High Dose and Low Dose Oxytocin Regimens as Determinants of Successful Labor Induction: A multicenter comparative study

Abstract Background: Induction of labor by Oxytocin is a routine obstetric procedure. However, little is known regarding the optimal dose of oxytocin so as to bring successful induction. This study was aimed at comparing the effects of high dose versus low dose oxytocin regimens on success of induction. Methods: Hospital-based comparative cross-sectional study was conducted in four selected hospitals in Ethiopia from October 1, 2017 to May 30, 2018. A total of 216 pregnant women who undergo induction of labor at gestational age of 37 weeks and above were included. Data were entered into Epi-data version 3.1 and then exported to SPSS version 20 for cleaning and analysis. Chi-square test and logistic regression were done to look for determinants of successful induction. The result was presented using 95% confidence interval of crude and adjusted odds ratios. P-value < 0.05 was used to declare statistical significance. Result: The mean “Induction to delivery time” was 5.9 hours and 6.3 hours for participants who received high dose Oxytocin and low dose Oxytocin respectively. Higher successful induction (72.2% versus 61.1%) and lower Cesarean Section rate (27.8% vs. 38.9) were observed among participants who received low dose Oxytocin compared to high dose. Favourable bishop score [AOR 4.0 95% CI 1.9, 8.5], elective induction [AOR 0.2 95% CI 0.1, 0.4], performing artificial rupture of membrane [AOR 10.1 95% CI 3.2, 32.2], neonatal birth weight of < 4Kg [AOR 4.3, 95% CI 1.6, 11.6] and being parous [AOR 2.1 95% CI 1.1, 4.0] were significantly associated with success of induction. Conclusions: In this study, Different oxytocin regimens didn’t show significant association with success of induction. But, high dose oxytocin regimen was significantly associated with slightly shorter induction to delivery time. Favourable bishop score, emergency induction, performing artificial rupture of membrane and delivery to non-macrosomic fetuses were positive determinants of successful induction.We recommend researchers to conduct multicenter research on a large number of patients that controls confounders to see the real effects of different oxytocin regimens on success of labor induction.

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High Dose and Low Dose Oxytocin Regimens as Determinants of Successful Labor Induction: A multicenter comparative study

10.21203/rs.2.17285/v4 ◽

2020 ◽

Author(s):

MELESE GEZAHEGN TESEMMA ◽

Demisew Amenu Sori ◽

Desta Hiko Gemeda

Keyword(s):

Low Dose ◽

Statistical Significance ◽

Labor Induction ◽

Induction Of Labor ◽

P Value ◽

High Dose ◽

Bishop Score ◽

Delivery Time ◽

Number Of Patients ◽

Successful Induction

Abstract Background: Induction of labor by Oxytocin is a routine obstetric procedure. However, little is known regarding the optimal dose of oxytocin so as to bring successful induction. This study was aimed at comparing the effects of high dose versus low dose oxytocin regimens on success of labor induction. Methods: Hospital-based comparative cross-sectional study was conducted in four selected hospitals in Ethiopia prospectively from October 1, 2017 to May 30, 2018. A total of 216 pregnant women who undergo induction of labor at gestational age of 37 weeks and above were included. Data were entered into Epi-data version 3.1 and then exported to SPSS version 20 for cleaning and analysis. Chi-square test and logistic regression were done to look for determinants of successful induction. The result was presented using 95% confidence interval of crude and adjusted odds ratios. P-value < 0.05 was used to declare statistical significance. Result: The mean “Induction to delivery time” was 5.9 hours and 6.3 hours for participants who received high dose Oxytocin and low dose Oxytocin respectively. Higher successful induction (72.2% versus 61.1%) and lower Cesarean Section rate (27.8% vs. 38.9) were observed among participants who received low dose Oxytocin compared to high dose. Favourable bishop score [AOR 4.0 95% CI 1.9, 8.5], elective induction [AOR 0.2 95% CI 0.1, 0.4], performing artificial rupture of membrane [AOR 10.1 95% CI 3.2, 32.2], neonatal birth weight of < 4Kg [AOR 4.3, 95% CI 1.6, 11.6] and being parous [AOR 2.1 95% CI 1.1, 4.0] were significantly associated with success of induction. Conclusions: In this study, Different oxytocin regimens didn’t show significant association with success of induction. But, high dose oxytocin regimen was significantly associated with slightly shorter induction to delivery time. Favourable bishop score, emergency induction, performing artificial rupture of membrane and delivery to non-macrosomic fetuses were positive determinants of successful induction. We recommend researchers to conduct multicenter research on a large number of patients that controls confounders to see the real effects of different oxytocin regimens on success of labor induction.

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High Dose and Low Dose Oxytocin Regimens as Determinants of Successful Labor Induction: A multicenter comparative study

10.21203/rs.2.17285/v5 ◽

2020 ◽

Author(s):

MELESE GEZAHEGN TESEMMA ◽

Demisew Amenu Sori ◽

Desta Hiko Gemeda

Keyword(s):

Low Dose ◽

Statistical Significance ◽

Labor Induction ◽

Induction Of Labor ◽

P Value ◽

High Dose ◽

Bishop Score ◽

Delivery Time ◽

Number Of Patients ◽

Successful Induction

Abstract Background: Induction of labor by Oxytocin is a routine obstetric procedure. However, little is known regarding the optimal dose of oxytocin so as to bring successful induction. This study was aimed at comparing the effects of high dose versus low dose oxytocin regimens on success of labor induction.Methods: Hospital-based comparative cross-sectional study was conducted in four selected hospitals in Ethiopia prospectively from October 1, 2017 to May 30, 2018. A total of 216 pregnant women who undergo induction of labor at gestational age of 37 weeks and above were included. Data were entered into Epi-data version 3.1 and then exported to SPSS version 20 for cleaning and analysis. Chi-square test and logistic regression were done to look for determinants of successful induction. The result was presented using 95% confidence interval of crude and adjusted odds ratios. P-value < 0.05 was used to declare statistical significance. Result: The mean “Induction to delivery time” was 5.9 hours and 6.3 hours for participants who received high dose Oxytocin and low dose Oxytocin respectively. Higher successful induction (72.2% versus 61.1%) and lower Cesarean Section rate (27.8% vs. 38.9) were observed among participants who received low dose Oxytocin compared to high dose. Favourable bishop score [AOR 4.0 95% CI 1.9, 8.5], elective induction [AOR 0.2 95% CI 0.1, 0.4], performing artificial rupture of membrane [AOR 10.1 95% CI 3.2, 32.2], neonatal birth weight of < 4Kg [AOR 4.3, 95% CI 1.6, 11.6] and being parous [AOR 2.1 95% CI 1.1, 4.0] were significantly associated with success of induction. Conclusions: In this study, Different oxytocin regimens didn’t show significant association with success of induction. But, high dose oxytocin regimen was significantly associated with slightly shorter induction to delivery time. Favourable bishop score, emergency induction, performing artificial rupture of membrane and delivery to non-macrosomic fetuses were positive determinants of successful induction. We recommend researchers to conduct multicenter research on a large number of patients that controls confounders to see the real effects of different oxytocin regimens on success of labor induction.

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High Dose and Low Dose Oxytocin Regimens as Determinants of Successful Labor Induction: A multicenter comparative study

10.21203/rs.2.17285/v3 ◽

2020 ◽

Author(s):

MELESE GEZAHEGN TESEMMA ◽

Demisew Amenu Sori ◽

Desta Hiko Gemeda

Keyword(s):

Low Dose ◽

Statistical Significance ◽

Labor Induction ◽

Induction Of Labor ◽

P Value ◽

High Dose ◽

Bishop Score ◽

Delivery Time ◽

Number Of Patients ◽

Successful Induction

Abstract Background : Induction of labor by Oxytocin is a routine obstetric procedure. However, little is known regarding the optimal dose of oxytocin so as to bring successful induction. This study was aimed at comparing the effects of high dose versus low dose oxytocin regimens on success of induction. Methods : Hospital-based comparative cross-sectional study was conducted in four selected hospitals in Ethiopia from October 1, 2017 to May 30, 2018. A total of 216 pregnant women who undergo induction of labor at gestational age of 37 weeks and above were included. Data were entered into Epi-data version 3.1 and then exported to SPSS version 20 for cleaning and analysis. Chi-square test and logistic regression were done to look for determinants of successful induction. The result was presented using 95% confidence interval of crude and adjusted odds ratios. P-value < 0.05 was used to declare statistical significance. Result : The mean “Induction to delivery time” was 5.9 hours and 6.3 hours for participants who received high dose Oxytocin and low dose Oxytocin respectively. Higher successful induction (72.2% versus 61.1%) and lower Cesarean Section rate (27.8% vs. 38.9) were observed among participants who received low dose Oxytocin compared to high dose. Favourable bishop score [AOR 4.0 95% CI 1.9, 8.5], elective induction [AOR 0.2 95% CI 0.1, 0.4], performing artificial rupture of membrane [AOR 10.1 95% CI 3.2, 32.2], neonatal birth weight of < 4Kg [AOR 4.3, 95% CI 1.6, 11.6] and being parous [AOR 2.1 95% CI 1.1, 4.0] were significantly associated with success of induction. Conclusions : In this study, Different oxytocin regimens didn’t show significant association with success of induction. But, high dose oxytocin regimen was significantly associated with slightly shorter induction to delivery time. Favourable bishop score, emergency induction, performing artificial rupture of membrane and delivery to non-macrosomic fetuses were positive determinants of successful induction.We recommend researchers to conduct multicenter research on a large number of patients that controls confounders to see the real effects of different oxytocin regimens on success of labor induction.

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High Dose and Low Dose Oxytocin Regimen as Determinants of Successful Induction: A multicenter comparative study

10.21203/rs.2.17285/v1 ◽

2019 ◽

Author(s):

MELESE GEZAHEGN TESEMMA ◽

Demisew Amenu Sori ◽

Desta Hiko Gemeda

Keyword(s):

Low Dose ◽

Optimal Dose ◽

Cross Sectional Study ◽

Induction Of Labor ◽

P Value ◽

High Dose ◽

Bishop Score ◽

Delivery Time ◽

Cross Sectional ◽

Successful Induction

Abstract Background Induction of labor by Oxytocin is a routine obstetric procedure. However, little is known regarding the optimal dose of oxytocin so as to bring successful induction. This study is aimed at comparing the effect of high dose versus low dose oxytocin regimen on success of induction.Methods Hospital based comparative cross-sectional study was conducted in four selected hospitals in Ethiopia from October 1, 2017 to May 30, 2018. A total of 216 pregnant women who undergo induction of labor at gestational age of 37 weeks and above were included. Data was entered into Epi-data version 3.1 and then exported to SPSS version 20 for cleaning and analysis. Chi-square test and logistic regression were done to look for determinants of successful induction. The result is presented using 95% confidence interval of crude and adjusted odds ratios. P-value < 0.05 was used to declare statistical significance.Result Mean “Induction to delivery time” was 5.9 hours and 6.3 hours for participants who received high dose Oxytocin and low dose Oxytocin respectively. Higher successful induction (72.2% versus 61.1%) and lower Cesarean Section rate (27.8% vs. 38.9) was observed among participants who received low dose Oxytocin compared to high dose. Favourable bishop score [AOR 4.0 95% CI 1.9, 8.5], elective induction [AOR 0.2 95% CI 0.1, 0.4], performing artificial rupture of membrane [AOR 10.1 95% CI 3.2, 32.2], neonatal birth weight of < 4Kg [AOR 4.3, 95% CI 1.6, 11.6] and being parous [AOR 2.1 95% CI 1.1, 4.0] were significantly associated with success of induction. Conclusions : In this study, oxytocin regimen didn’t show significant association with success of induction. But, high dose oxytocin regimen is significantly associated with slightly shorter induction to delivery time. Favourable bishop score, emergency induction, performing artificial rupture of membrane and delivery to non-macrosomic neonate are positive determinants of successful induction. Thus, we recommend ripening cervix when condition allows, estimating fetal weight and performing artificial rupture of membrane. We also recommend researchers to conduct more strong research that controls confounders to see the real effect of different oxytocin regimen on induction success.

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212172 ◽

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.

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Role of transvaginal ultrasonographic cervical assessment in predicting the outcome of induction of labor

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190296 ◽

2019 ◽

Vol 8 (2) ◽

pp. 628

Author(s):

Kiran Aggarwal ◽

Anita Yadav

Keyword(s):

Predictive Value ◽

Cervical Length ◽

Labor Induction ◽

Induction Of Labor ◽

Labour Induction ◽

Transvaginal Sonography ◽

Bishop Score ◽

Digital Examination ◽

Significant Difference ◽

Successful Induction

Background: Induction of labor is the most common intervention in modern obstetrics. The pre-induction ‘favourability’ of the cervix as assessed by the bishop score is very subjective. Transvaginal sonography appears to be a feasible alternative to the traditional bishop’s score. Aim of this study, was to compare cervical assessment by transvaginal sonography and digital examination in prediction of outcome of labor induction.Methods: Three hundred women at term with maternal and foetal indications for labor induction were included in the study. Modified Bishop score was assessed by digital examination and the cervical length was measured by Transvaginal sonography (TVS). Successful labor induction was taken as a vaginal delivery within 24 hours from the start of induction. Data were analyzed using SPSS for Windows 15.0.Results: Labour induction was successful in 81.33% of patients. Mean cervical length by digital examination was 2.6 cm, whereas the mean sonographic cervical length was 3.4cm. There was a significant difference of 0.8cm in mean cervical length measured by two methods (P=0.01). The best cut off point for predicting successful induction of labor was ≤3.4cm for sonographic cervical length (sensitivity 0.82, specificity 0.87, positive predictive value 0.77 and negative predictive value 0.25). The best cut off point for Modified Bishop score was 2 (sensitivity 0.95, specificity 0.93). The ROC curve showed that compared to TVS cervical length, Modified Bishop score was the best parameter for predicting successful induction of labor.Conclusions: Transvaginal sonographic cervical length measurement can be used as an adjunct tool to the traditional Bishop score for predicting successful labor induction in high risk pregnancies.

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125 Minimal Effects of Intravenous Administration of Xenogeneic Adipose Derived Stem Cells on Organ Function in a Porcine 40%TBSA Burn Model

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.129 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S84-S85

Author(s):

Tiffany C Heard ◽

Belinda Gomez ◽

Jamila Duarte ◽

Michael A Dubick ◽

Robert J Christy ◽

...

Keyword(s):

Stem Cells ◽

Organ Dysfunction ◽

Low Dose ◽

Statistical Significance ◽

Total Body Surface Area ◽

Cumulative Effect ◽

High Dose ◽

Organ Function ◽

Human Ascs ◽

Coagulation Status

Abstract Introduction Adipose stem cells (ASCs) have shown therapeutic promise for inflammatory conditions that beget multi organ dysfunction, including burns. While ASCs have immunomodulatory properties, some studies have brought up safety concerns of increased pro-coagulant activity such as pulmonary microvascular thrombi formation after intravenous (IV) administration of ASCs. In the present study, the aims are two-fold: 1) to verify if IV administration of human ASCs promotes coagulation and 2) to determine if human ASCs affect organ function in a 40% total body surface area (TBSA) swine burn model. Methods Female Yorkshire swine (39.63 ± 8.26kg) were anesthetized and subjected to 40% TBSA full thickness contact burns according to a formerly established model. After recovery from anesthesia, animals were randomized to receive 15ml/kg Lactated Ringer’s Solution containing: 1- no ASCs; 2- a low dose (5x105 ASCs/kg), or 3- a high dose (5x106 ASCs/kg) over a 15-minute period as a bolus. Blood was collected at baseline (BL) and 3, 6, 12, and 24h post burn to determine the effect of ASCs on organ function and coagulation status. At 24h post-burn, animals were humanely euthanized, and kidney and liver tissue was collected for histological and Western blot analyses. Data is presented as mean ± SEM, and statistical significance was set at p< 0.05. Results The high dose of ASCs significantly increased the circulating number of monocytes starting at 12 hours. Two-way ANOVA revealed a significant effect of ASCs on both prothrombin times (PT) and international normalized ratio (INR) (1.03 ± 0.04, 0.93 ± 0.03, and 1.02 ± 0.04 for no, low and high ASC groups, respectively at 24 hours). There were no differences in partial thromboplastin time, fibrinogen, or d-dimer levels. Both doses of ASCs briefly exacerbated burn-induced increases in total bilirubin at 3 hours (0.062 ± 0.025mg/dL, 0.148 ± 0.060mg/dL, and 0.211 ± 0.086mg/dL in no, low, and high ASC groups, respectively). ASCs did not alter urine output; yet, there was a significant effect of ASCs on creatinine. Western blotting revealed a rise in caspase expression in the liver of animals receiving a low dose of ASCs, while there was no difference in caspase expression in kidneys. Conclusions We show that IV administration of xenogeneic ASCs produces minimal changes in coagulation status and renal and hepatic dysfunction. Modest changes in the extrinsic coagulation pathway were dose-dependent, while exacerbation of liver dysfunction was brief and normalized after administration of ASCs was completed. We cannot rule out that continuous infusion of ASCs would not have a cumulative effect on organ dysfunction.

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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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Association of single-nucleotide polymorphisms in the ESR2 and FSHR genes with poor ovarian response in infertile Jordanian women

Clinical and Experimental Reproductive Medicine ◽

10.5653/cerm.2020.03706 ◽

2021 ◽

Vol 48 (1) ◽

pp. 69-79

Author(s):

Amer Mahmoud Sindiani ◽

Osamah Batiha ◽

Esra’a Al-zoubi ◽

Sara Khadrawi ◽

Ghadeer Alsoukhni ◽

...

Keyword(s):

Single Nucleotide Polymorphisms ◽

Statistical Significance ◽

Ovarian Response ◽

Control Group ◽

P Value ◽

Case Group ◽

Nucleotide Polymorphisms ◽

Poor Ovarian Response ◽

Single Nucleotide ◽

Number Of Patients

Objective: Poor ovarian response (POR) refers to a subnormal follicular response that leads to a decrease in the quality and quantity of the eggs retrieved after ovarian stimulation during assisted reproductive treatment (ART). The present study investigated the associations of multiple variants of the estrogen receptor 2 (ESR2) and follicle-stimulating hormone receptor (FSHR) genes with POR in infertile Jordanian women undergoing ART.Methods: Four polymorphisms, namely ESR2 rs1256049, ESR2 rs4986938, FSHR rs6165, and FSHR rs6166, were investigated in 60 infertile Jordanian women undergoing ART (the case group) and 60 age-matched fertile women (the control group), with a mean age of 33.60±6.34 years. Single-nucleotide polymorphisms (SNPs) were detected by restriction fragment length polymorphism and then validated using Sanger sequencing.Results: The p-value of the difference between the case and control groups regarding FSHR rs6166 was very close to 0.05 (p=0.054). However, no significant differences were observed between the two groups in terms of the other three SNPs, namely ESR2 rs1256049, ESR2 rs4986938, and FSHR rs6165 (p=0.561, p=0.433, and p=0.696, respectively).Conclusion: The association between FSHR rs6166 and POR was not statistically meaningful in the present study, but the near-significant result of this experiment suggests that statistical significance might be found in a future study with a larger number of patients.

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