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Barger MK, Howe-Heyman A. Systematic Reviews to Inform Practice, March/April 2023. J Midwifery Womens Health 2023; 68:294-299. [PMID: 36855030 DOI: 10.1111/jmwh.13479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Mary K Barger
- Midwifery researcher and consultant, San Diego, California
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Amerizadeh A, Farajzadegan Z, Asgary S. Effect and Safety of Castor Oil on Labor Induction and Prevalence of Vaginal Delivery: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2022; 27:251-259. [PMID: 36275342 PMCID: PMC9580580 DOI: 10.4103/ijnmr.ijnmr_7_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/16/2021] [Accepted: 02/23/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Castor oil is used in some countries to induce labor, but results on its effectiveness and safety is controversial. This systematic review and meta-analysis aimed to evaluate the effect of castor oil on labor induction and prevalence of vaginal delivery along with investigating its safety. MATERIALS AND METHODS PubMed, Scopus, Web of Science, and Google Scholar were searched systematically up to September 2020. Observational studies and Randomized Clinical Trials (RCTs), which assessed the effect of castor oil on labor induction in English and Persian languages using different combinations of the related key terms and Medical Subject Headings (MeSH) terms were collected and analyzed independently by two authors. Random effect model was used for meta-analysis. The studies were included in which the Relative Risk (RR) had been reported with 95% Confidence Intervals (CIs). RESULTS A total of 12 studies consisting 1653 pregnant women were included. The mean age of women who used castor oil was 24.72 years and in control group was 24.67 years. Results showed that labor induction was significantly higher in castor oil group than control group (RR: 3.27; 95% CI (1.96, 5.46)). Prevalence of vaginal delivery was 81% in the castor oil group and 69% in the control group. CONCLUSIONS It can be concluded that use of castor oil has positive effect on labor induction and increases the prevalence of vaginal delivery. None of the studies considered in this meta-analysis reported any serious harmful effects for the use of castor oil.
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Affiliation(s)
- Atefeh Amerizadeh
- Department of Pharmaceutical Sciences, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ziba Farajzadegan
- Department of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sedigheh Asgary
- Department of Pharmaceutical Sciences, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Prof. Sedigheh Asgary, Department of Pharmaceutical Sciences, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Guiguet-Auclair C, Rouzaire M, Debost-Legrand A, Dissard S, Rouille M, Delabaere A, Gallot D. Cross-Cultural Adaptation and Psychometric Properties of the French Version of the EXIT to Measure Women’s Experiences of Induction of Labor. J Clin Med 2022; 11:jcm11144217. [PMID: 35887980 PMCID: PMC9317795 DOI: 10.3390/jcm11144217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/01/2022] [Accepted: 07/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background: In France, more than 20% of women require induction of labor (IOL), which can be psychologically and emotionally challenging for patients. It is important to assess how they feel about their IOL experiences. Our aim was to cross-culturally adapt and evaluate the psychometric properties of a French version of the EXIT to assess women’s experiences of IOL. Methods: The EXIT was cross-culturally adapted by conducting forward and backward translations following international guidelines. A cross-sectional study was conducted to assess the psychometric properties of the ten French EXIT items: data completeness, factor analysis, internal consistency, score distribution, floor and ceiling effects, inter-subscale correlations, convergent validity, and test–retest reliability. Results: The EXIT was successfully cross-culturally adapted to the French context and any IOL method. The results obtained from 163 patients requiring IOL showed good acceptability. Exploratory factor analysis resulted in a three-factor solution with subscales reflecting the experiential aspects of time taken to give birth, discomfort with IOL, and subsequent contractions. Good internal consistency (Cronbach’s alpha or Spearman correlation coefficients ranging from 0.55 to 0.84) and good test–retest reliability (intraclass correlation coefficients ranging from 0.66 to 0.85) for the three identified subscales were found. Conclusions: The ten-item French EXIT is a valid and reliable instrument for the self-assessment of women’s experiences of IOL in the three weeks following delivery for any method of IOL used. As a patient-reported outcome measure, it would allow the comparison of experiential outcomes across IOL studies in order to include women’s preferences in decisions regarding their care.
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Affiliation(s)
- Candy Guiguet-Auclair
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, F-63000 Clermont-Ferrand, France; (A.D.-L.); (A.D.)
- Department of Public Health, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
- Correspondence:
| | - Marion Rouzaire
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (M.R.); (S.D.); (M.R.); (D.G.)
| | - Anne Debost-Legrand
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, F-63000 Clermont-Ferrand, France; (A.D.-L.); (A.D.)
- Réseau de Santé Périnatale d’Auvergne, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Sigrid Dissard
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (M.R.); (S.D.); (M.R.); (D.G.)
| | - Manon Rouille
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (M.R.); (S.D.); (M.R.); (D.G.)
| | - Amélie Delabaere
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, F-63000 Clermont-Ferrand, France; (A.D.-L.); (A.D.)
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (M.R.); (S.D.); (M.R.); (D.G.)
| | - Denis Gallot
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (M.R.); (S.D.); (M.R.); (D.G.)
- Translational Approach to Epithelial Injury and Repair, Faculty of Medicine, Université Clermont-Auvergne, CNRS 6293, INSERM 1103, GReD, F-63000 Clermont-Ferrand, France
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Abu-Zaid A, Saeed Alshahrani M, Al-Matary A, Khadawardi K, Talat Miski N, Abuzaid M, Alrasheed MA, Baradwan A, Salem A, Salem R, Ismail Albadawi M, Ziad Jamjoom M, AMA Almubarki A, Ahmed Abdulmalik N, Almugbel M, Tulbah M, Baradwan S, Alomar O. Isosorbide mononitrate for cervical ripening during labour induction: a systematic review and meta-analysis of 23 randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2022; 276:38-46. [DOI: 10.1016/j.ejogrb.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
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Victor SF, Bach DBB, Hvelplund AC, Nickelsen C, Lyndrup J, Wilken-Jensen C, Scharff LJ, Weber T, Secher NJ, Krebs L. Cardiotocography combined with ST analysis versus cardiotocography combined with fetal blood sampling in deliveries with abnormal CTG: a randomized trial. Arch Gynecol Obstet 2022; 307:1771-1780. [PMID: 35701639 DOI: 10.1007/s00404-022-06649-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/25/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The aim was to investigate if intrapartum monitoring with cardiotocography (CTG) in combination with ST analysis (STAN) results in an improved perinatal outcome. METHODS We performed a two-center randomized trial. 1013 women with term fetuses in cephalic presentation entered the trial. If a CTG showed intermediate or pathological abnormalities, they were offered fetal blood sampling (FBS) and inclusion if the pH value was above 7.25. They were randomized to either CTG + FBS or CTG + STAN. The primary outcome was neonatal metabolic acidosis, defined as umbilical cord arterial blood pH below 7.05, and base excess equal to or below -10. The secondary outcomes included operative vaginal delivery for fetal distress. RESULTS The rate of metabolic acidosis was 0.8% in the CTG + FBS group and 1.5% in women in the CTG + STAN (P = 0.338). More women in the CTG + STAN group delivered by operative vaginal delivery (25.6% vs 33.5%, P = 0.006). Significantly fewer women in the CTG + STAN group had three to five (28.8% vs 11.0%, P = < 0.001) and six to ten fetal blood samples taken (3.4% vs 0.4%, P = < 0.001). CONCLUSION CTG + STAN did not reduce the incidence of neonatal metabolic acidosis compared to CTG + FBS. CTG + STAN was, however, associated with an increased risk of operative vaginal delivery and a reduced use of FBS. If STAN is used for fetal surveillance, we recommend that it is combined with other methods, such as FBS, for confirmation of the need for operative delivery. CLINICALTRIALS gov ID: NCT01699646. Date of registration: October 4, 2012 (retrospectively registered). https://clinicaltrials.gov/ct2/show/NCT01699646?id=NCT01699646&draw=2&rank=1.
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Affiliation(s)
- Simon Foged Victor
- Department of Obstetrics and Gynecology, Zealand University Hospital, Holbæk, Denmark.
| | - Diana Bøttcher Brøndum Bach
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - Anna Carolina Hvelplund
- Department of Pediatrics, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - Carsten Nickelsen
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - Jens Lyndrup
- Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark
| | | | - Lise Jul Scharff
- Department of Gynecology and Obstetrics, Zealand University Hospital, Roskilde, Denmark
| | - Tom Weber
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - Niels Jørgen Secher
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - Lone Krebs
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Amager and Hvidovre Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Comparing apples and oranges? Variation in choice and reporting of short-term perinatal outcomes of term labor: a systematic review of Cochrane reviews. Eur J Obstet Gynecol Reprod Biol 2022; 276:1-8. [DOI: 10.1016/j.ejogrb.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022]
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Kim SE. Mucoprotectants. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2022. [DOI: 10.7704/kjhugr.2021.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Poinas AC, Padgett K, Heus RD, Perrotin F, Devlieger R. Oral misoprostol tablets (25 µg) for induction of labor: a targeted literature review and cost analysis. J Med Econ 2022; 25:428-436. [PMID: 35297743 DOI: 10.1080/13696998.2022.2053432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Various methods exist for the induction of labor (IOL), and there is limited consensus as to optimal methods. Off-label misoprostol is recommended by the World Health Organization (WHO) for IOL but preparing it into doses suitable for IOL lacks precision, with potential adverse outcomes if dosing is inaccurate. This study explores potential outcomes and costs associated with increased uptake of a low-dose (25 µg) oral misoprostol formulation (Angusta; Norgine BV, Amsterdam) approved for IOL, in France, Belgium, and the Netherlands. METHODS A literature review was undertaken to derive probabilities of delivery outcomes (vaginal, instrumental, and cesarean sections) for IOL methods, from published meta-analyses. Outcomes for oral misoprostol tablets (25 µg) were unavailable in the meta-analyses, so were estimated using data from two published retrospective cohort studies. A model was developed to predict the frequency of IOL outcomes and associated costs at the national level, across multiple scenarios. Scenarios were tested using a moderate, medium, and high increase in oral misoprostol tablet (25 µg) uptake. Market shares, costs, and induction rates were defined for each country using multiple data sources. RESULTS Increased uptake of oral misoprostol tablets (25 µg) was estimated to be associated with a slightly increased rate of routine vaginal deliveries, and concurrent decreases in instrumental vaginal deliveries and cesarean sections. Since routine vaginal deliveries are less costly than other delivery outcomes, increased uptake of oral misoprostol tablets (25 µg) within the IOL market has the potential to be cost-saving. These trends were predicted using 25 µg oral misoprostol tablet outcomes informed by both retrospective studies. CONCLUSION Preliminary outcomes suggest that oral misoprostol tablets at 25 µg per dose may improve outcomes in IOL and be cost-saving. Further study is required to validate these findings and assess the comparative efficacy of IOL methods, including oral misoprostol tablets (25 µg).
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Affiliation(s)
| | | | - Roel de Heus
- Department of Obstetrics and Gynaecology, St. Antonius Hospital, Utrecht, Netherlands
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9
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Roloff K, Nalbandyan K, Cao S, Okekpe CC, Dombrovsky I, Valenzuela GJ. Outpatient Cervical Ripening With Misoprostol in Low-Risk Pregnancies. Cureus 2021; 13:e19817. [PMID: 34956796 PMCID: PMC8694755 DOI: 10.7759/cureus.19817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/05/2022] Open
Abstract
Objective To determine if outpatient cervical ripening with daily misoprostol can reduce admission to delivery time in women with low-risk pregnancies at 39 or more weeks of gestation. Study design This is a retrospective cohort study of a convenience sample of low-risk pregnancies that underwent elective outpatient cervical ripening compared to matched controls for parity (nulliparous vs. parous) and gestational age. Time from admission to delivery, induction agents, presence of tachysystole, mode of delivery, length of hospitalization, neonatal intensive care unit (NICU) admission, and low Apgar scores were compared. Results Fifty-six patients who underwent outpatient cervical ripening with daily dosing of misoprostol were compared to 56 patients matched for parity and gestational weeks who underwent inpatient cervical ripening/induction of labor with misoprostol. We found the time from admission to delivery in the outpatient cervical ripening cohort was significantly lesser than the inpatient cohort (17.5 ± 11.5 hours outpatient vs. 26.6 ± 15.6 hours inpatient, P=0.001). More patients (N=18, 32%) were able to deliver within 12 hours of admission in the outpatient induction group compared to the inpatient group (N=8, 11%, P=0.010). There were no differences in frequency of cesarean delivery, uterine tachysystole with or without fetal heart rate changes, NICU admission, low Apgar scores, or low umbilical artery pH values between the two groups. Conclusion Outpatient cervical ripening with misoprostol may be a feasible alternative to inpatient cervical ripening in low-risk pregnancies, may help improve patient experience, and reduce the operational burden that elective induction confers upon labor and delivery units.
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Affiliation(s)
- Kristina Roloff
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, USA
| | - Kristina Nalbandyan
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, USA
| | - Suzanne Cao
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, USA
| | - C Camille Okekpe
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, USA
| | - Inessa Dombrovsky
- Department of Women's Health, Arrowhead Regional Medical Center, Colton, USA
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Chow R, Li A, Wu N, Martin M, Wessels JM, Foster WG. Quality appraisal of systematic reviews on methods of labour induction: a systematic review. Arch Gynecol Obstet 2021; 304:1417-1426. [PMID: 34495378 DOI: 10.1007/s00404-021-06228-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Induction of labour has become more common over the last decade, together with an increase in the number of systematic reviews of the subject. However, with multiple systematic reviews it is necessary to evaluate the methodological rigor to ensure the reliability of conclusions and recommendations for clinical practice. Therefore, the aim of this study was to appraise the quality of systematic reviews that examined the efficacy and/or safety of labour induction methods. METHODS An electronic search of MEDLINE, Embase, and the Cochrane Library from 2000 to 2020 was conducted. Study selection, data extraction and quality assessment were conducted using A Measurement Tool to Assess Systematic Reviews (AMSTAR) by two independent reviewers, in duplicate. RESULTS The search identified 387 publications, of which 48 studies (13%) met the a priori inclusion criteria. No significant relationships were found between study quality and number of citations, journal impact factor, or publication year. CONCLUSION Methodological quality for systematic reviews on the induction of labour were ranked as moderate with no significant changes in quality over the past 2 decades. Publication characteristics are not significantly associated with methodological quality, indicating that healthcare professionals should critically appraise studies before applying them to practice.
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Affiliation(s)
- Ryan Chow
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1N 6N5, Canada.,Department of Obstetrics and Gynecology, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Allen Li
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1N 6N5, Canada
| | - Nicole Wu
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Morgan Martin
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Jocelyn M Wessels
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Warren G Foster
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
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Kehl S, Hösli I, Pecks U, Reif P, Schild RL, Schmidt M, Schmitz D, Schwarz C, Surbek D, Abou-Dakn M. Induction of Labour. Guideline of the DGGG, OEGGG and SGGG (S2k, AWMF Registry No. 015-088, December 2020). Geburtshilfe Frauenheilkd 2021; 81:870-895. [PMID: 34393254 DOI: 10.1055/a-1519-7713] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 01/17/2023] Open
Abstract
Aim The aim of this official guideline published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG) in cooperation with the Austrian Society of Gynaecology and Obstetrics (OEGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG) is to provide a consensus-based overview of the indications, methods and general management of induction of labour by evaluating the relevant literature. Methods This S2k guideline was developed using a structured consensus process which included representative members from various professions; the guideline was commissioned by the guidelines commission of the DGGG, OEGGG and SGGG. Recommendations The guideline provides recommendations on the indications, management, methods, monitoring and special situations occurring in the context of inducing labour.
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Affiliation(s)
- Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Irene Hösli
- Frauenklinik, Universitätsspital Basel, Basel, Switzerland
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Philipp Reif
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Graz, Graz, Austria
| | - Ralf L Schild
- Klinik für Geburtshilfe und Perinatalmedizin, Diakovere Krankenhaus gGmbH, Hannover, Germany
| | - Markus Schmidt
- Frauenheilkunde und Geburtshilfe, Sana Kliniken Duisburg, Duisburg, Germany
| | - Dagmar Schmitz
- Institut für Geschichte, Theorie und Ethik der Medizin, Uniklinik RWTH Aachen, Aachen, Germany
| | - Christiane Schwarz
- Fachbereich Hebammenwissenschaft, Institut für Gesundheitswissenschaften, Universität zu Lübeck, Lübeck, Germany
| | - Daniel Surbek
- Frauenklinik, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | - Michael Abou-Dakn
- Klinik für Gynäkologie, St. Joseph Krankenhaus, Berlin Tempelhof, Berlin, Germany
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Stock SJ, Bhide A, Richardson H, Black M, Yuill C, Harkness M, Reid M, Wee F, Cheyne H, McCourt C, Rana D, Boyd KA, Sanders J, Heera N, Huddleston J, Denison F, Pasupathy D, Modi N, Smith G, Norrie J. Cervical ripening at home or in-hospital-prospective cohort study and process evaluation (CHOICE) study: a protocol. BMJ Open 2021; 11:e050452. [PMID: 33947741 PMCID: PMC8098973 DOI: 10.1136/bmjopen-2021-050452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The aim of the cervical ripening at home or in-hospital-prospective cohort study and process evaluation (CHOICE) study is to compare home versus in-hospital cervical ripening to determine whether home cervical ripening is safe (for the primary outcome of neonatal unit (NNU) admission), acceptable to women and cost-effective from the perspective of both women and the National Health Service (NHS). METHODS AND ANALYSIS We will perform a prospective multicentre observational cohort study with an internal pilot phase. We will obtain data from electronic health records from at least 14 maternity units offering only in-hospital cervical ripening and 12 offering dinoprostone home cervical ripening. We will also conduct a cost-effectiveness analysis and a mixed methods study to evaluate processes and women/partner experiences. Our primary sample size is 8533 women with singleton pregnancies undergoing induction of labour (IOL) at 39+0 weeks' gestation or more. To achieve this and contextualise our findings, we will collect data relating to a cohort of approximately 41 000 women undergoing IOL after 37 weeks. We will use mixed effects logistic regression for the non-inferiority comparison of NNU admission and propensity score matched adjustment to control for treatment indication bias. The economic analysis will be undertaken from the perspective of the NHS and Personal Social Services (PSS) and the pregnant woman. It will include a within-study cost-effectiveness analysis and a lifetime cost-utility analysis to account for any long-term impacts of the cervical ripening strategies. Outcomes will be reported as incremental cost per NNU admission avoided and incremental cost per quality adjusted life year gained. RESEARCH ETHICS APPROVAL AND DISSEMINATION CHOICE has been funded and approved by the National Institute of Healthcare Research Health Technology and Assessment, and the results will be disseminated via publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN32652461.
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Affiliation(s)
- Sarah Jane Stock
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Amarnath Bhide
- Obstetrics and Gynaecology, St George's University Hospitals Trust, London, UK
| | - Heather Richardson
- Women and Children's Health, NHS Lothian University Hospitals Division, Edinburgh, UK
| | - Mairead Black
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Cassandra Yuill
- Centre for Maternal & Child Health Research, School of Health Sciences, City University of London, London, UK
| | - Mairi Harkness
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP), University of Stirling, Stirling, UK
| | - Maggie Reid
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Fiona Wee
- Edinburgh Clinical Trials Unit (ECTU) Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP), University of Stirling, Stirling, UK
| | - Christine McCourt
- Centre for Maternal & Child Health Research, School of Health Sciences, City University of London, London, UK
| | - Dikshyanta Rana
- Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | | | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Neelam Heera
- Patient and Public Involvement Representative, Edinburgh, UK
| | - Jane Huddleston
- Patient and Public Involvement Representative, Edinburgh, UK
| | - Fiona Denison
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Dharmintra Pasupathy
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Neena Modi
- Department of Medicine, Imperial College London, London, UK
| | - Gordon Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit (ECTU) Usher Institute, University of Edinburgh, Edinburgh, UK
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Harkness M, Yuill C, Cheyne H, Stock SJ, McCourt C. Induction of labour during the COVID-19 pandemic: a national survey of impact on practice in the UK. BMC Pregnancy Childbirth 2021; 21:310. [PMID: 33874913 PMCID: PMC8054234 DOI: 10.1186/s12884-021-03781-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Induction of labour (IOL) is one of the most commonly performed interventions in maternity care, with outpatient cervical ripening increasingly offered as an option for women undergoing IOL. The COVID-19 pandemic has changed the context of practice and the option of returning home for cervical ripening may now assume greater significance. This work aimed to examine whether and how the COVID-19 pandemic has changed practice around IOL in the UK. METHOD We used an online questionnaire to survey senior obstetricians and midwives at all 156 UK NHS Trusts and Boards that currently offer maternity services. Responses were analysed to produce descriptive statistics, with free text responses analysed using a conventional content analysis approach. FINDINGS Responses were received from 92 of 156 UK Trusts and Boards, a 59% response rate. Many Trusts and Boards reported no change to their IOL practice, however 23% reported change in methods used for cervical ripening; 28% a change in criteria for home cervical ripening; 28% stated that more women were returning home during cervical ripening; and 24% noted changes to women's response to recommendations for IOL. Much of the change was reported as happening in response to attempts to minimise hospital attendance and restrictions on birth partners accompanying women. CONCLUSIONS The pandemic has changed practice around induction of labour, although this varied significantly between NHS Trusts and Boards. There is a lack of formal evidence to support decision-making around outpatient cervical ripening: the basis on which changes were implemented and what evidence was used to inform decisions is not clear.
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Affiliation(s)
- M Harkness
- Nursing Midwifery and Allied Health Professionals Research Unit (NMHAP-RU), University of Stirling, Pathfoot Building, Stirling, FK9 4NF, UK.
| | - C Yuill
- Centre for Maternal and Child Health Sciences, School of Health Sciences, City, University of London, 1 Myddleton Street, London, EC1R 1UB, UK
| | - H Cheyne
- Nursing Midwifery and Allied Health Professionals Research Unit (NMHAP-RU), University of Stirling, Pathfoot Building, Stirling, FK9 4NF, UK
| | - S J Stock
- Usher Institute, University of Edinburgh NINE Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
- MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - C McCourt
- Centre for Maternal and Child Health Sciences, School of Health Sciences, City, University of London, 1 Myddleton Street, London, EC1R 1UB, UK
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A Tribute to Nancy C. Chescheir, MD. Obstet Gynecol 2021; 137:1-2. [PMID: 33278282 DOI: 10.1097/aog.0000000000004215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rath W, Stelzl P, Kehl S. Outpatient Induction of Labor - Are Balloon Catheters an Appropriate Method? Geburtshilfe Frauenheilkd 2021; 81:70-80. [PMID: 33487667 PMCID: PMC7815336 DOI: 10.1055/a-1308-2341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/06/2020] [Indexed: 12/22/2022] Open
Abstract
As the number of labor inductions in high-income countries has steadily risen, hospital costs and the additional burden on obstetric staff have also increased. Outpatient induction of labor is therefore becoming increasingly important. It has been estimated that 20 – 50% of all pregnant women requiring induction would be eligible for outpatient induction. The use of balloon catheters in patients with an unripe cervix has been shown to be an effective and safe method of cervical priming. Balloon catheters are as effective as the vaginal administration of prostaglandin E
2
or oral misoprostol. The advantage of using a balloon catheter is that it avoids uterine hyperstimulation and monitoring is less expensive. This makes balloon catheters a suitable option for outpatient cervical ripening. Admittedly, intravenous administration of oxytocin to induce or augment labor is required in approximately 75% of cases. Balloon catheters are not associated with a higher risk
of maternal and neonatal infection compared to vaginal PGE
2
. Low-risk pregnancies (e.g., post-term pregnancies, gestational diabetes) are suitable for outpatient cervical ripening with a balloon catheter. The data for high-risk pregnancies are still insufficient. The following conditions are recommended when considering an outpatient approach: strict selection of appropriate patients (singleton pregnancy, cephalic presentation, intact membranes), CTG monitoring for 20 – 40 minutes after balloon placement, the patient must be given detailed instructions about the indications for immediate readmission to hospital, and 24-hour phone access to the hospital must be ensured. According to reviewed studies, the balloon catheter remained in place between 12 hours (“overnight”) and 24 hours. The most common reason for readmission to hospital was expulsion of the balloon catheter. The advantages of outpatient versus inpatient induction of cervical ripening with a balloon
catheter were the significantly shorter hospital stay, the lower costs, and higher patient satisfaction, with both procedures having been shown to be equally effective. Complication rates (e.g., vaginal bleeding, severe pain, uterine hyperstimulation syndrome) during the cervical ripening phase are low (0.3 – 1.5%); severe adverse outcomes (e.g., placental abruption) have not been reported. Compared to inpatient induction of labor using vaginal PGE
2
, outpatient cervical ripening using a balloon catheter had a lower rate of deliveries/24 hours and a significantly higher need for oxytocin; however, hospital stay was significantly shorter, frequency of pain during the cervical ripening phase was significantly lower, and patientsʼ duration of sleep was longer. A randomized controlled study comparing outpatient cervical priming with a balloon catheter with outpatient or inpatient induction of labor with oral misoprostol would be of clinical interest.
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Affiliation(s)
- Werner Rath
- Medizinische Fakultät, Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Patrick Stelzl
- Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz, Austria
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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Alfirevic Z, Gyte GM, Nogueira Pileggi V, Plachcinski R, Osoti AO, Finucane EM. Home versus inpatient induction of labour for improving birth outcomes. Cochrane Database Syst Rev 2020; 8:CD007372. [PMID: 32852803 PMCID: PMC8094591 DOI: 10.1002/14651858.cd007372.pub4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The setting in which induction of labour takes place (home or inpatient) is likely to have implications for safety, women's experiences and costs. Home induction may be started at home with the subsequent active phase of labour happening either at home or in a healthcare facility (hospital, birth centre, midwifery-led unit). More commonly, home induction starts in a healthcare facility, then the woman goes home to await the start of labour. Inpatient induction takes place in a healthcare facility where the woman stays while awaiting the start of labour. OBJECTIVES To assess the effects on neonatal and maternal outcomes of third trimester home induction of labour compared with inpatient induction using the same method of induction. SEARCH METHODS For this update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (31 January 2020)), and reference lists of retrieved studies. SELECTION CRITERIA Published and unpublished randomised controlled trials (RCTs) in which home and inpatient settings for induction have been compared. We included conference abstracts but excluded quasi-randomised trials and cross-over studies. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study reports for inclusion. Two review authors carried out data extraction and assessment of risk of bias independently. GRADE assessments were checked by a third review author. MAIN RESULTS We included seven RCTs, six of which provided data on 1610 women and their babies. Studies were undertaken between 1998 and 2015, and all were in high- or upper-middle income countries. Most women were induced for post dates. Three studies reported government funding, one reported no funding and three did not report on their funding source. Most GRADE assessments gave very low-certainty evidence, downgrading mostly for high risk of bias and serious imprecision. 1. Home compared to inpatient induction with vaginal prostaglandin E (PGE) (two RCTs, 1028 women and babies; 1022 providing data). Although women's satisfaction may be slightly better in home settings, the evidence is very uncertain (mean difference (MD) 0.16, 95% confidence interval (CI) -0.02 to 0.34, 1 study, 399 women), very low-certainty evidence. There may be little or no difference between home and inpatient induction for other primary outcomes, with all evidence being very low certainty: - spontaneous vaginal birth (average risk ratio (RR) [aRR] 0.91, 95% CI 0.69 to 1.21, 2 studies, 1022 women, random-effects method); - uterine hyperstimulation (RR 1.19, 95% CI 0.40 to 3.50, 1 study, 821 women); - caesarean birth (RR 1.01, 95% CI 0.81 to 1.28, 2 studies, 1022 women); - neonatal infection (RR 1.29, 95% CI 0.59 to 2.82, 1 study, 821 babies); - admission to neonatal intensive care unit (NICU) (RR 1.20, 95% CI 0.50 to 2.90, 2 studies, 1022 babies). Studies did not report serious neonatal morbidity or mortality. 2. Home compared to inpatient induction with controlled release PGE (one RCT, 299 women and babies providing data). There was no information on whether the questionnaire on women's satisfaction with care used a validated instrument, but the findings presented showed no overall difference in scores. We found little or no difference between the groups for other primary outcomes, all also being very low-certainty evidence: - spontaneous vaginal birth (RR 0.94, 95% CI 0.77 to 1.14, 1 study, 299 women); - uterine hyperstimulation (RR 1.01, 95% CI 0.51 to 1.98, 1 study, 299 women); - caesarean births (RR 0.95, 95% CI 0.64 to 1.42, 1 study, 299 women); - admission to NICU (RR 1.38, 0.57 to 3.34, 1 study, 299 babies). The study did not report on neonatal infection nor serious neonatal morbidity or mortality. 3. Home compared to inpatient induction with balloon or Foley catheter (four RCTs; three studies, 289 women and babies providing data). It was again unclear whether questionnaires reporting women's experiences/satisfaction with care were validated instruments, with one study (48 women, 69% response rate) finding women were similarly satisfied. Home inductions may reduce the number of caesarean births, but the data are also compatible with a slight increase and are of very low-certainty (RR 0.64, 95% CI 0.41 to 1.01, 2 studies, 159 women). There was little or no difference between the groups for other primary outcomes with all being very low-certainty evidence: - spontaneous vaginal birth (RR 1.04, 95% CI 0.54 to 1.98, 1 study, 48 women): - uterine hyperstimulation (RR 0.45, 95% CI 0.03 to 6.79, 1 study, 48 women); - admission to NICU (RR 0.37, 95% CI 0.07 to 1.86, 2 studies, 159 babies). There were no serious neonatal infections nor serious neonatal morbidity or mortality in the one study (involving 48 babies) assessing these outcomes. AUTHORS' CONCLUSIONS Data on the effectiveness, safety and women's experiences of home versus inpatient induction of labour are limited and of very low-certainty. Given that serious adverse events are likely to be extremely rare, the safety data are more likely to come from very large observational cohort studies rather than relatively small RCTs.
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Affiliation(s)
- Zarko Alfirevic
- Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Gillian Ml Gyte
- Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Vicky Nogueira Pileggi
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Rachel Plachcinski
- C/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Alfred O Osoti
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
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Intracervical Foley Catheter Plus Intravaginal Misoprostol vs Intravaginal Misoprostol Alone for Cervical Ripening: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061825. [PMID: 32168947 PMCID: PMC7143495 DOI: 10.3390/ijerph17061825] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/29/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023]
Abstract
Currently, there is no meta-analysis comparing intravaginal misoprostol plus intracervical Foley catheter versus intravaginal misoprostol alone for term pregnancy without identifying risk factors. Therefore, the purpose of this study is to conduct a systematic review and meta-analysis of randomized control trials (RCTs) comparing concurrent intravaginal misoprostol and intracervical Foley catheter versus intravaginal misoprostol alone for cervical ripening. We systematically searched Embase, Pubmed, and Cochrane Collaboration databases for randomized controlled trials (RCTs) comparing intracervical Foley catheter plus intravaginal misoprostol and intravaginal misoprostol alone using the search terms "Foley", "misoprostol", "cervical ripening", and "induction" up to 29 January 2019. Data were extracted and analyzed by two independent reviewers including study characteristics, induction time, cesarean section (C/S), clinical suspicion of chorioamnionitis, uterine tachysystole, meconium stain, and neonatal intensive care unit (NICU) admissions. Data was pooled using random effects modeling and calculated with risk ratio (RR) and 95% confidence interval (CI). Pooled analysis from eight studies, including 1110 women, showed that labor induction using a combination of intracervical Foley catheter and intravaginal misoprostol decreased induction time by 2.71 h (95% CI -4.33 to -1.08, p = 0.001), as well as the risk of uterine tachysystole and meconium staining (RR 0.54, 95% CI 0.30-0.99 and RR 0.48, 95% CI 0.32-0.73, respectively) significantly compared to those using intravaginal misoprostol alone. However, there was no difference in C/S rate (RR 0.93, 95% CI 0.78-1.11) or clinical suspicion of chorioamnionitis rate (RR 1.22, CI 0.58-2.57) between the two groups. Labor induction with a combination of intracervical Foley catheter and intravaginal misoprostol may be a better choice based on advantages in shortening induction time and reducing the risk of uterine tachysystole and meconium staining compared to intravaginal misoprostol alone.
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Abstract
The cervix is the essential gatekeeper for birth. Incomplete cervix remodeling contributes to problems with delivery at or post-term while preterm birth is a major factor in perinatal morbidity and mortality in newborns. Lack of cervix biopsies from women during the period preceding term or preterm birth have led to use of rodent models to advanced understanding of the mechanism for prepartum cervix remodeling. The critical transition from a soft cervix to a compliant prepartum lower uterine segment has only recently been recognized to occur in various mammalian species when progesterone in circulation is at or near the peak of pregnancy in preparation for birth. In rodents, characterization of ripening resembles an inflammatory process with a temporal coincidence of decreased density of cell nuclei, decline in cross-linked extracellular collagen, and increased presence of macrophages in the cervix. Although a role for inflammation in parturition and cervix remodeling is not a new concept, a comprehensive examination of literature in this review reveals that many conclusions are drawn from comparisons before and after ripening has occurred, not during the process. The present review focuses on essential phenotypes and functions of resident myeloid and possibly other immune cells to bridge the gap with evidence that specific biomarkers may assess the progress of ripening both at term and with preterm birth. Moreover, use of endpoints to determine the effectiveness of various therapeutic approaches to forestall remodeling and reduce risks for preterm birth, or facilitate ripening to promote parturition will improve the postpartum well-being of mothers and newborns.
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Affiliation(s)
- Steven M Yellon
- Department of Basic Sciences, Longo Center for Perinatal Biology, School of Medicine, Loma Linda University, Loma Linda, CA, United States
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Abstract
The rate of labor induction is steadily increasing and, in industrialized countries, approximately one out of four pregnant women has their labor induced. Induction of labor should be considered when the benefits of prompt vaginal delivery outweigh the maternal and/or fetal risks of waiting for the spontaneous onset of labor. However, this procedure is not free of risks, which include an increase in operative vaginal or caesarean delivery and excessive uterine activity with risk of fetal heart rate abnormalities. A search for “Induction of Labor” retrieves more than 18,000 citations from 1844 to the present day. The aim of this review is to summarize the controversies concerning the indications, the methods, and the tools for evaluating the success of the procedure, with an emphasis on the scientific evidence behind each.
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Affiliation(s)
- Anna Maria Marconi
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milano, Milano, Italy
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Smith V, Gallagher L, Carroll M, Hannon K, Begley C. Antenatal and intrapartum interventions for reducing caesarean section, promoting vaginal birth, and reducing fear of childbirth: An overview of systematic reviews. PLoS One 2019; 14:e0224313. [PMID: 31648289 PMCID: PMC6812784 DOI: 10.1371/journal.pone.0224313] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/11/2019] [Indexed: 12/16/2022] Open
Abstract
Concern has been expressed globally over rising caesarean birth rates. Recently, the International Federation of Gynaecology and Obstetrics (FIGO) called for help from governmental bodies, professional organisations, women’s groups, and other stakeholders to reduce unnecessary caesareans. As part of a wider research initiative, we conducted an overview of systematic reviews of antenatal and intrapartum interventions, and reports of evidence based recommendations, to identify and highlight those that have been shown to be effective for reducing caesarean birth, promoting vaginal birth and reducing fear of childbirth. Following registration of the review protocol, (PROSPERO 2018 CRD42018090681), we searched The Cochrane Database of Systematic Reviews, PubMed, CINAHL and EMBASE (Jan 2000-Jan 2018) and searched for grey literature in PROSPERO, and on websites of health professional and other relevant bodies. Screening and selection of reviews, quality appraisal using AMSTAR-2, and data extraction were performed independently by pairs of at least two reviewers. Excluding reviews assessed as ‘critically low’ on AMSTAR-2 (n = 54), 101 systematic reviews, and 10 reports of evidence based recommendations were included in the overview. Narrative synthesis was performed, due to heterogeneity of review methodology and topics. The results highlight twenty-five interventions, across 17 reviews, that reduced the risk of caesarean, nine interventions across eight reviews that increased the risk of caesarean, eight interventions that reduced instrumental vaginal birth, four interventions that increased spontaneous vaginal birth, and two interventions that reduced fear of childbirth. This overview of reviews identifies and highlights interventions that have been shown to be effective for reducing caesarean birth, promoting vaginal births and reducing fear of childbirth. In recognising that clinical practices change over time, this overview includes reviews published from 2000 onwards only, thus providing contemporary evidence, and a valuable resource for clinicians when making decisions on practices that should be implemented for reducing unnecessary caesarean births safely. Protocol Registration: PROSPERO 2018 CRD42018090681. Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018090681
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Affiliation(s)
- Valerie Smith
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Louise Gallagher
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Margaret Carroll
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Hannon
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Cecily Begley
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Košec V, Djaković I, Sabolović Rudman S. CERVICAL RIPENING BALLOON AS A METHOD OF PREINDUCTION - ONE CENTER STUDY. Acta Clin Croat 2018; 57:762-767. [PMID: 31168214 PMCID: PMC6544105 DOI: 10.20471/acc.2018.57.04.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
- Cervical ripening can be promoted in many ways, but mechanical methods are among the oldest. Like all other methods, this one also has its pros and cons. Disadvantages compared to pharmacological methods include some maternal discomfort upon manipulation of the cervix, a theoretical increase in the risk of maternal and neonatal infection from the introduction of a foreign body, potential disruption of a low-lying placenta, and increase in the need of oxytocin induction of labor. The aim of the study was to evaluate the effect of using cervical ripening balloon in preinduction on the mode of delivery. This was a longitudinal, cohort, intervention, non-randomized one center study. Inclusion criteria were term pregnancies with gestational diabetes, oligohydramnios, intrauterine growth restriction, gestational hypertension/preeclampsia and pregnancies after 41 weeks of pregnancy. Preinduction of labor was performed in term pregnancies at Sestre milosrdnice University Hospital Center. Results in the first 150 women having undergone labor preinduction with cervical ripening balloon were included. Two-sided p values <0.05 were considered significant. Statistical analysis was done using SPSS Version 20.0. The study included 150 women; one woman was excluded from further analyses due to conversion of fetal presentation (head to breech). Indications for labor preinduction were as follows: gestational diabetes, oligohydramnios, intrauterine growth restriction, gestational hypertension/preeclampsia and pregnancies after 41 weeks of pregnancy. Women with normal vaginal delivery (96/149) had lower rates of gestational diabetes and oligohydramnios and used epidural analgesia more frequently. Women with dystocia (32/53) had a significantly longer labor duration and higher neonatal birth weight. In multivariate analysis, multiparity, greater cervical dilatation after balloon removal and use of epidural analgesia were associated with a decreased risk of cesarean section, while the presence of gestational diabetes and oligohydramnios was associated with an increased risk of cesarean section. We found this preinduction method safe and efficient, with a potential to increase the rate of vaginal deliveries.
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Affiliation(s)
| | - Ivka Djaković
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Senka Sabolović Rudman
- Department of Gynecology and Obstetrics, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Wang Y, Boyd P, Hunter A, Malcolm RK. Intravaginal rings for continuous low-dose administration of cervical ripening agents. Int J Pharm 2018; 549:124-132. [DOI: 10.1016/j.ijpharm.2018.07.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/28/2018] [Accepted: 07/22/2018] [Indexed: 12/31/2022]
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Woeber K, Carlson NS. Current Resources for Evidence-Based Practice, January 2018. J Obstet Gynecol Neonatal Nurs 2017; 47:64-72. [PMID: 29144961 DOI: 10.1016/j.jogn.2017.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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