Cesarean delivery among women with prolonged labor induction

2016 ◽  
Vol 44 (7) ◽  
Author(s):  
Louise L. Highley ◽  
Rebecca A. Previs ◽  
Sarah K. Dotters-Katz ◽  
Leo R. Brancazio ◽  
Chad A. Grotegut
Keyword(s):  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Labor Induction ◽  
University Hospital ◽  
Delivery Rate ◽  
Multivariate Logistic Regression Model ◽  
Nulliparous Women ◽  
Prolonged Labor ◽  
Cesarean Delivery Rate

AbstractObjective:The objective of this study was to determine characteristics associated with cesarean delivery among women with labor induction lasting over 24 h.Study design:Women with live singleton pregnancies without prior cesarean delivery undergoing a labor induction lasting >24 h between September 2006 and March 2009 at Duke University Hospital were identified. Collected variables were compared between subjects by mode of delivery. A multivariate logistic regression model for the outcome cesarean delivery was constructed separately for nulliparous and parous women.Results:There were 303 women who met inclusion criteria. The overall cesarean delivery rate was 57% (n=172) and remained constant with time (P=0.15, test-for-trend). Nulliparous women having a cesarean delivery were more likely to be obese [adjusted OR (aOR) 2.00; 95% CI 1.05, 3.80] and have a larger fetus [aOR 1.11 (aOR for every 100 g increase in birthweight), 95% CI 1.03, 1.20] compared to those having a vaginal delivery.Conclusion:Increasing BMI and birthweight were independent predictors of cesarean delivery among nulliparous women with prolonged labor induction. Despite this, after 24 h of labor induction, the overall mean cesarean delivery rate remained constant at 57%, and did not change with time. Among women having a vaginal delivery following a prolonged labor induction, we saw high rates of shoulder dystocia, operative vaginal delivery and severe perineal laceration.

scholarly journals Intravenous fluid rate for reduction of cesarean delivery rate in nulliparous women: a systematic review and meta-analysis

2017 ◽  
Vol 96 (7) ◽  
pp. 804-811 ◽  
Author(s):  
Robert M. Ehsanipoor ◽  
Gabriele Saccone ◽  
Neil S. Seligman ◽  
Rebecca A.M. Pierce-Williams ◽  
Andrea Ciardulli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cesarean Delivery ◽  
Meta Analysis ◽  
Intravenous Fluid ◽  
Delivery Rate ◽  
Nulliparous Women ◽  
Cesarean Delivery Rate

343: Failed labor induction: Impact of body mass index on the cesarean delivery rate

2007 ◽  
Vol 197 (6) ◽  
pp. S104
Author(s):  
Michael Plevyak ◽  
Prasad Gawade ◽  
Glenn Markenson ◽  
Fadi Bsat ◽  
Andrew Healy
Keyword(s):  
Body Mass Index ◽  
Cesarean Delivery ◽  
Body Mass ◽  
Labor Induction ◽  
Delivery Rate ◽  
Cesarean Delivery Rate

scholarly journals 278: Maternal weight gain and cesarean delivery rate in nulliparous women with and without diabetes

2011 ◽  
Vol 204 (1) ◽  
pp. S117
Author(s):  
Yinka Oyelese ◽  
Revital Faro ◽  
Joseph Canterino ◽  
Candadai Ananth ◽  
Joaquin Santolaya-Forgas
Keyword(s):  
Weight Gain ◽  
Cesarean Delivery ◽  
Delivery Rate ◽  
Maternal Weight Gain ◽  
Maternal Weight ◽  
Nulliparous Women ◽  
Cesarean Delivery Rate

Association between Maternal Serum Hormones along the Maternal–Fetal Hypothalamic–Pituitary–Adrenal Axis and Successful Vaginal Delivery Measured Prior to Labor Induction

2020 ◽  
Vol 37 (12) ◽  
pp. 1195-1200
Author(s):  
Chase R. Cawyer ◽  
Elena Lobashevksy ◽  
Glenda Corley-Topham ◽  
Sarah Anderson ◽  
John Owen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Hpa Axis ◽  
Maternal Serum ◽  
Labor Induction ◽  
Vaginal Birth ◽  
Serum Hormones ◽  
Hypothalamic Pituitary Adrenal ◽  
Nulliparous Women

Abstract Objective This study aimed to evaluate if maternal serum hormones along the maternal–fetal hypothalamic–pituitary–adrenal (HPA) axis, when drawn prior to labor induction, differed between women who delivered vaginally and those who underwent cesarean. Study Design This was a prospective observational study at a single perinatal center performed from August 2017 to May 2018. Nulliparous women with uncomplicated singleton pregnancies ≥39 weeks had maternal serum collected prior to induction. Corticotrophin-releasing hormone (CRH) was measured by ELISA; dehydroepiandrosterone sulfate (DHEA-S), cortisol, estriol (E3) estradiol (E2), and progesterone (P4) were measured by chemiluminescent reaction. Mean analyte concentrations as well as three ratios (E2/P4, E3/P4, and E2/E3) were compared between women who had a vaginal versus cesarean delivery. Logistic regression was used to model the relationship between CRH and the odds of vaginal birth. We estimated that a sample size of 66 would have 90% power to detect a 25% difference in mean CRH levels assuming a vaginal:cesarean ratio of 2:1 with a baseline CRH concentration of 140 (standard deviation = 36) pg/mL. Results Of the 88 women who had their serum analyzed, 27 (31%) underwent cesarean. Mean maternal serum CRH levels were similar between the vaginal delivery and cesarean groups (122.6 ± 95.2 vs. 112.3 ± 142.4, p = 0.73). Similarly, there were no significant differences in any other maternal serum analytes or ratios. Logistic regression showed a nonsignificant odds ratio for successful vaginal birth (p = 0.69) even when evaluating only the 16 women who had a cesarean for an arrest disorder (p = 0.08). Conclusion In low-risk nulliparous women undergoing full-term labor induction, there were no differences noted in a broad array of other maternal-fetal HPA-axis hormones between women who had a vaginal or cesarean delivery.

Standard and adjusted criteria for the use of the misoprostol vaginal insert for labor induction: a comparative cohort study

2019 ◽  
Vol 47 (7) ◽  
pp. 750-756 ◽  
Author(s):  
Aleke Brandstetter ◽  
Moritz Döbert ◽  
Peter Schwaerzler ◽  
Timm Fabian Döbert ◽  
Hendrik Hasselbeck ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cesarean Delivery ◽  
Statistical Significance ◽  
Labor Induction ◽  
Delivery Rate ◽  
Consecutive Series ◽  
Academic Center ◽  
Significant Difference ◽  
Comparative Cohort Study ◽  
Cesarean Delivery Rate

Abstract Objective To compare the efficacy of misoprostol vaginal insert (MVI) for labor induction using standard and adjusted criteria. Methods A single-center, comparative cohort study using a consecutive series of pregnant women ≥37/0 weeks undergoing labor induction with either standard criteria for MVI (administration for up to 24 h; MVI-24) or with adjusted criteria (MVI administration for a maximum of 10 h; MVI-10) conducted at a tertiary academic center in Germany. The primary outcomes were the time from start of induction to any delivery and cesarean delivery rate. Results A total of 138 women were included in the study, 69 in each group. The mean time from MVI administration to any delivery showed no significant difference between the MVI-24 and MVI-10 groups (954 vs. 969 min, respectively; P = 0.679). The cesarean delivery rate was proportionally lower for the MVI-10 group [39.1% (27/69) vs. 24.6% (17/69); P = 0.10]. Conclusion The time from induction to delivery with MVI was similar when using standard criteria of up to 24 h of exposure vs. adjusted criteria of up to 10 h of exposure. Although the threshold for statistical significance for cesarean section was not attained, there is nonetheless a considerable difference between the MVI-24 and MVI-10 groups.

Term Labor Induction and Cesarean Delivery Risk among Obese Women with and without Comorbidities

2020 ◽  
Author(s):  
Kimberly B. Glazer ◽  
Valery A. Danilack ◽  
Alison E. Field ◽  
Erika F. Werner ◽  
David A. Savitz
Keyword(s):  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Maternal Age ◽  
Expectant Management ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Low Risk ◽  
Obese Women ◽  
Adjusted Risk ◽  
Nulliparous Women

Objective Findings of the recent ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial, showing reduced cesarean risk with elective labor induction among low-risk nulliparous women at 39 weeks' gestation, have the potential to change interventional delivery practices but require examination in wider populations. The aim of this study was to identify whether term induction of labor was associated with reduced cesarean delivery risk among women with obesity, evaluating several maternal characteristics associated with obesity, induction, and cesarean risk. Study Design We studied administrative records for 66,280 singleton, term births to women with a body mass index ≥30, without a prior cesarean delivery, in New York City from 2008 to 2013. We examined elective inductions in 39 and 40 weeks' gestation and calculated adjusted risk ratios for cesarean delivery risk, stratified by parity and maternal age. We additionally evaluated medically indicated inductions at 37 to 40 weeks among women with obesity and diabetic or hypertensive disorders, comorbidities that are strongly associated with obesity. Results Elective induction of labor was associated with a 25% (95% confidence interval: 19–30%) lower adjusted risk of cesarean delivery as compared with expectant management at 39 weeks of gestation and no change in risk at 40 weeks. Patterns were similar when stratified by parity and maternal age. Risk reductions in week 39 were largest among women with a prior vaginal delivery. Women with comorbidities had reduced cesarean risk with early term induction and in 39 weeks. Conclusion Labor induction at 39 weeks was consistently associated with reduced risk of cesarean delivery among women with obesity regardless of parity, age, or comorbidity status. Cesarean delivery findings from induction trials at 39 weeks among low-risk nulliparous women may generalize more broadly across the U.S. obstetric population, with potentially larger benefit among women with a prior vaginal delivery. Key Points

Quantifying the Risks and Benefits of Continuing Labor Induction: Data for Shared Decision-Making

2020 ◽  
Author(s):  
Elizabeth Nicole Teal ◽  
Adam K. Lewkowitz ◽  
Sarah L. P. Koser ◽  
Carol B. N. Tran ◽  
Stephanie L. Gaw
Keyword(s):  
Decision Making ◽  
Cesarean Delivery ◽  
Shared Decision Making ◽  
Vaginal Delivery ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Neonatal Morbidity ◽  
Labor Induction ◽  
Shared Decision ◽  
Risks And Benefits

Abstract Objective To quantify the relative maternal and fetal risks and benefits of continuing labor induction. Study Design This retrospective cohort study included nulliparous women with nonanomalous, singleton, vertex, term pregnancies undergoing labor induction with intact membranes at a tertiary-care academic hospital from January 2015 to April 2017. The primary outcome was mode of delivery. Secondary outcomes included hemorrhage, transfusion, infection, and composite neonatal morbidity. The data were analyzed using chi-square and Fisher's exact tests. Multivariable regression was used to control for potential confounders. Results A total of 955 patients met the inclusion criteria. The median induction duration was 32.3 hours (interquartile range: 20.4–41 hours) and the vaginal delivery rate was 70.5% (n = 673). The chance of vaginal delivery at 12, 24, 36, 48, 60, and ≥60 hours was 76, 83, 77, 74, 72, and 48%, respectively. After controlling for confounders, there was a 20% decrease in chance of vaginal delivery with induction ≥ 24 hours compared with induction < 24 hours. The adjusted relative risks of hemorrhage, transfusion, and infection with induction ≥ 24 hours compared with induction < 24 hours were 1.9, 2.2, and 2.7, respectively (95% confidence interval [CI] of 1.4–2.5, 1.1–3.9, and 1.8–4.0, respectively). The relative risk for these outcomes remained stable or decreased at each subsequent time point. The increasing risks of hemorrhage and infection were primarily among patients who underwent cesarean delivery. There was no association between induction duration and neonatal morbidity. Conclusion In this cohort, the chance of vaginal delivery remained nearly 50% even when induction extended beyond 60 hours. Risks of hemorrhage and maternal infection rose modestly over time, but primarily in patients who underwent cesarean delivery. There was no difference in the risk of transfusion beyond 24 hours and no association between induction duration and neonatal morbidity. These findings may be useful when engaging patients in shared decision-making during labor induction.

The active management of risk in multiparous women at term: An association between a higher preventive labor induction rate and a lower cesarean delivery rate

2006 ◽  
Vol 195 (6) ◽  
pp. S99 ◽  
Author(s):  
James Nicholson ◽  
Aaron Caughey ◽  
Morghan Stenson ◽  
Lisa Kellar ◽  
Peter Cronholm ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Labor Induction ◽  
Active Management ◽  
Delivery Rate ◽  
Induction Rate ◽  
Multiparous Women ◽  
Cesarean Delivery Rate ◽  
Management Of Risk

High dose vs. low dose oxytocin for labor augmentation: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Rehab Abdelhamid Aboshama ◽  
Ahmed Mohamed Abdelhakim ◽  
Mohammad Abrar Shareef ◽  
Abdulhadi A. AlAmodi ◽  
Mohammad Sunoqrot ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Low Dose ◽  
Delivery Rate ◽  
Cochrane Library ◽  
High Dose ◽  
Safety And Efficacy ◽  
Labor Duration ◽  
Uterine Hyperstimulation ◽  
Cesarean Delivery Rate ◽  
Labor Augmentation

AbstractObjectivesTo compare the safety and efficacy between high dose and low dose oxytocin administration for labor augmentation.MethodsWe searched for the available studies during March 2020 in PubMed, Cochrane Library, Scopus, and ISI Web of science. All randomized clinical trials (RCTs) that assessed safety and efficacy of high dose vs. low dose oxytocin for labor augmentation were considered. The extracted data were entered into RevMan software. Dichotomous and continuous data were pooled as odds ratio (OR) and mean difference (MD) respectively, with the corresponding 95% confidence intervals (CI). Our main outcomes were cesarean delivery rate, spontaneous vaginal delivery rate, uterine hyperstimulation and tachysystole, and labor duration from oxytocin infusion.ResultsEight RCTs with 3,154 patients were included. High dose oxytocin did not reduce cesarean delivery rate compared to low dose oxytocin (OR=0.76, 95% CI [0.52, 1.10], p=0.15). After solving the reported heterogeneity, high dose oxytocin did not increase the rate of spontaneous vaginal deliveries vs. low dose oxytocin (OR=1.06, 95% CI [0.84, 1.32], p=0.64). Low dose oxytocin was linked to a significant decline in uterine hyperstimulation and tachysystole (p>0.001). A reduction in labor duration was found in high dose oxytocin group over low oxytocin regimen (MD=−1.02 h, 95% CI [−1.77, −0.27], p=0.008).ConclusionsWe found no advantages for high dose oxytocin over low dose oxytocin in labor augmentation except in reducing labor duration. Low dose oxytocin is safer as it decreases the incidence of uterine hyperstimulation and tachysystole. More trials are needed to confirm our findings.

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