The Influence of Diabetes on Labor Induction with Dinoprostone Vaginal Inserts

Objective The aim of this study was to compare duration of labor induction between diabetic and nondiabetic women receiving dinoprostone vaginal insert (10 mg). Study Design This is a secondary analysis of two large randomized controlled trials using dinoprostone vaginal inserts for labor induction. We compare time to active labor, overall delivery, and vaginal delivery between diabetic and nondiabetic women undergoing induction of labor with a 10-mg dinoprostone vaginal insert. Results Diabetic women receiving dinoprostone vaginal insert had a longer time to onset of active labor, overall delivery, and vaginal delivery than their nondiabetic counterparts. There was no difference in abnormal labor affecting fetal heart rate pattern in diabetic women compared with nondiabetic women. The rates of neonatal hyperbilirubinemia were higher in diabetic women. Conclusion Diabetes may represent an independent factor associated with prolonged induction among women undergoing induction of labor with dinoprostone. Dinoprostone is well tolerated in both diabetic and nondiabetic women. Key Points

Comparison between AFI and DVP in predicting adverse neonatal respiratory outcomes in women with prolonged pregnancy undergoing induction of labour

Background The intrapartum management of prolonged pregnancies is aunique challenge to the obstetricians, as the perinatal outcomes areadverse after completed 40 weeks. In such cases, intrapartumasphyxia and meconium aspiration are associated with almost. Objective To comparison between MVP and AFI in predicting neonatal respiratory outcomes in induction of labour in prolonged pregnancies. Patients and Methods The study was a prospective comparative study that was conducted on 266 women with prolonged pregnancy undergoing induction of labour. The patients were recruited from Ain Shams university hospitals during the period from February 2019 to August 2019. Results Amniotic fluid index and MVP were evaluated in 269 women with pregnancies of 40 or more weeks and intact membranes using a 3.5-MHz linear transducer. Both measurements were obtained for each participant by the same obstetrician in one sitting. Oligohydramnios was defined as an AFI of 5 cm or less or an DVP of 1 cm or less. External cardiotocography was performed during intrapartum period in all cases. Fetal distress was diagnosed when any one of the nonreassuring fetal heart rate pattern occurred or when the Apgar score at birth was 6 or less. The results were analyzed by the chi(2) and the t tests. Conclusion The use of the AFI and SDVP is useful in predicting neonatal outcomes in the induction of labor in prolonged pregnancies. The SDVP measurement appears to be the more appropriate method for predicting neonatal outcomes. The same observation was found when AFI and SDVP were combined. It is also logical to recommend that only one method should be used for fetal assessment tests.

Outcome of Labor Induction and it’s Associated Factor among Laboring Women at Dilchora Referral Hospital, Dire Dawa, Eastern Ethiopia

Background: Induction of labor has a great role to prevent neonatal and maternal mortality and morbidity. Despite its role Induction sometimes fails with a potential risk of increasing maternal and neonatal mortality and morbidity. In Dire Dawa, there was no study done on outcomes of labor inductions. Therefore, this study is planned to fill this gap by studying the outcome of labor induction and associated factors among women who had delivered at Dilchora referral hospital in Dire Dawa, East Ethiopia. Objective: To determine the outcome of labor induction and associated factors among women who had delivered at Dilchora referral hospital Dire Dawa East Ethiopia, May 15 to June 1, 2020.Methods: Hospital-based retrospective cross-sectional study (July 8, 2014 up to July 08, 2019) was employed by using a pre-tested structured questionnaire to collect data from a sample of 444 charts using a systematic random sampling method by trained data collectors. First, bi-variate analysis was done to select variables for multivariate analysis and those variables with p-value 0.25 or less interred into multivariate analysis. In multivariable analysis, those variables with p-value <0.05 are considered as significantly associated. The model adequacy was checked by using the Hosmer and Lemeshow goodness of fit test.Result: The result of the study reveled Post-Term mother [(AOR: 0.49 (0.25-0.98.The mother whose labor is induced by misoprostol [(AOR: 2.5 (1.08-5.94] the mother whose labor is induced by both (oxytocin and misoprostol) [(AOR: 0.33 (0.13-0.86)] and non-reassuring fetal heart rate pattern [(AOR: 0.10(0.03-0.30)] were significantly associated with success of induction.Conclusion: The prevalence rate of success of labor induction was found (83.6%). And the most common indications for labor inductions were PROM and Post term. Furthermore, the study described that the most common method of induction in Dilchora referral Hospital is iv oxytocin and the minister of health should develop national evidence-based clinical practice guidelines for labour of induction and enforce its implementation.

Factors predicting success of vaginal delivery in women with oligohydramnios undergoing induction of labour

Background: Aim was to study the predicting factors for success of vaginal delivery, in women with oligohydramnios undergoing induction of labour.Methods: An observational study conducted in tertiary care centre Kamineni Hospital in 100 patients in 1-year duration with vaginal misoprostol tablets to predict the success of vaginal delivery in cases, if oligohydramnios undergoing induction of labor.Results: In our study total 100 cases was induced. Among these 81% had successful normal vaginal delivery and 19% had caesarean section delivery. Those who underwent caesarean section, their NST had become non reassuring at any time in labour, provided all supportive measures but their labour was terminated by caesarean section for sake of mother or baby.Conclusions: It is preferable to induce the patients of oligohydramnios at term with continous fetal heart rate monitoring and also variability of the fetal heart rate pattern with uterine contractions.

Feto-maternal Outcome in Pregnancies Complicated by Hypertensive Disorder: A Retrospective Study at a Tertiary Care Centre of Eastern Nepal

Introduction: Hypertensive disorder of pregnancy is one of the major cause of maternal and fetal morbidity and mortality. Objective: The objective of this study was to estimate the associated maternal and fetal outcome and complications in pregnancies complicated by hypertensive disorders at a tertiary care hospital in eastern Nepal. Methodology: This retrospective cross section observational study included purposely-selected one hundred thirty four pregnant women from April 2019 to April 2020 in the Department of Obstetrics and Gynaecology at Birat Medical College Teaching Hospital, Tankisinuwari, Morang, Nepal. Maternal age, gravidity, period of gestation at presentation, associated maternal comorbidities/ risk factors, mode of delivery, indication for surgery, maternal outcome and complications, fetal outcome was recorded and data was analysed using SPSS version 23 software. Result: Out of the 134 study population,35.8% of the mothers with hypertensive disorders were noted in the age group between 25-29 years and almost two third of the patients were multigravida. 55.2% patients had mild, while 44.8% had severe hypertension. About 83.6% of the hypertensive pregnant mothers delivered preterm between 33 to 36 weeks of gestation. 61.9% mothers underwent cesarean section with the most common indication being non-reassuring fatal heart rate pattern, while 34.3% women delivered vaginally. 86 out of 134 cases did not develop any complications while, postpartum haemorrhage was the most frequently encountered complication seen in 17.9% cases followed by eclampsia encountered in 13.4% patients. The mortality encountered was 0.7%. Neonatal complications were found in 50% cases, 15.7% neonates had low APGAR score and 8.2% had meconium aspiration, while 4.5% intrauterine deaths and 3% neonatal deaths were observed. Conclusion: There is adverse impact of hypertension during pregnancy over maternal and perinatal outcome. Hence, early identification and prompt referral to the well-equipped center is necessary to reduce the associated morbidity and mortality.