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Croll DMR, De Vaan MDT, Moes SL, Bloemenkamp KWM, Ten Eikelder MLG, De Heus R, Jozwiak M, Kooiman J, Mol BW, Verhoeven CJM, De Boer MA. Methods of induction of labor in women with obesity: A secondary analysis of two multicenter randomized controlled trials. Acta Obstet Gynecol Scand 2024; 103:470-478. [PMID: 38183287 PMCID: PMC10867363 DOI: 10.1111/aogs.14737] [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: 04/17/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Obesity is an increasing public health concern worldwide and can lead to more complications in pregnancy and childbirth. Women with obesity more often require induction of labor for various indications. The aim of this study is to assess which method of induction of labor is safest and most effective in women with obesity. MATERIAL AND METHODS This is a secondary analysis of two randomized controlled trials about induction of labor. Women with a term singleton pregnancy in cephalic presentation, an unfavorable cervix, intact membranes and without a previous cesarean section were randomly allocated to cervical priming with a Foley catheter or vaginal prostaglandin-E2-gel (PROBAAT-I) or a Foley catheter or oral misoprostol (PROBAAT-II). The inclusion and exclusion criteria for the studies were identical. Induction methods were compared in women with obesity (body mass index ≥30.0). Main outcomes were cesarean section and postpartum hemorrhage (blood loss >1000 mL). RESULTS A total of 2664 women, were included in the trials, 517 of whom were obese: 254 women with obesity received a Foley catheter, 176 oral misoprostol and 87 prostaglandin E2 (PGE2). A cesarean section was performed in 29.1% of women allocated to Foley vs 22.2% in the misoprostol and 23.0% in the PGE2 groups. Comparisons between groups revealed no statistically significant differences: the relative risk [RR] was 1.31 (95% confidence interval [CI] 0.94-1.84) in the Foley vs misoprostol group and 1.27 (95% CI 0.83-1.95) in the Foley vs PGE2 group. The rates of postpartum hemorrhage were comparable (10.6%, 11.4% and 6.9%, respectively; P = 0.512). In women with obesity, more often a switch to another method occurred in the Foley group, (20.1% vs 6.3% in misoprostol vs 1.1% in the PGE2 group; P < 0.001). The risk of a failed Foley placement was higher in women with obesity than in women without obesity (8.3% vs 3.2%; adjusted odds ratio 3.12, 95% CI 1.65-5.90). CONCLUSIONS In women with obesity we found a nonsignificant trend towards an increased rate of cesarean sections in the group induced with a Foley catheter compared to oral misoprostol; however, the study lacked power for this subgroup analysis. The finding of a higher risk of failed placement of a Foley catheter in women with obesity can be used in shared decision making.
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Affiliation(s)
- Dorothée M. R. Croll
- Department of Obstetrics, Division Woman and Baby, Wilhelmina Children's Hospital Birth CenterUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Marieke D. T. De Vaan
- Department of Obstetrics and GynecologyJeroen Bosch Hospital‘s‐Hertogenboschthe Netherlands
- Department of Health Care StudiesRotterdam University of Applied SciencesRotterdamThe Netherlands
| | - Shinta L. Moes
- Department of Obstetrics, Division Woman and Baby, Wilhelmina Children's Hospital Birth CenterUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Kitty W. M. Bloemenkamp
- Department of Obstetrics, Division Woman and Baby, Wilhelmina Children's Hospital Birth CenterUniversity Medical Center UtrechtUtrechtthe Netherlands
| | | | - Roel De Heus
- Department of Obstetrics and GynecologySt. Antonius HospitalUtrechtthe Netherlands
| | - Marta Jozwiak
- Outpatient Clinic for GynecologyVrouwenkliniek ZuidoostAmsterdamthe Netherlands
| | - Judith Kooiman
- Department of Obstetrics, Division Woman and Baby, Wilhelmina Children's Hospital Birth CenterUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and GynecologyMonash UniversityMelbourneVictoriaAustralia
- Aberdeen Centre for Women's Health ResearchUniversity of AberdeenAberdeenUK
| | - Corine J. M. Verhoeven
- Division of Midwifery, School of Health SciencesUniversity of NottinghamNottinghamUK
- Department of Obstetrics and GynecologyMaxima Medical CenterVeldhoventhe Netherlands
- Midwifery Science, AVAG, Amsterdam UMC, Location VUmcAmsterdamthe Netherlands
| | - Marjon A. De Boer
- Department of Obstetrics and GynecologyAmsterdam UMCAmsterdamthe Netherlands
- Amsterdam Reproduction and Development Research InstituteAmsterdamthe Netherlands
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Lauterbach R, Ben Zvi D, Dabaja H, Zidan R, Justman N, Vitner D, Beloosesky R, Ghanem N, Ginsberg Y, Zipori Y, Weiner Z, Khatib N. Vaginal Dinoprostone Insert versus Cervical Ripening Balloon for Term Induction of Labor in Obese Nulliparas-A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11082138. [PMID: 35456231 PMCID: PMC9029246 DOI: 10.3390/jcm11082138] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023] Open
Abstract
Data regarding the preferred induction method in women with obesity is scarce. The current study was aimed at comparing pharmacological and mechanical induction in this population. This prospective randomized controlled trial was conducted between 2016−2020, in nulliparas with a pre-pregnancy body mass index >30. Inclusion criteria were singleton-term pregnancies, bishop score < 5, and indication for induction. Patients were randomized to induction by a cervical ripening balloon (CRB) or a 10 mg vaginal dinoprostone insert. The primary outcome was delivery rate within 24 h. Secondary outcomes included time to delivery, cesarean section rate, maternal and neonatal outcomes, satisfaction, and anxiety. The study population comprised of 83 women in the CRB group and 81 in the dinoprostone group. There was a significant difference in delivery rates within 24 h and time to delivery between the dinoprostone and CRB groups (45% vs. 71%, p = 0.017 and 49.3 ± 6.8 h vs. 23.5 ± 5.9 h, p = 0.003, respectively). There were no differences in cesarean delivery rates or maternal and neonatal outcomes, though CRB induction was associated with a significantly lower rate of tachysystole. Induction with CRB was accompanied by higher satisfaction and lower anxiety. In summary, CRB induction is associated with shorter time to delivery, higher satisfaction, and lower anxiety compared to PGE2 in women with obesity, without compromising maternal or neonatal outcomes.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Correspondence: ; Tel.: +972-4-7771779; Fax: +972-4-7771778
| | - Dikla Ben Zvi
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Haneen Dabaja
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Ragda Zidan
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Naphtali Justman
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Nadir Ghanem
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Yaniv Zipori
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3109601, Israel; (D.B.Z.); (H.D.); (R.Z.); (N.J.); (D.V.); (R.B.); (N.G.); (Y.G.); (Y.Z.); (Z.W.); (N.K.)
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
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Du H, Zhang N, Xiao CY, Sun GQ, Zhao Y. Effectiveness of Dinoprostone and Cook's Balloon for Labor Induction in Primipara Women at Term. Curr Med Sci 2020; 40:951-959. [PMID: 33123908 DOI: 10.1007/s11596-020-2274-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
Labor induction is commonly used for achieving successful vaginal delivery. This study aimed to compare the effectiveness of dinoprostone and Cook's balloon as labor-inducing agents in primipara women at term. A retrospective cohort study among primipara women was conducted in Hubei Maternity and Child Health Hospital. Basic clinical characteristics were collected. The main outcomes were vaginal delivery rate, cesarean section rate and forceps delivery rate. Obstetric and perinatal outcomes were also compared. Univariate and multivariate analyses were further performed to evaluate the predictors for vaginal delivery within 24 h. A total of 845 eligible primipara women undergoing labor induction were recruited. Of them, 141 women were induced with dinoprostone (dinoprostone group, DG), and 704 with Cook's balloon (Cook's balloon group, CG). Groups were homogeneous except more women with premature rupture of membranes in DG, with gestational hypertension in CG (P<0.05). The vaginal delivery rate within 12 h was 1.98% and 16.52% in CG and DG respectively (P=0.0001). Besides, the vaginal delivery rate within 24 h was 37.62% and 52.26% in CG and DG respectively (P=0.0079). DG showed the lower rate of oxytocin augmentation, artificial rupture of membrane and postpartum hemorrhage and the shorter interval from insertion to active labor than CG (P<0.05). Multivariate regression analysis revealed that abortion history, oxytocin augmentation, artificial rupture of membrane, and obstetric analgesia were independent predictors for vaginal delivery within 24 h. In conclusion, dinoprostone was more effective than Cook's balloon to induce labor and achieve vaginal birth in the sample of primipara women at term.
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Affiliation(s)
- Hui Du
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China.
| | - Na Zhang
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Chan-Yun Xiao
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Guo-Qiang Sun
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Yun Zhao
- Department of Obstetrics, Maternity and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
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Kerbage Y, Senat MV, Drumez E, Subtil D, Vayssiere C, Deruelle P. Risk factors for failed induction of labor among pregnant women with Class III obesity. Acta Obstet Gynecol Scand 2019; 99:637-643. [PMID: 31863451 DOI: 10.1111/aogs.13794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/28/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Our aim was to identify risk factors for failed induction in morbidly obese patients undergoing the induction of labor at term. MATERIAL AND METHODS This was a retrospective multicenter study on a cohort of 235 patients with a body mass index greater than 40 kg/m2 and giving birth to a singleton in cephalic presentation, who had an induction of labor from 38 weeks of amenorrhea. Scheduled cesareans and spontaneous vaginal deliveries were excluded. Maternal, peri-partum and neonatal characteristics were analyzed according to the delivery route. RESULTS In all, 235 patients were included. Of these, 62.5% patients delivered vaginally and 37.5% by cesarean section. The frequency of nulliparity was greater in patients who had a cesarean section (56 [interquartile range, IQR, 38.1] vs 56 [IQR 63.6], P < .001). In multivariate analysis, nulliparity (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.58-4.97], P < .001), low Bishop's score (OR .794, 95% CI .70-.90, P < .001) and weight gain (OR 1.04, 95% CI 1.01-1.08, P = .033) were independent risk factors for failed induction. Umbilical cord pH at birth lower than 7 (0 vs 7 [IQR 8.0], P < .001) and lower than 7.20 (36 [IQR 24.5] vs 35 [IQR 39.8], P = .014) as well as the Apgar at 1 minute (14 [IQR 9.5] vs 17 [IQR 19.3], P = .032) was significantly higher in infants born by cesarean section. CONCLUSIONS In this cohort, 63% of women with Class III obesity had successful inductions of labor; risk factors for failed induction include nulliparity and unfavorable Bishop score.
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Affiliation(s)
- Yohan Kerbage
- Department of Obstetrics, Jeanne de Flandre University Hospital (CHRU), Lille, France
| | - Marie V Senat
- Gynecology-Obstetrics Service, Le Kremlin-Bicêtre Hospital, Public Hospital Assistance of Paris (APHP), Université Paris Sud, Orsay, France
| | - Elodie Drumez
- Department of Biostatistics, University of Lille, EA 2694 - Public Health: Epidemiology and Quality of Care, University Hospital of Lille (CHU), Lille, France
| | - Damien Subtil
- Department of Obstetrics, Jeanne de Flandre University Hospital (CHRU), Lille, France
| | - Christophe Vayssiere
- Women's-Maternity-Couple Center, Gynecology-Obstetrics Department, Paule de Viguier Hospital, University Hospital of Toulouse, Toulouse, France.,UMR 1027 INSERM, Université Paul-Sabatier Toulouse III, Toulouse, France
| | - Philippe Deruelle
- Department of Obstetrics, Jeanne de Flandre University Hospital (CHRU), Lille, France
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Kehl S, Born T, Weiss C, Faschingbauer F, Pretscher J, Beckmann MW, Sütterlin M, Dammer U. Induction of labour with sequential double-balloon catheter and oral misoprostol versus oral misoprostol alone in obese women. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100034. [PMID: 31403122 PMCID: PMC6687443 DOI: 10.1016/j.eurox.2019.100034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the efficacy of induction of labour in obese women using sequential double-balloon catheter and oral misoprostol in comparison with oral misoprostol alone. Study design In this cohort study, 400 pregnant women with BMI higher than 35 kg/m2 undergoing labour induction at term were included. Induction of labour with a double-balloon catheter and, if necessary, sequential oral misoprostol (n = 216) was compared to oral misoprostol alone (n = 184). The primary outcome measure was the caesarean section rate. Secondary outcome parameters were, among others, the induction-to-delivery-interval, the rate of vaginal delivery within 24 and 48 h as well as fetal outcome parameters. Results The caesarean section rate was significantly lower in the group with sequential use of double-balloon catheter and oral misoprostol (27.6% versus 37.5%, p = 0.0345). After stratification for parity this reduction was seen especially in nulliparous (38.6% versus 56.9%, p = 0.0039). The rate of abnormal CTG was significantly lower as well (19.9% versus 30.4%, p = 0.0150), particularly in nulliparous (25.9% versus 40.4%, p = 0.0138). Uni- and multivariable analyzes showed that the caesarean section rate was significantly influenced by the method of induction of labour (p = 0.0026), parity (p < 0.0001) and Bishop score (p = 0.0425). Conclusion In obese women, induction of labour with sequential use of double-balloon catheter and oral misoprostol is associated with significantly more normal vaginal deliveries and less caesarean sections.
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Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Germany
| | - Tilman Born
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Heidelberg University, Germany
| | | | - Jutta Pretscher
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Germany
| | - Ulf Dammer
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Germany
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