The Association Between the Length of First Stage of Labor, Mode of Delivery, and Perinatal Outcomes in Women Undergoing Induction of Labor

Background and objectives: Induction of labor (IOL) is an event that occurs in up to one-quarter of pregnancies; less is known about the outcomes and safety of IOL in obese pregnant woman; no data is available on misoprostol vaginal insert (MVI) IOL in high-risk pregnancy obese women. Objectives: (1) to evaluate the rate of successful IOL with 200 μg MVI in obese (Body Mass Index - BMI over 30 kg/m2) high-risk pregnant women: late-term pregnancy, hypertension or diabetes, compared to obese non-high-risk ones; (2) to evaluate the safety profile of MVI in high-risk pregnancy obese patients. Study design: We conducted a cross-sectional study in "Filantropia" Clinical Hospital, Bucharest, Romania, from June 2017 to September 2019 (28 months). From a total of 11,096 registered live births, IOL was performed in 206 obese patients; 74 obese high-risk pregnant patients matched the inclusion criteria; of these, 33.8% pregnancies (n=25) were late-term (41 – 41+6 weeks), 43.2% (n=32) had associated pathologies (hypertension and diabetes); labor induction was guided using a standardized protocol. We evaluated the maternal and gestational age, parity, fetal tachysystole, hyper-stimulation, initial cervical status, time from induction to delivery, drug side effects, mode of delivery, and neonatal outcomes. Results: (a) The overall successful labor induction rate, evaluated by the vaginal delivery rate, was 71.6% (n=53), spontaneously or instrumentally assisted; 28.4% (n=21) births were unsuccessful MVI IOL, converted into caesareans. (b) No significant differences were found regarding the maternal outcomes; in terms of perinatal outcomes of safety, four cases of high-risk pregnancies vaginally delivered were associated with neonatal intensive care unit (NICU) admissions and a one-minute Apgar score under seven (5.4%). Most cases with adverse effects of misoprostol have been managed conservatively, except for three emergency C-section cases. Conclusions: Misoprostol vaginal insert is a safe choice in IOL in obese high-risk pregnancies with good maternal and perinatal outcomes.

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Perinatal outcomes with isolated oligohydramnios at term pregnancy

Journal of Perinatal Medicine ◽

10.1515/jpm-2015-0198 ◽

2016 ◽

Vol 44 (7) ◽

Cited By ~ 2

Author(s):

Mariña Naveiro-Fuentes ◽

Alberto Puertas Prieto ◽

Rocío Sánchez Ruíz ◽

María Paz Carrillo Badillo ◽

Francisco Montoya Ventoso ◽

...

Keyword(s):

Amniotic Fluid ◽

Umbilical Artery ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Induction Of Labor ◽

Obstetric Outcomes ◽

Term Pregnancy ◽

Neonatal Birth Weight ◽

Blood Ph ◽

Discharge Status

AbstractAims:To compare the outcomes of term gestations with oligohydramnios in the absence of other underlying disorders and term gestations with normal amniotic fluid.Methods:A retrospective analysis of obstetric outcomes in 27,708 term pregnancies. We compared three groups: labor induced because of oligohydramnios, spontaneous onset of labor with normal amniotic fluid, and labor induced because of late term pregnancy with normal amniotic fluid. We excluded pregnancies with maternal or fetal diseases or disorders potentially related with amniotic fluid alterations. The main outcome measures were mode of delivery, neonatal birth weight, umbilical artery blood pH, Apgar scores and neonatal discharge status.Results:Compared to spontaneous labor, induction of labor because of oligohydramnios was associated with a higher risk of cesarean delivery and small size of the fetus for gestational age (SGA). Compared to induction because of late term pregnancy there were no significant differences in neonatal, although neonates had a higher risk of being SGA.Conclusion:The only perinatal outcome for which the risk was higher in term pregnancies with isolated oligohydramnios was SGA. The systematic induction of labor in these pregnancies should be questioned.

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Fetal CHD and perinatal outcomes

Cardiology in the Young ◽

10.1017/s1047951120000785 ◽

2020 ◽

Vol 30 (5) ◽

pp. 686-691

Author(s):

Christina J. Ge ◽

Amanda C. Mahle ◽

Irina Burd ◽

Eric B. Jelin ◽

Priya Sekar ◽

...

Keyword(s):

Cohort Study ◽

Preterm Delivery ◽

Odds Ratio ◽

Retrospective Cohort ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Fold Increase ◽

Cesarean Sections ◽

Increased Risk ◽

Gestational Age At Delivery

AbstractObjective:To evaluate delivery management and outcomes in fetuses prenatally diagnosed with CHD.Study design:A retrospective cohort study was conducted on 6194 fetuses (born between 2013 and 2016), comparing prenatally diagnosed with CHD (170) to those with non-cardiac (234) and no anomalies (5790). Primary outcomes included the incidence of preterm delivery and mode of delivery.Results:Gestational age at delivery was significantly lower between the CHD and non-anomalous cohorts (38.6 and 39.1 weeks, respectively). Neonates with CHD had a significantly lower birth weights (p < 0.001). There was an approximately 1.5-fold increase in the rate of primary cesarean sections associated with prenatally diagnosed CHD with an odds ratio of 1.49 (95% CI 1.06–2.10).Conclusions:Our study provides additional evidence that the prenatal diagnosis of CHD is associated with a lower birth weight, preterm delivery, and with an increased risk of delivery by primary cesarean section.

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Maternal and perinatal outcomes in women with eclampsia by mode of delivery at Riley mother baby hospital: a longitudinal case-series study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03875-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Koech Irene ◽

Poli Philippe Amubuomombe ◽

Richard Mogeni ◽

Cheruiyot Andrew ◽

Ann Mwangi ◽

...

Keyword(s):

Pregnant Women ◽

Perinatal Mortality ◽

Mode Of Delivery ◽

Case Series ◽

Perinatal Outcomes ◽

Induction Of Labour ◽

Chi Square ◽

Case Series Study ◽

Chi Square Test ◽

Series Study

Abstract Background Eclampsia, considered as serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital. Methods This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using frequencies and percentages. The significance of the obtained results was judged at the 5% level. The chi-square test was used for categorical variables, and Fisher’s exact test or the Monte Carlo correction was used for correction of the chi-square test when more than 20% of the cells had an expected count of less than 5. Results During the study period, 53 patients diagnosed with eclampsia were treated and followed up to 6 weeks postpartum. There was zero maternal mortality; however, perinatal mortality was reported in 9.4%. Parity was statistically associated with an increased odds of adverse perinatal outcomes (p = 0.004, OR = 9.1, 95% CI = 2.0–40.8) and caesarean delivery (p = 0.020, OR = 4.7, 95% CI = 1.3–17.1). In addition, the induction of labour decreased the risk of adverse outcomes (p = 0.232, OR = 0.3, 95% CI = 0.1–2.0). Conclusion There is no benefit of emergency caesarean section for women with eclampsia. This study showed that induction of labour and vaginal delivery can be successfully achieved in pregnant women with eclampsia. Maternal and perinatal mortality from eclampsia can be prevented through prompt and effective care.

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294: Induction of labor and mode of delivery: differences stratified by indication for induction

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2009.10.309 ◽

2009 ◽

Vol 201 (6) ◽

pp. S119

Author(s):

Melissa Rosenstein ◽

Lena Kim ◽

Yvonne Cheng ◽

Shani Delaney ◽

Clara Ward ◽

...

Keyword(s):

Mode Of Delivery ◽

Induction Of Labor

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Efficacy and Safety of Foley Catheter Balloon for Cervix Priming in Term Pregnancy

Acta Médica Portuguesa ◽

10.20344/amp.8003 ◽

2017 ◽

Vol 30 (4) ◽

pp. 281 ◽

Cited By ~ 2

Author(s):

Catarina Policiano ◽

Mariana Pimenta ◽

Diana Martins ◽

Nuno Clode

Keyword(s):

Foley Catheter ◽

Mode Of Delivery ◽

Tertiary Hospital ◽

Mechanical Effect ◽

Induction Of Labor ◽

Catheter Removal ◽

Bishop Score ◽

Delivery Time ◽

Singleton Pregnancy ◽

Previous Cesarean

Introduction: Foley catheter promotes cervix priming by a direct mechanical effect of distension.Material and Methods: A prospective observational study was conducted at a tertiary hospital, including all cases of induction of labor with Foley catheter between September 1, 2013 and November 30, 2015. Women were eligible if they had a singleton pregnancy with a Bishop score < 6 and a gestational age ≥ 41 weeks or a medical indication for induction of labor. The primary outcome was the Bishop score variation (difference between Bishop score before and after insertion of Foley catheter). Mode of delivery, induction-to-delivery time, uterine tachysystole with fetal decelerations, peripartum fever ≥ 38º C, maternal pain and mortality were also analyzed.Results: Within 201 inductions with Foley catheter, average increase in Bishop score after catheter placement was three (1 - 7), with only 5% (11/201) of unmodified cervix after catheter removal/extrusion. Vaginal delivery rate was 71% (142/201) and in women with a previous cesarean section (n = 40) was 37% (15/40). Average induction-to-delivery time was 38 hours (4 - 120). Uterine infection rate was 3% (6/201). There was only one case of significant vaginal bleeding which required immediate catheter removal. There has been no significative maternal or neonatal morbidity.Discussion/Conclusion: Foley catheter is a safe and effective method of cervical priming for women with an unfavorable cervix, even in the case of a previous cesarean delivery.

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A study of effect of oral PGE1 and cervical PGE2 on induction of labor and mode of delivery

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181995 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2160

Author(s):

Sukanya Mukherjee ◽

H. Valson ◽

Balaji K.

Keyword(s):

Mode Of Delivery ◽

Induction Of Labor ◽

Cervical Ripening ◽

P Value ◽

Singleton Pregnancy ◽

Outcome Indicators ◽

Oral Misoprostol ◽

Vaginal Deliveries ◽

Group A ◽

Group B

Background: Induction of labor is one of the most important procedures done by the Obstetricians. Induction of labor with the help of prostaglandins offer the advantage of promoting cervical ripening along with stimulating the contractility of the myometrium.Methods: 200 pregnant women with singleton pregnancy both nulliparous and multiparous, were included in the study at term gestation (>39weeks) with Bishop’s score <6, and reactive NST. The subjects were divided in to two groups Group A including patients who were given oral PGE1 - 50 mcg Tab, and Group B with cervical PGE2, 0.5 mg, gel. The outcome indicators were recorded in both Group A and Group B and analyzed. The mean time taken from induction to vaginal delivery in Group A was 628±67 minutes and in Group B was 839±118 minutes. Incidence of LSCS in Group B when compared to Group A (p value <0.005).Results: Incidence of LSCS in Primi’s in Group B compared to Primi’s in Group A was statistically significant (p value 0.009). Non-progression of labor was observed to be the major indication for LSCS in Group B. Meconium stained labor was found to be the major indication for LSCS in Group A.Conclusions: The study concludes that using 50 mcg oral misoprostol, is an effective and safe mode of induction of labor in comparison to PGE2 gel. Vaginal deliveries are more with the use of oral misoprostol and the induction to delivery interval is also lesser than that in cervical PGE2 use.

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Comparative study of misoprostol sublingually and dinoprostone gel intracervically for cervical ripening and induction of labor

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20173497 ◽

2017 ◽

Vol 6 (8) ◽

pp. 3624

Author(s):

Shikha Yadav ◽

Nootan Chandwaskar

Keyword(s):

Mode Of Delivery ◽

Cost Effective ◽

Active Phase ◽

Induction Of Labor ◽

Cervical Ripening ◽

Cost Effective Method ◽

Sublingual Misoprostol ◽

Misoprostol Group ◽

Oxytocin Augmentation ◽

Live Fetus

Background: Both Prostaglandin E1 and E2 analog are being used for cervical ripening. The aims of study was to compare the efficacy and safety profile of sublingual misoprostol (PGE2) and intracervical dinoprostone (PGE1) for cervical ripening and induction of labor.Methods: One hundred women with single live fetus and with gestational age of more than 37 weeks admitted for induction of labor were recruited for the study. Patients were randomized to receive either 25μg of misoprostol sublingually or dinaprostone gel (0.5mg) intracervically.Results: There was shorter induction to active phase, induction to delivery time intervals and less requirement of oxytocin augmentation in misoprostol group than dinoprostone gel group. Incidence of tachysystole was higher in misoprostol group than dinoprostone gel group (22% vs 10%) however this was not statistically significant. Mode of delivery, maternal and neonatal complications were similar in both the groups.Conclusions: Use of misoprostol in lower dose is a safe and cost-effective method for cervical ripening and induction of labor.

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Comparison of Amniotic Fluid Index and Single Deepest Vertical Pocket

Current Women s Health Reviews ◽

10.2174/1573404817666210223162752 ◽

2021 ◽

Vol 17 ◽

Author(s):

Roopa Padavagodu Shivananda ◽

Rekha Anbu ◽

Shubha Rao ◽

Nivedita Hegde ◽

Anjali Suneel Mundkur ◽

...

Keyword(s):

Birth Weight ◽

Amniotic Fluid ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Fluid Volume ◽

Maternal Outcomes ◽

Amniotic Fluid Index ◽

Amniotic Fluid Volume ◽

Vaginal Deliveries ◽

Nicu Admission

Background: The best method of estimation of amniotic fluid volume is a matter of ongoing debate. Objectives: To determine the perinatal & maternal outcomes in pregnant patients when the amniotic fluid volume was assessed by the amniotic fluid index (AFI) in comparison to the single deepest vertical pocket (SDVP). Methods: We studied abnormal Cardiotocograph, meconium stained amniotic fluid, birth weight <2.5kg, Apgar score at 5 min <7, cord blood pH <7.2 & necessity for NICU admission as perinatal outcomes. Rate of diagnosis of oligohydramnios, induction of labor for oligohydramnios & mode of delivery were observed in maternal outcomes. Results: Of the 697 pregnant patients recruited, 353 were in the AFI and 344 in the SDVP group. Perinatal outcomes were similar in both. In the AFI group, the number of women diagnosed with oligohydramnios was higher (p = 0.0333) & the rate of induction was also higher (p = 0.003378). Vaginal deliveries were more in the SDVP group. The Receiver Operating Characteristic curves showed statistically significant correlation with NICU stay, birth-weight, and mode of delivery. While an AFI of >5cm and SDVP of >1.9cm had good sensitivity in predicting babies with a birth weight of ≥ 2.5kg and avoiding NICU admissions, an AFI of > 5.8cm and an SDVP of > 1.9 cm had a sensitivity of around 80% in predicting successful vaginal deliveries. Conclusion: The SDVP method has a slight edge over the AFI in terms of lower inductions and higher vaginal deliveries with comparable perinatal outcomes.

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