Role of mifepristone in pre-induction cervical ripening: a double blind placebo-controlled study

Background: Mifepristone has been used for cervical priming and labour induction for long with modest success. This double-blind study compares mifepristone with placebo in causing cervical ripening and inducing spontaneous labour in women past their expected date of delivery.Methods: 200 women at 40 weeks gestation received mifepristone or placebo after Bishop score was assessed. 48 hours later, cervical score was rechecked. Improvement in Bishop score was noted as primary outcome measure. Incidence of spontaneous labour, cesarean delivery and meconium staining of liquor during labour was also monitored.Results: 16 women went into labour before 48 hours and 184 were evaluable. Improvement in Bishop score was noted in significantly more women in mifepristone group (82/94 versus 42/90, p<0.0001). Mean change in Bishop score was 3.22 in mifepristone group and 1.61 in placebo group. This advantage in cervical ripening with mifepristone did not translate into better obstetric outcome. The incidence of spontaneous labour (64/94 mifepristone versus 60/90 placebo), cesarean section (4/94 versus 12/90) and MSL (8/94 versus 10/90) was comparable in the two groups and did not reach statistical significance.Conclusions: Mifepristone has a beneficial effect on cervical ripening in term pregnancies but does not offer obstetric advantage in terms of higher rates of spontaneous labour or vaginal delivery.

A new indication for elective induction of labor COVID-19 pandemic effect

Background: Induction of labour is performed in certain circumstances which involve greater risks of waiting for the onset of spontaneous labour than the risks due to shortening the duration of pregnancy by induction. The objective of this study was to evaluate the maternal and fetal outcome in patients undergoing elective induction during COVID-19 pandemic.Methods: This prospective observational study was conducted on 60 ANC patients with singleton pregnancy and POG >39 weeks coming to OPD with negative COVID-19 RT-PCR report. To avoid the burden of repeat testing after one week and risk of exposure to COVID-19 virus from community, patients were induced. All the data was recorded and analyzed.Results: Most of the patients were in age group of 20-25 years (50%) and only 6.7% of the patients were older than 30 years. 32 (53.3%) patients were multiparous and 50% of the patients were having Bishop score between 2-5 and only 8.3% had bishop score of more than 5. 47 patients (78.3%) underwent normal vagina delivery whereas 12 patients (20%) underwent LSCS. Failure of Induction was the indication for LSCS in 5 patients (41.7%).Conclusions: Elective induction was found to be better option in COVID-19 negative patients. All pregnant women should be monitored for development of symptoms and signs of COVID-19 particularly if they have had close contact with a confirmed case. Pregnancy and childbirth generally do not increase the risk for acquiring SARS-CoV-2 infection but may worsen the clinical course of COVID-19 compared with nonpregnant individuals of the same age.

Prostaglandins in biofluids in pregnancy and labour: A systematic review

Prostaglandins are thought to be important mediators in the initiation of human labour, however the evidence supporting this is not entirely clear. Determining how, and which, prostaglandins change during pregnancy and labour may provide insight into mechanisms governing labour initiation and the potential to predict timing of labour onset. The current study systematically searched the existing scientific literature to determine how biofluid levels of prostaglandins change throughout pregnancy before and during labour, and whether prostaglandins and/or their metabolites may be useful for prediction of labour. The databases EMBASE and MEDLINE were searched for English-language articles on prostaglandins measured in plasma, serum, amniotic fluid, or urine during pregnancy and/or spontaneous labour. Studies were assessed for quality and risk of bias and a qualitative summary of included studies was generated. Our review identified 83 studies published between 1968–2021 that met the inclusion criteria. As measured in amniotic fluid, levels of PGE2, along with PGF2α and its metabolite 13,14-dihydro-15-keto-PGF2α were reported higher in labour compared to non-labour. In blood, only 13,14-dihydro-15-keto-PGF2α was reported higher in labour. Additionally, PGF2α, PGF1α, and PGE2 were reported to increase in amniotic fluid as pregnancy progressed, though this pattern was not consistent in plasma. Overall, the evidence supporting changes in prostaglandin levels in these biofluids remains unclear. An important limitation is the lack of data on the complexity of the prostaglandin pathway outside of the PGE and PGF families. Future studies using new methodologies capable of co-assessing multiple prostaglandins and metabolites, in large, well-defined populations, will help provide more insight as to the identification of exactly which prostaglandins and/or metabolites consistently change with labour. Revisiting and revising our understanding of the prostaglandins may provide better targets for clinical monitoring of pregnancies. This study was supported by the Canadian Institutes of Health Research.

The Integrated Neurophysiology of Emotions during Labour and Birth: a Feminist Standpoint Exploration of the Women's Perspectives of Labour Progress

<p>Within childbirth there is a common and widely known explanation of labour and birth which describes and defines the birth process as that of stages and phases. The boundaries between the stages and phases have been determined by cervical dilatation with time parameters set to measure progress. The measurement of cervical dilatation is determined by a health professional and has resulted in an apparent inability of women to determine themselves whether they are in labour and their closeness to the impending birth. The aims of this thesis were threefold; the first was to critically examine the knowledge base of labour progress, so that the influences on knowledge development were fully understood. Through exploring the historical and theoretical development I found that the current knowledge has come from a male understanding of female anatomy and observational data constructed within a discourse of male, medical, scientific superiority. The second aim of the thesis was to explore the perspectives of women who had experienced a spontaneous labour and birth in order to determine whether the discourse of labour as stages and phases resonated with them. This leads to the third aim of providing a description of the women’s voices and perspectives based on their experiential knowledge of spontaneous labour and birth. A critical feminist ontology and feminist standpoint methodology guided the research which used in-depth one-to-one interviews with 18 women who had experienced a spontaneous labour and birth. Early thematic analysis was developed further through feedback from the participants supporting a coconstruction of knowledge. Analysis revealed that women considered the stages and phases of labour to be an abstract concept which did not resonate with their experiences of labour and birth. An important aspect of labour was having support during the process, in terms of both emotional and physical support from midwives, partners, family and friends present during the labour and birth. Women’s perceptions were dominated by their feelings and a linear pattern of feelings was discerned consistently amongst the participants. The emotions of labour were an important finding in this research but during the feedback process the women requested a scientific foundation to support the findings. I therefore explored the recent advances in theoretical understanding of the role of emotion, cognition, physiology and behaviour. Contemporary theories define emotions and neurohormones as bi-directional and intricately linked to behaviour change and physiological adaptations. I argue that the feelings women have described give an indication of an underlying hormonal influence and a directing of behaviour, necessary for labour to move towards birth. The hormones involved in labour also support maternal behaviour and attachment to the baby. I suggest a new conceptual understanding of labour as the integration of the mind, body and behaviour in which the feelings and hormones that initiate and sustain labour to birth also support the necessary adaptation and transition to becoming a mother. This integrated neurophysiologic concept will help midwives and other health professionals involved in maternity to recognise emotions as a key to understanding physiological labour and birth. It has also highlighted the importance of emotional and physical support during labour. Further research is necessary to test the hypothesis that women experience a similar range of emotions at similar times during a spontaneous labour and birth and to what extent the described emotions resonate with other women’s experiences.</p>

The Integrated Neurophysiology of Emotions during Labour and Birth: a Feminist Standpoint Exploration of the Women's Perspectives of Labour Progress

<p>Within childbirth there is a common and widely known explanation of labour and birth which describes and defines the birth process as that of stages and phases. The boundaries between the stages and phases have been determined by cervical dilatation with time parameters set to measure progress. The measurement of cervical dilatation is determined by a health professional and has resulted in an apparent inability of women to determine themselves whether they are in labour and their closeness to the impending birth. The aims of this thesis were threefold; the first was to critically examine the knowledge base of labour progress, so that the influences on knowledge development were fully understood. Through exploring the historical and theoretical development I found that the current knowledge has come from a male understanding of female anatomy and observational data constructed within a discourse of male, medical, scientific superiority. The second aim of the thesis was to explore the perspectives of women who had experienced a spontaneous labour and birth in order to determine whether the discourse of labour as stages and phases resonated with them. This leads to the third aim of providing a description of the women’s voices and perspectives based on their experiential knowledge of spontaneous labour and birth. A critical feminist ontology and feminist standpoint methodology guided the research which used in-depth one-to-one interviews with 18 women who had experienced a spontaneous labour and birth. Early thematic analysis was developed further through feedback from the participants supporting a coconstruction of knowledge. Analysis revealed that women considered the stages and phases of labour to be an abstract concept which did not resonate with their experiences of labour and birth. An important aspect of labour was having support during the process, in terms of both emotional and physical support from midwives, partners, family and friends present during the labour and birth. Women’s perceptions were dominated by their feelings and a linear pattern of feelings was discerned consistently amongst the participants. The emotions of labour were an important finding in this research but during the feedback process the women requested a scientific foundation to support the findings. I therefore explored the recent advances in theoretical understanding of the role of emotion, cognition, physiology and behaviour. Contemporary theories define emotions and neurohormones as bi-directional and intricately linked to behaviour change and physiological adaptations. I argue that the feelings women have described give an indication of an underlying hormonal influence and a directing of behaviour, necessary for labour to move towards birth. The hormones involved in labour also support maternal behaviour and attachment to the baby. I suggest a new conceptual understanding of labour as the integration of the mind, body and behaviour in which the feelings and hormones that initiate and sustain labour to birth also support the necessary adaptation and transition to becoming a mother. This integrated neurophysiologic concept will help midwives and other health professionals involved in maternity to recognise emotions as a key to understanding physiological labour and birth. It has also highlighted the importance of emotional and physical support during labour. Further research is necessary to test the hypothesis that women experience a similar range of emotions at similar times during a spontaneous labour and birth and to what extent the described emotions resonate with other women’s experiences.</p>

Effect of Membrane Sweeping on the Initiation of Spontaneous Labour

Background: Membrane sweeping causes induction of labour by release of prostaglandins, and other hormones. Aim: To determine efficacy of membrane sweeping on induction of spontaneous labour in post-date women. Study design: Randomized controlled trial. Place and duration of study: Department of Obstetrics & Gynaecology, Health Bridge Hospital, Ghazi Road, Lahore from 1st January 2020 to 31st December 2020. Methodology: One hundred and fifty pregnantwomen with ≥40 weeks of gestationwere randomly divided into two groups of 75 pregnant women each. Group A were those who consented for undergoing membrane sweeping whereas group B did not undergo this process. Results: The mean age of the enrolled pregnant women was25.7±3.05 years. The mean duration of pregnancy in group A was 40.1±0.2 weeks and in group B was 40.2±0.1 weeks. Regarding spontaneous onset of labour, in group A, 38(50.6%) patients went into labour with sweeping of membranes and in group B, 10(13.4%) patients had spontaneous onset of labour. There were only two cases of infection reported in Group A and one in group B. Conclusion: Membrane sweeping for natural induction of spontaneous labour. Key words: Membrane sweeping, Labour induction, Efficacy

Study of comparison of maternal and fetal outcomes in spontaneous labour and induced labour

Background: There has been consistent proportionate increase in the cases of induction of labor, but both maternal and neonatal effects of it remain poorly analysed previously. The present study was undertaken with the objective of comparison of maternal and fetal outcomes between groups of patients undergoing induction of labor and those having spontaneous labor.Methods: In this comparative prevalence study, the participants selected by predefined criteria were divided into 2 groups on the basis of progression of labor. They were spontaneous labor (group A) and induction of labor (group B). All the participants were assessed for various relevant maternal and neonatal outcomes and valid comparisons drawn.Results: A total of 1300 participants were studied. Proportion of patients requiring caesarean section was significantly higher in induction group (39.17%) against the spontaneous labor group (15.37%), with fetal distress being the commonest indication in both groups. The commonest complication noted was postpartum hemorrhage (PPH) (2.96% in group A and 1.98% in group B, p<0.05). Mean birth weight of babies was 2.76±0.42 kgs in spontaneous labor group and 2.68±0.48 kgs in induction of labor group (p>0.05). Incidences of NICU admissions and neonatal deaths were significantly higher in induction of labor group.Conclusions: Induction of labor should be employed judiciously by assessing the maternal and fetal condition and confirming relevant indication and should only be done if continuation of pregnancy is relatively more hazardous to either mother or baby.

Can the Robson 10 Group Classification System help identify which groups of women are driving the high caesarean section rate in major private hospitals in eastern Ethiopia? A cross-sectional study

ObjectiveThe rates of caesarean section (CS) in Ethiopian private hospitals are high compared with those in public facilities, and there are limited descriptions of groups of women contributing to these high rates. The objective of this study was to describe the groups contributing to increased CS rates using the Robson classification in two major private hospitals in eastern Ethiopia.DesignCross-sectional study.SettingTwo major private hospitals in eastern Ethiopia.ParticipantsAll women who gave birth from 9 January 2019 to 8 January 2020 in two major private hospitals in eastern Ethiopia.Primary and secondary outcome measuresThe primary outcome was the Robson 10 Group Classification System. The secondary outcome was indication for CS as recorded in the medical files.ResultsOf 1203 births in both hospitals combined during the study period, 415 (34.5%) were by CS. Women with a uterine scar due to previous CS (group 5), single cephalic term multiparous women in spontaneous labour (group 3) and single cephalic term nulliparous women in spontaneous labour (group 1) were the leading groups contributing 33%, 27.5% and 17.1%, respectively. The leading documented indications were fetal compromise (29.4%), previous CS (27.2%) and obstructed labour (12.3%).ConclusionMore than three-fourths of CS were performed among Robson groups 5, 3 and 1, indicating inadequate trial of labour after CS or management of labour among relatively low-risk groups (3 and 1). Improving management of spontaneous labour and strengthening clinical practice around safely providing the option of vaginal birth after CS practice are strategies required to reduce the high CS rates in these private facilities.