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Tan SP, Bashirudin SB, Rajaratnam RK, Gan F. Short stature and vaginal dinoprostone as independent predictors of composite maternal-newborn adverse outcomes in induction of labor after one previous cesarean: a retrospective cohort study. BMC Pregnancy Childbirth 2024; 24:455. [PMID: 38951754 PMCID: PMC11218360 DOI: 10.1186/s12884-024-06650-5] [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: 02/04/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND The rates of labor induction and cesarean delivery is rising worldwide. With the confluence of these trends, the labor induction rate in trials of labor after cesarean can be as high as 27-32.7%. Induction of labor after one previous cesarean (IOLAC) is a high-risk procedure mainly due to the higher risk of uterine rupture. Nevertheless, the American College of Obstetricians and Gynecologists considers IOLAC as an option in motivated and informed women in the appropriate care setting. We sought to identify predictors of a composite of maternal and newborn adverse outcomes following IOLAC. METHODS The electronic medical records of women who delivered between January 2018 to September 2022 in a Malaysian university hospital were screened to identify cases of IOLAC. A case is classified as a composite adverse outcome if at least one of these 11 adverse outcomes of delivery blood loss ≥ 1000 ml, uterine scar complications, cord prolapse or presentation, placenta abruption, maternal fever (≥ 38 0C), chorioamnionitis, intensive care unit (ICU) admission, Apgar score < 7 at 5 min, umbilical artery cord artery blood pH < 7.1 or base excess ≤-12 mmol/l, and neonatal ICU admission was present. An unplanned cesarean delivery was not considered an adverse outcome as the practical management alternative for a clinically indicated IOLAC was a planned cesarean. Bivariate analysis of participants' characteristics was performed to identify predictors of their association with composite adverse outcome. Characteristics with crude p < 0.10 on bivariate analysis were incorporated into a multivariable binary logistic regression analysis model. RESULTS Electronic medical records of 19,064 women were screened. 819 IOLAC cases and 98 cases with composite adverse outcomes were identified. Maternal height, ethnicity, previous vaginal delivery, indication of previous cesarean, indication for IOLAC, and method of IOLAC had p < 0.10 on bivariate analysis and were incorporated into a multivariable binary logistic regression analysis. After adjustment, only maternal height and IOLAC by vaginal dinoprostone compared to Foley balloon remained significant at p < 0.05. Post hoc adjusted analysis that included all unplanned cesarean as an added qualifier for composite adverse outcome showed higher body mass index, short stature (< 157 cm), not of Chinese ethnicity, no prior vaginal delivery, prior cesarean indicated by labor dystocia, and less favorable Bishop score (< 6) were independent predictors of the expanded composite adverse outcome. CONCLUSION Shorter women and IOLAC by vaginal dinoprostone compared to Foley balloon were independently predictive of composite of adverse outcome.
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Affiliation(s)
- Sze Ping Tan
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur, 50603, Malaysia
- Deparment of Obstetrics and Gynecology, North Middlesex University Hospital NHS Trust, Sterling Way, London, N18 1QX, UK
| | - Saniyati Badri Bashirudin
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur, 50603, Malaysia
| | - Rajeev Kumar Rajaratnam
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur, 50603, Malaysia
| | - Farah Gan
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur, 50603, Malaysia.
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Dick A, Gutman-Ido E, Chill HH, Karavani G, Ryvkin I, Porat S, Rosenbloom JI. Artificial rupture of membranes as a mode for induction of labor in women with a previous cesarean section- a retrospective cohort study. BMC Pregnancy Childbirth 2022; 22:886. [PMID: 36447150 PMCID: PMC9710010 DOI: 10.1186/s12884-022-05237-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Induction of labor in women with a previous cesarean section (CS) is associated with increased rates of uterine rupture and failed attempt for vaginal delivery. Prostaglandins use is contraindicated in this population, limiting available options for cervical ripening. OBJECTIVE To evaluate the efficacy and safety of artificial rupture of membranes (AROM) as a mode of Induction of labor (IOL) in women with a previous cesarean section. METHODS A retrospective cohort study conducted in a single tertiary care center between January 2015 and October 2020. Women with one previous cesarean section and a current singleton term pregnancy requiring IOL, with an unfavorable cervix, were included. The primary outcome was a successful vaginal delivery (VBAC); secondary outcomes were rates of chorioamnionitis, uterine rupture and low Apgar score (< 7). RESULTS Of the 665 women who met the inclusion criteria, 492 (74%) did not receive subsequent oxytocin and 173 (26%) did. There were significant differences in the baseline characteristics between these two groups, including maternal age, cervical dilation at presentation, parity, and a history of a previous VBAC. Among women who were induced solely by AROM the rate of a successful TOLAC was higher (81.3% vs 73.9%), total time of IOL was shorter (mean 8.7 h vs.16.1 h) and the risk of chorioamnionitis was lower (7.3% vs 18.4%). When subdividing the women who received oxytocin into early (< 12 h after AROM) vs late (> 12 h after AROM) administration, there were no significant changes in the rates of successful VBAC or of chorioamnionitis. CONCLUSION AROM as a single mode of IOL in women with a previous CS is a safe and efficient practice with high rates of successful VBAC. When spontaneous labor does not develop, there is no advantage to delay the administration of oxytocin.
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Affiliation(s)
- Aharon Dick
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, 91120 Israel
| | - Einat Gutman-Ido
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel
| | - Henry Hillel Chill
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL USA
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ina Ryvkin
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shay Porat
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joshua Isaac Rosenbloom
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University of Jerusalem, Jerusalem, Israel
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Salzberger H, Maul H. Gutes Misoprostol, böses Misoprostol – oder wie ich es schaffe, ein Medikament mehr als 100-mal teurer zu machen? Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/a-1664-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Holger Maul
- Frauenkliniken der Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Asklepios Kliniken Hamburg, Hamburg, Deutschland
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Bossung V, Rath W, Rody A, Schwarz C. Heterogenous use of misoprostol for induction of labour: results of an online survey among midwives in German-speaking countries. Arch Gynecol Obstet 2021; 304:1501-1511. [PMID: 33938998 PMCID: PMC8553731 DOI: 10.1007/s00404-021-06079-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 04/23/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE This online survey looked at the experiences and general perceptions of midwives concerning induction of labour and the specific use of misoprostol. METHODS We published an online questionnaire with 24 questions in German on midwives' experiences and perceptions of different methods of induction of labour. RESULTS The online survey was answered by 412 midwives between February 2016 and February 2017. At least 20% of the 24 questions were answered in 333 questionnaires, which were included in this analysis. Oral misoprostol was the most common induction method for primipara and for women with a previous vaginal birth and an unfavourable cervix. Apart from alternative methods for induction of labour like castor oil and complementary/alternative methods, oral misoprostol was the preferred method of induction of labour by midwives. Midwives described a wide range of dosage schedules concerning application intervals, starting doses, and the maximum daily dose of misoprostol. Approximately 50% of the participants of this study described prescriptions of more than 200 µg misoprostol daily for induction of labour. CONCLUSION Misoprostol is widely used in Germany and was one of the three preferred methods of induction of labour among midwives in our study next to castor oil and complementary/alternative methods. The preparation and dosage of misoprostol vary significantly among hospitals and do not adhere to international guidelines. Midwives voiced their concerns about inconsistent indications and heterogenous use of different methods and dosages of induction. They wished for more patience with late-term pregnancies and individualized shared decision-making between pregnant women and obstetricians.
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Affiliation(s)
- Verena Bossung
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
| | - Werner Rath
- Department of Obstetrics and Gynecology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Christiane Schwarz
- Department of Midwifery Science, C/O BMO, University of Luebeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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López-Jiménez N, García-Sánchez F, Pailos RH, Rodrigo-Álvaro V, Pascual-Pedreño A, Moreno-Cid M, Hernández-Martínez A, Molina-Alarcón M. Induction of Labor with Vaginal Dinoprostone (PGE 2) in Patients with a Previous Cesarean Section: Obstetric and Neonatal Outcomes. J Clin Med 2021; 10:5221. [PMID: 34830502 PMCID: PMC8622073 DOI: 10.3390/jcm10225221] [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: 09/21/2021] [Revised: 11/01/2021] [Accepted: 11/07/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Vaginal dinoprostone (PGE2) is currently used as the prostaglandin of choice in many obstetric units. However, few studies have evaluated its safety, especially in women who previously had a cesarean section. OBJECTIVE To evaluate the efficacy and safety of PGE2 in pregnant women who are undergoing induction of labor (IOL), and who have had a previous cesarean section. MATERIALS AND METHODS A prospective observational study was conducted in La Mancha Centro Hospital in Alcázar de San Juan, Spain, from 1 February 2019 to 30 August 2020. Obstetric and neonatal outcomes, following IOL with PGE2, in 47 pregnant women who wanted a trial of labor after cesarean (TOLAC), and 377 pregnant women without a history of cesarean section, were analyzed. The outcomes were analyzed by bivariate and multivariate analyses using binary and multiple linear regression. RESULTS A total of 424 women were included in this study. The percentage of cesarean sections in the TOLAC group was 44.7% (21), compared with 31.6% (119) in the group without a history of cesarean section (adjusted odds ratio: 1.4; 95% CI: 0.68-2.86). In the multivariate analysis, no statistically significant differences were observed between both groups for obstetric and neonatal outcomes (p > 0.05). However, two uterine ruptures (4.3%) occurred in the group of patients with a history of cesarean section who underwent IOL with PGE2. CONCLUSIONS The induction of labor with vaginal dinoprostone (PGE2), in patients with a previous history of cesarean section, was not associated with worse obstetric or neonatal outcomes compared with the group of patients without a history of cesarean section in our study sample. However, further research is needed regarding this IOL method, and it should be used with caution in this population group.
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Affiliation(s)
- Nuria López-Jiménez
- Department of Obstetrics and Gynecology, La Mancha Centro Hospital, 13600 Alcázar de San Juan, Spain; (N.L.-J.); (F.G.-S.); (R.H.P.); (V.R.-Á.); (A.P.-P.); (M.M.-C.)
| | - Fiamma García-Sánchez
- Department of Obstetrics and Gynecology, La Mancha Centro Hospital, 13600 Alcázar de San Juan, Spain; (N.L.-J.); (F.G.-S.); (R.H.P.); (V.R.-Á.); (A.P.-P.); (M.M.-C.)
| | - Rafael Hernández Pailos
- Department of Obstetrics and Gynecology, La Mancha Centro Hospital, 13600 Alcázar de San Juan, Spain; (N.L.-J.); (F.G.-S.); (R.H.P.); (V.R.-Á.); (A.P.-P.); (M.M.-C.)
| | - Valentin Rodrigo-Álvaro
- Department of Obstetrics and Gynecology, La Mancha Centro Hospital, 13600 Alcázar de San Juan, Spain; (N.L.-J.); (F.G.-S.); (R.H.P.); (V.R.-Á.); (A.P.-P.); (M.M.-C.)
| | - Ana Pascual-Pedreño
- Department of Obstetrics and Gynecology, La Mancha Centro Hospital, 13600 Alcázar de San Juan, Spain; (N.L.-J.); (F.G.-S.); (R.H.P.); (V.R.-Á.); (A.P.-P.); (M.M.-C.)
| | - María Moreno-Cid
- Department of Obstetrics and Gynecology, La Mancha Centro Hospital, 13600 Alcázar de San Juan, Spain; (N.L.-J.); (F.G.-S.); (R.H.P.); (V.R.-Á.); (A.P.-P.); (M.M.-C.)
| | - Antonio Hernández-Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Man cha IDINE, Camilo José Cela, 14, 13071 Ciudad Real, Spain;
| | - Milagros Molina-Alarcón
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Man cha IDINE, Camilo José Cela, 14, 13071 Ciudad Real, Spain;
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Kehl S, Weiss C, Rath W, Schneider M, Stumpfe F, Faschingbauer F, Beckmann MW, Stelzl P. Labour Induction with Misoprostol in German Obstetric Clinics: What Are the Facts on Such Use? Geburtshilfe Frauenheilkd 2021; 81:955-965. [PMID: 34393259 PMCID: PMC8354357 DOI: 10.1055/a-1538-2200] [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: 04/07/2021] [Accepted: 06/25/2021] [Indexed: 11/09/2022] Open
Abstract
Subject While the synthetic prostaglandin E1 analogue misoprostol is the most effect labour induction agent, its use is off-label for the most part. For this reason, and in view of its potential adverse effects and varying approaches to its administration, the drug has recently once again become a focus of critical attention. The objective of this survey was thus to establish a record of labour induction with misoprostol in German clinics and determine the impact of the negative reporting on everyday obstetric practice. Material and Methods In this cross-sectional study, 635 obstetrics and gynaecology departments in Germany were requested by email to participate in our survey in February/March 2020. Online responses to 19 questions were requested regarding the clinic, use of misoprostol before and after the critical reporting, use of misoprostol (sourcing, method of administration, dosage, monitoring) and other labour induction methods. Results A total of 262 (41.3%) of the clinics solicited for the survey completed the questionnaire. There were no differences regarding the care level (Perinatal Centre Level I, Perinatal Centre Level II, Clinic with Perinatal Focus or Obstetric/Private Clinic; p = 0.2104) or birth counts (p = 0.1845). In most cases, misoprostol was prepared in the clinic's own pharmacy (54%) or imported from another country (46%) and administered orally in tablet form (95%). Misoprostol dosage levels varied (25 µg [48%], 50 µg [83%], 75 µg [6%], 100 µg [47%] and > 100 µg [5%]). Most of the clinics used premanufactured tablets/capsules (59%), although Cytotec tablets were also divided (35%) or dissolved in water (5%). Misoprostol administration intervals were mainly every 4 hours (64%) or every 6 hours (30%). CTG checks were run in most cases before and after administration of a dose of misoprostol (78% and 76%) and before and after administration of a dose of prostaglandin E2 (both 88%). Presence of contractions led to no misoprostol (59%) or no prostaglandin E2 (64%) being administered in most cases. The critical reporting resulted in discontinuation of use of misoprostol in 17% of the clinics - mainly smaller obstetric/private clinics with fewer than 1000 births. Labour cocktails were used mainly in obstetric and private clinics (61%). Conclusion Misoprostol is an established agent for labour induction in German clinics. The dosing schemes used vary. Improvements of currently common management practices are required, especially in the area of labour induction (CTG checks before and after administration of labour-inducing medication, no administration of prostaglandin if contractions are ongoing). The discussion of use of misoprostol in the media resulted in stoppage of its use mainly in smaller clinics.
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Affiliation(s)
- Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christel Weiss
- Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Werner Rath
- Medizinische Fakultät, Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Florian Stumpfe
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | | | | | - Patrick Stelzl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
- Abteilung für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum Linz, Linz, Austria
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Kerr RS, Kumar N, Williams MJ, Cuthbert A, Aflaifel N, Haas DM, Weeks AD. Low-dose oral misoprostol for induction of labour. Cochrane Database Syst Rev 2021; 6:CD014484. [PMID: 34155622 PMCID: PMC8218159 DOI: 10.1002/14651858.cd014484] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Misoprostol given orally is a commonly used labour induction method. Our Cochrane Review is restricted to studies with low-dose misoprostol (initially ≤ 50 µg), as higher doses pose unacceptably high risks of uterine hyperstimulation. OBJECTIVES To assess the efficacy and safety of low-dose oral misoprostol for labour induction in women with a viable fetus in the third trimester of pregnancy. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (14 February 2021) and reference lists of retrieved studies. SELECTION CRITERIA Randomised trials comparing low-dose oral misoprostol (initial dose ≤ 50 µg) versus placebo, vaginal dinoprostone, vaginal misoprostol, oxytocin, or mechanical methods; or comparing oral misoprostol protocols (one- to two-hourly versus four- to six-hourly; 20 µg to 25 µg versus 50 µg; or 20 µg hourly titrated versus 25 µg two-hourly static). DATA COLLECTION AND ANALYSIS Using Covidence, two review authors independently screened reports, extracted trial data, and performed quality assessments. Our primary outcomes were vaginal birth within 24 hours, caesarean section, and hyperstimulation with foetal heart changes. MAIN RESULTS We included 61 trials involving 20,026 women. GRADE assessments ranged from moderate- to very low-certainty evidence, with downgrading decisions based on imprecision, inconsistency, and study limitations. Oral misoprostol versus placebo/no treatment (four trials; 594 women) Oral misoprostol may make little to no difference in the rate of caesarean section (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.59 to 1.11; 4 trials; 594 women; moderate-certainty evidence), while its effect on uterine hyperstimulation with foetal heart rate changes is uncertain (RR 5.15, 95% CI 0.25 to 105.31; 3 trials; 495 women; very low-certainty evidence). Vaginal births within 24 hours was not reported. In all trials, oxytocin could be commenced after 12 to 24 hours and all women had pre-labour ruptured membranes. Oral misoprostol versus vaginal dinoprostone (13 trials; 9676 women) Oral misoprostol probably results in fewer caesarean sections (RR 0.84, 95% CI 0.78 to 0.90; 13 trials, 9676 women; moderate-certainty evidence). Subgroup analysis indicated that 10 µg to 25 µg (RR 0.80, 95% CI 0.74 to 0.87; 9 trials; 8652 women) may differ from 50 µg (RR 1.10, 95% CI 0.91 to 1.34; 4 trials; 1024 women) for caesarean section. Oral misoprostol may decrease vaginal births within 24 hours (RR 0.93, 95% CI 0.87 to 1.00; 10 trials; 8983 women; low-certainty evidence) and hyperstimulation with foetal heart rate changes (RR 0.49, 95% CI 0.40 to 0.59; 11 trials; 9084 women; low-certainty evidence). Oral misoprostol versus vaginal misoprostol (33 trials; 6110 women) Oral use may result in fewer vaginal births within 24 hours (average RR 0.81, 95% CI 0.68 to 0.95; 16 trials, 3451 women; low-certainty evidence), and less hyperstimulation with foetal heart rate changes (RR 0.69, 95% CI 0.53 to 0.92, 25 trials, 4857 women, low-certainty evidence), with subgroup analysis suggesting that 10 µg to 25 µg orally (RR 0.28, 95% CI 0.14 to 0.57; 6 trials, 957 women) may be superior to 50 µg orally (RR 0.82, 95% CI 0.61 to 1.11; 19 trials; 3900 women). Oral misoprostol probably does not increase caesarean sections overall (average RR 1.00, 95% CI 0.86 to 1.16; 32 trials; 5914 women; low-certainty evidence) but likely results in fewer caesareans for foetal distress (RR 0.74, 95% CI 0.55 to 0.99; 24 trials, 4775 women). Oral misoprostol versus intravenous oxytocin (6 trials; 737 women, 200 with ruptured membranes) Misoprostol may make little or no difference to vaginal births within 24 hours (RR 1.12, 95% CI 0.95 to 1.33; 3 trials; 466 women; low-certainty evidence), but probably results in fewer caesarean sections (RR 0.67, 95% CI 0.50 to 0.90; 6 trials; 737 women; moderate-certainty evidence). The effect on hyperstimulation with foetal heart rate changes is uncertain (RR 0.66, 95% CI 0.19 to 2.26; 3 trials, 331 women; very low-certainty evidence). Oral misoprostol versus mechanical methods (6 trials; 2993 women) Six trials compared oral misoprostol to transcervical Foley catheter. Misoprostol may increase vaginal birth within 24 hours (RR 1.32, 95% CI 0.98 to 1.79; 4 trials; 1044 women; low-certainty evidence), and probably reduces the risk of caesarean section (RR 0.84, 95% CI 0.75 to 0.95; 6 trials; 2993 women; moderate-certainty evidence). There may be little or no difference in hyperstimulation with foetal heart rate changes (RR 1.31, 95% CI 0.78 to 2.21; 4 trials; 2828 women; low-certainty evidence). Oral misoprostol one- to two-hourly versus four- to six-hourly (1 trial; 64 women) The evidence on hourly titration was very uncertain due to the low numbers reported. Oral misoprostol 20 µg hourly titrated versus 25 µg two-hourly static (2 trials; 296 women) The difference in regimen may have little or no effect on the rate of vaginal births in 24 hours (RR 0.97, 95% CI 0.80 to 1.16; low-certainty evidence). The evidence is of very low certainty for all other reported outcomes. AUTHORS' CONCLUSIONS Low-dose oral misoprostol is probably associated with fewer caesarean sections (and therefore more vaginal births) than vaginal dinoprostone, and lower rates of hyperstimulation with foetal heart rate changes. However, time to birth may be increased, as seen by a reduced number of vaginal births within 24 hours. Compared to transcervical Foley catheter, low-dose oral misoprostol is associated with fewer caesarean sections, but equivalent rates of hyperstimulation. Low-dose misoprostol given orally rather than vaginally is probably associated with similar rates of vaginal birth, although rates may be lower within the first 24 hours. However, there is likely less hyperstimulation with foetal heart changes, and fewer caesarean sections performed due to foetal distress. The best available evidence suggests that low-dose oral misoprostol probably has many benefits over other methods for labour induction. This review supports the use of low-dose oral misoprostol for induction of labour, and demonstrates the lower risks of hyperstimulation than when misoprostol is given vaginally. More trials are needed to establish the optimum oral misoprostol regimen, but these findings suggest that a starting dose of 25 µg may offer a good balance of efficacy and safety.
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Affiliation(s)
- Robbie S Kerr
- Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Nimisha Kumar
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Myfanwy J Williams
- Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Anna Cuthbert
- Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Nasreen Aflaifel
- Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew D Weeks
- Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
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Pirhonen J, Erkkola R. Delivery after fetal death in women with earlier cesarean section. A review. Eur J Obstet Gynecol Reprod Biol 2021; 260:150-153. [PMID: 33773261 DOI: 10.1016/j.ejogrb.2021.03.027] [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: 01/29/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/18/2022]
Abstract
The clinical management of intrauterine fetal demise (IUFD) in women with a previous cesarean delivery presents a dilemma for the obstetrician. With the current reluctance of obstetricians to perform vaginal birth after cesarean (VBAC) and the paucity of data to counsel women regarding maternal risks, management options are limited by physician's clinical experience and biases. In the setting of fetal demise, maternal safety becomes the primary concern. Medicolegal pressures may prevent physicians from attempting a trial of labor in this situation. In this review we will a focus on frequency of birth with IUFD after cesarean section (CS), we discuss the options (VBAC vs CS), different complications, methods for induction of vaginal birth as well as risk factors of vaginal birth and cesarean delivery.
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Affiliation(s)
- Jouko Pirhonen
- The Norwegian Continence and Pelvic Floor Center, University Hospital of North Norway, Tromsø, Norway.
| | - Risto Erkkola
- Department of Obstetrics and Gynecology, Turku University Central Hospital, Turku, Finland
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Hamidi O, Quist-Nelson J, Xodo S, Berghella V. Membrane sweeping in patients planning a trial of labor after cesarean: a systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 2019; 33:3103-3110. [PMID: 30700186 DOI: 10.1080/14767058.2019.1569612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Membrane sweeping has been shown to reduce time to the onset of labor in women at term but the effects of membrane sweeping in women with a prior cesarean delivery are largely unknown.Objective: To determine the effects of membrane sweeping on promoting labor in patients undergoing a trial of labor after cesarean.Study design: Searches were performed in Medline, Ovid, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials using a combination of keywords related to "membrane sweeping," "membrane stripping," "vaginal birth after cesarean," and "trial of labor after cesarean" from inception of databases until April 2018. Study eligibility criteria: We included all randomized controlled trials (RCTs) of singleton or twin gestations at 36 weeks or greater that evaluated prophylactic or prelabor membrane sweeping in patients undergoing a trial of labor after cesarean. Exclusion criteria were trials that did not include patients with a prior uterine scar or cesarean delivery, or that were studies of membrane sweeping during initiation of induction of labor. Study appraisal and synthesis methods: the primary outcome was the rate of spontaneous labor. Meta-analysis was performed using the random-effects model of DerSimonian and Laird, to produce relative risk (RR) with 95% confidence interval (CI).Results: Two studies met inclusion criteria and were included in our meta-analysis (n = 361). Membrane sweeping did not have an effect on the onset of labor (RR 1.05, 95% CI 0.92-1.20). There was no significant difference for the rate of spontaneous vaginal delivery (RR 1.06, 95% CI 0.84-1.34), operative vaginal delivery (RR 0.97, 95% CI 0.25-3.78), or cesarean delivery (RR 1.00, 95% CI 0.87-1.14).Conclusion: Membrane sweeping in patients planning a trial of labor after cesarean was not found to be effective in promoting the onset of labor. This systematic review highlights the limited data addressing the utility of membrane sweeping for women with prior cesarean delivery.
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Affiliation(s)
- Odessa Hamidi
- Department of Obstetrics and Gynecology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Johanna Quist-Nelson
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Serena Xodo
- Department of Gynecology and Obstetrics, School of Medicine, University of Udine, Udine, Italy
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Wallstrom T, Bjorklund J, Frykman J, Jarnbert-Pettersson H, Akerud H, Darj E, Gemzell-Danielsson K, Wiberg-Itzel E. Induction of labor after one previous Cesarean section in women with an unfavorable cervix: A retrospective cohort study. PLoS One 2018; 13:e0200024. [PMID: 29965989 PMCID: PMC6028115 DOI: 10.1371/journal.pone.0200024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/17/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Uterine rupture is a well-known but unusual complication in vaginal deliveries with a Cesarean section in the history. The risk of uterine rupture is at least two-fold when labor is induced. In Sweden, women are allowed to deliver vaginally after one previous Cesarean section, regardless if labor starts spontaneously or is induced. The aim of the study is to compare the proportion of uterine ruptures between the three methods (balloon catheter, Minprostin® and Cytotec®) for induction of labor in women with an unfavorable cervix and one previous Cesarean section. Material and methods Retrospective cohort study of all women with one previous Cesarean section and induction of labor with an unfavorable cervix at the four largest clinics in Stockholm during 2012–2015. Inclusion criteria: Women with a previous Cesarean section and induction of labor with a viable fetus, cephalic presentation, singleton, at ≥34 w, (n = 910). Results 3.0% (27/910) of the women with induction of labor had a uterine rupture, 91% of them had no previous vaginal delivery. The proportion of uterine ruptures was 2.0% (6/295) with orally administrated Cytotec®, 2.1% (7/335) with balloon catheter and 5.0% (14/ 281) when Minprostin® was used. Conclusions No difference in the proportion of uterine ruptures was shown when orally administrated Cytotec® and balloon catheter were compared (p = 0.64). Orally administrated Cytotec® and balloon catheter give a high success rate of vaginal deliveries (almost 70%) despite an unfavorable cervix.
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Affiliation(s)
- Tove Wallstrom
- Department of Clinical Science and Education Karolinska Institute, Women’s Clinic, Sodersjukhuset, Sweden
- * E-mail:
| | - Jenny Bjorklund
- Department of Clinical Science and Education Karolinska Institute, Women’s Clinic, Sodersjukhuset, Sweden
| | - Joanna Frykman
- Department of Clinical Science and Education Karolinska Institute, Women’s Clinic, Sodersjukhuset, Sweden
| | - Hans Jarnbert-Pettersson
- Department of Clinical Science and Education Karolinska Institute, Women’s Clinic, Sodersjukhuset, Sweden
| | - Helena Akerud
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Elisabeth Darj
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Oslo, Norway
| | - Kristina Gemzell-Danielsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Wiberg-Itzel
- Department of Clinical Science and Education Karolinska Institute, Women’s Clinic, Sodersjukhuset, Sweden
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11
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Sheibani L, Wing DA. A safety review of medications used for labour induction. Expert Opin Drug Saf 2017; 17:161-167. [DOI: 10.1080/14740338.2018.1404573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lili Sheibani
- Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Deborah A. Wing
- Obstetrics & Gynecology, University of California Irvine School of Medicine, Orange, CA, USA
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12
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Kruit H, Wilkman H, Tekay A, Rahkonen L. Induction of labor by Foley catheter compared with spontaneous onset of labor after previous cesarean section: a cohort study. J Perinatol 2017; 37:787-792. [PMID: 28406484 DOI: 10.1038/jp.2017.50] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/24/2017] [Accepted: 03/10/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the safety of induction of labor (IOL) with Foley catheter (FC) in women with a history of previous cesarean section (CS) and to assess risk factors for repeat CS and adverse maternal outcomes. STUDY DESIGN Cohort study of 1559 women with a history of previous CS in Helsinki University Hospital, Finland between 2013 and 2014. RESULTS Three hundred and sixty-one women (23.2%) underwent IOL by FC and 1198 (76.8%) had spontaneous onset of labor. The rate of repeat CS was higher in women undergoing IOL (38% vs 20.2%; P<0.001). The overall rate of uterine rupture was 0.3% in induced labor and 0.8% in spontaneous onset of labor (P=0.47). Adverse maternal outcomes were not significantly different. The intrapartum and postpartum infection rates were higher in women undergoing IOL compared with spontaneous onset of labor (6.1% vs 1.8%; P>0.001 and 5.3% vs 1.3%; P<0.001, respectively). CONCLUSION FC appears safe and effective method for IOL in women with a history of previous CS.
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Affiliation(s)
- H Kruit
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - H Wilkman
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - A Tekay
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L Rahkonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Abstract
BACKGROUND Women with a prior caesarean delivery have an increased risk of uterine rupture and for women subsequently requiring induction of labour it is unclear which method is preferable to avoid adverse outcomes. This is an update of a review that was published in 2013. OBJECTIVES To assess the benefits and harms associated with different methods used to induce labour in women who have had a previous caesarean birth. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (31 August 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing any method of third trimester cervical ripening or labour induction, with placebo/no treatment or other methods in women with prior caesarean section requiring labour induction in a subsequent pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and trial quality, extracted data, and checked them for accuracy. MAIN RESULTS Eight studies (data from 707 women and babies) are included in this updated review. Meta-analysis was not possible because studies compared different methods of labour induction. All included studies had at least one design limitation (i.e. lack of blinding, sample attrition, other bias, or reporting bias). One study stopped prematurely due to safety concerns. Vaginal PGE2 versus intravenous oxytocin (one trial, 42 women): no clear differences for caesarean section (risk ratio (RR) 0.67, 95% confidence interval (CI) 0.22 to 2.03, evidence graded low), serious neonatal morbidity or perinatal death (RR 3.00, 95% CI 0.13 to 69.70, evidence graded low), serious maternal morbidity or death (RR 3.00, 95% CI 0.13 to 69.70, evidence graded low). Also no clear differences between groups for the reported secondary outcomes. The GRADE outcomes vaginal delivery not achieved within 24 hours, and uterine hyperstimulation with fetal heart rate changes were not reported. Vaginal misoprostol versus intravenous oxytocin (one trial, 38 women): this trial stopped early because one woman who received misoprostol had a uterine rupture (RR 3.67, 95% CI 0.16 to 84.66) and one had uterine dehiscence. No other outcomes (including GRADE outcomes) were reported. Foley catheter versus intravenous oxytocin (one trial, subgroup of 53 women): no clear difference between groups for vaginal delivery not achieved within 24 hours (RR 1.47, 95% CI 0.89 to 2.44, evidence graded low), uterine hyperstimulation with fetal heart rate changes (RR 3.11, 95% CI 0.13 to 73.09, evidence graded low), and caesarean section (RR 0.93, 95% CI 0.45 to 1.92, evidence graded low). There were also no clear differences between groups for the reported secondary outcomes. The following GRADE outcomes were not reported: serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. Double-balloon catheter versus vaginal PGE2 (one trial, subgroup of 26 women): no clear difference in caesarean section (RR 0.97, 95% CI 0.41 to 2.32, evidence graded very low). Vaginal delivery not achieved within 24 hours, uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death were not reported. Oral mifepristone versus Foley catheter (one trial, 107 women): no primary/GRADE outcomes were reported. Fewer women induced with mifepristone required oxytocin augmentation (RR 0.54, 95% CI 0.38 to 0.76). There were slightly fewer cases of uterine rupture among women who received mifepristone, however this was not a clear difference between groups (RR 0.29, 95% CI 0.08 to 1.02). No other secondary outcomes were reported. Vaginal isosorbide mononitrate (IMN) versus Foley catheter (one trial, 80 women): fewer women induced with IMN achieved a vaginal delivery within 24 hours (RR 2.62, 95% CI 1.32 to 5.21, evidence graded low). There was no difference between groups in the number of women who had a caesarean section (RR 1.00, 95% CI 0.39 to 2.59, evidence graded very low). More women induced with IMN required oxytocin augmentation (RR 1.65, 95% CI 1.17 to 2.32). There were no clear differences in the other reported secondary outcomes. The following GRADE outcomes were not reported: uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. 80 mL versus 30 mL Foley catheter (one trial, 154 women): no clear difference between groups for the primary outcomes: vaginal delivery not achieved within 24 hours (RR 1.05, 95% CI 0.91 to 1.20, evidence graded moderate) and caesarean section (RR 1.05, 95% CI 0.89 to 1.24, evidence graded moderate). However, more women induced using a 30 mL Foley catheter required oxytocin augmentation (RR 0.81, 95% CI 0.66 to 0.98). There were no clear differences between groups for other secondary outcomes reported. Several GRADE outcomes were not reported: uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. Vaginal PGE2 pessary versus vaginal PGE2 tablet (one trial, 200 women): no difference between groups for caesarean section (RR 1.09, 95% CI 0.74 to 1.60, evidence graded very low), or any of the reported secondary outcomes. Several GRADE outcomes were not reported: vaginal delivery not achieved within 24 hours, uterine hyperstimulation with fetal heart rate changes, serious neonatal morbidity or perinatal death, and serious maternal morbidity or death. AUTHORS' CONCLUSIONS RCT evidence on methods of induction of labour for women with a prior caesarean section is inadequate, and studies are underpowered to detect clinically relevant differences for many outcomes. Several studies reported few of our prespecified outcomes and reporting of infant outcomes was especially scarce. The GRADE level for quality of evidence was moderate to very low, due to imprecision and study design limitations.High-quality, adequately-powered RCTs would be the best approach to determine the optimal method for induction of labour in women with a prior caesarean birth. However, such trials are unlikely to be undertaken due to the very large numbers needed to investigate the risk of infrequent but serious adverse outcomes (e.g. uterine rupture). Observational studies (cohort studies), including different methods of cervical ripening, may be the best alternative. Studies could compare methods believed to provide effective induction of labour with low risk of serious harm, and report the outcomes listed in this review.
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Affiliation(s)
- Helen M West
- The University of LiverpoolInstitute of Psychology, Health and SocietyLiverpoolUK
| | | | - Jodie M Dodd
- The University of Adelaide, Women's and Children's HospitalSchool of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology72 King William RoadAdelaideSouth AustraliaAustralia5006
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14
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Reif P, Brezinka C, Fischer T, Husslein P, Lang U, Ramoni A, Zeisler H, Klaritsch P. Labour and Childbirth After Previous Caesarean Section: Recommendations of the Austrian Society of Obstetrics and Gynaecology (OEGGG). Geburtshilfe Frauenheilkd 2016; 76:1279-1286. [PMID: 28017971 DOI: 10.1055/s-0042-118335] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The new expert recommendation from the Austrian Society of Obstetrics and Gynaecology (OEGGG) comprises an interpretation and summary of guidelines from the leading specialist organisations worldwide (RCOG, ACOG, SOGC, CNGOF, WHO, NIH, NICE, UpToDate). In essence it outlines alternatives to the direct pathway to elective repeat caesarean section (ERCS). In so doing it aligns with international trends, according to which a differentiated, individualised clinical approach is recommended that considers benefits and risks to both mother and child, provides detailed counselling and takes the patient's wishes into account. In view of good success rates (60-85 %) for vaginal birth after caesarean section (VBAC) the consideration of predictive factors during antenatal birth planning has become increasingly important. This publication provides a compact management recommendation for the majority of standard clinical situations. However it cannot and does not claim to cover all possible scenarios. The consideration of all relevant factors in each individual case, and thus the ultimate decision on mode of delivery, remains the discretion and responsibility of the treating obstetrician.
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Affiliation(s)
- P Reif
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
| | - C Brezinka
- Universitätsklinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - T Fischer
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Paracelsus Universität Salzburg, Salzburg, Austria
| | - P Husslein
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Wien, Vienna, Austria
| | - U Lang
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
| | - A Ramoni
- Universitätsklinik für Gynäkologie und Geburtshilfe, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - H Zeisler
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Wien, Vienna, Austria
| | - P Klaritsch
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
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15
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Shah U, Bellows P, Drexler K, Hawley L, Davidson C, Sangi-Haghpeykar H, Gandhi M. Comparison of induction of labor methods for unfavorable cervices in trial of labor after cesarean delivery. J Matern Fetal Neonatal Med 2016; 30:1010-1015. [PMID: 27265361 DOI: 10.1080/14767058.2016.1197903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare induction of labor methods in patients attempting a trial of labor after cesarean (TOLAC) with an unfavorable cervix. METHODS This is a retrospective cohort study from patients attempting TOLAC from 2009 to 2013. Patients with a simplified Bishop score of three or less where labor was initiated with either a Cook balloon or oxytocin were included. Our primary outcome was mode of delivery. Our secondary outcomes included duration of labor and multiple maternal and neonatal morbidities. RESULTS Two-hundred and fourteen women met inclusion criteria: 150 received oxytocin and 64 had the Cook balloon placed. The vaginal birth after cesarean delivery rate was significantly higher in the oxytocin group at 70.7% versus 50.0% in the Cook balloon group (p = 0.004). In the multivariable analysis, odds for cesarean delivery were two times higher with the Cook balloon than with oxytocin (Adjusted OR = 2.09, 95% CI = 1.05-4.18, p = 0.036). The duration of labor was longer with the Cook balloon versus oxytocin (21.9 versus 16.3 hours, p = 0.0002). There were no significant differences in maternal and neonatal health outcomes. CONCLUSION Oxytocin induction of labor was associated with a higher rate of vaginal delivery and a shorter duration of labor compared to the Cook balloon in women undergoing TOLAC with an unfavorable cervix.
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Affiliation(s)
- Utsavi Shah
- a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA
| | - Patricia Bellows
- a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA
| | - Kathleen Drexler
- a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA
| | - Lauren Hawley
- a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA
| | - Christina Davidson
- a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA
| | - Haleh Sangi-Haghpeykar
- a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA
| | - Manisha Gandhi
- a Department of Obstetrics and Gynecology , Baylor College of Medicine , Houston , Texas , USA
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16
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Stenson D, Wallstrom T, Sjostrand M, Akerud H, Gemzell-Danielsson K, Wiberg-Itzel E. Induction of labor in women with a uterine scar. J Matern Fetal Neonatal Med 2015; 29:3286-91. [PMID: 26699657 DOI: 10.3109/14767058.2015.1123242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the frequency of uterine rupture following induction of labor in women with a previous cesarean section. Misoprostol was compared to other methods of induction. METHODS A retrospective cohort study of 208 women attempting induction of labor after one previous cesarean section. Delivery data were collected retrospectively and compared. Group 1(2009-2010) was compared with Group 2 (2012-2013). In Group 1, the main method of induction was vaginal PGE2 (prostaglandin-E2), amniotomy, oxytocin or a balloon catheter. In Group 2, the dominant method of induction was an oral solution of misoprostol. MAIN OUTCOME MEASURES frequency of uterine rupture in the two groups. RESULTS Nine cases (4.3%) of uterine rupture occurred. There was no significant difference in the frequency of uterine rupture following the change of method of induction from PGE2, amniotomy, oxytocin or mechanical dilatation with a balloon catheter to orally administered misoprostol (4.1 versus 4.6%, p = 0.9). All ruptures occurred in women with no prior vaginal delivery. CONCLUSION The shift to oral misoprostol as the primary method of induction in women with a previous cesarean section did not increase the frequency of uterine rupture in the cohort studied.
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Affiliation(s)
- David Stenson
- a Department of Clinical Science and Education , Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital , Sweden
| | - Tove Wallstrom
- a Department of Clinical Science and Education , Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital , Sweden
| | - Maria Sjostrand
- a Department of Clinical Science and Education , Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital , Sweden
| | - Helena Akerud
- b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden , and
| | - Kristina Gemzell-Danielsson
- c Department of Women's and Children's Health , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Eva Wiberg-Itzel
- a Department of Clinical Science and Education , Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital , Sweden
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17
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Rath W, Tsikouras P. Misoprostol for Labour Induction after Previous Caesarean Section - Forever a "No Go"? Geburtshilfe Frauenheilkd 2015; 75:1140-1147. [PMID: 26719597 DOI: 10.1055/s-0035-1558171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Misoprostol in oral or vaginal form is an established method of labour induction worldwide. Its use after previous caesarean section is associated with a high rate of uterine rupture; according to international guidelines it is therefore contraindicated in this setting. However the evidence base for this recommendation comprises case reports, one randomised trial that was discontinued prematurely, and numerous low quality retrospective data analyses published between 1997 and 2004. New insights into e.g. resorption kinetics, dosage and application intervals, dose dependant uterine hyperstimulation rates, as well as increasing clinical experience with misoprostol have lead to a critical reappraisal of these "historical" studies. Accordingly the evidence supporting a ban on vaginal and particularly oral misoprostol for labour induction in the context of a scarred uterus is currently insufficient for a convincing guideline recommendation. In view of the clear advantages of misoprostol over prostaglandin E2 (cheaper, more effective) a retrospective review of registry data should be conducted to determine the incidence of uterine rupture following misoprostol and the circumstances in which it occurs. A prospective, randomised trial could then be conducted on the basis of these findings (e.g. oral misoprostol vs. vaginal prostaglandin E2); known risk factors for uterine rupture including the type of uterine scar would need to be taken into account when selecting patients for vaginal delivery. Until new data from well-designed studies are available, misoprostol will continue to be contraindicated in clinical guidelines for use in labour induction after previous caesarean section.
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Affiliation(s)
- W Rath
- Faculty of Medicine, Gynaecology and Obstetrics, University Hospital RWTH Aachen, Aachen
| | - P Tsikouras
- Democritus University of Thrace, Department of Obstetrics and Gynecology, Alexandroupolis, Greece
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18
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Patte C, Deruelle P. A critical appraisal of the misoprostol removable, controlled-release vaginal delivery system of labor induction. Int J Womens Health 2015; 7:889-99. [PMID: 26648758 PMCID: PMC4648618 DOI: 10.2147/ijwh.s62372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Induction of labor is a major issue in pregnancy management. Finding strategies to increase rate and decrease time to vaginal delivery is an important goal, but maternal or neonatal safety must remain the primary objective. Misoprostol is a synthetic analogue of prostaglandin used off label to ripen the cervix and induce labor. The misoprostol vaginal insert (MVI) was designed to allow a controlled-release delivery of misoprostol (from 50 to 200 μg) with a removal tape. The objective of this review was to make a critical appraisal of this device referring to the literature. METHODS A literature search was performed in the PubMed and Cochrane databases using the keywords "vaginal misoprostol insert". RESULTS Several studies compared different doses of MVI (50, 100, 150, and 200 μg) with the 10 mg dinoprostone insert. The 100 μg MVI compared with the dinoprostone vaginal insert (DVI) showed similar efficacy and no significant differences in cesarean delivery rate. MVI 200 μg compared with DVI showed a reduced time to vaginal delivery and oxytocin need but had an increased risk of uterine hyperstimulation. The rate of hyperstimulation syndrome was two to three times more frequent with the 200 μg MVI than the 100 μg. CONCLUSION Current data suggest that the 100 μg MVI would provide the best balance between efficacy and safety. Further studies should be performed to evaluate this dose, especially in high-risk situations needing induction of labor.
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Affiliation(s)
- Charlotte Patte
- Lille University Hospital, Jeanne De Flandre Maternity, Université Lille 2, Lille, France
| | - Philippe Deruelle
- Lille University Hospital, Jeanne De Flandre Maternity, Université Lille 2, Lille, France ; UPRES EA 4489, Environnement périnatal et santé, Faculté de médecine Henri Warembourg, Université Lille 2, Lille, France
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19
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Alfirevic Z, Keeney E, Dowswell T, Welton NJ, Dias S, Jones LV, Navaratnam K, Caldwell DM. Labour induction with prostaglandins: a systematic review and network meta-analysis. BMJ 2015; 350:h217. [PMID: 25656228 PMCID: PMC4353287 DOI: 10.1136/bmj.h217] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To assess the effectiveness and safety of prostaglandins used for labour induction. DESIGN Systematic review with Bayesian network meta-analysis DATA SOURCES The Cochrane Pregnancy and Childbirth Group's Database of Trials (which incorporates the results of a broad generic search for all pregnancy and postpartum trials). Sources included are CENTRAL, Medline, Embase, NHS Economic Evaluation Database, CINAHL, relevant journals, conference proceedings, and registries of ongoing trials. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised clinical trials of prostaglandin or prostaglandin analogues used for third trimester cervical ripening or labour induction versus placebo or no treatment, alternative prostaglandin dose or administration, or a different type of prostaglandin. We included studies recruiting women with a viable fetus, but had no other restrictions relating to indication for labour induction or language of publication. Outcomes assessed were serious neonatal morbidity (trialist defined) or perinatal death; serious maternal morbidity (trialist defined) or death; vaginal delivery not achieved within 24 hours, caesarean section, and uterine hyperstimulation with fetal heart rate changes. RESULTS 280 randomised clinical trials were included (48 068 women) in the review. Maternal and neonatal mortality and serious morbidity were rarely reported and are summarized narratively. Unresolved inconsistency was observed for the hyperstimulation outcome. Relative to placebo, the odds of failing to achieve a vaginal delivery were lowest for vaginal misoprostol (≥50 µg) (odds ratio 0.06 (95% credible interval 0.02 to 0.12)), with a 39% absolute probability of event (95% credible interval 1% to 94%). Compared with placebo, odds of caesarean section were lowest for titrated oral misoprostol solution (<50 µg) (odds ratio 0.65 (0.49 to 0.83)), with an absolute probability of event of 15% (3% to 40%). CONCLUSIONS Low dose(<50 µg) titrated oral misoprostol solution had the lowest probability of caesarean section, whereas vaginal misprostol (≥50 µg) had the highest probability of achieving a vaginal delivery within 24 hours. These findings have important implications for a series of current national and international guidelines for induction of labour and future research in this area. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2013:CRD42013005116.
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Affiliation(s)
- Zarko Alfirevic
- Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool L8 7SS, UK
| | - Edna Keeney
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Therese Dowswell
- Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool L8 7SS, UK
| | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Sofia Dias
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Leanne V Jones
- Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool L8 7SS, UK
| | - Kate Navaratnam
- Centre for Women's Health Research, University of Liverpool and Liverpool Women's Hospital, Liverpool L8 7SS, UK
| | - Deborah M Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
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Patil E, Edelman A. Medical Abortion: Use of Mifepristone and Misoprostol in First and Second Trimesters of Pregnancy. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-014-0109-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gaudineau A, Vayssière C. Maturation cervicale par misoprostol sur fœtus viable. ACTA ACUST UNITED AC 2014; 43:169-78. [DOI: 10.1016/j.jgyn.2013.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Clark W, Shannon C, Winikoff B. Misoprostol for uterine evacuation in induced abortion and pregnancy failure. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2.1.67] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rydahl E, Clausen JA. An Unreported Uterine Rupture in an Unscarred Uterus After Induced Labor With 25μg Misoprostol Vaginally. Case Rep Womens Health 2014. [DOI: 10.1016/j.crwh.2014.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Schmitz T, Pourcelot AG, Moutafoff C, Biran V, Sibony O, Oury JF. Cervical ripening with low-dose prostaglandins in planned vaginal birth after cesarean. PLoS One 2013; 8:e80903. [PMID: 24260505 PMCID: PMC3834249 DOI: 10.1371/journal.pone.0080903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 10/17/2013] [Indexed: 12/04/2022] Open
Abstract
Objectives To compare uterine rupture, maternal and perinatal morbidity rates in women with one single previous cesarean after spontaneous onset of labor or low-dose prostaglandin-induced cervical ripening for unfavourable cervix. Study Design This was a retrospective cohort study of 4,137 women with one single previous cesarean over a 22-year period. Inpatient prostaglandin administration consisted in single daily local applications. Results Vaginal delivery was planned for 3,544 (85.7%) patients, 2,704 (76.3%) of whom delivered vaginally (vaginal birth after Cesarean (VBAC) rate = 65.4%). Among women receiving prostaglandins (n=515), 323 (62.7%) delivered vaginally. Uterine rupture (0.7% compared with 0.8%, OR 1.1, 95% CI 0.4-3.4, p=0.88), maternal (0.9% compared with 1.2%, OR 1.3, 95% CI 0.5-3.2, p=0.63) and perinatal (0.3% compared with 0.8%, OR 2.4, 95% CI 0.7-8.5, p=0.18) morbidity rates did not differ significantly between patients with spontaneous onset of labor and those receiving prostaglandins, nor did these rates differ according to the planned mode of delivery. Conclusion In comparison with patients with spontaneous labor, inducing cervical ripening with low-dose prostaglandins in case of unfavourable cervix is not associated with appreciable increase in uterine rupture, maternal or perinatal morbidity.
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Affiliation(s)
- Thomas Schmitz
- Service de Gynécologie Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France
- Université Paris Diderot, Paris, France
- * E-mail:
| | - Anne-Gaelle Pourcelot
- Service de Gynécologie Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France
- Université Paris Diderot, Paris, France
| | - Constance Moutafoff
- Service de Gynécologie Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France
- Université Paris Diderot, Paris, France
| | - Valérie Biran
- Université Paris Diderot, Paris, France
- Service de Néonatalogie, Hôpital Robert Debré, AP-HP, Paris, France
| | - Olivier Sibony
- Service de Gynécologie Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France
- Université Paris Diderot, Paris, France
| | - Jean-François Oury
- Service de Gynécologie Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France
- Université Paris Diderot, Paris, France
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Scott JR. Intrapartum management of trial of labour after caesarean delivery: evidence and experience. BJOG 2013; 121:157-62. [DOI: 10.1111/1471-0528.12449] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2013] [Indexed: 11/29/2022]
Affiliation(s)
- JR Scott
- Department of Obstetrics and Gynecology; University of Utah Medical Center; Salt Lake City UT USA
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Abstract
INTRODUCTION Labor induction is now reported to occur in up to 30 - 40% of obstetrical patients. There are a number of pharmacological options available to facilitate labor induction, including oxytocin and analogues of prostaglandins E1 and E2, which have particular utility when labor induction necessitates cervical ripening, as when labor induction occurs in the context of an unfavorable cervix. AREAS COVERED This paper reviews acceptable pharmacological options for labor induction, especially when cervical ripening is required. These options include oxytocin and a number of prostaglandin formulations using dinoprostone and misoprostol. It also covers several analyses of published clinical trials (Phase-III) describing evidence of effectiveness. EXPERT OPINION Oxytocin is best used when labor needs to be induced in the context of a favorable cervix. When the cervix is not favorable, cervical ripening using prostaglandins should precede labor induction. Either dinoprostone or misoprostol are superior to oxytocin alone for cervical ripening. However, judicious, careful considerations need to be made at the outset of labor induction so as to balance maternal and fetal risks, and these should be guided by institutional policies that reflect the evidence-base.
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Affiliation(s)
- J Seth Hawkins
- University of Texas Southwestern School of Medicine, Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, 5323 Harry Hines Boulevard, Dallas, TX 75390-9032, USA
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Islam A, Ehsan A, Arif S, Murtaza J, Hanif A. Evaluating trial of scar in patients with a history of caesarean section. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 3:201-5. [PMID: 22540092 PMCID: PMC3336913 DOI: 10.4297/najms.2011.3201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aims: To analyze the outcome of trial of scar in patients with previous caesarean section and to assess the fetal and maternal complications after trial of scar. Patients and Methods: The study was conducted at Military Hospital, Rawalpindi, Pakistan, with 375 pregnant patients who had a previous delivery by caesarean and who had regular antenatal checkup. Data were recorded on special pro-forms designed for the purpose. Results: The results from the 375 patients who had one previous lower segment caesarean section due to non-recurrent causes were analyzed and compared with national and international studies. Indications of previous caesarean section (non-recurrent causes) included malpresentations, fetal distress/cord prolapse, failure to progress, severe pregnancy-induced hypertension/eclampsia and twins with abnormal lie of the first twin. 0 218 patients reported spontaneous labor. Among these patients, 176 delivered vaginally and 42 patients had repeat caesarean sections. There were a total of 157 patients who experienced induction of labor. 97 patients were induced by cervical ripening with mechanical method, followed by artificial rupture of membranes and augmentation (if required) with syntocinon infusion. 60 patients were induced with prostaglandin E2 vaginal tablet. Conclusion: This study concludes that females with a prior caesarean are at increased risk for subsequent caesareans, regardless of mode of delivery. Eliminating vaginal-birth-after-caesarean will not eliminate the risk. Therefore, vaginal birth after caesarean should be encouraged in selected cases from obstetric units to reduce the risks of repeated caesarean sections. Failed vaginal-birth-after-caesarean can result in increased morbidity than that with elective caesarean section.
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Affiliation(s)
- Aliya Islam
- Department of Obstetrics and Gynecology, Military Hospital, Rawalpindi, Pakistan
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Cogan A, Barlow P, Benali N, Murillo D, Manigart Y, Belhomme J, Rozenberg S. An audit about labour induction, using prostaglandin, in women with a scarred uterus. Arch Gynecol Obstet 2012; 286:1399-406. [PMID: 22836816 DOI: 10.1007/s00404-012-2481-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 07/12/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Induction of labour after a previous caesarean section is still controversial. We aim to analyse, in a population of women who have a uterine scar, the maternal, foetal and neonatal complications in relation to the mode of labour and delivery. STUDY DESIGN Retrospective analysis of collected data from all the singleton deliveries of patients with a scarred uterus (N=798), admitted to the hospital between August 2006 and March 2009. OUTCOMES maternal and perinatal complications. RESULTS Among 798 singleton deliveries, 36.1% had a spontaneous labour, 12.6% a prostaglandin-induced labour and 2.9% an ocytocin-induced labour, and 48.4% had an elective caesarean section. The chance of delivering vaginally was respectively 84.4% for those who had a spontaneous labour, 75.2% for those who were induced using prostaglandin, 82.6% after induction using ocytocin. There were eight uterine ruptures, four after spontaneous labour (1.4%), two after prostaglandin induction (2%) and two at the time of an iterative caesarean section (0.5%). There were no differences between groups, except the risk of haemorrhage (17.4% after spontaneously induced labour, 34.8% after ocytocin, 17.8% after prostaglandin and 44.6% after iterative caesarean section; p<0.005) and the neonatal admissions when analysed by intention to treat only (8.3% after spontaneously induced labour, 9.1% after ocytocin, 12% after prostaglandin and 16.8% after iterative caesarean section; p<0.009). CONCLUSION Although no increase in maternal or perinatal outcome was observed in relation to prostaglandin-induced labour after caesarean section, this study is too underpowered to exclude an increased risk.
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Affiliation(s)
- Alexandra Cogan
- Department of Obstetrics and Gynaecology, C.H.U. Saint-Pierre, Université Libre de Bruxelles, Hoog Str 322, 1000, Brussels, Belgium
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Domröse CM, Geipel A, Berg C, Lorenzen H, Gembruch U, Willruth A. Second- and third-trimester termination of pregnancy in women with uterine scar — a retrospective analysis of 111 gemeprost-induced terminations of pregnancy after previous cesarean delivery. Contraception 2012; 85:589-94. [PMID: 22079607 DOI: 10.1016/j.contraception.2011.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 10/03/2011] [Accepted: 10/05/2011] [Indexed: 10/15/2022]
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Normal First Stage of Labor in Women Undergoing Trial of Labor After Cesarean Delivery. Obstet Gynecol 2012; 119:732-6. [DOI: 10.1097/aog.0b013e31824c096c] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gómez LR, Burgos J, Cobos P, Melchor JC, Osuna C, Centeno MDM, Larrieta R, Fernández-Llebrez L, Martínez-Astorquiza T. Oxytocin versus dinoprostone vaginal insert for induction of labor after previous cesarean section: a retrospective comparative study. J Perinat Med 2011; 39:397-402. [PMID: 21604996 DOI: 10.1515/jpm.2011.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of two methods for induction of labor after previous cesarean section. METHODS To compare 247 women with a previous cesarean section who were induced with a dinoprostone vaginal insert and 279 women with a previous cesarean section induced with oxytocin, between 2001 and 2008. We evaluated vaginal delivery rate, maternal morbidity and newborn morbidity and mortality. RESULTS The overall rate of vaginal delivery was 65.2%. We did not find significant differences between induction with dinoprostone vaginal insert and oxytocin in the rate of cesarean section performed (35.6% vs. 34.1%, P=0.71). There were nine cases of uterine rupture (rate of 1.7%), of which four occurred with dinoprostone vaginal insert and five when using oxytocin (P=0.89). We found no significant differences in neonatal outcomes. CONCLUSIONS Both tested methods appear to be equally safe and effective for induction of labor in women with a previous cesarean section.
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Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev 2010; 2010:CD000941. [PMID: 20927722 PMCID: PMC7061246 DOI: 10.1002/14651858.cd000941.pub2] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Misoprostol (Cytotec, Searle) is a prostaglandin E1 analogue widely used for off-label indications such as induction of abortion and of labour. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology. OBJECTIVES To determine the effects of vaginal misoprostol for third trimester cervical ripening or induction of labour. SEARCH STRATEGY The Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008) and bibliographies of relevant papers. We updated this search on 30 April 2010 and added the results to the awaiting classification section. SELECTION CRITERIA Clinical trials comparing vaginal misoprostol used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods. DATA COLLECTION AND ANALYSIS We developed a strategy to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction.We used fixed-effect Mantel-Haenszel meta-analysis for combining dichotomous data.If we identified substantial heterogeneity (I² greater than 50%), we used a random-effects method. MAIN RESULTS We included 121 trials. The risk of bias must be kept in mind as only 13 trials were double blind.Compared to placebo, misoprostol was associated with reduced failure to achieve vaginal delivery within 24 hours (average relative risk (RR) 0.51, 95% confidence interval (CI) 0.37 to 0.71). Uterine hyperstimulation, without fetal heart rate (FHR) changes, was increased (RR 3.52 95% CI 1.78 to 6.99).Compared with vaginal prostaglandin E2, intracervical prostaglandin E2 and oxytocin, vaginal misoprostol was associated with less epidural analgesia use, fewer failures to achieve vaginal delivery within 24 hours and more uterine hyperstimulation. Compared with vaginal or intracervical prostaglandin E2, oxytocin augmentation was less common with misoprostol and meconium-stained liquor more common.Lower doses of misoprostol compared to higher doses were associated with more need for oxytocin augmentation and less uterine hyperstimulation, with and without FHR changes.We found no information on women's views. AUTHORS' CONCLUSIONS Vaginal misoprostol in doses above 25 mcg four-hourly was more effective than conventional methods of labour induction, but with more uterine hyperstimulation. Lower doses were similar to conventional methods in effectiveness and risks. The authors request information on cases of uterine rupture known to readers. The vaginal route should not be researched further as another Cochrane review has shown that the oral route of administration is preferable to the vaginal route. Professional and governmental bodies should agree guidelines for the use of misoprostol, based on the best available evidence and local circumstances.
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Affiliation(s)
- G Justus Hofmeyr
- University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of HealthDepartment of Obstetrics and Gynaecology, East London Hospital ComplexFrere and Cecilia Makiwane HospitalsPrivate Bag X 9047East LondonEastern CapeSouth Africa5200
| | - A Metin Gülmezoglu
- World Health OrganizationUNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerland1211
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34
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Abstract
Uterine rupture is the most serious complication for women undergoing trial of labor (TOL) after prior cesarean delivery. While rates of uterine rupture vary significantly according to a variety of clinically associated risk factors, the absolute risk for this complication ranges between 0.5 and 4 percent. Previous vaginal delivery and prior successful vaginal birth after cesarean delivery confer the lowest risk of rupture on women attempting TOL. In contrast, multiple prior cesareans, short interpregnancy interval, single layer uterine closure, prior preterm cesarean, labor induction and augmentation have all been suggested in some studies as factors which may increase the rate of uterine rupture. While considering these risk factors is important in counseling women regarding childbirth following cesarean delivery, the infrequency of uterine rupture coupled with relatively weak associations for most risk factors has prevented the development of an accurate prediction tool for uterine rupture. Preliminary studies suggest that sonographic evaluation of the uterine scar may hold some promise for identifying women at risk.
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Affiliation(s)
- Mark B Landon
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA.
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35
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Prise en charge de l’accouchement des patientes ayant un antécédent de césarienne. ACTA ACUST UNITED AC 2010; 38:48-57. [DOI: 10.1016/j.gyobfe.2009.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 11/13/2009] [Indexed: 11/23/2022]
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Church S, Van Meter A, Whitfield R. Dinoprostone compared with misoprostol for cervical ripening for induction of labor at term. J Midwifery Womens Health 2009; 54:405-411. [PMID: 19720343 DOI: 10.1016/j.jmwh.2009.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 12/29/2008] [Accepted: 03/06/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Sara Church
- Sara Church, CNM, MS, is a nurse-midwife with the Norwalk Hospital Midwifery Service in Norwalk, CT.Auben Van Meter, CNM, MS, is a nurse-midwife with the Dartmouth-Hitchcock Medical Center in Lebanon, NH.Rachael Whitfield, CNM, MPH, MS, is a nurse-midwife with Jamaica Hospital Women's Health Center in Jamaica, NY
| | - Auben Van Meter
- Sara Church, CNM, MS, is a nurse-midwife with the Norwalk Hospital Midwifery Service in Norwalk, CT.Auben Van Meter, CNM, MS, is a nurse-midwife with the Dartmouth-Hitchcock Medical Center in Lebanon, NH.Rachael Whitfield, CNM, MPH, MS, is a nurse-midwife with Jamaica Hospital Women's Health Center in Jamaica, NY
| | - Rachael Whitfield
- Sara Church, CNM, MS, is a nurse-midwife with the Norwalk Hospital Midwifery Service in Norwalk, CT.Auben Van Meter, CNM, MS, is a nurse-midwife with the Dartmouth-Hitchcock Medical Center in Lebanon, NH.Rachael Whitfield, CNM, MPH, MS, is a nurse-midwife with Jamaica Hospital Women's Health Center in Jamaica, NY
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Ezegwui HU. Uterine rupture in a primigravida when misoprostol was used for induction of labour and subsequent successful pregnancy outcome. J OBSTET GYNAECOL 2009; 26:160-1. [PMID: 16483979 DOI: 10.1080/01443610500459960] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- H U Ezegwui
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, PMB 01129, Enuga, Nigeria.
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38
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Hofmeyr GJ, Gülmezoglu AM. Misoprostol for the prevention and treatment of postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol 2008; 22:1025-41. [DOI: 10.1016/j.bpobgyn.2008.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Late second-trimester abortions induced with mifepristone, misoprostol and oxytocin: a report of 428 consecutive cases. Contraception 2008; 78:52-60. [DOI: 10.1016/j.contraception.2008.02.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2007] [Revised: 02/20/2008] [Accepted: 02/20/2008] [Indexed: 11/19/2022]
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Abstract
Uterine rupture, whether in the setting of a prior uterine incision or in an unscarred uterus, is an obstetric emergency with potentially catastrophic consequences for both mother and child. Numerous studies have been published regarding various risk factors associated with uterine rupture. Despite the mounting data regarding both antepartum and intrapartum factors, it currently is impossible to predict in whom a uterine rupture will occur. This article reviews the data regarding these antepartum and intrapartum predictors for uterine rupture. The author hopes that the information presented in this article will help clinicians assess an individual's risk for uterine rupture.
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Affiliation(s)
- Jennifer G Smith
- Section on Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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41
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DeFranco EA, Rampersad R, Atkins KL, Odibo AO, Stevens EJ, Peipert JF, Stamilio DM, Macones GA. Do vaginal birth after cesarean outcomes differ based on hospital setting? Am J Obstet Gynecol 2007; 197:400.e1-6. [PMID: 17904977 DOI: 10.1016/j.ajog.2007.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2007] [Revised: 05/02/2007] [Accepted: 06/07/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of the study was to test the null hypothesis that outcomes of vaginal birth after cesarean (VBAC) do not differ on the basis of the hospital setting. STUDY DESIGN The study was a retrospective cohort study of women who were offered VBAC in 17 hospitals from 1996 to 2000. VBAC attempts occurring in hospitals with and without obstetrics-gynecology residency programs were compared, as were outcomes from university and community hospitals. Bivariate and multivariate logistic regression analyses assessed the association between hospital setting and VBAC outcomes. RESULTS Of 25,065 women with 1 or more prior cesareans, the VBAC attempt rate was 56.1% at hospitals with obstetrics-gynecology residencies, 51.3% at hospitals without obstetrics-gynecology residencies, 61% at university hospitals, and 50.4% at community hospitals. The occurrence of failed VBAC, blood transfusion, or composite adverse outcome did not differ by hospital setting. There was a significant increase in the uterine rupture rate at community (1.2%) vs university hospitals (0.6%), but the absolute risk remained low. CONCLUSION The rate of VBAC-associated complications is low, independent of hospital setting.
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Affiliation(s)
- Emily A DeFranco
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Khooshideh M. The Comparison of Misoprostol and Dinoprostone for Termination of Second Trimester Pregnancy. JOURNAL OF MEDICAL SCIENCES 2007. [DOI: 10.3923/jms.2007.289.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Patel A, Talmont E, Morfesis J, Pelta M, Gatter M, Momtaz MR, Piotrowski H, Cullins V. Adequacy and safety of buccal misoprostol for cervical preparation prior to termination of second-trimester pregnancy. Contraception 2006; 73:420-30. [PMID: 16531179 DOI: 10.1016/j.contraception.2005.10.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Revised: 09/13/2005] [Accepted: 10/07/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this retrospective, descriptive study is to assess the adequacy and safety of buccal misoprostol with and without laminaria for cervical preparation prior to second-trimester abortion. METHODS We analyzed Planned Parenthood Federation of America data from 2,218 elective dilation and evacuation (D&E) procedures conducted on women at 12 to 23 6/7 weeks of gestation from April 2002 to March 2003. Each woman received 400, 600 or 800 microg of buccal misoprostol with or without laminaria for preprocedural cervical preparation. RESULTS Of the patients, 62% received 400 mug, 32% received 600 microg and 6% received 800 microg of buccal misoprostol; 42.8% had laminaria inserted for phased cervical preparation. The adequacy of cervical dilation was 88.7%. The D&E procedure was completed during a single surgical procedure for 99.8%. The overall adverse event rate was 19.39 per 1,000 women, with a rate of 4.51 per 1,000 women for serious adverse events. CONCLUSIONS This descriptive study suggests that use of buccal misoprostol with or without laminaria is effective and safe. If buccal misoprostol eliminates or reduces the need for phased, multiday laminaria 1-3 days prior to the surgical procedure, then its use may offer service advantages such as reduced number of clinic visits and fewer pelvic examinations per woman.
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Affiliation(s)
- Ashlesha Patel
- Department of Obstetrics and Gynecology, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA.
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Schmitz T, Goffinet F. [Against routine use of misoprostol in term labor induction]. ACTA ACUST UNITED AC 2006; 34:161-5; discussion 154. [PMID: 16442323 DOI: 10.1016/j.gyobfe.2005.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- T Schmitz
- Maternité de Port-Royal, Centre Hospitalier Cochin-Saint-Vincent-de-Paul, Université Paris-V, 123, boulevard de Port-Royal, 75014 Paris, France.
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Affiliation(s)
- C Vayssière
- Service de Gynécologie-Obstétrique, SIHCUS-CMCO, 19, rue Louis-Pasteur, Université Louis-Pasteur, 67000 Strasbourg, France.
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Zeteroglu S, Sahin GH, Sahin HA. Induction of labor with misoprostol in pregnancies with advanced maternal age. Eur J Obstet Gynecol Reprod Biol 2006; 129:140-4. [PMID: 16406221 DOI: 10.1016/j.ejogrb.2005.11.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Revised: 11/01/2005] [Accepted: 11/03/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective was to compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in advanced aged pregnancies with a Bishop score of < 6. STUDY DESIGN A hundred advanced aged (> or = 35 years) pregnant patients with a Bishop score of < 6 were randomized into two groups. The first group (50 patients) received 50 microg intravaginal misoprostol four times with 4 h intervals and the second group received oxytocin infusion for induction of labor starting from 2 mIU/min and was increased every 30 min with 2 mIU/min increments up to a maximum of 40 mIU/min. The time from induction to delivery, the route of delivery, fetal outcome, and maternal complications were recorded. Statistical analyses were performed using the Mann-Whitney U, Chi-squared and t tests to determine differences between the two groups. A p value < or = 0.05 was considered significant. RESULTS Misoprostol was superior for induction of labor in advanced aged pregnancies with Bishop score of < 6, as the mean time from induction to delivery was 9.61 +/- 4.12 h and 11.46 +/- 4.86 h in the misoprostol and oxytocin groups respectively, with a significant difference between the groups (p = 0.04). The rate of vaginal delivery was higher in the misoprostol group (84.0%) than in the oxytocin group (80.0%), but the difference did not reach significance (p = 0.60). The rates of placental abruption and postpartum hemorrhage were similar in both groups and no cases of uterine rupture occurred. The 1- and 5-min mean Apgar scores were 6.98 +/- 1.17 to 9.08 +/- 0.99 and 6.88 +/- 1.81 to 9.00 +/- 1.35 in the misoprostol and oxytocin groups respectively, with no significant differences between the groups (p = 0.74, p = 0.83). No cases of asphyxia were present. The rate of admission to the neonatal intensive care unit was similar in both groups. CONCLUSION Intravaginal misoprostol seems to be an alternative method to oxytocin in the induction of labor in advanced aged pregnant women with low Bishop scores, as it is efficacious, cheap, and easy to use. But large studies are necessary to clarify safety with regard to the rare complications such as uterine rupture.
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Affiliation(s)
- Sahin Zeteroglu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey.
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Zeteroglu S, Sahin HG, Sahin HA. Induction of labor in great grandmultipara with misoprostol. Eur J Obstet Gynecol Reprod Biol 2005; 126:27-32. [PMID: 16129547 DOI: 10.1016/j.ejogrb.2005.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Revised: 03/29/2005] [Accepted: 07/16/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in great grandmultiparous pregnancies with a Bishop score of <6. STUDY DESIGN Sixty-four great grandmultiparous (delivering the tenth, or greater, infant) pregnant patients with a Bishop score of <6 were randomized in two groups with 32 patients receiving 50 microg intravaginal misoprostol four times with 4h intervals, and 32 patients receiving oxytocin infusion for induction of labor starting from 2 mIU/min, increasing it every 30 min with 2 mIU/min increments up to maximum of 40 mIU/min. The time from induction to delivery, the route of delivery, fetal outcome and maternal complications were recorded. Statistical analyses were performed using Mann-Whitney U-test, Chi-Square test and hypothesis test about differences for two proportions (t-test) to determine differences between the two groups. P < or = 0.05 was considered significant. RESULT The mean time from induction to delivery was 9.91+/-4.30 and 10.88+/-4.72 h in the misoprostol and oxytocin administered group, respectively, with no significant difference between the groups. The rate of vaginal delivery was 84.4 and 87.5% in the misoprostol and oxytocin administered group, respectively, with no significant difference between the groups (P = 0.72). The rates of placental abruption and postpartum hemorrhage were similar in both groups and no case of uterine rupture occurred. The 1 and 5 min mean Apgar scores were 6.91+/-1.57-8.88+/-1.39 and 7.22+/-1.24-9.06+/-0.84 in the misoprostol and oxytocin administered group with no significant differences between the groups (P = 0.38 and 0.51). No case of asphyxia was present. The rate of admission to neonatal intensive care unit was higher in the misoprostol administered group, but the difference was not significant. CONCLUSION Intravaginal misoprostol is an alternative method to oxytocin in induction of labor in great grandmultiparous pregnant women with low Bishop scores, as it is effective, cheap and easy to use. Safety about rare complications and neonatal morbidity needs clarifications with further studies.
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Affiliation(s)
- Sahin Zeteroglu
- Department of Obstetrics and Gynecology, University of Mustafa Kemal, Medical Faculty, 31100 Antakya, Turkey.
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Nayki U, Taner CE, Mizrak T, Nayki C, Derin G. Uterine Rupture during Second Trimester Abortion with Misoprostol. Fetal Diagn Ther 2005; 20:469-71. [PMID: 16113576 DOI: 10.1159/000087115] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2004] [Accepted: 07/27/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Data are limited regarding the use of misoprostol in the midtrimester, therefore few cases with uterine rupture during the second trimester with a previous uterine scar have been reported in the literature. CASE REPORT A 23-year-old woman with a prior low transverse cesarean section presented at 26 weeks' gestation for pregnancy termination for a fetal abnormality. She was given 200 microg misoprostol intravaginally every 3 h until regular contractions began. After the fourth dose, she had vaginal bleeding and severe contractions. She aborted completely 2 h later after the last dose. Uterine rupture was diagnosed at the previous cesarean section scar by manual vaginal examination. She underwent emergency laparotomy and the uterus was repaired. CONCLUSION Misoprostol use in the second trimester in a woman with a uterine scar can trigger severe contractions that can lead to uterine rupture.
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Affiliation(s)
- Umit Nayki
- Aegean Social Security and Maternal Teaching Hospital, Izmir, Turkey
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Gregson S, Waterstone M, Norman I, Murrells T. A randomised controlled trial comparing low dose vaginal misoprostol and dinoprostone vaginal gel for inducing labour at term. BJOG 2005; 112:438-44. [PMID: 15777441 DOI: 10.1111/j.1471-0528.2004.00496.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the efficacy of low dose vaginal misoprostol and dinoprostone vaginal gel for induction of labour at term. DESIGN A single-blind randomised controlled trial. SETTING Antenatal and labour ward of a UK district general hospital. PARTICIPANTS Two hundred and sixty-eight women requiring induction of labour at term (>37 weeks of gestation) with no significant fetal or medical condition, no previous uterine surgery and no contraindication to prostaglandin. METHODS Misoprostol 25 microg (one-quarter of a 100 microg tablet) was inserted into the posterior vaginal fornix every 4 hours (to a maximum of six doses) or dinoprostone vaginal gel 1-2 mg 6 hourly (maximum of 3 mg in 24 hours). MAIN OUTCOME MEASURE Induction-to-vaginal delivery interval. SECONDARY OUTCOME MEASURES Requirements for oxytocin, mode of delivery, number of women delivering < 24 hours, incidence of uterine contraction abnormalities, incidence of abnormal cardiotocograph (CTG) recordings, 5-minute Apgar scores, umbilical cord pH recordings, analgesia requirements, admission to NICU and blood loss at delivery. RESULTS There were no significant differences between the two groups in induction-to-vaginal delivery interval, mode of delivery, number of women delivering within 24 hours and neonatal outcomes. The incidence of uterine contraction abnormalities (tachysystole and hyperstimulation) and the incidence of abnormal CTG recordings were also similar for both groups. CONCLUSION Low dose vaginal misoprostol is as effective as dinoprostone gel for inducing labour at term. There would be substantial cost savings, estimated at around 3.9 million UK pounds per annum, for maternity services if low dose misoprostol became the agent of choice for inducing labour in the UK.
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Affiliation(s)
- Sarah Gregson
- Maternity Unit, Queen Mary's Sidcup NHS Trust, Frognal Avenue, Sidcup, Kent DA14 6LT, UK
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Yogev Y, Ben-Haroush A, Lahav E, Horowitz E, Hod M, Kaplan B. Induction of labor with prostaglandin E2 in women with previous cesarean section and unfavorable cervix. Eur J Obstet Gynecol Reprod Biol 2005; 116:173-6. [PMID: 15358459 DOI: 10.1016/j.ejogrb.2004.02.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2003] [Accepted: 02/18/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study the pregnancy outcome of induction of labor with prostaglandin E2 (PGE2) in women with one previous lower segment cesarean section. METHODS A retrospective cohort design was used. The study sample included 1028 consecutive women with one previous cesarean section, of whom 97 underwent induction of labor (study group) and 931 were admitted with spontaneous onset of labor (control group). Vaginal tablets of PGE2 were used for cervical ripening in the study group. Mode of delivery, neonatal outcome, indications for cesarean section, and rate of uterine rupture were compared between the groups. RESULTS There were no significant differences between the study and control groups in mean (+/-S.D.) maternal age (30.9 +/- 4.7 years versus 31.2 +/- 4.8 years, P = 0.6), gestational age at delivery (39.2 +/- 1.8 weeks versus 39.3 +/- 1.6 weeks, P = 0.36), overall rate of cesarean section (36% versus 37.3%, P = 0.8), rates of low 5-min Apgar score < or =7 (3.1% versus 3.7%, P = 0.67) or cesarean section performed for nonreassuring fetal heart rate (6.1% versus 3.1%, P = 0.1). There were four cases of uterine rupture, all in the control group compared to none in the study group (nonsignificant). CONCLUSION The findings suggest that induction of labor in women with one previous cesarean section does not increase the risk of cesarean section rate and does not adversely affect immediate neonatal outcome. We cautiously suggest that when there is no absolute indication for repeated cesarean section, induction of labor may be considered.
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Affiliation(s)
- Yariv Yogev
- Perinatal Division and WHO Collaborating Center, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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