Induction of labor in patients with an unfavorable cervix after a cesarean using an osmotic dilator versus vaginal prostaglandin

2018 ◽  
Vol 46 (3) ◽  
pp. 299-307 ◽  
Author(s):  
Josefine T. Maier ◽  
Melanie Metz ◽  
Nina Watermann ◽  
Linna Li ◽  
Elisabeth Schalinski ◽  
...  
Keyword(s):  
Birth Rate ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Exact Test ◽  
Safe Delivery ◽  
Trial Of Labor ◽  
Increased Risk ◽  
Chi Squared ◽  
Maternal And Neonatal Outcomes ◽  
Unfavorable Cervix

Abstract Background: Trial of labor after cesarean (TOLAC) is a viable option for safe delivery. In some cases cervical ripening and subsequent labor induction is necessary. However, the commonly used prostaglandins are not licensed in this subgroup of patients and are associated with an increased risk of uterine rupture. Methods: This cohort study compares maternal and neonatal outcomes of TOLAC in women (n=82) requiring cervical ripening agents (osmotic dilator vs. prostaglandins). The initial Bishop scores (BSs) were 2 (0–5) and 3 (0–5) (osmotic dilator and prostaglandin group, respectively). In this retrospective analysis, Fisher’s exact test, the Kruskal-Wallis rank sum test and Pearson’s chi-squared test were utilized. Results: Vaginal birth rate (including operative delivery) was 55% (18/33) in the osmotic dilator group vs. 51% (25/49) in the dinoprostone group (P 0.886). Between 97% and 92% (32/33 and 45/49) (100%, 100%) of neonates had an Apgar score of >8 after 1 min (5, 10 min, respectively). The time between administration of the agent and onset of labor was 36 and 17.1 h (mean, Dilapan-S® group, dinoprostone group, respectively). Time from onset of labor to delivery was similar in both groups with 4.4 and 4.9 h (mean, Dilapan-S® group, dinoprostone group, respectively). Patients receiving cervical ripening with Dilapan-S® required oxytocin in 97% (32/33) of cases. Some patients presented with spontaneous onset of labor, mostly in the dinoprostone group (24/49, 49%). Amniotomy was performed in 64% and 49% (21/33 and 24/49) of cases (Dilapan-S® group and dinoprostone group, respectively). Conclusions: This pilot study examines the application of an osmotic dilator for cervical ripening to promote vaginal delivery in women who previously delivered via cesarean section. In our experience, the osmotic dilator gives obstetricians a chance to perform induction of labor in these women.

Chorioamnionitis after premature rupture of membranes in nulliparas undergoing labor induction: prostaglandin E2 vs. oxytocin

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Moti Gulersen ◽  
Cristina Zottola ◽  
Xueying Li ◽  
David Krantz ◽  
Mariella DiSturco ◽  
...  
Keyword(s):  
Prostaglandin E2 ◽  
Neonatal Intensive Care ◽  
Labor Induction ◽  
Cervical Ripening ◽  
Time Interval ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Chi Squared ◽  
Unfavorable Cervix ◽  
Cox Proportional Hazard Regression

Abstract Objectives To assess the risk of chorioamnionitis in nulliparous, term, singleton, vertex (NTSV) pregnancies with premature rupture of membranes (PROM) and an unfavorable cervix undergoing labor induction with either prostaglandin E2 (PGE2) or oxytocin only. Methods Retrospective cohort of NTSV pregnancies presenting with PROM who underwent labor induction with either PGE2 (n=94) or oxytocin (n=181) between October 2015 and March 2019. The primary outcome of chorioamnionitis was compared between the two groups. Statistical analysis included Chi-squared and Wilcoxon rank-sum tests, as well as logistic regression. For time to delivery, a Cox proportional hazard regression was used to determine the hazard ratio (HR) and adjusted HR (aHR). Results Baseline characteristics were similar between the two groups. Cervical ripening with PGE2 was associated with an increased rate of chorioamnionitis (18.1 vs. 6.1%; aOR 4.14, p=0.001), increased neonatal intensive care unit admissions (20.2 vs. 9.9%; aOR 2.4, p=0.02), longer time interval from PROM to delivery (24.4 vs. 17.9 h; aHR 0.56, p=<0.0001), and lower incidence of meconium (7.4 vs. 14.4%; aOR 0.26, p=0.01), compared to the oxytocin group. Conclusions Based on our data, the use of oxytocin appears both superior and safer compared to PGE2 in NTSV pregnancies with PROM undergoing labor induction.

scholarly journals Vaginal Progesterone Has No Diabetogenic Potential in Twin Pregnancies: A Retrospective Case-Control Study on 1686 Pregnancies

2020 ◽  
Vol 9 (7) ◽  
pp. 2249
Author(s):  
Klara Rosta ◽  
Katharina Al-Bibawy ◽  
Maria Al-Bibawy ◽  
Wilhelm Temsch ◽  
Stephanie Springer ◽  
...  
Keyword(s):  
Binary Logistic Regression ◽  
Control Group ◽  
Retrospective Case ◽  
Smoking During Pregnancy ◽  
Exact Test ◽  
Vaginal Progesterone ◽  
Increased Risk ◽  
Chi Squared ◽  
Student’S T ◽  
Twin Pregnancies

Background: In this study, we aimed to investigate the incidence of gestational diabetes mellitus (GDM) in women who carried twin pregnancies and received vaginal progesterone. Methods: In this retrospective cohort study, 203 out of 1686 women with twin pregnancies received natural progesterone (200 mg/day between gestational weeks 16 + 0 and 36 + 0) vaginally for ≥ 4 weeks. The control group consisted of 1483 women with twin pregnancies without progesterone administration. Pearson’s Chi squared test, Fisher’s exact test, and Student’s t-test was used to compare differences between the control and the progesterone-treated groups. A multivariate binary logistic regression was performed to assess relative independent associations on the dependent outcome of GDM incidence. Results: Vaginal progesterone treatment in twin pregnancies had no significant influence on developing GDM (p = 0.662). Higher pre-pregnancy BMI (OR 1.1; p < 0.001), GDM in previous pregnancy (OR 6.0; p < 0.001), and smoking during pregnancy (OR 1.6; p = 0.014) posed an increased risk for developing GDM. Conclusion: In twin pregnancies, the use of vaginal progesterone for the prevention of recurrent preterm delivery was not associated with an increased risk of GDM.

scholarly journals Is Foley Catheter Use during a Trial of Labor after Cesarean Associated with Uterine Rupture?

2019 ◽  
Vol 36 (14) ◽  
pp. 1431-1436
Author(s):  
Jennifer L. Katz Eriksen ◽  
Suchitra Chandrasekaran ◽  
Shani S. Delaney
Keyword(s):  
Uterine Rupture ◽  
Multinomial Logistic Regression ◽  
Foley Catheter ◽  
Secondary Analysis ◽  
Cervical Ripening ◽  
Trial Of Labor ◽  
Increased Risk ◽  
History Of ◽  
Observational Cohort ◽  
Uterine Scar

Objective We sought to assess the safety of transcervical Foley catheter (TCF) placement for cervical ripening in women undergoing induction of labor (IOL) after prior cesarean by evaluating the risk of uterine rupture. Study Design We performed a secondary analysis of the Maternal-Fetal Medicine Unit's Cesarean Section Registry, a prospective observational cohort study. We included women with a history of ≤2 low-transverse cesarean deliveries who underwent IOL at ≥24 weeks of gestational age with a live singleton fetus without major anomalies. We excluded those who received prostaglandins or laminaria. We performed multinomial logistic regression to calculate adjusted odds ratios (aORs) for uterine rupture and dehiscence. Relevant confounders included prior vaginal delivery, pregnancy-induced hypertension, chorioamnionitis, and cervical effacement and dilation on admission. Results A total of 2,564 women were eligible. Unadjusted analysis demonstrated no increased risk of uterine rupture with TCF (1.9 vs. 0.9%; p = 0.10) but an increased risk of uterine dehiscence (1.9 vs. 0.6%; p = 0.02). After adjustment, TCF was not associated with an increased risk of uterine rupture (aOR: 2.02; 95% confidence interval [CI]: 0.71–5.78) or uterine scar dehiscence (aOR: 1.32; 95% CI: 0.37–4.72). Conclusion Foley catheter is a safe tool for mechanical dilation in women undergoing IOL after prior cesarean.

scholarly journals The Relationship Between COVID-19-induced Death and Chronic Diseases

2021 ◽  
Vol 7 (3) ◽  
pp. 167-174
Author(s):  
Hasan Alinejad ◽  
◽  
Reza Vazirinejad ◽  
Ahmadreza Sayadi ◽  
Zeinab Hajaliakbari ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Multivariate Regression Analysis ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Exact Test ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Chi Squared ◽  
The Relationship

Background: Morbidity and mortality due to Coronavirus Disease 2019 (COVID-19) are mainly related to age and comorbidity diseases (hypertension, diabetes, cardiovascular disease, malignancies, etc.). These conditions are associated with poorer clinical outcomes and sometimes lead to long-term hospitalization. The current study aimed to investigate the relationship between COVID-19-induced mortality and various chronic diseases in patients admitted to Ali Ibn Abitaleb Hospital in Rafsanjan City, Iran, in 2020. Methods: In this retrospective, descriptive, and cross-sectional study, patients with COVID-19 referring to Ali Ibn Abitaleb Hospital in Rafsanjan City, Iran, from March 2020 to September 2020 were assessed. The required data were collected using patients’ records and telephone calls by a researcher-made checklist and analyzed by Independent Samples t-test, Chi-squared test, Fisher’s Exact test, Kaplan-Meier plots, and multivariate regression analysis in SPSS v. 20. Results: This study assessed 238 hospitalized patients with COVID-19. The risk of death was significantly higher in patients aged over 75 years; they were 5.5 times more prone to expire, compared to the youngest age group (P<0.001). Chronic diseases, such as hypertension, heart disease, lung disease, and various cancers were more prevalent in patients who expired, compared to those who survived (P≤0.05). Of the patients who died, 73.8% were transferred to the Intensive U (ICU), while only 7.5% of surviving patients were transferred to the ICU (P<0.001). Longer hospitalization was associated with an increased risk of death among patients with underlying diseases and hypertension (P<0.05). Conclusion: This study identified the role of chronic diseases and other important indicators in the survival of patients with COVID-19 who were admitted to a hospital in Rafsanjan. It is recommended that nurses and healthcare staff consider these findings in the care of patients with COVID-19.

Development of cavitation while on bevacizumab (BV) therapy in patients (pts) with non-small cell lung cancer (NSCLC): Results from ARIES—A bevacizumab (BV) treatment observational cohort study (OCS)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19045-e19045
Author(s):  
M. P. Kosty ◽  
P. Kumar ◽  
A. Wozniak ◽  
M. Jahanzeb ◽  
C. Chung ◽  
...  
Keyword(s):  
Pulmonary Hemorrhage ◽  
Final Analysis ◽  
Prior History ◽  
Exact Test ◽  
Increased Risk ◽  
Chi Squared ◽  
Potential Risk Factors ◽  
Independent Review ◽  
History Of ◽  
Grade 3

e19045 Background: BV (Avastin), an anti-VEGF monoclonal antibody, prolongs progression-free and overall survival in advanced NSCLC pts. Severe (≥grade 3) pulmonary hemorrhage (sPH) is a rare but serious event that has been associated with BV-based therapy in phase 3 trials (rate of 2–4%). Potential risk factors include squamous histology, prior history of hemoptysis, and presence of tumor cavitation. Rates of baseline (BL) cavitation in NSCLC pts and development of cavitation on BV therapy are unknown. Pts in ARIES, an OCS of approximately 2,000 pts with NSCLC, had BL scans assessed for tumor cavitation. A substudy of approximately 250 pts also had follow-up scans to analyze the likelihood of developing cavitation on BV therapy. For the entire ARIES population, any pt developing sPH is assessed for tumor cavitation. Methods: Pts at specified ARIES sites submitted on-treatment CT scans to an independent review facility (IRF), in addition to BL scans. Evaluable pts had measurable disease at BL and at least one-post-BL scan. Correlations between cavitation (pre-existing or developing on-study) and clinical, tumor and treatment characteristics are evaluated using a chi-squared test or t-test. Incidence of sPH based on cavitation status will be assessed using Fisher's exact test. Results: As of 9/15/08, 210 pts had a post-BL CT scan reviewed by the IRF. Of these pts, 171 had measurable tumors at BL. For the 171 pt cohort: median F/U is 9.2 m; 99% have ≥1 quarterly update. Key BL characteristics for the substudy and overall cohorts, respectively, include: 44% vs 51% ≥65 yrs; 67% vs 67% adenocarcinoma; 6% vs 5% therapeutic AC. BL radiographic features: 41% vs 39% presence of central tumor; 13% vs 15% presence of cavitation. In substudy pts, there is 1 sPH to date in a pt without baseline cavitation. Conclusions: sPH is a rare, potentially serious event in pts with NSCLC receiving BV. Whether cavitation (BL or developing on-treatment) is associated with an increased risk of sPH has not been defined. The final analysis of an ARIES Lung substudy assessing on-study development of cavitation and association with sPH will be presented at the meeting. [Table: see text]

Micropapillary Thyroid Carcinoma and Hashimoto's Thyroiditis

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P40-P40
Author(s):  
Michael Navid Pakdaman ◽  
Michael P Hier ◽  
Martin J Black ◽  
Michael Tamilia ◽  
Richard J Payne
Keyword(s):  
Thyroid Carcinoma ◽  
Hashimoto’S Thyroiditis ◽  
Statistical Significance ◽  
Hashimoto's Thyroiditis ◽  
P Value ◽  
Exact Test ◽  
Increased Risk ◽  
Chi Squared ◽  
Pathology Reports ◽  
The Relationship

Objective An increase in papillary thyroid carcinoma in patients with Hashimoto's thyroiditis has been described. We have yet to find literature discussing a relationship with micropapillary thyroid carcinoma(MPC). Our objective is (1) to assess the relationship between Papillary Microcarcinoma and Hashimoto's Thyroiditis in thyroids without malignant disease, (2) compare effect of the presence of Hashimoto's on prognostic factors in patients. Methods Pathology reports were reviewed for consecutive patients undergoing total thyroidectomy over a 6-year period from 2002 to 2007. Patients with benign pathologies were included. Patients with MPC and no other malignancy were also included. This lead to a cohort of 314 patients. Statistical significance was calculated using Fisher's exact test and a chi-squared analysis. Results Out of the 314 patients, 98 were positive for Hashimoto's thyroiditis on biopsy of the removed thyroid. 58% of the patients with Hashimoto's thyroiditis had an incidental MPC, as compared to 42% of patients where Hashimoto's was not found. Additionally, in Hashimoto patients, 61% of the MPCs were multifocal versus 43% multifocal in the non-Hashimoto group (p-value <0.05 in each comparison). Bilaterality of MPC was also increased in patients with Hashimoto's (22% vs 39%). Conclusions Patients with Hashimoto's thyroiditis in this study had an incidence of MPC of 58%, which is significantly greater than the 42% in those without. Hashimoto's was also associated with an increased risk of bilaterality and multifocality. Studies are needed to further corroborate these findings.

Wheezing during Induction of General Anesthesia in Patients with and without Asthma 

1995 ◽  
Vol 82 (5) ◽  
pp. 1111-1116 ◽  
Author(s):  
Reuven Pizov ◽  
Robert H. Brown ◽  
Yuval S. Weiss ◽  
Dimitry Baranov ◽  
Hans Hennes ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
General Anesthesia ◽  
Physical Status ◽  
Inhalational Anesthesia ◽  
Exact Test ◽  
Asthmatic Patients ◽  
Anesthetic Agents ◽  
Increased Risk ◽  
Chi Squared ◽  
Double Blinded

Background Patients with asthma who require general anesthesia and tracheal intubation are at increased risk for the development of bronchospasm during induction. The incidence of wheezing during induction with different intravenously administered agents is unknown. A randomized, double-blinded prospective study was undertaken to evaluate the incidence of wheezing in asymptomatic asthmatic and nonasthmatic patients receiving three commonly used intravenous anesthetic agents for induction of anesthesia. Methods Fifty-nine asymptomatic asthmatic and 96 nonasthmatic patients of ASA physical status 1 and 2 were studied. All patients received 1.5 micrograms/kg fentanyl, oxygen, followed by either 5 mg/kg thiopental or thiamylal, 1.75 mg/kg methohexital or 2.5 mg/kg propofol, 1.5 mg/kg succinylcholine, tracheal intubation, and inhalational anesthesia. Wheezing was assessed by an independent blinded observer, auscultating the lungs at 2 and 5 min postintubation. Data were analyzed by Pearson's chi-squared, Fisher's exact test, and multiple logistic regression with significance set at P &lt; 0.05. Results Both asthmatic and nonasthmatic patients who received a thiobarbiturate for induction had a greater incidence of wheezing than did patients receiving propofol. In asthmatic patients, 45% (23, 67) (mean and 95% confidence interval) who received a thiobarbiturate, 26% (8, 44) who received an oxybarbiturate, and none (0, 17) who received propofol wheezed after intubation. In nonasthmatic patients, 16% (3, 28) who received thiobarbiturate and 3% (0, 9) who received propofol wheezed. Conclusions This study suggests that propofol should be considered for induction of anesthesia in patients, particularly those with asthma, who require timely intubation.

scholarly journals A Retrospective Study Assessing the Effect of Infections in Myocardial Infarction Patients: Mortality and Complications

2022 ◽  
Author(s):  
Antoine El Khoury ◽  
Pascale Salameh ◽  
Sarah Hammoudeh ◽  
Ahmad El Mahmoud ◽  
Tonia Harb ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Escherichia Coli ◽  
Length Of Stay ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Concomitant Infection ◽  
Increased Risk ◽  
Chi Squared ◽  
Established Relationship ◽  
Dichotomous Outcomes

Abstract Background: There is a well-established relationship between myocardial infarction and infection. Multiple articles describe the increased risk of myocardial infarction, both type 1 and 2, following an infectious process. However few articles have described the relation between concomitant myocardial infarction and infections on same admission mortality and complications. Methods: The aim is to assess the effect of an acquired or concomitant infection on complications and mortality during hospitalized cases of myocardial infarction. 1197 patients of different types of myocardial infarction were studied in correlation to infectious processes. Cultures from different sites were collected and isolation of various bacterial agents were studied. Mortality and various complications were compared between infected and non-infected subjects. Pearson's chi squared test was used to compare percentages (or the Fisher exact test when expected values were lower than 5). Moreover, means were compared through ANOVA, after checking data normality and homoscedasticity. A likelihood ratio backward stepwise method was used to conduct dichotomous logistic regressions, taking dichotomous outcomes as dependent variables, and sociodemographic and biological characteristics as independent variables (potential confounders).Results: Wound, sputum, blood and urine infections were associated with increased same admission mortality and complications. Microorganisms were then studied alone regardless of the site of infection and it was shown that Escherichia Coli, Escherichia Coli ESBL, Candida Albicans, Pseudomonas Aeruginosa and Staphylococcus of any type were significantly associated with same admission complications when associated with myocardial infarction. Length of stay was significantly elevated in patients with concomitant infection and it increased with the addition of positive cultures from different sites. Conclusion: Concomitant infections with myocardial infarction significantly increase the risk of same admission complications, mortality and length of stay regardless of the site of infection and type of microorganisms.

Integrin subunit β1 and laminin γ1 chain expression: a potential prognostic biomarker in cervical cancer

2020 ◽  
Vol 14 (15) ◽  
pp. 1461-1471
Author(s):  
Ana E Zacapala-Gómez ◽  
Luz del C Alarcón-Romero ◽  
Miguel A Mendoza-Catalán ◽  
Eric G Salmerón-Bárcenas ◽  
Ma I Zubillaga-Guerrero ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Odds Ratio ◽  
Prognostic Value ◽  
Prognostic Biomarker ◽  
Integrin Subunit ◽  
Cytological Diagnosis ◽  
Exact Test ◽  
Increased Risk ◽  
Chi Squared

Aim: The aim of this study was to analyze the prognostic value of integrin subunit β1 and laminin γ1 chain in patients with cervical cancer (CC). Materials & methods: The study included 96 samples. Cytological diagnosis, human papillomavirus (HPV) genotyping, HPV integration status and integrin subunit β1 and laminin γ1 chain expressions were performed or determined using Papanicolaou smear, INNO-LiPA® Genotyping Extra Kit, in situ hybridization, and immunocytochemistry, respectively. The association between variables was calculated using chi-squared and Fisher’s exact test; logistic regression analysis was performed to calculate odds ratios and CI at 95%. Results: Our results show that integrin subunit β1 and laminin γ1 chain expressions increase according to tumor progression. Integrin subunit β1 and laminin γ1 chain expressions are associated with cytological diagnosis (p < 0.001 and p = 0.001, respectively) and laminin γ1 chain expression with the integration status of HPV (p < 0.001). Moderate/high expressions of integrin subunit β1 and laminin γ1 chain were correlated with overall survival and increased risk of CC (6.86 and 3.75, respectively), the odds ratio was 12.91 when the moderate/high expression of integrin subunit β1 and laminin γ1 chain were combined. Conclusion: Our results suggest that integrin subunit β1 and laminin γ1 chain expressions could be a prognostic biomarker in CC.

scholarly journals Vaginal administration of isosorbide mononitrate for cervical ripening prior to induction of labor for postdated pregnancy: a randomized controlled trial

2018 ◽  
Vol 1 (1) ◽  
pp. 51-58
Author(s):  
Rubina Rai ◽  
P Basnet ◽  
A Thakur ◽  
T Pradhan
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Controlled Trial ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Isosorbide Mononitrate ◽  
Oral Misoprostol ◽  
Significant Difference ◽  
Unfavorable Cervix

 Introduction: Induction of labor is commonly practiced intervention in modern Obstetrics. The aim of induction of labor is to initiate labor when maternal and fetal conditions necessitate delivery before the onset of spontaneous contraction with purpose to achieve safe vaginal delivery. Induction of labor is one of the most commonly practiced interventions in the Department of Obstetrics and Gynecology every day. The success of this obstetric practice is highly dependent upon the condition of the cervix which is assessed with Bishop‟s Score and it is well known that unfavorable cervix is associated with failure of induction and cesarean section. In the recent years, there has been a considerable interest in the use of nitrous oxide donors for cervical ripening and labor induction.Objective: To evaluate whether isosorbide mononitrate administered vaginally prior to induction in postdated pregnancy is effective for pre-induction cervical ripening and thus, improves the process of induction of labor.Methods: One hundred and twenty women scheduled for labor induction were recruited and assigned randomly to isosorbide mononitrate or placebo followed by misoprostol 25μg. The efficacy of the medication was evaluated by predetermined outcome variables for cervical ripening and induction of labor and delivery.Results: The groups were comparable with respect to age, gestational age and Bishop‟s score. Women receiving isosorbide with misoprostol didn‟t show any improvement in the Bishop‟s score compared to misoprostol and placebo. There was no significant difference between the two groups regarding time of delivery and onset of active stage of labor from induction. Cesarean delivery rates were similar between the two groups; however, the indications of the cesarean section were different between the two groups which were significant statistically. Neonatal outcome were similar between the two groups.Conclusion: The addition of vaginal isosorbide mononitrate to oral misoprostol for cervical ripening and labor induction did not reduce time to vaginal delivery and didn‟t help in improving pre-induction cervical score.Journal of BP Koirala Institute of Health Sciences, Vol. 1, No. 1, 2018, page: 51-58

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