hourly Dose

Labour was induced in 91 patients by means of low amniotomy and an escalating dose of oral prostaglandin E2 tablets* up to a maximum dose of 1.5 mg hourly. This regime led to vaginal delivery in 91.2% of patients. The induction delivery interval was 11.2 ± 4.9 and 7.5 ± 4.5 hours for primiparous and multiparous patients respectively. The incidence of gastrointestinal side-effects was 15.4%, with 6 patients being unable to tolerate the regime. It is suggested that a higher hourly dose is necessary for primiparous patients with a low Bishop score.

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Use of Misoprostol in Term pregnant women for Good Delivery Outcome: Experience at a tertiary care Hospital in Dhaka

Journal of Science Foundation ◽

10.3329/jsf.v12i2.27733 ◽

2016 ◽

Vol 12 (2) ◽

pp. 22-26

Author(s):

Aftabun Nahar ◽

Rifat Sultana ◽

Fatema Mahbooba Akter ◽

Munira Ferdausi ◽

Md Abdullah Yusuf ◽

...

Keyword(s):

Pregnant Women ◽

Vaginal Delivery ◽

Tertiary Care ◽

Induction Of Labour ◽

Care Hospital ◽

Term Pregnancy ◽

Singleton Pregnancy ◽

Delivery Outcome ◽

Unfavourable Cervix ◽

Study Population

Background: Use of misoprostol in term pregnancy is very useful for the better outcome during delivery. Objective: The purpose of the present study was to see the delivery outcome among the term pregnant women. Methodology: This cohort study was carried out in the Department of Obstetrics and Gynaecology at Sir Salimullah Medical College and Mitford Hospital during the period from 1 st September 2005 to 28th February 2006. Primi or second gravida patients with the gestational age between 37 weeks to 42 weeks in singleton pregnancy with cephalic presentation and not in labour who came for delivery purposes during the study period at any age were selected as study population. After proper selection of the cases, induction of labour (IOL) was done by applying Tab Misoprostol 50mcg in the posterior vaginal fornix. Purpose of induction of labour was successful when vaginal delivery occurred without any untoward side effects and without any surgical interference. Result: Out of 60 pregnant women 21 (35%) patients had unfavourable Bishops' score with 3-5 and 39 (65%) patients had favorable Bishops' score with 6-10. 39 patients had favourable pre- induction cervical score, among them 79% had delivered vaginally and 21% had undergone LUCS. 21 patients had unfavourable cervix, among them 57% experienced vaginal delivery and 43% experienced LUCS. Out of all study population 60% of study population who were primigravide had vaginal delivery in 67% cases and caesarean section in 33% cases and among 40% 2nd gravida cases vaginal delivery was 79% and caesarean delivery was 21%. Conclusion: In conclusion the use of misoprostol during term pregnancy is significantly related with the normal delivery.Journal of Science Foundation 2014;12(2):22-26DOI: http://dx.doi.org/10.3329/jsf.v12i2.27733

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