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Bender WR, Hamm RF, Dolin C, Levine LD. The Relationship between Gestational Weight Gain and Cesarean Delivery among Patients undergoing Induction of Labor. Am J Perinatol 2024; 41:669-676. [PMID: 37972937 DOI: 10.1055/s-0043-1776975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE This study aimed to determine the impact of pregnancy weight gain above National Academy of Medicine (NAM) guidelines on cesarean delivery rates following induction. STUDY DESIGN This is a secondary analysis of a prospective cohort study of patients who underwent induction at a single tertiary care center between July 2017 and July 2019. Included in the primary study were patients undergoing term (≥37 weeks) labor induction with a singleton gestation, intact membranes, and unfavorable cervical examination (Bishop score of ≤6 and cervical dilation ≤ 2 cm). Eligibility for this analysis was limited to patients with a documented prenatal body mass index (BMI) < 20 weeks' gestation. The primary exposure was gestational weight gain greater than NAM guidelines (WGGG) for a patient's initial BMI category. The primary outcome was cesarean delivery for any indication. RESULTS Of 1,610 patients included in the original cohort, 1,174 (72.9%) met inclusion criteria for this analysis and 517 (44.0%) of these had weight gain above NAM guidelines. Of the entire cohort, 60.0% were Black and 52.7% had private insurance. In total, 160 patients (31%) with WGGG underwent cesarean compared with 127 patients (19.3%) without WGGG (p < 0.001), which equates to a 59% increased odds of cesarean when controlling for initial BMI category, parity, gestational diabetes, and indication for induction (Adjusted Odds Ratio [aOR] 1.58, 95% confidence interval [CI] 1.17-2.12). Among only nulliparous patients, WGGG was associated with an increased odds of cesarean (26.4 vs. 38.2%, aOR 1.50, 95% CI 1.07-2.10). In multiparous patients, however, there was no difference in cesarean between those with and without WGGG (8.8 vs. 14.1%, aOR 1.85, 95% CI 0.96-3.58). CONCLUSION This study demonstrates that weight gain above NAM guidelines is associated with more than a 50% increased odds of cesarean. Patients should be informed of this association as gestational weight gain may be a modifiable risk factor for cesarean delivery. KEY POINTS · Weight gain above NAM guidelines was associated with a 59% increased odds of cesarean delivery.. · Nulliparous patients with weight gain above NAM guidelines are at higher risk of cesarean delivery.. · No difference in cesarean delivery among multiparous patients regardless of gestational weight gain..
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Affiliation(s)
- Whitney R Bender
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia
| | - Rebecca F Hamm
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cara Dolin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lisa D Levine
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Zhou H, Gu N, Yang Y, Wang Z, Hu Y, Dai Y. Nomogram predicting cesarean delivery undergoing induction of labor among high-risk nulliparous women at term: a retrospective study. BMC Pregnancy Childbirth 2022; 22:55. [PMID: 35062898 PMCID: PMC8783481 DOI: 10.1186/s12884-022-04386-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background Our aim was to create and validate a nomogram predicting cesarean delivery after induction of labor among nulliparous women at term. Methods Data were obtained from medical records from Nanjing Drum Tower Hospital. Nulliparous women with singleton pregnancies undergoing induction of labor at term were involved. A total of 2950 patients from Jan. 2014 to Dec. 2015 were served as derivation cohort. A nomogram was constructed by multivariate logistic regression using maternal, fetal and pregnancy characteristics. The predictive accuracy and discriminative ability of the nomogram were internal validated by 1000-bootstrap resampling, followed by external validation of a new dataset from Jan. 2016 to Dec. 2016. Results Logistic regression revealed nine predictors of cesarean delivery, including maternal height, age, uterine height, abdominal circumference, estimated fetal weight, indications for induction of labor, initial cervical consistency, cervical effacement and station. Nomogram was well calibrated and had an AUC of 0.73 (95% confidence interval [CI], 0.70-0.75) after bootstrap resampling for internal validation. The AUC in external validation reached 0.67, which was significantly higher than that of three models published previously (P<0.05). Conclusions This validated nomogram, constructed by variables that were obtained form medical records, can help estimate risk of cesarean delivery before induction of labor. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04386-8.
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Obeidat RA, Almaaitah M, Ben-Sadon A, Istaiti D, Rawashdeh H, Hamadneh S, Hammouri H, Bataineh A. Clinical predictive factors for vaginal delivery following induction of labour among pregnant women in Jordan. BMC Pregnancy Childbirth 2021; 21:685. [PMID: 34620120 PMCID: PMC8496008 DOI: 10.1186/s12884-021-04151-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Induction of labour (IOL) is an important and common clinical procedure in obstetrics. In the current study, we evaluate predictors of vaginal delivery in both nulliparous and multiparous women in north Jordan who were induced with vaginal prostaglandins. Method A prospective study was conducted on 530 pregnant women at King Abdullah University Hospital (KAUH) in north Jordan. All pregnant mothers with singleton live fetuses, who had induction of labour (IOL) between July 2017 and June 2019, were included in the study. Mode of delivery, whether vaginal or caesarean, was the primary outcome. Several maternal and fetal variables were investigated. The safety and benefit of repeated dosage of vaginal prostaglandin E2 (PGE2) tablets, neonatal outcomes and factors that affect duration of labour were also evaluated. Pearson χ2 test was used to investigate the significance of association between categorical variables, while student’s t-test and ANOVA were applied to examine the mean differences between categorical and numerical variables. Linear regression analysis was utilized to study the relation between two continuous variables. A multivariate regression analysis was then performed. Significance level was considered at alpha less than 0.05. Results Nulliparous women (N = 254) had significantly higher cesarean delivery rate (58.7% vs. 17.8%, p < 0.001) and longer duration of labour (16.1 ± 0.74 h vs. 11.0 ± 0.43 h, p < 0.001) than multiparous women (N = 276). In nulliparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop score; the mean Bishop score was 3.47 ± 0.12 in nulliparous women who had vaginal delivery vs. 3.06 ± 0.10 in women who had cesarean delivery (Adjusted odds ratio (AOR) = 1.2, 95% CI: 1.03–1.28, p = 0.03). In multiparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop scores and lower in women with higher body mass index (BMI). The mean Bishop score was 3.97 ± 0.07 in multiparous women who had vaginal delivery vs. 3.56 ± 0.16 in women who had cesarean delivery (AOR = 1.5, 95% CI: 1.1–2.1, p = 0.01). The mean BMI was 30.24 ± 0.28 kg/m2 in multiparous women who had vaginal delivery vs. 32.36 ± 0.73 kg/m2 in women who had cesarean delivery (AOR = 0.89, 95% CI: 0.84–0.96, p = 0.005). 27% of nulliparous women who received more than two PGE2 tablets and 50% of multiparous women who received more than two PGE2 tablets had vaginal delivery with no significant increase in neonatal morbidity. Conclusion Parity and cervical status are the main predictors of successful labour induction. Further studies are required to investigate the benefit of the use of additional doses of vaginal PGE2 above the recommended dose for IOL.
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Affiliation(s)
- Rawan A Obeidat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, P. O. Box: 3030, Irbid, 22110, Jordan.
| | - Mahmoud Almaaitah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, P. O. Box: 3030, Irbid, 22110, Jordan
| | - Abeer Ben-Sadon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, P. O. Box: 3030, Irbid, 22110, Jordan
| | - Dina Istaiti
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, P. O. Box: 3030, Irbid, 22110, Jordan
| | - Hasan Rawashdeh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, P. O. Box: 3030, Irbid, 22110, Jordan
| | - Shereen Hamadneh
- Department of Maternal and Child Health, Al Al-Bayt University, Mafraq, Jordan
| | - Hanan Hammouri
- Department of Mathematics and Statistics, Jordan University of Science and Technology, Irbid, Jordan
| | - Adel Bataineh
- Department of Anesthesia, Jordan University of Science and Technology, Irbid, Jordan
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Kajabwangu R, Bajunirwe F, Lukabwe H, Atukunda E, Mugisha D, Lugobe HM, Nakalinzi J, Mugyenyi GR. Factors associated with delayed onset of active labor following vaginal misoprostol administration among women at Mbarara Regional Referral Hospital, Uganda. Int J Gynaecol Obstet 2020; 153:268-272. [PMID: 33010030 DOI: 10.1002/ijgo.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/07/2020] [Accepted: 09/28/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the factors associated with delayed onset of active labor following labor induction with vaginal misoprostol. METHODS We conducted a prospective cohort study over 6 months at a tertiary hospital in Uganda. We enrolled mothers with pregnancies of at least 28 weeks, who were undergoing labor induction with 50 µg of vaginal misoprostol, administered every 6 hours with a maximum of four doses, and followed them up until onset of active labor. Labor onset was considered delayed if it occurred later than 12 hours after the first dose. Bivariate and multivariate analysis was performed to determine factors associated with delayed onset of active labor. RESULTS Of the 88 mothers enrolled, 22.7% (n=20) had delayed onset of active labor. Nulliparity (adjusted relative risk [aRR] 2.34, 95% confidence interval [CI] 1.17-4.68) and gestational age less than 37 weeks (aRR 3.79, 95% CI 1.40-10.23) were associated with delayed onset of active labor following vaginal misoprostol administration whereas higher body mass index (aRR 0.38, 95% CI 0.18-0.79) decreased the risk. CONCLUSION Delayed onset of active labor following labor induction remains an important obstetric care challenge. Mothers undergoing labor induction should have their body mass index documented, and nulliparous women and mothers at less than 37 weeks of gestation should have their labor monitored for a longer duration following labor induction.
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Affiliation(s)
- Rogers Kajabwangu
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Henry Lukabwe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Esther Atukunda
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dale Mugisha
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Henry M Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joanita Nakalinzi
- Department of Pharmacy, Kampala International University Teaching Hospital, Ishaka, Uganda
| | - Godfrey R Mugyenyi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
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Mariani LL, Mancarella M, Fuso L, Novara L, Menato G, Biglia N. Predictors of response after a second attempt of pharmacological labor induction: a retrospective study. Arch Gynecol Obstet 2020; 302:117-125. [PMID: 32445065 DOI: 10.1007/s00404-020-05578-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of our study was to assess the outcomes of a prolonged induction carried out with a second sequential cycle of pharmacological stimulation after unsatisfactory response to a first attempt, and to highlight variables correlated with higher response rates. METHODS A retrospective study was carried out on 157 women who underwent a two-step labor induction by vaginal prostaglandins followed by a second cycle of prostaglandins or intravenous oxytocin. Outcomes assessed were mode of delivery and maternal and neonatal morbidity. Main variables of pregnancy and delivery were collected to identify factors predicting the mode of delivery. RESULTS Among 157 patients, 63 (40.1%) achieved a vaginal delivery, whereas 94 (59.9%) underwent Cesarean section, 9 women (5.7%) had postpartum hemorrhage; in 2 cases (1.3%), an Apgar score < 7 at 5 min from birth was reported. Higher risk of Cesarean section was observed with advanced maternal age (OR 1.13 for additional year, CI 1.04-1.22) and nulliparity (OR 8.84, CI 2.69-29.06), whereas the response rates were better in carriers of group B streptococcus colonization (OR 0.38, CI 0.17-0.84) and in women with favorable cervical status after the first stimulation (OR 0.81 for additional point of Bishop score, CI 0.70-0.94). CONCLUSION Labor induction with two cycles of pharmacological stimulation is a procedure with fairly good success rates and a low risk of maternal and neonatal complications. Factors predicting its success encompass younger age, parity, a positive recto-vaginal swab for group B streptococcus and a favorable cervix following the first cycle of stimulation.
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Affiliation(s)
- Luca Liban Mariani
- Obstetrics and Gynaecology Unit, Mauriziano Umberto I Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Matteo Mancarella
- Obstetrics and Gynaecology Unit, Mauriziano Umberto I Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Luca Fuso
- Obstetrics and Gynaecology Unit, Mauriziano Umberto I Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Lorenzo Novara
- Obstetrics and Gynaecology Unit, Mauriziano Umberto I Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Guido Menato
- Academic Department of Obstetrics and Gynaecology, University of Turin School of Medicine, Turin, Italy
| | - Nicoletta Biglia
- Obstetrics and Gynaecology Unit, Mauriziano Umberto I Hospital, Largo Turati 62, 10128, Turin, Italy. .,Academic Department of Obstetrics and Gynaecology, University of Turin School of Medicine, Turin, Italy.
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Electrohysterographic characterization of the uterine myoelectrical response to labor induction drugs. Med Eng Phys 2018; 56:27-35. [DOI: 10.1016/j.medengphy.2018.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/21/2018] [Accepted: 04/10/2018] [Indexed: 11/19/2022]
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Marsdal KE, Sørbye IK, Gaudernack LC, Lukasse M. A comparison of misoprostol vaginal insert and misoprostol vaginal tablets for induction of labor in nulliparous women: a retrospective cohort study. BMC Pregnancy Childbirth 2018; 18:11. [PMID: 29304769 PMCID: PMC5756353 DOI: 10.1186/s12884-017-1647-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/27/2017] [Indexed: 11/21/2022] Open
Abstract
Background Since Misoprostol Vaginal Insert (MVI - Misodel ®) was approved for labor induction in Europe in 2013, to date, no study has been published comparing MVI to Misoprostol vaginal tablets (MVT). The aim of this study, performed as part of a quality improvement project, was to compare the efficacy and safety of 200 μg MVI versus 25 μg MVT for labor induction in nulliparous women. Methods This retrospective cohort study included 171 nulliparous singleton term deliveries induced with MVI (n = 85) versus MVT (n = 86) at Oslo University Hospital Rikshospitalet, Norway, from November 2014 to December 2015. Primary outcomes were time from drug administration to delivery in hours and minutes and the rate of cesarean section (CS). Results were adjusted for Bishop Score and pre-induction with balloon catheter. Results Median time from drug administration to delivery was shorter in the MVI group compared to the MVT group (15 h 43 min versus 19 h 37 min, p = 0.011). Adjusted for confounding factors, mean difference was 6 h 3 min (p = 0.002). The risk of CS was 67% lower in the MVI group compared to the MVT group (11.8% versus 23.3%, OR = 0.33; adjusted 95% CI 0.13–0.81). Adverse neonatal outcomes did not differ between the groups. Conclusions In a setting of routine obstetric care, MVI seems to be a more efficient labor induction agent than MVT, and with a lower CS rate and no increase in adverse infant outcomes.
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Affiliation(s)
- Kjersti Engen Marsdal
- Department of Obstetrics, Oslo University Hospital Rikshospitalet, P.O. Box 4956 Nydalen, 0424, Oslo, Norway.,Oslo and Akershus University College, Faculty of Health Sciences, Department of Nursing and Health Promotion, P.O. Box 4, 0130, Oslo, Norway
| | - Ingvil Krarup Sørbye
- Department of Obstetrics, Oslo University Hospital Rikshospitalet, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Lise C Gaudernack
- Department of Obstetrics, Oslo University Hospital Rikshospitalet, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Mirjam Lukasse
- Oslo and Akershus University College, Faculty of Health Sciences, Department of Nursing and Health Promotion, P.O. Box 4, 0130, Oslo, Norway.
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Batinelli L, Serafini A, Nante N, Petraglia F, Severi FM, Messina G. Induction of labour: clinical predictive factors for success and failure. J OBSTET GYNAECOL 2017; 38:352-358. [PMID: 29058493 DOI: 10.1080/01443615.2017.1361388] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Induction of labour (IOL) is a widely-used practice in obstetrics. Our aim was to evaluate predictors of vaginal delivery in postdate pregnancies induced with prostaglandins. We conducted a retrospective cross-sectional study with analytic component. A total of 145 women, admitted for IOL after the 41st week of gestation, were induced with a vaginal pessary releasing prostaglandins. Type of delivery, whether vaginal or caesarean, was the outcome. Several maternal and foetal variables were investigated. The Kaplan-Maier curves, monovariate and a multivariate logistic regression were carried out. In our population, 80.7% of women had vaginal delivery after the induction. Multiparity and a high Bishop score at the beginning of the IOL were protective factors for a vaginal delivery (respectively OR 0.16, p = .028 and OR 0.62, p = .034) while age >35 years, and the foetal birth weight >3500 g at the birth, resulted in being risk factors for caesarean section (respectively OR 4.20, p = .006 and OR 3.63, p = .013). IMPACT STATEMENT What is already known on this subject: Induction of labour (IOL) is a widely used practice in obstetrics. Scientific literature shows several predictors of successful induction, although there is no unanimity except for 'multiparity' and 'favourable Bishop score' which are associated with positive outcome of the induction. The main difficulty in finding other predictive factors is the heterogeneity of this field (different local protocols in each hospital, type of induction, populations and outcomes chosen in each study). In addition to that, populations are not always comparable due to the different gestation. For this reason, we decided to select a specific population of women, such as low risk postterm pregnancies induced with prostaglandins, in order to detect possible predictive factors for the success of the IOL for women with uncomplicated pregnancies. What the results of this study add: Our study agrees with existing literature that 'multiparity' and 'Bishop score' are linked with the success of IOL and adds that 'maternal age' and 'foetal birth weight' are significant risk factors for the population of uncomplicated post term pregnancies induced with prostaglandins. What the implications are of these findings for clinical practice and/or further research: Our results agreed with the existing literature regarding parity and Bishop score but not for maternal age and birth weight. This adds new precious data to the literature which could be used for systematic reviews and for implementing IOL guidelines and protocols, nationally and internationally. Our findings could be also used for guiding future research in this field. It will be interesting to investigate the existence of not just specific factors but also any combination of variables which could predict the success of the procedure. At the moment these information cannot be used in terms of decision making for healthcare professionals as no variable is 100% predictive but once further research will be added, we may be able to know when is best time to start the IOL, how to facilitate the success of the procedure and how to best support the woman throughout the whole experience.
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Affiliation(s)
- Laura Batinelli
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Andrea Serafini
- b Post Graduated School in Public Health , University of Siena , Siena , Italy
| | - Nicola Nante
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Felice Petraglia
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Filiberto Maria Severi
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Gabriele Messina
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
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Hadar E, Hiersch L, Ashwal E, Chen R, Wiznitzer A, Gabbay-Benziv R. Induction of labor in elderly nulliparous women. J Matern Fetal Neonatal Med 2016; 30:2146-2150. [PMID: 27677204 DOI: 10.1080/14767058.2016.1240165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Maternal age is an important consideration for antenatal care, labor and delivery. We aimed to evaluate the induction of labor (IoL) failure rates among elderly nulliparous women. MATERIALS AND METHODS We conducted a retrospective analysis of all nulliparous women at 34 + 0 to 41 + 6 weeks, undergoing cervical ripening by prostaglandin E2 (PGE2) vaginal insert. Study group included elderly (≥35 years) nulliparous and control group included non-elderly (<35 years) nulliparous women. Primary outcome was IoL failure rate and secondary outcome was cesarean delivery rate. Outcomes were compared between the groups by univariate analysis followed by regression analysis to adjust results to potential confounders. RESULTS Of 537 women undergoing IoL, 69 (12.8%) were elderly. The univariate analysis demonstrated no difference in IoL failure rate (26.5% versus 34.8%, p = 0.502) between groups. However, elderly nulliparous women had higher rates of cesarean delivery (36.2% versus 21.4%, p = 0.009). This difference was no longer significant after adjustment for maternal body mass index, indication for delivery, birth weight and gestational age at delivery. CONCLUSION Among nulliparous women, older maternal age is not associated with higher rates of IoL failure or cesarean deliveries.
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Affiliation(s)
- Eran Hadar
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel and.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Liran Hiersch
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel and.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Eran Ashwal
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel and.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Rony Chen
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel and.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Arnon Wiznitzer
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel and.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Rinat Gabbay-Benziv
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel and.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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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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Tolcher MC, Holbert MR, Weaver AL, McGree ME, Olson JE, El-Nashar SA, Famuyide AO, Brost BC. Predicting Cesarean Delivery After Induction of Labor Among Nulliparous Women at Term. Obstet Gynecol 2015; 126:1059-1068. [PMID: 26444107 PMCID: PMC4618703 DOI: 10.1097/aog.0000000000001083] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify independent risk factors for cesarean delivery after induction of labor and to develop a nomogram for predicting cesarean delivery among nulliparous women undergoing induction of labor at term. METHODS This is a retrospective cohort study including nulliparous women with singleton, term (37 0/7 weeks of gestation or greater), cephalic pregnancies undergoing induction of labor from July 1, 2006, through May 31, 2012, at a tertiary care academic center. Inductions were identified using International Classification of Diseases, 9th Revision codes. Demographic, delivery, and outcome data were abstracted manually from the medical record. Women with a contraindication to vaginal delivery (malpresentation, abnormal placentation, prior myomectomy) were excluded. Independent risk factors for cesarean delivery were identified using logistic regression. RESULTS During the study period, there were 785 nulliparous inductions that met study criteria; 231 (29.4%) underwent cesarean delivery. Independent risk factors associated with an increased risk of cesarean delivery included older maternal age, shorter maternal height, greater body mass index, greater weight gain during pregnancy, older gestational age, hypertension, diabetes mellitus, and initial cervical dilation less than 3 cm. A nomogram was constructed based on the final model with a bias-corrected c-index of 0.709 (95% confidence interval 0.671-0.750). CONCLUSION We identified independent risk factors that can be used to predict cesarean delivery among nulliparous women undergoing induction of labor at term. If validated in other populations, the nomogram could be useful for individualized counseling of women with a combination of identifiable antepartum risk factors. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | | | - Amy L. Weaver
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Michaela E. McGree
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Janet E. Olson
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN
| | | | | | - Brian C. Brost
- Division of Maternal-Fetal Medicine, Wake Forest Baptist Health, Wake Forest, NC
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Hong JS, Romero R, Lee DC, Than NG, Yeo L, Chaemsaithong P, Ahn S, Kim JS, Kim CJ, Kim YM. Umbilical cord prostaglandins in term and preterm parturition. J Matern Fetal Neonatal Med 2015; 29:523-31. [PMID: 25758616 DOI: 10.3109/14767058.2015.1011120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Prostaglandins (PGs) are considered the universal mediators of parturition. Amniotic fluid PGE2 and PGF2α concentrations increase before the onset of spontaneous labor at term, as well as during labor. This study was conducted to determine if the concentrations of umbilical cord PGE2 and PGF2α change with advancing gestational age, spontaneous labor at term, and preterm labor (with and without funisitis). METHODS Umbilical cord (UC) tissue samples were obtained from women (N = 158) with singleton pregnancies in the following groups: (1) term deliveries without labor (TNL; n = 20); (2) term deliveries with labor (TIL; n = 20); (3) spontaneous preterm deliveries (sPTD) with (n = 20) and without acute funisitis (n = 20); and (4) preeclampsia without labor (n = 78). The concentrations of PGs were determined in different locations of the UC. PGE2 and PGF2α were measured by specific immunoassays. Non-parametric statistics were used for analysis. RESULTS (1) In spontaneous preterm deliveries, the median UC PGE2 concentration was higher in cases with funisitis than in those without funisitis (233.7 pg/µg versus 87.4 pg/µg of total protein, p = 0.001); (2) the median UC PGE2 concentration in sPTD with funisitis was also higher than that obtained from samples who had undergone labor at term (233.7 pg/µg versus 116.1 pg/µg of total protein, p = 0.03); (3) the UC PGE2 and PGF2α concentration increased as a function of advancing gestational age before 36 weeks (PGE2: ρ = 0.59, p < 0.001; PGF2α: ρ = 0.39, p = 0.01), but not after 36 weeks (PGE2: ρ = -0.1, p = 0.5; PGF2α: ρ = -0.2, p = 0.2); (4) the median UC concentrations of PGE2 and PGF2α at term was similar in samples obtained from women with and without labor (PGE2: TNL 133.7 pg/µg versus TIL 116.1 pg/µg of total protein, p = 0.9; PGF2α: TNL 8.4 pg/µg versus TIL 8.1 pg/µg of total protein, p = 0.7); and (5) there was no correlation between UC PG concentration and gestational age at term pregnancy (PGE2: ρ = 0.01, p = 0.9; PGF2α: ρ = 0.07, p = 0.7). CONCLUSIONS (1) PGE2 concentrations in the UC are higher in the presence of acute funisitis than in the absence of this lesion; (2) spontaneous labor at term was not associated with a change in the UC concentration of PGE2 and PGF2α; and (3) the UC concentrations of PGE2 and PGF2α increased as a function of gestational age. We propose that UC PGs act as inflammatory mediators generated in the context of fetal systemic inflammation.
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Affiliation(s)
- Joon-Seok Hong
- a Perinatology Research Branch, NICHD/NIH/DHHS , Bethesda, MD, and Detroit , MI , USA .,b Department of Obstetrics and Gynecology , Seoul National University Bundang Hospital , Gyeonggi-do , Republic of Korea
| | - Roberto Romero
- a Perinatology Research Branch, NICHD/NIH/DHHS , Bethesda, MD, and Detroit , MI , USA .,c Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA .,d Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA
| | - Deug-Chan Lee
- a Perinatology Research Branch, NICHD/NIH/DHHS , Bethesda, MD, and Detroit , MI , USA .,e College of Biomedical Science, Kangwon National University , Chuncheon , Republic of Korea
| | - Nandor Gabor Than
- a Perinatology Research Branch, NICHD/NIH/DHHS , Bethesda, MD, and Detroit , MI , USA .,f Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Lami Yeo
- a Perinatology Research Branch, NICHD/NIH/DHHS , Bethesda, MD, and Detroit , MI , USA .,f Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Piya Chaemsaithong
- a Perinatology Research Branch, NICHD/NIH/DHHS , Bethesda, MD, and Detroit , MI , USA .,f Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Soyeon Ahn
- g Medical Research Collaborating Center, Seoul National University Bundang Hospital , Gyeonggi-do , Republic of Korea
| | - Jung-Sun Kim
- h Department of Pathology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Chong Jai Kim
- a Perinatology Research Branch, NICHD/NIH/DHHS , Bethesda, MD, and Detroit , MI , USA .,i Department of Pathology , Asan Medical, Center University of Ulsan College of Medicine , Seoul , Republic of Korea , and
| | - Yeon Mee Kim
- a Perinatology Research Branch, NICHD/NIH/DHHS , Bethesda, MD, and Detroit , MI , USA .,j Department of Pathology , Haeundae Paik Hospital, Inje University College of Medicine , Busan , Republic of Korea
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Marques RMCDP, Souza ASR, Costa AARD, Feitosa FEDL, Amorim MMR. Factors associated with vaginal delivery in hypertensive and normotensive pregnant women submitted to labor induction with misoprostol: a cohort study. Hypertens Pregnancy 2014; 34:153-70. [PMID: 25549056 DOI: 10.3109/10641955.2014.988351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the factors associated with vaginal delivery in hypertensive and normotensive pregnant women submitted to induction of labor with misoprostol. METHODS A cohort study. RESULTS The factors associated with vaginal delivery in both normotensive and hypertensive women were, respectively, Bishop score ≥ 4 (OR = 1.87; 95% CI: 1.06-3.29; p = 0.03) and (OR = 2.31; 95% CI: 1.25-4.28; p = 0.008) and parity ≥ 1 (OR = 4.36; 95% CI: 2.16-8.80; p < 0.0001) and (OR = 2.61; 95% CI: 1.36-5.04; p = 0.004). CONCLUSION The factors associated with vaginal delivery were Bishop score ≥ 4 and parity ≥ 1 irrespective of whether or not the women were hypertensive.
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Abstract
The incidence of both gestational and pre-gestational diabetes is increasing worldwide. The main cause of this increase is likely the concomitant increase in the incidence of global obesity, but in the case of gestational diabetes, changes in the diagnostic criteria are also a contributing factor. The adverse outcomes associated with pre-gestational diabetes are well known and have led clinicians to implement various strategies that include increased fetal surveillance and induction of labour at various gestational ages. In many cases these same strategies have been applied in clinical practice also to women with gestational diabetes despite there being differences in the type and magnitude of perinatal complications associated with this diagnosis. Despite the widespread application of these clinical practices, there is a paucity of quality data in the medical literature to guide the clinician in choosing a strategy for fetal surveillance and timing of delivery in both gestational diabetes and pre-gestational diabetes pregnancies. In the following review, we will discuss the rationale and consequences of planned delivery in gestational diabetes and pre-gestational diabetes, the evidence supporting different strategies for delivery and finally highlight future targets for research in this area.
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Affiliation(s)
- Howard Berger
- Maternal Fetal Medicine St Michael’s Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Nir Melamed
- Maternal Fetal Medicine St Michael’s Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Seadawy SY, Farag AH, Mohammed MEIDM. Relation between dehydroepiandrosterone sulfate (DHEA-S) and success of labour induction in prolonged gestation. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2013. [DOI: 10.1016/s2305-0500(13)60169-4] [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] Open
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16
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Cubal A, Carvalho J, Ferreira MJ, Rodrigues G, Carmo OD. Value of Bishop score and ultrasound cervical length measurement in the prediction of cesarean delivery. J Obstet Gynaecol Res 2013; 39:1391-6. [DOI: 10.1111/jog.12077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 01/08/2013] [Indexed: 11/30/2022]
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Melamed N, Yariv O, Hiersch L, Wiznitzer A, Meizner I, Yogev Y. Labor induction with prostaglandin E2: characteristics of response and prediction of failure. J Matern Fetal Neonatal Med 2012; 26:132-6. [PMID: 22928537 DOI: 10.3109/14767058.2012.722729] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To characterize the response to labor induction with prostaglandin E2 (PGE2) and to identify risk factors for induction failure. METHODS A prospective controlled study of women admitted for labor induction with PGE2. Maternal characteristics, Bishop score and sonographic cervical length were documented at admission. The change in cervical characteristics and the emergence of uterine contractions following each application of PGE2 were analyzed. RESULTS Of the 88 women who were included in the study, 19 (21.6%) failed to response to PGE2. The following factors were independently associated with induction failure: nulliparity (odds ratio [OR] = 5.9, 95% confidence interval (CI): 1.2-30.2), pre-pregnancy body mass index >25 kg/m2 (OR = 5.4, 95% CI: 1.1-26.5), Bishop score <4 (OR = 2.3, 95% CI: 1.05-14.4), cervical length <25 mm (OR = 0.2, 95% CI: 0.1-0.8) and the development of uterine contractions in response to the first application of PGE2 (OR = 0.4, 95% CI: 0.1-0.93). Overall, most women required only one (60.9%) or two (85.5%) applications of PGE2 to achieve successful induction. The number of applications of PGE2 required to achieve successful induction was related to parity and cervical status at presentation. CONCLUSIONS Overall, most women who eventually respond to PGE2 do so following the first two applications of PGE2, and the contribution of subsequent applications is relatively small and related to cervical status at admission.
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Affiliation(s)
- Nir Melamed
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
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Journet D, Gaucherand P, Doret M. [Adding parity to the Bishop score for term labor induction: a retrospective study]. J Gynecol Obstet Hum Reprod 2012; 41:339-345. [PMID: 22560659 DOI: 10.1016/j.jgyn.2012.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 03/14/2012] [Accepted: 03/28/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the interest to add parity to the Bishop score before induction of labor by intravenous oxytocin. PATIENTS AND METHODS This retrospective cohort study compared cesarean section rate for induction failure by intravenous oxytocin in nulliparous and multiparous with modified Bishop score from 7 to 9. The modified Bishop score is calculated by adding 2 points to the Bishop score if the patient had a previous vaginal delivery and 0 point in nulliparous. RESULTS Over 2 years, 468 patients were included (201 nulliparous and 267 multiparous). Cesarean section rate for induction failure was higher for nulliparous with a modified Bishop score equal to 7 or varying between 7 and 9. These results confirm that parity is an important predicting factor of successful labor induction. In multiparous, cesarean section rates for induction failure were not significantly different with Bishop score or modified Bishop score equal to 7. CONCLUSION Adding 2 points for multiparity at the Bishop score did not increase cesarean for failure of labor induction with intravenous oxytocin with a modified Bishop score from 7 to 9.
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Affiliation(s)
- D Journet
- Service d'obstétrique, université Lyon-1, hôpital Femme-mère-enfant, hospices civils de Lyon, 59 boulevard Pinel, Lyon, France
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Schuit E, Kwee A, Westerhuis MEMH, Van Dessel HJHM, Graziosi GCM, Van Lith JMM, Nijhuis JG, Oei SG, Oosterbaan HP, Schuitemaker NWE, Wouters MGAJ, Visser GHA, Mol BWJ, Moons KGM, Groenwold RHH. A clinical prediction model to assess the risk of operative delivery. BJOG 2012; 119:915-23. [PMID: 22568406 DOI: 10.1111/j.1471-0528.2012.03334.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To predict instrumental vaginal delivery or caesarean section for suspected fetal distress or failure to progress. DESIGN Secondary analysis of a randomised trial. SETTING Three academic and six non-academic teaching hospitals in the Netherlands. POPULATION 5667 labouring women with a singleton term pregnancy in cephalic presentation. METHODS We developed multinomial prediction models to assess the risk of operative delivery using both antepartum (model 1) and antepartum plus intrapartum characteristics (model 2). The models were validated by bootstrapping techniques and adjusted for overfitting. Predictive performance was assessed by calibration and discrimination (area under the receiver operating characteristic), and easy-to-use nomograms were developed. MAIN OUTCOME MEASURES Incidence of instrumental vaginal delivery or caesarean section for fetal distress or failure to progress with respect to a spontaneous vaginal delivery (reference). RESULTS 375 (6.6%) and 212 (3.6%) women had an instrumental vaginal delivery or caesarean section due to fetal distress, and 433 (7.6%) and 571 (10.1%) due to failure to progress, respectively. Predictors were age, parity, previous caesarean section, diabetes, gestational age, gender, estimated birthweight (model 1) and induction of labour, oxytocin augmentation, intrapartum fever, prolonged rupture of membranes, meconium stained amniotic fluid, epidural anaesthesia, and use of ST-analysis (model 2). Both models showed excellent calibration and the receiver operating characteristics areas were 0.70-0.78 and 0.73-0.81, respectively. CONCLUSION In Dutch women with a singleton term pregnancy in cephalic presentation, antepartum and intrapartum characteristics can assist in the prediction of the need for an instrumental vaginal delivery or caesarean section for fetal distress or failure to progress.
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Affiliation(s)
- E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
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The Bishop Score as a determinant of labour induction success: a systematic review and meta-analysis. Arch Gynecol Obstet 2012; 286:739-53. [PMID: 22546948 DOI: 10.1007/s00404-012-2341-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
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Palomäki O, Eerikäinen H, Huhtala H, Kirkinen P. Prediction of successful labor induction by evaluation of maternal symptoms at an early stage of the misoprostol induction protocol. J Perinat Med 2011; 39:299-304. [PMID: 21406040 DOI: 10.1515/jpm.2011.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This prospective observational study evaluated maternal symptoms and characteristics that predict successful labor induction with oral misoprostol. METHODS A total of 244 consecutive women undergoing labor induction voluntarily completed a questionnaire about subjective sensations and pain scores during the induction protocol. Maternal and neonatal characteristics were collected retrospectively from patient files. On the first day of induction, oral misoprostol (50 μg) every 4 h up to three doses was used. RESULTS A total of 46% of the parturients delivered or reached the active phase of labor 24 h after the initial dose of misoprostol (ID). In the whole study, 87% of the women delivered vaginally. In multivariable analysis, rupture of membranes, cervical dilatation before the initial dose, maternal sensation of painful contractions at 8 h after the initial dose, and gestational age, were found to be associated with successful labor induction. CONCLUSIONS Maternal sensation of painful contractions 8 h after an ID is an independent predictive factor of successful labor induction (defined as delivery or active phase of labor 24 h after beginning of induction). Other independent predictive factors are rupture of membranes, cervical dilatation before the initial dose, and gestational age.
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Affiliation(s)
- Outi Palomäki
- Department of Obstetrics and Gynecology, University Hospital of Tampere, Finland.
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Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol 2011; 117:805-811. [PMID: 21383643 PMCID: PMC3297470 DOI: 10.1097/aog.0b013e3182114ad2] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The Bishop score is the most commonly used method to assess the readiness of the cervix for induction. However, it was created without modern statistical methods. Our objective was to determine whether a simplified score can predict vaginal delivery equally well. METHODS Data were analyzed for 5,610 nulliparous women with singleton, uncomplicated pregnancies between 37 0/7 and 41 6/7 weeks of gestation undergoing labor induction. These women had all five components of the Bishop score recorded. Logistic regression was performed and a simplified score created with significant components. Positive and negative predictive values and positive likelihood ratios were calculated. RESULTS In the regression model, only dilation, station, and effacement were significantly associated with vaginal delivery (P<.01). The simplified Bishop score was then devised using these three components (range 0-9) and compared with the original Bishop score (range 0-13) for prediction of successful induction, resulting in vaginal delivery. Compared with the original Bishop score (greater than 8), the simplified Bishop score (greater than 5) had a similar or better positive predictive value (87.7% compared with 87.0%), negative predictive value (31.3% compared with 29.8%), positive likelihood ratio (2.34 compared with 2.19), and correct classification rate (51.0% compared with 47.3%). Application of the simplified Bishop score in other populations, including indicated induction and spontaneous labor at term and preterm, were associated with similar vaginal delivery rates compared with the original Bishop score. CONCLUSION The simplified Bishop score comprised of dilation, station, and effacement attains a similarly high predictive ability of successful induction as the original score. LEVEL OF EVIDENCE II.
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Affiliation(s)
- S. Katherine Laughon
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Jun Zhang
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - James Troendle
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Liping Sun
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Memon F, Wijesiriwardana A, Jonker L. Maternal and prenatal factors influencing the outcome of prostaglandin E2 induced labour. J OBSTET GYNAECOL 2011; 31:220-3. [DOI: 10.3109/01443615.2010.544424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kim SN, Park KH, Jung HJ, Hong JS, Shin DM, Kang WS. Clinical and sonographic parameters at 37 weeks' gestation for predicting the risk of primary Cesarean delivery in nulliparous women. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:486-492. [PMID: 20586108 DOI: 10.1002/uog.7734] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To identify the clinical and sonographic parameters at 37 weeks' gestation that predict the risk of Cesarean delivery in labor for nulliparas. METHODS This prospective observational study recruited nulliparas with singleton pregnancies at 37 weeks' gestation. Determination of the Bishop score, ultrasound measurement of the cervical length, and fetal biometry were performed. The clinical parameters studied were maternal age, height and weight and Bishop score. The sonographic parameters included fetal biparietal diameter, femur length, abdominal circumference (AC), estimated fetal weight (EFW), amniotic fluid index and cervical length. RESULTS Four hundred and fifty-three women were examined; 57 women (12.6%) underwent an emergency Cesarean delivery in labor. Logistic regression analysis identified maternal age and height and fetal AC and EFW, but not cervical length or Bishop score, as the best predictors of Cesarean delivery. Of these predictors, maternal age and height and fetal AC at 37 weeks were included in a final model for risk scoring. The model was shown to have an adequate goodness of fit (P = 0.473), and the area under the receiver-operating characteristics curve was 0.758, indicating reasonably good discrimination. CONCLUSIONS Maternal age and height and fetal AC and EFW at 37 weeks' gestation are the most important parameters in predicting the risk of Cesarean delivery in nulliparas; sonographic measurement of the cervical length and the Bishop score were not predictive of Cesarean delivery. A predictive model using these parameters at 37 weeks provides useful information in the decision-making process regarding the mode of delivery.
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Affiliation(s)
- S N Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnamsi, Korea
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Cheung CW, Leung TY, Sahota DS, Chan OK, Chan LW, Fung TY, Lau TK. Outcome of induction of labour using maternal characteristics, ultrasound assessment and biochemical state of the cervix. J Matern Fetal Neonatal Med 2010; 23:1406-12. [PMID: 20230317 DOI: 10.3109/14767051003678135] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess pre-induction sonographic, digital examination and biochemical changes in the cervix to predict induction outcome. METHODS Transvaginal and abdominal scans were performed in 460 women at 37-41 weeks of gestation to determine cervical length (CL), posterior cervical angle (PCA) and foetal occipital position. The Bishop Score (BS) and the absence/presence of phosphorylated form of insulin-like growth factor-binding protein-1 (phIGFBP-1) in cervical secretions were assessed. Independent parameters significantly associated with a vaginal delivery were identified. RESULTS A total of 340 (73.9%) women achieved a vaginal delivery following induction. Multivariate analysis indicated that significant independent predictors of vaginal delivery were CL (adjusted odds ratio [AOR]: 0.59, 95% confidence interval [CI]: 0.45-0.79), PCA (AOR: 1.89, 95% CI: 1.09-3.28) and multiparae (AOR: 10.02, 95% CI: 5.10-19.69). For a specificity of 75%, the sensitivity for prediction of vaginal delivery using the BS, the CL and the multivariate model using the identified significant independent predictors were 37.1, 46.8 and 68%, respectively. CONCLUSION The combination of sonographic assessment of the cervix and maternal characteristics was superior to the either BS or CL alone in the prediction of the induction outcome. Inclusion of the absence/presence of phIGFBP-1 did not further improve induction outcome.
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Affiliation(s)
- Chun Wai Cheung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Factors Predicting Successful Labor Induction With Dinoprostone and Misoprostol Vaginal Inserts. Obstet Gynecol 2009; 114:261-267. [DOI: 10.1097/aog.0b013e3181ad9377] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chan BCP, Leung WC, Lao TTH. Prelabor rupture of membranes at term requiring labor induction - a feature of occult fetal cephalopelvic disproportion? J Perinat Med 2009; 37:118-23. [PMID: 18681835 DOI: 10.1515/jpm.2009.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To examine the maternal and neonatal characteristics related to labor outcome following induction for prelabor rupture of membranes (PROM) after 37 weeks' gestation. METHOD All singleton pregnancies delivered following spontaneous or induced labor after 37 weeks in four years were analyzed. Patients with labor induction for PROM comprised the study group. Outcome of labor was analyzed according to gestational age at delivery. RESULTS Among the 13,505 patients in the entire cohort, 1710 (12.7%) had labor induction for PROM. These women were older and heavier, were more nulliparas and had more large-for-gestational age (LGA) infants, higher rates of instrumental and cesarean deliveries, and a shorter mean gestation, but no difference in height, mean birth weight, or incidence of male infants. Multiple logistic regression analysis confirmed that labor induction was a weak but significant independent factor for cesarean delivery (aOR 1.18, 95% CI: 1.01-1.38). The rates of cesarean delivery significantly correlated with gestational age at delivery for both LGA (P<0.001) and non-LGA (P<0.001) infants, together with significantly increased birth weight. CONCLUSION The results suggest that a likely explanation for the cesarean delivery following labor induction for PROM at term in our population is underlying cephalopelvic disproportion.
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Affiliation(s)
- Ben Chong-Pun Chan
- Department of Obstetrics and Gynecology, Queen Mary Hospital, Hong Kong.
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Chan BCP, Lao TTH. The impact of maternal height on intrapartum operative delivery: A reappraisal. J Obstet Gynaecol Res 2009; 35:307-14. [DOI: 10.1111/j.1447-0756.2008.00939.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yanik A, Gülümser C, Tosun M. Ultrasonographic measurement of cervical length in predicting mode of delivery after oxytocin induction. Adv Ther 2007; 24:748-56. [PMID: 17901024 DOI: 10.1007/bf02849968] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was conducted to explore the value of transvaginal ultrasonographic cervical length measurement, in addition to gestational age, maternal age, parity, Bishop score, and weight of the newborn, in predicting the mode of delivery in pregnancies in which labor is induced with oxytocin at or beyond the 40th gestational week. A total of 73 pregnancies at 40 to 42 weeks of gestation were included. After labor was induced, 29 women delivered vaginally and 44 underwent cesarean section. These groups were compared with respect to possible predictive parameters of delivery outcomes. Student t test, Pearson's correlation analysis, and logistic regression analysis were used for statistical evaluation. Mean preinduction cervical length was 26.8+/-9.9 mm in the vaginal delivery group and 34.2+/-8.1 mm in the cesarean section group (P<.05). Mean maternal age, parity, and Bishop score were significantly higher and mean weight of the newborn was significantly lower in the vaginal delivery group. Cervical length measurements showed a significant negative correlation with Bishop scores (r=-.584; P<.05). Logistic regression analysis revealed that Bishop score (likelihood ratio=.472; 95% confidence interval=.338-.658; P<.05) and weight of the newborn (likelihood ratio=1.002; 95% confidence interval=1.00007-1.003; P<.05) were significant independent predictors of the route of delivery. According to the results of this study, maternal age, parity, Bishop score, cervical length, and weight of the newborn all might affect the mode of delivery after labor induction. Bishop score, although a subjective measure, must be considered an important component of preinduction evaluation.
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Affiliation(s)
- Ali Yanik
- Department of Obstetrics and Gynecologym, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
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Crane JMG, Butler B, Young DC, Hannah ME. Misoprostol compared with prostaglandin E2 for labour induction in women at term with intact membranes and unfavourable cervix: a systematic review*. BJOG 2006; 113:1366-76. [PMID: 17081181 DOI: 10.1111/j.1471-0528.2006.01111.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Misoprostol is a commonly used prostaglandin to induce labour. A potential risk of induction, however, is caesarean delivery, especially in women with an unfavourable cervix. OBJECTIVES To evaluate the use of misoprostol, compared with prostaglandin E2 (PgE2), for labour induction in women at term with an unfavourable cervix and intact membranes. SEARCH STRATEGY PubMed, Medline, EMBASE and the Cochrane Library were searched for articles published in any language from January 1987 to December 2005, using the keywords 'misoprostol', 'labour/labor' and 'induction'. SELECTION CRITERIA We identified randomised trials of women at term (> or =37 weeks of gestation) with intact membranes and unfavourable cervix, undergoing labour induction with misoprostol, orally, vaginally, sublingually or buccally, compared with PgE2 vaginally or intracervically. DATA COLLECTION AND ANALYSIS Caesarean delivery was the primary outcome, with tachysystole and hyperstimulation as secondary outcomes. The primary analysis compared any misoprostol with any PgE2 for all women, with a subgroup analysis for nulliparous women. Secondary analyses compared different routes and doses of misoprostol (oral or vaginal and 25 microgram or >25 microgram) and PgE2 (intracervical or vaginal). Relative risks (RR) and 95% confidence intervals (CI) were calculated using random effects models. Main results Fourteen of 611 articles identified met the criteria for systematic review, with three providing information for nulliparous women. There was no difference in the risk of caesarean delivery between misoprostol and PgE2 groups (RR = 0.99, 95% CI = 0.83-1.17). Any misoprostol was associated with higher risks of tachysystole and hyperstimulation compared with any PgE2 (RR = 1.86, 95% CI = 1.01-3.43 and RR = 3.71, 95% CI = 2.00-6.88, respectively). There was a higher rate of vaginal delivery within 24 hours among all vaginal deliveries with any misoprostol compared with any PgE2 (RR = 1.14, 95% CI = 1.00-1.31), and among all deliveries, a lower rate of oxytocin use (RR = 0.71, 95% CI = 0.60-0.85) but a trend towards increased meconium staining was observed (RR = 1.22, 95% CI = 0.96-1.55). The use of misoprostol at starting dosages >25 microgram had similar findings to the primary analysis. Studies of lower misoprostol dosing (starting dose of 25 microgram) did not show any differences in the outcomes of interest, but the sample size of this secondary analysis was small (304 women, 155 receiving misoprostol). AUTHOR'S CONCLUSIONS Although misoprostol in women at term with an unfavourable cervix and intact membranes was more effective than PgE2 in achieving vaginal delivery within 24 hours, misoprostol does not reduce the rate of caesarean delivery either in all women or in the subgroup of nulliparous women, and it increases the rates of tachysystole and hyperstimulation. Further studies of misoprostol using a starting dose of 25 microgram may be warranted.
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Affiliation(s)
- J M G Crane
- Department of Obstetrics and Gynecology, Eastern Health, Memorial University of Newfoundland, St John's, Newfoundland, Canada.
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Abstract
Because of the risk of failed induction of labor, a variety of maternal and fetal factors as well as screening tests have been suggested to predict labor induction success. Certain characteristics of the woman (including parity, age, weight, height and body mass index), and of the fetus (including birth weight and gestational age) are associated with the success of labor induction; with parous, young women who are taller and lower weight having a higher rate of induction success. Fetuses with a lower birth weight or increased gestational age are also associated with increased induction success. The condition of the cervix at the start of induction is an important predictor, with the modified Bishop score being a widely used scoring system. The most important element of the Bishop score is dilatation. Other predictors, including transvaginal ultrasound (TVUS) and biochemical markers [including fetal fibronectin (fFN)] have been suggested. Meta-analyses of studies identified from MEDLINE, PubMed, and EMBASE and published from 1990 to October 2005 were performed evaluating the use of TVUS and fFN in predicting labor induction success in women at term with singleton gestations. Both TVUS and Bishop score predicted successful induction [likelihood ratio (LR)=1.82, 95% confidence interval (CI)=1.51-2.20 and LR=2.10, 95%CI=1.67-2.64, respectively]. As well, fFN and Bishop score predicted successful induction (LR=1.49, 95%CI=1.20-1.85, and LR=2.62, 95%CI=1.88-3.64, respectively). Although TVUS and fFN predicted successful labor induction, neither has been shown to be superior to Bishop score. Further research is needed to evaluate these potential predictors and insulin-like growth factor binding protein-1 (IGFBP-1), another potential biochemical marker.
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Affiliation(s)
- Joan M G Crane
- Memorial University of Newfoundland, Eastern Health of St John's, St. John's, NL, Canada.
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Peregrine E, O'Brien P, Omar R, Jauniaux E. Clinical and Ultrasound Parameters to Predict the Risk of Cesarean Delivery After Induction of Labor. Obstet Gynecol 2006; 107:227-33. [PMID: 16449105 DOI: 10.1097/01.aog.0000196508.11431.c0] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate whether factors in the maternal history and/or ultrasound parameters are useful in predicting the risk of cesarean delivery after induction of labor. METHODS Maternal age, height, body mass index, parity, gestational age, Bishop score, ultrasonic amniotic fluid volume, fetal head position, estimated fetal weight, and transvaginal cervical length were studied prospectively in 267 women at 36 or more weeks of gestation immediately before induction of labor. Logistic regression analysis was used to determine which factors best predicted the risk of cesarean delivery. Receiver operating characteristic curves and a resampling technique were used to evaluate the model's performance. RESULTS Eighty (30%) of these 267 women had cesarean delivery. Logistic regression was performed and a final model chosen, which included parity (odds ratio [OR] 20.56, 95% confidence interval [CI] 7.97-53.05, P < .001), body mass index (OR 6.17, 95% CI 2.10-18.13, P < .001), height (OR 0.94, 95% CI 0.89-0.98, P = .005), and ultrasonic transvaginal cervical length (OR 1.07, 95% CI 1.04-1.11, P < .001) as the best predictors of cesarean delivery. A risk score was calculated containing these 4 parameters, which predicted reasonably accurately the risk of cesarean delivery. CONCLUSION Parity, body mass index, height, and ultrasonic transvaginal cervical length are the most accurate parameters in predicting the risk of cesarean delivery after induction of labor. A predictive model using these would allow more accurate counseling and better informed consent in the decision-making process regarding induction of labor LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Elisabeth Peregrine
- Department of Obstetrics and Gynaecology, University College London Hospitals, UK
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