Study of Effectiveness of Medical Method for Induction of Labor and its Outcome

Background: Modern obstetrics has a tremendous issue in inducing full-term labor in women with a viable fetus. When the hazards of prolonging pregnancy outweigh the advantages of birth, induction is undertaken. This study’s objective was to evaluate the efficacy of misoprostol 50µg administered sublingually, orally and vaginally in the process of inducing labor.Material & Methods:Between June 2021 and July 2022, 120 pregnant women admitted in Department of Gynecology and Obstetrics, ShaheedZiaur Rahman Medical College and Hospital, Bogura in Bangladesh were recruited randomly for a randomized control trial as per inclusion criteria. Misoprostol was administered either orally or sublingually to each patient. A maximum of three doses might be administered if necessary. A previous cesarean birth was an exclusion criterion. The number of women who had a vaginal birth during 24 hours of induction was our major metric for success. SPSS 26 was used to analyze the data.Results:The induction to delivery intervals were considerably shorter in the sublingual group (18 hours versus 25.5 hours; mean difference was 6.2 hours; 95 percent confidence interval, 1.5 to 14.6). In the sublingual group, there was just 2% occurrence of uterine hyperstimulation. The two groups did not vary significantly in terms of delivery method, fetal distress, or newborn outcomes. A total of 80% percent and 82.60 percent of patients were satisfied with the oral and sublingual groups, respectively, and only 10% percent believed the sublingual tablets didn’t entirely dissolve.Conclusion:Sublingual misoprostol seems to be a successful method of delivery, although further clinical studies are needed to demonstrate the safety and effectiveness of the sublingual mode.

Resultados de la preinducción con Misofar en el Hospital Carlos Manuel de Céspedes. Enero - diciembre 2018 / Results of pre-induction with Misofar at the Carlos Manuel de Céspedes Hospital. January - December 2018 / Resultados da pré-indução com Misofar no Hospital Carlos Manuel de Céspedes. Janeiro - dezembro de 2018

RESUMEN Introducción: en la obstetricia moderna se establece la necesidad de aumentar las alternativas para vencer la constante de resistencia del cuello del útero a la actividad uterina durante todo el periodo gestacional. La preinducción con misofar fue introducido en la práctica clínica entre los procedimientos de aceleración en la madurez del cuello uterino. Objetivo: identificar los resultados perinatales con el uso del misofar en la preinducción del parto durante un año en el Hospital Carlos Manuel de Céspedes. Métodos: se realizó un estudio observacional descriptivo transversal con 732 en el Hospital Universitario "Carlos Manuel de Céspedes" de Bayamo, provincia Granma en el año 2018 a las que se le aplicaron de una a tres dosis de misofar como tratamiento facilitador para la preinducción del parto. Resultados: el índice de cesáreas en este grupo de pacientes fue de alrededor del 13%. Más del 50% de pacientes tuvieron parto Eutócico con la 1ª dosis. Se reportaron solo un 0.8% complicaciones relacionadas con hiperestimulación del útero, que resolvieron con medidas generales sin causar morbilidad en la madre ni el feto. Conclusiones: la administración de una dosis de 25 µg diaria por 3 días, es efectiva para lograr la remodelación cervical y pasar a la fase activa y alcanzando un test cervical igual o mayor de 7, considerado un criterio de éxito.

ABSTRACT Introduction: in modern obstetrics, the need to increase the alternatives to overcome the constant resistance of the cervix to uterine activity is established throughout the gestational period. Preinduction with misofar was introduced in clinical practice among acceleration procedures in the maturity of the cervix. Objective: to identify the perinatal results with the use of misofar in the pre-induction of labor for one year at the Carlos Manuel de Céspedes Hospital. Methods: a cross-sectional descriptive observational study was carried out with 732 at the "Carlos Manuel de Céspedes" University Hospital of Bayamo, Granma province in 2018, to which one to three doses of misofar were applied as a facilitating treatment for the preinduction of the Birth. Results: the cesarean section rate in this group of patients was around 13%. More than 50% of patients had Eutocic delivery with the 1st dose. Only 0.8% complications related to hyperstimulation of the uterus were reported, which resolved with general measures without causing morbidity in the mother or the fetus. Conclusions: the administration of a dose of 25 µg daily for 3 days is effective to achieve cervical remodeling and move to the active phase and reaching a cervical test equal to or greater than 7, considered a criterion of success.

RESUMO Introdução: na obstetrícia moderna, a necessidade de aumentar as alternativa para superar a resistência constante do colo do útero à atividade uterina se estabelece ao longo do período gestacional. A pré-indução com misofar foi introduzida na prática clínica entre os procedimentos de aceleração na maturidade do colo do útero. Objetivo: identificar os resultados perinatais com o uso de misofar na pré-indução do parto durante um ano no Hospital Carlos Manuel de Céspedes. Métodos: foi realizado um estudo transversal observacional descritivo com 732 pessoas no Hospital Universitário "Carlos Manuel de Céspedes" de Bayamo, província de Granma em 2018, ao qual foram aplicadas de uma a três doses de misofar como tratamento facilitador da pré-indução do Nascimento. Resultados: a taxa de cesárea neste grupo de pacientes foi em torno de 13%. Mais de 50% dos pacientes tiveram parto eutócico com a 1ª dose. Foram relatadas apenas 0,8% de complicações relacionadas à hiperestimulação do útero, que se resolveram com medidas gerais sem causar morbidade na mãe ou no feto. Conclusões: a administração de uma dose de 25 µg ao dia por 3 dias é eficaz para conseguir a remodelação cervical e passar para a fase ativa chegando a um teste cervical igual ou superior a 7, considerado critério de sucesso.

Efficacy and safety of prostaglandins vs double balloon catheter in inducing labor: a meta-analysis

Background: To compare the efficacy and safety of double‐balloon catheter with prostaglandin E2 (PGE2) in induction of labor.Methods: We searched electronic sources from Medline, Scopus, PubMed, Science Direct and Cochrane Library Database of Systematic Reviews. Only randomized controlled trials and observational studies comparing the PGE2 agents with double-balloon catheter for cervical ripening and labour induction in women with unfavorable cervix were included in the analysis. The main outcomes included vaginal delivery rate within 24 hours and cesarean delivery rates. We calculated relative risks and mean differences using fixed effects and random‐effects models.Results: Prostaglandin was more favourable for vaginal delivery within 24 hours compared to double balloon catheter, but was not statistically significant (RR 1.17: 95% CI 0.96-1.42 p =0.12). The induction to delivery time yielded a non-significant result that again favors prostaglandin (SMD 0.02 CI:0.18,0.22, p = 0.86). There was no significant difference in the cesarean delivery rates between the two groups (RR 1.02: 95% CI 0.92-1.14, p = 0.68). Uterine hyperstimulation and Neonatal Intensive Care Unit (NICU) admissions were significantly higher with prostaglandin. (RR 0.09: CI 0.04, 0.22 p<0.00001 and RR 0.75 CI: 0.62,0.90 p=003).Conclusions: There is no significant difference in the success of induction of labour between use of PGE2 and double balloon catheter. Uterine hyperstimulation and NICU admissions were significantly higher in Prostaglandin group.

Comparison of the efficacy, safety, acceptability and fetomaternal outcomes of combination of mifepristone and foley’s catheter with foley’s catheter alone in induction of labour in term pregnancies with previous lower segment caesarean section

Background: Objective of the study was to compare the efficacy, safety, acceptability, fetomaternal outcomes of combination of mifepristone and Foley’s catheter with Foley’s catheter alone in induction of labor in term pregnancies with previous Lower segment caesarean section (LSCS).Methods: This was a prospective study of 36 women induced with mifepristone and foley’s catheter and 36 women induced with foley’s catheter alone at 37 weeks to 41+6 weeks with previous LSCS.Results: Mean bishop score on admission in combined group (2.44) was comparable with that of foley’s alone group (2.91, p=0.888). Mean Bishop score (BS) after foley’s expulsion in group A and group B was 7.46 and 6.33 respectively, which was statistically significant (p<0.001). In group A 69.5% of women delivered vaginally compared to 52.2% in group B which was comparable (p=0.230). Mean induction to delivery interval was significantly short in combination group (15.5±1.3 hours versus 20.8±1.07 hours, p=0.003). 50% women in group A required oxytocin for induction/ augmentation of labour as compared to 77.8% in group B (p=0.02). Failed induction was statistically higher in group B (p<0.05). No difference was found with regards scar dehiscence, scar rupture, Postpartum hemorrhage (PPH), wound infection, puerperal pyrexia, Meconium stained liquor (MSL), fetal distress, mean birth weight, 1 and 5 minutes Appearance, pulse, grimace, activity, and respiration (APGAR) score, neonatal outcome, hospital stay.Conclusions: Priming with mifepristone before insertion of foley’s catheter results in significant change in BS signifying that combination promotes early cervical ripening as compared to foley’s catheter alone. Mifepristone plays significant role in cervical ripening, reduces induction to delivery interval, oxytocin requirement and failed induction.

A comparative study of vaginal misoprostol, dinoprostone gel, foley catheter, extra amniotic saline infusion along with vaginal misoprostol for induction of labor at term

Background: Objective of this study was to study the effect of vaginal misoprostol, dinoprostone gel, foley catheter, extra amniotic saline infusion along with vaginal misoprostol for induction of labor at term on maternal and fetal outcome.Methods: A one-year prospective observational study was conducted in the department of obstetrics and gynecology, SDM College of Medical Science and Hospital, Dharwad. Totally 100 postdated primigravida women with singleton gestation, vertex presentation and intact membrane who were induced with any four methods of induction 1) Tab. misoprostol 25 µg vaginally, 2) Intracervical dinoprostone gel, 3) Foley catheter and 4) Extra amniotic saline infusion along with tab. misoprostol 25 µg vaginally with 25 patients selected in each group, by random allocation technique and included in the study. Outcome measures analysed were the demographic profile, bishop score, induction to delivery interval, mode of delivery, maternal and fetal complications. Statistical analysis was done using SPSS 17 software.Results: Mean induction delivery interval was significant between PGE1 versus foley group (p=0.0034). In this study, 60% patients in dinoprostone group had Vaginal delivery and 72% in the EASI + misoprostol group underwent cesarean section (p=0.0372). NICU admission was maximum with EASI + vaginal misoprostol group and minimum with vaginal misoprostol alone.Conclusions: The groups were comparable with respect to maternal age, bishop score and fetal weight. The vaginal misoprostol group had shortest induction delivery interval. The maximum number of patients in dinoprostone gel group underwent vaginal delivery with a highest cesarean section and NICU admission with the EASI + misoprostol group.

Incidence of cesarean delivery after induction of labor with intravenous oxytocin drip among women undergoing induction of labor at Dessie referral hospital, Northeast Ethiopia, 2017

Background:The number of delivering women undergoing an induction of labor is greater than 20% and continues to rise. Simultaneously, the cesarean delivery rate continues to increase as well. This increase has resulted from evidence-based recommendations on how to handle certain conditions. Labor induction has been associated with increased likelihood of cesarean birth for some groups of women.Methods:Institutional based retrospective cross sectional study was conducted on 319 women medical chard who undergone induction of labor with oxytocin infusion at Dessie referral hospital. Systematic sampling techniques was used to select the samples. The data was cleaned, edited, coded, and entered in to EPI INFO version 3.5 and exported and analyzed by SPSS with windows version 20.0.Results:A total of 319 delivery records were reviewed. Out of this 256 (80.3%) was successful induction of labor. Incidence of cesarean section after induction of labor with oxytocin infusion among women at Dessie referral hospital was 136 (42.6%). The most frequent cause of induction of labor was due to hypertensive disorder 133 (41.7%) followed by pre labor rupture of membrane 111 (34.8%). Cesarean section was done due to failed induction of labor 63 (19.7%) followed by fetal distress 40 (12.5%).Conclusions:In present study incidence of cesarean delivery after induction of labor was 42.6%. Most frequent cause of induction of labor was due to hypertensive disorder followed by pre-labor rupture of membrane. Cesarean section was done due to failed induction of labor followed by fetal distress.

A prospective randomized comparative study of the efficacy of sustained release vaginal insert versus intracervical gel in primigravidae at term pregnancy

vBackground: Induction of labour is the intentional initiation of labour before spontaneous onset for the purpose of delivery of fetoplacental unit. Failure of induction is responsible for increased incidence of caesarean delivery. This study performed to assess and compare the clinical effects of sustained release vaginal insert versus intracervical gel in primiparous women with term pregnancy in terms of improvement of Bishop’s score, Induction delivery interval, incidence of hyperstimulation, maternal and neonatal outcomes.Methods: A total 100 consecutive term pregnant women who underwent labor induction for fetal or maternal indications were divided randomly into two groups. Group A - sustained release Vaginal insert and Group B - Intracervical gel. Informed consent was taken from each patient.Results: Statistically significant increase in final Bishop’s score (p=0.008) and hyperstimulation (p=0.04) was seen in Vaginal insert group as compared to Intracervical gel group, while there were no statistically significant differences in maternal outcomes, neonatal outcomes and need for oxytocin augmentation in both groups.Conclusions: In this study we found that insert did not improve the induction delivery interval or rate of successful induction, nor did it have any advantage in terms of neonatal outcome although it did improve the Bishops score – Its advantage was in terms of single application, few prevaginal examinations, longer duration of action and immediate retrieval in case of hyperstimulation. Its main drawback remained the maintenance of cold chain without which its efficacy decreases. Another significant observation was the dropout rate of insert (16%).

Comparative evaluation of intravaginal slow release Dinoprostone insert, transcervical foley’s catheter, intracervical Dinoprostone gel for induction of labor in patients with poor Bishop’s score: a randomized control study

Background: Induction of labor is indicated when the continuation of pregnancy poses risk to the mother or fetus. A variety of mechanical and pharmacologic methods are available but the best method of labor induction still remains unknown, study aimed at comparing the efficacy and safety among the two agents: transcervical Foley’s balloon catheter (FBC) and intravaginal slow release Dinoprostone E2 insert (DVI) with dinoprostone gel as control.Methods: A total of 174 patients were randomized into three groups of 58 each (Group A: dinoprostone 10 mg slow release intravaginal insert, Group B: transcervical Foley’s 16 French catheters, and Group C as control: 0.5 mg intracervical Dinoprostone gel. The safety and efficacy was compared among the groups. A p value of < 0.05 was considered statistically significant.Results: The mean insertion to active labor time (in hours) was significantly lower in Group A as compared to Group B (5.88±3.06 versus 13.56±2.8, p < 0.0001). Meantime of insertion to delivery (in hours) was significantly lower in Group A as compared to Group B (10.91±5.24 versus 21.17±2.99, p < 0.0001). The requirement of oxytocin for induction and augmentation in Group A was significantly lower as compared to Group B. Majority of the patients had normal vaginal delivery (NVD) in all the three groups. Regarding safety profile we found that slow-release DVI had more incidence of uterine tachysystole, but none of the cases had any fetal heart rate abnormality. Maternal fever was more in the FBC group, however, neonatal outcomes were comparable in both groups.Conclusions: The study concludes that slow release DVI is better in terms of efficacy as compared to transcervical FBC for induction of labor as assessed by improvement in Bishop score, insertion to active labor time and insertion to delivery time and comparable in terms of safety profile.

A Comparative Study of Sublingual and Vaginal Low Dose Misoprostol for Induction of Labor

Introduction: Labour induction is a clinical intervention thathas the potential to confer major benefits to the mother andnew-born. Study aimed to compare the safety and efficacyof sublingual versus vaginal misoprostol and to evaluatematernal and foetal outcomes after sublingual and vaginalroutes of administration.Material and methods: We conducted a study on inductionof labor with misoprostol on antenatal patients with medicalor obstetric indication who presented in the Department ofObstetrics and Gynaecology, RMCH.Result: There was no significant difference in the demographiccharacteristics between the two groups. The main indicationfor induction in both groups was pregnancy induced HT.Incidence of caesarean section was not significantly differentin the two groups. There was no significant difference inmaternal complications between the two groups.Conclusion: Sublingual misoprostol is as effective and safe asvaginal misoprostol for induction of labor at term.

Sublingual versus vaginal use of Misoprostol for induction of labor

Background: Induction of labor is one of the great challenges for obstetric care provider. Misoprostol is used for induction of labor by various routes with the advantages in being cheap and stable at room temperature and widely available even in resource-poor settings.Methods: A randomized controlled study was conducted in the obstetrics and gynecology department of Govt. Medical College and associated Maharani Hospital, Bastar, Chhattisgarh, India over a period of 1.75 years from September 2014 to May 2016. Study has comprised of 200 pregnant women admitted in the department for induction of labor fulfilling the inclusion and exclusion criteria. Data was collected and analyzed by SPSS 16.0. z-test and chi-square test to compare the safety and efficacy of both the routes of misoprostol use for IOL.Results: There were insignificant differences in number of doses required for induction with satisfactory maternal and neonatal outcome but shorter (12 hours) induction delivery interval with sublingual Misoprostol induction. Most of the cases of both the groups were delivered by vaginal route (86% and 62%) within 12 hours of induction(58% and 42%) yet significant (p value < 0.001) number of cases had undergone caesarean in group of vaginal misoprostol administration (29%) with major indications of meconium stained liquor (3% and 12%) and non assuring fetal heart rate (1% and 10%).Conclusions: Although both the routes of induction by Misoprostol are well tolerated by the women with satisfactory neonatal outcome, sublingual Misoprostol has an added advantage of quicker delivery, less caesarean and ease of administration indicates better safety and effectiveness.

A comparative study of intra-cervical foley’s catheter and PGE2 gel for induction of labour at term

Background: In cervical ripening, before induction of labour, is needed to increase the success of labour induction, to reduce complications and to diminish the rate of caesarean section and duration of labour. Pharmacological preparations are in widespread use for cervical ripening but are not free from side-effects and complications. Mechanical methods, i.e. the use of Foley’s catheter balloon, though effective have not gained much popularity because of the fear of infection. Therefore, the study has been conducted to prove the efficacy and safety of extra amniotic Foley catheter balloon and to compare it with intra-cervical prostaglandin E2 (PGE2) gel. The objective of the study was to the success of induction of labor depends on the cervical status at the time of induction. For effective cervical ripening both Foley's catheter and PGE2 gel are used. The aim of this study was to compare the efficacy of intra cervical Foley's catheter and intra cervical PGE2 gel in cervical ripening for the successful induction of labor.Methods: A randomized, comparative study was conducted in the department of obstetrics and gynaecology, Civil hospital, B.J. Medical College Ahmedabad, during a period of 8 month from September 2018 to April 2019. 100 patients at term with a Bishop's score ≤5 with various indications for induction were randomly allocated to group F (intra-cervical Foley’s catheter) and group P (PGE2 gel) with 50 women included in each group.Results: The groups were comparable with respect to maternal age, gestation age, indication of induction and initial Bishop's score. Both the groups showed significant change in the Bishop's score, 5.10±1.55 and 5.14±1.60 for Foley's catheter and PGE2 gel, respectively, p <0.001. However there was no significant difference between the two groups. There was no significant difference in the side effects and caesarean section rate in both groups. The induction to delivery interval was 16.01±5.50 hours in group F and 16.85 ± 3.81 hours in group P (p=0.073). Apgar scores, birth weights and NICU admissions showed no significant difference between the two groups.Conclusions: The study shows that both Foley's catheter and PGE2 gel are equally effective in pre induction cervical ripening.

Outcomes of induction in trial of labor after cesarean delivery

Background: The objective of this study is to evaluate the outcomes of induction of labor in women attempting trial of labor after cesarean delivery and to compare maternal and neonatal morbidity and mortality in women who were induced to those delivering spontaneously.Methods: The prospective study was carried out in the Department of Obstetrics and Gynecology in collaboration with the Neonatal Section, Department of Pediatrics at J.N. Medical College and Hospital, AMU Aligarh. The sample included 280 women with one previous cesarean section, of whom 130 women underwent induction of labor (study group) and 150 were admitted with spontaneous onset of labor. Prostaglandin gel and intracervical Foley’s were used for cervical ripening in the study group. Indication of cesarean section, mode of delivery, maternal and neonatal outcome were studied in between groups.Results: Overall rate of vaginal delivery after cesarean section was 45.3% and 56% in both study and control group respectively. The rate of cesarean section were higher in women who were induced and having unfavorable cervix. Maternal and neonatal morbidity were not significantly higher as compared in both groups, however one case of scar rupture was found in study group.Conclusions: Induction of labor in women with previous cesarean section had higher rates of cesarean section however it does not adversely affect neonatal and maternal morbidity. Overall vaginal birth is safe and effective in women with previous cesarean section by prostaglandin gel or intracervical Foley’s. Authors cautiously suggest, induction of labor should be considered in preselected patient with strict monitoring.

Role of transvaginal ultrasonographic cervical assessment in predicting the outcome of induction of labor

Background: Induction of labor is the most common intervention in modern obstetrics. The pre-induction ‘favourability’ of the cervix as assessed by the bishop score is very subjective. Transvaginal sonography appears to be a feasible alternative to the traditional bishop’s score. Aim of this study, was to compare cervical assessment by transvaginal sonography and digital examination in prediction of outcome of labor induction.Methods: Three hundred women at term with maternal and foetal indications for labor induction were included in the study. Modified Bishop score was assessed by digital examination and the cervical length was measured by Transvaginal sonography (TVS). Successful labor induction was taken as a vaginal delivery within 24 hours from the start of induction. Data were analyzed using SPSS for Windows 15.0.Results: Labour induction was successful in 81.33% of patients. Mean cervical length by digital examination was 2.6 cm, whereas the mean sonographic cervical length was 3.4cm. There was a significant difference of 0.8cm in mean cervical length measured by two methods (P=0.01). The best cut off point for predicting successful induction of labor was ≤3.4cm for sonographic cervical length (sensitivity 0.82, specificity 0.87, positive predictive value 0.77 and negative predictive value 0.25). The best cut off point for Modified Bishop score was 2 (sensitivity 0.95, specificity 0.93). The ROC curve showed that compared to TVS cervical length, Modified Bishop score was the best parameter for predicting successful induction of labor.Conclusions: Transvaginal sonographic cervical length measurement can be used as an adjunct tool to the traditional Bishop score for predicting successful labor induction in high risk pregnancies.

Programmed intermittent epidural bolus as compared to continuous epidural infusion for the maintenance of labor analgesia: a prospective randomized single-blinded controlled trial / 대한마취과학회지

BACKGROUND: Programmed intermittent epidural bolus (PIEB) techniques are a new area of interest for maintaining labor analgesia due to the potential to decrease motor block and improve labor analgesia. This study compares continuous epidural infusion (CEI) to 2 PIEB regimens for labor analgesia. METHODS: One hundred fifty patients undergoing scheduled induction of labor at term gestation having epidural labor analgesia were randomized to receive an epidural analgesia regimen of bupivacaine 0.125% with fentanyl 2 μg/ml at either PIEB 5 ml every 30 min (Group 5q30), PIEB 10 ml every 60 min (Group 10q60), or 10 ml/h continuous infusion (Group continuous epidural infusion [CEI]). The primary outcome is the pain scores throughout labor. Secondary outcomes include degree of motor block, dermatomal sensory levels, the number of physician-administered boluses, and patient satisfaction. RESULTS: While the average pain scores throughout labor did not differ significantly between groups, fewer patients in group 10q60 received physician-administered boluses for breakthrough pain (34.9% in 10q60 vs. 61.0% in 5q30 and 61.9% in CEI, P = 0.022). Dermatomal sensory levels, degree of motor block, and patient satisfaction did not differ significantly between groups. CONCLUSIONS: Our study suggests that high volume PIEB regimens for labor analgesia decrease breakthrough pain and physician-administered boluses.

Eficacia y seguridad de la sonda Foley transcervical y oxitocina vs oxitocina sola en la inducción del trabajo de parto en pacientes con cesárea previa / Efficacy and safety of the use of transcervical Foley catheter plus oxytocin vs oxytocin only in the induction of labor in patients with previous caesarean section

Resumen OBJETIVO: Evaluar si la combinación de la sonda Foley transcervical con oxitocina intravenosa, como método para inducción del parto en pacientes con cesárea previa, es más efectiva que la oxitocina sola para alcanzar una fase activa del trabajo de parto y, por consiguiente, incrementar la frecuencia de partos. MATERIALES Y MÉTODOS: Estudio de casos y controles efectuado en el Centro Hospitalario Nuevo Sanatorio Durango del 1 de marzo de 2017 al 31 de marzo de 2018. Criterios de inclusión: edad gestacional mayor o igual a 37 semanas, cesárea previa con incisión transversal baja (Kerr), embarazo único, feto en presentación cefálica. Se crearon dos grupos: A: inducción del parto con oxitocina intravenosa y B: inducción con sonda Foley transcervical y oxitocina. Las variables categóricas se describieron con frecuencias y porcentajes, y las numéricas con media (±), desviación estándar o mediana. Se utilizó la prueba de Kolmogorov-Smirnov y t de Student y se consideró estadísticamente significativo un valor de p < 0.05. RESULTADOS: Se estudiaron 50 pacientes; en el grupo A 16/25 lograron una fase activa del trabajo de parto y 14/25 tuvieron parto vaginal. En el grupo B 25/25 alcanzaron la fase activa y 17/25 tuvieron parto vaginal (p > 0.05; IC95%: 0.16-0.4). El tiempo del trabajo de parto fue: grupo A con una media de 17.11 horas y en el grupo B de 12.44 (p < 0.05; IC95%: 2.4-6.2 y 2.4-6.3, respectivamente). CONCLUSIONES: Por lo menos en la muestra estudiada la combinación de sonda Foley transcervical con oxitocina demostró ser sumamente eficaz y segura para la inducción del trabajo de parto en pacientes con cesárea previa; se consiguió disminuir significativamente el tiempo de trabajo de parto y aumentar la frecuencia de pacientes que logran llegar a una fase activa del trabajo de parto.

Abstract OBJECTIVE: To evaluate whether the combination of transcervical Foley catheter with intravenous oxytocin as a method for induction of labor in patients with previous caesarean section is more effective than using only intravenous oxytocin in achieving an active phase of labor and therefore increasing the frequency of vaginal delivery. MATERIALS AND METHODS: Case-control study performed at the Nuevo Sanatorio Durango Hospital Center from March 1, 2017 to March 31, 2018. Case-control study carried out at the New Sanatorio Durango Hospital Center from March 1, 2017 to March 31, 2018. Inclusion criteria: gestational age greater than or equal to 37 weeks, previous caesarean section with low transverse incision (Kerr), pregnancy unique, fetus in cephalic presentation. Two groups were created: group A, induction of labor with intravenous oxytocin and group B induction with transcervical foley plus oxytocin. The categorical variables are described with percentages and percentages, and the numerical variables with means ± standard deviation or median. The Kolmogorov-Smirnov test and Student's t test were used; A value of p <0.05 was considered statistically significant. RESULTS: Patients were studied, in group A of 25 patients, 16/25 achieved an active phase of labor and 14/25 had vaginal resolution; group B of 25 patients, 25/25 reached the active phase and 17/25 had vaginal resolution, we obtained a value of p > 0.05 (95%CI: 0.16-0.4). The time in labor hours: group A with an average of 17.11 hours and in group B of 12.44, p value < 0.05 (95%CI: 2.4-6.2 and 2.4-6.3). CONCLUSIONS: The combination of transcervical Foley catheter with oxytocin proved to be highly effective and safe for the induction of labor in patients with a previous caesarean section, significantly reducing labor time and increasing the frequency of patients who achieve an active dose of labor.

Sonda Foley: una alternativa efectiva para la inducción del trabajo de parto / Foley catheter: An effective alternative for induction of labor

Resumen OBJETIVO: Determinar la efectividad de la inducción del trabajo de parto con sonda Foley en pacientes con embarazo a término, con cesárea previa. MATERIALES Y MÉTODOS: ensayo clínico, no controlado, efectuado en pacientes con embarazo de término que acudieron al servicio de Tococirugía de un hospital de segundo nivel de atención de Sonora, México, entre enero y agosto de 2017. Para el procedimiento de inducción se colocó una sonda Foley intracervical, insuflándose el globo con 30-40 cc de solución y ejerciendo tracción constante y lenta. Se estimó el tiempo de inicio de la inducción y se mantuvo en vigilancia constante a la madre y al feto. Se revaloró la escala de Bishop a las 6 h, considerándose efectiva la inducción con la obtención del puntaje ≥ 6. También se valoró la vía de finalización del embarazo. RESULTADOS: Se estudiaron 36 pacientes; en 34 de 36 pacientes la sonda Foley fue efectiva. En cuanto a paridad, 13 de 26 eran primigestas. La inducción con sonda Foley fue exitosa en 34 de 36 pacientes, con vía de finalización del embarazo mediante parto en 24 de 36 y cesárea en 12 de 36 mujeres. Del total de participantes, 10 de 36 tenían cesárea previa, culminando 6 de 10 por parto y 4 de 10 por cesárea. CONCLUSIONES: La inducción de trabajo de parto con sonda Foley es efectiva y representa una buena alternativa en pacientes con antecedente de cesárea previa.

Abstract OBJECTIVE: To determine the effectiveness of induction of labor with Foley catheter in patients with full term pregnancy. MATERIAL AND METHODS: uncontrolled clinical trial in patients carried out in patients with term pregnancy who attended the Toco-surgery service of a second-level care hospital in Sonora, Mexico, between January and August 2017. To procedure: insufflating the balloon with 30-40cc of solution and exerting constant and gentle traction. The induction start time was taken and constant monitoring of the binomial was maintained. Bishop's scale was re-evaluated at 6 o'clock, with induction considered effective, obtaining a score on the modified Bishop's scale ≥6. The route of termination of pregnancy was also valued. RESULTS: 36 patients were studied; The efficacy of induction with Foley catheter was reported in 34 of 36 patients (94%). For parity, 13/26 women were primigravite. Induction with Foley catheter was successful in 34 of 36 patients, with a route of termination of pregnancy through delivery in 24/36 and cesarean section in 12/36 women. Of the total number of participants, 10 of 36 had a previous caesarean section, culminating 6/10 per delivery and 4/10 by caesarean section. CONCLUSIONS: The induction of labor with Foley catheter is effective and is a good alternative when there is a history of a previous caesarean section.

Robson classification system applied to induction of labor / Classificação de Robson aplicada à indução do trabalho de parto

Abstract Objective Induction of labor (IL) is a common obstetric procedure, but it is questionable whether or not it results in higher cesarean section (CS) rates. The present study aims to evaluate the impact of IL in the overall CS rates and to analyze these rates according to the method of IL employed and to the Robson group in which it was applied. Methods We have conducted a retrospective study including pregnant women whose labor was induced at a tertiary hospital in 2015 and 2016. All women were classified according to the Robson Classification System (RCS). The CS rates were analyzed and compared regarding the method of IL employed. Results A total of 1,166 cases were included. The CS rate after IL was 20.9%, which represented 23.1% of the total of CSs performed in 2015 and 2016. The highest CS rates were recorded in RCS groups 5 (65.2%) and 8 (32.3%). Group 2 was the highest contributor to the overall CS rate, since it represented 56.7% of the population. The intravaginal prostaglandins method was the most used (77%). Transcervical Foley catheter was the preferredmethod in group 5 and intravaginal prostaglandins in all the other groups. The CS rate was higher when transcervical Foley catheter was used (34.1%). Conclusion Transcervical Foley catheter induction was associated with a higher rate of CS, probably because it was the preferred method used in group 5.

Resumo Introdução A indução do trabalho de parto é uma prática comum e sua associação com o aumento da taxa de cesarianas tem sido questionada. O presente estudo surge com o objetivo de avaliar o impacto da indução do trabalho de parto na taxa global de cesarianas e de analisar as taxas de cesarianas de acordo com o método de indução do trabalho de parto utilizado e com o grupo de Robson. Métodos Realizamos umestudo retrospectivo cominclusão de grávidas submetidas a indução do trabalho de parto em um hospital terciário em 2015 e 2016. Todas as mulheres forram classificadas de acordo com a classificação de Robson. As taxas de cesarianas foram analisadas e comparadas em função do método de indução de trabalho de parto utilizado. Resultados Foram incluídos 1.166 casos. A taxa de cesarianas após a indução do trabalho de parto foi de 20,9%, correspondendo a 23,1% do total de cesarianas realizadas em 2015 e 2016. Os grupos 5 e 8 da classificação de Robson foram os que apresentaram as maiores taxas de cesarianas (65,2% e 32,3%, respectivamente). O grupo 2 foi o que mais contribuiu para a taxa global de cesarianas, por representar 56,7% do total da população. As prostaglandinas intravaginais foram o método mais utilizado (77%). O cateter de Foley transcervical foi o método mais utilizado no grupo 5 e as prostaglandinas intravaginais nos restantes. A taxa de cesarianas foi superior quando se utilizou o cateter de Foley transcervical (34,1%). Conclusão A indução do trabalho de parto com cateter de Foley transcervical associou-se a uma maior taxa de cesarianas, em provável relação com a sua maior utilização no grupo 5.

Analysis of Risk Factors for Cesarean Section after Induction of Late-term Pregnancy / 中国医科大学学报

Objective To explore the risk factors for cesarean section after induction of late-term pregnancy. Methods This study enrolled 275 primiparas with a single cephalic fetal presentation,admitted to our hospital between December 2010 and December 2016 for induction of late-term pregnancy. After induction,80 underwent cesarean section and 195 had a normal vaginal delivery. Clinical data were collected and analyzed retrospectively. Single factor analysis and two categories of logistic regression analysis were used to determine the independent risk factors for cesarean section after induction of late-term pregnancy. Results Single factor analysis showed that the differences between the two groups in maternal height,cervical Bishop score before induction of labor,latent phase,intrapartum amniotomy,intrapartum oxytocin,meconium stained amniotic fluid,and birth weight were statistically significant (P < 0. 05). Multivariate analysis showed that maternal height,cervical Bishop score before induction of labor,and latent phase were independent risk factors for cesarean section after induction of late-term pregnancy. Conclusion Late-term pregnant primiparas with short stature,low Bishop score,or a long latent phase should have comprehensive prenatal maternal-fetal assessment,and a reasonable delivery mode should be chosen to avoid adverse outcomes.

Misoprostol and Oxytocin in induction of labor

Background: Induction of labor is defined as the process of artificially stimulating the uterus to start labor. It is usually performed by administering oxytocin or prostaglandins to the pregnant woman or by manually rupturing the amniotic membranes. Objective: Main objective of the study was to find out are there any differences in maternal and neonatal / fetal outcomes after induction labor with misoprostol and oxytocin beyond 37 weeks of gestation. Materials and methods: This was a hospital-based study carried out in 431 inductions of labor during the study period. Total 327 women met the criteria and were enrolled into study. Misoprostol of 25 μg was inserted in posterior fornix of vagina or oxytocin infusion was started from 2.5 units on whom induction was decided. Maternal and fetal/ neonatal outcomes were observed. Collected data were analyzed using SPSS and MS Excel. Results: Analysis of onset of labor led to the finding that mean onset of labor was much rapid in oxytocin (7.2 h) than misoprostol (12.7 h). However, there is similarity in induction–delivery interval in both groups. Overall, the rate of normal delivery and caesarean section was found to be 64.8% and 38.2%, respectively. Fetal distress was found as the most common reason for caesarean section. The overall occurrence of maternal complication was found to be similar in misoprostol and oxytocin groups, nausea/vomiting being the most common complication followed by fever. Besides this, the most common neonatal complication found in overall cases was meconium stained liquor. K. Sharada, Hema Warrier, Ajay Kumar Reddy, P. Thulasi. Misoprostol and Oxytocin in induction of labor. IAIM, 2018; 5(3): 97-105. Page 98 Conclusion: It was found that misoprostol was used most frequently for induction of labor compared to oxytocin. The onset of labor was found to be rapid in oxytocin than misoprostol. However, the occurrence of side effects was found to be similar in both misoprostol and oxytocin groups.

Inducción del parto versus manejo expectante en ruptura prematura de membranas pretérmino: revisión sistemática y metanálisis / Induction of labor versus expectant management in patients with preterm premature rupture of membranes: a systematic review and meta-analysis

RESUMEN Introducción: La ruptura prematura de membranas pretérmino (PPROM) es una patología obstétrica que genera un alto riesgo de morbilidad fetal. Pese a esto, actualmente prevalece la incertidumbre ante el manejo adecuado para ésta entidad. Objetivo: Comparar los desenlaces materno-fetales de la inducción del parto (IL) y manejo expectante (EM) Metodología: Revisión sistemática y metanálisis Fuentes de datos: Se buscó en las bases de datos MEDLINE, EMBASE, SCIELO y Google Académico. Criterios de elección, pacientes e intervenciones: Se incluyeron ensayos clínicos aleatorizados controlados y estudios de cohortes que compararan el EM e IL en pacientes con PPROM entre la semana 24 a 36 6/7, y que adicionalmente tuvieran en cuenta como desenlaces analizados: sepsis neonatal (NS), síndrome de distrés respiratorio (SDR), muerte neonatal y corioamionitis. Recolección de datos y análisis: La extracción y registro de datos se ejecutó por dos revisores de forma independiente. La evaluación de calidad se realizó con CONSORT y STROBE, según corresponda. Metanálisis: Para cada desenlance, se realizó la estimación del Riesgo Relativo (RR) consolidado, usando modelos de efectos aleatorios. Resultados: Un total de 3378 mujeres con PPROM fueron incluidas en los 9 estudios (8 ensayos clínicos). En el meta-análisis no se encontraron diferencias significativas en la ocurrencia de SDR (RR= 1,08; IC 95%: 0,89-1,31), ni de sepsis neonatal (RR= 0,92; IC 95%: 0,61-1,39), en los tratados con IL comparados con el EM. Tampoco se encontraron diferencias significativas en la ocurrencia de muertes neonatales (RR= 1,34; IC 95%: 0,93-1,93) ni corioamnionitis (RR= 0,88; IC 95%: 0,58-1,35). Conclusiones: Los resultados sugieren que no existe evidencia de diferencias estadísticamente significativas en la ocurrencia de los principales desenlaces cuando se compara EM con IL. Más estudios y con mayores tamaños de muestras son necesarios.

ABSTRACT Introduction: Preterm premature rupture of membranes (PPROM), is an obstetric pathology that causes a high-risk of morbidities and higher rate of hospital readmission in the first month of life. However, the management of this patology is still uncertain. Objetive: To compare maternal-fetal outcomes of induction of labor (IL) and expectant management (EM) in order to determine the actions to follow. Methodology: Systematic review and meta-analysis Data collection: We searched MEDLINE, EMBASE, SCIELO and Google Scholar. Selection Criteria, patients and interventions: Controlled randomized clinical trial and cohort studies were included. These studies compared the EM and IL in patients with PPROM within 24 to 36 6/7 weeks and take into account outcomes such as neonatal sepsis (NS), respiratory distress syndrome (RDS), neonatal death or chorioamnionitis. Analysis and data collection: Two authors independently executed the extraction and recording of data. Quality assessment was performed with the CONSORT or STROBE score, accordingly. Meta-analysis: For each outcome, a pooled Relative Risk was estimated using random effects models. Results 3378 women with PPROM were included in 9 studies (8 clinical trials). In the meta-analysis, we did not find a statistically significant differences in the occurrence of RDS (RR =1.08; 95% CI: 0.89-1.31 or NS (RR= 0.92; IC 95%: 0.61-1.39), in the IL group in comparison with EM. We did not find either differences in the occurrence of neonatal deaths (RR= 1.34; IC 95%: 0.93-1.93) or chorioamnionitis ( RR= 0.88; IC 95%: 0.58-1.35). Conclusions: The results suggest that there is no evidence of statistically significant differences in the occurrence of major outcomes when comparing MS with IL. Further studies and larger sample sizes will be necesary.