Use of artificial intelligence to predict mean time to delivery following cervical ripening with dinoprostone vaginal insert

Background: Active induction of labour in prelabour rupture of membranes resulted in a lower risk of maternal and fetal sepsis as compared to conservative management. Pre-induction cervical ripening helps in successful induction of labour.in this study we have compared the efficacy of low dose 25 mcg oral misoprostol versus intracervical PGE2 gel for cervical ripening in term PROM patients.Methods: Women with pregnancies between 37 and 41 weeks gestational age presenting with PROM at term and a Bishop score of 4 or less were randomly assigned to receive either a 25-mcg oral misoprostol every 4-hourly interval or 3 applications of intracervical PGE2 gel at a 6-hour interval for effective cervical ripening. Oxytocin was initiated if labor had not started after 6 hours of last effective dose of prostaglandin.Results: Fifty-three women (75.73%) (n = 70) in the oral misoprostol group with 2 doses, 4 hours apart had successful cervical ripening within 8 hours in comparison to sixty-two women (88.58%) (n = 70) in the intracervical PGE2 gel group with 2 doses, 6 hrs apart approximately 12 hrs for successful ripening. (p = 0.021). Oral misoprostol group needed shorter mean duration interval for the Bishop score <4 to >6 than intracervical PGE2 gel group, 7.84±3.64 hours and 9.39±4.20 hours respectively (p = 0.022). Similarly, the mean time duration interval from ruptured membranes to vaginal delivery in oral misoprostol was shorter i.e. 12.60±3.78 hours versus 14.66±4.08 hours (p = 0.005).Conclusions: Low dose 25 mcg oral misoprostol is a safe, efficacious and better tolerated alternative to intracervical PGE2 gel for pre-induction cervical ripening in especially in PROM patients at term.

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Comparative study of intra vaginal misoprostol (PGE1) with intracervical dinoprostone (PGE2) gel for induction of labour

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183792 ◽

2018 ◽

Vol 7 (9) ◽

pp. 3769

Author(s):

Bina M. Raval ◽

Nainesh S. Zalavadiya ◽

Pushpa A. Yadava ◽

Shital T. Mehta

Keyword(s):

Caesarean Section Rate ◽

Cost Effective ◽

Active Phase ◽

Cross Sectional Study ◽

Cervical Ripening ◽

Cross Sectional ◽

Misoprostol Group ◽

The Mean ◽

Vaginal Misoprostol ◽

Mean Time

Background: Labour is a final consequence of Pregnancy and is inevitable. The timing of labour may vary widely but it will happen sooner or later. The aim of the present research was to study the safety, efficacy and effect of intra vaginal Misoprostol and intra cervical Dinoprostone gel for induction of labour.Methods: 100 patients who required labour of induction were included in this prospective cross-sectional study from September 2017- March 2018. 50 patients of them received 25mcg tablet misoprostol intravaginal and 50 patients of them required 0.5mg intracervical dinoprostone gel and doses were repeated every 6 hourly for up to maximum 6 doses for Misoprostol and 3 doses for Dinoprostone gel.Results: The majority of patients had gestational age above 40 weeks and between 37-40 weeks in PGE2 and PGE1 group respectively. The mean time taken for the onset of labour was less in Misoprostol than in Dinoprostone group (43.22min v/s 1 hr40 min). The mean time taken for induction to active phase of labour (1hr 42min v/s 4hr 10min) and active phase to delivery (3hr 6min v/s 4hr54min) was less in Misoprostol than Dinoprostone group. The mean time required for induction to delivery was less in Misoprostol group (5hr 2min v/s 11hrs). Requirement of oxytocin for augmentation of labour was almost equal in both groups. Caesarean section rate was less in Misoprostol group (10% v/s 22%). Maternal side effects were minimal in either groups and neonatal outcome was good in both the groups.Conclusions: Both Misoprostol and Dinoprostone gel are safe, effective for cervical ripening and induction but Misoprostol is more cost effective and stable at room temperature.

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For elective inductions at term, does cervical ripening with misoprostol result in shorter time to delivery than dinoprostone?

Evidence-Based Practice ◽

10.1097/ebp.0000000000000900 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Joel Soma ◽

Chee Lor ◽

Sarah Roe ◽

Kathryn Freeman

Keyword(s):

Cervical Ripening ◽

Time To Delivery

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Intravenous Dexamethasone Versus Vaginal Misoprostol in Enhancing Cervical Ripening and Labor Induction

QJM ◽

10.1093/qjmed/hcab115.021 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed Mahmoud Salman ◽

Fekria Ahmed Salama ◽

Mina Yacoub

Keyword(s):

Total Duration ◽

Active Phase ◽

Labor Induction ◽

Induction Of Labor ◽

Cervical Ripening ◽

Control Group ◽

P Value ◽

Time Interval ◽

Vaginal Misoprostol ◽

Mean Time

Abstract Background Induction of labor is one of the most common procedures performed in the world of Obstetrics. Traditionally, labor induction is performed using prostaglandin and oxytocin. However, usage of corticosteroids nowadays is gaining a lot of interest regarding its effects on cervical ripening and shortening the physiological process of labor. Aim of work to evaluate the efficacy of intravenous dexamethasone versus vaginal misoprostol in enhancing cervical ripening and labor induction. Patients and Methods A randomized controlled clinical trial was carried out at Ain Shams University Maternity Hospital on (60) full term pregnant women between 39 – 42 weeks undergoing induction of labor, during a period from April 01, 2019 to November 30, 2019. Pregnant women were divided into two groups; vaginal misoprostol (control) group and intravenous dexamethasone (experimental) group (30 cases each). Results Our study showed that the mean time interval (hours) from initiation of labor induction to initiation of active phase was statistically significantly shorter among the dexamethasone (experimental) group 7.36 ± 2.23 versus 12.20 ± 4.92 hours among the vaginal misoprostol (control) group (p value < 0.001). Also, the mean time interval of the total duration between the induction of labor to successful vaginal delivery was statistically significantly shorter among the dexamethasone group 10.90 ± 4.17 versus 19.20 ± 5.62 hours among the vaginal misoprostol group (p value < 0.001). The results of this study showed the rate of initiation of active phase and rate of successful vaginal delivery were more in the experimental dexamethasone group than the control vaginal misoprostol control group. Conclusion Intravenous injection of 8 mg of dexamethasone before induction of labor is found to shorten the duration of labor induction by reducing the time interval between the initiation of labor induction and onset of active phase and the total duration from initiation of labor induction to delivery with no marked maternal or fetal complications. Recommendations Intravenous Dexamethasone can help cervical ripening and accelerate induction of labor. Further research should be taken in consideration with more population for more global evaluation.

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Diffusion-Weighted and Intravoxel Incoherent Motion MRI of the pregnant cervix as a tool to monitor cervical ripening

Proceedings of IMPRS ◽

10.18060/23623 ◽

2019 ◽

Vol 2 (1) ◽

Author(s):

Adam Warner, BS ◽

Gary Hutchins, PhD ◽

Yu-Chien Wu, MD PhD ◽

Brandon Brown, MD ◽

Monica Forbes-Amrhein, MD PhD

Keyword(s):

Water Content ◽

Normal Pregnancy ◽

Cervical Length ◽

Intravoxel Incoherent Motion ◽

Cervical Ripening ◽

Capillary Perfusion ◽

Pregnant Females ◽

Diffusion Weighted ◽

Apparent Diffusion ◽

Time To Delivery

Background and Hypothesis: Preterm delivery is a major source of infant morbidity and mortality and is difficult to predict. The process of cervical ripening prior to delivery has known histologic changes including breakdown of collagen and increasing water content. It is hypothesized that the diffusion of water, which can be measured on MRI, will increase as the cervical water content increases. Diffusion weighted imaging (DWI) is a form of MRI that measures the random Brownian motion of water molecules (represented as the apparent diffusion coefficient (ADC)). Intravoxel incoherent motion (IVIM) MRI further subdivides the ADC into microcapillary perfusion (D*) and diffusion (D). We hypothesize that as the pregnant cervix ripens near delivery, diffusion of water within the cervix (ADC and D) will increase without changes in the capillary perfusion (D*). We sought to determine the relationship between ADC, D*, D, gestational age, and time to delivery in a cohort of volunteer pregnant females. Experimental Design or Project Methods: DWI and IVIM MR studies from a cohort of 45 volunteer pregnant females with no known underlying fetal anomalies were examined. Subglandular and stromal cervix thickness and cervical length were measured along with the ADC, D*, and D of the subglandular and stromal cervix. Gestational history and delivery information was documented. Results: Subglandular ADC inversely correlated with time to delivery (r=-0.393, p=0.052). Although not significant, subglandular D revealed a trend of increasing with increased gestation age (r=0.261, p=0.149). Subglandular ADC also varied inversely with thickness of the subglandular cervix (r=-0.352, p=0.047). Subglandular D* varied inversely with maternal age (r=-0.380, p=0.028). Conclusion and Potential Impact: Our data support the hypothesized trend of increased diffusion of water within the cervix with unchanged capillary perfusion as a normal pregnancy progressed throughout the second and third trimesters. This study suggests that diffusion measures (ADC and D) follow a predictable progression during the course of a normal pregnancy and have the potential to provide a means of predicting preterm labor in the setting of preterm cervical ripening.

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A Comparison of Human and Computer Information Processing

Encyclopedia of Multimedia Technology and Networking, Second Edition ◽

10.4018/978-1-60566-014-1.ch032 ◽

2009 ◽

pp. 230-239 ◽

Cited By ~ 3

Author(s):

Brian Whitworth ◽

Hokyoung Ryu

Keyword(s):

Artificial Intelligence ◽

Language Translation ◽

Voice Recognition ◽

Small Child ◽

Spatial Coordination ◽

Visual Tasks ◽

The Mean ◽

Computer Controlled ◽

Tv Shows ◽

Mean Time

Over 30 years ago, TV shows from The Jetsons to Star Trek suggested that by the millennium’s end computers would read, talk, recognize, walk, converse, think, and maybe even feel. People do these things easily, so how hard could it be? However, in general we still don’t talk to our computers, cars, or houses, and they still don’t talk to us. The Roomba, a successful household robot, is a functional flat round machine that neither talks to nor recognizes its owner. Its “smart” programming tries mainly to stop it getting “stuck,” which it still frequently does, either by getting jammed somewhere or tangling in things like carpet tassels. The idea that computers are incredibly clever is changing, as when computers enter human specialties like conversation, many people find them more stupid than smart, as any “conversation” with a computer help can illustrate. Computers do easily do calculation tasks that people find hard, but the opposite also applies, for example, people quickly recognize familiar faces but computers still cannot recognize known terrorist faces at airport check-ins. Apparently minor variations, like lighting, facial angle, or expression, accessories like glasses or hat, upset them. Figure 1 shows a Letraset page, which any small child would easily recognize as letter “As” but computers find this extremely difficult. People find such visual tasks easy, so few in artificial intelligence (AI) appreciated the difficulties of computer-vision at first. Initial advances were rapid, but AI has struck a 99% barrier, for example, computer voice recognition is 99% accurate but one error per 100 words is unacceptable. There are no computer controlled “auto-drive” cars because 99% accuracy means an accident every month or so, which is also unacceptable. In contrast, the “mean time between accidents” of competent human drivers is years not months, and good drivers go 10+ years without accidents. Other problems easy for most people but hard for computers are language translation, speech recognition, problem solving, social interaction, and spatial coordination.

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Intravaginal Misoprostol versus Transcervical Foley Catheter for Pre-Induction Cervical Ripening and their Outcome - A Comparative Study

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v27i2.29922 ◽

2016 ◽

Vol 27 (2) ◽

pp. 72-78

Author(s):

Sabiha Nazneen ◽

Ferdousi Sultana ◽

Kamrun Nahaer

Keyword(s):

Caesarean Section Rate ◽

Foley Catheter ◽

Mode Of Delivery ◽

Cervical Ripening ◽

Socioeconomic Condition ◽

Medical College ◽

Catheter Group ◽

Significant Difference ◽

Misoprostol Group ◽

Mean Time

Objective : To compare the efficacy of transcervical Foley Catheter and Intravaginal Misoprostol in pre-induction cervical ripeningMaterials & Methods : This crosssectional study was done in the inpatient dept. of obs. and gynae at the Rangpur Medical College and Hospital, Rangpur, Bangladesh between 1st July 2005 to 30th December, 2006. During 18 (eighteen) months of study period, 99 patients were enrolled, 50 were in group 1 where Misoprostol tablet was given vaginally and 49 were in group II where Foley Catheter was used transcervically. The Misoprostol tablet dosing regime was 50?g (one- fourth of a 200?g tablet), which was given vaginally (in the posterior vaginal fornix). The second dose was given after six hours. Though the maximum target was four doses that was 200?g, cervical ripening took place in all the cases with only two doses. Cervical scoring was reassessed after four hours in both the groups.Results: There were similar baseline characteristics such as age of the patients, socioeconomic condition etc. No significant difference was observed regarding parity, gravidity, gestational age, Bishops score and pre-induction of labour. There was also no significant difference in the mean time of pre-induction to delivery interval, mode of delivery and neonatal out come. Change in Bishops score was similar in both groups but more time was required from pre-induction to delivery in Foley catheter group. The most frequent complaint in Foley catheter group was mild discomfort at insertion. Vaginal delivery was higher in this group (63.3%) whereas Caesarean section rate was higher in Misoprostol group (36%) due to hyperstimulation syndrome.Conclusion: Both intravaginal Misoprostol and transcervical Foley catheter have similar effectiveness as pre-induction agents in unripe cervix. Transcervical Foley catheter is associated with a lower incidence of hyperstimulation syndrome (presence of hypertonous utrine contraction associated with abnormal foetal heart rate) and higher incidence of vaginal deliveries.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 72-78

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Implementation of Evidence-Based Cervical Ripening Protocol: Outcomes and Next Steps

American Journal of Perinatology Reports ◽

10.1055/s-0040-1721443 ◽

2020 ◽

Vol 10 (04) ◽

pp. e408-e412

Author(s):

Arthurine Zakama ◽

Nasim C. Sobhani ◽

Robyn Lamar ◽

Melissa G. Rosenstein

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

San Francisco ◽

Management Practices ◽

Low Dose ◽

Cervical Ripening ◽

Evidence Based ◽

Nulliparous Women ◽

Before And After ◽

Time To Delivery

Abstract Objective A prominent randomized controlled trial demonstrated that low-dose misoprostol with the concurrent cervical Foley shortened the median time to delivery when compared with either method alone. Our study aims to address implementation of this protocol and evaluate its impact on time to delivery. Study Design This was a retrospective before-and-after study of nulliparous women who delivered nonanomalous, term, singletons at the University of California San Francisco (UCSF) in two separate 2-year periods before and after changes in UCSF's cervical ripening protocol. The primary outcome was time from first misoprostol dose to delivery. Results A total of 1,496 women met inclusion criteria, with 698 in the preimplementation group and 798 in the postimplementation group. There were no statistically significant differences in time to delivery (29 vs. 30 hours, p = 0.69), rate of cesarean delivery (30 vs. 26%, p = 0.09), or cesarean delivery for fetal indications (11 vs. 8%, p = 0.15) between the groups. Conclusion Implementing evidence-based low-dose misoprostol with the concurrent cervical Foley did not change the time to delivery, time to vaginal-delivery, or likelihood of vaginal delivery in our population. This may be due to differences in labor management practices and incomplete fidelity to the protocol. Real-world effectiveness of these interventions will vary and should be considered when choosing an induction method.

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A Comparison of Human and Computer Information Processing

Machine Learning ◽

10.4018/978-1-60960-818-7.ch101 ◽

2012 ◽

pp. 1-12

Author(s):

Brian Whitworth ◽

Hokyoung Ryu

Keyword(s):

Artificial Intelligence ◽

Language Translation ◽

Voice Recognition ◽

Small Child ◽

Spatial Coordination ◽

Visual Tasks ◽

The Mean ◽

Computer Controlled ◽

Tv Shows ◽

Mean Time

Over 30 years ago, TV shows from The Jetsons to Star Trek suggested that by the millennium’s end computers would read, talk, recognize, walk, converse, think, and maybe even feel. People do these things easily, so how hard could it be? However, in general we still don’t talk to our computers, cars, or houses, and they still don’t talk to us. The Roomba, a successful household robot, is a functional flat round machine that neither talks to nor recognizes its owner. Its “smart” programming tries mainly to stop it getting “stuck,” which it still frequently does, either by getting jammed somewhere or tangling in things like carpet tassels. The idea that computers are incredibly clever is changing, as when computers enter human specialties like conversation, many people find them more stupid than smart, as any “conversation” with a computer help can illustrate. Computers do easily do calculation tasks that people find hard, but the opposite also applies, for example, people quickly recognize familiar faces but computers still cannot recognize known terrorist faces at airport check-ins. Apparently minor variations, like lighting, facial angle, or expression, accessories like glasses or hat, upset them. Figure 1 shows a Letraset page, which any small child would easily recognize as letter “As” but computers find this extremely difficult. People find such visual tasks easy, so few in artificial intelligence (AI) appreciated the difficulties of computer-vision at first. Initial advances were rapid, but AI has struck a 99% barrier, for example, computer voice recognition is 99% accurate but one error per 100 words is unacceptable. There are no computer controlled “auto-drive” cars because 99% accuracy means an accident every month or so, which is also unacceptable. In contrast, the “mean time between accidents” of competent human drivers is years not months, and good drivers go 10+ years without accidents. Other problems easy for most people but hard for computers are language translation, speech recognition, problem solving, social interaction, and spatial coordination.

Download Full-text