1
|
Baradwan S, Al-Matary A, Alshahrani MS, Khadawardi K, Latifah A, ElHodiby ME, Samy M, Safwat S, Zaki A, Hussein M, Hegazy MA, Elsharkawy S, Abdelhakim AM, Abdelwahed RM, Nawara M, Elsenity MA. Effect of Vaginal Washing before Intravaginal Prostaglandin Insertion on Induction of Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Perinatol 2024; 41:988-997. [PMID: 36809774 DOI: 10.1055/s-0043-1763502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Saline vaginal douching prior to intravaginal prostaglandin application might increase the vaginal pH, leading to improvement of prostaglandin bioavailability, by which the outcomes of labor induction can be greatly improved. Thus, we aimed to evaluate the effect of vaginal washing with normal saline before insertion of vaginal prostaglandin for labor induction. STUDY DESIGN A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI Web of Science from inception to March 2022. We selected randomized controlled trials (RCTs) that compared vaginal washing using normal saline versus no vaginal washing in the control group before intravaginal prostaglandin insertion during labor induction. We used RevMan software for our meta-analysis. Our main outcomes were the duration of intravaginal prostaglandin application, duration from intravaginal prostaglandin insertion to active phase of labor, duration from intravaginal prostaglandin insertion till total cervical dilatation, labor induction failure rate, incidence of cesarean section (CS), and rates of neonatal intensive care unit (NICU) admission and fetal infection postdelivery. RESULTS Five RCTs were retrieved with a total number of 842 patients. Duration of prostaglandin application, duration from prostaglandin insertion to active phase of labor, and time interval from prostaglandin insertion to total cervical dilatation were significantly shorter among vaginal washing group (p < 0.05). Vaginal douching prior to prostaglandin insertion significantly decreased the incidence of failed labor induction (p < 0.001). After the removal of reported heterogeneity, vaginal washing was linked to a significant decline in CS incidence (p = 0.04). In addition, the rates of NICU admission and fetal infection were significantly lower in the vaginal washing group (p < 0.001). CONCLUSION Vaginal washing with normal saline before intravaginal prostaglandin insertion is a useful and easily applicable method for labor induction with good outcomes. KEY POINTS · Induction of labor is frequently used in the obstetrics field.. · We assessed vaginal washing impact before prostaglandin insertion for labor induction.. · Vaginal washing is an easily applicable method for labor induction with good outcomes..
Collapse
Affiliation(s)
- Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | - Majed Saeed Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | - Khalid Khadawardi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Mohamed E ElHodiby
- Department of Obstetrics and Gynecology, Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt
| | - Mohammed Samy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sarah Safwat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Zaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Hussein
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mahmoud A Hegazy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, New Damietta, Egypt
| | - Suzan Elsharkawy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Rania Mahfouz Abdelwahed
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Maii Nawara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed A Elsenity
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
2
|
Nien YC, Kung HF, Chen MJ, Chen WC. Dinoprostone tablet versus continuous vaginal insert (Propess®) for elective induction in low-risk nulliparous women at term. Taiwan J Obstet Gynecol 2023; 62:858-862. [PMID: 38008505 DOI: 10.1016/j.tjog.2023.03.016] [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] [Accepted: 03/21/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of dinoprostone tablet and continuous vaginal insert (Propess®) in low-risk nulliparous women at term with insufficient cervical ripening receiving elective induction. MATERIALS AND METHODS A retrospective study was conducted between March 2020 and February 2022 and included 230 women who underwent elective induction with dinoprostone tablet or vaginal insert. The primary endpoint was failure of induction. Secondary endpoints included time to vaginal delivery, vaginal delivery rate, as well as maternal and neonatal complications and adverse outcomes. RESULTS No statistically significant differences were found between the two groups regarding the main outcome measures; however, the high responders had a significant higher proportion of hyperstimulation and non-reassuring fetal status. The high responder in the Propess group was statistically significant younger (31.68 ± 4.73 vs. 33.82 ± 4.39, p = 0.027), while they had a significantly lower BMI at delivery time of the tablet group (24.49 ± 2.24 vs. 27.42 ± 4.32, p = 0.024). Factors associated with success of vaginal delivery within 24 h (p = 0.015, OR = 0.9, 95%CI = 0.82-0.98) and the Cesarean section (p < 0.001, OR = 1.17, 95%CI = 1.08-1.27) was BMI at delivery time. CONCLUSION Slow-release vaginal insert and dinoprostone tablet had similar efficacy and safety for elective induction in low risk nulliparous women at term. Women with younger maternal age or lower BMI at delivery time may have a better response to dinoprostone and had a significantly higher proportion of hyperstimulation and non-reassuring fetal status.
Collapse
Affiliation(s)
- Yu-Cheng Nien
- Department of Obstetrics, Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsiao-Fan Kung
- Department of Obstetrics, Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Ming-Jer Chen
- Department of Obstetrics, Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Chi Chen
- Department of Obstetrics, Gynecology & Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan
| |
Collapse
|
3
|
Berezowsky A, Zeevi G, Hadar E, Krispin E. Maternal and perinatal outcomes of failed prostaglandin induction of labour: A retrospective cohort study. Heliyon 2023; 9:e13055. [PMID: 36820163 PMCID: PMC9938492 DOI: 10.1016/j.heliyon.2023.e13055] [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: 10/18/2022] [Revised: 12/28/2022] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
Background Induction of labor is performed in up to 25% of pregnant women. When the cervix is unfavorable, cervical ripening may be safely and effectively performed using slow-release vaginal inserts of prostaglandin E2. However, the risk factors, management, and outcome of patients who fail to respond remain unclear. Objective To evaluate the outcomes of women who fail to respond to cervical ripening with prostaglandins. Methods A retrospective cohort analysis (2013-2019) was conducted. Women with a singleton gestation who underwent induction of labor due to post-date pregnancy using a slow-release prostaglandin E2 vaginal insert for cervical ripening were included. Data on clinical and outcome factors were derived from the medical files, and findings were compared between patients who achieved ripening within 24 h of treatment onset and those who did not. The primary outcome measure was the vaginal delivery rate following the ripening process. Secondary outcome measures were adverse composite maternal and neonatal outcomes. A model combining maternal characteristics and response rates to ripening was constructed. Results The final cohort included 1285 women: 1202 responded to cervical ripening (93.54%) and 83 (6.46%) did not. Compared to non-responders, responders had higher rates of vaginal delivery (96.51% vs. 66.27%, P < 0.001); lower rates of adverse maternal composite outcome (12.81% vs. 24.10%, P = 0.031) and adverse neonatal composite respiratory outcome (1.33% vs. 6.02%, P = 0.009). Responders were younger than non-responders (mean 30.03 years vs 31.73 years, P = 0.005) and had a lower nulliparity rate (50.99% vs 76.92%, P < 0.001). On multivariate analysis, failure to achieve cervical ripening was an independent risk factor for intrapartum cesarean delivery due to prolonged labor (aOR 11.90, 95% CI 6.13-23.25). Conclusion Women who achieve cervical ripening with prostaglandin E2 vaginal inserts are younger and more often multiparous than women who fail to respond. Good response to the cervical ripening process is associated with lower rates of intrapartum cesarean delivery and of adverse outcomes.
Collapse
Affiliation(s)
- Alexandra Berezowsky
- Helen Schneider Hospital for Women, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel,Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel,University of Toronto, Ontario, Canada,Corresponding author. Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Toronto, ON, Canada.
| | - Gil Zeevi
- Helen Schneider Hospital for Women, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel
| | - Eyal Krispin
- Helen Schneider Hospital for Women, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel
| |
Collapse
|
4
|
Prevalence and factors associated with failed induction of labor in Worabe Comprehensive Specialized Hospital, Southern Ethiopia. PLoS One 2022; 17:e0263371. [PMID: 35089970 PMCID: PMC8797230 DOI: 10.1371/journal.pone.0263371] [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: 02/25/2021] [Accepted: 01/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Induction of labor is one of the most used obstetric procedures in the world. It is performed in around 20% of all pregnancies. Failed induction of labor, on the other hand, has been associated with poorer mother and newborn health outcomes. Besides, there is a scarcity of data on the current burden and drivers. Therefore, this study aimed to assess the prevalence and factors associated with failed induction in Worabe Comprehensive Specialized Hospital, Southern Ethiopia. Methods A retrospective cross-sectional study was conducted on medical records of mothers who delivered through induction of labor during September 1st, 2018 to August 30th, 2020. The samples were collected using a systematic sampling technique. The data was extracted using a checklist. Data were entered into EpiData (version 3.1) and analyzed using SPSS (version 24). Multivariable logistic regression analyses were used to decide the association of explanatory variables with the outcome variable. Odds ratio with their 95% CI were calculated to identify the presence and strength of an association. A p-value of < 0.05 was used to declare statistical significance. Results In this study, the prevalence of failed induction was observed to be 22.2%. The associated factors included rural residence (AOR = 5.7, 95% CI: 3.12–11.02), primiparity (AOR = 8.4, 95% CI: 2.72–22.36) and unfavourable bishop score (AOR = 5.9, 95% CI: 4.52–16.12). Conclusions In comparison to the rate reported in developed countries, the study area had a high rate of failed induction. Being rural residence, primiparity and unfavourable bishop score were the associated factors of failed induction. Therefore, to reduce of the rate of failed induction, health care practitioners should analyze cervical status (using Bishop Score) to decide the possibility of successful induction, with a focus on associated factors like parity.
Collapse
|
5
|
Amikam U, Hiersch L, Barrett J, Melamed N. Labour induction in twin pregnancies. Best Pract Res Clin Obstet Gynaecol 2021; 79:55-69. [PMID: 34844886 DOI: 10.1016/j.bpobgyn.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 01/21/2023]
Abstract
Medically-indicated deliveries are common in twin pregnancies given the increased risk of various obstetric complications in twin compared to singleton pregnancies, mainly hypertensive disorders of pregnancy and foetal growth restriction. Due to the unique characteristics of twin pregnancies, the success rates and safety of labour induction may be different than in singleton pregnancies. However, while there are abundant data regarding induction of labour in singleton pregnancies, the efficacy and safety of labour induction in twin pregnancies have been far less studied. In the current manuscript we summarize available data on various aspects of labour induction in twin pregnancies including incidence, success rate, prognostic factors, safety and methods for labour induction in twins. This information may assist healthcare providers in counselling patients with twin pregnancies when labour induction is indicated.
Collapse
Affiliation(s)
- Uri Amikam
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Hiersch
- Department of Obstetrics and Gynecology, Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jon Barrett
- Departments of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
| |
Collapse
|
6
|
Ejigu AG, Lambyo SH. Predicting factors of failed induction of labor in three hospitals of Southwest Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:387. [PMID: 34011318 PMCID: PMC8132374 DOI: 10.1186/s12884-021-03862-x] [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: 02/09/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Failed induction of labor affects maternal and neonatal outcomes as well as the cost of healthcare, especially in low-resource setting regions in which the prevalence of failed induction is higher despite the incidence of labor induction is low. This study aimed to assess the prevalence of failed induction of labor in southwest Ethiopia. Method A hospital-based cross-sectional study was conducted among 441 induced women from March 1 to August 30, 2018. A systematic random sampling technique was used to select study participants. Data were collected using a pretested and structured questionnaire. Bivariable and multivariable logistic regression models were done and fitted to identify predictors of failed induction. An adjusted odds ratio with 95% confidence interval (CI) was calculated to determine the level of significance. Result Premature rupture of membrane was the most common cause of labor induction and the commonly used method of labor induction were oxytocin infusion. Cesarean section was done for 28.1% of induced women. Failed induction of labor was found to be 21%. Primiparous [AOR = 2.35 (1.35–4.09)], analgesia/anesthesia [AOR = 4.37 (1.31–14.59)], poor Bishop Score [AOR = 2.37 (1.16–4.84)], Birth weight ≥ 4 k grams [AOR = 2.12 (1.05–4.28)] and body mass index [AOR = 5.71 (3.26–10.01)] were found to be significantly associated with failed induction of labor. Conclusion The prevalence of failed induction of labour was found to be high. Preparation of the cervix before induction in primi-parity women is suggested to improve the success of induction. To achieve the normal weight of women and newborns, proper nutritional interventions should be given for women of reproductive age. It is better to use analgesia/anesthesia for labor induction when it becomes mandatory and there are no other optional methods of no- pharmacologic pain management. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03862-x.
Collapse
Affiliation(s)
- Amare Genetu Ejigu
- Department of Midwifery, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Teferi, Ethiopia.
| | - Shewangizaw H/Mariam Lambyo
- Department of Midwifery, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| |
Collapse
|
7
|
Gulersen M, DiSturco M, Krantz DA, Bornstein E. Comparison of two management options for labor induction following unsuccessful prostaglandin E2 ripening. J Matern Fetal Neonatal Med 2020; 35:1759-1763. [PMID: 32449419 DOI: 10.1080/14767058.2020.1769594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: We sought to compare the likelihood of a vaginal delivery (VD) using oxytocin, with and without a cervical ripening balloon, in nulliparous women who did not respond to initial ripening with prostaglandin E2 (PGE2).Methods: We a performed a retrospective cohort study of nulliparous women with a singleton pregnancy at term who underwent cervical ripening with vaginal PGE2 between October 2015 and March 2019. Patients who did not respond to PGE2 ripening (bishop score (BS) of 6 or less with cervical dilation less than 3 cm) were stratified into two groups based on management: sequential ripening with a cervical ripening balloon in addition to oxytocin versus oxytocin alone. Patients who had PGE2 for less than 6 h, a BS greater than 6 after ripening, rupture of membranes or missing data were excluded. The primary outcome was VD. Secondary outcomes included VD within 24 h of induction, time from induction to delivery, rates of chorioamnionitis and postpartum hemorrhage, presence of meconium, neonatal birthweight, NICU admission, 5 min apgar < 5, and umbilical cord pH < 7. Statistical analysis included Chi-squared, Fisher's exact and Mann-Whitney U tests, as well as logistic regression. Odds ratios (ORs) were calculated and adjusted for significant confounders using backwards-stepwise logistic regression. For time to delivery, a Cox proportional hazard regression was used to determine the hazard ratio (HR) and adjusted HR.Results: 840 patients underwent cervical ripening with PGE2 during the study period. After the exclusion criteria were applied, 272 cases comprised the study cohort. Of those, 123 (45%) continued labor induction with a cervical ripening balloon and oxytocin and 149 (55%) continued labor induction with oxytocin alone. Baseline characteristics such as age, BMI, ethnicity, gestational age at induction and number of women undergoing elective induction were similar between both groups. There was no statistically significant difference in the likelihood of VD (oxytocin and cervical ripening balloon: 62.6% vs. oxytocin alone: 50.3%; a OR 1.61, p = .07) or rate of secondary outcomes between the two groups. Patients in the oxytocin alone group had a higher BS after PGE2 ripening, although both were very low (3 vs. 2, p < .0001).". Additionally, there were significantly more patients undergoing full PGE2 ripening for 12 h in the cervical ripening balloon and oxytocin group compared to oxytocin alone (65.9% vs. 49.7%, p = .02).Conclusion: Our data did not show a difference in VD rate in nulliparous women unresponsive to PGE2 ripening who underwent continued induction with oxytocin and cervical ripening balloon compared to oxytocin alone. Larger studies investigating the utility of sequential ripening and determining the optimal induction method following unsuccessful ripening are needed.
Collapse
Affiliation(s)
- Moti Gulersen
- Department of Obstetrics and Gynecology, North Shore University Hospital - Northwell Health, Manhasset, NY, USA.,Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health, NY, NY, USA
| | - Mariella DiSturco
- Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health, NY, NY, USA
| | | | - Eran Bornstein
- Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health, NY, NY, USA
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Oğlak SC, Bademkıran MH, Obut M. Predictor variables in the success of slow-release dinoprostone used for cervical ripening in intrauterine growth restriction pregnancies. J Gynecol Obstet Hum Reprod 2020; 49:101739. [PMID: 32251738 DOI: 10.1016/j.jogoh.2020.101739] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/20/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aims to evaluate the consequences of a trigger by vaginal Dinoprotone on outcome of pregnancies with Intrauterine growth restriction (IUGR). MATERIALS AND METHODS This retrospective study included 161 induced IUGR fetuses (35-39 weeks). Consecutive patients who were evaluated formed the basis of the clinical outcomes. The penalized maximum likelihood estimation (PMLE) method was used instead of traditional logistic regression in order to reduce the risk of overfitting. RESULTS Of the 25,678 deliveries that occurred during the study period, 161 (0.6%) women underwent IUGR delivery; of these, 117 (73%) succeeded and 44 (27%) failed to achieve cervical ripening using the dinoprostone slow-release vaginal insert. Two predictors were associated with dinoprostone vaginal delivery success: Parity (OR:1.4([0.89-2.3]), and Bishop score (OR:1.54[1.23-1.94]). The PMLE model correctly classified 78% participants (c-index: 0.78). CONCLUSION Basic parameters such as parity and Bishop score can be used to predict successful vaginal birth following dinoprostone slow-release vaginal insert administration.
Collapse
Affiliation(s)
- Süleyman Cemil Oğlak
- Department of Obstetrics and Gynecology, University of Health Sciences, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
| | - Muhammed Hanifi Bademkıran
- Department of Obstetrics and Gynecology, University of Health Sciences, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Mehmet Obut
- Department of Obstetrics and Gynecology, University of Health Sciences, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| |
Collapse
|
10
|
Yayla Abide Ç, Kurek Eken M, Ozkaya E, Yenidede I, Bostanci Ergen E, Kilicci C, Sanverdi I, Eroğlu M. Effect of vaginal washing before intravaginal dinoprostone insertion for labor induction: A randomized clinical trial. J Obstet Gynaecol Res 2018; 44:2149-2155. [PMID: 30094885 DOI: 10.1111/jog.13777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/08/2018] [Indexed: 11/30/2022]
Abstract
AIM Prostaglandins have a dual action of cervical ripening and induction of uterine contraction. This study was designed to compare the effectiveness of vaginal washing just before insertion of intravaginal dinoprostone. METHODS A randomized controlled trial was conducted at the Zeynep Kamil Women and Children's Health Training and Research Hospital. One hundred and ninety-one women with singleton, term pregnancy who underwent labor induction were randomly assigned to two groups: Group 1 consisted of 95 pregnant women with vaginal washing before intravaginal dinoprostone (Propess system for slow release system of 10 mg of dinoprostone) insertion (study group), and 96 pregnant women constituted the control group who did not undergo vaginal washing before intravaginal dinoprostone insertion. A parallel randomized controlled trial was conducted with an allocation ratio of 1:1 to compare the effectiveness of vaginal washing before intravaginal dinoprostone insertion. RESULTS The groups had similar mean age, body mass index, gestational age, gravidity, parity and Bishop score before agent insertion (P > 0.05). Duration of dinoprostone kept intravaginally, duration from the beginning of dinoprostone insert vaginally to the active phase of labor and duration from the time of intravaginal dinoprostone insertion to delivery were significantly longer in the control group (P < 0.05). Uterine hyperstimulation rate was significantly higher in study group compared to control group (P < 0.05). Meconium passage, fetal infection and neonatal intensive care unit admission were significantly higher in the control group (P < 0.05). CONCLUSION Vaginal washing before intravaginal dinoprostone insertion may increase Prostaglandin E2 bioavailability as we found shorter duration and better outcome of labor induction in the present study.
Collapse
Affiliation(s)
- Çigdem Yayla Abide
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Children's Health Training & Research Hospital-İstanbul, Turkey
| | - Meryem Kurek Eken
- Department of Obstetrics and Gynecology, Adnan Menderes University Medical Faculty-Aydın, Turkey
| | - Enis Ozkaya
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Children's Health Training & Research Hospital-İstanbul, Turkey
| | - Ilter Yenidede
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Children's Health Training & Research Hospital-İstanbul, Turkey
| | - Evrim Bostanci Ergen
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Children's Health Training & Research Hospital-İstanbul, Turkey
| | - Cetin Kilicci
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Children's Health Training & Research Hospital-İstanbul, Turkey
| | - Ilhan Sanverdi
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Children's Health Training & Research Hospital-İstanbul, Turkey
| | - Mustafa Eroğlu
- Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Children's Health Training & Research Hospital-İstanbul, Turkey
| |
Collapse
|
11
|
Lajusticia H, Martínez-Domínguez SJ, Pérez-Roncero GR, Chedraui P, Pérez-López FR. Single versus double-balloon catheters for the induction of labor of singleton pregnancies: a meta-analysis of randomized and quasi-randomized controlled trials. Arch Gynecol Obstet 2018; 297:1089-1100. [PMID: 29445926 DOI: 10.1007/s00404-018-4713-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/05/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the efficacy of single- versus double-balloon catheter (SBC vs. DBC) for cervical ripening and labor induction with an unfavorable cervix. METHODS Systematic review and meta-analysis of randomized controlled trials (RCTs) or quasi-RCTs (qRCT) regarding the use of SBC or DBC for labor induction of live singleton cephalic pregnancies (≥ 35 weeks) of any parity with an unripe cervix (Bishop score ≤ 6). Nine research databases were searched for original articles published in all languages up to November 2017 comparing both devices for labor induction. Five RCTs and one qRCT were included. Primary outcome measures were time from intervention (device placement) to birth time, vaginal delivery and cesarean section rates, and maternal satisfaction with the procedure. Risk of bias was evaluated with the Cochrane tool. Random effects models were used to combine data for meta-analyses. Summary measures were reported as mean differences and risk ratios (RR) with 95% confidence intervals. RESULTS Regardless of parity, pooled analyses of the six trials (n = 1060 women) found that mean intervention to birth time, vaginal delivery and cesarean section rates, and maternal satisfaction to the procedure were similar for both studied groups (SBC vs. DBC). CONCLUSION Measured primary outcome measures were similar regardless of the type of device used for labor induction of singleton pregnancies.
Collapse
Affiliation(s)
- Héctor Lajusticia
- Red de Investigación en Ginecología, Obstetricia y Reproducción, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Samuel J Martínez-Domínguez
- Red de Investigación en Ginecología, Obstetricia y Reproducción, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Gonzalo R Pérez-Roncero
- Red de Investigación en Ginecología, Obstetricia y Reproducción, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Peter Chedraui
- Institute of Biomedicine, Research Area for Women's Health, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.,Facultad de Ciencias de la Salud, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
| | - Faustino R Pérez-López
- Red de Investigación en Ginecología, Obstetricia y Reproducción, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain. .,Departamento de Obstetricia y Ginecología, Faculty of Medicine, Hospital Lozano-Blesa, University of Zaragoza, Domingo Miral s/n, 50009, Zaragoza, Spain.
| | | |
Collapse
|
12
|
Zhao L, Lin Y, Jiang TT, Wang L, Li M, Wang Y, Sun GQ, Xiao M. Vaginal delivery among women who underwent labor induction with vaginal dinoprostone (PGE2) insert: a retrospective study of 1656 women in China. J Matern Fetal Neonatal Med 2017; 32:1721-1727. [PMID: 29268652 DOI: 10.1080/14767058.2017.1416351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lei Zhao
- Department of Obstetric, Hubei Maternal and Child Health Hospital, Hongshan District, Wuhan, China
| | - Ying Lin
- Department of Obstetric, Hubei Maternal and Child Health Hospital, Hongshan District, Wuhan, China
| | - Ting-ting Jiang
- Department of Obstetric, Hubei Maternal and Child Health Hospital, Hongshan District, Wuhan, China
| | - Ling Wang
- Department of Obstetric, Hubei Maternal and Child Health Hospital, Hongshan District, Wuhan, China
| | - Min Li
- Department of Obstetric, Hubei Maternal and Child Health Hospital, Hongshan District, Wuhan, China
| | - Ying Wang
- Department of Obstetric, Hubei Maternal and Child Health Hospital, Hongshan District, Wuhan, China
| | - Guo-qiang Sun
- Department of Obstetric, Hubei Maternal and Child Health Hospital, Hongshan District, Wuhan, China
| | - Mei Xiao
- Department of Obstetric, Hubei Maternal and Child Health Hospital, Hongshan District, Wuhan, China
| |
Collapse
|
13
|
Vannuccini S, Torricelli M, Bocchi C, Severi FM, Di Tommaso M, Petraglia F. Fetal middle cerebral artery Doppler in late-term pregnancy: a predicting factor for failed induction of labor. J Matern Fetal Neonatal Med 2017; 31:2756-2762. [DOI: 10.1080/14767058.2017.1355900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Silvia Vannuccini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Michela Torricelli
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Caterina Bocchi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Filiberto M. Severi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | | | - Felice Petraglia
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Careggi University Hospital, University of Florence, Florence, Italy
| |
Collapse
|
14
|
Double-balloon catheter for induction of labour in women with a previous cesarean section, could it be the best choice? Arch Gynecol Obstet 2017; 295:1135-1143. [PMID: 28315935 PMCID: PMC5388719 DOI: 10.1007/s00404-017-4343-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/07/2017] [Indexed: 11/06/2022]
Abstract
Introduction We analysed the efficacy and safety of double-balloon catheter for cervical ripening in women with a previous cesarean section and which were the most important variables associated with an increased risk of repeated cesarean delivery. Materials and methods We designed an observational retrospective study of 418 women with unfavourable cervices (Bishop Score <5), a prior cesarean delivery, and induction of labour with a double-balloon catheter. Baseline maternal data and perinatal outcomes were recorded for a descriptive, bivariate, and multivariate analysis. A p value <0.05 was considered statistically significant. Results Most women improved their initial Bishop Score (89.5%) although only a 20.8% of them went into spontaneous active labour. Finally, 51.4% of the women achieved a vaginal delivery. Five cases of intrapartum uterine rupture (1.2%) occurred. After multivariate analysis, main risk factors for repeated cesarean section were dystocia in the previous pregnancy (OR 1.744; CI 95% 1.066–2.846), the absence of previous vaginal delivery (OR 2.590; CI 95% 1.066–6.290), suspected fetal macrosomia (OR 2.410; CI 95% 0.959–6.054), and duration of oxytocin induction period (OR 1.005; CI 95% 1.004–1.006). The area under the curve was 0.789 (p < 0.001). Conclusions Double-balloon catheter seems to be safe and effective for cervical ripening in women with a previous cesarean delivery and unfavourable cervix. In our study, most women could have a vaginal delivery in spite of their risk factors for cesarean delivery. A multivariate model based on some clinical variables has moderate predictive value for intrapartum cesarean section.
Collapse
|
15
|
Hiersch L, Borovich A, Gabbay-Benziv R, Maimon-Cohen M, Aviram A, Yogev Y, Ashwal E. Can we predict successful cervical ripening with prostaglandin E2 vaginal inserts? Arch Gynecol Obstet 2016; 295:343-349. [DOI: 10.1007/s00404-016-4260-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
|
16
|
Hiersch L, Krispin E, Aviram A, Mor-Shacham M, Gabbay-Benziv R, Yogev Y, Ashwal E. Predictors for prolonged interval from premature rupture of membranes to spontaneous onset of labor at term. J Matern Fetal Neonatal Med 2016; 30:1465-1470. [DOI: 10.1080/14767058.2016.1219992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
17
|
Mizrachi Y, Levy M, Weiner E, Bar J, Barda G, Kovo M. Pregnancy outcomes after failed cervical ripening with prostaglandin E2 followed by Foley balloon catheter. J Matern Fetal Neonatal Med 2015; 29:3229-33. [DOI: 10.3109/14767058.2015.1121477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yossi Mizrachi
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Michal Levy
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Eran Weiner
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Jacob Bar
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Giulia Barda
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| | - Michal Kovo
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
| |
Collapse
|
18
|
Abstract
Obese women are at an increased risk of antepartum pregnancy complications and are therefore more likely to require an induction of labor than normal weight women. They also have an increased rate of failing an induction of labor, a rate that rises significantly with increasing body mass index, and subsequent surgical and neonatal complications of an intrapartum cesarean delivery. This increase in induction failure may be due to differences in the myometrium of obese women resulting in decreased contraction strength. There have been only a few studies comparing the efficacy of the various cervical ripening agents in obese women and at this point no recommendation can be made as to what method may result in the greatest chance of a successful induction.
Collapse
Affiliation(s)
- Kelly Ruhstaller
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104.
| |
Collapse
|
19
|
Abstract
Induction of labor will affect almost a quarter of all pregnancies, but historically there has been no generally accepted definition of failed induction of labor. Only recently have studies analyzed the lengths of latent labor that are associated with successful labor induction ending in a vaginal delivery, and recommendations for uniformity in the diagnosis of failed induction have largely resulted from this data. This review assesses the most recent and inclusive definition for failed induction, risk factors associated with failure, complications, and special populations that may be at risk for a failed induction.
Collapse
Affiliation(s)
- Corina Schoen
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical School at Thomas Jefferson University, 833 Chestnut St, 1st floor, Philadelphia, PA 19107; Department of Obstetrics and Gynecology, Christiana Care Hospital, Newark, DE.
| | - Reshama Navathe
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical School at Thomas Jefferson University, 833 Chestnut St, 1st floor, Philadelphia, PA 19107; Department of Obstetrics and Gynecology, Christiana Care Hospital, Newark, DE
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|