Outcome of induction of labour at 41 weeks with foley catheter in midwifery-led care.

OBJECTIVE: Assess the outcome of induction of labour (IOL) with a Foley catheter in pregnancies at 41 weeks in midwifery-led care setting compared to consultant-led care setting. DESIGN: Mixed-methods cohort study at a midwifery - hospital partnership in Amsterdam, the Netherlands. SETTING AND PARTICIPANTS: Prospectively, women undergoing IOL in midwifery-led care were recruited at a secondary hospital. This group was compared to a retrospective cohort, in which IOL was exclusively performed under consultant-led care. MEASUREMENTS AND FINDINGS: We compared 320 women whose induction started in midwifery-led care to a historical cohort of 320 women induced for the same reason under consultant-led care. Both groups exhibited similar rates of spontaneous vaginal births (64.2 %vs62.5 %). Caesarean section and assisted vaginal birth rates did not significantly differ. Maternal adverse outcomes were comparable, while neonatal adverse outcomes were significantly higher in the midwifery-led care group (8.1 %vs3.8 %; OR 2.27, 95 % CI 1.12-4.58). The use of pain relief was significantly lower in midwife-led care (65.3 %vs75.3 %; OR 0.62, 95 % CI 0.44-0.87). 20.6 % of births occurred in midwife-led care. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: In this single-centre study, spontaneous vaginal birth rates following IOL with a Foley catheter were similar between midwife- and consultant-led care. However, the midwife-led group showed a higher risk of adverse neonatal outcomes, mainly early onset neonatal sepsis, with a minority eventually delivering under midwife-led care. Implications highlight the need for broader research, validation across diverse settings and exploration of patient and healthcare worker perspectives to refine the evolving midwifery-led care model.

Identification of first-stage labor arrest by electromyography in term nulliparous women after induction of labor.

INTRODUCTION: Worldwide induction and cesarean delivery rates have increased rapidly, with consequences for subsequent pregnancies. The majority of intrapartum cesarean deliveries are performed for failure to progress, typically in nulliparous women at term. Current uterine registration techniques fail to identify inefficient contractions leading to first-stage labor arrest. An alternative technique, uterine electromyography has been shown to identify inefficient contractions leading to first-stage arrest of labor in nulliparous women with spontaneous onset of labor at term. The objective of this study was to determine whether this finding can be reproduced in induction of labor. MATERIAL AND METHODS: Uterine activity was measured in 141 nulliparous women with singleton term pregnancies and a fetus in cephalic position during induced labor. Electrical activity of the myometrium during contractions was characterized by its power density spectrum. RESULTS: No significant differences were found in contraction characteristics between women with induced labor delivering vaginally with or without oxytocin and women with arrested labor with subsequent cesarean delivery. CONCLUSION: Uterine electromyography shows no correlation with progression of labor in induced labor, which is in contrast to spontaneous labor.

Uterine electromyography for identification of first-stage labor arrest in term nulliparous women with spontaneous onset of labor.

OBJECTIVE: We sought to study whether uterine electromyography (EMG) can identify inefficient contractions leading to first-stage labor arrest followed by cesarean delivery in term nulliparous women with spontaneous onset of labor. STUDY DESIGN: EMG was recorded during spontaneous labor in 119 nulliparous women with singleton term pregnancies in cephalic position. Electrical activity of the myometrium during contractions was characterized by its power density spectrum (PDS). RESULTS: Mean PDS peak frequency in women undergoing cesarean delivery for first-stage labor arrest was significantly higher (0.55 Hz), than in women delivering vaginally without (0.49 Hz) or with (0.51 Hz) augmentation of labor (P = .001 and P = .01, respectively). Augmentation of labor increased the mean PDS frequency when comparing contractions before and after start of augmentation. This increase was only significant in women eventually delivering vaginally. CONCLUSION: Contraction characteristics measured by uterine EMG correlate with progression of labor and are influenced by labor augmentation.

A validation of electrohysterography for uterine activity monitoring during labour.

OBJECTIVES: Validation of electrohysterography (EHG) as a method for uterine activity monitoring during labour by comparing with intra-uterine pressure catheter (IUPC) recordings. DESIGN: Prospective observational study. SETTING: Labour ward in a tertiary centre in the Netherlands. POPULATION: Thirty-two women in labour. METHODS: Simultaneous recording of uterine activity with EHG and IUPC for at least 30 min. MAIN OUTCOME MEASURES: Number of uterine contractions detected by both EHG and IUPC (sensitivity). Number of contractions detected by EHG only [positive predictive value (PPV)]. Correlation between contraction amplitude and duration measured by EHG and IUPC. RESULTS: EHG detects uterine contractions accurately: sensitivity = 94.5% (95%CI: 87.5-100), PPV = 88.3% (95%CI: 76.2-100). The correlation of contractions' duration and amplitude between both methods is r = 0.31 (95%CI: 0.23-0.39) and r = 0.45 (95%CI: 0.38-0.52), respectively. CONCLUSIONS: EHG detects uterine contractions accurately during labour but the contraction's characteristics it measures are not directly comparable with that of IUPC.