1
|
Gomez Slagle HB, Hoffman MK, Sciscione AC, Ma'ayeh M. Combination Foley Catheter-Oxytocin versus Oxytocin Alone following Preterm Premature Rupture of Membranes. Am J Perinatol 2024; 41:e3030-e3034. [PMID: 37793430 DOI: 10.1055/a-2185-4102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The benefit of mechanical ripening agents following preterm premature rupture of membranes (PPROM) has not been established. We sought to compare the time to delivery in women who received transcervical Foley catheter plus oxytocin infusion versus oxytocin infusion alone in patients with unfavorable cervices and PPROM. STUDY DESIGN This is a retrospective cohort study of patients presenting with PPROM of a live, singleton gestation between 240/7 and 366/7 weeks' gestation from January 2005 to October 2018 at a single, tertiary care institution. Patients with an unfavorable cervical examination (≤2-cm dilation), no contraindication to labor and undergoing labor induction were analyzed. Time to delivery was analyzed using multivariable linear regression adjusting for cervical dilation at induction and nulliparity. Bivariate and multivariate analyses were used where appropriate. RESULTS A total of 260 participants were included: 109 who received a Foley catheter and oxytocin (Foley/oxytocin) and 151 who had oxytocin alone. Demographic characteristics were similar between the two groups. Unadjusted time to delivery was significantly shorter in the oxytocin only group (Foley/oxytocin: 20.35 hours vs. oxytocin alone: 14.7 hours, p < 0.001). No differences in length of labor were detected after adjusting for cervical dilation at induction and nulliparity (p = 0.5). The unadjusted rate of cesarean delivery was higher in the combination Foley/oxytocin group (Foley/oxytocin: 16.5% vs. oxytocin alone: 7.3%, p = 0.03), but no differences were found in the adjusted analysis (p = 0.06). There were no differences in clinical chorioamnionitis rates between the two groups (Foley/oxytocin: 8.3% vs. oxytocin alone: 9.3%, p = 0.83). Furthermore, no significant differences were found in maternal and neonatal outcomes between the two groups. CONCLUSION In patients with PROM, the use of a transcervical Foley catheter in addition to oxytocin is not associated with a shorter time to delivery compared with oxytocin alone. KEY POINTS · Transcervical Foley catheter did not shorten length of labor in PPROM.. · Transcervical Foley catheter did not increase infection risk.. · Pitocin alone can be used in PPROM population..
Collapse
Affiliation(s)
- Helen B Gomez Slagle
- Division of Maternal Fetal Medicine, Columbia University Irving Medical Center, New York, New York
| | - Matthew K Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
| | - Anthony C Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
- Department of Maternal-Fetal Medicine, Delaware Center for Maternal Fetal Medicine, Newark, Delaware
| | - Marwan Ma'ayeh
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
- Department of Maternal-Fetal Medicine, Delaware Center for Maternal Fetal Medicine, Newark, Delaware
| |
Collapse
|
2
|
Bridges AG, Allshouse AA, Canfield DR, Grover BW, Son SL, Einerson BD, Silver RM, Haas DM, Grobman WA, Simhan HN, Day RC, Blue NR. Association of Prostaglandin Use for Cervical Ripening with Mode of Delivery in Small for Gestational Age versus Non-Small for Gestational Age Neonates. Am J Perinatol 2024; 41:e456-e464. [PMID: 35863371 DOI: 10.1055/a-1906-8919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Prostaglandins (PGs) use for cervical ripening with small for gestational age (SGA) fetuses is controversial since it remains uncertain if use increases the chance of cesarean delivery (CD). We aimed to assess the association between PG use for cervical ripening and mode of delivery between SGA and appropriate for gestational age (AGA) neonates. STUDY DESIGN Secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), a prospective observational cohort study of 10,038 nulliparas. We included women undergoing induction with nonanomalous fetuses in the cephalic presentation. Women with >2 cm cervical dilation or prior uterine scar were excluded. We assessed the association of PG use with CD among women with SGA and AGA neonates. SGA was defined as birth weight <10th percentile for gestational age and sex. Multivariable logistic regression was used to adjust for potential confounders and test for interaction. Secondary outcomes included adverse neonatal outcomes, indication for CD, maternal hemorrhage, and chorioamnionitis. RESULTS Among 2,353 women eligible, PGs were used in 54.8%, SGA occurred in 15.1%, and 35.0% had CD. The association between PG use and CD differed significantly (interaction p = 0.018) for SGA versus AGA neonates; CD occurred more often in SGA neonates exposed to PGs than not (35 vs. 22%, p = 0.009). PG use was not associated with CD among AGA neonates (36 vs. 36%, p = 0.8). This effect remained significant when adjusting for body mass index, race/ethnicity, and cervical dilation. Among SGA neonates, CD for "nonreassuring fetal status" was similar between PG groups. Among SGA neonates, PG use was not associated with adverse neonatal outcomes or postpartum hemorrhage but had a higher rate of chorioamnionitis (7.0 vs. 2.1%, p = 0.048). CONCLUSION PG use was associated with a higher rate of CD in SGA but not AGA neonates; however, further studies are needed before PG use is discouraged with SGA neonates. KEY POINTS · PGs are commonly used for cervical ripening.. · PG use was associated with increased risk of cesarean delivery in SGA neonates.. · PG use was not associated with adverse neonatal outcomes..
Collapse
Affiliation(s)
- Alexis G Bridges
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
- Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
| | - Amanda A Allshouse
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Dana R Canfield
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
- Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
| | - Bryan W Grover
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Shannon L Son
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
- Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
| | - Brett D Einerson
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
- Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
- Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana
| | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Hyagriv N Simhan
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert C Day
- Department of Obstetrics and Gynecology, University of California-Irvine, Irvine, California
| | - Nathan R Blue
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
- Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
| |
Collapse
|
3
|
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
|
4
|
PoorHosseini SA, Mirteimouri M, RakhshaniFar M, Mousavi Vahed SH, Haghollahi F. Comparison of Misoprostol with Foley Catheter vs Misoprostol alone for Cervical Ripening and Induction of Labor in Patients with Premature Rupture of Membrane: A Randomized Clinical Trial Study. Adv Biomed Res 2024; 13:18. [PMID: 38525402 PMCID: PMC10958730 DOI: 10.4103/abr.abr_78_23] [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] [Received: 02/26/2023] [Revised: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 03/26/2024] Open
Abstract
Background This study evaluates the effect of misoprostol alone in comparison with misoprostol with Foley catheter in preparing the cervix for induction of labor in women with premature rupture of the amniotic sac. Materials and Methods This randomized clinical trial study was performed from 2017 to 2019 on 206 pregnant women with singleton pregnancy and gestational age more than 36 weeks, whose rupture of the amniotic sac had occurred less than 12 hours and had a Bishop score less than 4. These women were randomly assigned to two groups of Foley catheters with misoprostol (intervention group, P = 103) or misoprostol alone (control group, P = 103) to induce labor. In both groups, sublingual misoprostol (25 micrograms) was administered at intervals of 4-6 hours. The collected data were analyzed by SPSS.21 software. Results There is no significant difference between age and Bishop score in the two groups (P = 0.19, P = 0.31, respectively). Lower doses (0 to 3) of misoprostol were used in the intervention group versus 0 to 5 doses in the control group (P = 0.001). Delivery time was shorter in the intervention group (10.83 hours vs. 13.10 hours in the control group, P = 0.001). Also, the probability of complications such as fever, tachysystole, and hospitalization of an infant in the neonatal intensive care unit (NICU) did not increase. Conclusion An intracervical Foley catheter with misoprostol is more effective in inducing labor in pregnancies with premature rupture of the membranes than using misoprostol alone and can be a safe and effective option.
Collapse
Affiliation(s)
- Seyyedeh Azam PoorHosseini
- Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Mirteimouri
- Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maliheh RakhshaniFar
- Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyede Houra Mousavi Vahed
- Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fedyeh Haghollahi
- Vali-E- Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Zambrano Guevara LM, Buckheit C, Kuller JA, Gray B, Dotters-Katz S. Evidence Based Management of Labor. Obstet Gynecol Surv 2024; 79:39-53. [PMID: 38306291 DOI: 10.1097/ogx.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
Importance Induction of labor (IOL) is a common obstetric intervention. Augmentation of labor and active management of the second stage is frequently required in obstetric practice. However, techniques around labor and induction management vary widely. Evidence-based practice regarding induction and labor management can reduce birth complications such as infection and hemorrhage and decrease rates of cesarean delivery. Objective To review existing evidence on IOL and labor management strategies with respect to preparing for induction, cervical ripening, induction and augmentation, and second stage of labor techniques. Evidence acquisition Review of recent original research, review articles, and guidelines on IOL using PubMed (2000-2022). Results Preinduction, pelvic floor training and perineal massage reduce postpartum urinary incontinence and perineal trauma, respectively. Timely membrane sweeping (38 weeks) can promote spontaneous labor and prevent postterm inductions. Outpatient Foley bulb placement in low-risk nulliparous patients with planned IOL reduces time to delivery. Inpatient Foley bulb use beyond 6 to 12 hours shows no benefit. When synthetic prostaglandins are indicated, vaginal misoprostol should be preferred. For nulliparous patients and those with obesity, oxytocin should be titrated using a high-dose protocol. Once cervical dilation is complete, pushing should begin immediately. Warm compresses and perineal massage decrease risk of perineal trauma. Conclusion and relevance Several strategies exist to assist in successful IOL and promote vaginal delivery. Evidence-based strategies should be used to improve outcomes and decrease risk of complications and cesarean delivery. Recommendations should be shared across interdisciplinary team members, creating a model that promotes safe patient care.
Collapse
Affiliation(s)
- Linda M Zambrano Guevara
- Resident, New York University Langone Health, Department of Obstetrics and Gynecology, New York, NY
| | - Caledonia Buckheit
- Former Resident, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC; Physician, Kamm McKenzie OBGYN, Raleigh, NC
| | | | - Beverly Gray
- Associate Professor, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Sarah Dotters-Katz
- Associate Professor, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| |
Collapse
|
6
|
de Vaan MD, Ten Eikelder ML, Jozwiak M, Palmer KR, Davies-Tuck M, Bloemenkamp KW, Mol BWJ, Boulvain M. Mechanical methods for induction of labour. Cochrane Database Syst Rev 2023; 3:CD001233. [PMID: 36996264 PMCID: PMC10061553 DOI: 10.1002/14651858.cd001233.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND Mechanical methods were the first methods developed to ripen the cervix and induce labour. During recent decades they have been substituted by pharmacological methods. Potential advantages of mechanical methods, compared with pharmacological methods may include reduction in side effects that could improve neonatal outcomes. This is an update of a review first published in 2001, last updated in 2012. OBJECTIVES To determine the effectiveness and safety of mechanical methods for third trimester (> 24 weeks' gestation) induction of labour in comparison with prostaglandin E2 (PGE2) (vaginal and intracervical), low-dose misoprostol (oral and vaginal), amniotomy or oxytocin. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies (9 January 2018). We updated the search in March 2019 and added the search results to the awaiting classification section of the review. SELECTION CRITERIA Clinical trials comparing mechanical methods used for third trimester cervical ripening or labour induction with pharmacological methods. Mechanical methods include: (1) the introduction of a catheter through the cervix into the extra-amniotic space with balloon insufflation; (2) introduction of laminaria tents, or their synthetic equivalent (Dilapan), into the cervical canal; (3) use of a catheter to inject fluid into the extra-amniotic space (EASI). This review includes the following comparisons: (1) specific mechanical methods (balloon catheter, laminaria tents or EASI) compared with prostaglandins (different types, different routes) or with oxytocin; (2) single balloon compared to a double balloon; (3) addition of prostaglandins or oxytocin to mechanical methods compared with prostaglandins or oxytocin alone. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and assessed risk of bias. Two review authors independently extracted data and assessed the quality of the evidence using the GRADE approach. MAIN RESULTS This review includes a total of 112 trials, with 104 studies contributing data (22,055 women; 21 comparisons). Risk of bias of trials varied. Overall, the evidence was graded from very-low to moderate quality. All evidence was downgraded for lack of blinding and, for many comparisons, the effect estimates were too imprecise to make a valid judgement. Balloon versus vaginal PGE2: there may be little or no difference in vaginal deliveries not achieved within 24 hours (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.82 to 1.26; 7 studies; 1685 women; low-quality evidence) and there probably is little or no difference in caesarean sections (RR 1.00, 95% CI 0.92 to 1.09; 28 studies; 6619 women; moderate-quality evidence) between induction of labour with a balloon catheter and vaginal PGE2. A balloon catheter probably reduces the risk of uterine hyperstimulation with fetal heart rate (FHR) changes (RR 0.35, 95% CI 0.18 to 0.67; 6 studies; 1966 women; moderate-quality evidence), serious neonatal morbidity or perinatal death (RR 0.48, 95% CI 0.25 to 0.93; 8 studies; 2757 women; moderate-quality evidence) and may slightly reduce the risk of aneonatal intensive care unit (NICU) admission (RR 0.82, 95% CI 0.65 to 1.04; 3647 women; 12 studies; low-quality evidence). It is uncertain whether there is a difference in serious maternal morbidity or death (RR 0.20, 95% CI 0.01 to 4.12; 4 studies; 1481 women) or five-minute Apgar score < 7 (RR 0.74, 95% CI 0.49 to 1.14; 4271 women; 14 studies) because the quality of the evidence was found to be very low and low, respectively. Balloon versus low-dose vaginal misoprostol: it is uncertain whether there is a difference in vaginal deliveries not achieved within 24 hours between induction of labour with a balloon catheter and vaginal misoprostol (RR 1.09, 95% CI 0.85 to 1.39; 340 women; 2 studies; low-quality evidence). A balloon catheter probably reduces the risk of uterine hyperstimulation with FHR changes (RR 0.39, 95% CI 0.18 to 0.85; 1322 women; 8 studies; moderate-quality evidence) but may increase the risk of a caesarean section (RR 1.28, 95% CI 1.02 to 1.60; 1756 women; 12 studies; low-quality evidence). It is uncertain whether there is a difference in serious neonatal morbidity or perinatal death (RR 0.58, 95% CI 0.12 to 2.66; 381 women; 3 studies), serious maternal morbidity or death (no events; 4 studies, 464 women), both very low-quality evidence, and five-minute Apgar score < 7 (RR 1.00, 95% CI 0.50 to 1.97; 941 women; 7 studies) and NICU admissions (RR 1.00, 95% CI 0.61 to 1.63; 1302 women; 9 studies) both low-quality evidence. Balloon versus low-dose oral misoprostol: a balloon catheter probably increases the risk of a vaginal delivery not achieved within 24 hours (RR 1.28, 95% CI 1.13 to 1.46; 782 women, 2 studies, and probably slightly increases the risk of a caesarean section (RR 1.17, 95% CI 1.04 to 1.32; 3178 women; 7 studies; both moderate-quality evidence) when compared to oral misoprostol. It is uncertain whether there is a difference in uterine hyperstimulation with FHR changes (RR 0.81, 95% CI 0.48 to 1.38; 2033 women; 2 studies), serious neonatal morbidity or perinatal death (RR 1.11, 95% CI 0.60 to 2.06; 2627 women; 3 studies), both low-quality evidence, serious maternal morbidity or death (RR 0.50, 95% CI 0.05 to 5.52; 2627 women; 3 studies), very low-quality evidence, five-minute Apgar scores < 7 (RR 0.71, 95% CI 0.38 to 1.32; 2693 women; 4 studies) and NICU admissions (RR 0.82, 95% CI 0.58 to 1.17; 2873 women; 5 studies) both low-quality evidence. AUTHORS' CONCLUSIONS Low- to moderate-quality evidence shows mechanical induction with a balloon is probably as effective as induction of labour with vaginal PGE2. However, a balloon seems to have a more favourable safety profile. More research on this comparison does not seem warranted. Moderate-quality evidence shows a balloon catheter may be slightly less effective as oral misoprostol, but it remains unclear if there is a difference in safety outcomes for the neonate. When compared to low-dose vaginal misoprostol, low-quality evidence shows a balloon may be less effective, but probably has a better safety profile. Future research could be focused more on safety aspects for the neonate and maternal satisfaction.
Collapse
Affiliation(s)
- Marieke Dt de Vaan
- Department of Obstetrics, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
- Department of Health Care Studies, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Mieke Lg Ten Eikelder
- Department of Obstetrics and Gynaecology, Royal Cornwall Hospital NHS Trust, Truro, UK
| | | | - Kirsten R Palmer
- Department of Obstetrics and Gynaecology, Monash Health and Monash University, Clayton, Australia
| | | | - Kitty Wm Bloemenkamp
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Michel Boulvain
- Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- UZ Brussel, VUB, Brussels, Belgium
| |
Collapse
|
7
|
Evaluation of mechanical and nonmechanical methods of cervix ripening in women with premature rupture of membranes: a randomized controlled trial. Am J Obstet Gynecol MFM 2023; 5:100868. [PMID: 36690182 DOI: 10.1016/j.ajogmf.2023.100868] [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: 10/19/2022] [Revised: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Premature rupture of membranes occurs in 8% of pregnancies. In the absence of spontaneous labor, induction of labor is considered an appropriate strategy for term pregnant women with premature rupture of membranes. There are several approaches for preinduction cervical ripening, including mechanical methods, such as Foley catheterization, and nonmechanical methods, such as oral misoprostol. OBJECTIVE This study aimed to evaluate and compare the effects of oral misoprostol and Foley catheterization in pregnant women with premature rupture of membranes at ≥34 weeks of gestation who underwent induction of labor. STUDY DESIGN A randomized clinical trial was conducted. The inclusion criteria included nulliparous and multiparous pregnant women at ≥34 weeks of gestation with singleton pregnancies, cephalic presentation, and confirmed amniotic fluid leakage for more than 60 minutes. A total of 104 participants were randomly allocated into 2 groups, one receiving sublingual misoprostol and the other receiving transcervical Foley catheter for cervical ripening. The primary outcome was time from intervention to delivery, and the secondary outcomes included delivery method, maternal and neonatal results (chorioamnionitis, Apgar score, neonatal sepsis, and asphyxia), and arterial blood gas analysis of the umbilical cord. RESULTS The mean time from induction of labor to delivery (11.6±1.98 hours for Foley catheter vs 10.16±2.35 hours for misoprostol; P=.007) and the median duration of cervical ripening (4.5 hours [interquartile range, 0.0-6.0] for Foley catheter vs 4.0 hours [interquartile range, 1.5-6.0] for misoprostol; P=.04) were longer in the Foley catheter group than in the misoprostol group. There was no statistically significant difference in the cesarean delivery rate between the 2 groups (29.6% for Foley catheter vs 38.5% for misoprostol; P=.2). There was no case of chorioamnionitis or asphyxia in the 2 groups. There was no significant difference between the 2 groups in terms of umbilical cord pH and the 1- and 5-minute Apgar scores (P=.1, P=.4, and P=.1); nevertheless, these values were higher in the Foley catheter group. There was no statistically significant difference among additional secondary outcomes. CONCLUSION In premature rupture of membranes cases, cervical ripening with a Foley catheter was associated with a longer duration of ripening and time from induction to delivery than cervical ripening with misoprostol. The cesarean delivery rate and the maternal and neonatal infection rates were not different between these methods.
Collapse
|
8
|
Du Plessis AH, van Rooyen DRM, Jardien-Baboo S, Ten Ham-Baloyi W. Screening and diagnosis of women for chorioamnionitis: An integrative literature review. Midwifery 2022; 113:103417. [PMID: 35863118 DOI: 10.1016/j.midw.2022.103417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 06/03/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This integrative literature review provides an overview of current best research evidence on the screening and diagnosis of women for chorioamnionitis, as no current review has been conducted. An overview of best practices on screening and diagnosis of women for chorioamnionitis can assist midwives with an accurate diagnosis, allowing for early referral and adequate management of this infection. DESIGN An integrative literature review was conducted using a systematic electronic literature search through EBSCOhost (CINAHL with Full Text, e-Book Collection, Health Source: Nursing/Academic Edition, MEDLINE, Open Dissertations and PsycINFO), Cochrane Online, PubMed, Scopus, followed by a manual search for grey literature using Google and a citation search. Guidelines, research studies, and reports in English related to chorioamnionitis from 2008 up until 2020 were included in the study. FINDINGS After critical appraisal, using the Joanna Briggs Institution's checklists, Evaluation Tool for Quantitative Research Studies' tool and the Appraisal of Guidelines for Research & Evaluation instrument, 31 articles were included. More than half (64%) of the literature included ranked on the three highest levels of evidence (Level I, II and III). Data extracted regarding screening and diagnosis of women for chorioamnionitis was synthesised into four themes, namely: screening by clinical signs and symptoms, screening by causative factors of chorioamnionitis, screening of obstetric history, and essential biomarkers to diagnose chorioamnionitis. KEY CONCLUSIONS Screening and recording of any risk factors will assist midwives in providing tailored health education to possibly prevent causative factors that could lead to chorioamnionitis. Although matrix-metalloproteinase-8 (MMP-8) seems the most suitable test to use for screening, an accurate diagnosis of chorioamnionitis requires a combination of screening methods and tests, such as clinical signs and symptoms, maternal biomarkers, amniotic fluid testing and histology. Screening for chorioamnionitis, particularly the parameters for maternal fever as a clinical symptom of chorioamnionitis, contributing factors and microbes responsible for chorioamnionitis, the usability of MMP-8 and the development of rapid, inexpensive, easy-to-use techniques for screening and diagnosis of chorioamnionitis, warrants further research. IMPLICATIONS FOR PRACTICE Findings can be used by midwives in the screening and diagnosis of women for chorioamnionitis which allows for early referral and adequate management before maternal and neonatal complications arise.
Collapse
Affiliation(s)
- Allison Herelene Du Plessis
- Nelson Mandela University, Department of Nursing Science, Faculty of Health Sciences, Summerstrand, 6031, Port Elizabeth, South Africa
| | - Dalena R M van Rooyen
- Nelson Mandela University, Faculty of Health Sciences, Summerstrand, 6031, Port Elizabeth, South Africa
| | - Sihaam Jardien-Baboo
- Nelson Mandela University, Department of Nursing Science, Faculty of Health Sciences, Summerstrand, 6031, Port Elizabeth, South Africa
| | - Wilma Ten Ham-Baloyi
- Nelson Mandela University, Faculty of Health Sciences, Summerstrand, 6031, Port Elizabeth, South Africa.
| |
Collapse
|
9
|
Double Balloon Catheter (Plus Oxytocin) versus Dinoprostone Vaginal Insert for Term Rupture of Membranes: A Randomized Controlled Trial (RUBAPRO). J Clin Med 2022; 11:jcm11061525. [PMID: 35329852 PMCID: PMC8952372 DOI: 10.3390/jcm11061525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 01/27/2023] Open
Abstract
Background: The aim of this study is to demonstrate that a double balloon catheter combined with oxytocin decreases time between induction of labor and delivery (TID) as compared to a vaginal dinoprostone insert in cases of premature rupture of membranes at term. Methods: This is a prospective, randomized, controlled trial including patient undergoing labor induction for PROM at term with an unfavorable cervix in Clermont-Ferrand university hospital. We compared the double balloon catheter over a period of 12 h with adjunction of oxytocin 6 h after catheter insertion versus dinoprostone vaginal insert. After device ablation, cervical ripening continued only with oxytocin. The main outcome was TID. Secondary outcomes concerned delivery mode, as well as maternal and fetal outcome, and were adjusted for parity. Results: 40 patients per group were randomized. Each group had similar baseline characteristics. The study failed to demonstrate reduced TID (16.2 versus 20.2 h, ES = 0.16 (−0.27 to 0.60), p = 0.12) in the catheter group versus dinoprostone except in nulliparous women (17.0 versus 26.5 h, ES = 0.62 (0.10 to 1.14), p = 0.006). The rate of vaginal delivery <24 h significantly increased with combined induction (88.5% versus 66.6%, p = 0.03). No statistical difference was observed concerning caesarean rate (12.5% versus 17.5%, p > 0.05), chorioamnionitis (0% versus 2.5%, p = 1), postpartum endometritis, or maternal or neonatal outcomes. Procedure-related pain and tolerance to devices were found to be similar for the two methods. Interpretation: The double balloon catheter combined with oxytocin is an alternative for cervical ripening in case of PROM at term, and may reduce TID in nulliparous women.
Collapse
|
10
|
Delorme P, Lorthe E, Sibiude J, Kayem G. Preterm and term prelabour rupture of membranes: A review of timing and methods of labour induction. Best Pract Res Clin Obstet Gynaecol 2021; 77:27-41. [PMID: 34538740 DOI: 10.1016/j.bpobgyn.2021.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 01/07/2023]
Abstract
Prelabour rupture of membranes (PROM) exposes both foetuses and mothers to the risk of infection. Induction of labour has been proposed to reduce this risk, but its neonatal and maternal risks and benefits must be balanced against those of expectant management (EM). Recent randomized studies of preterm PROM show that EM until 37 weeks of gestation is associated with lower overall neonatal morbidity. In term PROM, active management is associated with a shorter birth interval but not with lower rates of neonatal infection. Similar maternal and neonatal outcomes are reported regardless of whether induction uses oxytocin, PGE2, or oral misoprostol.
Collapse
Affiliation(s)
- Pierre Delorme
- Sorbonne Université, AP-HP, Department of Gynaecology and Obstetrics, Trousseau Hospital, Paris, France; INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA, Paris Descartes University, Paris, France
| | - Elsa Lorthe
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA, Paris Descartes University, Paris, France; Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, 1205, Geneva, Switzerland
| | - Jeanne Sibiude
- Université de Paris, IAME, INSERM, F-75018, Paris, France; AP-HP, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, F-92700, Colombes, France
| | - Gilles Kayem
- Sorbonne Université, AP-HP, Department of Gynaecology and Obstetrics, Trousseau Hospital, Paris, France; INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA, Paris Descartes University, Paris, France.
| |
Collapse
|
11
|
Towards an evidence-based approach to optimize the success of labour induction. Best Pract Res Clin Obstet Gynaecol 2021; 77:129-143. [PMID: 34497038 DOI: 10.1016/j.bpobgyn.2021.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/22/2022]
Abstract
Induction of labour is a two-step process involving cervical ripening and the initiation of uterine contractions, with the goal of achieving vaginal birth. To optimize the chance of a safe and timely vaginal birth, the process of induction of labour should be evidence based and individualized to the given person and situation. In this study, we lay out a framework for how this should be done, emphasizing on careful clinical assessment and planning, flexibility in the strategy of induction, patience during the ripening and latent phases of labour, and thoughtful consideration regarding changing the strategy if active labour is not initially achieved. The goal of this review is to present the current evidence on this topic in the form of a user-friendly protocol that can be easily adapted to institutional practice.
Collapse
|
12
|
Induction of labour in low-resource settings. Best Pract Res Clin Obstet Gynaecol 2021; 77:90-109. [PMID: 34509391 DOI: 10.1016/j.bpobgyn.2021.08.004] [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: 02/09/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022]
Abstract
Due to the disparity in resource availability between low- and high-resource settings, practice recommendations relevant to high-income countries are not always relevant and often need to be adapted to low-resource settings. The adaptation applies to induction of labour (IOL) which is an obstetric procedure that deserves special attention because it involves the initiation of a process that requires regular and frequent monitoring of the mother and foetus by experienced healthcare professionals. Lack of problem recognition and/or substandard care during IOL may result in harm with long-term sequelae. In this article, the authors discuss unique challenges such as insufficient resources (including staff, midwives, doctors, equipment, and medications) that result in occasional inadequate patient monitoring and/or delayed interventions during IOL in low-resource settings. We also discuss modifications in indications and methods for IOL, issues related to human immunodeficiency virus (HIV) infections, the feasibility of outpatient induction, clinical protocols and a minimum dataset for quality improvement projects. Overall, the desire to achieve a vaginal birth with IOL should not cloud the necessity to observe the required safety measures and implement necessary interventions; given that childbirth practices are the major determinants of pregnancy outcomes and patient satisfaction.
Collapse
|
13
|
Mackeen AD, Quinn ST, Movva VC, Berghella V, Ananth CV. Intracervical balloon catheter for labor induction after rupture of membranes: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 224:624-628. [PMID: 33689751 DOI: 10.1016/j.ajog.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/26/2022]
|
14
|
Cañadas JV, González MT, Limón NP, Alguacil MS, Prieto MGL, Riaza RC, Montero-Macías R. Intracervical double-balloon catheter versus dinoprostone for cervical ripening in labor induction in pregnancies with a high risk of uterine hyperstimulation. Arch Gynecol Obstet 2021; 304:1475-1484. [PMID: 33904957 DOI: 10.1007/s00404-021-06071-1] [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: 11/12/2020] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE There are numerous methods for cervical ripening although not all of them are indicated in women presenting a higher risk of uterine hyperstimulation. To compare the efficacy and security of the two methods for cervical ripening in the induction of labor in these pregnancies. METHODS Retrospective analysis of two cohorts consisting of pregnant women who gave birth from 2016 to 2019 (112 inductions with dinoprostone and 112 with intracervical double- balloon). RESULTS There are statistically significant differences in favor of dinoprostone in deliveries that occurred before 12 h since the start of the induction (28.6% vs 13.4%, p = 0.005) and a higher rate of cervical ripening (55.4% vs 33.9%; p = 0.001). There were no statistically significant differences in induction time, the percentage of women delivering within 24 h or beyond, nor in the type of delivery. Additionally, a decreased need of oxytocin (60.7% vs 42.9%; p = 0.001) and a lower dose when used has been observed in the dinoprostone group. However, Dinoprostone also has a higher rate of minor maternal complications as uterine hyperstimulation (18.8% vs 3.6%; p = 0.001) and altered cardiotocography (26.8% vs 4.5%; p = 0.001). No significant difference has been found between the two groups regarding severe complications. CONCLUSIONS Dinoprostone presents a greater efficacy for cervical ripening and delivery in ≤ 12 h, with less need of oxytocin perfusion than inductions using an intracervical double-balloon. There is no significant difference in severe maternal complications between the two groups. In conclusion, Dinoprostone could be an effective and safe option for patients at risk of uterine hyperstimulation.
Collapse
Affiliation(s)
- Javier Vega Cañadas
- Obstetrics and Gynecology Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain.
| | - María Teulón González
- Obstetrics and Gynecology Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain
| | - Natalia Pagola Limón
- Obstetrics and Gynecology Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain
| | - María Sanz Alguacil
- Obstetrics and Gynecology Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain
| | - María García-Luján Prieto
- Obstetrics and Gynecology Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain
| | - Rocío Canete Riaza
- Obstetrics and Gynecology Department, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain
| | - Rosa Montero-Macías
- Obstetrics and Gynecology Department, Centre Hospitalier Simone-Veil, Eaubonne, France
| |
Collapse
|
15
|
Shazly SA, Ahmed IA, Radwan AA, Abd-Elkariem AY, El-Dien NB, Ragab EY, Abouzeid MH, Shams AH, Ali AK, Hemdan HN, Hemdan MN, Nassr AA, AbdelHafez FF, Eltaweel NA, Ghoniem K, El Saman AM, Ali MK, Thompson AC. Middle-East OBGYN Graduate Education (MOGGE) Foundation Practice Guidelines: Prelabor rupture of membranes; Practice guideline No. 01-O-19. J Glob Health 2021; 10:010325. [PMID: 32257148 PMCID: PMC7125938 DOI: 10.7189/jogh.10.010325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Sherif A Shazly
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Islam A Ahmed
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Ahmad A Radwan
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Ahmed Y Abd-Elkariem
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | | | - Esraa Y Ragab
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Mostafa H Abouzeid
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | | | - Ahmed K Ali
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Heba N Hemdan
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Menna N Hemdan
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Ahmed A Nassr
- Department of Obstetrics & Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Faten F AbdelHafez
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | | | - Khaled Ghoniem
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ali M El Saman
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Mohamed K Ali
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Angela C Thompson
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | | |
Collapse
|
16
|
Bigelow CA, Pan S, Overbey JR, Stone J. Propranolol for Induction of Labor in Nulliparas trial a double-blind, randomized, placebo-controlled trial. Am J Obstet Gynecol MFM 2021; 3:100301. [PMID: 33421647 DOI: 10.1016/j.ajogmf.2020.100301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Propranolol hydrochloride is a nonselective beta-adrenergic antagonist that has a known activity in the myometrium. Small trials have shown that propranolol decreases the duration of induced labor, although those studies are limited by methodological variability. OBJECTIVE Our objective was to determine whether the addition of a single dose of propranolol to induce labor in nulliparous women would decrease total time to vaginal delivery. STUDY DESIGN This study was a double-blind, randomized, placebo-controlled trial of nulliparous patients undergoing term induction of labor with a singleton, nonanomalous gestation. Subjects were randomized to 2 mg of intravenous propranolol hydrochloride or an identical-appearing saline placebo, administered 30 minutes after starting the induction of labor. Investigators, labor floor staff, and patients were blinded to the study drug allocation. The primary outcome was time to vaginal delivery. Secondary outcomes included mode of delivery, duration of the phases of labor, time to full dilation, composite maternal morbidity, and composite neonatal morbidity. Data were analyzed by intention-to-treat analysis with a P value of ≤.05 considered significant. RESULTS In this study, 240 patients were enrolled from December 2017 to December 2018, with 121 patients randomized to the propranolol group and 119 to the placebo group. The 2 groups had similar baseline characteristics. Of the patients randomized, 154 (64.2%) delivered vaginally. There was no significant difference in time from the start of the induction of labor to vaginal delivery (13.8±5.4 hours for propranolol vs 14.3±5.3 hours for placebo; P=.58). There was also no difference in the rate of cesarean delivery (38% vs 33.6%; P=.48), time to active labor (11.0±5.0 vs 11.2±4.5 hours; P=.77), or time to full dilation (12.4±5.1 vs 12.8±5.2 hours; P=.60) in patients receiving propranolol compared with those receiving placebo. Subjects randomized to the propranolol group had a significantly lower rate of composite maternal morbidity (28.9% vs 41.2%; risk ratio, 0.70; 95% confidence interval, 0.49-1.00; P=.047). Rates of postpartum hemorrhage (12.4% vs 21.8%; P=.05) and transfusion (0% vs 4.2%; P=.03) were also lower in the treated group. There was no significant difference in neonatal outcomes or composite morbidity (risk ratio, 0.74; 95% confidence interval, 0.44-1.22). CONCLUSION In this study, there is no evidence that the addition of a 1-time dose of propranolol to induce labor in nulliparous women decreases time to delivery or the rate of cesarean delivery. However, propranolol significantly reduced composite maternal morbidity without adverse neonatal effects.
Collapse
Affiliation(s)
- Catherine A Bigelow
- Minnesota Perinatal Physicians, Allina Health, Minneapolis, MN; Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, New York, NY.
| | - Stephanie Pan
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, New York, NY
| | - Jessica R Overbey
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, New York, NY
| | - Joanne Stone
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, New York, NY
| |
Collapse
|
17
|
Abstract
Preterm birth occurs in approximately 10% of all births in the United States and is a major contributor to perinatal morbidity and mortality (). Prelabor rupture of membranes (PROM) that occurs preterm complicates approximately 2-3% of all pregnancies in the United States, representing a significant proportion of preterm births, whereas term PROM occurs in approximately 8% of pregnancies (). The optimal approach to assessment and treatment of women with term and preterm PROM remains challenging. Management decisions depend on gestational age and evaluation of the relative risks of delivery versus the risks (eg, infection, abruptio placentae, and umbilical cord accident) of expectant management when pregnancy is allowed to progress to a later gestational age. The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented. This Practice Bulletin is updated to include information about diagnosis of PROM, expectant management of PROM at term, and timing of delivery for patients with preterm PROM between 34 0/7 weeks of gestation and 36 6/7 weeks of gestation.
Collapse
|
18
|
Berghella V, Bellussi F, Schoen CN. Evidence-based labor management: induction of labor (part 2). Am J Obstet Gynecol MFM 2020; 2:100136. [PMID: 33345875 DOI: 10.1016/j.ajogmf.2020.100136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Abstract
Induction of labor is indicated for many obstetrical, maternal, and fetal indications. Induction can be offered for pregnancy at 39 weeks' gestation. No prediction method is considered sensitive or specific enough to determine the incidence of cesarean delivery after induction. A combination of 60- to 80-mL single-balloon Foley catheter for 12 hours and either 25-μg oral misoprostol initially, followed by 25 μg every 2-4 hours, or 50 μg every 4-6 hours (if no more than 3 contractions per 10 minutes or previous uterine surgery), or oxytocin infusion should be recommended for induction of labor. Adding membrane stripping at the beginning of induction should be considered. Once 5-6 cm of cervical dilation is achieved during the induction of labor, consideration can be given to discontinue oxytocin infusion if in use at that time and adequate contractions are present. Induction with oxytocin immediately (as soon as feasible) or up to 12 hours of term prelabor rupture of membranes if labor is not evident is recommended. Outpatient Foley ripening can be considered for low-risk women. Cesarean delivery should not be performed before 15 hours of oxytocin infusion and amniotomy if feasible and ideally after 18-24 hours of oxytocin infusion.
Collapse
Affiliation(s)
- Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
| | - Federica Bellussi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Corina N Schoen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts-Baystate, Springfield, MA
| |
Collapse
|
19
|
Athiel Y, Crequit S, Bongiorno M, Sanyan S, Renevier B. Term prelabor rupture of membranes: Foley catheter versus dinoprostone as ripening agent. J Gynecol Obstet Hum Reprod 2020; 49:101834. [PMID: 32585393 DOI: 10.1016/j.jogoh.2020.101834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/26/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Term prelabor rupture of membranes (TPROM) occurs in approximately 8 % of pregnancies. This condition regularly requires medical intervention such as induction of labor. The actual data concerning cervical ripening in case of TPROM does not favor any of the available techniques. This is the first study comparing dinoprostone versus Foley catheter for cervical ripening in TPROM. MATERIALS AND METHODS We conducted a retrospective before-after study. We enrolled all the patients with confirmed TPROM after 37 weeks of gestation (WG) who required cervical ripening. Women were included if they had a singleton fetus in cephalic presentation, with unfavorable cervix (Bishop ≤ 6). Patients were excluded if they had a previous uterine surgery, a multiple pregnancy, contraindication to vaginal delivery, spontaneous labor or favorable cervix (Bishop > 6). During the first period (2015), the protocol of cervical ripening involved dinoprostone (prostaglandins E2) by vaginal administration (vaginal gel or pessary). During the second period (2016-2017), the protocol of cervical ripening involved Foley catheter (FC). The primary outcome was the rate of cesarean section. RESULTS Two hundred and thirty-eight patients were included for the analysis: 131 in the first period (dinoprostone group) and 107 in the second period (foley catheter group). There was no significant difference between the two groups regarding the mode of delivery (cesarean section: 206 % vs 13 %, p = 016). Concerning tolerance, the were no difference in the rates of postpartum hemorrhage, maternal per-partum fever and endometrisis. Neonatal outcomes were similar between the two groups. The induction to delivery interval was lower with dinoprostone (20,3 h versus 26,0 h, p = 0001). The mean duration of labor was also significantly different (6,9 h for dinoprostone group versus 8,7 h for FC group, p = 001). CONCLUSION Cervical ripening in case of TPROM after 37 W G with Foley catheter seems to be a safe technique with similar outcomes to prostaglandins regarding the mode of delivery.
Collapse
Affiliation(s)
- Yoann Athiel
- Service de gynécologie-obstétrique, Hôpital André Grégoire, Montreuil, France.
| | - Simon Crequit
- Service de gynécologie-obstétrique, Hôpital André Grégoire, Montreuil, France
| | - Marica Bongiorno
- Service de gynécologie-obstétrique, Hôpital André Grégoire, Montreuil, France
| | - Stéphanie Sanyan
- Service de gynécologie-obstétrique, Hôpital André Grégoire, Montreuil, France
| | - Bruno Renevier
- Service de gynécologie-obstétrique, Hôpital André Grégoire, Montreuil, France
| |
Collapse
|
20
|
Levine LD, Valencia CM, Tolosa JE. Induction of labor in continuing pregnancies. Best Pract Res Clin Obstet Gynaecol 2020; 67:90-99. [PMID: 32527660 DOI: 10.1016/j.bpobgyn.2020.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
This chapter aims to provide an evidence-based approach to cervical-ripening methods and induction of labor in high-, middle-, and low-income countries. We will review the epidemiology of induction and will also review pharmacological and mechanical methods of cervical-ripening as well as oxytocin for induction. Lastly, we will review current guidelines of when to determine an induction to be failed.
Collapse
Affiliation(s)
- Lisa D Levine
- Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Catalina M Valencia
- Fetal Medicine Foundation, London, UK; Fundared-Materna, Bogotá, Colombia; Medicina Fetal S.A.S Medellin, Colombia
| | - Jorge E Tolosa
- Fundared-Materna, Bogotá, Colombia; Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Director of Research, St. Luke's University Health Network, 701 Ostrum Street, Suite 303, Bethlehem, PA, 18015, USA; Global Network for Perinatal & Reproductive Health (GNPRH), Division of Maternal Fetal Medicine Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
21
|
Appointment of Joanne Stone as an Editor of Expert Reviews for AJOG. Am J Obstet Gynecol 2020; 222:395-396. [PMID: 32354407 DOI: 10.1016/j.ajog.2020.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 11/20/2022]
|
22
|
Kruit H, Tolvanen J, Eriksson J, Place K, Nupponen I, Rahkonen L. Balloon catheter use for cervical ripening in women with term pre-labor rupture of membranes: A 5-year cohort study. Acta Obstet Gynecol Scand 2020; 99:1174-1180. [PMID: 32242917 DOI: 10.1111/aogs.13856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To investigate the safety of balloon catheter for cervical ripening in women with term pre-labor rupture of membranes (PROM) and to compare the incidence of maternal and neonatal infections in women with PROM and women with intact membranes undergoing cervical ripening with a balloon catheter. MATERIAL AND METHODS This retrospective cohort study of 1923 women with term singleton pregnancy and an unfavorable cervix undergoing cervical ripening with a balloon catheter was conducted in Helsinki University Hospital between January 2014 and December 2018. For each case of PROM, two controls were assigned. The main outcome measures were the rates of maternal and neonatal infections. Statistical analyses were performed by SPSS. RESULTS In all, 641 (33.3%) women following PROM and 1282 (66.6%) women with intact amniotic membranes underwent labor induction. The rates of intrapartum infection (3.7% vs 7.7%; P = .001) and neonatal infection (1.7% vs 3.8%; P = .01) were not increased in women induced by balloon catheter following PROM. Intrapartum infections were associated with nulliparity (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.6-6.5), history of previous cesarean section (OR 2.8, 95% CI 1.2-6.4), extended gestational age ≥41 weeks (OR 1.9, 95% CI 1.2-3.0) and an induction to delivery interval of 48 hours or more (OR 2.0, 95% CI 1.2-3.3). The risk of neonatal infection was associated with nulliparity (OR 3.3, 95% CI 1.4-8.0), gestational age ≥41 weeks (OR 1.9, 95% CI 1.09-3.36) and induction to delivery interval of 48 hours or more (OR 3.4, 95% CI 1.9-6.0). CONCLUSIONS Use of balloon catheter in women with term PROM appears safe and was not associated with increased maternal or neonatal infectious morbidity.
Collapse
Affiliation(s)
- Heidi Kruit
- Department of Obstetrics and Gynecology, Univesrsity of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jenna Tolvanen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jasmin Eriksson
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Katariina Place
- Department of Obstetrics and Gynecology, Univesrsity of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Irmeli Nupponen
- Department of Neonatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leena Rahkonen
- Department of Obstetrics and Gynecology, Univesrsity of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
23
|
Hruban L, Janku P, Gerychova R, Jouzova A, Tesarikova T. Mechanical pre-induction in women with premature rupture of membranes. Eur J Obstet Gynecol Reprod Biol 2020; 247:265-266. [PMID: 32089320 DOI: 10.1016/j.ejogrb.2020.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/05/2020] [Accepted: 02/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Lukas Hruban
- Department of Obstetrics and Gynaecology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic.
| | - Petr Janku
- Department of Obstetrics and Gynaecology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Romana Gerychova
- Department of Obstetrics and Gynaecology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Anna Jouzova
- Department of Obstetrics and Gynaecology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Tereza Tesarikova
- Department of Obstetrics and Gynaecology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
| |
Collapse
|
24
|
Choo SN, Kanneganti A, Abdul Aziz MNDB, Loh L, Hargreaves C, Gopal V, Biswas A, Chan YH, Ismail IS, Chi C, Mattar C. MEchanical DIlatation of the Cervix-- in a Scarred uterus (MEDICS): the study protocol of a randomised controlled trial comparing a single cervical catheter balloon and prostaglandin PGE2 for cervical ripening and labour induction following caesarean delivery. BMJ Open 2019; 9:e028896. [PMID: 31699720 PMCID: PMC6858154 DOI: 10.1136/bmjopen-2019-028896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 08/13/2019] [Accepted: 09/24/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Labour induction in women with a previous caesarean delivery currently uses vaginal prostaglandin E2 (PGE2), which carries the risks of uterine hyperstimulation and scar rupture. We aim to compare the efficacy of mechanical labour induction using a transcervically applied Foley catheter balloon (FCB) with PGE2 in affected women attempting trial of labour after caesarean (TOLAC). METHODS AND ANALYSIS This single-centre non-inferiority prospective, randomised, open, blinded-endpoint study conducted at an academic maternity unit in Singapore will recruit a total of 100 women with one previous uncomplicated caesarean section and no contraindications to vaginal delivery. Eligible consented participants with term singleton pregnancies and unfavourable cervical scores (≤5) requiring labour induction undergo stratified randomisation based on parity and are assigned either FCB (n=50) or PGE2 (n=50). Treatments are applied for up to 12 hours with serial monitoring of the mother and the fetus and serial assessment for improved cervical scores. If the cervix is still unfavourable, participants are allowed a further 12 hours' observation for cervical ripening. Active labour is initiated by amniotomy at cervical scores of ≥6. The primary outcome is the rate of change in the cervical score, and secondary outcomes include active labour within 24 hours of induction, vaginal delivery, time-to-delivery interval and uterine hyperstimulation. All analyses will be intention-to-treat. The data generated in this trial may guide a change in practice towards mechanical labour induction if this proves efficient and safer for women attempting TOLAC compared with PGE2, to improve labour management in this high-risk population. ETHICS AND DISSEMINATION Ethical approval is granted by the Domain Specific Review Board (Domain D) of the National Healthcare Group, Singapore. All adverse events will be reported within 24 hours of notification for assessment of causality. Data will be published and will be available for future meta-analyses. TRIAL REGISTRATION NUMBER NCT03471858; Pre-results.
Collapse
Affiliation(s)
- Soe-Na Choo
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Abhiram Kanneganti
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | | | - Leta Loh
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Carol Hargreaves
- Data Analytics Consulting Centre, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Vikneswaran Gopal
- Data Analytics Consulting Centre, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Arijit Biswas
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
- Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Ida Suzani Ismail
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Claudia Chi
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Citra Mattar
- Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
- Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
25
|
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.
Collapse
Affiliation(s)
- Anna Maria Marconi
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milano, Milano, Italy
| |
Collapse
|
26
|
Girault A. [Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Methods for Inducing Labor]. ACTA ACUST UNITED AC 2019; 48:48-58. [PMID: 31669528 DOI: 10.1016/j.gofs.2019.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the studies comparing induction methods in women with term prelabor rupture of the membranes and establish if one is superior to the others. METHODS The MedLine database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS The included studies compared medical induction methods: oxytocin (intravenous), dinoprostone (vaginal gel, pessary or intracervical gel), and misoprostol (oral or vaginal route); and a mechanical induction method: the Foley catheter. The primary outcome measures were: labor induction to delivery interval, number of women delivered within 12 or 24hours of initiation of induction and cesarean delivery rate. The small sample size of the included studies as well as the limited number of reported complications does not provide a reasonable basis for concluding on the secondary outcome measures: pyrexia, chorioamnionitis, uterine tachysystole, Apgar scores of<7 at 5minutes. Induction of labor with misoprostol (oral and vaginal) reduced the labor induction to delivery interval compared with dinoprostone (LE2). This interval was unchanged when comparing induction with oxytocin and Foley catheter (LE2). The data comparing this interval in women induced with dinoprostone versus oxytocin and misoprostol versus oxytocin is limited or inconsistent. The cesarean delivery rate was comparable in women induced with dinoprostone (vaginal gel) versus oxytocin (LE2), misoprostol (oral and vaginal route) versus oxytocin (LE2), Foley catheter versus oxytocin (LE2), misoprostol versus dinoprostone (LE2) and misoprostol versus Foley catheter (LE2). The number of women delivered within 24hours of initiation of induction was comparable when induced with oral misoprostol versus oxytocin (LE2) and Foley catheter versus oxytocin (LE2). There is a lack of data for this outcome when comparing dinoprostone versus oxytocin, vaginal misoprotsol versus oxytocin, and misoprostol (oral and vaginal) versus dinoprostone. No induction method is superior to another for nulliparous women or women with unfavorable cervix (LE2). CONCLUSION The superiority of an induction method, in terms of effectiveness or safety, could not be established with the current available data for women with term prelabor rupture of the membranes. An increased risk of chorioamnionitis due to induction using Foley catheter could not be ruled out by the available data. All medical methods are suitable for inducing women with term prelabor rupture of the membranes (Grade B).
Collapse
Affiliation(s)
- A Girault
- Service de gynécologie-obstétrique, maternité Port-Royal, université de Paris, DHU risques et grossesse, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France; Epidemiology and statistics research center/CRESS, Inserm, INRA, université de Paris, 75004 Paris, France.
| |
Collapse
|
27
|
de Vaan MDT, ten Eikelder MLG, Jozwiak M, Palmer KR, Davies‐Tuck M, Bloemenkamp KWM, Mol BWJ, Boulvain M. Mechanical methods for induction of labour. Cochrane Database Syst Rev 2019; 10:CD001233. [PMID: 31623014 PMCID: PMC6953206 DOI: 10.1002/14651858.cd001233.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Mechanical methods were the first methods developed to ripen the cervix and induce labour. During recent decades they have been substituted by pharmacological methods. Potential advantages of mechanical methods, compared with pharmacological methods may include reduction in side effects that could improve neonatal outcomes. This is an update of a review first published in 2001, last updated in 2012. OBJECTIVES To determine the effectiveness and safety of mechanical methods for third trimester (> 24 weeks' gestation) induction of labour in comparison with prostaglandin E2 (PGE2) (vaginal and intracervical), low-dose misoprostol (oral and vaginal), amniotomy or oxytocin. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies (9 January 2018). We updated the search in March 2019 and added the search results to the awaiting classification section of the review. SELECTION CRITERIA Clinical trials comparing mechanical methods used for third trimester cervical ripening or labour induction with pharmacological methods.Mechanical methods include: (1) the introduction of a catheter through the cervix into the extra-amniotic space with balloon insufflation; (2) introduction of laminaria tents, or their synthetic equivalent (Dilapan), into the cervical canal; (3) use of a catheter to inject fluid into the extra-amniotic space (EASI).This review includes the following comparisons: (1) specific mechanical methods (balloon catheter, laminaria tents or EASI) compared with prostaglandins (different types, different routes) or with oxytocin; (2) single balloon compared to a double balloon; (3) addition of prostaglandins or oxytocin to mechanical methods compared with prostaglandins or oxytocin alone. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and assessed risk of bias. Two review authors independently extracted data and assessed the quality of the evidence using the GRADE approach. MAIN RESULTS This review update includes a total of 113 trials (22,373 women) contributing data to 21 comparisons. Risk of bias of trials varied. Overall, the evidence was graded from very-low to moderate quality. All evidence was downgraded for lack of blinding and, for many comparisons, the effect estimates were too imprecise to make a valid judgement.Balloon versus vaginal PGE2: there may be little or no difference in vaginal deliveries not achieved within 24 hours (average risk ratio (RR) 1.01, 95% confidence interval (CI) 0.82 to 1.26; 7 studies; 1685 women; I² = 79%; low-quality evidence) and there probably is little or no difference in caesarean sections (RR 1.00, 95% CI 0.92 to 1.09; 28 studies; 6619 women; moderate-quality evidence) between induction of labour with a balloon catheter and vaginal PGE2. A balloon catheter probably reduces the risk of uterine hyperstimulation with fetal heart rate (FHR) changes (RR 0.35, 95% CI 0.18 to 0.67; 6 studies; 1966 women; moderate-quality evidence), serious neonatal morbidity or perinatal death (RR 0.48, 95% CI 0.25 to 0.93; 8 studies; 2757 women; moderate-quality evidence) and may slightly reduce the risk of aneonatal intensive care unit (NICU) admission (RR 0.82, 95% CI 0.65 to 1.04; 3647 women; 12 studies; low-quality evidence). It is uncertain whether there is a difference in serious maternal morbidity or death (RR 0.20, 95% CI 0.01 to 4.12; 4 studies; 1481 women) or five-minute Apgar score < 7 (RR 0.74, 95% CI 0.49 to 1.14; 4271 women; 14 studies) because the quality of the evidence was found to be very low and low, respectively.Balloon versus low-dose vaginal misoprostol: it is uncertain whether there is a difference in vaginal deliveries not achieved within 24 hours between induction of labour with a balloon catheter and vaginal misoprostol (RR 1.09, 95% CI 0.85 to 1.39; 340 women; 2 studies; low-quality evidence). A balloon catheter probably reduces the risk of uterine hyperstimulation with FHR changes (RR 0.39, 95% CI 0.18 to 0.85; 1322 women; 8 studies; moderate-quality evidence) but may increase the risk of a caesarean section (average RR 1.28, 95% CI 1.02 to 1.60; 1756 women; 12 studies; I² = 45%; low-quality evidence). It is uncertain whether there is a difference in serious neonatal morbidity or perinatal death (RR 0.58, 95% CI 0.12 to 2.66; 381 women; 3 studies), serious maternal morbidity or death (no events; 4 studies, 464 women), both very low-quality evidence, and five-minute Apgar score < 7 (RR 1.00, 95% CI 0.50 to 1.97; 941 women; 7 studies) and NICU admissions (RR 1.00, 95% CI 0.61 to 1.63; 1302 women; 9 studies) both low-quality evidence.Balloon versus low-dose oral misoprostol: a balloon catheter probably increases the risk of a vaginal delivery not achieved within 24 hours (RR 1.28, 95% CI 1.13 to 1.46; 782 women, 2 studies, and probably slightly increases the risk of a caesarean section (RR 1.17, 95% CI 1.04 to 1.32; 3178 women; 7 studies; both moderate-quality evidence) when compared to oral misoprostol. It is uncertain whether there is a difference in uterine hyperstimulation with FHR changes (RR 0.81, 95% CI 0.48 to 1.38; 2033 women; 2 studies), serious neonatal morbidity or perinatal death (RR 1.11, 95% CI 0.60 to 2.06; 2627 women; 3 studies), both low-quality evidence, serious maternal morbidity or death (RR 0.50, 95% CI 0.05 to 5.52; 2627 women; 3 studies), very low-quality evidence, five-minute Apgar scores < 7 (RR 0.71, 95% CI 0.38 to 1.32; 2693 women; 4 studies) and NICU admissions (RR 0.82, 95% CI 0.58 to 1.17; 2873 women; 5 studies) both low-quality evidence. AUTHORS' CONCLUSIONS Low- to moderate-quality evidence shows mechanical induction with a balloon is probably as effective as induction of labour with vaginal PGE2. However, a balloon seems to have a more favourable safety profile. More research on this comparison does not seem warranted.Moderate-quality evidence shows a balloon catheter may be slightly less effective as oral misoprostol, but it remains unclear if there is a difference in safety outcomes for the neonate. When compared to low-dose vaginal misoprostol, low-quality evidence shows a balloon may be less effective, but probably has a better safety profile.Future research could be focused more on safety aspects for the neonate and maternal satisfaction.
Collapse
Affiliation(s)
- Marieke DT de Vaan
- Jeroen Bosch HospitalDepartment of ObstetricsHenri Dunantstraat 1's‐HertogenboschNetherlands5223 GZ
- Rotterdam University of Applied SciencesDepartment of Health Care StudiesRotterdamNetherlands
| | - Mieke LG ten Eikelder
- Royal Cornwall Hospital NHS TrustDepartment of Obstetrics and GynaecologyPrincess Alexandra Wing, TreliskeTruroUK
| | - Marta Jozwiak
- Erasmus Medical CenterDr Molewaterplein 40RotterdamNetherlands3015 GD
| | - Kirsten R Palmer
- Monash Health and Monash UniversityDepartment of Obstetrics and Gynaecology246 Clayton RoadClaytonVictoriaAustralia3168
| | | | - Kitty WM Bloemenkamp
- Birth Centre Wilhelmina’s Children Hospital, University Medical Center UtrechtDepartment of Obstetrics, Division Women and BabyUtrechtNetherlands
| | - Ben Willem J Mol
- Monash UniversityDepartment of Obstetrics and Gynaecology246 Clayton RoadClaytonVictoriaAustralia3168
| | - Michel Boulvain
- University of Geneva/GHOL‐Nyon HospitalDepartment of Gynecology and ObstetricsNYONSwitzerland
| | | |
Collapse
|
28
|
Devillard E, Delabaere A, Rouzaire M, Pereira B, Accoceberry M, Houlle C, Dejou-Bouillet L, Bouchet P, Gallot D. Induction of labour in case of premature rupture of membranes at term with an unfavourable cervix: protocol for a randomised controlled trial comparing double balloon catheter (+oxytocin) and vaginal prostaglandin (RUBAPRO) treatments. BMJ Open 2019; 9:e026090. [PMID: 31227530 PMCID: PMC6596956 DOI: 10.1136/bmjopen-2018-026090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Premature rupture of membranes (PROM) occurs at term in 8% of pregnancies. Several studies have demonstrated that the risk of chorioamnionitis and neonatal sepsis increases with duration of PROM. Decreasing the time interval between PROM and delivery is associated with lower rates of maternal infections. In case of an unfavourable cervix, the use of prostaglandin for cervical maturation demonstrates some advantages over oxytocin. The use of double balloon catheter in reduction of PROM duration has not been evaluated in the literature. METHODS AND ANALYSIS We are conducting a prospective, monocentric, randomised clinical trial on pregnant women with an unfavourable cervix showing PROM at term (RUBAPRO).After 12-24 hours of PROM, women are randomly assigned to one group treated with a double balloon catheter for 12 hours, with oxytocin administered after 6 hours or to the control group treated with 24 hours of vaginal prostaglandin followed by oxytocin infusion alone. Patients (n=80) are randomised at a 1:1 ratio with stratification on parity.The inclusion criteria are a Bishop score of <6, cephalic presentation at term and confirmed PROM. Women with suspected chorioamnionitis; group B streptococcus (GBS) carrier; a history of caesarean delivery or any contraindication for vaginal delivery are excluded.The time from induction to delivery is the primary outcome. Secondary outcomes were mode of delivery, maternofetal morbidity and the effect of parity on strategies for reduction of PROM duration.To sufficiently demonstrate a difference (10 hours) between groups-with a statistical power of 90% and a two-tailed α of 5%-40 patients per group will be required. ETHICS AND DISSEMINATION Written informed consent is required from participants.National Ethics Committee approval was obtained in August 2017. The results will be published in a peer-reviewed journal and presented at relevant conferences. Access to raw data will be available only to members of the research team. TRIAL REGISTRATION NUMBER NCT03310333.
Collapse
Affiliation(s)
- Eric Devillard
- Obstetrics and Gynaecology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Amélie Delabaere
- Obstetrics and Gynaecology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- 'Translational approach to epithelial injury and repair' team, Auvergne University, CNRS, Inserm, GReD, Clermont-Ferrand, France
| | - Marion Rouzaire
- Obstetrics and Gynaecology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics 1 Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Marie Accoceberry
- Obstetrics and Gynaecology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Céline Houlle
- Obstetrics and Gynaecology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Lydie Dejou-Bouillet
- Obstetrics and Gynaecology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Pamela Bouchet
- Obstetrics and Gynaecology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Denis Gallot
- Obstetrics and Gynaecology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- 'Translational approach to epithelial injury and repair' team, Auvergne University, CNRS, Inserm, GReD, Clermont-Ferrand, France
| |
Collapse
|
29
|
[Modalities of birth in case of uncomplicated preterm premature rupture of membranes: CNGOF Preterm Premature Rupture of Membranes Guidelines]. ACTA ACUST UNITED AC 2018; 46:1068-1075. [PMID: 30389541 DOI: 10.1016/j.gofs.2018.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify the ideal gestational age at delivery for preterm premature rupture of membranes and modalities of birth. METHOD To identify studies, research was conducted using Pub-Med, Embase and Cochrane databases. RESULTS Prolonged latency duration after pPROM does not worsen neonatal prognosis (NP3). Therefore, it is recommended not to deliver before 34 weeks of gestation for patient with uncomplicated preterm rupture of membranes (pPROM) (Grade C). After 34 weeks of gestation, expectant management for pPROM is not associated with neonatal sepsis (NP1) but is associated to intra-uterine infection (NP2). Early delivery is associated with higher risk of respiratory distress syndrome (NP2), higher risk of cesarean section (NP2) and longer duration of NICU hospitalization (NP2). Before 37 weeks of gestation, expectant management is recommended for uncomplicated pPROM (Grade A), even if vaginal group B streptococcus is positive, as long as antibiotics are used at the time of membranes rupture (Professional consensus). Elective cesarean section is reserved for usual obstetrical indications. Oxytocin and prostaglandins are reasonable options for inducing labor (Professional consensus). Data are too scarce to establish recommendation regarding intra-cervical balloons in case of pPROM (Professional consensus). CONCLUSION Expectant management is recommended for uncomplicated pPROM before 37 weeks of gestation.
Collapse
|
30
|
McGee TM, Gidaszewski B, Khajehei M, Tse T, Gibbs E. Foley catheter silicone versus latex for term outpatient induction of labour: A randomised trial. Aust N Z J Obstet Gynaecol 2018; 59:235-242. [DOI: 10.1111/ajo.12828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/16/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Therese M McGee
- Department of Obstetrics and GynaecologyWestmead Hospital Sydney New South Wales Australia
- Sydney Medical School WestmeadUniversity of Sydney Sydney New South Wales Australia
| | - Beata Gidaszewski
- Department of Women's and Newborn HealthWestmead Hospital Sydney New South Wales Australia
| | - Marjan Khajehei
- Department of Obstetrics and GynaecologyWestmead Hospital Sydney New South Wales Australia
- Sydney Medical School WestmeadUniversity of Sydney Sydney New South Wales Australia
- School of Women's and Children's HealthUniversity of New South Wales Sydney New South Wales Australia
| | - Toni Tse
- Department of Obstetrics and GynaecologyWestmead Hospital Sydney New South Wales Australia
| | - Emma Gibbs
- NHMRC Clinical Trials CentreUniversity of Sydney Sydney New South Wales Australia
| |
Collapse
|
31
|
Foley Plus Oxytocin Compared With Oxytocin for Induction After Membrane Rupture: A Randomized Controlled Trial. Obstet Gynecol 2018; 131:4-11. [PMID: 29215519 DOI: 10.1097/aog.0000000000002374] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the use of a transcervical Foley catheter plus oxytocin infusion compared with oxytocin infusion alone for labor induction and cervical ripening in women 34 weeks of gestation or greater with prelabor rupture of membranes. METHODS This is a randomized, multicenter trial of women with a live, singleton gestation at 34 weeks of gestation or greater with prelabor rupture of membranes, an unfavorable cervical examination (less than or equal to 2
cm dilated and less than or equal to 80% effaced), and no contraindication to labor. Participants were randomly allocated to a transcervical Foley catheter inflated to 30 cc with concurrent oxytocin infusion or oxytocin infusion alone. Oxytocin administration was standardized across sites. The primary study outcome was interval from induction to delivery. To detect a 2.5-hour difference in the interval from induction to delivery, we required outcome data on 194 women, assuming 80% power and a two-tailed α of 5%. Analysis was by intent to treat. RESULTS We enrolled 201 women: 93 were allocated to Foley and 108 to oxytocin. Demographics were similar between the groups. Time to delivery was not significantly different between groups: in the Foley group, it was 13.9 hours (±6.9 SD) compared with 14.4 hours (±7.9 SD) in the oxytocin group (P=.69). There were more cases of clinical chorioamnionitis (8% compared with 0%, P<.01) in the Foley group compared with the oxytocin group. There were no differences for other infectious morbidities or any other variable studied. CONCLUSION In patients with prelabor rupture of membranes, the use of a transcervical Foley catheter in addition to oxytocin does not shorten the time to delivery compared with oxytocin alone, but may increase the incidence of intraamniotic infection. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01973036.
Collapse
|