1
|
Sanchez-Ramos L, Levine LD, Sciscione AC, Mozurkewich EL, Ramsey PS, Adair CD, Kaunitz AM, McKinney JA. Methods for the induction of labor: efficacy and safety. Am J Obstet Gynecol 2024; 230:S669-S695. [PMID: 38462252 DOI: 10.1016/j.ajog.2023.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 03/12/2024]
Abstract
This review assessed the efficacy and safety of pharmacologic agents (prostaglandins, oxytocin, mifepristone, hyaluronidase, and nitric oxide donors) and mechanical methods (single- and double-balloon catheters, laminaria, membrane stripping, and amniotomy) and those generally considered under the rubric of complementary medicine (castor oil, nipple stimulation, sexual intercourse, herbal medicine, and acupuncture). A substantial body of published reports, including 2 large network meta-analyses, support the safety and efficacy of misoprostol (PGE1) when used for cervical ripening and labor induction. Misoprostol administered vaginally at doses of 50 μg has the highest probability of achieving vaginal delivery within 24 hours. Regardless of dosing, route, and schedule of administration, when used for cervical ripening and labor induction, prostaglandin E2 seems to have similar efficacy in decreasing cesarean delivery rates. Globally, although oxytocin represents the most widely used pharmacologic agent for labor induction, its effectiveness is highly dependent on parity and cervical status. Oxytocin is more effective than expectant management in inducing labor, and the efficacy of oxytocin is enhanced when combined with amniotomy. However, prostaglandins administered vaginally or intracervically are more effective in inducing labor than oxytocin. A single 200-mg oral tablet of mifepristone seems to represent the lowest effective dose for cervical ripening. The bulk of the literature assessing relaxin suggests this agent has limited benefit when used for this indication. Although intracervical injection of hyaluronidase may cause cervical ripening, the need for intracervical administration has limited the use of this agent. Concerning the vaginal administration of nitric oxide donors, including isosorbide mononitrate, isosorbide, nitroglycerin, and sodium nitroprusside, the higher incidence of side effects with these agents has limited their use. A synthetic hygroscopic cervical dilator has been found to be effective for preinduction cervical ripening. Although a pharmacologic agent may be administered after the use of the synthetic hygroscopic dilator, in an attempt to reduce the interval to vaginal delivery, concomitant use of mechanical and pharmacologic methods is being explored. Combining the use of a single-balloon catheter with dinoprostone, misoprostol, or oxytocin enhances the efficacy of these pharmacologic agents in cervical ripening and labor induction. The efficacy of single- and double-balloon catheters in cervical ripening and labor induction seems similar. To date, the combination of misoprostol with an intracervical catheter seems to be the best approach when balancing delivery times with safety. Although complementary methods are occasionally used by patients, given the lack of data documenting their efficacy and safety, these methods are rarely used in hospital settings.
Collapse
Affiliation(s)
- Luis Sanchez-Ramos
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL.
| | - Lisa D Levine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Anthony C Sciscione
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Christiana Hospital, Newark, DE
| | - Ellen L Mozurkewich
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM
| | - Patrick S Ramsey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, TX
| | - Charles David Adair
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN
| | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
| | - Jordan A McKinney
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
| |
Collapse
|
2
|
Baena-García L, Marín-Jiménez N, Romero-Gallardo L, Borges-Cosic M, Ocón-Hernández O, Flor-Alemany M, Aparicio VA. Association of Self-Reported Physical Fitness during Late Pregnancy with Birth Outcomes and Oxytocin Administration during Labour-The GESTAFIT Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8201. [PMID: 34360494 PMCID: PMC8346096 DOI: 10.3390/ijerph18158201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
We explored (a) the associations between self-reported maternal physical fitness and birth outcomes; (b) whether self-reported maternal physical fitness (PF) is related to the administration of oxytocin to induce or stimulate labour. Pregnant women from the GESTAFIT project randomized controlled trial (n = 117) participated in this prospective longitudinal study. Maternal physical fitness was assessed through the International Fitness Scale at the 34th gestational week. Maternal and neonatal birth outcomes and oxytocin administration were collected from the obstetric medical records. Umbilical arterial and venous cord blood gas were analysed immediately after birth. Self-reported overall fitness, cardiorespiratory fitness, muscular strength and flexibility were not related to any maternal and neonatal birth outcomes (all p > 0.05). Greater speed-agility was associated with a more alkaline arterial (p = 0.04) and venous (p = 0.02) pH in the umbilical cord blood. Women who were administered oxytocin to induce or stimulate labour reported lower cardiorespiratory fitness (p = 0.013, Cohen's d = 0.55; 95% confidence interval (CI): 0.14, 0.93) and flexibility (p = 0.040, Cohen´s d = 0.51; 95% CI: 0.09, 0.89) compared to women who were not administered oxytocin. Greater maternal physical fitness during pregnancy could be associated with better neonatal birth outcomes and lower risk of needing oxytocin administration.
Collapse
Affiliation(s)
- Laura Baena-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 51001 Ceuta, Spain;
| | - Nuria Marín-Jiménez
- Sport and Health University Research Institute (iMUDS), 18007 Granada, Spain; (L.R.-G.); (M.B.-C.); (M.F.-A.)
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
| | - Lidia Romero-Gallardo
- Sport and Health University Research Institute (iMUDS), 18007 Granada, Spain; (L.R.-G.); (M.B.-C.); (M.F.-A.)
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
| | - Milkana Borges-Cosic
- Sport and Health University Research Institute (iMUDS), 18007 Granada, Spain; (L.R.-G.); (M.B.-C.); (M.F.-A.)
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
| | - Olga Ocón-Hernández
- Gynaecology and Obstetrics Unit, ‘San Cecilio’ University Hospital, 18016 Granada, Spain;
| | - Marta Flor-Alemany
- Sport and Health University Research Institute (iMUDS), 18007 Granada, Spain; (L.R.-G.); (M.B.-C.); (M.F.-A.)
- Institute of Nutrition and Food Technology (INYTA), Biomedical Research Centre (CIBM), University of Granada, 18016 Granada, Spain;
- Department of Physiology, Faculty of Pharmacy, University of Granada, 18011 Granada, Spain
| | - Virginia A. Aparicio
- Institute of Nutrition and Food Technology (INYTA), Biomedical Research Centre (CIBM), University of Granada, 18016 Granada, Spain;
- Department of Physiology, Faculty of Pharmacy, University of Granada, 18011 Granada, Spain
| |
Collapse
|
3
|
Zhang J, Pan M, Zhan W, Zheng L, Jiang X, Xue X. Two-stage nomogram models in mid-gestation for predicting the risk of spontaneous preterm birth in twin pregnancy. Arch Gynecol Obstet 2020; 303:1439-1449. [PMID: 33201373 DOI: 10.1007/s00404-020-05872-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to develop two-stage nomogram models to predict individual risk of preterm birth at < 34 weeks of gestation in twin pregnancies by incorporating clinical characteristics at mid-gestation. METHODS We used a case-control study design of women with twin pregnancies followed up in a tertiary medical centre from January 2018 to March 2019. Maternal demographic characteristics and transvaginal cervical length data were extracted. The nomogram models were constructed with independent variables determined by multivariate logistic regression analyses. The risk score was calculated based on the nomogram models. RESULTS In total, 65 twin preterm birth cases (< 34 weeks) and 244 controls met the inclusion criteria. Based on univariate and multivariate logistic regression analyses, we built two-stage nomogram prediction models with satisfactory discrimination and calibration when applied to the validation sets (first-stage [22-24 weeks] prediction model, C-index: 0.805 and 0.870, respectively; second-stage [26-28 weeks] prediction model, C-index: 0.847 and 0.908, respectively). Restricted cubic splines graphically showed the risk of preterm birth among individuals with increased risk scores. Moreover, the decision curve analysis indicated that both prediction models show positive clinical benefit. CONCLUSION We developed and validated two-stage nomogram models at mid-gestation to predict the individual probability of preterm birth at < 34 weeks in twin pregnancy.
Collapse
Affiliation(s)
- Jun Zhang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350108, Fujian, China
| | - Mian Pan
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350108, Fujian, China.
| | - Wenqiang Zhan
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Lianghui Zheng
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350108, Fujian, China
| | - Xiaoxiang Jiang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350108, Fujian, China
| | - Xiaoying Xue
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350108, Fujian, China
| |
Collapse
|
4
|
Hong S, Park KH, Kim YM, Lee YE, Park Y, Lee JE. A Protein Microarray Analysis of Plasma Proteins for the Prediction of Spontaneous Preterm Delivery in Women with Preterm Labor. Reprod Sci 2020; 27:1187-1196. [PMID: 32046457 DOI: 10.1007/s43032-019-00114-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
We aimed to identify novel biomarkers in maternal plasma that predict spontaneous preterm delivery (SPTD) in women with preterm labor (PTL) using an antibody microarray and to develop the best prediction model for SPTD based on these biomarkers in combination with clinical and ultrasound factors. This retrospective cohort study included 215 women with singleton pregnancies and PTL (23-33 weeks) who gave plasma samples. In a nested case-control study design, plasma proteomes from SPTD (case subjects, n = 15) and term delivery (control subjects, n = 15) groups were differentially profiled using a membrane-based antibody microarray. Six candidate biomarkers of interest were validated by enzyme-linked immunosorbent assay (ELISA) in the total cohort (n = 215). Cervical lengths were also measured. The primary outcome measure was SPTD within 48 h after sampling. Twenty of the molecules studied displayed significant intergroup differences. Validation by ELISA confirmed significantly higher levels of plasma endostatin and lipopolysaccharide binding protein (LBP) in women who had SPTD within 48 h than in those delivering after 48 h. However, plasma macrophage inflammatory protein (MIP)-1α levels were significantly lower in women who delivered within 48 h. A combined model was developed to predict SPTD within 48 h using a stepwise regression procedure, which included plasma endostatin and LBP levels, nulliparity, and cervical length (area under the curve = 0.920). Plasma LBP, endostatin, and MIP-1α are potential new biomarkers for predicting imminent SPTD and a combined noninvasive model based on these biomarkers and clinical and ultrasound factors can accurately predict imminent SPTD in women with PTL.
Collapse
Affiliation(s)
- Subeen Hong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Seongnam-si, Kyeonggido, 463-707, South Korea
| | - Kyo Hoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Seongnam-si, Kyeonggido, 463-707, South Korea.
| | - Yu Mi Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Seongnam-si, Kyeonggido, 463-707, South Korea
| | - Young Eun Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Seongnam-si, Kyeonggido, 463-707, South Korea
| | - Yehyon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Seongnam-si, Kyeonggido, 463-707, South Korea
| | - Ji Eun Lee
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, South Korea
| |
Collapse
|