Preterm induction of labor: predictors of vaginal delivery and labor curves (original) (raw)
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BMC pregnancy and childbirth, 2016
Preterm birth is a major cause of neonatal mortality and morbidity. As preventive strategies are largely ineffective, threatened preterm labor is a frequent problem that affects approximately 10 % of pregnancies. In recent years, risk assessment in these women has incorporated cervical length measurement and fetal fibronectin testing, and this has improved the capacity to identify women at increased risk for delivery within 14 days. Despite these improvements, risk for preterm birth continues to be increased in women who did not deliver after an episode of threatened preterm labor, as indicated by a preterm birth rate between 30 to 60 % in this group of women. Currently no effective treatment is available. Studies on maintenance tocolysis and progesterone have shown ambiguous results. The pessary has not been evaluated in women with threatened preterm labor, however studies in asymptomatic women with a short cervix show reduced rates of preterm birth rates as well as perinatal compl...
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2005
Objective: To compare the obstetric outcome of induction of labor at 41 weeks and of follow-up until 42 weeks and induction if the patient has still not given birth at 42 weeks. Study design: Six hundred women at 287 AE 1 days of gestation with definitely unfavorable cervical scores were randomized to labor induction (N = 300) or spontaneous follow-up (N = 300) with twice-weekly nonstress testing and amniotic fluid measurement and onceweekly biophysical scoring. The treatments used in the induction group were (1) vaginal administration of 50 mg misoprostol (n = 100), (2) oxytocin induction (n = 100), and (3) transcervical insertion of a Foley balloon (n = 100). The primary outcome measures were the cesarean delivery rate, whether or not the normal hospital stay had to be extended, and the neonatal outcomes. Secondary outcome measure included number of emergency cesarean deliveries performed for abnormalities of the fetal heart rate (FHR). Results: The abdominal delivery rate was 19.3% in the induction group and 22% in the follow-up group (p = 0.4). The mean length of hospital stay in the two main groups was 1.4 AE 0.8 days and 1.3 AE 1 days, respectively (p = 0.1). Significantly higher rates of macrosomia and shoulder dystocia were seen in the follow-up group (24.6 and 2.3%) than in the induction group (7.6%, p < 0.001; 0.3%, p = 0.03). Meconium-stained amniotic fluid and meconium aspiration syndrome were observed significantly less frequently in the induction group (9.3 and 1.3%) than in the follow-up group (20.3%, p < 0.001; 4%, p = 0.03). Rates of emergency abdominal delivery in response to worrying FHR traces, neonatal intensive care unit admission, and low umblical artery pH were similar in the two groups. There was one intrauterine fetal death in the follow-up group. Conclusion: Induction of labor at 41 weeks of gestation does not increase the cesarean delivery rate or cause a longer stay in hospital than follow-up until 42 weeks, and neonatal morbidity is also lower after induction.
BMC Pregnancy and Childbirth, 2021
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/ m 2 in multiparous women who had vaginal delivery vs. 32.36 ± 0.73 kg/m 2 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.
A study of vaginal birth with previous caesarean pregnancies
Innovative Publication, 2017
Objective: To study and analyse the vaginal birth with previous caesarean section and its out come Methods: A study of 100 cases of post caesarean pregnancies with induction of labour carried out. Trial is given with one previous lower segment caesarean section with no obstetric contraindication and scoring system to predict the success in trail of labour with the inclusion criteria including singleton pregnancy presenting with vertex, with adequate pelvis without any antenatal complications. The exclusion criteria included classical or unknown uterine scar type, past history of uterine rupture, past history of corporeal surgery, severe myopia complicated by retinal detachment, incompatible with safe vaginal delivery and multiple pregnancy. Results: In our study we found that out of 100 cases, 61% had viganial delivery and 39% underwent caesarean section. Out of 61 cases delivered vaginally, 45 cases had FTND with episiotomy, 07 FTND without episiotomy, 04 FTND with first degree perianal tear, 11 cases were by outlet forceps with episiotomy and 5 cases were delivered by low forceps. Conclusion: conclude that predicting the score for VBAC and giving trial of labour helps in decreasing the number of repeat caesarean sections in selected cases where there is no contraindication for vaginal delivery. The high probability of success and minimum risk of uterine rupture, favours the use of trial for vaginal delivery in women with previous caesarean section.
Relationship between cervical dilation and time to delivery in women with preterm labor
Journal of Research in Medical Sciences, 2015
Although over the years, many studies investigated the mechanisms involved in the cascade of preterm delivery and the methods for the prevention and early diagnosis of PTL, few studies have been performed on cervical dilation. [5-9] How et al. [5] found that dilatation of the cervix in women with threatened PTL was inversely associated with time from admission to delivery. In another study, the same inverse relation was shown for women with PTL treated with tocolytic agents. [6] Early recognition of the signs and symptoms of PTL is important in order to establish a tocolytic therapy and to allow antenatal steroids. Dilatation of the cervix is one of the parameters to be evaluated for the diagnosis of threatened PTL, and it may have an important role in the risk stratification of women presenting with PTL. On the basis of these considerations, the aim of this study was to evaluate the relation between dilatation of the cervix and time between threatened PTL and subsequent preterm delivery. Background: Early recognition of the signs and symptoms of preterm labor (PTL) is important in order to establish treatment. Our aim was to determine the relation between cervical dilatation and time interval from admission to delivery in women with preterm labor. Materials and Methods: A retrospective cohort study was conducted on 83 singleton gestations admitted for preterm labor between 24 weeks and 34 weeks, who subsequently delivered preterm. Women were categorized into three groups of cervical dilatation (0-2 cm, 3-6 cm, >6 cm) and the time interval from admission to delivery was compared. Cox regression analysis was performed to assess the association between cervical dilatation and time interval from admission to delivery. The other variables examined were gestational age (GA) at admission and length of the cervix, when performed. Results: The time interval from admission to delivery was significantly shorter in women with higher dilatation of the cervix (p < 0.02) and in those admitted at a more advanced gestational age (p < 0.05). Forty-eight percent of women with cervical dilatation 0-2 cm delivered in the first 48 h compared to 85% of the women with a dilatation of 3-6 cm. No significant association was found between the length of the cervix and the time interval to delivery. Conclusion: Dilatation of the cervix and gestational age at admission are associated with the time interval to delivery in women with preterm labor. The assessment of the length of the cervix is unlikely to add clinical information in women with an already dilated cervix.
Bjog: An International Journal Of Obstetrics And Gynaecology, 2016
Objective To evaluate caesarean section and adverse neonatal outcome rates after induction of labour or expectant management in women with an unripe cervix at or near term. Design Secondary analysis of data from two randomised clinical trials. Setting Data were collected in two nationwide Dutch trials. Population Women with hypertensive disease (HYPITAT trial) or suspected fetal growth restriction (DIGITAT trial) and a Bishop score ≤6. Methods Comparison of outcomes after induction of labour and expectant management. Main outcome measures Rates of caesarean section and adverse neonatal outcome, defined as 5-minute Apgar score ≤6 and/or arterial umbilical cord pH <7.05 and/or neonatal intensive care unit admission and/or seizures and/or perinatal death. Results Of 1172 included women with an unripe cervix, 572 had induction of labour and 600 had expectant management. We found no significant difference in the overall caesarean rate (difference À1.1%, 95% CI À5.4 to 3.2). Induction of labour did not increase caesarean rates in women with Bishop scores from 3 to 6 (difference À2.7%, 95% CI À7.6 to 2.2) or adverse neonatal outcome rates (difference À1.5%, 95% CI À4.3 to 1.3). However, there was a significant difference in the rates of arterial umbilical cord pH <7.05 favouring induction (difference À3.2%, 95% CI À5.6 to À0.9). The number needed to treat to prevent one case of umbilical arterial pH <7.05 was 32. Conclusions We found no evidence that induction of labour increases the caesarean rate or compromises neonatal outcome as compared with expectant management. Concerns over increased risk of failed induction in women with a Bishop score from 3 to 6 seem unwarranted.
Midwifery
Objective: Knowledge about labour characteristics of women achieving successful vaginal birth after caesarean section (VBAC) might be used to improve labour and birth management. This study examined sociodemographic and labour process-related factors regarding a) differences between countries, b) the comparison of successful VBAC with unplanned caesarean section, and c) predictors for the success of planned VBAC in three European countries. Design: We analysed observational data collected within the OptiBIRTH trial, a clusterrandomised controlled trial. Setting: Fifteen study sites in Ireland, Italy and Germany, five in each country. Participants: 790 participants going into labour for planned VBAC. Measurements: Descriptive statistics and random-effects logistic regression models were applied. Findings: The pooled successful VBAC-rate was 74.6%. Italy had the highest proportion of women receiving none of the four intrapartum interventions amniotomy (ARM), oxytocin, epidural or opioids (42.5% vs Ireland: 26.8% and Germany: 25.3%, p<0.001). Earlier performance of ARM was associated with successful VBAC (3.50 hrs vs 6.08 hrs, p=0.004). A positive predictor for successful vaginal birth was a previous vaginal birth (OR=3.73, 95% CI [2.17, 6.44], p<0.001). The effect of ARM increased with longer labour duration (OR for interaction term=1.06, 95% CI [1.004, 1.12], p=0.035). Higher infant birthweight (OR per kg=0.34, 95% CI [0.23, 0.50], p<0.001), ARM (reference spontaneous rupture of membranes (SROM), OR=0.20, 95% CI [0.11, 0.37], p<0.001) and a longer labour duration (OR per hour=0.93, 95% CI [0.90, 0.97], p<0.001) decreased the odds of a vaginal birth. Key conclusion: Women with a previous vaginal birth, an infant with a lower birth weight, SROM and a shorter labour duration were most likely to have a successful vaginal birth. If SROM did not occur, an earlier ARM increased the odds of a vaginal birth. Implication for practice: Labour progress should be accelerated by fostering endogenous uterine contractions. With slow labour progress and intact membranes, ARM might increase the chance of a vaginal birth.
Journal of Clinical Obstetrics & Gynecology, 2020
This guideline is prepared as a consensus report of the Preterm Labor and Delivery Workshop of PUDER, in Bolu, on 22 February 2020. The authors are listed according to the alphabetic order of surnames. ABS TRACT Preterm delivery (PTD) occurs between 20 0/7-36 6/7 weeks of pregnancy and is a major cause of perinatal mortality and morbidity. The prevalence is around 12% in Turkey, ranging between 10 to 15% in different centers. Indicated preterm deliveries due to maternal or fetal reasons constitute approximately 20-30% of the total. The rest occur as a result of spontaneous preterm labor (PTL) or preterm prelabor rupture of the membranes (PPROM), about half and half. Although etiology of spontaneous preterm birth has not been fully elucidated, several risk factors are defined. History of PTD and short cervix are two most important risk factors, particularly in singleton pregnancies. If the cervical length is measured to be <25 mm via transvaginal ultrasonography before the 32 nd gestational week, it is defined as short cervix. In women with prior PTD, progesterone preparations are recommended between 16 th-36 th gestational weeks and cervical length is monitorized; additional preventive measures may be required if short cervix is diagnosed. In women without prior PTD, we universally offer transvaginal ultrasonographic cervical length measurement at the time of midtrimester fetal anomaly scan. When short cervix is determined in such cases, cervical cerclage, vaginal progesterone, cervical pessary, alone or in combination, may be recommended depending on the measurement and the gestational age. Asymptomatically dilated cervix, PTL, and PPROM are generally managed according to the gestational age on a case-by-case basis. Data are limited in twin and higher order multiple pregnancies to recommend standart prevention and management protocols.
American Journal of Perinatology Reports, 2015
Objective The aim of this study was to assess which characteristics and results of vaginal examination are predictive for delivery within 7 days, in women with threatened preterm labor after initial treatment. Study Design A secondary analysis of a randomized controlled trial on maintenance nifedipine includes women who remained undelivered after threatened preterm labor for 48 hours. We developed one model for women with premature prelabor rupture of membranes (PPROM) and one without PPROM. The predictors were identified by backward selection. We assessed calibration and discrimination and used bootstrapping techniques to correct for potential overfitting. Results For women with PPROM (model 1), nulliparity, history of preterm birth, and vaginal bleeding were included in the multivariable analysis. For women without PPROM (model 2), maternal age, vaginal bleeding, cervical length, and fetal fibronectin (fFN) status were in the multivariable analysis. Discriminative capability was moderate to good (c-statistic 0.68; 95% confidence interval [CI] 0.60-0.77 for model 1 and 0.89; 95% CI, 0.84-0.93 for model 2). Conclusion PPROM and vaginal bleeding in the current pregnancy are relevant predictive factors in all women, as are maternal age, cervical length, and fFN in women without PPROM and nulliparity, history of preterm birth in women with PPROM.