Single-balloon catheter with concomitant vaginal misoprostol is the most effective strategy for labor induction: a meta-review with network meta-analysis

A comparative analysis of methods of preinduction cervical ripening and induction of labor in Poland and in Germany (Part II): maternal and neonatal outcomes

The benefits and risks of delivery should always be considered before initiating preinduction cervical ripening and labor induction. Understanding the benefits and potential complications is crucial for healthcare professionals to make informed decisions and provide optimal care. The research was conducted retrospectively between January 2019 and July 2022. It involved the analysis of the medical records of 154 pregnant women staying in the Clinic of Obstetrics and Gynecology in the city of Szczecin and 150 pregnant women hospitalized in the Clinic of Obstetrics and Gynecology in the town of Schwedt/Oder in Germany. Inclusion criteria were consent to participate and the implementation of internal written protocols in line with national guidelines for labor induction. The research concerned a group of pregnant women with postdate pregnancy, calculated according to the Naegele's rule and confirmed by the USG examination conducted in the first trimester of the pregnancy, as well as an unfavorable cervix that received less than 6 points in the Bishop score. Moreover, the pregnant patients with a low biophysical profile and an abnormal record of CTG or comorbidities were also included, as these factors determined the classification of the group above. The study did not include patients who had undergone cesarean section. The average change in evaluation of the cervix marked on the Bishop Score was higher in Germany, and it was 2.7 points, whereas in Poland, it was 1.6 points. The largest percentage of the scores on the Apgar Scale in the first, third and fifth minutes after birth was in the norm and indicated a good health condition of infants. They reached 8 to 10 points in both countries. Significantly more infants in Germany received pH from the umbilical cord within the limits of the norm. And it marks the welfare of neonates (7.20-7.45). The duration of hospitalization in Poland was shorter than in Germany. It was 3.8 days in the case when the median equalled 3. The number of days of preinduction cervical ripening and induction was similar in both countries. The levels of haemoglobin were comparable in both countries. The most common postpartum complications in Poland and Germany were first-degree perineal tears, episiotomies and anemia. Among the postpartum complications, cervical tears, revision of the uterine cavity, and episiotomy were significantly more common in Poland. First- and second-degree perineal tears were more frequent in Germany.

How labor induction methods have evolved throughout history, from the Egyptian era to the present day: evolution, effectiveness, and safety

Induction of labor (IOL) is currently used for one in 10 pregnancies globally. Methods used for induction have shown major changes over time. Medical interventions trace their origins back to ancient civilizations, with evidence suggesting that they began over 5000 years ago in ancient Egypt. During this era, the Egyptians employed natural remedies such as castor oil and date fruits for the IOL. These early practices highlight the rich history and long-standing tradition of using natural substances in medical treatments, laying the foundation for the development of modern obstetric practices. After that, Hippocrates practiced mammary stimulation and mechanical cervical dilatation about 2500 years ago in Greece. Since then, there has been a marked change, especially over the last century, with the development of safer and more effective methods. Mechanical methods were the main method until the early 20th century, which were then substituted by pharmacological methods with more experiments in the mid to late 20th century. Nowadays, effectiveness, safety, cost, and client satisfaction are the main determinants of the methods used. This review summarizes how labor induction practices have evolved from the Egyptian era to the present-day randomized controlled trials and meta-analysis evidence, paying attention to their effectiveness, safety, and future directions.

Parturition at term: induction, second and third stages of labor, and optimal management of life-threatening complications-hemorrhage, infection, and uterine rupture

Childbirth is a defining moment in anyone's life, and it occurs 140 million times per year. Largely a physiologic process, parturition does come with risks; one mother dies every two minutes. These deaths occur mostly among healthy women, and many are considered preventable. For each death, 20 to 30 mothers experience complications that compromise their short- and long-term health. The risk of birth extends to the newborn, and, in 2020, 2.4 million neonates died, 25% in the first day of life. Hence, intrapartum care is an important priority for society. The American Journal of Obstetrics & Gynecology has devoted two special Supplements in 2023 and 2024 to the clinical aspects of labor at term. This article describes the content of the Supplements and highlights new developments in the induction of labor (a comparison of methods, definition of failed induction, new pharmacologic agents), management of the second stage, the value of intrapartum sonography, new concepts on soft tissue dystocia, optimal care during the third stage, and common complications that account for maternal death, such as infection, hemorrhage, and uterine rupture. All articles are available to subscribers and non-subscribers and have supporting video content to enhance dissemination and improve intrapartum care. Our hope is that no mother suffers because of lack of information.