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.

Elective induction of labour and caesarean section in low-moderate risk nulliparous women: a retrospective cohort study

Objective: To evaluate whether elective induction of labour (eIOL) influences the rate of caesarean birth in uncomplicated pregnant women at term, compared to expectant management. Design: Retrospective cohort study. Setting: Births in Victoria between 2010 and 2018. Population: Term, singleton, vertex births from low-moderate risk pregnancies (n=396,164). Methods: Preliminary analyses compared eIOL at 37 weeks with expectant management both beyond that gestational age (preliminary analysis I) and at that gestational age and beyond (preliminary analysis II). Similar comparisons were made for eIOL at 38, 39, 40 and 41 weeks’ gestation and expectant management. The primary analysis repeated these comparisons, limiting the population to nulliparous women whose recorded indication for induction did not include one of a specified list of conditions. Chi-square tests and multivariable logistic regression were used. Adjusted odds ratios and 99% confidence intervals were reported. P<0.01 denoted statistical significance. Main Outcome Measures: Unplanned caesarean birth, perinatal mortality Results: The proportion of nulliparous, low-moderate risk women who underwent IOL ≥37 weeks’ gestation in Victoria increased from 24.6% in 2010 to 30.0% in 2018 (p-value <0.001). eIOL in nulliparous women was associated with an increased odds of caesarean birth when performed at 38 (aOR 1.23((1.13-1.32)), 39 (aOR 1.31((1.23-1.40)), 40 (aOR 1.42((1.35-1.50)), and 41 weeks’ gestation (aOR 1.43((1.35-1.51)). Perinatal mortality was rare in both groups and non-significantly lower in the induced group at most gestations. Conclusions: eIOL was associated with an increased odds of caesarean birth from 38 weeks’ gestation and a decrease in the odds of perinatal mortality.

Comparison of caesarean section rate and maternal complications in elective induction versus spontaneous labor

Background: Elective induction of labor is defined as an initiation of labor, either by mechanical or pharmacological means at a time earlier than nature regardless of a medical or obstetric indication. Objectives were to estimate the proportion of caesarean sections and vaginal deliveries and magnitude of maternal complications following elective induction and spontaneous labor.Methods: The study entitled “comparison of caesarean section rate and maternal complications in elective induction versus spontaneous labor in LD Hospital, Kashmir” was a hospital based observational study, conducted in the Postgraduate Department of Obstetrics and Gynaecology, LallaDed Hospital of Government Medical College, Srinagar over a period of one and a half years.Results: Women in induced labor group had slightly increased risk of caesarean section than those in spontaneous group. Fetal distress was the most common indication for caesarean section in both the groups. There was no difference in both groups regarding maternal complications such as perineal lacerations; postpartum hemorrhage (PPH); need for blood transfusions and post partum hospital stay.Conclusions: Though induction of labor is associated with a slight increased risk of caesarean delivery, it is not related to other maternal complications. Therefore inductions are safe in hands of safe obstetricians.

Dysfunctional labor and hemoperitoneum secondary to an incidentally discovered dysgerminoma: a case report

Background Ovarian dysgerminoma, a subtype of malignant germ cell tumor (GCT), is a rare ovarian neoplasm that is infrequently found in the gravid patient. When dysgerminomas do occur in pregnancy, the rapidly growing tumors can have a heterogeneous presentation and lead to peripartum complications and morbidity. Due to the rarity of this condition, diagnostic and therapeutic strategies are not well described in the literature. Case presentation A healthy multigravida with an uncomplicated antenatal history presented for elective induction of labor. She had a protracted labor course, persistently abnormal cervical examinations, and eventually developed a worsening Category II tracing that prompted cesarean birth. Intraoperatively, a 26 cm pelvic mass later identified as a Stage IA dysgerminoma was discovered along with a massive hemoperitoneum. The mass was successfully resected, and the patient remains without recurrence 6 months postoperatively. Conclusion Although rare and generally indolent, dysgerminomas can grow rapidly and cause mechanical obstruction of labor and other complications in pregnancy. Pelvic masses, including malignant neoplasms, should be included in as part of a broad differential diagnosis when evaluating even routine intrapartum complications such as abnormal labor progression. Additionally, we demonstrate that adnexal masses can be a source of life-threatening intraabdominal hemorrhage.

COMPARISON OF MISOPROSTOLAND DINOPROSTONE FOR ELECTIVE INDUCTION OF LABOUR IN NULLIPAROUS WOMEN AT FULL TERM: A RANDOMIZED PROSPECTIVE STUDY

Background: The objective of this randomized prospective study was to compare the efcacy of 50 mcg vaginal misoprostol and 3 mg dinoprostone, administered every nine hours for a maximum of three doses, for elective induction of labor in nulliparous women with an unfavorable cervix and more than 40 weeks of gestation. Material And Methods: One hundred and sixty-three pregnant women with more than 285 days of gestation were recruited and analyzed. The main outcome measures were time from induction to delivery and incidence of vaginal delivery within 12 and 24 hours. Admission rate to the neonatal intensive care unit within 24 hours post delivery was a secondary outcome. Results: The induction-delivery interval was signicantly lower in the misoprostol group than in the dinoprostone group (11.9 h vs. 15.5 h, p < 0.001). With misoprostol, more women delivered within 12 hours (57.5% vs. 32.5%, p < 0.01) and 24 hours (98.7% vs. 91.4%, p < 0.05), spontaneous rupture of the membranes occurred more frequently (38.8% vs. 20.5%, p < 0.05), there was less need for oxytocin augmentation (65.8% vs. 81.5%, p < 0.05) and fewer additional doses were required (7.5% vs. 22%, p < 0.05). Although not statistically signicant, a lower Caesarean section (CS) rate was observed with misoprostol (7.5% vs. 13.3%, p > 0.05) but with the disadvantage of higher abnormal fetal heart rate (FHR) tracings (22.5% vs. 12%, p > 0.05). From the misoprostol group more neonates were admitted to the intensive neonatal unit, than from the dinoprostone group (13.5% vs. 4.8%, p > 0.05). One woman had an unexplained stillbirth following the administration of one dose of dinoprostone. Conclusions: Vaginal misoprostol, compared with dinoprostone in the regimens used, is more effective in elective inductions of labor beyond 40 weeks of gestation. Nevertheless, this is at the expense of more abnormal FHR tracings and more admissions to the neonatal unit, indicating that the faster approach is not necessarily the better approach to childbirth

Current practice of induction of labour and maternal outcome in ≥37 week of gestation: an observational study

Background: As we know induction is done when benefit to mother and fetus overweigh benefits of continuing the pregnancy. According to NICE guidelines, induction of labor leads to 15% of instrumental deliveries and 22% of total LSCS. In new civil hospital, Surat (according to 2017) failure of induction of labor was 2nd most common indication of LSCS. The objective of this study were to analyse labor induction with respect to indication for induction of labor and its maternal outcome so that we optimize our protocol of labor and reduce our LSCS rates for the same, can reduce feto-maternal morbidities also.Methods: This was prospective observational descriptive study carried out over duration of 6 month. 200 consecutive cases of consenting women requiring induction of labour and fulfilling inclusion criteria were selected. Induction was done with prostaglandin analogous. Data were collected includes age, parity, gestational age, bishop score, indication of induction, and maternal outcome. And data was analyzed by using EMI software.Results: Timely induction of labor can reduce maternal morbidity and ensure the delivery of a healthy baby. Among 200 consenting women 58.5% were multigravida and 41.5% were primigravida. Most common indication of induction among study participants is prolong rupture of membrane which is 35.5%. Among them 71.4% had vaginal delivery having poor bishop score. Most common indication for LSCS were fetal distress (34.8%).Conclusions: We concluded that elective induction of labor was associated with lower rates of LSCS and improved maternal and neonatal outcome.

COMPARATIVE STUDY OF MATERNALAND NEONATAL OUTCOME OF ELECTIVE INDUCTION OF LABOUR VS EXPECTANT MANAGEMENT AT 40- 40+6 WEEKS OF GESTATION

OBJECTIVES: To compare and analyse in each group- delivery complications like postpartum haemorrhage, obstetric anal sphincter injury at 40-40+6 Week of Gestation. To compare and analyse in each group- perinatal outcomes, mainly perinatal mortality and special care unit admission. METHODS: This prospective comparative observational study was conducted in the Department of Gynaecology & Obstetrics, R. G. Kar Medical College and Hospital. For my study I had taken a total of 276 mothers whom I had subdivided into 2 groups. Group Ahad 138 mothers who had induction of labour (I) by some method. Remaining 138 mothers were allocated to Group B who had only watchful expectancy with monitoring and labeed as expectant management group(EM). RESULT: In group-A (I), 5(3.6%) patients had instrumental delivery in comparison to group B(EM) which had 15(10.9%) of instrumental delivery. LSCS was also higher in group B i.e 36(26.1%) as compared to group A i.e 25(18.1%). 108(78.3%) mothers had vaginal delivery who were induced whereas 87(63.0%) had vaginal delivery in expectant management group. Therefore, induction group had better outcome in terms of mode of delivery.It was also statistically signicant (p=0.0098). The distribution on the basis of APGAR score at 5 minutes of babies in between two groups was signicant. CONCLUSION: Elective induction at 40+ weeks is associated with a lower rate of caesarean delivery and does not increase the risk of major complications for newborns and can be offered to mothers having low risk and crossed their expected date of delivery.The ACOG says elective induction at 40+ weeks is a reasonable option for healthy women. Induction of labour at 40+ weeks should not be routine for women but it is important to counsel them and let them decide whether they want to be induced and when.

Prognostic Value of Cerebroplacental Ratio in Appropriate-for-Gestational-Age Fetuses Before Induction of Labor in Late-Term Pregnancies

Purpose To evaluate the relationship between cerebroplacental ratio (CPR) and the need for operative delivery due to intrapartum fetal compromise (IFC) and adverse perinatal outcome (APO) in appropriate-for-gestational-age (AGA) late-term pregnancies undergoing induction of labor. The predictive performance of CPR was also assessed. Materials and Methods Retrospective study including singleton AGA pregnancies that underwent elective induction of labor between 41 + 0 and 41 + 6 weeks and were delivered before 42 + 0 weeks. IFC was defined as persistent pathological CTG or pathological CTG and fetal scalp pH < 7.20. Operative delivery included instrumental vaginal delivery (IVD) and cesarean section (CS). APO was defined as a composite of umbilical artery pH < 7.20, Apgar score < 7 at 5 minutes, and admission to the neonatal intensive care unit for > 24 hours. Results The study included 314 women with 32 (10 %) IVDs and 49 (16 %) CSs due to IFC and 85 (27 %) APO cases. Fetuses with CPR < 10th percentile showed a significantly higher rate of operative delivery for IFC (40 % (21/52) vs. 23 % (60/262); p = 0.008) yet not a significantly higher rate of APO (31 % (16/52) vs. 26 % (69/262); p = 0.511). The predictive values of CPR for operative delivery due to IFC and APO showed sensitivities of 26 % and 19 %, specificities of 87 % and 84 %, positive LRs of 2.0 and 1.2, and negative LRs of 0.85 and 0.96, respectively. Conclusion Low CPR in AGA late-term pregnancies undergoing elective induction of labor was associated with a higher risk of operative delivery for IFC without increasing the APO rate. However, the predictive value of CPR was poor.