The Influence of Diabetes on Labor Induction with Dinoprostone Vaginal Inserts

2021 ◽  
Author(s):  
Jennifer Y. Duffy ◽  
Cindy Chau ◽  
Kyle Raymond ◽  
Olof Rugarn ◽  
Deborah A. Wing
Keyword(s):  
Vaginal Delivery ◽  
Fetal Heart ◽  
Secondary Analysis ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Randomized Controlled ◽  
Key Points ◽  
Active Labor ◽  
Heart Rate Pattern ◽  
Time To Onset

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

scholarly journals Induction of labor compared to expectant management in term nulliparas with a latent phase of labor of more than 8 hours: a randomized trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Patrick Naveen Sargunam ◽  
Lindy Li Mei Bak ◽  
Peng Chiong Tan ◽  
Narayanan Vallikkannu ◽  
Mat Adenan Noor Azmi ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Cesarean Delivery ◽  
Hospital Discharge ◽  
Expectant Management ◽  
Primary Outcome Measure ◽  
Labor Induction ◽  
Induction Of Labor ◽  
National Medical ◽  
Active Labor ◽  
Latent Phase

Abstract Background Prolonged latent phase of labor is associated with adverse maternal and neonatal outcomes. Preliminary data indicate that labor induction for prolonged latent phase may reduce cesarean delivery. We performed a study powered to Cesarean delivery to evaluate labor induction compared to expectant management in full term nulliparas hospitalized for persistent contractions but non-progressive to established labor after an overnight stay. Methods From 2015 and 2017, nulliparas, ≥ 39 weeks’ gestation with prolonged latent phase of labor (persistent contractions after overnight hospitalization > 8 h), cervical dilation ≤3 cm, intact membranes and reassuring cardiotocogram were recruited. Participants were randomized to immediate induction of labor (with vaginal dinoprostone or amniotomy or oxytocin as appropriate) or expectant management (await labor for at least 24 h unless indicated intervention as directed by care provider). Primary outcome measure was Cesarean delivery. Results Three hundred eighteen women were randomized (159 to each arm). Data from 308 participants were analyzed. Cesarean delivery rate was 24.2% (36/149) vs. 23.3%, (37/159) RR 1.0 95% CI 0.7–1.6; P = 0.96 in induction of labor vs. expectant arms. Interval from intervention to delivery was 17.1 ± 9.9 vs. 40.1 ± 19.8 h; P < 0.001, intervention to active labor 9.6 ± 10.2 vs. 29.6 ± 18.5 h; P < 0.001, active labor to delivery 7.6 ± 3.6 vs. 10.5 ± 7.2 h; P < 0.001, intervention to hospital discharge 2.4 ± 1.2 vs. 2.9 ± 1.4 days; P < 0.001 and dinoprostone use was 19.5% (29/149) vs. 8.2% (13/159) RR 2.4 95% CI 1.3–4.4; P = 0.01 in IOL compared with expectant arms respectively. Intrapartum oxytocin use, epidural analgesia and uterine hyperstimulation syndrome, postpartum hemorrhage, patient satisfaction on allocated intervention, during labor and delivery and baby outcome were not significantly different across trial arms. Conclusions Induction of labor did not reduce Cesarean delivery rates but intervention to delivery and to hospital discharge durations are shorter. Patient satisfaction scores were similar. Induction of labor for prolonged latent phase of labor can be performed without apparent detriment to expedite delivery. Trial registration Registered in Malaysia National Medical Research Register (NMRR-15-16-23,886) on 6 January 2015 and the International Standard Randomised Controlled Trials Number registry, registration number ISRCTN14099170 on 5 Nov 2015.

scholarly journals Study of pre induction transvaginal ultra-sonographic cervical length and its comparison with bishop score in predicting successful labor induction

2021 ◽  
Vol 10 (6) ◽  
pp. 2335
Author(s):  
Santosh Khajotia ◽  
Madhuri Sharma ◽  
Mool Chand Khichar ◽  
Manoj Gupta ◽  
Kavita Choudhary
Keyword(s):  
Vaginal Delivery ◽  
Prospective Observational Study ◽  
Mode Of Delivery ◽  
Cervical Length ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Bishop Score ◽  
Receiver Operating Characteristic Curves ◽  
Medical College ◽  
Successful Induction

Background: Induction of labor means initiation of uterine contraction, after period of viability by any method (medical, surgical or combined) before spontaneous onset of labor for the purpose of vaginal delivery. The condition of cervix or favorability is important for successful labor induction. Assessment of cervix has been used as a predictor of successful vaginal delivery. Induction of labor carried out in approximately 20% of all pregnancies. Aim and objectives of the current study were to compare the predictive value of trans-vaginal ultra-sonographic measurement of cervical length versus Bishop score prior to induction of labor in predicting the mode of delivery and maternal and fetal outcome.Methods: This prospective observational study was conducted in the department of obstetrics and gynecology, Sardar Patel medical college and associated group of hospitals, Bikaner between February to November 2020. Study group included 100 pregnant women in which induction of labor was performed at 37-42 weeks of gestation.Results: Bishop Score appears to be a better predictor than the cervical length with sensitivity of 1.00 and a specificity of 0.12 compared to 0.52 and 1.00 respectively. In the receiver operating characteristic curves, the cut-off point for the prediction of successful induction taken was 2.6 cm cervical length and >4 for the bishop score.Conclusions: TVS cervical length could be used as alternative to Bishop score for prediction of successful labor induction in the sitting where the appropriate equipment and expertise are available. Bishop score and TVS cervical length both are good predictors of successful induction of labor. 

scholarly journals Planned Cesarean or planned vaginal delivery for twins: a secondary analysis of a randomized controlled trial

2019 ◽  
Author(s):  
M. Hadi Zafarmand ◽  
Simone M. T. A. Goossens ◽  
Parvin Tajik ◽  
Patrick M. M. Bossuyt ◽  
Elizabeth V. Asztalos ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Vaginal Delivery ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Randomized Controlled

scholarly journals Pre-labor Cesarean delivery or induction of labor in twin gestation

2020 ◽  
Author(s):  
Claire Dougan ◽  
Lara Gotha ◽  
Nir Melamed ◽  
Amir Aviram ◽  
Elizabeth Asztalos ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Primary Outcome ◽  
Secondary Analysis ◽  
Neonatal Morbidity ◽  
Induction Of Labor ◽  
Secondary Outcome ◽  
Maternal Outcomes ◽  
Maternal Morbidity And Mortality ◽  
Spontaneous Onset

Abstract BACKGROUND: We aimed to compare neonatal and maternal outcomes of twin gestations without spontaneous onset of labor, which underwent induction of labor or pre-labor cesarean section.METHODS: In the Twin Birth Study (TBS), women at 320/7-386/7 weeks of gestation, in whom the first twin was in cephalic presentation, were randomized to planned vaginal delivery or cesarean section. In this secondary analysis of the TBS we focused on the outcomes of the subset of women who did not have a spontaneous onset of labor. We compared those who had an induction of labor with those who had a pre-labor cesarean section. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity. Secondary outcome was a composite of maternal morbidity and mortality.RESULTS: Of the 2,804 women included in the TBS, a total of 1,347 (48%) women did not have a spontaneous onset of labor: 568 (42%) in the planned vaginal delivery arm and 779 (58%) in the planned cesarean arm. Induction of labor was attempted in 409 (30%), and 938 (70%) had a pre-labor cesarean section. The rate of intrapartum cesarean section in the induction of labor group was 41.3%. The rate of the primary outcome was comparable between the pre-labor cesarean section and induction of labor groups (1.65% vs. 1.97%; p=0.61; OR 0.83; 95% CI 0.43-1.62). The maternal composite outcome was found to be lower with pre-labor cesarean section compared to induction of labor (7.25% vs. 11.25%; p=0.01; OR 0.61; 95% CI 0.41-0.91).CONCLUSION: In women with twin gestation between 320/7-386/7 weeks of gestation with the first twin in cephalic presentation, induction of labor and pre-labor cesarean section have similar neonatal outcomes. Pre-labor cesarean section is associated with favorable maternal outcomes.

scholarly journals Sublingual vs Vaginal Misoprostol for Labor Induction

2012 ◽  
Vol 46 (3) ◽  
pp. 138-143
Author(s):  
Sujata Siwatch ◽  
Vanita Jain
Keyword(s):  
Uterine Contraction ◽  
Controlled Trial ◽  
Mode Of Delivery ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Randomized Controlled ◽  
Sublingual Misoprostol ◽  
Misoprostol Group ◽  
Vaginal Misoprostol ◽  
To Receive

ABSTRACT Background This study is a randomized controlled trial comparing the efficacy and safety of sublingual vs vaginal misoprostol for induction of labor. Materials and methods A total of 160 women admitted for induction of labor at the PGIMER, Chandigarh, India were randomized to receive 25 μg of vaginal or sublingual misoprostol for labor induction. The two groups were compared for mode of delivery, induction delivery interval, misoprostol dose required, uterine contraction abnormalities and neonatal outcomes. Results Majority of women in both groups delivered vaginally (91 and 89% in vaginal and sublingual misoprostol groups respectively). Mean number of doses of misoprostol required for induction of labor was similar in vaginal misoprostol group and sublingual misoprostol group (1.81 ± 0.84 vs 2.05 ± 0.98). The occurrence of uterine contraction abnormalities and neonatal outcome was similar in both groups. Conclusion The low dose of 25 μg is equally efficacious and safe by both vaginal and sublingual routes. How to cite this article Siwatch S, Kalra J, Bagga R, Jain V. Sublingual vs Vaginal Misoprostol for Labor Induction. J Postgrad Med Edu Res 2012;46(3):138-143.

Induction of labor in twin gestation: can we predict success?

2018 ◽  
Vol 46 (7) ◽  
pp. 771-775 ◽  
Author(s):  
Armin S. Razavi ◽  
Stephen T. Chasen ◽  
Fiona Chambers ◽  
Robin B. Kalish
Keyword(s):  
Vaginal Delivery ◽  
Maternal Morbidity ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Secondary Outcome ◽  
Estimated Blood Loss ◽  
Multiparous Women ◽  
Successful Induction ◽  
Twin Pregnancies ◽  
Uterotonic Agent

Abstract Objective: To identify factors associated with a successful induction of labor in twin pregnancies and associated maternal morbidity. Study design: This was a retrospective review of twin pregnancies ≥24 weeks’ gestation undergoing labor induction from 2011 to 2016. The primary outcome was a successful induction of labor. The secondary outcome was a composite of maternal morbidity, including ≥1 of the following: estimated blood loss (EBL) >1500 ml, blood transfusion, hysterectomy, intensive care unit (ICU) admission or maternal death. Results: Of 104 twin pregnancies undergoing labor induction, 64 (61.5%) had a vaginal delivery of both twins. Multiparity [odds ratio (OR) 12.3, 95% confidence interval (CI) 3.9–38.8, P≤0.005] and maternal age <35 years (OR 2.33, 95% CI 1.1–5.2, P=0.038) were independently associated with vaginal delivery. The overall rate of composite maternal morbidity was 7.7%. Cesarean delivery (CD) was associated with an increased rate of composite maternal morbidity compared to the successful induction group (17.5% vs. 1.6%, P≤0.005). An EBL >1500 ml, uterine atony and the use of ≥1 uterotonic agent were more frequent in the CD group. Conclusions: Multiparous women and those <35 years of age were more likely to have a vaginal delivery. Maternal morbidity is increased in women who required a CD after labor induction compared to those who achieved a vaginal delivery.

Factors Predicting Successful Vaginal Delivery Following Induction of Labor in Term Pregnancy v1

2021 ◽  
Author(s):  
Wirada Hansahiranwadee ◽  
Threebhorn Kamlungkuea ◽  
Jittima Manonai Bartlett
Keyword(s):  
Prediction Model ◽  
Vaginal Delivery ◽  
Gestational Age ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Fetal Weight ◽  
Term Pregnancy ◽  
Individual Probability ◽  
History Of ◽  
Estimated Fetal Weight

Objective This study was proposed to evaluatefactors predicting successful vaginal delivery following labor induction and develop induction prediction model in term pregnancy among Thai pregnant women. Method We conducted a retrospective cohort study using electronic medical recordsof 23,833 deliveries from April 2010 - July 2021 at tertiary-level hospital in Bangkok, Thailand. Univariate regression was performed to identify association of individual parameters to successful vaginal delivery. Multiple logistic regression analysis of all possible variables from univariate analysis was performed to develop prediction model with statistically significant of p value < 0.05. Results Of thetotal 809 labor-induced pregnancies, the vaginal delivery rate was 56.6%. Among predicting variables, history of previous vaginal delivery (aOR 5.75, 95%CI3.701-8.961), maternal delivery BMI < 25 kg/m2 (aOR 2.010, 95%CI1.303-3.286), estimated fetal weight < 3500 g (aOR 2.193, 95%CI1.246-3.860), and gestational age ≤ 39 weeks (aOR 1.501, 95%CI1.038-2.173) significantly increased the probability of successful vaginal delivery following labor induction. The final prediction model has been internally validated. Model calibration and discrimination were satisfactory with Hosmer-Lemeshow test P= 0.21 and with AUC of 0.732 (95% CI 0.692-0.772). Conclusions This study determined the pragmatic predictors for successful vaginal delivery following labor induction comprised of history of previous vaginal delivery, maternal delivery BMI < 25 kg/m2, estimated fetal weight < 3500 g, and gestational age ≤ 39 weeks. The final induction prediction model was well-performing internally validated prediction model to estimate individual probability when undergoing induction of labor. Despite of restricted population, the predicting factors and model could be useful for further prospective study and clinical practice to improve induction outcomes.

scholarly journals Misoprostol versus oxytocin for labor induction in term and post-term pregnancy: randomized controlled trial

2003 ◽  
Vol 121 (3) ◽  
pp. 102-106 ◽  
Author(s):  
Márcia Maria Auxiliadora de Aquino ◽  
José Guilherme Cecatti
Keyword(s):  
Randomized Controlled Trial ◽  
Pregnant Women ◽  
Latent Period ◽  
Vaginal Delivery ◽  
Controlled Trial ◽  
Neonatal Morbidity ◽  
Labor Induction ◽  
Cervical Ripening ◽  
Randomized Controlled ◽  
Misoprostol Group

CONTEXT: Misoprostol, a synthetic E1 methyl analog prostaglandin, is at present receiving attention as a cervical modifier and labor induction agent. However, there is still a need for better determination of its safety and effectiveness. OBJECTIVE: To compare intravaginal misoprostol versus intravenous oxytocin for cervical ripening and labor induction in pregnant women with unripe cervices. DESIGN: Randomized controlled trial. SETTING: The study was performed at the Leonor Mendes de Barros Maternity Hospital between November 1998 and December 2000. PARTICIPANTS: 210 pregnant women with intact membranes and indication for labor induction were selected. PROCEDURES: The women randomly received 25 µg of vaginal misoprostol every 4 hours, not exceeding 8 doses (105 women), or oxytocin in a continuous infusion (105 women). MAIN MEASUREMENTS: The main parameters measured were: latent period, time from induction to vaginal delivery, delivery route, occurrence of vaginal delivery with time, occurrence of uterine tonus alterations, hypoxia and neonatal morbidity. To verify the statistical significance of the differences between the groups, the chi-squared, Student t and log-rank tests were used. RESULTS: There were no significant differences between the groups concerning conditions for labor induction, age, parity, race, marital status, family income, initial Bishop Index and number of prenatal visits. The cesarean section rate, latent period and period from induction to vaginal delivery were significantly lower for the misoprostol group. With regard to uterine tonus alterations, tachysystole was significantly more common in the misoprostol group. However, there was no difference in hypoxia and neonatal morbidity between the groups. CONCLUSION: 25 µg of misoprostol used vaginally every 4 hours is safer and more efficient for cervical ripening and labor induction than oxytocin.

Sign in / Sign up

Export Citation Format

Share Document